Group Community Reinforcement Training for Parents of Treatment-Elusive Youth

为难以接受治疗的青少年家长提供团体社区强化培训

• 批准号: 8620635
• 负责人: Erica Miller Finstad
• 金额: $ 33.28万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8620635
• 关键词: Address; Adolescent; Adoption; Alcohol or Other Drugs use; Behavior; Chronic; Clinical Trials; Clinical effectiveness; Communities; Cost Effectiveness Analysis; Data; Drug Addiction; Drug abuse; Drug usage; Educational process of instructing; Emotional; Family; Family member; Fostering; Group Psychotherapy; HIV; HIV risk; Health; Healthcare; Illicit Drugs; Impotence; Individual; Institution; Intervention; Investigation; Justice; Learning; Legal system; Link; Mediating; Modality; Modeling; Motivation; Outcome; Parents; Pharmaceutical Preparations; Population; Procedures; Process; Psychological reinforcement; Public Health; Randomized; Recommendation; Recruitment Activity; Relative (related person); Research; Research Training; Resistance; Resources; Risk; Risk Behaviors; Sampling; Schools; Services; Sexually Transmitted Diseases; Social isolation; Social support; Source; System; Testing; Time; Training; Treatment outcome; United States; United States Substance Abuse and Mental Health Services Administration; Work; Youth; addiction; adolescent drug abuse; adolescent drug use; base; community organizations; community setting; cost; cost effective; design; drug abuser; effective intervention; experience; financial relationship; high risk; improved; innovation; juvenile justice system; novel; parental involvement; peer; pressure; prevent; public health relevance; response; skill acquisition; sobriety; social; substance abuser; success; successful intervention

DESCRIPTION (provided by applicant): Adolescent drug abusers are particularly at high risk for a host of problems, such as HIV-related behaviors, for themselves and their families. Unfortunately, very few youth with drug abuse or dependence in the United States receive treatment. This population of untreated youth represents a massive "treatment gap" in adolescent health care that renders impotent a potentially important avenue for preventing chronic drug abuse and related difficulties. While the juvenile justice system represents a prominent path linking drug-abusing adolescents with treatment services, only one fifth of the adolescents who need treatment each year are apprehended by the legal system. As a result, large numbers of youth in need of treatment go undetected by the most typical entry way into the system. Moreover, the lack of motivation for treatment characterizing most adolescent drug abusers significantly decreases the likelihood these youth will enter treatment, barring mandates from the legal system or other social institutions. These adolescents represent a sizeable and, heretofore, overlooked population of treatment-elusive youth. Efficacy studies have demonstrated that Community Reinforcement Training (CRT), an approach that involves teaching parents how to engage their youth into treatment can work to recruit 60-80% of these treatment-elusive youth. The proposed study will improve upon our prior work by using a group format to provide a less costly procedure for engaging youth into treatment to make it more portable to treatment agencies, schools, juvenile justice, and other community organizations seeking to offer support to parents or engage youth in treatment, thus significantly increasing the adoption and sustainability of the approach. The proposed pilot research will examine the efficacy of the group format (G-CRT) for helping parents engage their unmotivated, resistant youth in treatment compared to the traditional individual format (I-CRT). Parents (n = 60) will be randomly assigned to G-CRT or to I-CRT. We will evaluate the differential efficacy of G-CRT, relative to I-CRT, on rates of adolescent engagement in treatment. We expect that G-CRT compared to I-CRT will also be associated with greater parent encouragement of adolescent sobriety, perceived social support, and family functioning. We also predict that changes on these process variables will predict increased success in engaging adolescents. We will also examine treatment outcomes for youth engaged in CBT as a function of parental involvement in G-CRT or I-CRT. We predict enhanced support received by parents in G-CRT will result in greater reductions in drug use and lower levels of HIV-risk behaviors, outcomes hypothesized to be mediated by motivation to change and session attendance. Finally, we will conduct an informal cost-effectiveness analysis to derive preliminary estimates of the relative costs of each treatment modality per outcome unit and hypothesize that G-CRT will be more cost effective than I-CRT by virtue of having higher clinical effectiveness and lower costs. Successful outcomes here will provide the basis for a full clinical trial with larger samples.

描述（由申请人提供）：青少年药物滥用者对他们自己和他们的家人来说，尤其容易产生一系列问题，例如与艾滋病毒相关的行为。不幸的是，在美国，很少有滥用或依赖毒品的年轻人接受治疗。这些未经治疗的青年构成了青少年保健方面的巨大“治疗缺口”，使阳痿成为预防慢性药物滥用和相关困难的潜在重要途径。虽然少年司法系统是将吸毒青少年与治疗服务联系起来的重要途径，但每年需要治疗的青少年中只有五分之一被法律系统逮捕。结果，大量需要治疗的青年没有通过最典型的进入系统的方式被发现。此外，大多数青少年药物滥用者缺乏治疗动机的特点大大降低了这些青少年接受治疗的可能性，这阻碍了法律系统或其他社会机构的授权。这些青少年代表了一个相当大的，迄今为止被忽视的治疗难以捉摸的青年群体。疗效研究表明，社区强化训练（CRT），一种包括教导父母如何让他们的青少年参与治疗的方法，可以招募60-80%的这些难以接受治疗的青少年。拟议的研究将改进我们之前的工作，采用小组形式，提供一种成本更低的程序，让青少年参与治疗，使其更便于治疗机构、学校、少年司法和其他寻求为父母提供支持或让青少年参与治疗的社区组织，从而显著提高该方法的采用率和可持续性。拟议的试点研究将检验小组形式（G-CRT）与传统的个人形式（I-CRT）相比，在帮助父母吸引缺乏动力、有抵触心理的青少年参与治疗方面的效果。60名家长将被随机分配到G-CRT组或I-CRT组。我们将评估G-CRT相对于I-CRT在青少年参与治疗率方面的不同疗效。我们预计，与I-CRT相比，G-CRT也将与父母对青少年清醒、感知社会支持和家庭功能的更大鼓励有关。我们还预测，这些过程变量的变化将预测青少年参与的成功程度。我们还将研究父母参与G-CRT或I-CRT对青少年CBT治疗结果的影响。我们预测，家长在G-CRT中得到的更多支持将导致更大程度的药物使用减少和更低水平的艾滋病毒风险行为，假设结果是由改变的动机和会议出席率介导的。最后，我们将进行非正式的成本效益分析，以得出每个结果单位的每种治疗方式的相对成本的初步估计，并假设G-CRT由于具有更高的临床疗效和更低的成本，将比I-CRT更具成本效益。这里的成功结果将为更大样本的全面临床试验提供基础。