Reducing Offenders' HIV Risk: MI Enhanced Case Management with Drug-Free Housing

降低罪犯感染艾滋病毒的风险：MI 通过无毒品住房加强案件管理

基本信息

批准号：
8680198
负责人：
DOUGLAS L POLCIN
金额：
$ 64.72万
依托单位：
PUBLIC HEALTH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-15 至 2018-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8680198
关键词：
Address Adult Affect Alcohol abuse Alcohol consumption Alcohol or Other Drugs use Alcoholics Anonymous Alcohols Area Back California Case Management Communities Control Groups Crime Criminal Justice Databases Diagnostic and Statistical Manual of Mental Disorders Disease Drug usage Employee Strikes Employment Environment Failure Family General Population Grant HIV HIV Infections HIV risk Health Services Accessibility Home environment Homelessness Housing Human immunodeficiency virus test Imprisonment Individual Infection Institution Intervention Interview Jail Legal Life Manuals Measures Mediating Mediator of activation protein Medical Mental Health Methamphetamine dependence Modeling Motivation Outcome Persons Pharmaceutical Preparations Prevalence Prisons Public Health Punishment Randomized Recovery Relapse Resources Risk Risk Behaviors Safety Sampling Services Severities Social support Support Groups Symptoms System Testing Time Trust Unsafe Sex Woman Work addiction base case-by-case basis court drug relapse drug/alcohol abstinence follow-up help-seeking behavior high risk housing instability improved indexing injection drug use innovation meetings men men who have sex with men motivational enhancement therapy offender parole parolee peer probation probationer public health relevance rearrest recidivism reincarceration service utilization sobriety theories transgender transmission process

项目摘要

DESCRIPTION (provided by applicant): HIV risk among criminal justice offenders is high. Rates of infection are up to 10 times higher than the general population and 25% of all HIV infected persons have contact with the criminal justice system. Overcrowding of jails and prisons puts offenders at increased risk for HIV as does a failure to successfully transition from prison or jail into the community. Overcrowding of criminal justice institutions has reached crisis proportions in the U.S. and nowhere is the problem worse than in California. In 2006 the state had the largest prison system in the nation with over 173,000 inmates, but it only had capacity for about 100,000. In 2011 the U.S. Supreme Court ruled that prisons in California must release over 30,000 offenders because the extent of overcrowding constituted cruel and unusual punishment. It is not clear where these offenders will live once they are released or how they will access services they need to succeed in the community. Without access to housing, work and services needed to support transition to the community the risk for HIV infection and transmission is high as are risks for re-arrest and re-incarceration. Nationwide, about 40% of offenders on parole are re-arrested within one year of their release. Drawing on syndemics theory, a new intervention that enhances case management with motivational interviewing (Motivational Interviewing Case Management [MICM]) will address HIV and a host of related problems known to exacerbate HIV disease among criminal justice offenders. Innovative differences from standard MI include: 1) Using an MI based intervention for the first time with offenders at risk for HIV. 2) Using MI to adapt to a residential recovery environment. 3) Using MI to target syndemic factors known to affect HIV (e.g., mental health, medical, and housing instability), 4) Using MI to increase compliance with terms of parole and probation, 5) Using MI to find and maintain work, 6) Using MI to access services and maintain retention. 6) Using MI to reestablish recovery after drug relapse. 7) Using MI to address setbacks (e.g., drug relapse, loss of work). Selection of areas to focus on is made on a case by case basis depending on offender needs. Drug-free housing will be accessed through the Sober Living Network (SLN), an organization that certifies over 500 sober living houses (SLHs) in California. Our recent study of SLHs showed residents improved in terms of alcohol and drug use, work, arrests, and psychiatric problems. However, criminal justice offenders fared worse than other residents and HIV issues were not assessed. Expanding on our current HIV service grants that use MI for MSM and transgenders, we will use MICM to address HIV risk and the syndemic mix of factors that increase risk. A sample of 330 offenders at high risk for HIV who are entering SLHs will be randomly assigned to a referral resources (comparison) or MICM (intervention) condition. Outcomes will be assessed at baseline, 6, and 12 months and include measures of HIV testing and risk, substance use, arrests and re-incarceration, and problems on the Addiction Severity Index. Results will validate the use of MICM with SLHs as an inexpensive and replicable option for offenders.

描述（由申请人提供）：刑事司法罪犯的艾滋病毒风险很高。感染率比普通人群高10倍，所有艾滋病毒感染者中有25％与刑事司法系统接触。监狱和监狱的拥挤使罪犯遭受艾滋病毒的风险增加，而未能成功从监狱或监狱过渡到社区。刑事司法机构人满为患已经危机美国的比例并没有比加利福尼亚州更严重的问题。 2006年，该州拥有全美最大的监狱制度，拥有173,000多名囚犯，但它的能力仅为100,000。 2011年，美国最高法院裁定，加利福尼亚州的监狱必须释放30,000多名罪犯，因为人满为患的程度构成了残酷和不寻常的惩罚。尚不清楚这些罪犯一旦被释放，或者他们将如何获得在社区中取得成功所需的服务。如果没有获得住房，需要支持向社区过渡的工作和服务，艾滋病毒感染和传播的风险很高，是重新逮捕和重新监禁的风险。在全国范围内，大约40％的假释罪犯在释放后的一年内被重新逮捕。利用集团理论，一种新的干预措施，通过动机访谈（动机访谈案例管理[MICM]）增强病例管理，将解决艾滋病毒和许多有关加剧刑事司法罪犯的艾滋病毒疾病的相关问题。与标准MI的创新差异包括：1）首次与处于艾滋病毒风险的罪犯首次使用基于MI的干预措施。 2）使用MI适应住宅恢复环境。 3）使用MI靶向已知会影响艾滋病毒的联合因素（例如，心理健康，医疗和住房不稳定性），4）使用MI提高对假释和缓刑术语的依从性，5）使用MI来寻找和维持工作，6）使用MI使用MI来访问服务并维持保留。 6）使用MI在药物复发后重建恢复。 7）使用MI解决挫折（例如，药物复发，工作损失）。根据犯罪者的需求，选择要关注的领域是在情况下进行的。将通过清醒的生活网络（SLN）访问无药物的住房，该组织将在加利福尼亚州认证500多个清醒的住所（SLH）。我们最近对SLH的研究表明，居民在酒精和吸毒，工作，逮捕和精神病问题方面有所改善。但是，刑事司法罪犯的表现要比其他居民还糟，艾滋病毒问题未得到评估。为了扩展我们当前使用MI用于MSM和Transgenders的HIV服务赠款，我们将使用MICM来解决艾滋病毒风险和增加风险因素的集合组合。将进入SLH的艾滋病毒高风险的330名罪犯的样本将随机分配给推荐资源（比较）或MICM（干预）条件。结果将在基线，6和12个月进行评估，包括艾滋病毒测试和风险，物质使用，逮捕和重新监禁的措施以及成瘾严重程度指数的问题。结果将验证MICM与SLH的使用作为罪犯的便宜且可复制的选择。