CRA AND ENHANCED JOB TRAINING FOR HOMELESS WOMEN

CRA 和针对无家可归妇女的强化职业培训

• 批准号: 6641202
• 负责人: JANE ELLEN SMITH
• 金额: $ 41.74万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-27 至 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6641202
• 关键词: adult human (21+); alcoholism /alcohol abuse; alcoholism /alcohol abuse prevention; alcoholism /alcohol abuse therapy; behavior therapy; blood tests; clinical trials; eating disorders; employment /unemployment; family structure /dynamics; female; homeless; human subject; human therapy evaluation; interview; longitudinal human study; patient care management; patient oriented research; psychological reinforcement; questionnaires; sex abuse; social support network; statistics /biometry; training; urinalysis; women's health

Women and families now comprise about 30 percent of the homeless population and they are viewed as the fastest rising subgroup. Alcoholism is their most widespread health problem It is unfortunate, then, that despite the availability of efficacious treatment programs, women enter and remain in them at much lower rates than do men. Some suggest that women will only seek treatment if women's issues are addressed or when they have options other than predominantly male programs. Since the proposed study will attempt to recruit a large sample of homeless women, an all-female program will be conducted utilizing a treatment that has been modified to take women's issues into consideration. Ninety-nine alcohol-dependent or alcohol-abusive homeless women will be randomly assigned to one of three conditions: case management (CM), the Community Reinforcement Approach (CRA), or an enhanced CRA program called CREATE (Community Reinforcement, Employment, and Training Enhancement). It is considered essential to investigate a CM program, both due to its widespread popularity, and the fact that it has only inconsistent empirical backing. The behavioral intervention, CRA, has proven to be efficacious for treating alcoholics and was listed as the most cost-effective treatment in the latest meta- analytic review. In its recent successful application to a homeless population, promising preliminary outcomes were detected for the small sample of female participants. However, two limitations were apparent. First, a considerable number of women relapsed when both their treatment and their stay in the abstinence-contingent, free housing ended. Consequently, the current proposal is an attempt to provide aftercare services during this high-risk period. It also will specifically address critical issues for these women (e.g. sexual victimization) from the start. A second problem was the high rate of unemployment posttreatment. In response, this project will offer basic computer skills training to the CREATE group through an empirically-based contingency management (voucher) program proven to enhance job-training attendance. The CREATE condition also will receive motivational CRA procedures called Systematic Encouragement to bolster job-training attendance and to make the work environment a reinforcing community. It is predicted that both of the CRA conditions will result in significant improvement in alcohol use, employment, and housing stability compared to CM, and that the CREATE group will obtain employment outcomes superior to the regular CRA group.

目前，妇女和家庭约占无家可归人口的 30%，她们被视为增长最快的群体。 酗酒是她们最普遍的健康问题。不幸的是，尽管有有效的治疗方案，但女性参与和继续接受治疗的比例远低于男性。 一些人认为，只有在妇女问题得到解决或除了以男性为主的项目之外还有其他选择时，妇女才会寻求治疗。 由于拟议的研究将尝试招募大量无家可归妇女样本，因此将使用经过修改以考虑妇女问题的治疗方法来开展一项全女性计划。 99 名酒精依赖或酗酒的无家可归妇女将被随机分配到以下三种情况之一：案例管理 (CM)、社区强化方法 (CRA) 或名为 CREATE（社区强化、就业和培训强化）。研究 CM 程序被认为是必要的，因为它广泛流行，而且它只有不一致的经验支持。 行为干预 CRA 已被证明对治疗酗酒有效，并在最新的荟萃分析综述中被列为最具成本效益的治疗方法。 在最近对无家可归人群的成功应用中，在一小部分女性参与者中发现了有希望的初步结果。 然而，有两个明显的限制。 首先，相当多的妇女在治疗和禁欲免费住房结束后病情复发。 因此，当前的提议是尝试在这个高风险时期提供善后服务。 它还将从一开始就专门解决这些妇女的关键问题（例如性受害）。 第二个问题是治疗后的高失业率。 作为回应，该项目将通过基于经验的应急管理（凭证）计划向 CREATE 小组提供基本的计算机技能培训，该计划已被证明可以提高职业培训的出勤率。 CREATE 条件还将接受称为“系统鼓励”的激励性 CRA 程序，以提高职业培训的参加率并使工作环境成为一个强化社区。 预计与 CM 相比，这两种 CRA 条件都将导致酒精使用、就业和住房稳定性的显着改善，并且 CREATE 组将获得优于常规 CRA 组的就业结果。