Effectiveness of Assertive Aftercare for Youth

描述（由申请人提供）： 进入社区住院治疗的青少年有严重的酗酒和其他吸毒问题，在出院后的头90天内复发的风险很高。通常情况下，这些青少年中只有约三分之一得到任何善后治疗，50%-70%在此期间复发。断言善后协议（AAP）结合青少年社区强化方法程序与出院后三个月的家访期间的病例管理。虽然这种事后护理方法在最初的实验中显示出了希望，（第一个发表在青少年身上的善后实验），本研究采用随机2 × 2析因设计，探讨加强青少年日常善后辅导对青少年社会行为的影响。在治疗后3个月内，AAP、CM、两者或两者均不存在。具体目标是评估这些增强措施的主要效果和相互作用，包括中间结果（更多的善后参与，更好的恢复环境和更多的亲社会活动）和长期物质使用结果及相关问题。 约324名青少年从两个网站将接受采访时，他们入院治疗，并在3，6，9和12个月后出院。在住院出院时，所有研究受试者将被转诊至UA，四分之一的受试者将被随机分配至仅UA，四分之一将被随机分配至AAP，四分之一将被随机分配至CM，四分之一将被随机分配至AAP+CM。核心数据源包括：服务联系日志，使用个人需求全球评估（GAIN）的摄入量和后续访谈，以及与家庭环境，同伴环境，参与亲社会活动，对青少年生活领域的满意度和参与善后工作有关的其他措施。青少年在入院和出院后三个月的报告将通过与父母报告和大麻和可卡因的尿检进行比较来验证。预计AAP加CM条件将导致上级的结果优于其他条件，更有可能为客户及其家庭带来长期利益。

DESCRIPTION (provided by applicant): Adolescents who enter community-based residential treatment have serious alcohol and other drug use problems and are at high risk of relapse in the first 90 days after their discharge. Typically, only about a third of these adolescents get any aftercare treatment and 50%-70% relapse during this period. The Assertive Aftercare Protocol (AAP) combines adolescent community reinforcement approach procedures with case management during home visits for three months after discharge. While this aftercare approach showed promise in the original experiment (the first aftercare experiment published on adolescents), it is hypothesized that using contingency management (CM) procedures to reinforce adolescents when they engage in pro-social activities and abstain from alcohol and other drugs can strengthen it. The proposed study will use a randomized 2 x 2 factorial design to evaluate the impact of enhancing usual aftercare (UA) with AAP, CM, both or neither in the three months after treatment. The specific aims are to evaluate the main effects and interaction of these enhancements in terms of both intermediate outcomes (more aftercare participation, better recovery environment, and more pro-social activities) and longer-term substance use outcomes and related problems. Approximately 324 adolescents from two sites will be interviewed at their admission to residential treatment and at 3, 6, 9, and 12 months post discharge. At residential discharge, all study participants will be referred to UA, a quarter of the participants will be randomly assigned to UA only, a quarter will be randomly assigned to AAP, a quarter will be randomly assigned to CM, and a quarter will be randomly assigned to AAP+CM. The core data sources include: service contact logs, intake and follow-up interviews using the Global Appraisal of Individual Needs (GAIN), and additional measures related to family environment, peer environment, involvement in pro-social activities, satisfaction with adolescent life areas, and involvement in aftercare. Adolescent reports at intake and three months post discharge will be validated by comparison to parent report and urine tests for marijuana and cocaine. It is anticipated that the AAP plus CM condition will result in outcomes superior to the other conditions and be more likely to contribute to longer-term benefits to clients and their families.