Methods for Understanding Sentinel Events

描述（由申请人提供）：我们对个人在入狱后如何改变物质使用行为，这种变化发生的机制，以及哪些干预措施对不同的人最有效的理解是最少的。因此，重新使用药物是一种常态，对前囚犯和他们的社区造成了毁灭性的影响。第一步是了解那些导致入狱后药物使用短期和长期变化的因素。为了开始这一过程，我们将扩大我们的试点工作，对最近被监禁的有物质使用问题的个人进行深入访谈，以描述在监禁事件和物质使用行为改变之间进行调解的认知和情感机制。这些访谈的结果将用于开发量表来测量所提出的模型的不同结构。然后将使用认知访谈对量表项目进行细化。最后一种乐器将用于400名囚犯。所得数据将用于心理测量分析，以检查个体构念的维度（内部效度），确认和完善所得量表，计算每个量表的信度系数，并检查模型构念彼此之间的关系。在过去的三十年里，美国的惩教系统经历了指数级的增长，绝大多数的监禁与酒精或非法药物使用有关。国家囚犯的药物使用量大约是一般人口的27倍。尽管监禁物质使用障碍患者的趋势不断增加，但人们对监禁可能影响物质使用行为的认知和情感机制知之甚少。哨兵事件模型是一种动态模型，基于以下观察：在尝试停止使用药物之前，通常会出现使用的负面后果，例如经历健康、人际关系或法律问题（“触底”）。我们试图更好地描述在哨兵事件（监禁或“教育时刻”）和行为改变之间调解的认知和情感机制。为了充分测试这个模型，我们首先需要验证模型构造的度量。这些措施将评估几个结构，其中一些可能会随着时间的推移而迅速改变。为了捕捉随着时间的变化，我们需要一些可以在监禁期间和释放后反复实施的措施。在本R21中，我们将创建和验证模型构建的措施，并检查在监狱和社区中获得生态瞬时评估的不同方法的可行性。为此，我们的具体目标是：SA 1：通过深入访谈了解和完善模型的结构。SA 2：创建并验证这些构造的度量。SA 3：与EMA一起使用这些经过验证的措施来完善程序，以确定评估的最佳频率和深度。

DESCRIPTION (provided by applicant): Our understanding of how individuals change substance use behaviors after being in jail, the mechanisms whereby this change occurs, and which interventions might work best for different individuals is minimal at best. As a result, relapse back to substance use is the norm with devastating effects on ex-inmates and their communities. The first step is to understand those factors that lead to short- and long-term changes in drug use after incarceration. To begin this process we will expand our pilot work conducting in-depth interviews with recently incarcerated individuals with substance use problems in order to delineate the cognitive and affective mechanisms of action that mediate between the event of incarceration and substance use behavior change. Results of these interviews will be used to develop scales to measure the different constructs of the proposed model. Scale items will then be refined using cognitive interviews. The final instrument will be administered to 400 inmates. The resulting data will be used in psychometric analyses to examine the dimensionality (internal validity) of the individual constructs, confirm and refine the resulting scales, calculate reliability coefficients for each scale, and to examine the relationship of the model constructs to each other. The US correctional system has experienced exponential growth in the past three decades with the vast majority of incarcerations related to alcohol or illicit substance use. Substance use among State prisoners is approximately 27 times greater than in the general population. Despite this ever increasing trend of incarcerating individuals with substance use disorders little is known about the cognitive and affective mechanisms by which incarceration may impact substance use behaviors. The Sentinel Events Model is a dynamic model predicated on the observation that an attempt to stop using a drug is often preceded by a negative consequence of use, such as the experience of a health, interpersonal, or legal problem ("hitting bottom"). We seek to better delineate the cognitive and affective mechanisms of action that mediate between a sentinel event (incarceration or "a teachable moment") and behavior change. To test this model fully we need to first have validated measures of the model's constructs. These measures will assess several constructs, some of which may change rapidly over time. To capture changes over time we need measures than can be administered repeatedly during incarceration and after release. In this R21 we will create and validate measures of the model's constructs and examine the feasibility of different methods for obtaining ecological momentary assessment in jail and in the community. To this end, our specific aims are: SA 1: To understand and refine the model's constructs through in-depth interviews. SA 2: To create and validate measures of those constructs. SA 3: To refine procedures using these validated measures with EMA to determine the optimal frequency and depth of assessments. PUBLIC HEALTH RELEVANCE: We seek to better delineate the cognitive and affective mechanisms of action that mediate between a sentinel event (incarceration or "a teachable moment") and behavior change by developing measures of these constructs that can be administered in a jail. Such measures should aide in drug treatment for incarcerated men and women.