Development of LEAP for the Homeless with Alcohol Problems

为有酗酒问题的无家可归者开发 LEAP

• 批准号: 9000079
• 负责人: Seema Lisa Clifasefi
• 金额: $ 17.46万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9000079
• 关键词: Abstinence; Academic Training; Achievement; Address; Adherence; Affect; Alcohol abuse; Alcohol consumption; Alcohols; Area; Biomedical Research; Clinical; Code; Cognitive Science; Communities; Competence; Cost Savings; County; Criminal Justice; Data; Data Collection; Development; Development Plans; Emergency medical service; Ensure; Environment; Evaluation; Evidence based practice; Evidence based program; Experimental Psychology; Focus Groups; Foundations; Funding; Glean; Goals; Grant; Growth; Health; Health Policy; Healthcare; Homelessness; Housing; Imprisonment; Individual; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Knowledge; Life; Maintenance; Manuals; Measures; Medical; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methodology; Methods; Mission; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outcome Measure; Participant; Phase; Population; Process; Program Development; Program Effectiveness; Protocols documentation; Public Health; Publications; Publishing; Qualifying; Qualitative Evaluations; Quality of life; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Design; Research Training; Sampling; Scientist; Secure; Services; Staging; Supervision; System; Target Populations; Testing; Training; Translating; Treatment Effectiveness; United States National Institutes of Health; Work; Writing; alcohol abstinence; alcohol abuse therapy; alcohol related problem; alcohol research; base; biopsychosocial; career; career development; clinically significant; comparative; control trial; cost; design; improved; improved outcome; innovation; interest; neglect; novel strategies; pilot trial; preconditioning; program dissemination; programs; reduced alcohol use; research and development; research data dissemination; skills; supported housing; theories; therapy development; treatment program

DESCRIPTION (provided by applicant): Since receiving my doctorate in Cognitive and Experimental Psychology in 2003, I have been designing, conducting and publishing high-quality experimental alcohol research. Over the past few years, I have become increasingly interested in applying my alcohol research skills to addressing "real-world" clinical problems. I am therefore submitting this proposal for a K01 Mentored Career Development Award to support my burgeoning interest and independent research program in community-based, clinically focused alcohol intervention research. The K01 will facilitate my acquisition of trainin and knowledge in community and clinical theory, research and design and compliment my foundation in experimental alcohol research, which will thereby help me reach my research training goals and longer-term career objectives. The career development plan that I am proposing for the K01 includes a) obtaining training in community and clinical theory, research and practice; b) enhancing my scientific publication and research dissemination record in community-based, clinically focused alcohol intervention research; and c) honing my grant-writing skills to secure independent funding in this new area. My primary mentor, Dr. Mary Larimer, is a well-established leader in clinically focused alcohol intervention research, and my proposed team of expert collaborators and consultants is well-qualified to provide me with the supervision and support I need to work towards my career objectives and successfully complete the proposed research. Additionally, the UW research and academic environment, where the proposed career and research plans will be implemented, is internationally recognized for its collegial environment and excellence in research and academic training. Most important, my proposed research and career goals are relevant to larger public health issues, because I intend to design, implement, evaluate and disseminate alcohol-specific interventions to improve alcohol, health and quality-of-life outcomes for severely affected, costly and marginalized populations. With my strong background in alcohol research and my burgeoning interest in clinically focused and community-based interventions, I believe I am a strong candidate for this K01 award mechanism. Within the context of the proposed K01, I will be designing, implementing, evaluating, leading, and disseminating innovative and clinically significant, community-based alcohol intervention research. Specifically, I am proposing to work with a community-based agency, the Downtown Emergency Service Center (DESC), and use a CBPR paradigm to develop and evaluate a comprehensive life enhancing alcohol- management program (LEAP) to improve alcohol, health and quality-of-life outcomes for formerly chronically homeless individuals with alcohol problems. Chronically homeless individuals with alcohol problems often have co-occurring medical and psychiatric disorders, which can translate into increased public costs due to greater use of emergency medical services, criminal arrests, and incarceration. DESC uses an innovative approach, project-based housing first (HF), to provide supportive housing for this severely affected and marginalized population. In project-based HF, individuals are offered permanent, low-barrier housing without preconditions such as alcohol abstinence or treatment attendance. This approach has been associated with reduced costs and improved alcohol, health and quality-of-life outcomes. While HF approaches are associated with improved outcomes for the target population and the larger community, most residents continue to consume alcohol and report clinically significant alcohol- related problems. This population also encounters various barriers to alcohol treatment, and traditional treatment options are generally ineffective. One reason why traditional treatment may not engage this population is that its exclusive focus on abstinence neglects individuals' overall quality of life and the larger biopsychosocial context for their alcohol use. To more comprehensively and effectively address the needs of this population, I am proposing a 5-year project to develop and test the treatment effectiveness and integrity of the LEAP in improving alcohol, health and quality-of-life outcomes. This intervention will be compatible with and integrated into the low- barrier HF approach currently in place in DESC housing. Phase I will involve baseline qualitative data collection to identify potential points for intervention enhancement (year 1). Phase II will entail community-based LEAP manual development (year 2). Phase III will consist of a 12-month, nonrandomized controlled trial (NRCT) testing LEAP effectiveness compared to a project-based HF control (years 3,4). Latent growth models will be used to test LEAP effectiveness compared to IAU in improving alcohol-use, health, and quality-of-life outcomes from baseline through the 3-, 6- and 12-month follow-ups. Phase IV will comprise treatment integrity analyses, including manual adherence and competence as well as participants' treatment receipt and enactment (years 4,5). This study will build a foundation for longer- term research objectives: a multisite, cluster-randomized controlled trial of the LEAP and wider dissemination of this comprehensive, evidence-based program. In summary, my proposed career development and research plan are an excellent fit with the K01 mechanism as well as with the NIAAA mission to further scientific knowledge to improve and address public health-related research needs of our nation.

