Bringing What Works to Youth in Prison: An Evidence-Based Trauma Intervention

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DESCRIPTION (provided by applicant): Finding effective treatments for incarcerated youth with mental health problems is a critical public health need. Adolescents residing in juvenile correctional facilities have high rates of exposure to traumatic events (e.g., child abuse, domestic violence, community violence) and elevated rates of mental disorders. The long-term outcomes for these youth are disheartening. Correctional systems are limited in their ability to address these complex psychological needs, and administrators and clinicians need research-based guidance to identify which treatments offer the best opportunity to reduce risk factors and enhance the resiliency of youth in their care. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been shown to be effective with a variety of youth and in a variety of community settings, but has not been studied in correctional settings. Several characteristics of the juvenile justice setting, such as limited availability of parents, may impede implementation. The proposed study has three primary aims: (1) to adapt the TF-CBT protocol to increase its transportability into the prison setting; (2) to conduct a feasibility study of this modified TF-CBT; and (3) to identify factors that facilitate or inhibit the effectiveness of TF-CBT within the prison setting. To accomplish these aims, a team of stakeholders with experience using TF-CBT in a correctional setting will work with one of the treatment developers to adapt the model to address any barriers to its use. Following adaptation, eight to ten practitioners employed within three high-restriction correctional facilities will receive advanced training in TF-CBT followed by nine months of coaching and technical assistance. Youth will be enrolled in a pilot study to determine the feasibility of the screening, recruitment, and consent processes and to examine the acceptability and tolerability of the treatment approach to youth and participating families. Youth receiving TF-CBT will be compared to similar youth waiting for services to explore any differences between groups in changes in emotional and behavioral problems over time. The study will also explore youth, provider, and organizational characteristics that impact treatment effectiveness with this setting. This pilot study will provide preliminary information on the feasibility of implementing a modified version of TF-CBT within juvenile correctional facilities and provide guidance for future research endeavors. The proposed project will begin to address a critical gap in knowledge about effective strategies for treating trauma-related mental disorders in incarcerated youth. PUBLIC HEALTH RELEVANCE: Youth with mental illnesses are disproportionately represented in juvenile correctional facilities and limited evidence exists about effective treatments in this setting. This study will adapt Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), a treatment found to be efficacious in community settings, to the correctional setting and study the feasibility of its implementation. Conducted within Texas Youth Commission facilities, the findings will be rapidly disseminated in the state. The goal is to enhance the TF-CBT approach to meet the unique needs of incarcerated youth and the correctional system, one of the priorities outlined in the NIMH Strategic Plan.