Evaluation of EBT with Young, Substance Abusing Homeless Mothers

描述(由申请人提供)：无家可归的母亲有年幼的孩子在她们的照顾下，与高吸毒率、艾滋病毒风险、身心健康问题和育儿压力作斗争。除了无家可归和满足自己及其子女的基本需要外，还有这些斗争。然而，研究与住房和支持性服务有关的母婴结局的研究非常有限。尽管越来越关注那些无家可归的人，但无家可归家庭的数量继续上升，对临时住所的需求如此之高，以至于许多城市无法满足这些家庭的需求。可以在庇护所之外提供的全面干预可能会为那些无家可归而没有进入庇护所系统的人以及那些没有庇护所的社区提供更大的帮助。在年轻的无家可归者中，25岁以下的人，研究文件表明，大多数(70%)从未使用过收容所服务。因此，研究注重为这一群体确定有效的干预措施，以满足这些家庭的多种需要，被认为是一个重要的重点。建议的干预措施(基于生态的治疗，EBT)包括住房和支持性服务，并使用生态系统方法作为理论基础。它是在一项第一阶段治疗发展研究中严格开发的，研究对象是通过危机庇护所参与的物质使用障碍无家可归的母亲。EBT显示了几个优于收容所服务的结果，因此被认为非常适合那些避开收容所但非常需要住房和支助服务的人群。240名(N=240)有物质使用障碍的18至24岁无家可归的年轻妇女，其子女未满6岁，将被随机分配到以下三种情况之一：(1)住房和支助服务(EBT)+照常治疗(N=80)；(2)仅住房(HO)+TAU(N=80)；或(3)仅TAU(N=80)。除了3个月的租金援助外，EBT还包括6个月的支持性服务(病例管理、艾滋病毒预防和社区强化办法)。HO包括3个月的租金援助，但不包括支持性服务。Tau是一家无家可归的青少年收容中心通常提供的服务。参与者将在基线后3、6、9和12个月进行重新评估。从理论上得出的改革调解人以及正式的经济评估将提供重要的政策影响。由于无家可归物质使用障碍的母亲及其子女面临各种不良后果的风险增加，干预措施可能会给他们的家庭和整个社会带来实质性的保健好处。

DESCRIPTION (provided by applicant): Homeless mothers with young children in their care contend with high rates of substance use, HIV risk, physical and mental health problems and parenting stress. These struggles are in addition to homelessness and meeting the basic needs of themselves and their children. However, a very limited number of studies have examined mother and child outcomes associated with housing and supportive services. Even with increased focus on those experiencing homelessness, the number of homeless families continues to rise, with the demand for temporary shelter so high that many cities are unable to meet the needs of these families. A comprehensive intervention that can be offered outside the shelter setting may offer greater reach to those experiencing homelessness who do not make it in to the shelter system, and for those communities that do not have shelters available. Among the young homeless, those under age 25, research documents that the majority (70%) have never used shelter services. Research attention towards identifying efficacious interventions for this population which address the multiple needs of these families is thus considered an important focus. The proposed intervention (Ecologically-Based Treatment, EBT) includes housing and supportive services and utilizes an ecological systems approach as the theoretical base. It was rigorously developed in a Stage 1 treatment development study with substance use disordered homeless mothers who were engaged through a crisis shelter. EBT showed several outcomes superior to shelter services and is therefore considered a good fit for a population who avoids the shelter but is in great need of housing and support services. Two hundred forty (N = 240) substance use disordered homeless young women between the ages of 18 to 24 years with a biological child under the age of 6 years in their care will be randomly assigned to one of three conditions: (1) housing and support services (EBT) + Treatment as Usual (TAU) (N = 80), (2) housing only (HO) + TAU (N = 80), or (3) TAU only (N=80). EBT includes 6 months of supportive services (case management, HIV prevention and the Community Reinforcement Approach) in addition to 3 months of rental assistance. HO includes 3 months of rental assistance, but without supportive services. TAU is usual services offered by a homeless youth drop-in center. Participants will be re-assessed at 3, 6, 9 and 12 months post-baseline. Theoretically derived mediators of change as well as a formal economic evaluation will offer important policy implications. Since homeless substance use disordered mothers and their children are at increased risk for a variety of adverse outcomes, the intervention may produce substantial health-care benefits to their families and society at large.