Testing a Comorbid PTSD & Substance/Alcohol Use Intervention in Delinquent Girls

描述（由申请人提供）：许多因遭受暴力和虐待而出现最严重心理健康问题的青少年从未接受过心理健康服务[MHS]。8,11这些青少年不成比例地出现在少年犯人群中，其中67% - 75%患有精神障碍，20%患有严重精神障碍，超过三分之一的人需要持续的临床MHS护理，这一数字是普通青少年人口比例的两倍。7-10-12女孩是最脆弱的，未被充分研究和服务不足的，但增长最快的犯罪亚组，数据强烈表明她们有最严重的MHS需求：75-95%有儿童虐待史，95-100%有暴力暴露，性侵犯和儿童虐待的多重创伤史，高达50%患有创伤后应激障碍[PTSD]和物质和酒精使用障碍[SAUD]，她们的PTSD和自杀率高于犯罪男孩。7,10,12,26-28然而，在青少年司法系统[JJS]中，对于有这些共病问题的青少年，几乎没有经过严格测试的干预措施。在本研究中，我们的主要目的是评估寻求安全的有效性，寻求安全是一种同时治疗合并PTSD和SAUD的干预措施，同时也解决了自我伤害和负面影响调节问题。这项研究为开发一种模型奠定了基础，该模型将基于证据的治疗方法（EBT）引入到高危青少年中，这些青少年得到了JJS的关注。我们将通过圣地亚哥缓刑部的女孩康复中心招募250名13至18岁的女性罪犯，她们同时患有创伤后应激障碍和沙特阿拉伯。我们的主要目的是：1)使用随机对照试验设计来确定8周24期的创伤后应激障碍/沙特干预的效果，13与缓刑部门提供的“照例治疗”[TAU]（8周24期）相比；2)确定认知因素（语言技能、执行功能）是否与SS和TAU的治疗结果有关。我们的第二个目标是1)评估对SS治疗的可能修改，以改善对受试者人群的服务；2)将本研究作为一个模型，通过与(a)加州大学圣地亚哥分校健康差异综合研究中心合作，将ebt引入儿童福利和JJS的其他高风险青少年，以确定促进圣地亚哥社区诊所联盟内合作关系的最佳方法，并确定提供的资金来源(b)犯罪和成瘾研究、培训和应用中心，学习如何在全国范围内传播青少年在JJS中的ebt数据，并探索培训惩教人员的策略，以便更有效地与受创伤的青少年和沙特青少年一起工作。在圣地亚哥县少年法庭和缓刑部门前所未有的支持和支持下，以及目前嵌入的多学科，转化研究项目（跨越神经认知，精神病学，影像学，遗传学研究），我们处于一个独特的位置来实施这项具有深远政策意义的拟议研究。

DESCRIPTION (provided by applicant): Many youth with the most serious mental health problems resulting from violence exposure and maltreatment never receive mental health services [MHS].8,11 These youth are disproportionately found in juvenile delinquent populations where 67% - 75% have impairing psychiatric disorders, 20% have severe mental disorders and more than 1/3 need ongoing clinical MHS care- a figure twice the rate of the general adolescent population.7-10-12 Girls are the most vulnerable, understudied and underserved but fastest growing delinquent subgroup, with data strongly suggesting they have the most serious MHS needs: 75-95% have histories of child maltreatment, 95-100% have poly-trauma histories of violence exposure, sexual assault and child maltreatment, up to 50% have current Post Traumatic Stress Disorder [PTSD] and substance and alcohol use disorders [SAUD] and they have higher rates of PTSD and suicidality than delinquent boys.7,10,12,26-28 However there are few, if any, rigorously tested interventions available in the juvenile justice system [JJS] for youth with these comorbid problems. Our primary aim in this proposed study is to evaluate the efficacy of Seeking Safety [SS], an intervention for concurrently treating comorbid PTSD and SAUD that also addresses self harm and negative affect regulation, for female delinquents. This study lays the groundwork for developing a model for importing evidence based treatment [EBT] to high-risk youth who gain the attention of the JJS. We will recruit 250 female delinquents, 13 to 18 years old, with comorbid PTSD and SAUD through the San Diego Probation Department's Girls' Rehabilitation Facility. Our primary aims are to 1) use a randomized control trial design to determine the efficacy of an 8-week, 24 session manualized PTSD/SAUD intervention, 13 compared to the 'treatment as usual' [TAU] (8-week, 24 sessions) provided by the Probation Department for SAUD problems and 2) determine if cognitive factors (verbal skills, executive function) are related to treatment outcomes for SS and TAU. Our secondary aims are to 1) evaluate possible modifications to the SS treatment for improving services to the subject population and 2) use this study as a model for importing EBTs to other high-risk youth in Child Welfare and the JJS by partnering with (a) UC San Diego Comprehensive Research Center in Health Disparities to determine the best approach for fostering collaborative relationships within the alliance of San Diego's community clinics and identify funding streams to provide community-based services for a larger high- risk youth population and (b) Center for Criminality & Addiction Research, Training & Application to learn how to disseminate data about EBTs for youth in JJS across the nation and explore strategies to train correctional officers to work more effectively with traumatized and SAUD youth. With unprecedented support and access through the San Diego County Juvenile Court and Probation Department and a currently embedded multi- disciplinary, translational research program (spanning neurocognitive, psychiatric, imaging, genetics research), we are in a unique position to implement this proposed study that bears far reaching policy implications. PUBLIC HEALTH RELEVANCE: Youth who become involved with the Juvenile Court, either through the Child Welfare or Juvenile Justice system, demonstrate elevated rates of psychopathology and functional impairment, pose significant social and fiscal costs to society and often escape the attention of traditional mental health services. This research examines the efficacy of an evidence based intervention that simultaneously treats comorbid Post Traumatic Stress Disorder and Substance/Alcohol Use Disorders, the most prevalent comorbid pattern observed among high-risk and delinquent girls and a pattern that often results in future arrests (substance use, prostitution). This research will serve as a model for implementing and evaluating evidence based treatments with high-risk youth who gain the attention of the Juvenile Court but are traditionally underserved in the general community.