Integrated Mental Health Treatment & HIV Prevention for Court-Involved Youth

说明(由申请人提供)：少年司法系统中的青年和青年同时患有精神疾病和药物使用障碍的比例很高，感染艾滋病毒的风险也很高。然而，即使认识到障碍和风险，大多数方案也不能解决所有这些重要问题，而且对这些多问题青年同时治疗所有结果的长期疗效尚未得到证明。对年轻人的不利后果包括部分治疗或复发的精神障碍、持续的药物滥用、艾滋病毒风险不变以及进一步的法律问题。该项目与罗德岛家庭法院合作，将通过实施针对精神健康/药物滥用障碍和艾滋病毒风险的综合治疗计划(ITP)来解决这些问题。ITP是一种新颖的方法，它同时针对多个青少年问题，让父母参与进来，以增加变化，并在家庭法院内交付。这项研究将把我们以前对患有精神障碍的青少年进行的有效干预扩展到与法庭有关的青少年。青少年及其父母将从罗德岛家庭法院精神健康诊所登记，法官将在那里转介13-17岁的青少年进行全面评估和转介治疗。这项随机对照试验将在200名需要门诊治疗的性行为活跃的青少年中测试新型综合治疗(ITP，n=100)与社区门诊服务强化标准护理(ESC，n=100)在18个月期间(ITP或ESC治疗6个月和12个月随访)的疗效。ITP由三个部分组成：1)个人认知行为治疗，包括一个激励性访谈部分，以模块为基础，解决同时存在的精神健康和药物滥用问题；2)家庭和父母培训课程，以解决父母沟通和监测，以支持青少年减少风险；3)多家庭小组讲习班，以解决艾滋病毒风险、家庭沟通和同伴抵抗技能。患有这两种情况的青少年(ITP和ESC)将从法院获得类似的案件管理服务，并从研究精神病学家那里获得精神药物管理(如果需要)。ITP将在减少性危险行为、药物使用、精神障碍症状和法律罪行方面与ESC进行比较。

DESCRIPTION (provided by applicant): Youth and young adults in the juvenile justice system have a high prevalence of concurrent psychiatric and substance use disorders and are also at high risk for HIV. However, even when the disorders and risks are recognized, most programs do not address all of these important problems and long-term efficacy for all outcomes simultaneously has yet to be demonstrated for these multi-problem youth. Adverse outcomes for youth include partially treated or relapsing psychiatric disorders, continued substance abuse, unchanged HIV risk, and further legal problems. This project, in collaboration with the Rhode Island Family Court, with whom we have existing collaborations, will address these issues by implementing an Integrated Treatment Program (ITP) that targets mental health/substance abuse disorders and HIV risk. ITP is novel by targeting multiple adolescent problems simultaneously, involving parents to augment change, and its delivery within the Family Court. This study will extend our previous efficacious interventions among youth with psychiatric disorders to court-involved youth. Adolescents and their parents will be enrolled from the Rhode Island Family Court Mental Health Clinic where youth aged 13-17 are referred by judges for comprehensive assessment and referral for treatment. This randomized controlled trial will test the efficacy, among 200 sexually active court-involved youth who need outpatient treatment, of the novel, integrated treatment (ITP, n=100) as compared to enhanced standard care in community outpatient services (ESC, n=100) over an 18-month period (6 months of ITP or ESC and 12 months of follow-up). ITP consists of three components: 1) individual cognitive behavioral therapy which includes a motivational interviewing component and is modular-based to address concurrent mental health and substance abuse issues; 2) family and parent training sessions to address parental communication and monitoring to support risk reduction among youth; 3) multifamily group workshops to address HIV risk, family communication and peer resistance skills. Youth in both conditions (ITP and ESC) will receive similar case management services from the court and psychiatric medication management (if needed) from a study psychiatrist. ITP will be compared to ESC on reductions in sexual risk behavior, substance use, symptoms of psychiatric disorders, and legal offenses.