Effectiveness of Assertive Aftercare for Youth

描述(申请人提供)：进入社区居民治疗的青少年有严重的酒精和其他药物使用问题，并在出院后的头90天内有很高的复发风险。通常，只有大约三分之一的青少年得到任何善后治疗，在此期间50%-70%的青少年复发。《主张善后护理议定书》(AAP)将青少年社区强化办法程序与出院后三个月家访期间的病例管理结合起来。虽然这种善后护理方法在最初的实验(第一个关于青少年的善后护理实验)中显示出了希望，但它假设，使用应急管理(CM)程序来加强青少年从事亲社会活动并戒除酒精和其他药物可以加强这种能力。这项拟议的研究将使用随机2×2析因设计来评估在治疗后三个月内使用AAP、CM、两者或两者都不使用来加强通常的后续护理(UA)的影响。具体目的是从中期结果(更多的善后参与、更好的康复环境和更多的亲社会活动)和较长期的药物使用结果和相关问题两方面评估这些改进的主要影响和相互作用。来自两个地点的大约324名青少年将在接受住院治疗时以及出院后3、6、9和12个月接受面谈。在住院出院时，所有研究参与者将被转介到UA，四分之一的参与者将被随机分配到UA，四分之一将被随机分配到AAP，四分之一将被随机分配到CM，四分之一将被随机分配到AAP+CM。核心数据来源包括：服务联系日志、使用全球个人需求评估(GREAM)进行的接收和后续访谈，以及与家庭环境、同伴环境、参与亲社会活动、对青少年生活领域的满意度和参与善后护理有关的其他措施。青少年在吸食和出院后三个月的报告将通过与父母报告和大麻和可卡因的尿液测试进行比较来验证。预计AAP加CM的情况将导致比其他情况更好的结果，并更有可能为客户及其家人带来更长期的好处。

DESCRIPTION (provided by applicant): Adolescents who enter community-based residential treatment have serious alcohol and other drug use problems and are at high risk of relapse in the first 90 days after their discharge. Typically, only about a third of these adolescents get any aftercare treatment and 50%-70% relapse during this period. The Assertive Aftercare Protocol (AAP) combines adolescent community reinforcement approach procedures with case management during home visits for three months after discharge. While this aftercare approach showed promise in the original experiment (the first aftercare experiment published on adolescents), it is hypothesized that using contingency management (CM) procedures to reinforce adolescents when they engage in pro-social activities and abstain from alcohol and other drugs can strengthen it. The proposed study will use a randomized 2 x 2 factorial design to evaluate the impact of enhancing usual aftercare (UA) with AAP, CM, both or neither in the three months after treatment. The specific aims are to evaluate the main effects and interaction of these enhancements in terms of both intermediate outcomes (more aftercare participation, better recovery environment, and more pro-social activities) and longer-term substance use outcomes and related problems. Approximately 324 adolescents from two sites will be interviewed at their admission to residential treatment and at 3, 6, 9, and 12 months post discharge. At residential discharge, all study participants will be referred to UA, a quarter of the participants will be randomly assigned to UA only, a quarter will be randomly assigned to AAP, a quarter will be randomly assigned to CM, and a quarter will be randomly assigned to AAP+CM. The core data sources include: service contact logs, intake and follow-up interviews using the Global Appraisal of Individual Needs (GAIN), and additional measures related to family environment, peer environment, involvement in pro-social activities, satisfaction with adolescent life areas, and involvement in aftercare. Adolescent reports at intake and three months post discharge will be validated by comparison to parent report and urine tests for marijuana and cocaine. It is anticipated that the AAP plus CM condition will result in outcomes superior to the other conditions and be more likely to contribute to longer-term benefits to clients and their families.