Family-Based Treatment for Parental Substance Abuse and Child Maltreatment

描述(由申请人提供)：父母滥用药物是虐待儿童的主要决定因素，因此，往往与儿童的有害临床后果、儿童福利系统过高的财政成本以及我国的严重社会成本联系在一起。然而，尽管在父母滥用药物的背景下虐待儿童的问题非常严重，但滥用药物的父母很少得到针对他们的问题的循证治疗。相反，这样的父母通常被从儿童福利系统转介到成人药物滥用系统。不幸的是，成人药物滥用治疗系统很少提供让父母参与治疗所需的外展，也很少提供将这些父母和家庭置于更有成效的生活轨迹所需的服务强度和广度。四年前，在康涅狄格州儿童与家庭部的要求和安妮·E·凯西基金会的支持下，调查人员开发了一个以社区为基础的综合治疗计划，以解决父母滥用药物和虐待儿童并存的问题。重要的是，与约翰·霍普金斯大学的研究人员合作，这项名为“建立更强大的家庭”(BSF)的计划将成人药物滥用的创新循证治疗(即基于强化的治疗[RBT]；Jones，Wong，Tuten和Stitzer，2005)与儿童虐待和忽视的循证治疗(即，儿童虐待和忽视的多系统治疗[MST-CAN]；Swenson，Schaeffer，Hengeler等，2009)整合在一起。本提案的目的是为BSF模式的随机试验申请资金，该模式现已运作4年。完成了BSF的可行性评价和准实验评价。关于可行性，为临床服务提供资金的儿童和家庭部，以及为质量保证(例如，治疗手册、培训)和调查人员的持续参与提供资金的安妮·E·凯西基金会，仍然是BSF的热情支持者。此外，BSF的可接受性和可行性得到了87%的参与者招募和93%的治疗完成率的支持。关于初步结果，一项配对比较研究(N=52)表明，BSF在预防再虐待方面明显比综合社区治疗(CCT)有效，BSF在24个月后证实的虐待报告平均减少了75%。此外，BSF参与者在18个月时经历过外出安置的可能性降低了50%，在24个月时降低了65%，结果在24个月时接近显著水平。鉴于这些有希望的结果，拟议的研究旨在通过将该模型与CCT在从基线到18个月的关键临床和系统指标上进行比较，来提供对BSF的严格和全面的评估。干预措施涉及儿童福利和父母药物滥用领域中最普遍、最具挑战性、成本最高、研究最少的领域。如果成功，这项研究可能会做出重大贡献，对数百万最脆弱家庭的生活产生积极影响。 公共卫生相关性：父母滥用药物是虐待儿童的主要决定因素，因此，往往与儿童的有害临床后果、儿童福利系统过高的财政成本以及我国的严重社会成本联系在一起。然而，尽管在父母滥用药物的情况下虐待儿童的问题很严重，而且有针对成人药物滥用的成熟有效的治疗方法，但儿童福利系统中滥用药物的父母得到服务和接受服务的可能性较小，研究文献中几乎不存在针对双重问题的良好综合治疗。这项应用是一项随机对照试验，比较了综合社区治疗和建立更强大的家庭(BSF)，这是一种针对父母药物滥用和儿童虐待的两种循证治疗的综合模式，在为期4年的试点中显示出了希望。

DESCRIPTION (provided by applicant): Parental substance abuse is a leading determinant of child maltreatment and, consequently, is often linked with detrimental clinical outcomes for children, exorbitant fiscal costs for the child welfare system, and serious social costs for our nation. Yet, in spite of the gravity of child maltreatment in the context of parental substance abuse, substance abusing parents rarely receive evidence-based treatments for their problems. Rather, such parents are usually referred from the child welfare system to the adult substance abuse system. Unfortunately, the adult substance abuse treatment system rarely provides the type of outreach needed to engage the parents in treatment or the intensity and breadth of services needed to place these parents and families on more productive life trajectories. Four years ago, at the behest of the Connecticut Department of Children and Families and with the support of the Annie E. Casey Foundation, the investigators developed a comprehensive community-based treatment program to address the problem of co-occurring parental substance abuse and child maltreatment. Importantly, and in collaboration with investigators at the Johns Hopkins University, this program, named "Building Stronger Families" (BSF), integrated an innovative evidence-based treatment for adult substance abuse (i.e., Reinforcement-Based Therapy [RBT]; Jones, Wong, Tuten, & Stitzer, 2005) with an evidence-based treatment of child abuse and neglect (i.e., Multisystemic Therapy for Child Abuse and Neglect [MST-CAN]; Swenson, Schaeffer, Henggeler, et al., 2009). The purpose of the present proposal is to request funding for a randomized trial of the BSF model, now 4 years in operation. A feasibility review and quasi-experimental evaluation of BSF have been completed. Regarding feasibility, the Department of Children and Families, which funds the clinical services, and the Annie E. Casey Foundation, which funds the quality assurance (e.g., treatment manuals, training) and ongoing involvement of the investigators, remain enthusiastic supporters of BSF. Moreover, BSF acceptability and feasibility are supported by 87 percent participant recruitment and 93 percent treatment completion rates. Regarding preliminary outcomes, a matched-comparison study (N = 52) indicated that BSF was significantly more effective than Comprehensive Community Treatment (CCT) at preventing reabuse, with BSF achieving an average reduction of 75 percent in substantiated reports of maltreatment at 24 months. Further, BSF participants were 50 percent less likely to have experienced an out-of- home placement at 18 months and 65 percent less likely at 24 months, with results approaching significance at 24 months. In light of these promising results, the proposed study aims to provide a rigorous and comprehensive evaluation of BSF by comparing this model to CCT on key clinical and system indices from baseline through 18 months. The intervention addresses the most prevalent, challenging, costly, and understudied area within the child welfare and parental substance abuse fields. If successful, this research could provide a substantial contribution, positively impacting the lives of millions of the most vulnerable families. PUBLIC HEALTH RELEVANCE: Parental substance abuse is a leading determinant of child maltreatment and, consequently, is often linked with detrimental clinical outcomes for children, exorbitant fiscal costs for the child welfare system, and serious social costs for our nation. Yet, in spite of the gravity of child maltreatment in the context of parental substance abuse and that there are well-established effective treatments for adult substance abuse, substance-abusing parents in the child welfare system are less likely to be offered services and receive services and well-integrated treatments for the dual problem are virtually nonexistent in the research literature. This application is a randomized controlled trial comparing Comprehensive Community Treatment to Building Stronger Families (BSF), an integrated model of two evidence-based treatments for parental substance abuse and child maltreatment that has shown promise in a 4-year pilot.