Sustainable HIV Risk Reduction Strategies for CJ Systems

这项拟议的研究为期5年，包括2个主要研究阶段，旨在减少刑事司法（CJ）人群中的艾滋病毒和其他成瘾相关疾病风险。第一阶段是减少疾病风险（DRR）干预措施的有效性研究，第二阶段是在CJ现场实施。手册指导的DRR规划和决策策略将基于认知工具，重点是基于证据的视觉空间（而不是传统的说教）沟通方法。它将侧重于重返社会期间的危险性行为和药物使用行为，包括问题识别，承诺改变，以及避免感染行为风险的策略。激励和规划会议将在CJ机构为基础的药物滥用治疗结束时提供，他们还将通过使用一系列强调DRR原则应用的自学工具包，在社区过渡治疗期间融入重返社会护理服务。罪犯一级的参与和运作将是这一初步研究阶段的主要分析重点。在该项目的第二阶段，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，依靠组织需求和功能评估（基于工作人员对减灾干预培训和利用的评价），分析CJ系统机构和社区重返社会部门的执行进展情况。与目前在机构治疗期间使用的“标准护理”相比，DRR干预预计将显着提高罪犯的动机，承诺和自信心，在规划他们的行为风险降低策略，用于在社区重返社会。预计DRR重返社会自学指南还将进一步提高罪犯利用社区支助网络的比率，降低他们与吸毒和性行为有关的风险水平，并降低他们在后续行动中再次入狱的可能性。更有利的罪犯心理社会功能和参与机构为基础的治疗同样预计将与更好的结果在重返社区。在实施评估研究（第2阶段），机构和社区为基础的重返团队（代表CJ系统跨越4个州）预计将响应创新培训，并使应用程序的DRR组件与他们的集体感知程序的需求，压力，资源和组织的健身相称。也就是说，CJ站点的工作人员的较高（平均）评级（例如，监狱治疗和缓刑/假释地区）的需求、艾滋病干预服务的准备情况、组织资源、使命和业务环境，预计将有更多的人参与和响应随后的减少灾害风险创新培训。预计这些指标反过来又能预测减少灾害风险的利用率和工作人员对培训后后续行动的满意度。 公共卫生相关性：对刑事司法人员采取有效的减少艾滋病毒/艾滋病风险的干预措施，可为罪犯本人和广大公众带来重大的公共健康惠益。然而，在监禁后关键的重返社区阶段，“吸引”和说服有药物滥用史的罪犯充分规划和适用减少风险原则是一项挑战。惩教系统往往也是支离破碎的，这对向有传染病风险的罪犯提供综合护理和监督的努力构成了另一个挑战。目前的建议涉及这两个非常重要的问题。

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.