Steps to Effective Problem Solving

有效解决问题的步骤

• 批准号: 9175453
• 负责人: Sarah Herrink Ailey
• 金额: $ 41.7万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-07 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9175453
• 关键词: 18 year old; Accident and Emergency department; Accounting; Address; Admission activity; Age; Attention; Attitude; Behavior; Behavior Control; Behavioral; Caring; Cessation of life; Clinical; Clinical Trials; Clinical Trials Design; Communities; Control Groups; Data; Educational workshop; Emergency department visit; Emotional; Employment; Ensure; Environment; Equipment and supply inventories; Family; Female; Forensic Medicine; Friction; Group Homes; Health; Healthcare Systems; Home environment; Hospitalization; Imprisonment; Individual; Injury; Intellectual functioning disability; Intervention; Iowa; Lead; Life; Mediating; Medical center; Mind; Modification; Occupations; Outcome; Pain; Participant; Plant Roots; Population; Preventive; Preventive Intervention; Prisons; Problem Solving; Problem behavior; Property; Public Health; Qualifying; Randomized; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Residential Facilities; Services; Shelter facility; Social Distance; Social Network; Social Problems; Source; Support System; Supported Employment; Testing; Time; Training Programs; Training and Education; Work; Workplace; abstracting; base; behavior change; behavioral outcome; community setting; cost; cost effectiveness; demographics; dyadic interaction; efficacy testing; efficacy trial; experience; family support; improved; indexing; innovation; intervention effect; nutrition; population based; prevent; programs; response; satisfaction; skills; treatment as usual

Project Summary/Abstract Aggressive/challenging behaviors (AC/Bs) are a major public health problem for individuals with intellectual disabilities (ID) living in group homes. A leading reason for psychiatric hospitalizations and incarcerations, A/CBs are costly to the healthcare system, agencies and families. Social problem solving (SPS) training programs for individuals with ID have had positive behavioral results, but most were conducted in clinical or forensic settings. None were community-based preventive interventions, none examined whether A/CBs decreased in participants’ group homes and work settings, and none addressed cost effectiveness. In our preliminary work, we modified an effective SPS training program, using input from individuals with ID and residential staff, as a preventive intervention for the group home setting. Steps to Effective Problem-solving (STEPS) includes residential staff and uses the group home environment to facilitate behavior change. The purpose of this clinical trial is to test the efficacy of STEPS for individuals with ID. Specific aims are to 1) Assess the efficacy of the STEPS intervention in group homes to improve SPS skills and reduce A/CBs of the individuals with ID compared to an attention-control nutrition program from baseline to 12, 24 and 36 weeks, controlling for behavioral determinants of A/CBs (demographics, agency/home environment, current health). 2) Assess the mediating effect of the support environment for SPS (residential staff SPS skills, group home level SPS skills, and group cohesiveness) on the improvement of SPS skills and reductions in A/CBs. 3) Evaluate cost effectiveness of STEPS relative to usual care for A/CB incidents in group homes. .A cluster-randomized clinical trial design will be used in which 36 group homes (18 male, 18 female) will be randomly assigned to STEPS or attention-control. We will recruit 180 individuals with mild to moderate ID, at least 18 years old (approximately 5 per home), and at least two residential staff from each home (2-3 per home). SPS outcomes will be assessed with Iowa Family Interactions Rating Scales (IFIRS) Individual-level Problem-solving Scales and the Problem-solving Task. A/CB outcomes will be assessed with IFIRS Dyadic-interaction Scales, General Maladaptive Index (agency, work settings), and incident reports (agency). Mediating effects will be assessed for residential staff with SPS Inventory Revised- Short Form and IFIRS Individual-level Problem-Solving Scales; for group home level SPS skills by IFIRS Group Level Problem-Solving scales; and for group cohesiveness by the Cohesiveness subscale of Group Environment for the Intervention Scale. Cost- effectiveness of STEPS will be evaluated taking into account costs of A/CBs borne by the participant and family, program, group home, healthcare system, and public services. STEPS will be compared to usual care, (control group costs of behavior incidents). We expect to show STEPS to be a preventive behavioral strategy to reduce A/CBs among individuals with ID, improve the cost effectiveness of their care and make an important incremental advance in SPS research.

项目摘要/摘要 攻击性/挑战性行为(AC/B)是智力障碍患者的主要公共卫生问题 居住在儿童之家的残疾人(ID)。精神科住院和监禁的主要原因， A/CBS对医疗系统、机构和家庭来说代价高昂。社会问题解决(SPS)培训 针对ID患者的计划已经有了积极的行为结果，但大多数是在临床或 取证设置。没有一项是以社区为基础的预防干预，没有一项检查A/CBS 减少了参与者的集体家庭和工作环境，没有一个涉及成本效益。在我们的 初步工作，我们修改了有效的SPS培训计划，使用具有ID和 寄宿工作人员，作为对集体之家环境的预防性干预。有效解决问题的步骤 (STEPS)包括居家工作人员，并使用团体之家环境来促进行为改变。这个 本临床试验的目的是测试STEPS对ID患者的疗效。具体目标为1) 评估STEPS干预在团体之家提高SPS技能和降低A/CBS的效果 将ID患者与注意控制营养计划从基线到12周、24周和36周进行比较， 控制A/CBS的行为决定因素(人口统计数据、机构/家庭环境、当前健康状况)。2) 评估支持环境对SPS(驻地工作人员SPS技能、团体之家级别)的中介作用 SPS技能和团队凝聚力)关于提高SPS技能和减少A/CBS。3)评估 与团体之家的A/CB事件的常规护理相比，步骤的成本效益。A集群-随机化 将采用临床试验设计，将36个团体家庭(男性18个，女性18个)随机分配到 步数或注意力控制。我们将招募180名轻到中度ID的人，年龄至少18岁 (每家约5名)，以及每家至少两名住宿工作人员(每家2-3名)。SPS结果 将使用爱荷华州家庭互动评定量表(IFIRS)个人层面的问题解决量表进行评估 和解决问题的任务。A/CB结果将使用IFIRS二元互动量表进行评估，一般 适应不良指数(机构、工作环境)和事件报告(机构)。将评估调解效果 对于修订了SPS清单的驻地工作人员--简表和IFIRS个人层面的问题解决 量表；根据IFIRS团体层面的问题解决量表，针对团体家庭一级的SPS技能；对于团体 凝聚力采用团体环境凝聚力分量表为干预量表。成本- 评估措施的有效性时将考虑到参与者承担的A/CBS费用，以及 家庭、方案、团体之家、医疗保健系统和公共服务。步骤将与通常的护理进行比较， (控制组行为事件的成本)。我们希望展示作为预防性行为策略的步骤 减少ID患者的A/CBS，提高其护理的成本效益，并使重要的 SPS研究的渐进式进展。