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

描述(申请人提供)：许多因暴力接触和虐待而产生最严重精神健康问题的青少年从未接受过精神健康服务[MHS]。8，11这些青少年在青少年犯罪人群中不成比例地被发现，那里67%-75%有精神障碍，20%有严重的精神障碍，超过三分之一需要持续的临床MHS护理--这一比例是一般青少年人口的两倍。7-10-12女孩是最脆弱、未得到充分教育和服务不足但增长最快的犯罪群体，数据有力地表明，她们有最严重的MHS需求：75%-95%有虐待儿童的历史，95%-100%的人有暴力暴露、性侵犯和虐待儿童的多处创伤病史，高达50%的人目前患有创伤后应激障碍(PTSD)和物质和酒精使用障碍[沙特]，他们的创伤后应激障碍和自杀率高于犯罪男孩。在这项拟议的研究中，我们的主要目的是评估寻求安全[SS]的有效性，这是一种同时治疗创伤后应激障碍和SAUD的干预措施，也解决了自我伤害和负面情绪调节问题，对女性罪犯来说。这项研究为开发向JJS关注的高危青年引入循证治疗[EBT]的模式奠定了基础。我们将通过圣地亚哥缓刑部门的女孩康复设施招募250名女性罪犯，年龄在13岁到18岁之间，患有创伤后应激障碍和沙特症。我们的主要目标是1)使用随机对照试验设计来确定为期8周、24疗程的手动PTSD/SAUD干预的疗效，13与缓刑部门针对沙特问题提供的[TAU](8周、24疗程)[TAU](8周、24疗程)进行比较；2)确定认知因素(言语技能、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)将这项研究作为将EBTS引入儿童福利和JJS的其他高危青年的模式，方法是与(A)加州大学圣地亚哥分校健康差距综合研究中心合作，以确定在圣地亚哥社区诊所联盟内促进合作关系的最佳方法，并确定资金来源，为更多的高危青年人口提供社区服务，以及(B)犯罪与成瘾研究中心，培训与应用，以了解如何在全国范围内传播关于JJS青少年EBTS的数据，并探索培训惩教官员更有效地与受创伤和沙特青年一起工作的战略。在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下，以及目前嵌入的多学科转换研究计划(涵盖神经认知、精神病学、成像、遗传学研究)，我们处于独特的地位，能够实施这项具有深远政策影响的拟议研究。 与公共卫生有关：通过儿童福利或少年司法系统参与少年法庭的青年，表现出较高的精神病变率和功能障碍，对社会造成巨大的社会和财政成本，并往往逃脱传统精神卫生服务的注意。这项研究考察了同时治疗创伤后应激障碍和物质/酒精使用障碍并存的循证干预的有效性，这是在高危和犯罪女孩中观察到的最普遍的共病模式，也是一种经常导致未来逮捕(药物使用、卖淫)的模式。这项研究将作为对高危青少年实施和评估循证治疗的模式，这些青少年得到了少年法院的关注，但传统上在一般社区中得不到足够的服务。

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.