Sustainable HIV Risk Reduction Strategies for CJ Systems

描述（由申请人提供）：拟议的研究为期5年，包括两个主要研究阶段，旨在减少刑事司法（CJ）人群中艾滋病毒和其他成瘾相关疾病的风险。第一阶段是疾病风险降低（DRR）干预效果研究，第二阶段是在CJ现场环境中实施。手册指导的DRR规划和决策战略将基于认知工具，这些工具侧重于基于证据的视觉空间（而不是传统的教学）沟通方法。它将重点关注重返社会期间的高危性行为和吸毒行为，包括问题识别、改变的承诺以及避免感染行为风险的策略。在CJ机构药物滥用治疗结束时，将举行激励和规划会议，并在社区过渡治疗期间，通过使用一系列强调DRR原则应用的自学工具包，将会议过渡到重返社会护理服务。罪犯层面的参与和功能将是这个初始研究阶段的关键分析焦点。在项目的第二阶段，将在德克萨斯州以及3个相邻州（亚利桑那州、新墨西哥州和俄克拉荷马州）的CJ系统扩展网络中检查干预实施过程。这一阶段将采用自然主义的研究设计，依靠组织的需要和功能评估（根据工作人员对减少灾害风险干预培训和利用的评价）来分析CJ系统机构和社区再入司的执行进展。与目前在机构治疗中使用的“标准治疗”相比，DRR干预有望显著提高罪犯的动机、承诺和自信，以规划他们在重返社区时使用的行为风险降低策略。预计DRR再入自我学习指南将进一步提高社区中罪犯使用支持网络的比率，降低他们与吸毒和性行为相关的风险水平，并在随访期间降低他们再次入狱的可能性。同样，在机构治疗期间，更有利的罪犯心理社会功能和参与也有望与重返社区的更好结果呈正相关。在实施评估研究（第二阶段）中，机构和以社区为基础的再入团队（代表4个州的CJ系统）预计将对创新培训做出回应，并使DRR组件的应用与他们对项目需求、压力、资源和组织适应性的集体看法相称。也就是说，希杰工作人员（例如，监狱治疗和缓刑/假释区域）对需求、艾滋病毒干预服务的准备情况、组织资源、任务和业务环境的评价较高（平均），预计将预示着对后续DRR创新培训的更多参与和响应。反过来，这些指标预期将预测更高的减灾资源利用率和工作人员对培训后后续行动的满意度。

DESCRIPTION (provided by applicant): The proposed study covers 5 years and includes 2 major research phases intended to reduce HIV and other addiction-related disease risks in criminal justice (CJ) populations. The first phase is a Disease Risk Reduction (DRR) intervention effectiveness study, and the second addresses its implementation in CJ field settings. A manual-guided DRR planning and decision-making strategy will be based on cognitive tools that focus on an evidence-based, visual-spatial (rather than traditional didactic) communication approach. It will focus on risky sexual and drug use behaviors during re-entry, including problem recognition, commitment to change, and strategies for avoiding behavioral risks of infections. Motivational and planning sessions will be delivered near the end of CJ institution-based substance abuse treatment, and they will also bridge into re- entry care services during community transitional treatment by using a series of self-study toolkits emphasizing applications of DRR principles. Offender-level engagement and functioning will be the key analytical focus of this initial study phase. In the second phase of the project, the process of intervention implementation will be examined in an expanded network of CJ systems in Texas as well as 3 adjoining states (Arizona, New Mexico, and Oklahoma). This phase will employ a naturalistic research design relying on organizational needs and functioning assessments (based on staff evaluations of DRR intervention training and utilization) in the analyses of implementation progress in institution and community-based re-entry divisions of the CJ system. When compared to "standard care" currently used during institution-based treatment, the DRR intervention is expected to significantly improve offender motivation, commitment, and self-confidence in planning their behavioral risk-reduction strategies for use during community re-entry. It also is expected that DRR re-entry self-study guides will further increase the rate of offender use of support networks in the community, reduce their risk levels related to drug use and sexual behaviors, and decrease their likelihood of re-incarceration during follow-up. More favorable offender psychosocial functioning and engagement during institution-based treatment likewise are expected to be positively associated with better outcomes during community re-entry. In the implementation evaluation study (Phase 2), institution and community-based re-entry teams (representing CJ systems across 4 states) are expected to respond to innovation training and make applications of DRR components commensurate with their collective perceptions about program needs, pressures, resources, and organizational fitness. That is, higher (average) ratings by staff members at CJ sites (e.g., in-prison treatment and probation/parole regions) of needs, readiness for HIV intervention services, organizational resources, mission, and operational climate are expected to predict greater participation and responsiveness to subsequent training for the DRR innovation. These indicators, in turn, are expected to predict higher DRR utilization and staff satisfaction at the post-training follow-up. PUBLIC HEALTH RELEVANCE: Effective HIV/AIDS-risk reduction interventions for criminal justice populations can offer significant public health benefits, both to offenders themselves and the public at large. However, there are challenges to "engaging" and convincing offenders with substance abuse histories to adequately plan and apply risk reduction principles during the crucial community re-entry phase after imprisonment. Correctional systems also are often fragmented, representing another challenge to efforts to provide integrated care and supervision to offenders at-risk for infectious diseases. The current proposal addresses both of these highly significant issues.