Health Promotion Coaching/Vaccine for Homeless Parolees

为无家可归假释者提供健康促进指导/疫苗

• 批准号: 8265699
• 负责人: Adeline M Nyamathi
• 金额: $ 62.52万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8265699
• 关键词: Adult; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; Behavior; Behavioral; California; Car Phone; Case Manager; Cellular Phone; Communicable Diseases; Communication; Communities; Comprehensive Health Care; Coupled; Data; Dose; Drug usage; Education; Effectiveness; Employment; Enrollment; Family; Foundations; Funding; General Population; HBV Vaccination; HIV; Health; Health Policy; Health Promotion; Health Services; Health Services Accessibility; Healthcare; Hepatitis; Hepatitis A; Hepatitis B; Hepatitis B Prevalence; Hepatitis B Vaccines; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Homeless persons; Homelessness; Housing; Imprisonment; Individual; Infection; Injection of therapeutic agent; Intervention; Knowledge; Lead; Leadership; Link; Measures; Mediating; Mental Health; Mentors; National Institute of Drug Abuse; Needle Sharing; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Policies; Population; Prevention; Prisoner; Prisons; Program Effectiveness; Provider; Randomized; Recording of previous events; Relative (related person); Research Personnel; Residential Treatment; Risk; Risk Behaviors; Risk Reduction; Schedule; Series; Services; Sex Behavior; Social Health Services; Social Work; Subgroup; Substance abuse problem; Technology; Telephone; Time; Unemployment; Urine; Vaccination; Vaccines; Virus; Virus Diseases; Visit; Work; base; compare effectiveness; condoms; coping; cost; design; experience; follow-up; health care service utilization; high risk; housing instability; improved; innovation; intervention program; male; men; novel strategies; offender; parole; parolee; prevent; programs; prospective; rearrest; recidivism; reincarceration; sex risk; skills; social; substance abuse treatment; success; treatment as usual; treatment program

DESCRIPTION (provided by applicant): Homeless parolees are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Although HBV is a vaccine-preventable illness, 12% to 25% of formerly incarcerated individuals are infected with HBV. Homeless parolees pose a particular challenge for successful reentry as they have underlying mental health issues combined with substance use and abuse and must contend with unstable housing situations, disorganized lives, unemployment, and limited access to health care and social services. Generally about 50% of all parolees scheduled to enroll in community-based drug treatment fail to enroll and less than 10% of enrollees actually complete treatment. Not surprisingly, about two-thirds of all individuals on parole are rearrested and return to custody within three years of release from prison. Our recent data also revealed homeless persons least likely to complete a HAV/HBV vaccine series were young (< 40), and were men who had been discharged from prison. Therefore, it is critical to engage paroled adults in comprehensive intervention programs that not only protect them from HBV, but also reduce risky behavior, promote access to health care, social and employment services, and enable positive coping and communication skills. With advice from our community partners who have successfully treated parolees and our experience with hepatitis vaccination work, we propose to conduct a prospective, three-group study that randomly assigns 700 ready-for- discharge parolees, scheduled to enter a community residential drug treatment program, to enter one of three groups: 1) a PCPC (Parolee Comprehensive Care + Phone Coaching Program), which includes nurse case management and specialized hepatitis education sessions and referrals, the HAV/HBV vaccination series (to all eligible) and coach- facilitated mentoring (mostly by cell-phone); 2) a Parolee Brief Hepatitis Education + HBV vaccination + Phone Coaching (PBCP) Program, which includes brief hepatitis/HIV education, the HAV/HBV vaccination and coach-facilitated mentoring; or 3) a Usual Care (UC) control program, which includes brief general health information, and the HAV/HBV vaccine. For the randomized parolees, the primary aims will be to examine: reincarceration (any vs none), number of days to first reincarceration, completion of HAV/HBV vaccination (among those HBV-negative), and completion of six months of the Amity community-based residential drug treatment program. Secondary aims are to examine program- related differences in potential mediating variables, such as reduction in drug and alcohol use and sexual risk behaviors, visit to health care or social service providers, and improved knowledge of Hepatitis/HIV and communication skills, between 6 and 12 months or over the one-year study period, depending on the measure, and to assess the relative costs of the three programs. This study will advance our knowledge about drug treatment and HBV vaccine completion and recidivism among homeless parolees. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and recidivism in this group who are a reservoir for these viruses in the general population, and are returning to prison at unprecedented numbers. PUBLIC HEALTH RELEVANCE: In this study, researchers from UCLA will partner with Amity Foundation and will work together in designing a program to engage soon-to-be discharged prisoners targeted to enter community-based residential drug treatment to receive a comprehensive program that not only protects them from hepatitis A and B infection by means of the hepatitis vaccination, but also reduces risky behaviors, helps them access health care, and social services, and help them to use more positive coping and communication skills. Using nurse case management strategies found successful with homeless adults, incorporating phone coaching, where a buddy who has successfully completed the drug treatment program supports the newly released parolee, we will evaluate the effectiveness of a Parolee Comprehensive Phone Coaching program compared to a less intense program or a usual care program. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and rearrest and/or return to custody in this group who can spread hepatitis infection in the general population, and, are returning to prison at unprecedented numbers.

