Family-Based Treatment for Parental Substance Abuse and Child Maltreatment

描述（由申请人提供）：父母滥用药物是儿童虐待的主要决定因素，因此，通常与儿童的有害临床结果，儿童福利系统的过高财政成本以及我们国家的严重社会成本有关。然而，尽管在父母滥用药物的情况下虐待儿童很严重，但滥用药物的父母很少接受以证据为基础的治疗。相反，这样的父母通常从儿童福利系统转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联式服务，也很少提供使这些父母和家庭走上更有成效的生活轨道所需的强度和广度的服务。四年前，在康涅狄格儿童和家庭部的要求下，在安妮·e·凯西基金会的支持下，调查人员制定了一个全面的社区治疗计划，以解决父母滥用药物和虐待儿童同时发生的问题。重要的是，该项目与约翰霍普金斯大学的研究人员合作，名为“建立更强大的家庭”（BSF），将成人药物滥用的创新循证治疗（即强化疗法[RBT]； Jones, Wong, Tuten, & 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， Henggeler等，2009）结合起来。本提案的目的是为目前已运行4年的BSF模型的随机试验申请资助。完成了BSF的可行性审查和准实验评价。在可行性方面，为临床服务提供资金的儿童和家庭部，以及为质量保证（如治疗手册、培训）和调查人员的持续参与提供资金的Annie E. Casey基金会，仍然是BSF的热情支持者。此外，87%的参与者招募和93%的治疗完成率支持BSF的可接受性和可行性。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）更有效，在24个月时，BSF在证实的虐待报告中平均减少了75%。此外，BSF参与者在18个月和24个月时经历离家安置的可能性分别减少了50%和65%，结果在24个月时接近显著性。鉴于这些有希望的结果，拟议的研究旨在通过比较该模型与CCT从基线到18个月的关键临床和系统指标，对BSF进行严格和全面的评估。干预措施解决了儿童福利和父母药物滥用领域中最普遍、最具挑战性、最昂贵和研究不足的领域。如果取得成功，这项研究将作出重大贡献，对数百万最脆弱家庭的生活产生积极影响。

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.