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

描述（申请人提供）：许多因遭受暴力和虐待而有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这些青少年在青少年犯罪人口中的比例过高，其中67% - 75%患有损害性精神疾病，20%的人患有严重的精神障碍，超过三分之一的人需要持续的临床MHS护理-这一数字是一般青少年人口的两倍。7 -10-12女孩是最脆弱的，研究不足，服务不足，但增长最快的违法亚组，数据强烈表明他们有最严重的MHS需求：75-95%有虐待儿童的历史，95-100%有暴力暴露，性侵犯和虐待儿童的多重创伤历史，高达50%的青少年目前患有创伤后应激障碍（PTSD）和物质与酒精使用障碍（SAUD），他们的PTSD和自杀倾向的发生率高于犯罪男孩。7，10，12，26 -28然而，在青少年司法系统中，很少有（如果有的话）经过严格测试的干预措施可用于患有这些共病问题的青少年。我们在这项拟议研究中的主要目的是评估寻求安全[SS]的有效性，这是一种同时治疗PTSD和SAUD共病的干预措施，也涉及自我伤害和负面情绪调节，用于女性犯罪者。这项研究奠定了基础，开发一个模型，进口循证治疗[EBT]的高危青年谁获得JJS的关注。我们将通过圣地亚哥缓刑部门的女孩康复设施招募250名13至18岁的女性罪犯，患有PTSD和SAUD共病。我们的主要目的是：1）使用随机对照试验设计，以确定为期8周，24个疗程的手动PTSD/SAUD干预的有效性，13与缓刑部门为SAUD问题提供的“常规治疗”[TAU]（8周，24个疗程）进行比较; 2）确定认知因素（语言技能，执行功能）是否与SS和TAU的治疗结果相关。我们的次要目的是：1）评估SS治疗的可能修改，以改善对受试人群的服务; 2）通过与（a）加州大学圣地亚哥分校健康差异综合研究中心，以确定促进圣地亚哥社区联盟内合作关系的最佳方法（B）犯罪和成瘾研究、培训和应用中心，以学习如何在全国各地传播关于JJS青年EBT的数据，并探索培训管教人员的战略，以便更有效地与受创伤和SAUD青年一起工作。通过圣地亚哥县少年法院和缓刑部门的前所未有的支持和访问以及目前嵌入的多学科转化研究计划（跨越神经认知，精神病学，成像，遗传学研究），我们处于独特的地位来实施这项具有深远政策影响的拟议研究。 公共卫生相关性：通过儿童福利或少年司法系统卷入少年法庭的青少年，表现出精神病理和功能障碍的比例升高，给社会带来重大的社会和财政成本，而且往往逃避传统精神卫生服务的关注。本研究探讨了基于证据的干预措施，同时治疗共病创伤后应激障碍和物质/酒精使用障碍，高风险和犯罪女孩中观察到的最普遍的共病模式和模式，往往会导致未来的逮捕（物质使用，卖淫）的有效性。这项研究将作为一个模型，用于实施和评估以证据为基础的治疗与高风险的青少年谁获得少年法庭的注意，但传统上在一般社区服务不足。

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.