Recent epidemiologic findings suggest that trauma is highly prevalent among American Indians (Al) adolescents and adults and that Posttraumatic Stress Disorder (PTSD) is the most common mental disorder in this population. These studies also show that trauma-related symptoms and PTSD are highly comorbid with other behavioral health problems, such as depression, anxiety, and substance use problems. Unfortunately, Al communities suffer from substantial disparities in access to quality behavioral health services for their adolescents. These disparities are largely the result of the lack of adequate funding, lack of properly trained personnel, and substantial geographic barriers. Use of these services is also compromised by perceptions of Al adolescents and their parents that those services that are available are difficult to access and often fail to provide the full range of interventions that they want and need. In this application, we propose to engage in the process of identifying and assessing potential interventions for improving the quality, accessibility, and acceptability of behavioral health services for traumatized Al adolescents with comorbid substance use and other behavioral health problems who receive services at a tribally-operated residential substance abuse treatment program. Guided by a Steering Committee of parent and youth advocates, clinicians, administrators, policymakers, and researchers, we will engage a broad array of key stakeholders in a process to identify those interventions that are of greatest relevance to these adolescents and their families, most feasible given the program's and community's resources, and have the strongest prospects for long-term sustainability. The specific aims of this project are as follows: 1) to assess the relevance, feasibility, and sustainability of potential interventions for traumatized adolescents with comorbid substance use problems who are served by the Jack Brown Center; 2) to target the highest ranked interventions for subsequent development and pilot testing; and 3) to describe and analyze this investigative process itself so that the methods that emerge can be used for similar intervention development efforts in Al and non-AI communities. Through this project, we will identify an intervention fits with this community's strengths and needs. This work will also allow us to start developing this intervention for testing and use in this and other Al communities.

R34MH077872

2006-09-21

2010-06-30