Stage 1 Treatment Development with Homeless Mothers and their 2-6 Year Old Childr

描述(申请人提供)：即使越来越多地关注那些无家可归的人，无家可归家庭的数量仍在继续上升，对临时住所的需求如此之高，以至于许多城市无法满足这些家庭的需求。这些家庭中的大多数是由单身母亲领导的，她们中的许多人都在与药物使用和精神健康问题作斗争。这些斗争除了满足他们自己和他们的孩子的基本需要之外。没有研究记录有效的方法来干预无家可归物质滥用有孩子的母亲。因此，研究注重为这一群体确定有效的干预措施，以满足这些家庭的多种需要，被认为是减少与药物使用和无家可归有关的重大个人和社会成本的重要重点。目前的研究利用生态系统方法作为拟议治疗的理论基础。目前的治疗发展研究的总体目标是首先确定无家可归母亲所希望的干预目标和过程，然后试点测试一种新的手动干预措施，重点是提高这一特殊人群的治疗成功率。在阶段1a，来自N=30名无家可归母亲的多方法评估和重点小组的信息将指导对综合干预措施的修改，其中包括住房、病例管理和社区加强办法。这项重要研究产生的最终手册将涉及无家可归母亲的多种需求，包括基本需求和物质使用/心理健康问题。干预措施将在非随机试验(N=15)中进行测试，在该试验中，将使用访谈和自我报告的方法收集数据。将在基线后3个月和6个月进行后续跟踪，并将根据过程和结果分析修改干预措施。最后，修订后的干预措施将在1b阶段进行随机试点研究，涉及60名妇女和儿童，他们被分配到项目干预组(N=30)或照常治疗(N=30)，并在基线后3、6和9个月进行跟踪。在随机先导研究中，将计算效应大小，以用于通知更大的随机II阶段试验。该项目利用现有有效的药物滥用治疗模式，产生对为药物滥用特殊人群提供治疗服务至关重要的有价值的新信息。由于滥用无家可归物质的妇女及其子女面临各种不良后果的风险增加，改善孕产妇和儿童的结局可能会给妇女、她们的子女和整个社会带来实质性的保健益处。这项研究的结果将作为完善和实施对吸毒成瘾的无家可归妇女和儿童的有希望的干预措施的基础，然后可以在第二阶段试验中测试其有效性。与公共卫生相关：迫切需要采取有效的干预措施，以改善在其照料下滥用药物的无家可归母亲和儿童的生活。目前的提案试图通过修改和评估一种基于生态的治疗方法来解决这一差距，其中包括住房、病例管理和社区加强办法。需要重视这方面的研究，以减少这些弱势妇女和儿童因持续使用药物、精神健康和无家可归而付出的巨大个人和社会代价。

DESCRIPTION (provided by applicant): Even with increased focus on those experiencing homelessness, the number of homeless families continues to rise, with the demand for temporary shelter so high that many cities are unable to meet the needs of these families. The majority of these families are headed by single mothers, many of whom struggle with substance use and mental health issues. These struggles are in addition to meeting the basic needs of themselves and their children. No study has documented an effective approach for intervening with homeless substance abusing mothers with children. Research attention towards identifying efficacious interventions for this population which address the multiple needs of these families is thus considered an important focus for reducing significant individual and social costs associated with substance use and homelessness. The current study utilizes an ecological systems approach as the theoretical base for the proposed treatment. The overarching goals of the current treatment development study are to first identify targets and processes of intervention desired by homeless mothers and then pilot test a novel manualized intervention focused on improving treatment success of this special population. In Stage 1a, information from the multi-method assessment and focus groups with N=30 homeless mothers will guide modifications to an integrated intervention that includes housing, case management and the Community Reinforcement Approach. The final manual resulting from this important study will address the multiple needs of homeless mothers, including basic needs and substance use/mental health problems. The intervention will be tested in a nonrandomized pilot (N = 15) in which interview and self-report methods will be used for data gathering. Follow-up will be conducted at 3 and 6 months post baseline and the intervention will be modified based upon the process and outcome analyses. Finally, the revised intervention will be tested in Stage 1b in a randomized pilot study involving 60 women and children assigned to the project intervention (N = 30) or treatment as usual (N=30) and followed at 3, 6, and 9 months post- baseline. In the randomized pilot study an effect size will be computed for use in informing a larger, randomized Stage II trial. This project utilizes existing efficacious models of drug abuse treatment to generate valuable new information critical to treatment services delivery for a special population of substance abusers. Since homeless substance abusing women and their children are at increased risk for a variety of adverse outcomes, improved maternal and child outcomes may produce substantial health-care benefits to the women, their children, and society at large. The findings from this study will serve as the foundation for the refinement and implementation of a promising intervention for drug-addicted homeless women and children that can then be tested for efficacy in a Stage II trial. PUBLIC HEALTH RELEVANCE: Effective interventions are critically needed to improve the lives of substance abusing homeless mothers and children in their care. The current proposal seeks to address this gap through modifying and evaluating an ecologically based treatment that includes housing, case management and the Community Reinforcement Approach. Such research attention is needed in order to reduce the significant individual and social costs of continued substance use, mental health and homelessness among these vulnerable women and children.