Enhancing Evidence Based Home Visiting to Address Substance Abuse and Mental Heal

加强基于证据的家访，以解决药物滥用和心理治疗问题

• 批准号: 8510214
• 负责人: SARAH E. DAUBER
• 金额: $ 16.35万
• 依托单位: NY SOCIETY/PREVENTION/CRUELTY/CHILDREN
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510214
• 关键词: Address; Americas; Attitude; Case Management; Child; Child Abuse and Neglect; Client; Country; County; Data; Development; Early Intervention; Educational Curriculum; Educational Intervention; Educational process of instructing; Effectiveness; Family; Funding; Goals; Health Services; Health Services Accessibility; Home environment; Home visitation; House Call; Individual; Infant; Intervention; Lead; Link; Medical; Mental Healing; Mental Health; Modeling; Monitor; New Jersey; Outcome; Outpatients; Parenting behavior; Parents; Participant; Patient Self-Report; Positioning Attribute; Prevention strategy; Procedures; Protocols documentation; Provider; Public Health; Research; Research Infrastructure; Risk; Risk Factors; Services; Site; Structure; Substance Abuse Detection; Substance abuse problem; Target Populations; Test Result; Testing; Training; Treatment Protocols; Trust; Waiting Lists; base; behavioral health; community based treatment; design; economic cost; evidence base; high risk; improved; maltreatment; motivational enhancement therapy; pilot trial; prevent; programs; public health relevance; randomized trial; screening; skills; success; tool

DESCRIPTION (provided by applicant): The goal of this R21 proposal is to develop and pilot a standardized behavioral health screening and linkage to treatment protocol designed to increase access to behavioral health services among at-risk parents participating in evidence-based home visiting programs. Home visiting is the most widely used child maltreatment prevention strategy across the country, but does not adequately address parental substance abuse and mental health problems, key risk factors for child maltreatment. Substance abuse and mental health problems are prevalent among home visiting clients, and their presence diminishes positive program impacts. The proposed R21 will develop and test a protocol for a Behavioral Health Enhancement (BHE) to the home visiting model that will be adapted from an evidence-based intensive case management approach and will include expanded home visitor training in parental behavioral health risks, use of well-validated screening tools for substance abuse and mental health problems, and standardized case management procedures for linking clients with needed services following positive screens. The BHE will be designed and piloted within the context of Healthy Families America (HFA), one of the most widely implemented home visiting models, with high adaptability potential to other models. Participants will be drawn from among HFA clients in four New Jersey counties, with two counties receiving the BHE and two counties serving as matched controls. Specific aims are (1) to develop a protocol for a BHE to evidence-based home visiting models that includes procedures for training providers, screening families, and linking families to behavioral health services using evidence- based case management and motivational interviewing interventions; (2) to test the feasibility, acceptability, and fidelity of BHE within HFA; and (3) to pilot test the impact of the BHE on increasing identification of behavioral health problems and engagement in services compared to matched controls from a demographically similar county. Study findings will yield important data on whether incorporating standardized screening and linkage procedures into home visiting increases identification of parental behavioral health risks and engagement into needed services, and on whether such procedures are feasible to implement with fidelity by paraprofessional home visitors. Additionally, the proposed study will aid in determining key barriers that prevent successful linkages to treatment for home visiting clients. New study products will include a standardized and piloted BHE toolkit, home visitor training and fidelity monitoring procedures, and a fidelity monitoring tool. If validated, the resulting BHE protocol has the potential for widespread deployment within HFA and eventual adaptation for use with other home visiting models.

描述（由申请人提供）：该R21提案的目标是开发和试行标准化的行为健康筛查，并与治疗方案联系，旨在增加参加基于证据的家庭访问计划的高危父母的行为卫生服务的机会。家庭访问是全国最广泛使用的儿童虐待预防策略，但没有充分解决父母的药物滥用和心理健康问题，这是儿童虐待儿童的关键危险因素。在家访问客户中，药物滥用和心理健康问题普遍存在，他们的存在减少了积极的计划影响。拟议的R21将开发和测试针对家庭访问模型的行为健康增强（BHE）的协议，该协议将根据基于证据的强化案例管理方法进行调整，并将包括扩大父母行为健康风险中的家庭访客培训，使用经过良好验证的筛选工具用于药物滥用和精神健康问题，并将案例管理问题链接到所需的客户范围内。 BHE将在健康家庭（HFA）的背景下进行设计和驾驶，这是最广泛实施的家庭访问模型之一，对其他模型具有很高的适应性潜力。参与者将从四个新泽西州的HFA客户中吸引，两个县接收BHE，两个县充当匹配的控制。具体目的是（1）为基于证据的家庭访问模型制定BHE协议，其中包括培训提供者，筛查家庭的程序，并使用基于证据的案例管理和动机访谈干预措施将家庭与行为卫生服务联系起来； （2）测试HFA内BHE的可行性，可接受性和保真度； （3）试点测试BHE对行为健康问题的识别和服务的识别与人口相似的县的匹配控制相比，对行为健康问题和服务的参与度增加。研究结果将产生有关将标准化的筛查和连锁程序纳入家庭访问是否会增加对父母行为健康风险和参与所需服务的识别的重要数据，以及该程序是否可行，可以通过专员家庭访客忠实地实施。此外，拟议的研究将有助于确定关键障碍，以防止成功与家庭访问客户的治疗联系。新的研究产品将包括标准化和试验的BHE工具包，家庭访问者培训和保真性监控程序以及忠实监控工具。如果被验证，则由此产生的BHE协议具有 HFA中广泛部署的潜力以及最终适应其他家庭访问模型。