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

描述(由申请人提供)：为有心理健康问题的被监禁青年寻找有效的治疗方法是一项重要的公共卫生需求。居住在少年管教所的青少年接触创伤性事件(例如，虐待儿童、家庭暴力、社区暴力)的比率很高，精神错乱率也较高。这些年轻人的长期结果令人沮丧。惩教系统在满足这些复杂的心理需求方面的能力有限，管理人员和临床医生需要基于研究的指导，以确定哪些治疗提供了减少风险因素和提高青年在其照料中的复原力的最佳机会。以创伤为中心的认知行为疗法(TF-CBT)已被证明对各种青少年和各种社区环境有效，但尚未在惩教环境中进行研究。少年司法环境的几个特点，如父母人数有限，可能会阻碍执行。拟议的研究有三个主要目的：(1)调整TF-CBT议定书，以增加其在监狱环境中的可移动性；(2)对这种经修改的TF-CBT进行可行性研究；以及(3)确定在监狱环境中促进或抑制TF-CBT有效性的因素。为了实现这些目标，一个有在矫正环境中使用TF-CBT的经验的利益相关者团队将与其中一名治疗开发人员合作，调整该模型，以解决其使用的任何障碍。在适应后，受雇于三个高限制惩教机构的8至10名从业人员将接受特遣部队-CBT高级培训，随后将接受9个月的教练和技术援助。青年将参加一项试点研究，以确定筛查、招募和同意程序的可行性，并检查治疗方法对青年和参与其中的家庭的可接受性和耐受性。接受TF-CBT的青年将与等待服务的类似青年进行比较，以探索不同群体之间随着时间的推移在情绪和行为问题方面的变化是否存在差异。这项研究还将探索在这种情况下影响治疗效果的青年、提供者和组织特征。这项试点研究将提供关于在少年教养设施中实施修订版本的TF-CBT的可行性的初步信息，并为未来的研究工作提供指导。拟议的项目将开始解决在治疗被监禁青年创伤相关精神障碍的有效战略方面的一个严重知识差距。

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.