Cognitive Behavioral Therapy for Homeless Women with PTSD

描述(申请人提供)：暴露在创伤性事件中可能会导致精神健康问题，如创伤后应激障碍(PTSD)，这是一种对个人和社会具有潜在代价的衰弱状况。无家可归的妇女遭受创伤和创伤后应激障碍的比率通常高于有住房的妇女。尽管有治疗创伤后应激障碍的有效、经验性验证的治疗方法，但无家可归的妇女不太可能获得心理健康服务，尽管需求很高。这里提出的这项为期三年的研究解决了治疗研究中的一个关键缺口，以满足无家可归妇女的心理健康服务需求。这项研究的具体目标与三个阶段的活动相一致：目标1/阶段1：通过a)有创伤后应激障碍症状的无家可归妇女的焦点小组(2组，每组6-8人)，收集和分析关于18岁及以上无家可归妇女的创伤后应激障碍和创伤后应激障碍治疗情况的信息，以及b)由收容所主任、个案管理人员和向无家可归妇女提供心理健康和其他服务的焦点小组(2组，每组6-8人)。目标2/阶段2：根据a)目标1/阶段1重点小组的调查结果，以及b)无家可归妇女(2组2个重点小组，每组6-8名妇女)、收容所主任、个案管理人员以及向无家可归妇女提供心理健康和其他服务的提供者(2组2个重点小组，每组6-8人)不断提供的咨询和反馈，编制一本基于认知行为疗法(CBT)的现有创伤后应激障碍治疗手册，使其适用于无家可归妇女的生活。目标3/阶段3：对有创伤后应激障碍症状的无家可归妇女进行适应干预的试点测试。我们提出了一项随机设计，在研究干预期间，32名妇女，在两个参与收容所的每个收容所中各16名，将被分配到创伤后应激障碍干预条件或仅接受评估的对照条件。 这项研究将在第三年达到高潮，产品包括：1)适用于收容所无家可归妇女的创伤后应激障碍干预和手册，2)关于干预实施情况和结果变化的试点数据，以便对关键结果进行权力分析，3)两份学术期刊出版物和一次会议演示，以及4)R01应用程序计划，以测试创伤后应激障碍干预的效果。

DESCRIPTION (provided by applicant): Exposure to traumatic events may lead to mental health problems such as posttraumatic stress disorder (PTSD), a debilitating condition with potentially costly implications for the individual and society. Homeless women suffer from traumas and PTSD at rates typically higher than among housed women. Although effective, empirically validated treatments for PTSD are available, homeless women are unlikely to avail themselves of mental health services despite high levels of need. The three-year study proposed here addresses a critical gap in treatment research to meet the mental health service needs of homeless women. The Specific Aims of this study correspond with three phases of activities: Aim 1/Phase 1: Gather and analyze information on the context of PTSD and PTSD treatment for homeless women ages 18 and older through a) focus groups with homeless women having symptoms of PTSD (2 groups, 6-8 persons per group), and b) focus groups with shelter directors, case managers, and providers of mental health and other services to homeless women (2 groups, 6-8 persons per group). Aim 2/Phase 2: Develop an adaptation of an existing cognitive behavioral therapy (CBT)-based PTSD treatment manual to make it relevant for the lives of homeless women based on a) findings from Aim 1/ Phase I focus groups, and b) ongoing advice and feedback from homeless women (2 sets of 2 focus groups, 6-8 women per group), and shelter directors, case managers, and providers of mental health and other services to homeless women (2 sets of 2 focus groups, 6-8 persons per group). Aim 3/Phase 3: Conduct a pilot test of the adapted intervention with homeless women who have symptoms of PTSD. We propose a randomized design in which 32 women, 16 in each of two participating shelters, will be assigned to either the PTSD intervention condition or to an assessment-only control condition during the study intervention period. This study will culminate in Year 3 with several products: 1) a PTSD intervention and manual adapted for use with homeless women in shelter settings, 2) pilot data on intervention implementation and variation in outcomes that allow power analyses for key outcomes, 3) two scholarly journal publications and a conference presentation, and 4) a plan for an R01 application to test the efficacy of the PTSD intervention.