Using Incentives to Improve Parolee Participation and Attendance in Community Tx

说明(申请人提供)：虽然大量研究表明，监狱治疗和社区持续治疗在减少吸毒罪犯的药物滥用和犯罪方面是有效的，但提供治疗的影响并不是最理想的，因为罪犯往往没有贯彻治疗转介，及早离开治疗，或参与治疗活动较少。特别是，除非参与社区治疗，否则仅参加监狱治疗很难有效地减少吸毒或再犯罪。对于提供从监狱到社区的连续护理模式的惩教系统来说，低入院率和低保留率导致结果不佳和资源利用不佳。解决这一问题的一个办法是向假释犯提供参与社区治疗的奖励。虽然研究支持行为强化的有效性，主要是以应急管理(CM)的形式，用于一般药物滥用人群，但CM尚未被测试或调整用于针对罪犯群体的社区计划，特别是鼓励接受治疗。加州大学洛杉矶分校综合药物滥用计划(ISAP)与瓦尔登之家和加州惩教和康复部合作，正在提议一项为期五年的医疗服务研究研究，其中将涉及对社区TC中假释者使用激励措施的随机测试，以增加治疗入院和治疗保留，从而增加改善结果的可能性。研究参与者将从监狱治疗项目的客户中招募，这些客户被转介到瓦尔登豪斯社区项目。这项研究的录取阶段评估了粉丝激励(代金券)对注册瓦尔登豪斯计划的影响。出席阶段评估激励对治疗出席和治疗后药物使用、犯罪和心理社会行为的影响。干预将持续六个月。研究参与者将在基线和干预后12个月接受采访。将获得治疗和刑事司法数据。关于可接受性、满意度和可持续性的数据将从工作人员和客户的焦点小组中收集。这项研究有四个具体目标：(1)确定提供激励(代金券)是否会增加参与监狱治疗的假释犯接受社区治疗的机会。(2)对于进入社区治疗的假释犯，确定为出席提供奖励是否会导致更大的治疗保留率。(3)在为期6个月的干预结束后的12个月，评估激励措施的使用对药物使用、犯罪和心理社会结果的长期影响。(4)评估使用激励措施以增加工作人员和客户的录用和留住的可接受性、满意度和可持续性问题。公共卫生相关性：如果研究结果是积极的，CM干预将为社区治疗方案和矫正治疗系统提供一种有效、成本适中的技术，以促进社区治疗的登记和参加，从而通过减少药物使用和犯罪以及改善心理社会功能来改善公共卫生和公共安全。

DESCRIPTION (provided by applicant): Although a considerable body of research indicates that prison-based treatment followed by continuing treatment in the community is effective in reducing drug abuse and crime among drug-abusing offenders, the impact of providing treatment is less than optimal because offenders often fail to follow through on treatment referrals, leave treatment early, or have poor engagement in treatment activities. In particular, participation in prison-based treatment alone is seldom effective in reducing drug use or recidivism unless it is followed by participation in community treatment. For correctional systems that provide a continuum of care model from prison to community, low rates of admission and retention result in poor outcomes and poor resource utilization. One way to address this problem is to provide incentives to parolees for community treatment participation. Although research supports the effectiveness of behavioral reinforcement, mainly in the form of contingency management (CM), for general substance abuse populations, CM has not yet been tested or adapted for use in community-based programs for offender populations, particularly to encourage treatment attendance. The UCLA Integrated Substance Abuse Programs (ISAP), in collaboration with Walden House and the California Department of Corrections and Rehabilitation, is proposing a five-year health services research study that will involve a randomized test of the use of incentives with parolees in a community-based TC to increase treatment admission and treatment retention, and thereby increase the likelihood of improved outcomes. Study participants will be recruited from clients in a prison-based treatment program who have a referral to the Walden House community program. The Admission Phase of the study assesses the effect to fan incentive (voucher) on enrolling in the Walden House program. The Attendance Phase assesses the effect of incentives on treatment attendance and on post-treatment drug use, crime, and psychosocial behaviors. The intervention will last for six months. Study participants will be interviewed at baseline and at 12 months following the intervention. Treatment and criminal justice data will be obtained. Data on acceptability, satisfaction, and sustainability will be collected from focus groups with staff and clients. The study has four specific aims: (1) Determine whether offering an incentive (voucher) increases admission to community treatment by parolees who have participated in prison treatment. (2) For parolees who enter community treatment, determine whether providing incentives for attendance results in greater retention in treatment. (3) Assess the long-term impact of the use of incentives on drug use, crime, and psychosocial outcomes at 12 months following the end of the six-month intervention. (4) Assess issues of acceptability, satisfaction, and sustainability of the use of incentives to increase admission and retention among staff and clients. PUBLIC HEALTH RELEVANCE: If the results of the study are positive, the CM intervention would provide community treatment programs and correctional treatment systems with an effective, moderate-cost technique to promote enrollment in and attendance at community treatment and thereby improve public health and public safety through reductions in drug use and crime and improvements in psychosocial functioning.