Reducing Offenders' HIV Risk: MI Enhanced Case Management with Drug-Free Housing

降低罪犯感染艾滋病毒的风险：MI 通过无毒品住房加强案件管理

• 批准号: 9022454
• 负责人: DOUGLAS L POLCIN
• 金额: $ 65.56万
• 依托单位: PUBLIC HEALTH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-15 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9022454
• 关键词: Address; Adult; Affect; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcoholics Anonymous; Alcohols; Area; Back; California; Case Management; Communities; Control Groups; Crime; Criminal Justice; Databases; Diagnostic and Statistical Manual of Mental Disorders; Disease; Drug usage; Employee Strikes; Employment; Environment; Failure; Family; General Population; Grant; HIV; HIV Infections; HIV risk; Health; Health Services Accessibility; Home environment; Homelessness; Housing; Human immunodeficiency virus test; Imprisonment; Individual; Infection; Institution; Intervention; Interview; Jail; Legal; Life; Manuals; Measures; Mediating; Mediator of activation protein; Medical; Mental Health; Methamphetamine dependence; Modeling; Motivation; Outcome; Persons; Pharmaceutical Preparations; Prevalence; Prisons; Public Health; Punishment; Randomized; Recovery; Relapse; Resources; Risk; Risk Behaviors; Safety; Sampling; Services; Severities; Social support; Support Groups; System; Testing; Time; Trust; Unsafe Sex; Woman; Work; addiction; base; case-by-case basis; court; drug relapse; drug/alcohol abstinence; follow-up; help-seeking behavior; high risk; housing instability; improved; indexing; injection drug use; innovation; meetings; men; men who have sex with men; motivational enhancement therapy; offender; parole; parolee; peer; peer support; probation; probationer; psychiatric symptom; rearrest; recidivism; reduced substance use; reincarceration; service utilization; sobriety; theories; transgender; transmission process

DESCRIPTION (provided by applicant): HIV risk among criminal justice offenders is high. Rates of infection are up to 10 times higher than the general population and 25% of all HIV infected persons have contact with the criminal justice system. Overcrowding of jails and prisons puts offenders at increased risk for HIV as does a failure to successfully transition from prison or jail into the community. Overcrowding of criminal justice institutions has reached crisis proportions in the U.S. and nowhere is the problem worse than in California. In 2006 the state had the largest prison system in the nation with over 173,000 inmates, but it only had capacity for about 100,000. In 2011 the U.S. Supreme Court ruled that prisons in California must release over 30,000 offenders because the extent of overcrowding constituted cruel and unusual punishment. It is not clear where these offenders will live once they are released or how they will access services they need to succeed in the community. Without access to housing, work and services needed to support transition to the community the risk for HIV infection and transmission is high as are risks for re-arrest and re-incarceration. Nationwide, about 40% of offenders on parole are re-arrested within one year of their release. Drawing on syndemics theory, a new intervention that enhances case management with motivational interviewing (Motivational Interviewing Case Management [MICM]) will address HIV and a host of related problems known to exacerbate HIV disease among criminal justice offenders. Innovative differences from standard MI include: 1) Using an MI based intervention for the first time with offenders at risk for HIV. 2) Using MI to adapt to a residential recovery environment. 3) Using MI to target syndemic factors known to affect HIV (e.g., mental health, medical, and housing instability), 4) Using MI to increase compliance with terms of parole and probation, 5) Using MI to find and maintain work, 6) Using MI to access services and maintain retention. 6) Using MI to reestablish recovery after drug relapse. 7) Using MI to address setbacks (e.g., drug relapse, loss of work). Selection of areas to focus on is made on a case by case basis depending on offender needs. Drug-free housing will be accessed through the Sober Living Network (SLN), an organization that certifies over 500 sober living houses (SLHs) in California. Our recent study of SLHs showed residents improved in terms of alcohol and drug use, work, arrests, and psychiatric problems. However, criminal justice offenders fared worse than other residents and HIV issues were not assessed. Expanding on our current HIV service grants that use MI for MSM and transgenders, we will use MICM to address HIV risk and the syndemic mix of factors that increase risk. A sample of 330 offenders at high risk for HIV who are entering SLHs will be randomly assigned to a referral resources (comparison) or MICM (intervention) condition. Outcomes will be assessed at baseline, 6, and 12 months and include measures of HIV testing and risk, substance use, arrests and re-incarceration, and problems on the Addiction Severity Index. Results will validate the use of MICM with SLHs as an inexpensive and replicable option for offenders.

描述（由申请人提供）：刑事司法罪犯的艾滋病毒风险很高。感染率比一般人群高出 10 倍，所有艾滋病毒感染者中有 25% 与刑事司法系统有过接触。监狱和看守所过度拥挤会增加罪犯感染艾滋病毒的风险，而未能成功地从监狱或看守所过渡到社区也会增加罪犯感染艾滋病毒的风险。刑事司法机构人满为患已陷入危机 加州的问题最为严重。 2006年，该州拥有全国最大的监狱系统，关押着超过173,000名囚犯，但其容量只能容纳约100,000人。 2011年，美国最高法院裁定加州监狱必须释放3万名以上罪犯，因为过度拥挤的程度构成了残酷和不寻常的惩罚。目前尚不清楚这些罪犯获释后将住在哪里，也不清楚他们将如何获得在社区取得成功所需的服务。如果无法获得支持向社区过渡所需的住房、工作和服务，艾滋病毒感染和传播的风险就会很高，再次被捕和再次监禁的风险也会很高。在全国范围内，大约 40% 的假释罪犯在释放后一年内再次被捕。借鉴流行病理论，一种通过动机访谈（动机访谈案例管理[MICM]）加强案件管理的新干预措施将解决艾滋病毒和一系列已知会加剧刑事司法罪犯中艾滋病毒疾病的相关问题。与标准 MI 的创新差异包括： 1) 首次对面临 HIV 风险的罪犯使用基于 MI 的干预措施。 2）利用MI来适应住宅恢复环境。 3) 使用 MI 来针对已知影响 HIV 的流行因素（例如心理健康、医疗和住房不稳定），4) 使用 MI 来提高对假释和缓刑条款的遵守率，5) 使用 MI 来寻找和维持工作，6) 使用 MI 来获得服务并维持保留。 6) 使用 MI 来恢复药物复发后的恢复。 7) 使用 MI 来解决挫折（例如，药物复发、失业）。根据罪犯的需要，根据具体情况选择重点关注领域。无毒品住房将通过清醒生活网络 (SLN) 获得，该组织为加州 500 多个清醒生活之家 (SLH) 提供认证。我们最近对 SLH 的研究表明，居民在酗酒和吸毒、工作、被捕和精神问题方面都有所改善。然而，刑事司法罪犯的处境比其他居民更糟糕，而且艾滋病毒问题也没有得到评估。我们目前将 MI 应用于 MSM 和跨性别者的 HIV 服务补助金的基础上进行扩展，我们将使用 MICM 来解决 HIV 风险和增加风险的综合流行病因素。进入 SLH 的 330 名艾滋病毒高危罪犯样本将被随机分配到转诊资源（比较）或 MICM（干预）条件。结果将在基线、6 个月和 12 个月时进行评估，包括艾滋病毒检测和风险、药物使用、逮捕和重新监禁以及成瘾严重程度指数问题的衡量。结果将验证 MICM 与 SLH 的使用对于犯罪者来说是一种廉价且可复制的选择。