自2003年获得认知与实验心理学博士学位以来，我一直在设计，进行和发表高质量的实验酒精研究。在过去的几年里，我越来越有兴趣将我的酒精研究技能应用于解决“现实世界”的临床问题。因此，我提交了K01辅导职业发展奖的建议，以支持我在社区为基础的，临床为重点的酒精干预研究的新兴兴趣和独立的研究计划。K01将有助于我获得社区和临床理论，研究和设计方面的培训和知识，并补充我在实验酒精研究方面的基础，从而帮助我实现我的研究培训目标和长期职业目标。我为K01提出的职业发展计划包括：a）获得社区和临床理论、研究和实践方面的培训; B）提高我在以社区为基础、以临床为重点的酒精干预研究中的科学出版和研究传播记录; c）磨练我的赠款写作技能，以确保在这个新领域获得独立资金。我的主要导师，玛丽拉里默博士，是一个成熟的领导者，在临床重点酒精干预研究，我建议的专家合作者和顾问团队是合格的，为我提供监督和支持，我需要努力实现我的职业目标，并成功完成拟议的研究。此外，华盛顿大学的研究和学术环境，在那里拟议的职业和研究计划将被实施，是国际公认的大学环境和卓越的研究和学术培训。最重要的是，我提出的研究和职业目标与更大的公共卫生问题有关，因为我打算设计，实施，评估和传播酒精特定的干预措施，以改善酒精，健康和生活质量的结果，为受影响严重，昂贵和边缘化的人群。凭借我在酒精研究方面的强大背景，以及我对临床重点和社区干预的浓厚兴趣，我相信我是这个K01奖励机制的有力候选人。 在拟议的K01的背景下，我将设计，实施，评估，领导和传播创新和临床意义，以社区为基础的酒精干预研究。具体来说，我建议与一个以社区为基础的机构，市中心紧急服务中心（DESC），并使用CBPR范式来开发和评估一个全面的生活改善酒精管理计划（LEAP），以改善酒精，健康和生活质量的结果为以前长期无家可归的人与酒精问题。长期无家可归的人与酒精问题往往有共同发生的医疗和精神疾病，这可以转化为增加公共成本，由于更多地使用紧急医疗服务，刑事逮捕和监禁。DESC采用了一种创新的方法，即基于项目的住房优先（HF），为这一受严重影响和边缘化的人口提供支持性住房。在以项目为基础的住房基金中，向个人提供永久性低障碍住房，没有戒酒或接受治疗等先决条件。这种方法与降低成本和改善酒精，健康和生活质量结果有关。虽然HF方法与目标人群和更大社区的结局改善相关，但大多数居民继续饮酒并报告临床显著的酒精相关问题。这一人群在酒精治疗方面也遇到了各种障碍，传统的治疗方法通常无效。传统治疗可能无法吸引这一人群的一个原因是，它只关注戒酒，忽视了个人的整体生活质量和他们饮酒的更大生物心理社会背景。 为了更全面有效地满足这一人群的需求，我提出了一个为期5年的项目，以开发和测试LEAP在改善酒精、健康和生活质量方面的治疗有效性和完整性。这种干预措施将与目前在DESC住房中采用的低屏障HF方法兼容并整合。第一阶段将涉及基线定性数据收集，以确定加强干预的潜在点（第1年）。第二阶段将涉及以社区为基础的LEAP手册编制（第2年）。III期将包括一项为期12个月的非随机对照试验（NRCT），与基于项目的HF对照相比，测试LEAP的有效性（第3、4年）。潜在增长模型将用于测试LEAP与IAU相比在改善酒精使用，健康和生活质量方面的有效性，从基线到3个月，6个月和12个月的随访。第IV阶段将包括治疗完整性分析，包括手册依从性和能力以及参与者的治疗接受和制定（第4年、第5年）。这项研究将为长期研究目标奠定基础：LEAP的多中心，随机分组对照试验和更广泛地传播这一全面的循证计划。 总之，我提出的职业发展和研究计划非常适合K01机制以及NIAAA的使命，以进一步提高科学知识，以改善和解决我国公共卫生相关的研究需求。