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

描述（由申请人提供）：青少年司法系统中的青少年和年轻人同时患有精神疾病和物质使用障碍，并且感染艾滋病毒的风险也很高。然而，即使这些疾病和风险被认识到，大多数项目并没有解决所有这些重要的问题，而且对于这些有多重问题的青少年，所有结果的长期疗效也尚未得到证实。青少年的不良后果包括部分治疗或复发的精神疾病、持续的药物滥用、不变的艾滋病毒风险和进一步的法律问题。该项目与罗德岛家庭法院（我们与该法院已有合作）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方案（ITP）来解决这些问题。ITP的新颖之处在于，它同时针对多个青少年问题，让父母参与进来以增加改变，并在家庭法院内实施。本研究将我们先前对青少年精神障碍的有效干预扩展到涉及法庭的青少年。青少年及其父母将从罗德岛家庭法院心理健康诊所登记，法官将13-17岁的青少年转介到该诊所接受综合评估和转介治疗。这项随机对照试验将在200名需要门诊治疗的性活跃的法庭参与青年中测试新型综合治疗（ITP, n=100）与社区门诊服务（ESC, n=100）的增强标准治疗的疗效，为期18个月（6个月的ITP或ESC和12个月的随访）。ITP由三个部分组成：1)个人认知行为疗法，包括动机访谈部分，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)家庭和家长培训课程，解决家长沟通和监测问题，以支持青少年减少风险；3)多家庭小组研讨会，以解决艾滋病毒风险，家庭沟通和同伴抵抗技能。两种情况下的青少年（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（如有需要）。ITP将与ESC在减少性风险行为、物质使用、精神障碍症状和法律犯罪方面进行比较。

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.