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The Causal Effect of Community-Based Treatment for Youths

青少年社区治疗的因果效应

基本信息

批准号：
9386740
负责人：
Beth Ann Griffin
金额：
$ 34.16万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-04-05 至 2019-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9386740
关键词：
Address Adolescent Adult Advocate Alcohol or Other Drugs use American Client Clinical Trials Cohort Studies Complex Data Data Set Decision Making Empirical Research Family Foundations Funding Grant Guidelines Heterogeneity Individual Influentials Intervention Knowledge Lead Learning Literature Medicine Methodology Methods Modernization Observational Study Outcome Outpatients Patients Policies Probability Process Provider Publications Publishing Recording of previous events Research Research Methodology Research Personnel Sequential Treatment Services Severity of illness Societies Software Tools Statistical Methods Structural Models Substance Abuse Treatment Centers Substance Use Disorder Testing Time United States Variant Weight Work Youth addiction adolescent substance use base clinical practice clinically relevant community based treatment effective therapy experimental study improved novel overtreatment personalized approach public health relevance relative effectiveness response substance abuse treatment treatment duration treatment effect treatment services trial comparing user friendly software

项目摘要

DESCRIPTION (provided by applicant): Over 1.6 million adolescents in the United States meet criteria for substance use disorders (SUDs). Promising treatments for reducing the immediate and long-term negative effects of SUDs are available. However, deciding between outpatient, intensive outpatient, and residential services for adolescents needing treatment is complex, as it often requires a sequential, individualized approach. Those treating adolescents with SUDs must attend to the specific needs of adolescents and observe how their clients are responding to treatment and, in response, make choices about the types and duration of services they should receive. This type of sequential decision-making is imperative given the significant heterogeneity in how adolescents respond to treatment over time. In practice, these sequential decisions are often made without any empirical support. The American Society of Addiction Medicine's Patient Placement Criteria (ASAM PPC) was a major step forward in services planning for adults and adolescents but the empirical research foundations of the PPC are based primarily on adult, rather than adolescent, data [6-13]. Empirical work is needed to address this gap and evaluate decision rules that can lead to effective treatment services planning for adolescents with SUDs. The purpose of this five-year R01 study is to develop well-operationalized, empirically-supported sequences of decision rules-known as "Adaptive Interventions" (AIs)-to provide guidance for providers, families, and policymakers involved in making treatment services decisions for adolescent clients. AIs can improve clinical practice by guiding the placement of adolescents into the most appropriate treatment service at the appropriate time. To develop these AIs, we propose a novel, mixed-method approach. First, an iterative stakeholder engagement process will elucidate the complex issues in sequential treatment services decision-making; this formal process is a vital step for developing feasible AIs. Second, equipped with knowledge from our stakeholders, we will utilize modern statistical methods to empirically identify and then evaluate AIs using a large, observational dataset-funded by the Center for Substance Abuse Treatment (CSAT)-of over 24,000 adolescents in substance use treatment. Specifically, we aim to (1) understand how sequential decisions are made in current practice, and identify key components of feasible AIs with input from adolescent substance use providers, policymakers, researchers, and advocates; (2) empirically identify high-quality candidate AIs for adolescent clients; and (3) evaluate the relative effectiveness of the candidate AIs by examining their causal effect on relevant clinical outcomes. Identifying AIs that most effectively move youth between outpatient, intensive outpatient, and residential services is a complex but policy-relevant problem. Developing AIs from observational study data, by applying the modern methods proposed in our study will provide guidance to current practitioners and lay the foundation for subsequent experiments that can test candidate AIs in rigorous clinical trials.

描述(由申请人提供)：在美国，超过160万青少年符合物质使用障碍(SUDS)标准。有希望的治疗方法可以减少肥皂水的直接和长期负面影响。然而，在需要治疗的青少年的门诊、强化门诊和住院服务之间做出决定是复杂的，因为它通常需要顺序的、个性化的方法。那些治疗患有肥胖症的青少年的人必须关注青少年的具体需求，观察他们的客户对治疗的反应，并作为回应，就他们应该接受的服务的类型和持续时间做出选择。鉴于随着时间的推移，青少年对治疗的反应存在显著的异质性，这种类型的顺序决策势在必行。在实践中，这些循序渐进的决策往往是在没有任何经验支持的情况下做出的。美国成瘾医学会的患者安置标准(ASAM PPC)是成人和青少年服务规划的重要一步，但PPC的实证研究基础主要基于成人数据，而不是青少年数据[6-13]。需要实证性工作来解决这一差距并评估决策规则，这些规则可以导致为患有SUDS的青少年制定有效的治疗服务规划。这项为期五年的R01研究的目的是开发一系列可操作性好、有经验支持的决策规则--称为“适应性干预”(AIS)--为参与为青少年客户制定治疗服务决策的提供者、家庭和政策制定者提供指导。AIS可以通过指导青少年在适当的时间接受最适当的治疗服务来改善临床实践。为了发展这些人工智能，我们提出了一种新颖的混合方法。首先，迭代的利益相关者参与过程将阐明顺序治疗服务决策中的复杂问题；这一正式过程是制定可行的人工智能机构的关键步骤。其次，借助我们利益相关者的知识，我们将利用现代统计方法，使用由物质滥用治疗中心(CSAT)资助的大型观察性数据集，对接受药物滥用治疗的24,000多名青少年进行经验性识别和评估。具体地说，我们的目标是(1)了解当前实践中顺序决策是如何做出的，并根据青少年药物使用提供者、政策制定者、研究人员和倡导者的意见确定可行的人工智能的关键组件；(2)经验地为青少年客户识别高质量的候选人工智能；以及(3)通过检查候选人工智能对相关临床结果的因果影响来评估候选人工智能的相对有效性。确定最有效地让年轻人在门诊、密集门诊和住院服务之间移动的人工智能是一个复杂但与政策相关的问题。通过应用我们研究中提出的现代方法，从观察性研究数据中开发人工智能，将为当前的从业者提供指导，并为随后的实验奠定基础，这些实验可以在严格的临床试验中测试候选人工智能。

项目成果

期刊论文数量（18）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A prospective investigation of suicide ideation, attempts, and use of mental health service among adolescents in substance abuse treatment.

对青少年在药物滥用治疗中的自杀意念、尝试和心理健康服务的使用进行前瞻性调查。

DOI：
10.1037/a0012969
发表时间：
2008
期刊：
Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors
影响因子：
0
作者：
Ramchand,Rajeev;Griffin,BethAnn;Harris,KatherineM;McCaffrey,DanielF;Morral,AndrewR
通讯作者：
Morral,AndrewR

Identifying optimal level-of-care placement decisions for adolescent substance use treatment.

确定青少年药物滥用治疗的最佳护理水平决策。

DOI：
10.1016/j.drugalcdep.2020.107991
发表时间：
2020
期刊：
Drug and alcohol dependence
影响因子：
4.2
作者：
Agniel,Denis;Almirall,Daniel;Burkhart,Q;Grant,Sean;Hunter,SarahB;Pedersen,EricR;Ramchand,Rajeev;Griffin,BethAnn
通讯作者：
Griffin,BethAnn

Interpreting treatment effects when cases are institutionalized after treatment.

解释治疗后病例送院时的治疗效果。