Family-Based Juvenile Drug Court Services
Condition: Substance Use; Delinquency
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The objective of the proposed study is to adapt and implement an efficacious adolescent
      substance abuse treatment, Multidimensional Family Therapy (MDFT), within the juvenile drug
      court service system. Additionally, the investigators will also examine the extent to which
      MDFT can enhance the effectiveness of existing juvenile drug court services in terms of
      decreasing drug use, delinquent behavior and arrests and improving school and vocational
      outcomes. The study design is a fully randomized controlled trial.
    

Detailed description: 
      Many questions remain regarding optimal treatments for juvenile drug court. To address this
      gap, the investigators will compare two treatments delivered in a drug court setting:
      Multidimensional Family Therapy (MDFT) and adolescent group therapy (AGT). This 5-year study
      will employ a fully randomized (2 conditions) by 5 assessment points (baseline, 6, 12, 18,
      and 24 months following baseline), repeated measures intent-to-treat design with multiple
      dependent variables. Adolescents who have been accepted into the Miami Juvenile Drug Court
      (MJDC) will be randomized to receive one of two treatments: MDFT (n = 57) or AGT (n = 55).
      The substance abuse treatments will be equivalent in terms of therapeutic dosage, and all
      youth with receive the same drug court program with wtreatment received being the only
      difference (family vs non-family treatment). In order to maximize the ecological validity of
      the study, both treatments will be delivered by community-based drug abuse counselors. MDFT
      will be delivered by providers at Jackson Memorial Hospital's Adolescent Substance Abuse
      Program and AGT by providers at a separate facility, Here's Help.

      Aim 1. Acceptability and Effectiveness. The study will address the comparative acceptability
      and effectiveness of the two drug court programs in ways that are consistent with
      recommendations from the juvenile drug court literature to consider multi-domain and multiple
      perspectives of program goals and outcomes. First, effectiveness will be assessed in terms of
      the differential rates at which youth in MDFT and AGT graduate from drug court, a primary
      goal of the drug court program. Juvenile offending substance abusers and their families are
      notoriously difficult to engage and retain in any type of treatment program, yet family-based
      interventions have demonstrated impressive retention rates with these populations. Thus an
      important aspect of the proposed effectiveness evaluation will be the extent to which the
      MDFT intervention improves drug court program completion rates. Our second perspective on
      effectiveness involves an examination of the rates of change in a number of critical domains,
      including reductions in substance use, arrests, and delinquent behaviors, as well as
      improvements in school/vocational performance over a 2-year period. With these
      multidimensional outcome assessments the investigators will be able to explore different
      dimensions and trajectories of recovery following drug court participation. This is
      consistent with the aims of juvenile drug courts not only to reduce drug use and delinquency
      but also to increase adolescents' prosocial skills and behaviors. The investigators are also
      interested in examining multiple perspectives on the relative acceptability of MDFT to drug
      court staff, teens, and families, as recommended by drug court researchers.

      Aim 2. Drug Court Program Mechanisms. While the few existing studies of key drug court
      factors have focused mainly on the structural and judicial aspects of drug court programs,
      almost nothing is known about the treatment processes affecting drug court outcomes, or the
      mechanisms of clinical and judicial component impact. Clearly, an important next step in this
      specialty is to delineate the treatment processes and ingredients that maximize outcomes in
      drug court, particularly in relation to the application of evidence-based therapy models
      within drug court programs. Examination of change mechanisms is now recognized as an
      essential feature of state-of-the-art drug abuse intervention research. Among those process
      variables considered important in mediating drug treatment outcomes are the therapeutic
      alliance that is formed between provider and client , and the extent to which a positive
      collaborative relationship develops among all drug court team members, including the judge.
      Research on family-based interventions supports the contention that family-based treatments
      exert their effects through the reduction of family risk and the facilitation of protective
      processes, and family functioning has been found to play a primary role in helping teens
      achieve and maintain recovery after substance abuse treatment. In sum, given that the quest
      to improve drug court program development, implementation, and outcomes rests in large part
      on the clarification of the programs' mechanisms of action, drug court researchers have
      turned their attention to analyses linking within-program processes to outcomes. The proposed
      study will do likewise.
    

Intervention name(s): Miami Juvenile Drug Court-MDFT; Miami Juvenile Drug Court -TAU
Intervention type(s): Behavioral; Behavioral
Intervention description(s): MDFT assesses and intervenes in five domains: 1) Interventions with the adolescent, 2) interventions with the parent, 3) interventions to improve the parent-adolescent relationship, 4) interventions with other family members, and 5) interventions with external systems.; Each client is provided with a primary outpatient counselor who develops a treatment plan to address long-range goals. Family members are included in an assessment and treatment planning session at the beginning of treatment, but no formal family therapy is provided. Group therapy topics include self-esteem enhancement, decision-making skills, stress/anger management, communication skills, health education, teen pregnancy prevention, and occupational/career planning.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: juvenile drug court; adolescents; substance abuse; delinquency; family therapy; multidimensional family therapy