Teens' Risk During Transition: Preventing Drug Use, HIV & School Problems

青少年在变性过程中的风险：预防吸毒、艾滋病毒

• 批准号: 8219064
• 负责人: PATRICIA CHAMBERLAIN
• 金额: $ 60.42万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-15 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8219064
• 关键词: Accounting; Adherence; Adolescent; Area; Behavior Therapy; Behavioral; Calibration; California; Caring; Child Welfare; Communities; Cost Savings; Data; Development; Drops; Drug Addiction; Drug usage; Effectiveness; Enrollment; Evidence based intervention; Failure; Female; Fostering; Future; Gender; Goals; HIV; Health; Homelessness; Human Resources; Incidence; Individual; Intervention; Interview; Leadership; Link; Measures; Mediating; Mental Health; Methods; Modeling; Monitor; Outcome; Paper; Parents; Participant; Performance; Pharmaceutical Preparations; Pregnancy; Preventive Intervention; Randomized; Records; Recruitment Activity; Relative (related person); Research; Risk; Role; Savings; Schools; Services; Symptoms; System; Teenagers; Testing; Time; Tobacco use; Training; Trauma; Work; Youth; base; behavioral health; cost; cost effective; cost effectiveness; design; early onset drug use; economic evaluation; economic impact; effectiveness trial; efficacy trial; experience; follow-up; foster care; foster parent; group intervention; information gathering; intervention effect; maltreatment; middle school; peer; prevent; scale up; service intervention; sex risk; skills; social; staff intervention; uptake

DESCRIPTION (provided by applicant): The transition to middle school can be a risky time for many adolescents, as youth are exposed to a host of new academic challenges and social relationships with older peers. Being placed foster care amplifies this risk. The purpose of this study is to conduct a randomized effectiveness trial to determine whether adding a preventive intervention at this critical transition period is effective and cost effective in terms of ameliorating outcomes such as drug and tobacco use, participation in HIV- risking sexual behavior, delinquency, mental health problems, and school failure for young adolescents in foster care. The proposed LINKS intervention marries the goals of child welfare and educational systems and will be implemented in the San Diego Unified School District which is the 2nd largest school district in California. LINKS, a 20-week, two pronged intervention that focuses on increasing parent and youth skills and support will be delivered by community-based paraprofessionals who will be trained and supervised to implement the intervention. An ongoing fidelity monitoring system will allow for the calibration of intervention staff performance to adherence standards, provide performance standards for local staff training, and build in monitoring for local support and oversight (i.e., at the system leadership level) in the school district and child welfare systems. The study is designed to maximize the potential for uptake, sustainability, and future scale-up to other school and child welfare systems given positive results from this effectiveness trial. The aims are: a) to determine the effectiveness of the LINKS intervention on key behavioral health and school adjustment outcomes, b) to examine mechanisms of action; specifically the mediating effects of placement failure on outcomes, c) to examine the moderating role of fidelity on outcomes, and d) to examine cost effectiveness and cost avoidance of LINKS. All eligible 5th graders enrolled in the San Diego Unified School District placed in foster or kinship care (and their caretakers) will be recruited over a 4-year period and will be assessed at baseline, and at 6, 12, and 18 month follow-ups. It is hypothesized that those participating in LINKS will experience fewer negative behavioral health outcomes and better school adjustment and that these effects will be mediated by higher levels of placement stability and moderated by intervention fidelity scores. PUBLIC HEALTH RELEVANCE: The project seeks to determine if a preventive intervention delivered at the entry to middle school ameliorates the well-documented risks of negative behavioral health and school adjustment outcomes for youth placed in foster care. An estimated 20 billion dollars are spent annually in the child welfare system, yet studies consistently find that youth in foster care have disproportionately high rates of drug and tobacco use, delinquency, participation in health risking sexual behavior, and poor developmental and mental health problems. The period of transition into middle school is a critical time when there is an opportunity to prevent school adjustment and behavioral health difficulties that cause cascading negative long term outcomes. The proposed trial is situated within community systems and implemented by paraprofessional interventionists to promote uptake and sustainability.

描述（由申请人提供）：对于许多青少年来说，向中学的过渡可能是一个冒险的时刻，因为青年人面临许多新的学术挑战和与老年同龄人的社会关系。放置寄养护理会放大这种风险。这项研究的目的是进行一项随机有效性试验，以确定在此关键过渡期间增加预防性干预措施是否有效且具有成本效益，并且在改善诸如药物和烟草使用之类的结果方面是否有效，参与HIV风险性行为，犯罪行为，犯罪性，心理健康问题，以及对年轻青少年在寄养中的失败。拟议的链接干预措施与儿童福利和教育系统的目标结合，并将在加利福尼亚州第二大学区的圣地亚哥统一学区实施。 Links是一项为期20周，两次较长的干预措施，侧重于增加父母和青年技能和支持，将由社区基于社区的专业人士提供，他们将受到培训和监督以实施干预措施。持续的忠诚监控系统将允许对依从性标准进行干预人员绩效的校准，为当地员工培训提供绩效标准，并在学区和儿童福利系统中监测当地的支持和监督（即在系统领导力级别）。这项研究旨在最大程度地提高其他学校和儿童福利系统的吸收，可持续性以及未来扩大规模的可能性，从而获得了这项有效性试验的积极结果。目的是：a）确定链接干预对关键行为健康和学校调整结果的有效性，b）检查行动机制；具体来说，放置失败对结果的介导影响，c）检查忠诚对结果的调节作用，d）检查成本效益和避免链接的成本效益。所有合格的五年级学生都将在圣地亚哥统一学区招募寄养或亲属护理（及其护理人员），并将在4年内招募，并在基线和6、12和18个月的随访中进行评估。假设参与链接的人会经历更少的负面行为健康结果和更好的学校调整，并且这些效果将由更高的放置稳定性介导，并通过干预保真度得分来调节。 公共卫生相关性：该项目旨在确定进入中学时提供的预防性干预是否可以改善对寄养护理中青年的负面行为健康和学校调整成果的有据可查的风险。估计每年在儿童福利系统上花费了200亿美元，但研究始终发现，寄养的青年在药物和烟草使用，犯罪，参与健康风险性行为以及性行为不良以及发育和心理健康问题的比例高。过渡到中学的时期是有机会防止学校调整和行为健康困难的关键时期，导致长期负面的负面结果。拟议的试验位于社区系统中，并由专业干预者实施，以促进吸收和可持续性。