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年和年轻成年人同时患有精神疾病和药物使用障碍的患病率很高，也有感染艾滋病毒的高风险。然而，即使认识到这些疾病和风险，大多数方案也没有解决所有这些重要问题，而且尚未证明这些多问题青年同时对所有结果的长期疗效。对青年人的不良后果包括部分治疗或复发的精神疾病，继续滥用药物，不变的艾滋病毒风险，以及进一步的法律的问题。该项目与我们现有合作关系的罗得岛家庭法院合作，将通过实施针对心理健康/药物滥用障碍和艾滋病毒风险的综合治疗方案来解决这些问题。ITP的新颖之处在于同时针对多个青少年问题，让父母参与改变，并在家庭法院内实施。这项研究将扩展我们以前的有效干预与精神疾病的青年，以法院参与的青年。青少年及其父母将从罗得岛家庭法院心理健康诊所登记，在那里，13-17岁的青少年由法官转介进行全面评估和转介治疗。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）中的增强标准治疗在18个月期间（6个月的ITP或ESC和12个月的随访）的疗效。ITP包括三个组成部分：1）个人认知行为治疗，包括动机访谈部分，并以模块为基础，以解决同时存在的精神健康和药物滥用问题; 2）家庭和父母培训课程，以解决父母沟通和监测问题，以支持减少青年人的风险; 3）多家庭小组讲习班，以解决艾滋病毒风险，家庭沟通和同伴抵制技能。这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，并从研究精神科医生那里获得精神病药物管理（如果需要）。将ITP与ESC在降低性风险行为、物质使用、精神疾病症状和法律的犯罪方面进行比较。 公共卫生相关性：少年司法环境中的青少年可能有多种问题，需要治疗精神健康和药物使用障碍以及艾滋病毒风险行为。我们希望我们的综合治疗方案，一个在少年司法环境中的强化治疗，涉及父母和目标多个关注领域，将为这些多问题的青年带来更好的结果。

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. PUBLIC HEALTH RELEVANCE: Youth in the juvenile justice setting are likely to have multiple problems and require treatment for mental health and substance use disorders, as well as HIV risk behavior. We expect that our Integrated Treatment Program, an intensive treatment within the juvenile justice setting that involves parents and targets multiple areas of concern, will result in better outcomes for these multi-problem youth.