The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty.
The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty.
复制标题
美国部落社区应急管理的迫切需要：实施、政策和主权的考虑。
DOI：
10.1016/j.ypmed.2023.107662
复制
发表时间：
2023
影响因子：
5.1
通讯作者：
Rawson,Rich
中科院分区：
文献类型：
--
作者：
Hirchak,KatherineA;Echo-Hawk,Holly;Parent,Sara;Peavy,KMichelle;Webb,Kellie;Bajet,Kelsey;Richardson,Meenakshi;Granbois,Alexandria;Herron,JaleneL;Catron,Krista;King,Keli;Parsells,Ed;Freese,ThomasE;Thomas,LisaRey;Rawson,Rich
在两项随机对照试验中，文化适应的应急管理（即，在地理位置不同的美洲印第安人和阿拉斯加原住民（AI/AN）成年人中，为物质阴性尿液样本提供的奖励与酒精和药物使用的减少有关。为了回应其他部落和AI/AN社区对应急管理的兴趣，我们的研究团队与AI/AN行为健康专家合作，将研究转化为新的AI/AN社区合作伙伴的实践。基于社区的参与性研究的原则适用于开发，试点和完善应急管理培训和实施工具，并确定实施的挑战。在与AI/AN社区的合作中，大学团队的四名成员开发了工具，并确定了实施和政策战略，以提高每个地点应急管理的成功率。通过我们的合作，我们确定了政策障碍，包括应急管理激励措施的联邦资金不足，以及需要进一步明确联邦反回扣法规。采用应急管理是可行的，可以加强部落社区的能力，提供基于证据的物质使用障碍治疗人工智能/AN人。不幸的是，非证据为基础的限制使用联邦资金的应急管理奖励歧视人工智能/AN社区。我们建议具体的联邦政策改革，以及对应急管理感兴趣的部落社区的其他实际解决方案。
In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.