描述（由申请人提供）：由于注射吸毒率高和无保护的性活动，无家可归的假释者感染乙型肝炎病毒 (HBV)、丙型肝炎病毒 (HCV) 和艾滋病毒的风险很高。尽管 HBV 是一种疫苗可预防的疾病，但 12% 至 25% 的曾被监禁者感染了 HBV。无家可归的假释者对成功重返社会构成了特殊的挑战，因为他们有潜在的心理健康问题，加上药物滥用和滥用，必须应对不稳定的住房状况、无组织的生活、失业以及获得医疗保健和社会服务的机会有限。一般来说，计划参加社区戒毒治疗的所有假释犯中，约有 50% 未能参加，只有不到 10% 的参加者真正完成治疗。毫不奇怪，大约三分之二的假释者在出狱后三年内再次被捕并重新被拘留。我们最近的数据还显示，最不可能完成 HAV/HBV 疫苗系列的无家可归者是年轻人（< 40 岁），并且是已出狱的男性。因此，让假释成年人参与综合干预计划至关重要，这不仅可以保护他们免受乙肝病毒感染，还可以减少危险行为，促进获得医疗保健、社会和就业服务，并提高积极的应对和沟通技巧。根据成功治疗假释者的社区合作伙伴的建议以及我们在肝炎疫苗接种工作方面的经验，我们建议进行一项前瞻性三组研究，随机分配 700 名准备出院的假释者，计划进入社区住宅戒毒治疗计划，进入三组之一：1) PCPC（假释犯综合护理 + 电话辅导计划），其中包括护士病例管理和专门的肝炎教育课程和转介、HAV/HBV 疫苗接种系列（针对所有符合条件的人）以及教练协助指导（主要通过手机）； 2) 假释犯简短肝炎教育 + HBV 疫苗接种 + 电话辅导 (PBCP) 计划，其中包括简短肝炎/HIV 教育、HAV/HBV 疫苗接种和教练辅导；或 3) 常规护理 (UC) 控制计划，其中包括简要的一般健康信息和 HAV/HBV 疫苗。对于随机假释者，主要目标是检查：再监禁（任何与无）、第一次再监禁的天数、完成 HAV/HBV 疫苗接种（其中 HBV 阴性）以及完成六个月的 Amity 社区生活基于住院的戒毒治疗计划。次要目标是检查潜在中介变量中与计划相关的差异，例如减少吸毒和酗酒以及性危险行为、拜访医疗保健或社会服务提供者以及提高肝炎/艾滋病毒知识和沟通技巧，6 至12 个月或一年以上的学习期（具体取决于衡量标准），并评估三个项目的相对成本。这项研究将增进我们对无家可归假释者的药物治疗、乙型肝炎疫苗接种和累犯的认识。这项研究的结果可以为有针对性的干预措施提供信息，并为可能影响肝炎和艾滋病毒风险降低和累犯的健康政策决策奠定基础，这些群体是普通人群中这些病毒的储存库，并且以前所未有的数量返回监狱。公共健康相关性：在这项研究中，加州大学洛杉矶分校的研究人员将与 Amity 基金会合作，共同设计一项计划，让即将出狱的囚犯参与社区住院戒毒治疗，以接受一项综合计划，该计划不仅通过肝炎疫苗接种来保护他们免受甲型和乙型肝炎感染，同时也减少危险行为，帮助他们获得医疗保健和社会服务，并帮助他们使用更积极的应对和沟通技巧。使用在无家可归的成年人中取得成功的护士案例管理策略，结合电话辅导，其中成功完成药物治疗计划的伙伴支持新释放的假释者，我们将评估假释者综合电话辅导计划与强度较低的计划相比的有效性或常规护理计划。这项研究的结果可以为有针对性的干预措施提供信息，并为可能影响肝炎和艾滋病毒风险降低的卫生政策决策奠定基础，并重新逮捕和/或返回拘留这一可能在普通人群中传播肝炎感染的群体，并且正在返回监狱数量空前。