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重大的公共卫生问题，具有广泛的负面影响。怀孕期间使用药物的现象很普遍，特别是在弱势群体中，而且往往与零星的、晚的或没有产前护理有关，从而妨碍了住院分娩前的识别、转诊和治疗。使用药物的母亲所生的婴儿往往是早产儿或出生体重低的婴儿，因此被送入新生儿重症监护室，使其成为初步干预的一个重要场所。母亲使用药物与儿童保育不足和忽视有关，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，增加她们自己、家庭和社会的负担。在新生儿重症监护室长期住院提供了一个独特的机会来干预处于危机中的苦恼的年轻母亲，他们可能有更高的动机寻求高风险行为（物质使用）的帮助，并采取健康的行为（计划生育;疾病预防）。我们预测，一种新的，基于外科学的，医院定制的干预措施结合NICU的妇科随访（即，提供生殖健康和HIV/HCV咨询的医生）将增加治疗启动，减少物质使用，预防未来的物质暴露妊娠（SEP），并降低HIV和HCV的风险。由于新生儿重症监护室的婴儿不成比例地出生于弱势群体和少数民族家庭，因此对这一人群的干预对于减少经济和种族健康差距至关重要。将采用随机化、对照组设计，严格评估适应性、简短、医院提供的干预措施的可行性和有效性，该干预措施包括一种新型循证治疗组合（动机访谈[MI]和接受和承诺疗法[ACT]），旨在启动药物滥用治疗并降低高危NICU婴儿母亲的SEP风险。母亲（N = 64）将被随机分配至MI-ACT或常规护理（CC）组。MI-ACT治疗强度（1、2或3个疗程）将根据受试者的反应而变化（即，治疗开始），根据适应性干预策略。基线后8周的疗效评估将评估治疗入组、物质使用和SEP/HIV/HCV风险。MI-ACT治疗机制（即，改变的动机;心理灵活性）也将被调查。在6个月随访时， 将评估产妇和婴儿的益处（例如，儿童监护;急性护理儿科访视;再住院）。计划进行一项创新的贝叶斯分析，以确定MI-ACT干预措施的潜在益处，该干预措施在相对较小的样本中进行新干预措施的初步疗效试验时，主动解决了不可避免的功效问题。针对高医疗风险婴儿的药物使用母亲的有效的基于医院的干预措施可能会大大减少不良健康和社会影响以及大量相关费用。

 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.