Family Therapy via Video Teleconference for Substance-Abusing Rural Adolescents

描述（由申请人提供）：有充分的证据表明，在任何一年中，只有约10%的具有临床诊断的物质使用问题的青少年接受治疗。造成这一人群的治疗需求长期得不到满足的主要因素之一是无法获得治疗服务。农村地区获得服务的机会特别有限。为了解决农村地区提供服务和获得服务的问题，特别是在医学和精神病学领域，已经出现了利用视频电话会议技术提供直接服务的情况。使用这种技术来增强行为心理治疗的效果也开始出现。一些主要是小规模的试点和可行性研究表明，使用视频电话会议技术进行的心理治疗干预可能与传统的面对面干预一样有效。然而，迄今为止，远程心理治疗的随机临床试验很少，而且几乎没有人研究过视频远程会议对任何类型的儿童或青少年行为问题（包括药物滥用）的干预。拟议的研究旨在解决需要进行的研究，评价视像电话会议技术作为向农村地区滥用药物的青少年及其家庭提供服务的一种手段的应用。具体来说，目前的建议是一项随机临床试验，测试通过视频电话会议（FFT- v）在药物滥用青少年家中实施的功能家庭治疗（FFT）的效果。在拟议的调查中，FFT- v将与在家庭家中面对面进行的FFT以及与正常服务（SAU）条件进行比较。该研究的首要目标是检查基于经验的药物滥用治疗模式，如FFT，可以通过视频电话会议有效地管理到生活在农村和偏远地区的青少年和家庭的程度，否则他们不太可能获得治疗。本研究的具体目的是：(1)评估FFT- v相对于FFT和SAU在减少青少年吸毒、艾滋病毒风险行为、犯罪和再犯方面的功效；(2)评估FFT- v相对于FFT在建立治疗联盟形成、治疗出勤、保持和治疗满意度的功能水平方面的功效。(3)与FFT和SAU相比，评估FFT- v在影响青少年行为改变的核心机制方面的功效，包括改善家庭功能水平和青少年与物质使用同伴的联系；(4)进行初步的成本效益分析，得出每个结果单位每种治疗方式的相对成本的初步估计。

DESCRIPTION (provided by applicant): It has been well documented that only about 10% of adolescents with clinically diagnosable substance use problems receive treatment in any given year. One of the major contributing factors to chronic levels of unmet need for treatment among this population is the unavailability and inaccessibility of treatment services. Service accessibilty is particularly limited in rural areas. To address problems of service availability and accessibiliy in rural areas, the use of video teleconferencing technology to provide direct services has emerged within the fields of medicine and psychiatry in particular. The use of such technology to enhance the delivery of behavioral psychotherapy is beginning to emerge as well. A handful of primarily small-scale pilot and feasibility studies indicate that psychotherapy interventions administered using video teleconferencing technology may be as effective as traditional face-to-face interventions. Few randomized clinical trials of telepsychotherapy have been conducted to date, however, and virtually none have examined video teleconferencing interventions for any type of child or adolescent behavioral problem including substance abuse. The proposed study is intended to address the need for research evaluating the application of video teleconferencing technology as a means of service delivery for substance abusing adolescents and their families living in rural areas. Specifically, the current proposal is a randomized clinical trial testing th efficacy of Functional Family Therapy (FFT) administered by video teleconference (FFT-V) in the homes of substance abusing adolescents. In the proposed investigation, FFT-V will be compared with FFT administered face-to- face in the family home as well as to a services-as-usual (SAU) condition. The overarching objective of the study is to examine the degree to which an empirically based model of substance abuse treatment such as FFT can be effectively administered via video teleconferencing to adolescents and families living in rural and remote areas who would be otherwise unlikely to access treatment. The specific aims of the proposed study are to (1) evaluate the efficacy of FFT-V compared to FFT and SAU in reducing adolescent drug use, HIV risk behavior, delinquency, and recidivism, (2) evaluate the efficacy of FFT-V compared to FFT in establishing functional levels of therapeutic alliance formation, treatment attendance, retention, and satisfaction with treatment, (3) evaluate the efficacy of FFT-V compared to FFT and SAU in impacting core mechanisms of change in adolescent behavior including improved levels of family functioning and adolescent association with substance using peers, and (4) conduct a preliminary cost-effectiveness analysis to derive initial estimates of the relative costs of each treatment modality per outcome unit. .