Family Therapy Development for Incarcerated Mothers with Substance Use Disorders

描述（由申请人提供）：提交此SOAR提案是为了扩展和加强目前正在与John A.哈特福德基金会资助的主要研究者，谁符合国家卫生研究院早期阶段的研究者标准。这项研究解决了美国妇女监禁率的惊人增长，其与药物滥用的交叉，以及对非洲裔美国人和拉丁美洲妇女的不成比例的影响。大多数被监禁的妇女在被监禁前与其未成年子女居住在一起，其子女中有一半以上在被监禁期间由祖父母照顾，特别是祖母。越来越多的研究表明，与酒精和物质使用障碍成年人的个人治疗或等待名单条件相比，家庭治疗可以改善治疗参与和保留，减少物质使用，改善个人和家庭功能。研究也已开始表明，对被监禁母亲及其子女的干预措施产生了积极的心理社会结果，包括减少再次监禁，但只有一项已知的干预研究包括了祖母，尽管祖母在家庭中发挥着关键作用，而且她们的参与有可能提高患有药物使用障碍的被监禁母亲的治疗保留率和收益。本阶段Ia/Ib治疗开发研究借鉴了多代压力过程理论框架和基于社区的参与性研究原则，以实现以下目标：1）与患有药物使用障碍的被监禁母亲和在监禁期间照顾女儿的祖母进行单独的焦点小组，以确定母亲的心理社会优势、需求和服务偏好，2）利用收集的焦点小组数据和家庭系统，认知和行为理论来设计和试点测试一个创新的，与文化相关的家庭治疗模式; 3）招募30名正在县监狱参加毒品法庭推荐的住院治疗的被监禁妇女，随机分配到正常治疗组（n=15）或接受常规治疗加新型家庭治疗部分（n=15），并招募参与新型家庭治疗组的女性的母亲参与家庭治疗部分（n=15）; 4）对母亲的家庭关系、应对方式、药物使用、监禁状况和艾滋病毒风险行为进行基线和治疗后测量;家庭关系，应对，物质使用，和祖母的心理社会压力;和儿童的行为功能;和5）评估新的家庭治疗组成部分的参与者的可接受性。鉴于家庭治疗在减少母亲的物质使用、重新监禁和参与艾滋病毒药物和性风险行为方面的巨大潜力;减少祖母的心理社会压力和物质使用风险，并加强儿童的行为功能，本研究解决了这一领域科学和循证实践的关键差距。 公共卫生相关性：鉴于被监禁妇女中药物使用障碍的高患病率，孕产妇监禁和药物滥用的多代影响，以及该领域有限的家庭治疗研究，本研究解决了科学和实践中的一个至关重要的差距。本研究开发了一种新的家庭治疗方法，用于治疗患有药物使用障碍的被监禁母亲及其在监禁期间照顾子女的母亲，有可能对几个严重的公共卫生问题产生积极影响，包括母亲的药物滥用、重新监禁、艾滋病毒药物和性风险行为;祖母的生物心理社会压力和药物使用风险;和行为功能。

DESCRIPTION (provided by applicant): This SOAR proposal is submitted to expand and strengthen a study that is currently underway with John A. Hartford Foundation funding awarded to the principal investigator, who meets the NIH early stage investigator criteria. This research addresses the alarming increase in the rate of incarceration among women in the United States, its intersection with substance abuse, and its disproportionate impact upon African American and Latina women. The majority of women who are incarcerated resided with their minor children prior to their incarceration and more than half of their children are cared for by a grandparent, disproportionately a grandmother, during their incarceration. A growing body of research suggests that family treatments yield improved treatment engagement and retention, reduced substance use, and improved individual and family functioning in comparison to individual treatment or waitlist conditions for adults with alcohol and substance use disorders. Research has also begun to demonstrate that interventions with incarcerated mothers and their children yield positive psychosocial outcomes, including reduced re-incarceration, but only one known intervention study has included caregiving grandmothers, despite their key familial roles and the potential for their involvement to enhance treatment retention and gains for incarcerated mothers with substance use disorders. This stage Ia/Ib therapy development study draws upon a multigenerational stress-process theoretical framework and principles of community-based participatory research to pursue the following aims: 1)conduct separate focus groups with incarcerated mothers with substance use disorders and grandmothers who are caring for their daughters' children during their incarceration to identify the psychosocial strengths, needs, and service preferences of the mothers, grandmothers and children; 2)draw upon gathered focus group data and family systems, cognitive and behavioral theories to design and pilot-test an innovative, culturally- relevant family therapy model; 3)recruit 30 incarcerated women who are participating in drug court-referred residential treatment in a county jail to be randomly assigned to treatment as usual (n=15) or to treatment as usual plus the novel family therapy component (n=15) and recruit the mothers of the women participating in the novel family therapy arm to participate in the family therapy component (n=15); 4)conduct baseline and post- treatment measurement of family relationships, coping, substance use, incarceration status and HIV risk behaviors among mothers; family relationships, coping, substance use, and psychosocial strain among grandmothers; and behavioral functioning among children; and 5)evaluate the acceptability of the novel family treatment component to the participants. In light of the significant potential for family treatment to reduce mothers' substance use, re-incarceration, and involvement in HIV drug and sexual risk behaviors; to reduce caregiving grandmothers' psychosocial strain and substance use risk, and to strengthen children's behavioral functioning, this study addresses a critical gap in both science and evidence-based practice in this area. PUBLIC HEALTH RELEVANCE: In light of the high prevalence of substance use disorders among women who are incarcerated, the multigenerational effects of maternal incarceration and substance abuse, and the limited family treatment research in this area, this study addresses a critically important gap in science and practice. This study's development of a novel family treatment for incarcerated mothers with substance use disorders and their mothers who are caring for their children during their incarceration holds potential to positively affect several serious public health concerns, including substance abuse, re-incarceration, and HIV drug and sexual risk behaviors among the mothers; biopsychosocial strain and substance use risk among the grandmothers; and behavioral functioning among the children.