Prevention of Substance Abuse and Problem Behaviors in High-Risk Adolescents

描述（由申请人提供）：大量的研究表明，未成年人犯罪往往是物质使用的前兆，这两种行为的开始往往发生在儿童正在经历其他困难的生活转变时。犯罪和物质使用之间相互关系的证据使研究人员假设了一系列共同的潜在原因，其中可能包括认知和自我控制缺陷，在某些情况下也包括心理健康问题。这项研究提出了一种可能性，即针对犯罪或物质使用（或潜在的共同原因）的干预可能有助于防止这两种行为的持续或升级。不幸的是，我们社会中最脆弱的青年也不成比例地可能与关键的社会制度脱节。这表明，选择性预防干预措施的一个特别重要的实施环境可能是少年司法系统。我们要求提供资金，以实施和试点测试综合认知行为疗法（CBT）计划，该计划广泛用于青少年矫正环境，但尚未适应交付或测试用于社区环境中的青少年罪犯群体。一个基于社区的CBT计划，这将是一个更大的青少年罪犯人口相比，在拘留中交付的程序相关，必须解决额外的挑战，是不那么紧迫的拘留设置，如确保持续的方案参与和竞争与外部社区的影响，青年的态度和结果。我们提出的项目是由我们的跨学科芝加哥大学的研究团队和库克县巡回法院的少年缓刑和法院服务部之间的独特合作。目标人群是受少年缓刑监督的13至17岁的大批青年。拟议的研究采用两阶段设计：（1）随机化前开发阶段，包括一个小组可行性研究，以适应社区试用环境的CBT干预模式;（2）有效性的试点随机临床试验（RCT）。随机对照试验将受缓刑监督的青少年随机分配到：（a）现状缓刑服务（N=100）;（B）针对高危青少年的12周团体CBT干预（CBT-ARY）（N=100）;或（c）补充CBT与出勤监督员的联合干预（CBT-ARY+）鼓励计划参与（N=100）。主要结果指标将集中在干预的近端目标，包括认知过程，态度和心理健康。物质使用，侵略，其他形式的暴力或犯罪行为，以及累犯率的远端结果也将被测量。这两个阶段的结果将指导未来全面有效性试验的应用。 公共卫生相关性：拟议的项目将实施和试点测试的综合认知行为疗法的青少年罪犯谁住在社区设置-一个关键的人口的公共卫生问题。先前对青少年被拘留者进行的研究表明，这种干预措施在减少药物使用和犯罪方面具有潜在的前景，尽管这种前景尚未在其他青少年犯罪人群中进行严格评估。研究调查人员和青少年拘留和缓刑当局之间的密切伙伴关系加强了该项目的公共卫生意义，该项目有可能影响全国第三大城市的政策和实践，因此在全国范围内。

DESCRIPTION (provided by applicant): A large body of research suggests that minor delinquency is often a precursor to substance use, and that initiation of both behaviors often occurs as children are experiencing other difficult life transitions. Evidence of a reciprocal relationship between delinquency and substance use has led researchers to hypothesize a set of shared underlying causes, which may include cognitive and self-control deficits and in some cases mental health problems as well. This research raises the possibility that interventions that target either delinquency or substance use (or underlying shared causes) may help prevent the persistence or escalation of both behaviors. Unfortunately the most vulnerable youth in our society are also disproportionately likely to be disconnected from key social systems. This suggests that a particularly important delivery context for selective prevention interventions may be the juvenile justice system. We request funding to implement and pilot-test an integrated cognitive behavioral therapy (CBT) program that is widely used in juvenile correctional settings but has not yet been adapted for delivery or tested for use with juvenile offender populations in the community setting. A community-based CBT program, which would be relevant for a much larger juvenile offender population compared to a program delivered in detention, must address additional challenges that are less pressing within the detention setting, such as ensuring sustained program participation and contending with outside community influences on youth attitudes and outcomes. Our proposed project is made possible by a unique collaboration between our interdisciplinary University of Chicago-based research team and the Juvenile Probation and Court Services Department of the Circuit Court of Cook County. The targeted population is the large group of youth 13-17 years of age who are under the supervision of Juvenile Probation. The proposed study utilizes a two-phase design: (1) a pre-randomized development phase that involves a small group feasibility study to adapt the CBT intervention model for the community probation setting; and (2) the pilot randomized clinical trial (RCT) of efficacy. The RCT will randomly assign youths who are under probation supervision to: (a) status quo probation services (N=100); (b) a 12-week group CBT intervention for at-risk youth (CBT-ARY) (N=100); or (c) a combined intervention that supplements CBT with attendance reinforcers to (CBT-ARY+) encourage program participation (N=100). Primary outcome measures will focus on proximal goals of intervention, including cognitive processes, attitudes, and mental health. Distal outcomes of substance use, aggression, other forms of violent or criminal behavior, and recidivism rates will be also be measured. Results from the two phases will guide a future application for a full-scale effectiveness trial. PUBLIC HEALTH RELEVANCE: The proposed project would implement and pilot-test an integrated cognitive behavioral therapy for juvenile offenders who live in community settings-a key population of public health concern. Prior research conducted with juvenile detainees suggests the potential promise of such interventions in reducing substance use and delinquency, though this promise has yet to be rigorously evaluated in other juvenile offending populations. The close partnership between study investigators and juvenile detention and probation authorities heightens the public health significance of this project, which has the potential to influence policy and practice in the nation's third-largest city, and hence across the nation.