Facilitating treatment entry and family planning in substance-using NICU mothers

 描述(由申请人提供)：母体药物滥用是一个严重的公共卫生问题，具有广泛的负面后果。在怀孕期间使用药物很普遍，特别是在弱势群体中，而且往往与零星的、晚期的或没有产前护理联系在一起，排除了在医院分娩之前的识别、转诊和治疗。使用药物的母亲所生的婴儿往往早产或出生体重较低，并被送往新生儿重症监护病房(NICU)，这使这成为最初干预的重要环境。母亲使用药物与儿童照料不足和忽视有关，这可能对脆弱的NICU婴儿造成特别严重的后果。此外，如果不进行干预，这些母亲中的许多人将在短时间内再次怀孕，增加自己、家庭和社会的负担。在NICU的长期住院提供了一个独特的机会，可以对处于危机中的痛苦的年轻母亲进行干预，她们可能有更高的动机寻求帮助，以应对高危行为(药物使用)和采用健康的行为(计划生育；疾病预防)。我们预测，在NICU(即提供生殖健康和艾滋病毒/丙型肝炎咨询的医生)中，一种新颖的、以经验为基础的、医院量身定做的干预措施与妇科随访相结合，将增加治疗开始，减少药物使用，防止未来的物质暴露怀孕(SEP)，并降低艾滋病毒和丙型肝炎的风险。由于NICU婴儿不成比例地出生于处境不利的少数族裔家庭，对这一群体的干预对于减少经济和种族健康差距至关重要。随机对照小组设计将用于对适应性、简短、医院提供的干预措施的可行性和有效性进行严格评估，该干预措施包括一种新的循证治疗组合(动机访谈[MI]和接受与承诺治疗[ACT])，旨在为患有高危NICU婴儿的母亲启动药物滥用治疗并降低SEP的风险。母亲(N=)将被随机分为MI-ACT组或传统护理组(CC)。根据适应性干预策略，MI-ACT治疗强度(1次、2次或3次)将根据参与者的反应(即治疗开始)而不同。基线后8周的疗效评估将评估进入治疗的情况、物质使用情况和SEP/艾滋病毒/丙型肝炎风险。还将调查MI-ACT治疗机制(即，改变的动机；心理灵活性)。在6个月的随访中，范围更广 将评估产妇和婴儿福利(例如，儿童监护权；急性护理；儿科就诊；再次住院)。计划进行一项创新的贝叶斯分析，以确定MI-ACT干预的潜在好处，该分析主动解决在相对较小的样本中进行新干预措施的初始疗效试验时不可避免的功率问题。针对高医疗风险婴儿的使用药物的母亲的有效的基于医院的短期干预措施可能会大幅减少对健康和社会的不利影响以及巨大的相关成本。

 DESCRIPTION (provided by applicant): Maternal substance abuse is a significant public health problem with wide-ranging, negative consequences. Substance use in pregnancy is prevalent, particularly among disadvantaged groups, and is often associated with sporadic, late, or no prenatal care, precluding identification, referral and treatment prior to hospital delivery. Infants born to substance-using mothers are often premature or at low birth weights and admitted to the neonatal intensive care unit (NICU), making this an important setting for initial intervention. Maternal substance use is associated with inadequate childcare and neglect which can have especially devastating consequences for fragile NICU infants. Further, without intervention, many of these mothers will become pregnant again within a short period of time, increasing burden on themselves, their families and society. Prolonged hospitalization in the NICU provides a unique opportunity to intervene with distressed young mothers in crisis, who may have higher levels of motivation to seek help for high-risk behaviors (substance use) and adopt healthy ones (family planning; disease prevention). We predict that a novel, empirically-grounded, hospital-tailored intervention combined with gynecological follow-up in the NICU (i.e., physicians providing reproductive health and HIV/HCV counseling) will increase treatment initiation, reduce substance use, prevent future substance-exposed pregnancies (SEPs), and reduce risk of HIV and HCV. As NICU infants are disproportionately born to disadvantaged, minority families, intervention with this population is critical for reducing economic and racial health disparities. A randomized, controlled group design will be used to allow a rigorous assessment of the feasibility and efficacy of an adaptive, brief, hospital-delivered intervention comprising a novel combination of evidence- based treatments (motivational interviewing [MI] and acceptance and commitment therapy [ACT]) targeting substance abuse treatment initiation and reduced risk of SEPs for mothers with a high-risk, NICU infant. Mothers (N = 64) will be randomized to either: MI-ACT or Conventional Care (CC). MI-ACT treatment intensity (1, 2, or 3 sessions) will vary based upon participant response (i.e., treatment initiation), per the adaptive intervention strategy. An efficacy assessment at 8 weeks post-baseline will assess treatment entry, substance use, and SEP/HIV/HCV risk. MI-ACT treatment mechanisms (i.e., motivation for change; psychological flexibility) will also be investigated. At the 6-month follow-up, broader maternal and infant benefit will be assessed (e.g., child custody; acute care pediatric visits; re-hospitalization). An innovative Bayesian analysis is planned to determine potential benefit of the MI-ACT intervention, which proactively addresses the inevitable problem of power when conducting initial efficacy trials of new interventions in relatively smaller samples. Effective bref, hospital-based interventions targeting substance-using mothers of infants at high medical risk could result in substantial decreases in adverse health and social effects and the large associated costs.