Adaptive Services in Drug Court

毒品法庭的适应性服务

• 批准号: 7881401
• 负责人: Douglas B Marlowe
• 金额: $ 50.93万
• 依托单位: TREATMENT RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-25 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7881401
• 关键词: Algorithms; Antisocial Personality Disorder; Case Management; Cells; Characteristics; Client; Clinical; Consent; Counseling; DSM-IV; Diagnostic; Drug Courts; Drug abuse; Employment; Enrollment; Family health status; Grant; Health; Health Services Research; Hearing; Intervention; Justice; Measures; Mediating; Mediator of activation protein; Medical; Outcome; Participant; Patient Self-Report; Perception; Performance; Pharmaceutical Preparations; Preclinical Drug Evaluation; Procedures; Process; Randomized; Recording of previous events; Research; Risk; Risk Behaviors; Rural Community; Schedule; Screening Result; Services; Specific qualifier value; Specimen; Supervision; Testing; Time; Urine; Work; court; design; dosage; drug abstinence; high risk; improved; meetings; non-compliance; offender; primary outcome; programs; prospective; psychosocial; public health relevance; response; satisfaction; secondary outcome; social

DESCRIPTION (provided by applicant): This is an application for a second competing-renewal grant to extend a line of health-services research aimed at adapting services in drug courts to the needs of drug-abusing offenders. Our previous studies demonstrated a reliable and robust matching effect in drug courts, in which certain high-risk participants had significantly better counseling attendance, longer durations of drug abstinence and higher graduation rates when required to attend frequent, bi-weekly judicial status hearings in court. In contrast, low-risk participants performed equivalently regardless of the schedule of court hearings. We replicated this matching effect in two additional jurisdictions and then confirmed it using a prospective matching design, in which outcomes from the matching procedure were shown to be superior to those achieved by drug court as-usual. The current application will examine the incremental utility gained by re-adjusting the dosage of both court hearings and clinical case-management sessions in response to participants' on-going performance in the program. We crafted an adaptive algorithm that distinguishes between non-compliance with supervisory conditions of the drug court (e.g., failing to show for counseling) and non-responsiveness to the interventions (e.g., providing drug-positive urines). We specified increased judicial supervision as the consequence for non- compliance and enhanced clinical case-management services as the consequence for non-responsiveness. We piloted the adaptive algorithm in a small preliminary study (N = 30) to confirm that it is acceptable to both clients and staff, feasible to implement with greater than 85% experimental integrity, and shows substantial promise for eliciting clinically meaningful improvements in both drug abstinence and graduation rates. The estimated effect sizes from the adaptive algorithm ranged from 0.40 to 0.60 across dependent measures, representing a significant increase in effects beyond what was obtained from our baseline-matching procedure alone. Much of the incremental improvement was derived for low-risk participants who had shown minimal effects from the prior matching procedure. We now propose to test the incremental utility of this adaptive algorithm in a fully powered experimental trial. Consenting misdemeanor drug court participants will be randomly assigned at entry to the full adaptive intervention or to baseline-matching only (n = 75 per cell). Primary outcomes will be graduation rates, urine drug-screen results during enrollment in drug court and at 6 and 12 months post-entry, and re-arrest rates at 24 months post-entry. Secondary outcomes will include self-report measures of HIV-risk behaviors, medical health, psychiatric health, family/social relationships and employment. Finally, we will conduct exploratory analyses to identify potential mediating variables that may help explain the process by which the adaptive algorithm improves outcomes. Potential mediators to be examined are (1) the fidelity and timing of adaptive responses, (2) participants' perceptions of procedural justice in the program, (3) participants' perceptions of perceived deterrence and (4) participants' satisfaction with the drug court program. Public Health Relevance: This competing-renewal grant will extend a program of health-services research aimed at adapting services in drug courts to the needs of drug-abusing offenders. Our prior studies demonstrated a reliable and robust baseline-matching effect in drug courts, in which high-risk offenders performed significantly better with intensive supervision from a judge. The current project will examine the incremental utility gained by continuously re-adjusting the intensity of both judicial supervision and clinical case-management services in response to clients' on-going performance in the program.

描述（由申请人提供）：这是第二次申请竞争性续期补助金，以扩大一系列卫生服务研究，旨在使毒品法庭的服务适应吸毒罪犯的需要。我们以前的研究表明，在毒品法庭，其中某些高风险的参与者有显着更好的咨询出勤率，更长的戒毒持续时间和更高的毕业率时，需要参加频繁的，每两周一次的法庭司法地位听证会。相比之下，低风险的参与者表现相当，无论法庭听证会的时间表。我们在另外两个司法管辖区复制了这种匹配效应，然后使用前瞻性匹配设计进行了确认，其中匹配程序的结果上级毒品法庭的结果。当前的应用程序将检查通过重新调整法庭听证会和临床病例管理会议的剂量以响应参与者在该计划中的持续表现而获得的增量效用。我们精心设计了一种自适应算法，可以区分不遵守毒品法庭监督条件的行为（例如，未能进行咨询）和对干预无反应（例如，提供药物阳性尿液）。我们明确指出，增加司法监督是不遵守的后果，加强临床病例管理服务是不响应的后果。我们在一项小型初步研究（N = 30）中试用了自适应算法，以确认客户和工作人员都可以接受，实验完整性大于85%的实施是可行的，并且在药物戒断率和毕业率方面都显示出有临床意义的改善。自适应算法的估计效应量在依赖性测量中的范围为0.40至0.60，这表明效应显著增加，超出了仅从我们的基线匹配程序中获得的效应。大部分增量改善来自低风险参与者，他们从先前的匹配程序中表现出最小的影响。现在，我们建议在一个完全强大的实验性试验中测试这种自适应算法的增量效用。轻罪药物法庭参与者将在进入时被随机分配到完全适应性干预或仅基线匹配（每个细胞n = 75）。主要结果将是毕业率，在药物法庭注册期间以及进入后6个月和12个月的尿液药物筛查结果，以及进入后24个月的再逮捕率。次要结果将包括艾滋病毒风险行为、医疗健康、精神健康、家庭/社会关系和就业的自我报告措施。最后，我们将进行探索性分析，以确定可能有助于解释自适应算法改善结果的过程的潜在中介变量。要检查的潜在中介是（1）适应性反应的保真度和时间，（2）参与者对程序正义的看法，（3）参与者对感知威慑的看法和（4）参与者对毒品法庭计划的满意度。公共卫生相关性：这一竞争性更新赠款将扩大一项卫生服务研究计划，旨在使毒品法庭的服务适应吸毒罪犯的需要。我们之前的研究表明，在毒品法庭上，高风险罪犯在法官的强化监督下表现得更好，这是一种可靠而强大的基线匹配效应。目前的项目将审查通过不断调整司法监督和临床病例管理服务的强度以应对客户在该方案中的持续表现而获得的增量效用。