Concurrent Treatment of Substance Abuse and Child Maltreatment

描述（由申请人提供）：儿童虐待和父母滥用药物的共同出现是一个重大的公共卫生问题，对儿童、父母、家庭和整个社区都有严重后果。对照顾者药物滥用和儿童虐待进行有效的双重治疗的必要性是毋庸置疑的，但缺乏对从事儿童虐待的药物滥用父母的对照治疗结果研究。本项目研究了两种基于证据的治疗方法——药物滥用应急管理和Pathways Triple 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、因子、随机对照试验，以衡量对结果变量的影响，包括父母药物滥用、父母相关功能（父母行为、儿童虐待累犯、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。样本包括在儿童福利系统中挣扎于药物滥用困难的父母，并且至少有一个2-8岁的孩子。研究设计和实施的特点是严格的，建立在足够的统计能力、谨慎的随机化程序、保留治疗意图模型、多种数据来源（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12个月和18个月的随访评估。第二项研究借鉴了第一项研究的部分内容，重点关注双重治疗结果中个体差异的潜在相关性或预测因素，如父母年龄和受教育程度、社会经济劣势水平、心理困扰、家庭困难和法律困难。该项目的结果将使该领域了解药物滥用和虐待儿童的最先进治疗相结合对儿童福利系统中的家庭产生的影响，并进一步减少与这些严重公共卫生问题相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.