• Interview (CAPS-CA) assessing posttraumatic stress disorder and questionnaires (PTCI, IPSI, TMQ, TSCC) and clinician ratings (SOTS) assessing posttraumatic stress symptom severity. [ Time Frame: Post-treatment, 4-6 months post-treatment ] [ Designated as safety issue: Yes ]
  

• Questionnaires assessing problems with externalizing behaviors (Weinberger Adjustment Survey) and socioemotional strengths (Hope, NMR, Weinberger Adjustment Survey) [ Time Frame: Post-treatment and 4-6 months post-treatment ] [ Designated as safety issue: Yes ]
  

Hypotheses, Objectives and Aims:

The purpose of the GIRLS study is to provide counseling to adolescent girls who are (a) at high risk for delinquency and/or are juvenile justice involved and (b) are experiencing symptoms of PTSD, in order to help them regulate their emotions, planning, decision-making, and actions/ interactions in ways that will reduce PTSD and enhance their safety, responsible civic involvement, learning, peer, family, and adult relationships, and physical and psychological well-being. The study will be the first randomized clinical trial of a therapeutic intervention for complex post-traumatic stress disorder (PTSD)with girls: 1) Trauma Affect Regulation: Guide for Education and Therapy (TARGET; Frisman, Ford, Lin, Mallon, & Chang, in press), compared to Enhanced Treatment as Usual (ETAU). Both interventions will provide 12 one-to-one manualized, educational and therapeutic sessions that teach coping skills and stress reduction techniques.

The aims of the study are:

Aim 1) To test if participation in TARGET results in clinically and statistically significant improvements in PTSD symptoms, psychosocial functioning, and emotion/impulse regulation.

Aim 2) To compare the differential affects of TARGET and ETAU on affect regulation, social support, stress-related information processing and cognitive coping, and the reduction of impulsive or aggressive thinking/behavior.

Aim 3) To identify changes in daily self-regulation after TARGET and ETAU.

Aim 4) To identify alterations in brain activity that change after TARGET and ETAU.

An ethnically diverse sample (N=90) of girls at high risk for delinquency and/or with current or past juvenile justice-involvement between 13 and 17 years of age will be recruited in clinic, community, detention, schools, and residential programs. After screening for eligibility and obtaining valid signed consent forms, participants will be randomly assigned to one of the two experimental conditions. Within each condition, trained clinicians will administer 12 sessions of individualized counseling using a manual for the specified intervention. Psychometric self-report and daily monitoring measures will be obtained at baseline, post-treatment, and 6-month follow-up assessments and multivariate statistical techniques will be used for analysis of treatment effects.

Scientific Background and Significance:

Prior research highlights the need to address trauma among justice-involved and delinquent adolescent girls. Delinquency and other high-risk behaviors (e.g., substance use and suicidal ideation) among adolescent girls are often associated with exposure to domestic violence, as well as physical and sexual abuse. Most have experienced past traumas. Impulsive behaviors and poor coping skills often jeopardize and place them at risk for further victimization, physical and psychological harm, and deeper involvement in criminal activities. Consequently, mental health and juvenile justice professionals recognize the need to engage at-risk girls in age-appropriate and gender-sensitive treatment services that treat trauma-related symptoms. However, research that demonstrates the effectiveness of trauma-sensitive interventions for adolescents is still needed. The current study will build the evidence base for the adolescent version of Trauma Affect Regulation: Guide for Education and Therapy, (TARGET) a promising trauma treatment for adolescents.

Inclusion Criteria:

• Female
• Age 13-17 years old
• Past and/or current juvenile justice involvement AND/OR past and/or current delinquent behavior
• Able to obtain assent from youth
• Able to obtain consent from legal guardian
• Willing to assent/consent to be audiotaped for research purposes in assessment and intervention sessions
• Currently experiencing negative reactions to past traumas (PTSD symptoms)

Exclusion Criteria:

• Imminently suicidal
• Past 30 days inpatient psychiatric treatment
• IF meetings take place at a school or group facility and the girl/participant is NOT willing to schedule appointments through the school or group facility staff