Sustainable HIV Risk Reduction Strategies for CJ Systems

描述(由申请人提供)：拟议的研究涵盖5年，包括两个主要研究阶段，旨在降低刑事司法(CJ)人群中艾滋病毒和其他成瘾相关疾病的风险。第一阶段是降低疾病风险(DRR)干预效果研究，第二阶段是在CJ现场环境中实施。手动引导的DRR规划和决策战略将基于认知工具，这些工具侧重于以证据为基础的视觉空间(而不是传统的说教)交流方法。它将侧重于重返大气层期间的危险性行为和吸毒行为，包括认识到问题、致力于改变以及避免感染的行为风险的策略。激励和规划课程将在CJ基于机构的药物滥用治疗接近尾声时举行，这些课程还将通过使用一系列强调应用DRR原则的自学工具包，过渡到社区过渡治疗期间的重返护理服务。罪犯一级的参与和运作将是这一初始研究阶段的主要分析重点。在该项目的第二阶段，将在德克萨斯州以及邻近的3个州(亚利桑那州、新墨西哥州和俄克拉何马州)扩大的CJ系统网络中审查干预实施过程。这一阶段将根据组织需要和职能评估(基于对减少灾害风险干预、培训和利用的工作人员评价)，采用自然主义的研究设计，分析社区司法系统各机构和社区重返职司的实施进展情况。与目前在以机构为基础的治疗中使用的“标准护理”相比，DRR干预有望显著提高犯罪者的动机、承诺和自信，以规划他们在社区重新进入期间使用的行为风险降低策略。预计DRR重新进入自学指南将进一步增加罪犯对社区支持网络的使用率，降低他们与药物使用和性行为有关的风险水平，并降低他们在后续行动中再次被监禁的可能性。同样，在基于机构的治疗期间，更有利的罪犯的心理社会功能和参与度也将与重新进入社区期间的更好结果积极相关。在实施评估研究(阶段2)中，机构和基于社区的再入团队(代表4个州的CJ系统)将响应创新培训，并使DRR组件的应用与他们对计划需求、压力、资源和组织适合性的集体看法相称。也就是说，CJ地点(如监狱内治疗和缓刑/假释区)工作人员对需求、艾滋病毒干预服务的准备情况、组织资源、特派团和业务环境的(平均)评分较高，预计将预示着更多人参与和响应后续的DRR创新培训。反过来，这些指标预计将在培训后后续行动中预测更高的DRR利用率和工作人员满意度。 公共卫生相关性：对刑事司法人员采取有效的艾滋病毒/艾滋病减少风险干预措施可以为犯罪者本身和广大公众提供重大的公共健康益处。然而，在监禁后重新进入社区的关键阶段，“接触”和说服有药物滥用史的罪犯充分规划和应用减少风险的原则存在挑战。惩教系统也往往是支离破碎的，这是向易患传染病的罪犯提供综合护理和监督的努力面临的另一个挑战。目前的提案涉及这两个非常重要的问题。

DESCRIPTION (provided by applicant): The proposed study covers 5 years and includes 2 major research phases intended to reduce HIV and other addiction-related disease risks in criminal justice (CJ) populations. The first phase is a Disease Risk Reduction (DRR) intervention effectiveness study, and the second addresses its implementation in CJ field settings. A manual-guided DRR planning and decision-making strategy will be based on cognitive tools that focus on an evidence-based, visual-spatial (rather than traditional didactic) communication approach. It will focus on risky sexual and drug use behaviors during re-entry, including problem recognition, commitment to change, and strategies for avoiding behavioral risks of infections. Motivational and planning sessions will be delivered near the end of CJ institution-based substance abuse treatment, and they will also bridge into re- entry care services during community transitional treatment by using a series of self-study toolkits emphasizing applications of DRR principles. Offender-level engagement and functioning will be the key analytical focus of this initial study phase. In the second phase of the project, the process of intervention implementation will be examined in an expanded network of CJ systems in Texas as well as 3 adjoining states (Arizona, New Mexico, and Oklahoma). This phase will employ a naturalistic research design relying on organizational needs and functioning assessments (based on staff evaluations of DRR intervention training and utilization) in the analyses of implementation progress in institution and community-based re-entry divisions of the CJ system. When compared to "standard care" currently used during institution-based treatment, the DRR intervention is expected to significantly improve offender motivation, commitment, and self-confidence in planning their behavioral risk-reduction strategies for use during community re-entry. It also is expected that DRR re-entry self-study guides will further increase the rate of offender use of support networks in the community, reduce their risk levels related to drug use and sexual behaviors, and decrease their likelihood of re-incarceration during follow-up. More favorable offender psychosocial functioning and engagement during institution-based treatment likewise are expected to be positively associated with better outcomes during community re-entry. In the implementation evaluation study (Phase 2), institution and community-based re-entry teams (representing CJ systems across 4 states) are expected to respond to innovation training and make applications of DRR components commensurate with their collective perceptions about program needs, pressures, resources, and organizational fitness. That is, higher (average) ratings by staff members at CJ sites (e.g., in-prison treatment and probation/parole regions) of needs, readiness for HIV intervention services, organizational resources, mission, and operational climate are expected to predict greater participation and responsiveness to subsequent training for the DRR innovation. These indicators, in turn, are expected to predict higher DRR utilization and staff satisfaction at the post-training follow-up. PUBLIC HEALTH RELEVANCE: Effective HIV/AIDS-risk reduction interventions for criminal justice populations can offer significant public health benefits, both to offenders themselves and the public at large. However, there are challenges to "engaging" and convincing offenders with substance abuse histories to adequately plan and apply risk reduction principles during the crucial community re-entry phase after imprisonment. Correctional systems also are often fragmented, representing another challenge to efforts to provide integrated care and supervision to offenders at-risk for infectious diseases. The current proposal addresses both of these highly significant issues.