Integration of substance use and mental health services for justice-involved young women in Brazil

项目摘要 目前的建议旨在研究实施综合药物使用和精神健康服务 为巴西参与司法的年轻妇女举办的培训班。尽管物质使用障碍的比率显著上升， 在过去十年中，在全球JIY女性（18-24岁）中， 在低收入和中等收入国家（LMIC），卫生服务仍然非常低，全球卫生领域 在严格审查制约其执行的因素方面进展甚微。共现 物质使用和精神障碍的JIY妇女是世界范围内的常态，暴露于创伤 理论上认为这是共同发生的症状的发作和相互维持的机制。在LMIC 像巴西一样，物质使用服务是在孤立和资金最少的医疗保健系统中提供的， 提供者处理同时出现的精神症状和创伤的能力低， 产生和维持物质使用。物质使用和心理健康的适当整合 服务（即，由一个或一组提供者同时提供药物使用和精神卫生服务） 可能是一个可行的手段，增加实施物质使用服务的JIY妇女在LMIC 设置.这项拟议的研究利用了物质使用服务研究、实施 科学，青少年司法和全球健康，以指导应急管理（CM）的整合， 标准物质使用干预，与简短的认知行为治疗（CBT）服务，为JIY妇女重新- 从巴西的少年拘留所进入社区。从拘留所释放的JIY妇女（18-22岁） 高风险人群，物质使用复发率高，同时发生精神疾病的比率高 疾病和创伤暴露。混合方法数据将用于探索个人和提供者层面 为这一人群整合CM/CBT服务的障碍和促进因素。理解多层次 实施因素将为制定综合CM/CBT中的供应商实施计划提供信息 提供服务。一项混合方法的开放试验将检查综合治疗的初步可行性和可接受性。 服务供应商实施计划将包括创伤知情的考虑，以提高 提供物质使用服务。研究结果可用于提供最佳做法， 为LMIC的JIY成年人口以及高收入人群提供综合药物使用和心理健康服务 综合干预措施的执行严重滞后的国家。这些发现也可以作为 这是LMIC环境中的一个重要示范项目，因为它们解决了年轻成人物质的重大负担 使用.这项研究得益于巴西完善的社区合作，强大的导师团队， 以及F32申请人之前的全球心理健康研究培训，以实现其目标。

PROJECT ABSTRACT The current proposal seeks to study implementation of integrated substance use and mental health services for justice-involved young (JIY) women in Brazil. Despite a significant rise in rates of substance use disorders among JIY women (age 18-24) globally the past decade, implementation of evidence-based substance use services remains critically low in low- and middle-income countries (LMIC), and the global health field has made minimal progress in rigorously examining factors governing their implementation. Co-occurrence of substance use and psychiatric disorders among JIY women is the norm worldwide, with exposure to trauma theorized as a mechanism underlying the onset and mutual maintenance of co-occurring symptoms. In LMIC like Brazil, substance use services are delivered in isolated and minimally funded healthcare systems by providers with low capacity to address simultaneous psychiatric symptoms and exposure to trauma that may generate and maintain substance use. Contextually appropriate integration of substance use and mental health services (i.e., concurrent provision of substance use and mental health services by one or a set of providers) may be a viable means of increasing implementation of substance use services for JIY women in LMIC settings. The proposed study leverages advances in substance use services research, implementation science, juvenile justice, and global health to guide integration of Contingency Management (CM), a gold standard substance use intervention, with brief cognitive behavioral therapy (CBT) services for JIY women re- entering community from juvenile detention in Brazil. JIY women released from detention (age 18-22 years) are a high-risk population with elevated rates of substance use relapse and high rates of co-occurring psychiatric disorders and trauma exposure. Mixed-methods data will be used to explore individual- and provider-level barriers and facilitators to integration of CM/CBT services for this population. An understanding of multi-level implementation factors will inform development of a provider implementation plan in integrated CM/CBT services delivery. A mixed-method open trial will examine preliminary feasibility and acceptability of integrated services. The provider implementation plan will include trauma-informed considerations to enhance implementation of substance use services. Study findings can be used to inform best practices for delivering integrated substance use and mental health services for JIY adult populations in LMIC, as well as high-income countries where implementation of integrated interventions significantly lags. Findings may also serve as an important demonstration project in LMIC settings as they tackle the significant burden of young adult substance use. The study benefits from well-established community collaborations in Brazil, a strong mentorship team, and the F32 applicant’s prior global mental health research training to fulfill its aims.