Feasibility and Acceptability of Home-Based Continuing Care

描述(由申请人提供)：每年约有50万年轻人(YA；这里定义为19-25岁)接受药物滥用治疗，但尽管承认成瘾是一种慢性病，但很少有研究研究这一年龄段的持续护理模式。昂贵的住宅治疗通过转介到门诊护理或自助小组来出院，但许多人不使用或最低限度地参与其中。住院治疗后的复发率很高，许多父母在孩子出院回家时感到没有支持和准备不足。需要有效的持续护理来吸引YAS，为父母做好准备和支持，并阻止病情发展为一种令人衰弱的成人疾病。必须设计具有成本效益、易于传播、可持续的持续护理模式。此R21应用程序建议为YAS离开住院治疗开发和试点以家庭为基础的持续护理(HCC)。CC将结合两种有效的方法：基于电话的CC(TCC)和应急管理(CM)。一种远程的、基于电话的模式将允许从一小部分提供者提供肝细胞癌，减少传播的挑战。这项研究的具体目的是探讨：1)父母和YAS对肝癌的接受性；2)持续干预的可行性；3)进行肝癌随机对照试验(RCT)的可行性；以及4)对肝癌疗效和进行随机对照试验的必要性的初步评估。在三期项目的第一和第二阶段，家长和YA将从住院治疗计划和家长支持小组中招募。第一阶段将对50名家长和50名YA进行调查，以形成对肝细胞癌手术可接受性的知情判断，并确定和找到解决家长和YA参与障碍的方法。在第二阶段，试点研究将以基线、16周和32周的评估为试点，随机将20对父母-YA分配到肝细胞癌或照常继续服务(SAU)。在YA住院治疗期间，肝细胞癌父母将接受沟通、尿检程序和CM方面的培训，以便出院后他们可以与肝细胞癌项目合作，支持YA的康复。在治疗师的监测和反馈下，肝细胞癌父母将随机安排在家中进行尿液测试，并为经核实的禁欲和参与由住宿计划制定的持续服务计划提供激励。肝细胞癌YAS将通过短信和/或电话定期与治疗师联系，以评估复发风险并提供简短的咨询。我们将探讨：1)通过检查肝细胞癌的参与度、保留率和治疗满意度来探讨肝细胞癌的可接受性；2)通过估计肝细胞癌的成本并询问父母愿意为其支付多少来实现可持续发展；3)通过检查两组中的招募比率、治疗保真度和随访保留率来探讨随机对照试验的可行性；以及4)通过检查(A)估计的效应大小以及(B)父母、YAS和成瘾专家对结果的临床重要性的评估来探讨随机对照试验的初步疗效和必要性。在第三阶段，我们将与家长和青年咨询委员会以及专家小组一起审查项目结果，并就随机对照研究的必要性和可行性作出最后决定。

DESCRIPTION (provided by applicant): About half a million young adults (YA; defined here as 19-25 years old) enter substance abuse treatment each year, but despite recognizing addiction as a chronic disease, little research has examined models of continuing care for this age group. Costly residential treatments discharge YAs with referral to outpatient care or self-help groups, but many do not use or minimally participate in them. Relapse rates are high after residential treatment and many parents feel unsupported and poorly prepared when their child is discharged and returns to their home. Effective continuing care is needed to engage YAs, prepare and support parents, and halt progression to a debilitating adult disease. Cost-efficient, easily disseminated, sustainable continuing care models must be designed. This R21 application proposes to develop and pilot test Home-based Continuing Care (HCC) for YAs leaving residential treatment. HCC will combine two efficacious approaches: Telephone-based CC (TCC) and Contingency Management (CM). A remote, telephone-based model would allow delivery of HCC from a small cadre of providers, reducing challenges of dissemination. The specific aims of the research are to explore the: 1) Acceptability of HCC to parents and YAs; 2) Feasibility of sustaining the intervention; 3) Feasibility of conducting a randomized controlled trial (RCT) of HCC; and 4) Preliminary estimation of HCC efficacy and need for a RCT. During Phases 1 & 2 of the three-phase project, parents and YAs will be recruited from residential treatment programs and parent support groups. Phase 1 will survey 50 parents and 50 YAs to develop informed judgments on the acceptability of HCC procedures and identify and find solutions to barriers to parent and YA participation. In Phase 2 a pilot study with baseline, 16- and 32 week assessments will be piloted with 20 parent-YA pairs randomly assigned to HCC or continuing services as usual (SAU). While the YA is in residential treatment HCC parents will receive training in communication, urine testing procedures, and CM so that after discharge they can partner with the HCC program to support the YA's recovery. With therapist monitoring and feedback, HCC parents will administer randomly scheduled home- based urine tests and provide incentives for verified abstinence and engagement in the continuing service plan developed by the residential program. HCC YAs will receive TCC with regular therapist contact by text message and/or phone to assess relapse risk and provide brief counseling. We will explore: 1) HCC accept- ability by examining HCC engagement, retention and treatment satisfaction; 2) sustainability by estimating HCC costs and asking parents what they would be willing to pay for it; 3) RCT feasibility by examining recruitment rate, treatment fidelity, and follow-up retention in both groups; and 4) preliminary efficacy and need for a RCT by examining (a) estimated effect size in conjunction with (b) assessment by parents, YAs, and addiction experts of the clinical importance of outcomes. In Phase 3 we will review project results with Parent and Youth Advisory Boards and the expert panel and make final decisions on need and feasibility of an RCT.