Feasibility and Acceptability of Home-Based Continuing Care

家庭持续护理的可行性和可接受性

• 批准号: 8772273
• 负责人: KIMBERLY C KIRBY
• 金额: $ 22.23万
• 依托单位: TREATMENT RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772273
• 关键词: Abstinence; Address; Admission activity; Adult; Aftercare; Age; Alcohol or Other Drugs use; Ambulatory Care; Area; Asthma; Biological; Caring; Center for Translational Science Activities; Child; Chronic; Chronic Disease; Clinical; Communication; Counseling; Development; Disease; Evaluation; Family; Family member; Feedback; Feeling; Goals; Health; Health Care Costs; Health Personnel; Home environment; Hypertension; Incentives; Individual; Instruction; Insurance; Insurance Carriers; Intervention; Interview; Judgment; Lead; Left; Life; Link; Mission; Modeling; Monitor; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outpatients; Parents; Participant; Patient Discharge; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Poisoning; Procedures; Productivity; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Relapse; Reporting; Research; Research Institute; Residential Treatment; Risk; Running; Schedule; Services; Severities; Solutions; Substance Use Disorder; Support Groups; Surveys; Telephone; Testing; Text; Training; Urine; Work; Youth; addiction; age group; aged; arm; base; burden of illness; contingency management; cost; design; disability; dissemination research; economic cost; follow-up; improved; interest; mortality; parent project; programs; public health relevance; reduced substance use; satisfaction; self help; substance abuse treatment; treatment program; young adult

DESCRIPTION (provided by applicant): About half a million young adults (YA; defined here as 19-25 years old) enter substance abuse treatment each year, but despite recognizing addiction as a chronic disease, little research has examined models of continuing care for this age group. Costly residential treatments discharge YAs with referral to outpatient care or self-help groups, but many do not use or minimally participate in them. Relapse rates are high after residential treatment and many parents feel unsupported and poorly prepared when their child is discharged and returns to their home. Effective continuing care is needed to engage YAs, prepare and support parents, and halt progression to a debilitating adult disease. Cost-efficient, easily disseminated, sustainable continuing care models must be designed. This R21 application proposes to develop and pilot test Home-based Continuing Care (HCC) for YAs leaving residential treatment. HCC will combine two efficacious approaches: Telephone-based CC (TCC) and Contingency Management (CM). A remote, telephone-based model would allow delivery of HCC from a small cadre of providers, reducing challenges of dissemination. The specific aims of the research are to explore the: 1) Acceptability of HCC to parents and YAs; 2) Feasibility of sustaining the intervention; 3) Feasibility of conducting a randomized controlled trial (RCT) of HCC; and 4) Preliminary estimation of HCC efficacy and need for a RCT. During Phases 1 & 2 of the three-phase project, parents and YAs will be recruited from residential treatment programs and parent support groups. Phase 1 will survey 50 parents and 50 YAs to develop informed judgments on the acceptability of HCC procedures and identify and find solutions to barriers to parent and YA participation. In Phase 2 a pilot study with baseline, 16- and 32 week assessments will be piloted with 20 parent-YA pairs randomly assigned to HCC or continuing services as usual (SAU). While the YA is in residential treatment HCC parents will receive training in communication, urine testing procedures, and CM so that after discharge they can partner with the HCC program to support the YA's recovery. With therapist monitoring and feedback, HCC parents will administer randomly scheduled home- based urine tests and provide incentives for verified abstinence and engagement in the continuing service plan developed by the residential program. HCC YAs will receive TCC with regular therapist contact by text message and/or phone to assess relapse risk and provide brief counseling. We will explore: 1) HCC accept- ability by examining HCC engagement, retention and treatment satisfaction; 2) sustainability by estimating HCC costs and asking parents what they would be willing to pay for it; 3) RCT feasibility by examining recruitment rate, treatment fidelity, and follow-up retention in both groups; and 4) preliminary efficacy and need for a RCT by examining (a) estimated effect size in conjunction with (b) assessment by parents, YAs, and addiction experts of the clinical importance of outcomes. In Phase 3 we will review project results with Parent and Youth Advisory Boards and the expert panel and make final decisions on need and feasibility of an RCT.

描述（由申请人提供）：每年约有半百万年轻人（YA；在此定义为19-25岁）进行药物滥用治疗，但尽管认识到成瘾是一种慢性疾病，但很少研究研究该年龄段的继续护理模型。代价高昂的住宅治疗方法将YA带到门诊护理或自助群体中，但许多人不使用或最少参与其中。住院治疗后，复发率很高，许多父母在孩子出院并返回家中时感到不受支持和准备不足。需要有效的持续护理来吸引YA，准备和支持父母，并阻止令人衰弱的成年疾病。必须设计成本效益，易于传播，可持续的持续护理模型。该R21申请建议开发和试行基于家庭的持续护理（HCC），以便离开住宅治疗。 HCC将结合两种有效方法：基于电话的CC（TCC）和应急管理（CM）。基于远程电话的模型将允许从一小群提供商干部提供HCC，从而减少传播挑战。该研究的具体目的是探索：1）HCC对父母和YA的可接受性； 2）维持干预的可行性； 3）进行HCC的随机对照试验（RCT）的可行性； 4）HCC功效和RCT的需求的初步估计。在三相项目的第1阶段和第2阶段，父母和YA将从住宅治疗计划和家长支持小组中招募。第1阶段将调查50个父母和50个YA，以制定有关HCC程序可接受性的知情判断，并确定并找到对父母和您参与的障碍的解决方案。在第2阶段，一项基线的试点研究，将通过20个父对hCC或像往常一样（SAU）随机分配给HCC或持续服务的20周评估。 YA正在住院治疗时，HCC父母将接受通信，尿液测试程序和CM的培训，以便在出院后可以与HCC计划合作以支持YA的恢复。通过治疗师的监测和反馈，HCC父母将管理随机安排的家庭尿液检查，并激励验证验证的禁欲和参与该住宅计划的持续服务计划。 HCC YAS将通过短信和/或电话接收定期治疗师联系的TCC，以评估复发风险并提供简短的咨询。我们将探索：1）通过检查HCC参与，保留和治疗满意度来接受HCC的能力； 2）可持续性通过估计HCC成本并询问父母愿意为此付出什么； 3）通过检查两组的招聘率，治疗保真度和随访保留率，可行性； 4）通过检查（a）估计的效果大小以及（b）父母，YAS和成瘾专家对结果的临床重要性的评估，通过（a）估计的效应大小以及（b）评估（b）对结果的评估来进行初步疗效和RCT的需求。在第3阶段，我们将与父母和青年咨询委员会和专家小组一起审查项目结果，并就RCT的需求和可行性做出最终决定。