Enhancing Evidence Based Home Visiting to Address Substance Abuse and Mental Heal

描述(由申请人提供)：这项R21提案的目标是开发和试点标准化的行为健康筛查和与治疗方案的联系，旨在增加参与循证家访计划的高危父母获得行为健康服务的机会。家访是全国使用最广泛的儿童虐待预防战略，但没有充分解决父母滥用药物和精神健康问题，这些都是虐待儿童的关键风险因素。药物滥用和心理健康问题在家访客户中很普遍，他们的存在削弱了项目的积极影响。拟议的R21将开发和测试从基于证据的密集病例管理方法改编而来的家访模式的行为健康促进(BHE)方案，将包括扩大家访人员对父母行为健康风险的培训，使用经过充分验证的药物滥用和精神健康问题筛查工具，以及标准化的病例管理程序，以便在筛查呈阳性后将客户与所需服务联系起来。BHE将在健康家庭美国(HFA)的背景下设计和试点，HFA是实施最广泛的家访模式之一，对其他模式具有很高的适应性潜力。参与者将从新泽西州四个县的HFA客户中挑选出来，其中两个县接受BHE，两个县作为配对对照。具体目标是(1)制定BHE到循证家访模式的协议，其中包括培训提供者、筛查家庭，以及使用循证病例管理和动机访谈干预将家庭与行为健康服务联系起来的程序；(2)测试BHE在HFA内的可行性、可接受性和保真度；以及(3)与人口统计相似县的匹配对照相比，BHE在增加行为健康问题识别和服务参与度方面的影响进行试点测试。研究结果将产生重要的数据，即在家访中纳入标准化的筛查和联系程序是否会增加对父母行为健康风险的识别和对所需服务的参与，以及此类程序是否可以由准专业家访人员忠实地实施。此外，拟议的研究将有助于确定阻碍家访客户与治疗成功联系的关键障碍。新的研究产品将包括一个标准化和试点的BHE工具包，家庭访客培训和保真度监测程序，以及保真度监测工具。如果经过验证，生成的BHE协议具有 在HFA内广泛部署的潜力，并最终适应用于其他家访模式。

DESCRIPTION (provided by applicant): The goal of this R21 proposal is to develop and pilot a standardized behavioral health screening and linkage to treatment protocol designed to increase access to behavioral health services among at-risk parents participating in evidence-based home visiting programs. Home visiting is the most widely used child maltreatment prevention strategy across the country, but does not adequately address parental substance abuse and mental health problems, key risk factors for child maltreatment. Substance abuse and mental health problems are prevalent among home visiting clients, and their presence diminishes positive program impacts. The proposed R21 will develop and test a protocol for a Behavioral Health Enhancement (BHE) to the home visiting model that will be adapted from an evidence-based intensive case management approach and will include expanded home visitor training in parental behavioral health risks, use of well-validated screening tools for substance abuse and mental health problems, and standardized case management procedures for linking clients with needed services following positive screens. The BHE will be designed and piloted within the context of Healthy Families America (HFA), one of the most widely implemented home visiting models, with high adaptability potential to other models. Participants will be drawn from among HFA clients in four New Jersey counties, with two counties receiving the BHE and two counties serving as matched controls. Specific aims are (1) to develop a protocol for a BHE to evidence-based home visiting models that includes procedures for training providers, screening families, and linking families to behavioral health services using evidence- based case management and motivational interviewing interventions; (2) to test the feasibility, acceptability, and fidelity of BHE within HFA; and (3) to pilot test the impact of the BHE on increasing identification of behavioral health problems and engagement in services compared to matched controls from a demographically similar county. Study findings will yield important data on whether incorporating standardized screening and linkage procedures into home visiting increases identification of parental behavioral health risks and engagement into needed services, and on whether such procedures are feasible to implement with fidelity by paraprofessional home visitors. Additionally, the proposed study will aid in determining key barriers that prevent successful linkages to treatment for home visiting clients. New study products will include a standardized and piloted BHE toolkit, home visitor training and fidelity monitoring procedures, and a fidelity monitoring tool. If validated, the resulting BHE protocol has the potential for widespread deployment within HFA and eventual adaptation for use with other home visiting models.