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

拟议的研究将进行一项转化随机试验，比较结构生态系统疗法（SET）作为药物滥用后护理治疗的增强，与常规后护理治疗（TAU）相比，172名从住宅药物滥用治疗出院的黑人、西班牙裔和白人非西班牙裔母亲。该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，机构执业护士将提供SET。数据将在基线和随机化后4、8和12个月收集。本研究的具体目的是：1)检验SET在药物滥用康复中改善母亲身心健康和减少复发的有效性；2)检验SET对改善康复母亲子女健康和心理健康结局的有效性；3)测试SET的作用机制（自我照顾、环境风险、家庭功能和耻辱感）；4)评估SET的实施和可持续性因素以及保真度与结果之间的关系；5)研究种族和种族相关因素对结果的相互作用。SET是一种人为的、以力量为基础的、指导性的、以过程为导向的家庭生态系统干预，旨在解决少数民族妇女的需求。SET以妇女的社会环境为目标，以现有的适应性互动为基础，减少家庭内部以及妇女、家庭和支持性资源之间的不适应互动。最近完成的一项针对艾滋病毒阳性的少数族裔妇女的随机试验发现，对于抚养孩子的妇女来说，SET减少了母亲的复发和心理困扰，减少了孩子的抑郁、焦虑和行为问题的症状。建议的研究将旨在证明在社区环境中实施SET的有效性、可接受性和可行性。El Centro与Banyan Health Systems（一家具有丰富研究经验的药物滥用和初级保健提供商）之间的合作伙伴关系提供了一个独特的机会，可以在现实环境中严格测试SET增强的药物滥用后护理治疗。

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.