Feasibility and Acceptability of Home-Based Continuing Care

描述（由申请人提供）：每年大约有50万年轻人（YA；这里定义为19-25岁）接受药物滥用治疗，但是尽管认识到成瘾是一种慢性疾病，但很少有研究检查对这个年龄组的持续护理模式。昂贵的住院治疗使他们转介到门诊护理或自助团体，但许多人不使用或最低限度地参与。住院治疗后的复发率很高，许多父母在孩子出院回家时感到得不到支持和准备不足。需要有效的持续护理来吸引青少年，为父母做好准备和提供支持，并阻止发展为使人衰弱的成人疾病。必须设计具有成本效益、易于传播、可持续的持续护理模式。这项R21申请建议为离开住院治疗的青少年开发和试点基于家庭的持续护理（HCC）。HCC将结合两种有效的方法：基于电话的CC （TCC）和应急管理（CM）。一种远程的、基于电话的模式将允许由一小群提供者提供HCC，减少传播的挑战。本研究的具体目的是探讨：1)家长和家长对HCC的可接受性；2)持续干预的可行性；3)开展HCC随机对照试验（RCT）的可行性；4)初步评估HCC的疗效和进行随机对照试验的必要性。在三阶段项目的第一和第二阶段，将从住院治疗项目和家长支持小组中招募家长和青少年家长。第一阶段将调查50名家长和50名青少年，对HCC治疗过程的可接受性做出明智的判断，并确定和找到阻碍家长和青少年参与的解决方案。在第二阶段的试点研究中，16周和32周的评估将在20对随机分配到HCC或继续照常服务（SAU）的父母- ya对中进行试点。当青少年接受住院治疗时，HCC的父母将接受沟通、尿检程序和CM方面的培训，以便在出院后，他们可以与HCC项目合作，支持青少年的康复。在治疗师的监督和反馈下，HCC家长将随机安排以家庭为基础的尿检，并为经过验证的戒断和参与由住院项目制定的持续服务计划提供奖励。HCC青少年将接受TCC，并通过短信和/或电话定期与治疗师联系，以评估复发风险并提供简短咨询。我们将探讨：1)HCC接受能力，通过检查HCC参与，保留和治疗满意度；2)通过估算HCC费用并询问家长愿意为此支付的费用来实现可持续性；3)通过检查两组的招募率、治疗保真度和随访保留度，RCT的可行性；4)通过检查(a)估计的效应大小，以及(b)父母、成人协会和成瘾专家对结果的临床重要性的评估，初步疗效和RCT的必要性。在第三阶段，我们将与家长及青少年谘询委员会及专家小组检讨项目结果，并就进行随机对照试验的需要及可行性作出最终决定。

DESCRIPTION (provided by applicant): About half a million young adults (YA; defined here as 19-25 years old) enter substance abuse treatment each year, but despite recognizing addiction as a chronic disease, little research has examined models of continuing care for this age group. Costly residential treatments discharge YAs with referral to outpatient care or self-help groups, but many do not use or minimally participate in them. Relapse rates are high after residential treatment and many parents feel unsupported and poorly prepared when their child is discharged and returns to their home. Effective continuing care is needed to engage YAs, prepare and support parents, and halt progression to a debilitating adult disease. Cost-efficient, easily disseminated, sustainable continuing care models must be designed. This R21 application proposes to develop and pilot test Home-based Continuing Care (HCC) for YAs leaving residential treatment. HCC will combine two efficacious approaches: Telephone-based CC (TCC) and Contingency Management (CM). A remote, telephone-based model would allow delivery of HCC from a small cadre of providers, reducing challenges of dissemination. The specific aims of the research are to explore the: 1) Acceptability of HCC to parents and YAs; 2) Feasibility of sustaining the intervention; 3) Feasibility of conducting a randomized controlled trial (RCT) of HCC; and 4) Preliminary estimation of HCC efficacy and need for a RCT. During Phases 1 & 2 of the three-phase project, parents and YAs will be recruited from residential treatment programs and parent support groups. Phase 1 will survey 50 parents and 50 YAs to develop informed judgments on the acceptability of HCC procedures and identify and find solutions to barriers to parent and YA participation. In Phase 2 a pilot study with baseline, 16- and 32 week assessments will be piloted with 20 parent-YA pairs randomly assigned to HCC or continuing services as usual (SAU). While the YA is in residential treatment HCC parents will receive training in communication, urine testing procedures, and CM so that after discharge they can partner with the HCC program to support the YA's recovery. With therapist monitoring and feedback, HCC parents will administer randomly scheduled home- based urine tests and provide incentives for verified abstinence and engagement in the continuing service plan developed by the residential program. HCC YAs will receive TCC with regular therapist contact by text message and/or phone to assess relapse risk and provide brief counseling. We will explore: 1) HCC accept- ability by examining HCC engagement, retention and treatment satisfaction; 2) sustainability by estimating HCC costs and asking parents what they would be willing to pay for it; 3) RCT feasibility by examining recruitment rate, treatment fidelity, and follow-up retention in both groups; and 4) preliminary efficacy and need for a RCT by examining (a) estimated effect size in conjunction with (b) assessment by parents, YAs, and addiction experts of the clinical importance of outcomes. In Phase 3 we will review project results with Parent and Youth Advisory Boards and the expert panel and make final decisions on need and feasibility of an RCT.