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

描述（由申请人提供）：本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项目的高危父母获得行为健康服务的机会。家访是全国最广泛使用的儿童虐待预防策略，但没有充分解决父母滥用药物和精神健康问题，这是儿童虐待的主要风险因素。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将制定和测试一项家访模式的行为健康增强（BHE）协议，该协议将改编自以证据为基础的密集案例管理方法，并将包括扩大家访者在父母行为健康风险方面的培训，使用经过良好验证的药物滥用和精神健康问题筛查工具，以及标准化的案例管理程序，以便在阳性筛查后将客户与所需服务联系起来。健康家庭计划将在美国健康家庭计划的背景下进行设计和试点，健康家庭计划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。参与者将从新泽西州四个县的HFA客户中抽取，其中两个县接受BHE，另外两个县作为匹配的对照。具体目标是：(1)制定一个BHE到循证家访模式的协议，包括培训提供者的程序，筛选家庭，并使用循证病例管理和动机访谈干预措施将家庭与行为健康服务联系起来；(2)在HFA内测试BHE的可行性、可接受性和保真度；(3)与人口结构相似的县的匹配对照相比，试点测试BHE在增加行为健康问题识别和服务参与方面的影响。研究结果将提供重要数据，说明将标准化筛查和联系程序纳入家访是否能增加对父母行为健康风险的识别和对所需服务的参与，以及这些程序是否可以由辅助专业家访人员忠实地执行。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主要障碍。新的研究产品将包括标准化和试点的BHE工具包、家访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，则生成的BHE协议具有

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.