Teens' Risk During Transition: Preventing Drug Use, HIV & School Problems

青少年在变性过程中的风险：预防吸毒、艾滋病毒

• 批准号: 8219064
• 负责人: PATRICIA CHAMBERLAIN
• 金额: $ 60.42万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-15 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8219064
• 关键词: Accounting; Adherence; Adolescent; Area; Behavior Therapy; Behavioral; Calibration; California; Caring; Child Welfare; Communities; Cost Savings; Data; Development; Drops; Drug Addiction; Drug usage; Effectiveness; Enrollment; Evidence based intervention; Failure; Female; Fostering; Future; Gender; Goals; HIV; Health; Homelessness; Human Resources; Incidence; Individual; Intervention; Interview; Leadership; Link; Measures; Mediating; Mental Health; Methods; Modeling; Monitor; Outcome; Paper; Parents; Participant; Performance; Pharmaceutical Preparations; Pregnancy; Preventive Intervention; Randomized; Records; Recruitment Activity; Relative (related person); Research; Risk; Role; Savings; Schools; Services; Symptoms; System; Teenagers; Testing; Time; Tobacco use; Training; Trauma; Work; Youth; base; behavioral health; cost; cost effective; cost effectiveness; design; early onset drug use; economic evaluation; economic impact; effectiveness trial; efficacy trial; experience; follow-up; foster care; foster parent; group intervention; information gathering; intervention effect; maltreatment; middle school; peer; prevent; scale up; service intervention; sex risk; skills; social; staff intervention; uptake

DESCRIPTION (provided by applicant): The transition to middle school can be a risky time for many adolescents, as youth are exposed to a host of new academic challenges and social relationships with older peers. Being placed foster care amplifies this risk. The purpose of this study is to conduct a randomized effectiveness trial to determine whether adding a preventive intervention at this critical transition period is effective and cost effective in terms of ameliorating outcomes such as drug and tobacco use, participation in HIV- risking sexual behavior, delinquency, mental health problems, and school failure for young adolescents in foster care. The proposed LINKS intervention marries the goals of child welfare and educational systems and will be implemented in the San Diego Unified School District which is the 2nd largest school district in California. LINKS, a 20-week, two pronged intervention that focuses on increasing parent and youth skills and support will be delivered by community-based paraprofessionals who will be trained and supervised to implement the intervention. An ongoing fidelity monitoring system will allow for the calibration of intervention staff performance to adherence standards, provide performance standards for local staff training, and build in monitoring for local support and oversight (i.e., at the system leadership level) in the school district and child welfare systems. The study is designed to maximize the potential for uptake, sustainability, and future scale-up to other school and child welfare systems given positive results from this effectiveness trial. The aims are: a) to determine the effectiveness of the LINKS intervention on key behavioral health and school adjustment outcomes, b) to examine mechanisms of action; specifically the mediating effects of placement failure on outcomes, c) to examine the moderating role of fidelity on outcomes, and d) to examine cost effectiveness and cost avoidance of LINKS. All eligible 5th graders enrolled in the San Diego Unified School District placed in foster or kinship care (and their caretakers) will be recruited over a 4-year period and will be assessed at baseline, and at 6, 12, and 18 month follow-ups. It is hypothesized that those participating in LINKS will experience fewer negative behavioral health outcomes and better school adjustment and that these effects will be mediated by higher levels of placement stability and moderated by intervention fidelity scores. PUBLIC HEALTH RELEVANCE: The project seeks to determine if a preventive intervention delivered at the entry to middle school ameliorates the well-documented risks of negative behavioral health and school adjustment outcomes for youth placed in foster care. An estimated 20 billion dollars are spent annually in the child welfare system, yet studies consistently find that youth in foster care have disproportionately high rates of drug and tobacco use, delinquency, participation in health risking sexual behavior, and poor developmental and mental health problems. The period of transition into middle school is a critical time when there is an opportunity to prevent school adjustment and behavioral health difficulties that cause cascading negative long term outcomes. The proposed trial is situated within community systems and implemented by paraprofessional interventionists to promote uptake and sustainability.

描述(由申请人提供)：对于许多青少年来说，过渡到中学可能是一个危险的时期，因为年轻人面临着一系列新的学业挑战和与年长同龄人的社会关系。被寄养会放大这种风险。本研究的目的是进行一项随机有效性试验，以确定在这一关键的过渡期增加预防性干预在改善寄养青少年的结果方面是否有效和成本效益高，例如，药物和烟草的使用，参与有艾滋病毒风险的性行为，青少年犯罪，心理健康问题，以及学业失败。拟议的LINKS干预措施将儿童福利和教育系统的目标结合在一起，并将在加州第二大学区圣地亚哥联合学区实施。LINKS是一项为期20周的双管齐下的干预措施，重点是提高家长和青少年的技能和支持，将由社区辅助专业人员提供，他们将接受培训和监督，以实施干预措施。持续的忠诚度监测系统将使干预工作人员的业绩符合遵守标准，为当地工作人员培训提供业绩标准，并内置对学区和儿童福利系统的地方支持和监督(即，在系统领导一级)的监测。这项研究旨在最大限度地扩大吸收、可持续性和未来扩大到其他学校和儿童福利系统的潜力，因为这项有效性试验取得了积极的结果。其目的是：a)确定LINKS干预对关键行为健康和学校适应结果的有效性，b)检查行动机制，特别是安置失败对结果的中介效应，c)检查忠诚度对结果的调节作用，d)检查LINKS的成本效益和成本避免。在圣地亚哥联合学区注册的所有符合条件的5年级学生(以及他们的监护人)将在4年内被招募，并将在基线、6个月、12个月和18个月的随访中接受评估。据假设，那些参与LINKS的人将体验到更少的负面行为健康结果和更好的学校适应，这些影响将通过更高水平的安置稳定性和干预保真度分数来调节。 公共卫生相关性：该项目试图确定在进入中学时提供的预防性干预是否可以改善寄养青少年的不良行为健康和学校适应结果的有据可查的风险。据估计，儿童福利系统每年花费200亿美元，但研究一直发现，寄养家庭的青少年吸毒和吸烟、犯罪、参与有风险的性行为的健康以及不良的发展和心理健康问题的比例高得不成比例。进入中学的过渡期是一个关键时期，此时有机会防止导致连锁负面长期后果的学校适应和行为健康困难。拟议的试验设在社区系统内，由准专业干预者实施，以促进吸收和可持续性。