Targeting HIV Risk Behaviors in Juvenile Drug Court-Involved Youth
Condition: Substance Use; Sexual Risk Behaviors
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      This study is designed to gain knowledge about effective interventions for reducing HIV risk
      in a high risk population. A new Risk Reduction Therapy for Adolescents (RRTA) will be
      compared to usual services received by youth in juvenile drug courts. It is expected that
      youth treated with RRTA will show greater reductions in substance use and risky sexual
      behaviors. Reducing HIV risk by effectively targeting substance use and risky sexual
      behaviors in high-risk groups such as juvenile drug court-involved youth could favorably
      impact society at multiple levels (individual, family, peer, community, fiscal).
    

Detailed description: 
      The overriding purpose of this study is to develop and test an intervention for reducing
      substance use and risky sexual behaviors among youth involved in juvenile drug court.
      Juvenile drug court provides an excellent setting in which to pursue the key study objectives
      by providing access to a well identified high risk population. Second, in addition to
      frequent judicial oversight, juvenile drug courts include several features that can enhance
      intervention effectiveness, sustainability, and potential for adoption. In addition, the fact
      that all juvenile drug courts have community-based treatment components and that such courts
      have been disseminated nationwide suggests the possibility of eventual widespread adoption if
      the proposed intervention is effective. The proposed intervention integrates evidence-based
      protocols for contingency management (CM) for substance abusing youth and family engagement
      strategies, with an evidence-informed family systems intervention for sexual risk originally
      developed to address substance use and sexual risk behaviors in HIV+ youth. These three
      interventions will be integrated into an efficient intervention that, if effective, can be
      amenable to adoption by juvenile drug courts. Following protocol development and beta
      testing, 160 drug court youth and their families will be randomized to the experimental
      intervention condition (Risk Reduction Therapy for Adolescents or "RRTA") versus Drug Court
      with Community Services (DC) conditions. Key outcomes will be assessed through 18-months
      post-baseline using a multi-method approach that will include assessment of substance use,
      risky sexual behaviors, criminal behavior, and participation in HIV counseling and testing
      services. Specific aims include: 1: Adapt existing intervention and training protocols into a
      single, efficient RRTA intervention, beta test this RRTA protocol with four youth in juvenile
      drug court and their families, and revise treatment and research protocols accordingly; 2:
      Conduct a randomized trial with 160 youth in juvenile drug court and their families to
      examine youth-level intervention effects (i.e., on substance use, sexual risk behavior, HIV
      counseling and testing, delinquent behavior) in comparison to DC through 18- months post
      referral and assess intervention fidelity. 3. If results suggest a positive RRTA treatment
      effect, revise the intervention and training protocols in preparation for an effectiveness
      study and extended follow-up study. Importantly, the proposed study will (1) consider the
      multiple levels of influence on juvenile drug use, criminal justice involvement, and HIV risk
      behaviors, (2) integrate a drug abuse and HIV prevention intervention for youth in the
      criminal justice system with drug-related offenses, (3) address health disparities by
      targeting a primarily minority population of youth, and (4) increase referrals to HIV testing
      and counseling of drug court-involved youth. This study is designed to reduce HIV risk by
      addressing the potent interaction of drug use and risky sexual behaviors in drug court youth
      with evidence-based treatment components to maximize the likelihood of reversing these
      youths' adverse behavioral trajectories.
    

Intervention name(s): Risk Reduction Therapy for Adolescents; Usual services
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This project integrates CM and a family systems intervention for sexual risk with evidence-based family engagement strategies, and tests this intervention in a juvenile drug court setting. Due to the individualized nature of the proposed intervention, the specific course of treatment will vary by youth and family. Based on our experience with clinic-based treatment models it is anticipated that most families will remain in active treatment for 4-6 months and that, during this time, they will attend approximately 1-2 sessions per week, for 1-2 hours per session.; In addition to the standard juvenile drug court requirements, youth randomly assigned to the usual services condition are also ordered to receive treatment services from the local state or privately-funded alcohol and drug treatment provider agencies. The service delivery model for agencies typically includes intensive outpatient, traditional outpatient, and home-based services, depending upon assessment of youth and family needs. Groups focus on risk reduction, peer influence, conflict resolution, and anger management. Additionally, youth might receive treatment pertaining to drug selling behavior, individual sessions and/or family group therapy. The theoretical orientations of the provider agencies are cognitive-behavioral and systems theory. Interventions are not usually manual driven, and selection of material is typically left to the therapists' discretion.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: juvenile; randomized trial; substance abuse; sexual risk; contingency management