A Brief Family-Based Program to Bridge Youth on Probation to Trauma-Specific Treatment

摘要/概要 青少年司法系统中的青少年经历创伤事件和不良童年 创伤后应激障碍（posttraumatic stress，PTS）的发生率极高。如果不治疗， YIJ的PTS导致创伤后应激障碍（PTSD），自杀行为，非自杀性自伤， 导致青年人身心障碍的其他疾病，以及青年人参与司法系统的程度不断上升。最近 立法和政策趋势导致越来越多的YIJ不被拘留，而是被拘留， 社区监督（即，试用期）。然而，尽管存在循证治疗， 在社区的PTS中，由于复杂的、多方面的原因，试用期内的YIJ经常得不到他们需要的照顾。 水平因子（例如，行为健康和司法之间的跨系统协调;长的等待名单;缺乏 查明和适当转诊;照顾者尽量减少青少年的问题;青少年对提供者的不信任）。 有一些很有前途的循证协议将YIJ转介并与社区治疗服务联系起来， 然而，这些方法还没有被调整以解决YIJ PTS（例如，通过掺入 适当的转诊途径，或增加青年对创伤治疗的动力和护理人员对创伤治疗的支持）。 该K23奖建立在候选人之前的培训和经验基础上，以填补稳健领域的关键空白 制定干预措施，纳入实施考虑因素、创伤后遗症和创伤方面的专门知识 治疗，以及行为试验的设计和评估。此外，该奖项将导致 开发T-Connect，一种在社区监督下桥接YIJ的创伤知情多层次干预 照顾和增加青年和照顾者参与YIJ的创伤治疗。研究计划分为 根据考生的培养目标和研究目的，分三个阶段进行。首先，候选人 我将与有PTS的YIJ、他们的照顾者、缓刑工作人员和社区工作人员一起开展形成性工作。 创伤治疗提供者其次，候选人将通过建立，协作，社区- 参与式方法，一种干预（T-Connect），它集成到现有的试用协议中，以1）参考/链接 需要创伤治疗的YIJ得到适当的护理，2）增加青年和护理人员的动机， 支持治疗。第三，候选人将通过随机试验评估T-Connect， 将T-Connect连接到“服务照常”控件。拟议的培训和研究活动将 在哥伦比亚大学/纽约州立精神病医院的行为健康和青年正义中心 研究所和由NIMH资助的导师团队监督，他们在后遗症和治疗方面具有专业知识。 创伤、在社区监督下为YIJ提供服务以及设计、实施和 行为试验的评估。

Abstract/Summary Youth involved in the juvenile justice system (YIJ) experience traumatic events and adverse childhood experiences (ACEs) at disproportionately high rates, leading to posttraumatic stress (PTS). When left untreated, YIJ’s PTS contributes to posttraumatic stress disorder (PTSD), suicidal behavior, non-suicidal self-injury, and other disorders which factor into youth impairment and the escalation of their justice system involvement. Recent legislative and policy trends have led to an increasing number of YIJ residing not in detention, but instead under community supervision (i.e., on probation). However, despite the existence of evidence-based treatments for PTS in the community, YIJ on probation frequently do not receive the care they need, due to complex, multi- level factors (e.g., cross-system coordination between behavioral health and justice; long waitlists; lack of identification and appropriate referral; caregiver minimization of youths’ problems; youths’ distrust of providers). There are promising, evidence-based protocols to refer and link YIJ to community-based treatment services, however, these methods have not yet been adapted to address YIJ PTS (e.g., through the incorporation of appropriate referral pathways, or increasing youth motivation for, and caregiver support of, trauma treatment). This K23 Award builds upon the candidate’s prior training and experience to fill critical gaps in the areas of robust intervention development incorporating implementation considerations, expertise in trauma sequalae and trauma treatment, and the design and evaluation of behavioral trials. Additionally, this award will result in the development of T-Connect, a trauma-informed multi-level intervention to bridge YIJ under community supervision to care and increase youth and caregiver engagement in YIJ’s trauma treatment. The research plan is divided in to three phases, which correspond to the candidates training objectives and research aims. First, the candidate will conduct formative work with YIJ who have PTS, their caregivers, probation staff, and community-based trauma treatment providers. Second, the candidate will develop, through established, collaborative, community- engaged methods, an intervention (T-Connect) that integrates into existing probation protocols to 1) refer/link YIJ in need of trauma treatment to appropriate care and 2) increase youth and caregiver motivation for and support of treatment. Third, the candidate will evaluate T-Connect through a randomized trial, comparing youth who receive T-Connect to a services-as-usual control. The proposed training and research activities will take place at the Center for Behavioral Health and Youth Justice at Columbia University/New York State Psychiatric Institute and be supervised by a team of NIMH-funded mentors with expertise in the sequalae and treatment of trauma, the provision of services for YIJ under community supervision, and the design, implementation, and evaluation of behavioral trials.