Facilitating treatment entry and family planning in substance-using NICU mothers

促进新生儿重症监护室药物使用母亲的治疗进入和计划生育

• 批准号: 9087714
• 负责人: Angela L Stotts
• 金额: $ 23.1万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9087714
• 关键词: Acute; Address; Adopted; Alcohol or Other Drugs use; Attention; Bayesian Analysis; Bayesian Method; Behavior; Behavior Therapy; Behavioral; Caring; Child; Child Abuse; Child Custody; Childhood; Clinical Investigator; Consent; Contraceptive methods; Control Groups; Counseling; Data; Disadvantaged; Distress; Drug usage; Economics; Emergency department visit; Enrollment; Environment; Evidence based treatment; Family; Family Planning; Foundations; Future; HIV/HCV; Health; Health Services Accessibility; Health behavior; Healthcare; Hepatitis C; Hospitalization; Hospitals; Infant; Intervention; Interview; Knowledge; Legal system; Licensing; Low Birth Weight Infant; Medical; Methodology; Minority; Mothers; Motivation; Neonatal Abstinence Syndrome; Neonatal Intensive Care Units; Newborn Infant; Participant; Persons; Physicians; Population; Postpartum Period; Pregnancy; Premature Birth; Prenatal care; Prevalence; Probability; Professional counselor; Public Health; Quality of life; Randomized; Reproductive Health; Research; Risk; Risk Behaviors; Sample Size; Sampling; Services; Severities; Sexually Transmitted Diseases; Site; Societies; Substance abuse problem; Technology; Testing; Therapeutic Intervention; Time; Visit; Woman; Work; active method; base; child bearing; child neglect; cost; critical period; design; disorder prevention; effectiveness trial; efficacy trial; evidence base; experience; flexibility; follow-up; health seeking behavior; help-seeking behavior; high risk; high risk behavior; high risk infant; illicit drug use; improved outcome; innovation; meetings; motivational enhancement therapy; neglect; neurobehavioral; novel; pregnant; premature; prevent; psychologic; public health relevance; racial health disparity; randomized trial; reduced substance use; response; satisfaction; social; substance abuse treatment; targeted treatment; young mother

 DESCRIPTION (provided by applicant): Maternal substance abuse is a significant public health problem with wide-ranging, negative consequences. Substance use in pregnancy is prevalent, particularly among disadvantaged groups, and is often associated with sporadic, late, or no prenatal care, precluding identification, referral and treatment prior to hospital delivery. Infants born to substance-using mothers are often premature or at low birth weights and admitted to the neonatal intensive care unit (NICU), making this an important setting for initial intervention. Maternal substance use is associated with inadequate childcare and neglect which can have especially devastating consequences for fragile NICU infants. Further, without intervention, many of these mothers will become pregnant again within a short period of time, increasing burden on themselves, their families and society. Prolonged hospitalization in the NICU provides a unique opportunity to intervene with distressed young mothers in crisis, who may have higher levels of motivation to seek help for high-risk behaviors (substance use) and adopt healthy ones (family planning; disease prevention). We predict that a novel, empirically-grounded, hospital-tailored intervention combined with gynecological follow-up in the NICU (i.e., physicians providing reproductive health and HIV/HCV counseling) will increase treatment initiation, reduce substance use, prevent future substance-exposed pregnancies (SEPs), and reduce risk of HIV and HCV. As NICU infants are disproportionately born to disadvantaged, minority families, intervention with this population is critical for reducing economic and racial health disparities. A randomized, controlled group design will be used to allow a rigorous assessment of the feasibility and efficacy of an adaptive, brief, hospital-delivered intervention comprising a novel combination of evidence- based treatments (motivational interviewing [MI] and acceptance and commitment therapy [ACT]) targeting substance abuse treatment initiation and reduced risk of SEPs for mothers with a high-risk, NICU infant. Mothers (N = 64) will be randomized to either: MI-ACT or Conventional Care (CC). MI-ACT treatment intensity (1, 2, or 3 sessions) will vary based upon participant response (i.e., treatment initiation), per the adaptive intervention strategy. An efficacy assessment at 8 weeks post-baseline will assess treatment entry, substance use, and SEP/HIV/HCV risk. MI-ACT treatment mechanisms (i.e., motivation for change; psychological flexibility) will also be investigated. At the 6-month follow-up, broader maternal and infant benefit will be assessed (e.g., child custody; acute care pediatric visits; re-hospitalization). An innovative Bayesian analysis is planned to determine potential benefit of the MI-ACT intervention, which proactively addresses the inevitable problem of power when conducting initial efficacy trials of new interventions in relatively smaller samples. Effective bref, hospital-based interventions targeting substance-using mothers of infants at high medical risk could result in substantial decreases in adverse health and social effects and the large associated costs.

 描述（由适用提供）：孕妇滥用是一个重大的公共卫生问题，带有广泛的，负面的后果。怀孕的药物使用很普遍，尤其是在受干扰的群体中，通常与零星，晚期或没有产前护理，排除医院分娩前的识别，转诊和治疗有关。用物质母亲出生的婴儿通常是早产或低出生体重，并接受了新生儿重症监护病房（NICU），这使得这是初步干预的重要环境。产妇使用与育儿和忽视不足有关，这可能会对脆弱的NICU婴儿产生毁灭性的后果。此外，如果没有干预，许多母亲将在短时间内再次怀孕，从而增加对自己，家人和社会的烧伤。 NICU的长时间住院提供了一个独特的机会，可以干预危机中的苦恼年轻母亲，他们可能有更高水平的动力来寻求高风险行为（药物使用）和采用健康的行为（计划生育；预防疾病）。我们预测，一种新颖的，经验基础的医院卫生干预措施，结合NICU中的妇科随访（即提供生殖健康和HIV/HCV咨询的医生）将增加治疗倡议，减少药物使用，防止未来的药物暴露于妊娠（SEP），并减少HIV和HCV的风险。由于不利的儿童儿童不成比例，少数族裔家庭对这种人群的干预对于降低经济和种族健康差异至关重要。随机，受控的小组设计将用于允许对适应性，短暂，医院服务的可行性和效率进行严格的评估，以完成基于证据的治疗方法（动机访谈[MI]以及接受和承诺疗法[ACT]）的新型组合，以靶向药物滥用治疗启动性和对SEP的高级母体的SEP侵害药物滥用治疗的风险，而NICES NICES NICES，NICES NICE INVIST。母亲（n = 64）将被随机分为：MI-ACT或常规护理（CC）。根据适应性干预策略，MI-ACT治疗强度（1、2或3个课程）将根据参与反应（即治疗计划）而有所不同。基线后8周的效率评估将评估治疗条目，物质使用和SEP/HIV/HCV风险。还将研究MI-ACT治疗机制（即变革动机；心理灵活性）。在6个月的随访中，更广泛 将评估产妇和婴儿的福利（例如，儿童监护权；急性护理小儿就诊；重新住院）。计划进行创新的贝叶斯分析，以确定MI-ACT干预的潜在益处，该分析在进行相对较小的样本中的新干预措施进行初步有效试验时，积极解决了不可避免的权力问题。有效的BREF，基于医院的干预措施，针对使用物质的母亲处于高医疗风险的母亲可能会导致不利的健康和社会影响以及大量相关成本的大幅下降。