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 50 万年轻人（YA；此处定义为 19-25 岁）接受药物滥用治疗，但尽管承认成瘾是一种慢性疾病，但很少有研究检验持续护理的模型这个年龄段。费用高昂的住院治疗让青少年学生转诊至门诊护理或自助团体，但许多人不使用或很少参与这些治疗。住院治疗后复发率很高，许多家长在孩子出院回家时感到得不到支持和准备不足。需要有效的持续护理来吸引青少年，为父母提供准备和支持，并阻止进展为使人衰弱的成人疾病。必须设计具有成本效益、易于传播、可持续的持续护理模式。该 R21 申请建议为离开住院治疗的青少年开发和试点家庭持续护理 (HCC)。 HCC 将结合两种有效的方法：基于电话的 CC (TCC) 和应急管理 (CM)。基于电话的远程模式将允许一小部分提供者提供 HCC，从而减少传播的挑战。该研究的具体目的是探讨： 1) 家长和青少年对 HCC 的接受程度； 2）维持干预的可行性； 3）开展HCC随机对照试验（RCT）的可行性； 4) HCC 疗效和 RCT 需求的初步估计。在这个三阶段项目的第一阶段和第二阶段，将从住宿治疗计划和家长支持小组中招募家长和青少年学生。第一阶段将调查 50 名家长和 50 名青少年学生，以就 HCC 手术的可接受性做出明智的判断，并确定并找到解决家长和青少年学生参与障碍的解决方案。在第 2 阶段，将进行一项包含基线、16 周和 32 周评估的试点研究，其中 20 名家长-青少年对被随机分配到 HCC 或照常继续服务 (SAU)。当 YA 接受住院治疗时，HCC 家长将接受沟通、尿液检测程序和 CM 方面的培训，以便出院后他们可以与 HCC 计划合作，支持 YA 的康复。通过治疗师的监测和反馈，HCC 家长将进行随机安排的家庭尿液检测，并为经过验证的禁欲和参与住院计划制定的持续服务计划提供激励。 HCC 青少年将接受 TCC，并通过短信和/或电话定期与治疗师联系，以评估复发风险并提供简短的咨询。我们将探讨：1）通过检查 HCC 参与度、保留率和治疗满意度来探讨 HCC 的可接受性； 2) 通过估算 HCC 成本并询问家长他们愿意为此支付的费用来实现可持续性； 3）通过检查两组的招募率、治疗保真度和随访保留率来进行随机对照试验（RCT）可行性； 4) 通过检查 (a) 估计的效应大小以及 (b) 家长、青少年协会和成瘾专家对结果的临床重要性的评估来确定初步疗效和 RCT 需求。在第三阶段，我们将与家长和青少年咨询委员会以及专家小组一起审查项目结果，并就随机对照试验的必要性和可行性做出最终决定。