Family Therapy Development for Incarcerated Mothers with Substance Use Disorders

描述（由申请人提供）：提交此SOAR提案是为了扩大和加强目前正在进行的一项研究，该研究由John a. Hartford基金会资助，授予符合NIH早期研究者标准的首席研究员。这项研究解决了美国女性监禁率的惊人增长，它与药物滥用的交叉，以及它对非洲裔美国人和拉丁裔妇女的不成比例的影响。大多数被监禁的妇女在被监禁之前与她们的未成年子女住在一起，其中一半以上的子女在监禁期间由祖父母照顾，其中不成比例地由祖母照顾。越来越多的研究表明，与酒精和物质使用障碍的成人个体治疗或候补条件相比，家庭治疗可以提高治疗的参与性和保持性，减少物质使用，改善个人和家庭功能。研究也开始表明，对被监禁母亲及其子女的干预产生了积极的社会心理结果，包括减少再监禁，但只有一项已知的干预研究包括照顾祖母，尽管她们在家庭中扮演着关键角色，并且她们的参与有可能提高治疗的保留度，并为有物质使用障碍的被监禁母亲带来收益。本Ia/Ib阶段治疗发展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，旨在实现以下目标：1)对有物质使用障碍的被监禁母亲和在监禁期间照顾女儿子女的祖母进行单独的焦点小组研究，以确定母亲、祖母和子女的社会心理优势、需求和服务偏好；2)利用收集到的焦点小组数据和家庭系统、认知和行为理论，设计并试点一个创新的、与文化相关的家庭治疗模式；3)招募30名正在县监狱接受药物法庭推荐的住院治疗的在囚妇女，随机分配到常规治疗组（n=15）或常规治疗组加新型家庭治疗组（n=15），并招募参与新型家庭治疗组妇女的母亲参加家庭治疗组（n=15）；4)对母亲的家庭关系、应对、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；祖母之间的家庭关系、应对、物质使用和社会心理压力；以及儿童的行为功能；5)评估参与者对新家庭治疗组件的可接受性。鉴于家庭治疗在减少母亲药物使用、再次入狱以及参与艾滋病毒药物和性危险行为方面具有巨大潜力；为了减少照顾祖母的心理社会压力和药物使用风险，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空白。

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.