将同伴康复教练提供的行为激活干预措施改编用于巴尔的摩市医疗服务不足社区中存在问题的物质使用。

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City.

机构信息

Department of Psychology, University of Maryland, College Park, Maryland, United States of America.

Department of Nursing, University of Maryland, Baltimore, Maryland, United States of America.

出版信息

PLoS One. 2020 Jan 31;15(1):e0228084. doi: 10.1371/journal.pone.0228084. eCollection 2020.

Abstract

Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.

摘要

低收入、少数族裔群体中存在着不成比例的高问题物质使用率,但他们在获得基于证据的干预措施(EBIs)方面存在障碍。同伴康复教练(PRC),即有过问题物质使用经历的个人,可能是一种有效接触这些个体的方法。传统上,PRC 专注于与其他类型的护理相衔接,而不是自行提供 EBI。本研究旨在评估 PRC 提供的适应性行为激活(BA)干预措施对未接受护理的个体减少问题物质使用的适当性。这项研究是在马里兰州巴尔的摩的一个社区资源中心进行的,为那些低收入和无家可归的客户提供服务,这些客户的问题物质使用率很高,但也面临着获得护理的障碍。本研究以 ADAPT-ITT 框架为指导,对过去或现在有过问题物质使用经历的客户(n=30)进行了半结构化关键知情人访谈,并对社区提供者(包括社区资源中心的工作人员(n=5)和社区的 PRC(n=6))进行了焦点小组讨论。接受访谈的客户中有 30%(n=9)报告过去有过问题物质使用,70%(n=21)符合当前使用的标准,最常见的是可卡因和阿片类药物。客户、中心工作人员和 PRC 都认为 PRC 提供的 BA 是可以接受和合适的,可以进行一些调整,包括增加同伴提供的个案管理和与护理的衔接,以及根据 BA 调整活动,使其包括在社区中可及和可行的活动。这些发现将为在这一环境中采用 PRC 提供的 BA 来解决问题物质使用提供信息。

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