Harm-reduction treatment for homeless adults with alcohol-use disorders (HaRT-A)

对患有酒精使用障碍的无家可归成年人进行减害治疗 (HaRT-A)

• 批准号: 8633344
• 负责人: Susan E Collins
• 金额: $ 18.47万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8633344
• 关键词: Abstinence; Achievement; Address; Adherence; Adult; Advocate; Affect; Aftercare; Alcohol consumption; Alcohol dependence; Alcohols; Anus; Behavior Therapy; Behavioral; Client; Code; Communities; Competence; Criminal Justice; Data; Development; Disadvantaged; Drops; Ensure; Evaluation; Evidence based practice; Feedback; Focus Groups; Foundations; General Population; Glean; Goals; Guidelines; Harm Reduction; Healthcare; Homelessness; Individual; Intervention; Interview; Manuals; Measurement; Measures; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Phase; Population; Positioning Attribute; Process; Public Health; Qualitative Evaluations; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Research; Research Personnel; Research Project Grants; Sampling; Services; Staging; Testing; Time; Treatment Efficacy; United States National Institutes of Health; Work; alcohol use disorder; base; behavior change; community based participatory research; comparative; design; drinking; efficacy testing; evidence base; flexibility; health care service utilization; health related quality of life; improved; innovation; interest; member; programs; public health relevance; response; skills; theories; therapy design; therapy development; treatment as usual

DESCRIPTION (provided by applicant): Homelessness and alcohol-use disorders (AUDs) are commonly co-occurring and serious public health issues. Unfortunately, abstinence-based treatment approaches are generally ineffective in engaging and successfully treating homeless individuals with AUDs. There have therefore been calls for more flexible and client-centered approaches tailored to this population. In response to this need, we are proposing the development and pilot evaluation of a harm-reduction treatment for homeless individuals with AUDs (HaRT-A) as an innovative, empirically informed and client-driven alternative to abstinence-based AUD treatment. As initially planned, the HaRT-A will comprise a 3-session, individual, behavioral intervention. Preliminary components include providing personalized alcohol feedback, eliciting clients' harm-reduction goals, building motivation to change, and encouraging safer drinking using a nonjudgmental, empathetic stance, and acceptance of clients wherever they are along the spectrum of behavior change. To maximize its efficacy, the HaRT-A is being collaboratively designed with a community advisory board (CAB) made up of homeless advocates as well as staff, management and clients (i.e., homeless individuals with AUDs) at two, nonprofit agencies on the forefront of harm reduction oriented supportive service provision for homeless individuals. Consistent with NIH Stage I treatment development guidelines, we will develop and pilot test the HaRT-A in four phases. In Phase I, we will collect qualitative data via interviews and focus groups with agency clients and staff. Grounded theory analyses will yield a conceptual/thematic description of key alcohol themes and will thereby identify potential points for intervention to be addressed in the HaRT-A. In Phase II, we will develop the HaRT-A treatment manual using qualitative data gleaned from Specific Aim 1; evidence-based, best-practice approaches; and guidance of the CAB. Phase III will feature a small, pilot RCT (N=160) of the HaRT-A at the two agencies. Participants will be randomized to receive either the HaRT-A or agency services as usual (TAU), and will be assessed at baseline, posttest (immediately following treatment end), 1-month and 3-month follow-ups. Quantitative analyses will test the efficacy of the HaRT-A compared to TAU. It is hypothesized that HaRT-A participants will show significantly greater improvements on alcohol outcomes, motivation to change, and health-related quality of life (HRQoL) compared to TAU participants. Secondary, exploratory analyses will preliminarily test HaRT-A effects on health-care and criminal justice utilization outcomes up to 6 months posttreatment. Consistent with NIH treatment fidelity recommendations, treatment integrity will be tested in Phase IV of this project. In achieving these specific aims, this project will lay the groundwork for longer-term research objectives, including a larger RCT of the HaRT-A and dissemination of this intervention to researchers, clinicians and community-based organizations to improve outcomes for affected individuals and their communities.

描述（由申请人提供）：无家可归和酒精疾病（AUDS）通常是同时发生和严重的公共卫生问题。不幸的是，基于禁欲的治疗方法通常无效地参与并成功地治疗无家可归的人。因此，已经呼吁采用针对该人群量身定制的更灵活和以客户为中心的方法。为了应对这种需求，我们提出了对无家可归者（Hart-A）的危害减少治疗的发展和试点评估，作为一种创新的，经验知情的和客户驱动的基于禁欲的aud治疗的替代方案。按照最初计划的计划，Hart-A将构成三项，个人，行为干预。初步组件包括提供个性化的酒精反馈，提高客户减少损害的目标，建立改变的动力，并鼓励使用非判断性，善解人意的立场来鼓励更安全的饮酒，以及对客户沿着行为改变的范围的接受。为了最大化其功效，Hart-A正在与社区顾问委员会（CAB）进行协作，由无家可归者的倡导者以及两个非营利机构的员工，管理人员和客户（即，无家可归者的无家可归者）在面向危害减少危害减少的支持服务的前提下为无家可归者提供服务。与NIH I期治疗开发指南一致，我们将在四个阶段开发和初步测试HART-A。在第一阶段，我们将通过访谈和焦点小组与代理商客户和员工收集定性数据。扎根的理论分析将产生关键酒精主题的概念/主题描述，从而确定在HART-A中解决干预措施的潜在点。在第二阶段，我们将使用从特定目标1中收集的定性数据开发Hart-A治疗手册；基于证据的最佳实践方法；和出租车的指导。第三阶段将在两个机构的HART-A中具有少量的，n = 160的试点RCT（n = 160）。参与者将像往常一样随机地接受HART-A或代理服务，并将在基线，后测（即治疗结束后立即），1个月和3个月的随访中进行评估。与TAU相比，定量分析将测试HART-A的功效。假设与TAU参与者相比，HARTA参与者将在酒精结果，改变动机以及与健康相关的生活质量（HRQOL）方面表现出更大的改善。次要的探索性分析将初步测试HartA对治疗后长达6个月的医疗保健和刑事司法利用结果的影响。与NIH治疗保真性建议一致，将在该项目的IV期中测试治疗完整性。在实现这些特定目标时，该项目将为长期研究目标奠定基础，包括更大的HART-A-A RCT以及将这种干预措施传播给研究人员，临床医生和社区组织，以改善受影响个人及其社区的成果。