ASSERTIVE COMMUNITY TREATMENT FOR THE DUALLY DIAGNOSED

为双重诊断者提供积极的社区治疗

• 批准号: 2675251
• 负责人: Susan M Essock
• 金额: $ 39万
• 依托单位: CONNECTICUT ST DEPT OF MH/ADDICTION SRVS
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-30 至 2000-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2675251
• 关键词: behavioral /social science research tag; bipolar depression; clinical trials; community mental health services; comprehensive care; correctional institutions; functional ability; health care cost /financing; health care model; health care service evaluation; health care service utilization; homeless; hospital utilization; housing; human subject; longitudinal human study; medical outreach /case finding; mental disorder diagnosis; patient care management; psychosis; psychotherapy; quality of life; schizophrenia; social support network; substance abuse related disorder

Abuse of alcohol and other drugs is a frequent diagnosis among people with severe mental disorders (SMD) particularly among those who are homeless. A significant proportion, typically 50% or more, of people with SMD abuse alcohol or other non-prescribed psychoactive substances. Their substance abuse is strongly associated with clinical disability, homelessness, institutionalization, and treatment difficulty. To address this problem, the Connecticut Department of Mental Health has provided 'funding for the creation of a new assertive community treatment (ACT) team to provide integrated treatment for substance abuse and SMD to dually diagnosed clients in Connecticut's largest and poorest city, Bridgeport. The proposed research will be a collaboration between the Connecticut Department of Mental Health and the Dartmouth Medical School to conduct a rigorous evaluation of the effectiveness and costs of the ACT program design for dually diagnosed clients in an urban area where cocaine and other drugs are readily available and widely used. The research will carefully document the interventions provided to clients in the ACT and control conditions to document both what interventions actually occurred and the costs of the interventions so that any differences in clinical outcomes and costs can be attributed to differences identified in the processes of care. The first objective of the project is to decrease the problems most characteristic of dually diagnosed clients: alcohol and drug abuse, housing instability and homelessness, and institutionalization in hospitals and jails. A second objective is to determine whether good outcomes in these primary domains will be associated with more general improvements in symptoms, functional status, and quality of life. A third objective is to identify the qualities of case management that are associated with successful engagement and treatment of dually diagnosed clients. Separate data analysis strategies will be applied to each of these objectives. The research design is a randomized clinical trial. A total of 200 consenting, dually diagnosed clients will be randomly assigned to either ACT or to standard case management. Study participants will be interviewed with standard quantitative instruments at baseline and at six-month followup intervals for three years.

滥用酒精和其他药物是一种常见的诊断， 严重精神障碍（SMD），尤其是无家可归者。 一个显着的比例，通常为50%或更多的人与SMD滥用 酒精或其他非处方精神活性物质。 其实质内容 虐待与临床残疾，无家可归， 制度化和治疗困难。为了解决这个问题， 康涅狄格州精神卫生部为 建立一个新的自信社区治疗（ACT）团队， 综合治疗药物滥用和SMD双重诊断 客户在康涅狄格州最大也是最穷的城市布里奇波特。的 拟议的研究将是康涅狄格州 精神卫生部和达特茅斯医学院进行了一次 对ACT计划的有效性和成本进行严格评估 为城市地区的双重诊断客户设计， 其他药物也很容易获得并广泛使用。这项研究将 仔细记录在ACT中向客户提供的干预措施， 控制条件，以记录实际发生的干预 以及干预的成本， 结果和成本可以归因于差异中确定的 护理过程。 该项目的第一个目标是尽量减少问题 双重诊断客户的特征：酒精和药物滥用， 住房不稳定和无家可归， 医院和监狱。第二个目标是确定是否良好 这些主要领域的成果将与更普遍的 改善症状、功能状态和生活质量。 第三 目标是确定案件管理的质量， 与成功参与和治疗双重诊断 客户.单独的数据分析策略将应用于 这些目标。 研究设计为随机临床试验。共200 同意，双重诊断的客户将被随机分配到 ACT或标准病例管理。研究参与者将接受采访 在基线和6个月时使用标准定量工具 随访时间间隔为三年。