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

描述（由申请人提供）：为有精神健康问题的在押青少年找到有效的治疗方法是一项关键的公共卫生需求。居住在少管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）的比例很高，患精神障碍的比例也较高。这些年轻人的长期后果令人沮丧。惩教系统在处理这些复杂的心理需求方面能力有限，管理人员和临床医生需要基于研究的指导，以确定哪些治疗方法可以提供最佳机会，减少风险因素，增强青少年在其护理中的适应能力。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，但尚未在矫正环境中进行研究。少年司法环境的几个特点，如父母有限，可能会妨碍执行。提出的研究有三个主要目的：(1)调整TF-CBT协议，以提高其在监狱环境中的可移植性；(2)对改进后的TF-CBT进行可行性研究；(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，一个具有在矫正环境中使用TF-CBT经验的利益相关者团队将与治疗开发人员之一合作，调整该模型以解决其使用的任何障碍。适应后，在三个高限制的惩教设施中雇用的8到10名从业人员将接受TF-CBT的高级培训，随后是9个月的指导和技术援助。青年将参加一项试点研究，以确定筛选、招募和同意程序的可行性，并审查青年和参与家庭对治疗方法的可接受性和可容忍性。接受TF-CBT治疗的青少年将与等待治疗的类似青少年进行比较，以探索随着时间的推移，两组之间在情绪和行为问题变化方面的差异。该研究还将探讨在这种情况下影响治疗效果的青年、提供者和组织特征。该试点研究将为在青少年惩教机构中实施改进版TF-CBT的可行性提供初步信息，并为未来的研究工作提供指导。拟议的项目将开始解决关于治疗监禁青少年创伤相关精神障碍的有效策略的知识鸿沟。

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.