SET-Enhanced Aftercare for Mothers in Substance Abuse Recovery and Their Childre

这项拟议的研究将在172名从住宅药物滥用治疗中出院的黑人、西班牙裔和白人非西班牙裔母亲中进行一项翻译随机试验，比较结构生态系统疗法(SET)作为加强物质滥用善后治疗与照常善后治疗(TAU)。这项研究将与提供综合药物滥用治疗和初级保健的社区合作伙伴一起进行。机构工作人员将进行数据收集，机构护士从业者将交付SET。数据将在基线和随机化后4、8和12个月收集。拟议研究的具体目的是：1)测试SET对改善身心健康和减少母亲在药物滥用康复中复发的有效性；2)测试SET对改善康复中母亲的子女的健康和精神健康结果的有效性；3)测试SET的行动机制(自我护理、环境风险、家庭功能和耻辱)；4)评估SET的执行和可持续性因素以及忠诚度和结果之间的关系；以及5)检查族裔和族裔相关因素对结果的相互作用。SET是为满足少数群体妇女的需要而开发的一种手动的、基于力量的、指导性的和面向过程的家庭生态系统干预措施。SET以妇女的社会环境为目标，建立在现有适应性互动的基础上，减少家庭内部以及妇女、家庭和支助资源之间的不良适应性互动。最近完成的一项对患有艾滋病毒的少数族裔戒毒妇女进行的随机试验发现，对于抚养孩子的妇女来说，SET可以减少母亲的复发和心理困扰，并减少孩子的抑郁、焦虑和行为问题的症状。拟议的研究将旨在证明SET的有效性、接受性和在社区环境中实施的可行性。El Centro与拥有丰富研究经验的药物滥用和初级保健提供商Banyan Health Systems之间的合作提供了一个独特的机会，可以在现实世界中严格测试SET增强的药物滥用善后治疗。

The proposed study will conduct a translational randomized trial comparing Structural Ecosystems Therapy (SET) as an enhancement of substance abuse aftercare treatment, to aftercare treatment as usual (TAU) among 172 Black, Hispanic and White non-Hispanic mothers discharged from residential substance abuse treatment. The study will be conducted with a community partner that delivers integrated substance abuse treatment and primary care. Agency staff will conduct data collection and agency nurse practitioners will deliver SET. Data will be collected at baseline and 4, 8, and 12 month post-randomization. The Specific Aims of the proposed study are to: 1) test the effectiveness of SET for improving physical and mental health and reducing relapse of mothers in substance abuse recovery; 2) test the effectiveness of SET for improving health and mental health outcomes of children of mothers in recovery; 3) test mechanisms of action of SET (self care, environmental risk, family functioning and stigma); 4) assess SET implementation and sustainability factors and the relationship between fidelity and outcomes; and 5) examine the interactions of ethnicity and ethnicity-related factors on outcomes. SET is a manualized, strength-based, directive and process-oriented family-ecosystemic intervention developed to address the needs of minority women. SET targets the woman's social environment by building on existing adaptive interactions and reducing maladaptive interactions within the family and between the woman, family and supportive resources. A recently completed randomized trial with minority women in drug recovery who were also HIV+ found that for women who were raising children, SET resulted in reduced relapse and psychological distress in the mothers, and reduced symptoms of depression, anxiety and behavioral problems in the children. The proposed study will aim to demonstrate SET'S effectiveness, acceptability and feasibility for implementation in a community setting. The partnership between El Centro and Banyan Health Systems, a substance abuse and primary care provider with considerable research experience, provides a unique opportunity to rigorously test substance abuse aftercare treatment enhanced by SET in a real-world setting.