Preventing Parental Opioid and/or Methamphetamine Addiction within DHS-Involved Families: FAIR

项目摘要/摘要 这与最初提交的文件没有变化。 在过去的5年里，全国许多州都经历了卷入 寄养系统是由于年轻父母滥用阿片类药物和甲基苯丙胺而造成的。2017年， 儿童福利系统收到了约750万名儿童的410万次转介，这些儿童服用父母的药物 虐待和忽视儿童占案件的绝大多数。这在俄勒冈州尤其如此，那里 超过55%的病例涉及30岁以下的父母，寄养系统中超过60%的病例是 与父母滥用药物有关。家庭积极改善关系(公平)计划是一项 最近制定的、经过严格评估的强化门诊治疗计划，适用于参与 父母阿片类和/或苯丙胺类物质使用障碍儿童福利系统--甲基苯丙胺 (声音；泥巴)。公平有效性试验的结果表明，公平有可能被调整为 为参与儿童福利和自给自足制度的父母提供预防方案，并将予以实施 在服务可获得性和可获得性较低的县。本UG3/UH3勘探开发阶段性项目 致力于与俄勒冈州公共服务部(DHS)合作一年的活动 合作伙伴和领导层制定适应、招聘和实施公平的计划 预防。在UG3阶段，拥有干预开发和专业知识的调查小组 临床有效性试验、实施科学、决策科学、卫生经济学，包括国土安全部 领导力-将与协调中心合作(UG3目标1)制定战略，以 识别、接触和接触参与国土安全部系统的父母，年龄在16岁到30岁之间，他们有升级的风险 误用或发展OUD和/或MUD；以及(UG3目标2)发展和适应公平，以防止引发 阿片类药物和/或甲基苯丙胺滥用并升级为精神障碍。在完成了一组 具体里程碑在第一年，UGH阶段的项目将进行随机混合II 临床试验，评估调整后的公平方案及其实施情况。在两个县，父母 由国土安全部转介的阿片类药物或甲基苯丙胺的使用或滥用有升级风险(n=240)，将是 招募并纵向跟踪了24个月。家长将被随机接受改编后的公平 预防，或标准病例管理和转介(立场)。这一阶段的首要目标是测试 在普遍定期审议阶段设计的适应的有效性，并建立在国家合作的基础上-- 具体地说，要：(UH3目标1)评估公平在预防16岁涉及国土安全部的父母方面的有效性 至30，从开始滥用或升级阿片类药物和/或甲基苯丙胺的使用；(UH3目标2)检查和 评估公平在县主导的国土安全部系统中的执行情况，为可持续发展计划提供信息；和(UH3 目的3)评估与采纳公平原则相关的实施和干预成本。结果来自 该项目将为进一步完善议定书和扩大公平贸易协定的规模提供信息。

PROJECT SUMMARY/ABSTRACT This has not changed from the original submission. Over the last 5 years, many states across the country have experienced an increase in children involved in the foster care system as a result of young parental opioid and methamphetamine misuse and disorder. In 2017, the child welfare system received 4.1 million referrals for approximately 7.5 million children, with parental drug abuse and child neglect accounting for the large majority of cases. This is particularly true in Oregon, where over 55% of cases involve parents under the age of 30, and over 60% of cases in the foster care system are associated with parental drug abuse. The Families Actively Improving Relationships (FAIR) program is a recently developed, rigorously evaluated, intensive outpatient treatment program for parents involved in the child welfare system for parental opioid and/or amphetamine type substance use disorder–methamphetamine (OUD; MUD). Outcomes from the FAIR effectiveness trial suggest the potential for FAIR to be adapted as a prevention program for parents involved with child welfare and self-sufficiency systems, and to be implemented in counties with low service availability and access. This UG3/UH3 exploratory-developmental phased project dedicates a year of activities toward collaborating with Oregon state Department of Human Services (DHS) partners and leadership to develop a plan for adaptation, recruitment, and implementation of FAIR for prevention. During the UG3 phase, the investigative team—with expertise in intervention development and clinical effectiveness trials, implementation science, decision science, health economics, and including DHS leadership—will work in collaboration with the Coordinating Center to (UG3 Aim 1) Develop strategies to identify, reach, and engage parents involved in the DHS system, aged 16 to 30, who are at-risk for escalation of misuse or development of OUD and/or MUD; and (UG3 Aim 2) Develop and adapt FAIR to prevent initiation of opioid and/or methamphetamine misuse and escalation to disorder. Following the completion of a set of concrete milestones during the first year, the UGH phase of the project will conduct a Hybrid II randomized clinical trial, to evaluate the adapted FAIR program and its implementation. Across two counties, parents referred by DHS for opioid or methamphetamine use or misuse with risk for escalation (n = 240), will be recruited and followed longitudinally for 24 months. Parents will be randomized to receive the adapted FAIR as prevention, or standard case management and referral (STAND). Overarching goals of this phase are to test the effectiveness of the adaptations designed in the UG3 phase and to build upon state collaborations— specifically, to: (UH3 Aim 1) Evaluate the effectiveness of FAIR in preventing DHS-involved parents, aged 16 to 30, from initiating misuse or escalating opioid and/or methamphetamine use; (UH3 Aim 2) Examine and assess the implementation of FAIR in the county-driven DHS system to inform sustainability plans; and (UH3 Aim 3) Assess the implementation and intervention costs associated with the adoption of FAIR. Outcomes from this project will inform further refinement of protocols and the potential for broader scale-up of FAIR.