Steps to Effective Problem Solving

有效解决问题的步骤

• 批准号: 9175453
• 负责人: Sarah Herrink Ailey
• 金额: $ 41.7万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-07 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9175453
• 关键词: 18 year old; Accident and Emergency department; Accounting; Address; Admission activity; Age; Attention; Attitude; Behavior; Behavior Control; Behavioral; Caring; Cessation of life; Clinical; Clinical Trials; Clinical Trials Design; Communities; Control Groups; Data; Educational workshop; Emergency department visit; Emotional; Employment; Ensure; Environment; Equipment and supply inventories; Family; Female; Forensic Medicine; Friction; Group Homes; Health; Healthcare Systems; Home environment; Hospitalization; Imprisonment; Individual; Injury; Intellectual functioning disability; Intervention; Iowa; Lead; Life; Mediating; Medical center; Mind; Modification; Occupations; Outcome; Pain; Participant; Plant Roots; Population; Preventive; Preventive Intervention; Prisons; Problem Solving; Problem behavior; Property; Public Health; Qualifying; Randomized; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Residential Facilities; Services; Shelter facility; Social Distance; Social Network; Social Problems; Source; Support System; Supported Employment; Testing; Time; Training Programs; Training and Education; Work; Workplace; abstracting; base; behavior change; behavioral outcome; community setting; cost; cost effectiveness; demographics; dyadic interaction; efficacy testing; efficacy trial; experience; family support; improved; indexing; innovation; intervention effect; nutrition; population based; prevent; programs; response; satisfaction; skills; treatment as usual

Project Summary/Abstract Aggressive/challenging behaviors (AC/Bs) are a major public health problem for individuals with intellectual disabilities (ID) living in group homes. A leading reason for psychiatric hospitalizations and incarcerations, A/CBs are costly to the healthcare system, agencies and families. Social problem solving (SPS) training programs for individuals with ID have had positive behavioral results, but most were conducted in clinical or forensic settings. None were community-based preventive interventions, none examined whether A/CBs decreased in participants’ group homes and work settings, and none addressed cost effectiveness. In our preliminary work, we modified an effective SPS training program, using input from individuals with ID and residential staff, as a preventive intervention for the group home setting. Steps to Effective Problem-solving (STEPS) includes residential staff and uses the group home environment to facilitate behavior change. The purpose of this clinical trial is to test the efficacy of STEPS for individuals with ID. Specific aims are to 1) Assess the efficacy of the STEPS intervention in group homes to improve SPS skills and reduce A/CBs of the individuals with ID compared to an attention-control nutrition program from baseline to 12, 24 and 36 weeks, controlling for behavioral determinants of A/CBs (demographics, agency/home environment, current health). 2) Assess the mediating effect of the support environment for SPS (residential staff SPS skills, group home level SPS skills, and group cohesiveness) on the improvement of SPS skills and reductions in A/CBs. 3) Evaluate cost effectiveness of STEPS relative to usual care for A/CB incidents in group homes. .A cluster-randomized clinical trial design will be used in which 36 group homes (18 male, 18 female) will be randomly assigned to STEPS or attention-control. We will recruit 180 individuals with mild to moderate ID, at least 18 years old (approximately 5 per home), and at least two residential staff from each home (2-3 per home). SPS outcomes will be assessed with Iowa Family Interactions Rating Scales (IFIRS) Individual-level Problem-solving Scales and the Problem-solving Task. A/CB outcomes will be assessed with IFIRS Dyadic-interaction Scales, General Maladaptive Index (agency, work settings), and incident reports (agency). Mediating effects will be assessed for residential staff with SPS Inventory Revised- Short Form and IFIRS Individual-level Problem-Solving Scales; for group home level SPS skills by IFIRS Group Level Problem-Solving scales; and for group cohesiveness by the Cohesiveness subscale of Group Environment for the Intervention Scale. Cost- effectiveness of STEPS will be evaluated taking into account costs of A/CBs borne by the participant and family, program, group home, healthcare system, and public services. STEPS will be compared to usual care, (control group costs of behavior incidents). We expect to show STEPS to be a preventive behavioral strategy to reduce A/CBs among individuals with ID, improve the cost effectiveness of their care and make an important incremental advance in SPS research.

项目摘要/摘要 对于具有智力的人来说 残疾（ID）生活在集体住宅中。精神病和事件的主要原因， A/CBS对医疗保健系统，机构和家庭的代价很高。社会问题解决（SP）培训 具有ID的个人的计划具有积极的行为结果，但大多数是在临床上进行的 法医设置。没有人是基于社区的预防干预措施，没有人检查A/CBS是否 参与者的团体房屋和工作环境下降，没有任何解决成本效益。在我们的 初步工作，我们使用了具有ID和ID的个人的意见，修改了一个有效的SPS培训计划 住宅工作人员，作为集体家庭环境的预防干预措施。有效解决问题的步骤 （步骤）包括居民工作人员，并利用小组家庭环境来促进行为改变。这 该临床试验的目的是测试ID个体的步骤效率。具体目标是1） 评估小组房屋中的步骤干预的效率以提高SPS技能并降低A/CB 与从基线到12、24和36周的注意力控制营养计划相比，具有ID的个体 控制A/CB的行为确定（人口统计学，代理/家庭环境，当前健康）。 2） 评估SPS支持环境的中介效果（住宅人员SPS技能，小组家庭级别 SPS技能和小组凝聚力）关于A/CBS中SPS技能和降低的提高。 3）评估 步骤相对于对集体房屋中A/CB事件的常规护理的成本效益。 。一个群集随机 将使用临床试验设计，其中36个组（18名男性，18名女性）将随机分配给 步骤或注意力控制。我们将招募180名轻度至中度ID的人，至少18岁 （每个家庭约5个），每个家庭中至少有两名居民工作人员（每家家庭2-3）。 SPS结果 将通过爱荷华州家庭互动评估量表（IFIRS）个人级别解决问题量表进行评估 以及解决问题的任务。 A/CB结果将通过IFIRS二元相互作用量表进行评估，一般 适应不良指数（代理，工作环境）和事件报告（代理）。将评估中介效果 适用于SPS库存的居民工作人员修订 - 简短形式和IFIRS个人级别解决问题 秤;对于小组家庭级别SPS技能，ifirs群组级别解决问题范围；和小组 干预量表的团体环境的凝聚力子量表的凝聚力。成本- 考虑到参与者承担的A/CBS的成本，将评估步骤的有效性 家庭，计划，团体家庭，医疗保健系统和公共服务。将步骤与通常的护理进行比较 （行为事件的对照组成本）。我们期望显示步骤是一种预防行为策略 为了减少具有ID的个体中的A/CB，提高护理的成本效益 SPS研究中的增量进步。