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

成人创伤知情治疗：基于力量和技能的干预措施减少阿帕奇药物使用和自杀的随机对照试验

• 批准号: 10021425
• 负责人: MARIDDIE J CRAIG
• 金额: $ 20.12万
• 依托单位: WHITE MOUNTAIN APACHE TRIBE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021425
• 关键词: Address; Adult; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Apache; Caring; Childhood; Clinical; Collaborations; Communities; Competence; Country; Data; Diagnosis; Dimensions; Disease; Drug abuse; Drug usage; Elements; Enrollment; Ethics; Evidence based intervention; Evidence based practice; Feeling suicidal; Funding; Goals; Health; Indian reservation; International; Intervention; Interview; Knowledge; Master' s Degree; Mental Depression; Mental Health; Mentors; Methods; Modeling; Native American Research Center for Health; Native Americans; Participant; Pathway interactions; Pharmaceutical Preparations; Plant Roots; Play; Population; Public Health; Qualitative Methods; Qualitative Research; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Research Project Grants; Risk; Risk Factors; Sampling; Services; Specialist; Substance abuse problem; Suicide; Suicide attempt; Supervision; Symptoms; Testing; Time; Training; Transcend; Trauma; Trauma Research; Underserved Population; Waiting Lists; White Mountain Apache; adverse childhood events; adverse outcome; base; behavioral health; commune; contextual factors; data management; effectiveness testing; empowered; evidence base; experience; healing; health disparity; innovation; non-Native; physical conditioning; post intervention; programs; protective factors; resilience; service gap; skills; suicidal behavior; suicidal risk; trauma exposure; trauma symptom

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.

项目概要 美洲原住民 (NA) 针对童年不良事件 (ACE) 的研究发现 与酒精、毒品和自杀风险的关联；以及针对酒精和毒品的 NA 研究 虐待和自杀已将 ACE 确定为危险因素 Apache-JHU NARCH 的目标。 创伤研究项目旨在：1）更好地理解 ACE 的类型、含义和影响， 2) 如何有效减少这些经历对酗酒的阿帕奇成年人的影响， 我们将采用严格的混合方法、基于社区的方法。 将定性方法与随机对照试验相结合，以适应和测试基于力量和技能的 干预，“我的治愈之路”。我的治愈之路是基于创伤知情的、 共同要素干预措施在国际上拥有坚实的证据基础，并将 由嵌入文化的 Apache Community Mental 使用任务转移方法交付 健康专家 (CMHS) 的具体目标是： 1) 描述其含义和影响。 ACES 并使用免费列表和确定 18-65 岁 Apache 成年人的关键弹性因素 与 N=30 个关键利益相关者进行深度访谈 2) 为了调整共同要素干预措施， 我的治愈之路，基于 Aim 1 发现和 CAB 输入，由 Apache CMHS 进行试点 N=10 名 18-65 岁的阿帕奇人，最近有自杀意念和/或物质使用 3) 测试。 使用 N=104 Apache 的等待名单控制 RCT 实现我的治疗之路的有效性 近期有自杀意念和/或滥用药物的 18-65 岁成年人。 参与者的风险（创伤症状、抑郁症）将大大降低，并且 与以下相关的保护因素（希望、公共掌握、功能）增加 干预后 6 个月的物质使用和自杀行为与对照 4) 训练和。 指导 8 名 NA 初级研究者进行创伤知情干预、混合方法研究、 数据管理和研究道德行为 Apache-JHU NARCH 创伤研究。 该项目建立在 NARCH 几轮成功融资的基础上，最终产生了两个 Apache Co- 研究人员完成硕士学位，参加兼职博士课程 心理健康领域，并有权为此提供当地临床监督 该项目将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酗酒、吸毒和自杀——一些 NA 最大的健康差异的使用 CMHS 模型将扩大范围和影响。 以及为成人提供文化上适当且基于证据的创伤知情护理的可扩展性 社区环境中的自杀风险。