Concurrent Treatment of Substance Abuse and Child Maltreatment

描述(由申请人提供)：虐待儿童和父母滥用药物并存是一个严重的公共卫生问题，对儿童、父母、家庭和整个社区都有严重的后果。对照料者滥用药物和虐待儿童的有效双重治疗的必要性是毋庸置疑的，但缺乏对有虐待儿童行为的滥用药物的父母进行的受控治疗结果研究。该项目审查了两种循证治疗方法--药物滥用应急管理和路径三P育儿干预，以改善育儿和解决儿童虐待问题。主要研究是一项纵向、因素、随机对照试验，以衡量对结果变量的影响，这些变量包括父母滥用药物、与育儿相关的功能(育儿实践、儿童虐待再犯罪、观察到的亲子互动)、儿童适应、父母的艾滋病毒行为风险和父母的生活质量。样本包括儿童福利体系中的父母，这些父母正在与滥用药物的困难作斗争，并且至少有一个2-8岁的孩子。这项研究的设计和实施特征是严格的，建立在足够的统计能力、谨慎的随机化程序(保持治疗意图模型)、多元数据来源(即毒理学样本、自我报告、观察、CPS数据、治疗记录和教师报告)、促进和验证治疗保真度的程序、以随机截距线性增长模型为中心的分析框架以及纳入12个月和18个月的随访评估的基础上。第二项研究借鉴了第一项研究的一部分，侧重于双重治疗结果中个体差异的潜在相关或预测因素，如父母年龄和教育程度、社会经济劣势程度、心理困扰、家庭困难和法律困难。TIS项目的成果将使实地了解药物滥用和虐待儿童的最新治疗对儿童福利系统中的家庭的影响程度，并进一步减少与这些严重公共卫生问题有关的痛苦和社会成本。

DESCRIPTION (provided by applicant): The co-occurrence of child maltreatment and parental substance abuse is a major public health problem with serious consequences for children, parents, families, and the community at large. The need for effective dual treatment of caregiver substance abuse and child maltreatment is unquestionable, but there is a dearth of controlled treatment outcome studies with substance-abusing parents who have engaged in child maltreatment. This project examines two evidence-based treatments-Contingency Management for substance abuse and Pathways Triple P parenting intervention to improve parenting and address child maltreatment. The main study is a longitudinal, factorial, randomized controlled trial to gauge impact on outcome variables that include parental substance abuse, parenting-related functioning (parenting practices, child-maltreatment recidivism, observed parent-child interaction), child adjustment, parent's HIV behavioral risk, and parental quality of life. The sample includes parents in the child welfare system that is struggling with substance-abuse difficulties and has at least one child 2-8 years of age. The study design and implementation features are rigorous and build on adequate statistical power, careful randomization procedures preserving an intent-to-treat model, multiple sources of data (i.e., toxicology samples, self-report, observation, CPS data, treatment records, and teacher report), procedures for promoting and verifying treatment fidelity, an analytic framework centering on random-intercept linear growth models and inclusion of 12 and 18 month follow-up assessments. A second study draws on part of the first study and focuses on potential correlates or predictors of individual variabilty in outcome with the dual treatment, such as parent age and education, level of socioeconomic disadvantage, psychological distress, family difficulties, and legal difficulties. The results of tis project will inform the field about how well the combination of state-of-the-art treatments for substance abuse and child maltreatment impacts families in the child welfare system and move closer to reducing the misery and societal costs associated with these serious public health problems.