This grant application is for the Scientist Development Award for Clinicians. The comorbidity of psychiatric disorders and substance abuse among American Indian adolescents is a serious problem. Depression, suicide, conduct disorder, school dropout, delinquency, and running away have been shown to be related to substance abuse among American Indian adolescents. The treatments, treatment pathways, and outcomes for American Indian adolescents with psychiatric and comorbid substance abuse disorders have never been systematically examined. Yet the system of services for this population is acknowledged to be fragmented with poor articulation of substance abuse treatment programs with mental health services, schools, social services, and other treatment providers in the community. This study proposes to fill this vital gap in knowledge by examining the treatment pathways for American Indian adolescents who receive treatment for substance abuse at a residential treatment program. The following are the specific aims of the proposed study: (1) Determine the effects of comorbid psychiatric disorders as well as individual, social network, and service system characteristics on treatments received and treatment pathways for American Indian adolescents who receive residential substance abuse treatment, and (2) Determine the effects of types of treatment received, treatment pathways, and the characteristics listed above on treatment outcome for this population. The study consists of Preliminary, Pilot, and Full implementation phases. In the Preliminary Phase, the system of services for this population will be determined. In the Pilot Phase, the selected interviews, questionnaires, and follow- up techniques will be tested on a small sample of patients. In the full Implementation Phase, the refined research methodology will be applied prospectively to a randomly selected group of patients admitted to a residential substance abuse treatment center to determine their individual characteristics (particularly the presence of a comorbid psychiatric disorder) and pathways through the system of care. This information will have a major impact on understanding of the treatment pathways for American Indian adolescents with substance abuse problems and comorbid psychiatric disorders who receive residential substance abuse treatment. The Career Development Plan has been designed specifically to develop the principal investigator's knowledge and skills so that he will be capable of conducting independent mental health services research in transcultural settings. The goals of this plan are to develop mastery in: (1) the design of health services research; (2) the use questionnaires, as well as structured and semi- structured interview methods; (3) the techniques for adapting such methods for cross-cultural application; (4) the reduction, management, analysis, and interpretation of research data generated by the proposed study; and (5) the reporting of these findings in scientific fashion. The methods for career development include: (1) the proposed research project; (2) the mentorship and supervision of Dr. Manson, Dr. Bechtold, and other members of the University of Colorado Health Sciences Center faculty; (3) off-site tutorials and ongoing consultations with experts in the areas of child and adolescent psychiatric services and transcultural research; (4) coursework; (5) participation in the ongoing training activities of the National Center for American Indian and Alaska Native Mental Health Research; (6) attendance at scientific conferences, and (7) preparation of the data generated by the project for submission to professionally refereed journals.
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