Trauma-informed Treatment for Adults: RCT of a Strength and Skills-Based Intervention to Decrease Apache Substance Use and Suicide

项目摘要 美国原住民（NA）研究儿童不良事件（ACE）发现， 与酒精、药物和自杀风险的相关性;以及针对酒精和药物的NA研究 滥用和自杀已确定ACE为风险因素。Apache-JHU Numbers的目标 创伤研究项目的目的是：1）更好地了解ACE的类型，含义和影响， 以及2）如何有效地减少这些经验对酗酒的阿帕奇成年人的影响， 毒品和自杀风险。我们将采用严格的混合方法，以社区为基础的方法 将定性方法与RCT相结合，以适应和测试基于力量和技能的 《我的治愈之路》（My Pathway to Healing）我的治愈之路是基于一个创伤知情， 共同要素干预措施，在国际上具有强大的证据基础， 通过文化嵌入式Apache Community Mental使用任务转移方法交付 健康专家。具体目标是：1）描述其含义和影响 的ACES，并确定关键弹性因素的Apache成年人年龄在18-65使用免费上市， 与N=30个关键利益相关者进行深入访谈。2)为了适应共同要素干预， My Pathway to Healing，基于Aim 1发现和CAB输入，由Apache CMHS进行试点 其中N=10名年龄在18-65岁之间的阿帕切人，最近有自杀意念和/或物质使用。3)测试 使用等待列表对照RCT（N=104 Apache）评估我的治愈之路的有效性 18-65岁的成年人，近期有自杀意念和/或滥用药物。我们假设 参与者将经历更大的风险降低（创伤症状，抑郁症）， 保护性因素（自主性，社区掌握，功能）的增加与 药物使用和自杀行为与对照组在干预后6个月。4)培养和 指导8名NA初级研究人员进行创伤知情干预，混合方法研究， 数据管理和研究的道德行为。Apache-JHU Nervous创伤研究 该项目建立在几轮成功的NXP融资的基础上，最终获得了两个Apache Co- 完成硕士学位的研究员，参加兼职博士课程 在精神健康方面，并有权为此提供当地临床监督， study.该项目将通过以下方式解决创伤知情护理研究的关键后续步骤： 研究ACE和其他创伤如何影响酒精滥用，药物滥用和自杀-一些 最大的健康差距。CMHS模型的使用将扩大覆盖范围、影响 为成年人提供文化上适当和基于证据的创伤知情护理的可扩展性， 在社区环境中的自杀风险。

PROJECT SUMMARY Native American (NA) studies focused on Adverse Childhood Events (ACEs) have found associations with alcohol, drug, and suicidal risk; and NA studies targeting alcohol and drug abuse and suicide have identified ACEs as risk factors. The goal of the Apache-JHU NARCH trauma research project is to: 1) better understand the types, meanings and impact of ACEs, and 2) how to effectively reduce the impact of these experiences in Apache adults with alcohol, drug and suicide risks. We will use a rigorous mixed-methods, community-based approach combining qualitative methods with a RCT to adapt and test a strength- and skills-based intervention, “My Pathway to Healing.” My Pathway to Healing is based on a trauma-informed, common elements intervention that has a robust evidence-base internationally, and will be delivered using a task-shifting approach by culturally embedded Apache Community Mental Health Specialists (CMHS). The specific aims are to: 1) to characterize the meaning and impact of ACES and identify key resilience factors for Apache adults ages 18-65 using Free Listing and In-Depth Interviews with N=30 key stakeholders. 2) To adapt a common elements intervention, My Pathway to Healing, based on Aim 1 findings and CAB input for piloting by Apache CMHS with N=10 Apaches ages 18-65 with recent suicide ideation and/or substance use. 3) To test the effectiveness of My Pathway to Healing using a wait-list controlled RCT with N=104 Apache adults ages 18-65 with recent suicide ideation and/or binge substance use. We hypothesize that participants will experience greater reductions in risk (trauma symptoms, depression) and increases in protective factors (hopefulness, communal mastery, functioning) related to substance use and suicidal behavior vs. controls at 6 months post-intervention. 4) To train and mentor 8 NA junior investigators in the trauma informed intervention, mixed methods research, data management, and ethical conduct of research. The Apache-JHU NARCH trauma research project builds on several successful rounds of NARCH funding, culminating in two Apache Co- Investigators completing their Master's degrees, enrolling in part-time doctoral programs in mental health, and being empowered to provide local clinical supervision for this study. This project will address critical next steps in trauma-informed care research by examining how ACEs and other trauma affect alcohol abuse, drug abuse, and suicidality—some of the largest health disparities for NAs. The use of a CMHS model will extend the reach, impact and scalability of culturally appropriate and evidence-based trauma-informed care for adults at risk of suicide in a community-based setting.