Health Promotion Coaching/Vaccine for Homeless Parolees

为无家可归假释者提供健康促进指导/疫苗

• 批准号: 7924817
• 负责人: Adeline M Nyamathi
• 金额: $ 66.43万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7924817
• 关键词: Adult; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; Behavior; Behavioral; California; Car Phone; Case Manager; Cellular Phone; Communicable Diseases; Communication; Communities; Comprehensive Health Care; Coupled; Data; Dose; Drug usage; Education; Effectiveness; Employment; Enrollment; Family; Foundations; Funding; General Population; HBV Vaccination; HIV; Health; Health Policy; Health Promotion; Health Services; Health Services Accessibility; Healthcare; Hepatitis; Hepatitis A; Hepatitis B Vaccines; Hepatitis B Virus; Hepatitis C virus; Homeless persons; Homelessness; Housing; Imprisonment; Individual; Infection; Injection of therapeutic agent; Intervention; Knowledge; Lead; Leadership; Life; Link; Measures; Mediating; Mental Health; Mentors; Needle Sharing; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Policies; Population; Prevalence; Prevention; Prisoner; Prisons; Program Effectiveness; Provider; Randomized; Recording of previous events; Relative (related person); Research Personnel; Residential Treatment; Risk; Risk Behaviors; Risk Reduction; Schedule; Series; Services; Sex Behavior; Simian B disease; Social Health Services; Social Work; Subgroup; Technology; Telephone; Time; Unemployment; Urine; Vaccination; Vaccines; Virus; Virus Diseases; Visit; Work; base; compare effectiveness; condoms; coping; cost; design; experience; follow-up; high risk; housing instability; improved; innovation; intervention program; male; men; novel strategies; offender; parole; parolee; prevent; programs; prospective; public health relevance; rearrest; recidivism; reincarceration; sex risk; skills; social; substance abuse treatment; success; treatment as usual; treatment program

DESCRIPTION (provided by applicant): Homeless parolees are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Although HBV is a vaccine-preventable illness, 12% to 25% of formerly incarcerated individuals are infected with HBV. Homeless parolees pose a particular challenge for successful reentry as they have underlying mental health issues combined with substance use and abuse and must contend with unstable housing situations, disorganized lives, unemployment, and limited access to health care and social services. Generally about 50% of all parolees scheduled to enroll in community-based drug treatment fail to enroll and less than 10% of enrollees actually complete treatment. Not surprisingly, about two-thirds of all individuals on parole are rearrested and return to custody within three years of release from prison. Our recent data also revealed homeless persons least likely to complete a HAV/HBV vaccine series were young (< 40), and were men who had been discharged from prison. Therefore, it is critical to engage paroled adults in comprehensive intervention programs that not only protect them from HBV, but also reduce risky behavior, promote access to health care, social and employment services, and enable positive coping and communication skills. With advice from our community partners who have successfully treated parolees and our experience with hepatitis vaccination work, we propose to conduct a prospective, three-group study that randomly assigns 700 ready-for- discharge parolees, scheduled to enter a community residential drug treatment program, to enter one of three groups: 1) a PCPC (Parolee Comprehensive Care + Phone Coaching Program), which includes nurse case management and specialized hepatitis education sessions and referrals, the HAV/HBV vaccination series (to all eligible) and coach- facilitated mentoring (mostly by cell-phone); 2) a Parolee Brief Hepatitis Education + HBV vaccination + Phone Coaching (PBCP) Program, which includes brief hepatitis/HIV education, the HAV/HBV vaccination and coach-facilitated mentoring; or 3) a Usual Care (UC) control program, which includes brief general health information, and the HAV/HBV vaccine. For the randomized parolees, the primary aims will be to examine: reincarceration (any vs none), number of days to first reincarceration, completion of HAV/HBV vaccination (among those HBV-negative), and completion of six months of the Amity community-based residential drug treatment program. Secondary aims are to examine program- related differences in potential mediating variables, such as reduction in drug and alcohol use and sexual risk behaviors, visit to health care or social service providers, and improved knowledge of Hepatitis/HIV and communication skills, between 6 and 12 months or over the one-year study period, depending on the measure, and to assess the relative costs of the three programs. This study will advance our knowledge about drug treatment and HBV vaccine completion and recidivism among homeless parolees. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and recidivism in this group who are a reservoir for these viruses in the general population, and are returning to prison at unprecedented numbers. PUBLIC HEALTH RELEVANCE: In this study, researchers from UCLA will partner with Amity Foundation and will work together in designing a program to engage soon-to-be discharged prisoners targeted to enter community-based residential drug treatment to receive a comprehensive program that not only protects them from hepatitis A and B infection by means of the hepatitis vaccination, but also reduces risky behaviors, helps them access health care, and social services, and help them to use more positive coping and communication skills. Using nurse case management strategies found successful with homeless adults, incorporating phone coaching, where a buddy who has successfully completed the drug treatment program supports the newly released parolee, we will evaluate the effectiveness of a Parolee Comprehensive Phone Coaching program compared to a less intense program or a usual care program. Findings from this study can inform targeted interventions and lay the groundwork for health policy decisions that may impact hepatitis and HIV risk reduction and rearrest and/or return to custody in this group who can spread hepatitis infection in the general population, and, are returning to prison at unprecedented numbers.

