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

为巴西参与司法的年轻女性整合药物滥用和心理健康服务

基本信息

批准号：
10680331
负责人：
MEGAN RAMAIYA
金额：
$ 7.36万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10680331
关键词：
Address Adolescent Age Behavior Brazil Child Abuse Cognitive Therapy Collaborations Communities Country Criminal Justice Data Development Educational Curriculum Educational workshop Family Fracture Funding Future General Population Goals Health Services Research Healthcare Healthcare Systems Imprisonment Income Individual Interpersonal Violence Intervention Justice Maintenance Mental Health Mental Health Services Mental disorders Mentorship Methods National Institute of Drug Abuse Politics Population Provider Psychiatric Diagnosis Public Health Qualitative Methods Relapse Research Research Training Resources Risk Services Substance Use Disorder Suicide attempt System Training Trauma Violence Youth acceptability and feasibility adolescent substance use associated symptom contingency management detention center evidence base global environment global health high risk behavior high risk population implementation determinants implementation science implementation strategy low and middle-income countries male mortality risk non-suicidal self injury novel provider-level barriers psychiatric symptom recidivism reduced substance use service delivery service providers social stigma substance use substance use treatment theories trauma exposure young adult young woman

项目摘要

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.

项目摘要目前的提案旨在研究综合药物使用和心理健康服务的实施尽管物质使用障碍的发生率显着上升，但巴西参与正义的年轻女性 (JIY) 仍然受到关注。过去十年，全球 JIY 女性（18-24 岁）中实施循证药物使用情况低收入和中等收入国家 (LMIC) 的服务水平仍然极低，全球卫生领域在严格审查其实施的共现因素方面进展甚微。 JIY 女性中的药物滥用和精神疾病是世界范围内的常态，并且遭受创伤理论上被认为是中低收入国家共同出现症状的发生和相互维持的机制。像巴西一样，物质使用服务是在孤立且资金最少的医疗保健系统中提供的提供者同时处理精神症状和遭受创伤的能力较低，这可能会导致产生并维持物质使用与心理健康的适当结合。服务（即由一个或一组提供者同时提供药物使用和心理健康服务）可能是为中低收入国家的 JIY 妇女增加实施药物滥用服务的可行方法拟议的研究利用了物质使用服务研究和实施方面的进展。科学、青少年司法和全球健康来指导应急管理（CM）的整合，这是黄金标准物质使用干预，为 JIY 妇女提供简短的认知行为治疗 (CBT) 服务从巴西少年拘留所进入社区的 JIY 妇女是从拘留所释放的（18-22 岁）。物质使用复发率较高且同时发生精神疾病的比例较高的高危人群混合方法数据将用于探索个人和提供者层面。为该人群整合 CM/CBT 服务的障碍和促进因素对多层次的理解。实施因素将为综合 CM/CBT 中提供商实施计划的制定提供信息混合方法公开试验将检验综合服务的初步可行性和可接受性。提供者实施计划将包括创伤知情的考虑因素，以加强服务。研究结果可用于提供提供最佳实践的信息。为中低收入国家和高收入地区的 JIY 成年人提供综合药物使用和心理健康服务综合干预措施实施严重滞后的国家的调查结果也可作为参考。中低收入国家环境中的重要示范项目，因为它们解决了年轻人物质负担的重大负担该研究受益于巴西完善的社区合作、强大的指导团队、 F32 申请人之前为实现其目标而接受的全球心理健康研究培训。