Feasibility and Acceptability of Home-Based Continuing Care

描述（由申请人提供）：每年约有50万年轻人（YA;在此定义为19-25岁）进入药物滥用治疗，但尽管认识到成瘾是一种慢性疾病，但很少有研究对该年龄组的持续护理模式进行研究。昂贵的住院治疗使YA出院，并转介到门诊护理或自助团体，但许多人不使用或很少参与。住院治疗后复发率很高，许多父母在孩子出院回家时感到没有支持和准备不足。需要有效的持续护理来吸引YAs，准备和支持父母，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、易于推广、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YAs开发和试点测试以家庭为基础的持续护理（HCC）。HCC将结合联合收割机两种有效的方法：基于电话的CC（TCC）和应急管理（CM）。远程电话模式将允许一小批供应商提供HCC，减少传播挑战。本研究的具体目的是探索：1）父母和YAs对HCC的可接受性; 2）维持干预的可行性; 3）进行HCC随机对照试验（RCT）的可行性;以及4）初步估计HCC疗效和RCT的需求。在三个阶段项目的第一和第二阶段，家长和YAs将从住宿治疗计划和家长支持小组招募。第一阶段将调查50名家长和50名青年，以制定对HCC程序的可接受性的明智判断，并确定和找到父母和青年参与障碍的解决方案。在II期研究中，将对20对父母-YA进行基线、16周和32周评估的初步研究，这些父母-YA被随机分配至HCC或继续照常服务（SAU）。当YA在住院治疗时，HCC父母将接受沟通，尿检程序和CM的培训，以便出院后他们可以与HCC计划合作，以支持YA的康复。在治疗师的监测和反馈下，HCC父母将随机安排家庭尿检，并为经验证的禁欲和参与住宅项目制定的持续服务计划提供激励。HCC YAs将通过短信和/或电话定期与治疗师联系，以评估复发风险并提供简短的咨询。我们将探索：1）通过检查HCC参与度、保留率和治疗满意度来评估HCC的可接受性; 2）通过估计HCC成本并询问父母愿意为此支付多少来评估HCC的可持续性; 3）通过检查两组的招募率、治疗忠诚度和随访保留率来评估RCT的可行性;和4）通过检查（a）估计的效应量结合（B）父母、YAs和成瘾专家对结局临床重要性的评估，初步确定RCT的疗效和必要性。在第三阶段，我们将与家长和青少年咨询委员会以及专家小组一起审查项目结果，并就RCT的需求和可行性做出最终决定。

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.