Trauma-informed Treatment for Adults: RCT of a Strength and Skills-Based Intervention to Decrease Apache Substance Use and Suicide

成人创伤知情治疗：基于力量和技能的干预措施减少阿帕奇药物使用和自杀的随机对照试验

• 批准号: 10021425
• 负责人: MARIDDIE J CRAIG
• 金额: $ 20.12万
• 依托单位: WHITE MOUNTAIN APACHE TRIBE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021425
• 关键词: Address; Adult; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Apache; Caring; Childhood; Clinical; Collaborations; Communities; Competence; Country; Data; Diagnosis; Dimensions; Disease; Drug abuse; Drug usage; Elements; Enrollment; Ethics; Evidence based intervention; Evidence based practice; Feeling suicidal; Funding; Goals; Health; Indian reservation; International; Intervention; Interview; Knowledge; Master' s Degree; Mental Depression; Mental Health; Mentors; Methods; Modeling; Native American Research Center for Health; Native Americans; Participant; Pathway interactions; Pharmaceutical Preparations; Plant Roots; Play; Population; Public Health; Qualitative Methods; Qualitative Research; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Research Project Grants; Risk; Risk Factors; Sampling; Services; Specialist; Substance abuse problem; Suicide; Suicide attempt; Supervision; Symptoms; Testing; Time; Training; Transcend; Trauma; Trauma Research; Underserved Population; Waiting Lists; White Mountain Apache; adverse childhood events; adverse outcome; base; behavioral health; commune; contextual factors; data management; effectiveness testing; empowered; evidence base; experience; healing; health disparity; innovation; non-Native; physical conditioning; post intervention; programs; protective factors; resilience; service gap; skills; suicidal behavior; suicidal risk; trauma exposure; trauma symptom

PROJECT SUMMARY Native American (NA) studies focused on Adverse Childhood Events (ACEs) have found associations with alcohol, drug, and suicidal risk; and NA studies targeting alcohol and drug abuse and suicide have identified ACEs as risk factors. The goal of the Apache-JHU NARCH trauma research project is to: 1) better understand the types, meanings and impact of ACEs, and 2) how to effectively reduce the impact of these experiences in Apache adults with alcohol, drug and suicide risks. We will use a rigorous mixed-methods, community-based approach combining qualitative methods with a RCT to adapt and test a strength- and skills-based intervention, “My Pathway to Healing.” My Pathway to Healing is based on a trauma-informed, common elements intervention that has a robust evidence-base internationally, and will be delivered using a task-shifting approach by culturally embedded Apache Community Mental Health Specialists (CMHS). The specific aims are to: 1) to characterize the meaning and impact of ACES and identify key resilience factors for Apache adults ages 18-65 using Free Listing and In-Depth Interviews with N=30 key stakeholders. 2) To adapt a common elements intervention, My Pathway to Healing, based on Aim 1 findings and CAB input for piloting by Apache CMHS with N=10 Apaches ages 18-65 with recent suicide ideation and/or substance use. 3) To test the effectiveness of My Pathway to Healing using a wait-list controlled RCT with N=104 Apache adults ages 18-65 with recent suicide ideation and/or binge substance use. We hypothesize that participants will experience greater reductions in risk (trauma symptoms, depression) and increases in protective factors (hopefulness, communal mastery, functioning) related to substance use and suicidal behavior vs. controls at 6 months post-intervention. 4) To train and mentor 8 NA junior investigators in the trauma informed intervention, mixed methods research, data management, and ethical conduct of research. The Apache-JHU NARCH trauma research project builds on several successful rounds of NARCH funding, culminating in two Apache Co- Investigators completing their Master's degrees, enrolling in part-time doctoral programs in mental health, and being empowered to provide local clinical supervision for this study. This project will address critical next steps in trauma-informed care research by examining how ACEs and other trauma affect alcohol abuse, drug abuse, and suicidality—some of the largest health disparities for NAs. The use of a CMHS model will extend the reach, impact and scalability of culturally appropriate and evidence-based trauma-informed care for adults at risk of suicide in a community-based setting.

项目摘要 美国原住民（NA）研究的重点是儿童事件（ACE） 与酒精，毒品和自杀风险的关联；和针对酒精和药物的NA研究 滥用和自杀已确定ACE是危险因素。 Apache-Jhu Narch的目标 创伤研究项目是：1）更好地了解ACE的类型，含义和影响， 2）如何有效地减少这些经历对酒精的Apache成年人的影响， 毒品和自杀风险。我们将使用严格的混合方法，基于社区的方法 将定性方法与RCT相结合，以适应和测试基于力量和技能的方法 干预，“我的康复途径。”我的康复途径是基于创伤信息， 在国际上具有强大的证据基础的常见元素干预措施，将是 通过文化嵌入的Apache社区的精神使用任务转换方法交付 卫生专家（CMHS）。具体目的是：1）表征含义和影响 使用免费上市和 n = 30个主要利益相关者的深入访谈。 2）适应共同元素干预措施， 我的康复途径，基于AIM 1发现和Apache CMH驾驶的驾驶室输入 N = 10岁的Apaches 18-65岁，最近自杀的想法和/或使用物质。 3）测试 使用等待名单控制的RCT n = 104 Apache，我的治疗途径的有效性 18-65岁的成年人最近自杀的想法和/或暴饮暴食。我们假设这一点 参与者的风险会更大（创伤症状，抑郁症）和 增加的保护因素（希望，公共精通，功能）与 干预后6个月，药物使用和自杀行为与对照。 4）训练和 Mentor 8 NA初级调查员在创伤知情干预，混合方法研究中 数据管理和研究的道德行为。 Apache-Jhu Narch创伤研究 项目以几个成功的Narch资金为基础 调查人员完成硕士学位，参加兼职博士课程 在心理健康方面，并有权为此提供当地的临床监督 学习。该项目将解决创伤性护理研究的关键下一步 检查ac和其他创伤如何影响酗酒，滥用药物和自杀 - 有些 NAS最大的健康分配。 CMHS模型的使用将扩展覆盖范围，影响 以及对成年人的文化适当和基于证据的创伤信息护理的可伸缩性 在社区环境中自杀的风险。