ASSERTIVE COMMUNITY TREATMENT AND CONTINGENCY MANAGEMENT

积极的社区治疗和应急管理

• 批准号: 2046826
• 负责人: Susan M Essock
• 金额: $ 19.39万
• 依托单位: CONNECTICUT ST DEPT OF MH/ADDICTION SRVS
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-30 至 1999-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2046826
• 关键词: alcoholism /alcohol abuse; behavioral medicine; clinical trials; community mental health services; disulfiram; functional ability; health care cost /financing; health care model; health care service evaluation; health care service organization; homeless; hospital utilization; housing; human subject; legal /correctional; longitudinal human study; mental disorder diagnosis; patient care management; psychological reinforcement; psychosis; quality of life; residential mobility; social support network; substance abuse related disorder; therapy compliance

Abuse of alcohol is a frequent diagnosis among people with severe mental disorders (SMD), particularly among those who are homeless. A significant proportion, typically 50% or more, of people with SMD abuse alcohol. Their alcohol abuse is strongly associated with clinical disability, homelessness, institutionalization, and treatment difficulty. To address this problem, the Connecticut Department of Mental Health has provided funding for the creation of a new assertive community treatment (ACT) team to provide integrated treatment for substance abuse and SMD to dually diagnosed clients in Connecticut's largest and poorest city, Bridgeport. The proposed research will be a collaboration between the Connecticut Department of Mental Health and the Dartmouth Medical School to conduct a rigorous evaluation of the effectiveness and costs of the ACT program design for dually diagnosed clients in an urban area where alcohol, cocaine, and other drugs are readily available and widely used. Half of the consenting study participants in both the ACT and standard Case- management condition who reach the active treatment phase will be randomly assigned to a contingency management intervention which will employ behavioral treatment based on the community reinforcement approach. The research will carefully document the interventions provided to clients in each treatment condition to document both what interventions actually occurred and the costs of the interventions so that any differences in clinical outcomes and costs can be attributed to differences identified in the processes of care. The first objective of the project is to decrease the problems most characteristic of dually diagnosed clients: alcohol abuse, housing instability and homelessness, and institutionalization in hospitals and jails. A second objective is to determine whether good outcomes in these primary domains will be associated with more general improvements in symptoms, functional status, and quality of life. A third objective is to identify the qualities of case management that are associated with successful engagement and treatment. Separate data analysis strategies will be applied to each of these objectives. The research design is a randomized clinical trial with a 2x2 factorial design (service organization by community reinforcement). A total of 150 consenting, dually diagnosed clients will be randomly assigned to either ACT or to standard case management, with half of the participants from each service condition who enter active treatment participating in the community reinforcement intervention. Study participants will be interviewed with quantitative instruments at baseline and at 6-month followup intervals for 3 years.

酗酒是患有严重精神疾病的人的常见诊断 疾病（SMD），尤其是无家可归者。一个重要的 比例（通常为 50% 或更多）SMD 患者滥用酒精。 他们的酗酒与临床残疾密切相关， 无家可归、收容和治疗困难。致地址 对于这个问题，康涅狄格州心理健康部提供了 为创建新的自信社区治疗 (ACT) 团队提供资金 为药物滥用和 SMD 提供综合治疗，以双重治疗 康涅狄格州最大也是最贫困的城市布里奇波特的确诊客户。 拟议的研究将是康涅狄格州与 心理健康部和达特茅斯医学院开展了一项 严格评估 ACT 计划的有效性和成本 为患有酒精、酒精的城市地区双重诊断的客户设计 可卡因和其他药物很容易获得并广泛使用。一半 ACT 和标准案例中同意的研究参与者 达到积极治疗阶段的管理情况将随机 分配给应急管理干预，该干预将采用 基于社区强化方法的行为治疗。这 研究将仔细记录向客户提供的干预措施 记录每种治疗条件的实际干预措施 发生的情况以及干预措施的成本，因此任何差异 临床结果和成本可归因于在以下方面发现的差异： 护理过程。 该项目的首要目标是最大限度地减少问题 双重诊断客户的特征：酗酒、住房 不稳定和无家可归，以及医院和机构的收容 监狱。第二个目标是确定这些方面是否取得了良好的结果 主要领域将与更一般的改进相关联 症状、功能状态和生活质量。第三个目标是 确定与以下方面相关的案件管理质量 成功的参与和治疗。单独的数据分析策略 将应用于其中的每一个目标。 研究设计是一项随机临床试验，采用 2x2 析因 设计（通过社区强化来组织服务）。共150个 同意的双重诊断客户将被随机分配到 ACT 或标准案例管理，一半的参与者来自 参加积极治疗的每个服务条件 社区强化干预。研究参与者将是 在基线和 6 个月时使用定量工具进行访谈 随访间隔为3年。