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

项目总结 美国原住民(NA)对不良童年事件(ACE)的研究发现 与酒精、药物和自杀风险的关系；以及针对酒精和药物的NA研究 虐待和自杀被认为是危险因素。阿帕奇-JHU NARCH的目标 创伤研究项目是为了：1)更好地了解ACE的类型、含义和影响， 2)如何有效地减少这些经历对阿帕奇成年人饮酒的影响， 吸毒和自杀的风险。我们将使用严格的混合方法，以社区为基础的方法 将定性方法与RCT相结合，以适应和测试基于实力和技能的 干预，《我的治愈之路》。我的治愈之路是基于一种创伤-知情的， 共同要素干预，在国际上有强有力的证据基础，并将 通过文化根深蒂固的阿帕奇社区心理，使用任务转移方法交付 健康专家(CMHS)。具体目的是：1)描述其含义和影响 使用免费列表并确定18-65岁的阿帕奇成年人的关键弹性因素 对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， 我的治愈之路，基于Aim 1的调查结果和由ApacheCMHS为飞行员提供的CAB输入 其中N=10，年龄18-65岁，最近有自杀意念和/或药物使用。3)测试 使用N=104个APACHE的等待名单控制RCT的我的康复之路的有效性 18-65岁的成年人，最近有自杀念头和/或滥用药物。我们假设 参与者将体验到更大的风险降低(创伤症状、抑郁)和 与以下方面相关的保护性因素(希望、集体掌握、功能)的增加 干预后6个月药物使用和自杀行为与对照组比较。4)培训和 导师8名初级调查人员在创伤知情干预，混合方法研究， 数据管理，以及研究的道德行为。APACHE-JHU NARCH创伤研究 该项目建立在几轮成功的NARCH资金的基础上，最终达成了两个阿帕奇联合项目- 调查人员完成硕士学位，攻读兼职博士学位 在精神健康方面，并有权为此提供当地的临床监督 学习。该项目将讨论创伤知情护理研究的关键下一步 研究ACEs和其他创伤如何影响酗酒、吸毒和自杀--一些 NAS最大的健康差距之一。CMHS模式的使用将扩大覆盖范围、影响 为成年人提供符合文化需要和基于证据的创伤知情护理的可扩展性 在以社区为基础的环境中自杀的风险。

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.