Quality Community Services for Adolescent Drug Abuse

描述（由申请人提供）： 拟议的研究的最终目标是测试的有效性，实施质量和成本效益的青少年药物滥用的家庭为基础的治疗服务提供机构设置。尽管以家庭为基础的生态干预（FBEI）在对照试验中取得了成功，但这种非常有前途的服务方法尚未在纯田间条件下对阿萨人群进行测试。控制有效性研究总是加强培训，监督和服务提供条件的合作网站，努力确保治疗的坚持性和一致性。推进传播科学的另一种策略是对社区诊所进行严格的自然主义研究，这些诊所已经在日常护理过程中实施了循证实践。拟议的研究将遵循这种“自下而上”的策略，通过调查社区精神卫生中心一线治疗师提供的阿萨服务的质量和影响，该中心已经将FBEI作为常规护理标准。本研究将采用随机设计，比较阿萨的自然FBEI服务与常规服务（SAD）。参与者（N = 200）将从当地高中，青年计划和社区辅导计划的少年犯招募。符合条件的青少年将符合ASAM门诊治疗标准。SAU条件将包含城市社区阿萨最常见的三个服务场所：医院门诊心理健康诊所、药物咨询/成瘾专科诊所和社区心理健康中心。该研究的主要目的是检查FBEI与SAU的有效性，并将FBEI依从性的强度和结果与先前FBEI II期疗效试验期间设定的性能基准进行比较。次要目的是比较FBEI与SAU的成本效益、服务利用率和消费者满意度。多特质、多方法评估设计（自我报告、治疗师日志、观察措施、存档记录）将包括基线和3、6和12个月随访时的青少年和家长访谈。在这两种情况下，将从自我报告和提供机构收集成本和服务利用数据。该研究将首次提供证据，证明广泛认可的阿萨治疗方法在现实条件下是否有效和可行，以及在结局和成本效益方面是否上级SAU。一个重要的次要收益将是增加在SAU条件下常用社区方法的稀缺知识基础。

DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to test the effectiveness, implementation quality, and cost effectiveness of family-based treatment services for adolescent substance abuse delivered in an agency setting. Despite the success of family-based ecological interventions (FBEI) in controlled trials, this highly promising services approach has not been tested under pure field conditions with ASA populations. Controlled effectiveness research invariably enhances training, supervision, and service delivery conditions in partnering sites in an effort to ensure treatment adherence and consistency. An alternative strategy for advancing dissemination science is rigorous naturalistic research on community clinics that already implement evidence-based practices in the course of routine care. The proposed study will follow this "bottom up" strategy by investigating the quality and impact of ASA services delivered by front-line therapists in a community-based mental health center that already features FBEI as the routine standard of care. The study will use a randomized design to compare naturalistic FBEI services to services as usual (SAD) for ASA. Participants (N = 200) will be recruited from local high schools, youth programs, and a community-mentoring program for juvenile offenders. Eligible adolescents will meet ASAM criteria for outpatient treatment. The SAU condition will contain the three most common service venues for ASA in urban communities: hospital-based ambulatory mental health clinics, drug counseling/addictions specialty clinics, and community mental health centers. The primary aims of the study are to examine the effectiveness of FBEI versus SAU and to compare the strength of FBEI adherence and outcomes to performance benchmarks set during a previous FBEI Stage II efficacy trial. The secondary aims are to compare cost effectiveness, services utilization, and consumer satisfaction in FBEI versus SAU. A multitrait, multimethod assessment design (self report, therapist logs, observational measures, archived records) will include adolescent and parent interviews at baseline and 3, 6, and 12 months follow-up. Cost and service utilization data will be collected from self-report and from provider agencies in both conditions. The study will yield the first evidence on whether a widely endorsed treatment approach for ASA is potent and feasible in real-world conditions and superior to SAU in outcomes and cost-benefit. An important secondary yield will be increasing the scarce knowledge base on commonly practiced community approaches in the SAU condition.