Prevention Adaptation of an Evidence-Based Treatment for Parents Involved With Child Welfare Who Use Substances.
Prevention Adaptation of an Evidence-Based Treatment for Parents Involved With Child Welfare Who Use Substances.
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DOI：
10.3389/fpsyg.2021.689432
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发表时间：
2021
影响因子：
3.8
通讯作者：
Saldana L
中科院分区：
文献类型：
--
作者：
Cruden G;Crawford S;Saldana L
背景资料：父母使用药物，特别是阿片类药物滥用和/或甲基苯丙胺的使用，是最近美国家庭参与儿童福利和寄养安置增加的一个关键驱动因素。迫切需要预防父母物质使用障碍的方案，但很少有针对父母独特需求和优势的预防方案。采用循证治疗方法进行预防可能是解决这一差距的有效途径。目前的研究报告了一种基于证据的治疗方法的严格适应，该方法支持因药物使用而参与儿童福利的家庭，积极改善家庭关系（FAIR），以预防为导向的干预措施：“PRE-FAIR”。FAIR涉及四个治疗领域：物质使用、养育子女、心理健康和辅助服务（例如，住房、医疗和食品）。FAIR在三项严格的治疗试验中显着改善了父母的养育方式并减少了父母的物质使用，但FAIR在预防阿片类药物滥用和/或甲基苯丙胺使用的开始或升级方面的有效性未经测试。通知适应，特别注意的是操作策略的基础上的一个关键的假设调解成功的父母的结果参与。研究方法：毕业的FAIR家长（n = 9）和FAIR管理人员，临床主管和临床医生（n = 11）参加了半结构化访谈。内容分析用于确定驱动公平参与和家长结果的关键变量。因果循环图是一种定性系统科学方法，用于操作涌现主题，并描述关键变量之间的因果联系如何随时间动态地相互关联。结果如下：主题加强了公平的治疗领域的价值，支持父母的清醒和育儿技能的预防方向。辅助支持和牢固的关系对于帮助父母科普导致药物使用的压力源特别重要。五个参与策略被认为是父母成功的关键：24/7临床医生可用性，临床医生亲自倡导，在家分娩，基于优势的互动和尿液分析。确定了预公平参与策略和剂量的影响。讨论内容：传统的定性分析和基于系统科学的定性分析可以为严格的循证预防治疗方案提供信息。未来的研究将探讨额外的要求，健康一致的预防适应公平，和预公平对父母的物质使用和儿童福利的情况下的结果的影响。
Background: Parental substance use, especially opioid misuse and/or methamphetamine use, is a key driver for recent increases in family involvement with child welfare and foster care placements in the United States. There is an urgent need for programs that prevent parental substance use disorders, yet few prevention programs exist that target parents’ unique needs and strengths. Adapting evidence-based treatment approaches for prevention might be an efficient, effective way to address this gap. The current study informed the rigorous adaptation of an evidence-based treatment that supports families involved with child welfare due to substance use, Families Actively Improving Relationships (FAIR), to a prevention-oriented intervention: “PRE-FAIR.” FAIR entails four treatment domains: substance use, parenting, mental health, and ancillary services (e.g., housing, medical care, and food). FAIR significantly improved parenting and reduced parental substance use in three rigorous treatment trials, but FAIR’s effectiveness in preventing the initiation or escalation of opioid misuse and/or methamphetamine use is untested. To inform adaptation, particular attention was paid to operationalizing strategies underlying a key hypothesized mediator of successful parent outcomes—engagement. Methods: Graduated FAIR parents (n = 9) and FAIR administrators, clinical supervisors, and clinicians (n = 11) participated in semi-structured interviews. Content analysis was used to identify key variables driving FAIR engagement and parent outcomes. Causal loop diagramming, a qualitative systems science method, was employed to operationalize emergent themes, and describe how causal links between key variables interrelated dynamically over time. Results: Themes reinforced the value of FAIR’s treatment domains for supporting parent’s sobriety and parenting skills within a prevention orientation. Ancillary supports and strong relationships were particularly crucial for helping parents cope with stressors leading to substance use. Five engagement strategies were identified as essential to parent success: 24/7 clinician availability, in-person clinician advocacy, in-home delivery, strengths-based interactions, and urinalysis. Implications for PRE-FAIR engagement strategies and dosage were identified. Discussion: Traditional qualitative analyses and qualitative analyses based in systems science can inform rigorous adaptations of evidence-based treatment programs for prevention. Future research will explore additional required, fidelity-consistent prevention adaptations to FAIR, and the impact of PRE-FAIR on parental substance use and child welfare case outcomes.
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影响因子：
3.5
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