描述（由申请人提供）：由于高注射药物使用率和未受保护的性活动，无家可归的假释乙型肝炎病毒（HBV），乙型肝炎病毒（HCV）和HIV感染的风险很高。尽管HBV是一种可预防疫苗的疾病，但12％至25％以前被监禁的个体感染了HBV。无家可归的假释对成功的再入构成了一个特殊的挑战，因为他们存在着根本的心理健康问题以及药物使用和滥用，并且必须与不稳定的住房情况，混乱的生活，失业以及有限的医疗保健和社会服务的机会抗衡。通常，计划参加基于社区的药物治疗的所有假释中约有50％无法参加，不到10％的参与者实际上完成了治疗。毫不奇怪，大约三分之二的假释人被重新搁置，并在从监狱释放后的三年内返回监护权。我们最近的数据还显示，无家可归的人最不可能完成HAV/HBV疫苗系列的年轻人（<40），是从监狱出院的男人。因此，至关重要的是，与假释的成年人一起参与全面的干预计划，这些计划不仅可以保护他们免受HBV的侵害，还可以减少风险行为，促进获得医疗保健，社会和就业服务，并启用积极的应对和沟通技巧。 With advice from our community partners who have successfully treated parolees and our experience with hepatitis vaccination work, we propose to conduct a prospective, three-group study that randomly assigns 700 ready-for- discharge parolees, scheduled to enter a community residential drug treatment program, to enter one of three groups: 1) a PCPC (Parolee Comprehensive Care + Phone Coaching Program), which includes nurse case management and specialized hepatitis education sessions and推荐，HAV/HBV疫苗接种系列（所有合格的）和教练的指导（主要是通过手机）； 2）释放术简短的肝炎教育 + HBV疫苗接种 +电话教练（PBCP）计划，其中包括简短的肝炎/艾滋病毒教育，HAV/HBV疫苗接种和教练促成的指导；或3）通常的护理（UC）控制计划，其中包括简短的一般健康信息和HAV/HBV疫苗。对于随机假释者，主要目的是检查：重新批量（任何vs none），首先再碳化的天数，HAV/HBV疫苗接种（在HBV阴性中）以及六个月的基于Amity Community Community Community Community Community Community Community Community Community Codjection Prundial药物治疗计划。次要目的是检查潜在介导变量的计划差异，例如减少毒品和饮酒和性风险行为，访问医疗保健或社会服务提供者，以及对肝炎/艾滋病毒和沟通技巧的提高知识，在一年的研究期内，在6到12个月之间，取决于度量，以及评估三个计划的相对成本。这项研究将促进我们对无家可归者释放的药物治疗和HBV疫苗完成和累犯的了解。这项研究的结果可以为有针对性的干预措施提供依据，并为健康政策决策奠定了基础，这些决策可能会影响该群体中这些病毒的储藏室的肝炎和艾滋病毒风险降低和累犯，并以前所未有的数量返回监狱。 PUBLIC HEALTH RELEVANCE: In this study, researchers from UCLA will partner with Amity Foundation and will work together in designing a program to engage soon-to-be discharged prisoners targeted to enter community-based residential drug treatment to receive a comprehensive program that not only protects them from hepatitis A and B infection by means of the hepatitis vaccination, but also reduces risky behaviors, helps them access health care, and social services, and help them to use more positive coping and communication技能。使用护士案件管理策略，发现了无家可归的成年人，并结合了电话指导，在那里成功完成药物治疗计划的好友支持了新发布的假释者，我们将评估假释者综合电话教练计划的有效性与较少的激烈计划或一项通常的护理计划相比。这项研究的结果可以为有针对性的干预措施提供依据，并为可能影响肝炎和艾滋病毒风险的降低和重新搁置和/或返回该小组的拘留所奠定基础，这些决策可能会在普通人群中传播肝炎，并且正在以前所未有的数字返回监狱。