Juvenile Detention to Community Life
Condition: Substance Use; Delinquency; Risk for HIV Infection
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The fundamental objective of the proposed study is to develop and test an innovative
      two-stage, cross-systems family-based intervention for substance abusing juvenile offenders.
      The first stage of the experimental treatment is provided for youths in juvenile detention
      settings. Stage two of the intervention occurs after the offender is released to the
      community. Participants are randomized to one of two study conditions: the cross-systems
      family-based intervention (Multidimensional Family Therapy-Cross Systems (MDFT-CS), or 2)
      Enhanced Services as Usual (ESAU). Both conditions incorporate HIV prevention in detention
      and we will also examine the effects of a family-based HIV/STD prevention module beyond the
      impact of a standard HIV/STD education intervention delivered in detention by including
      ongoing HIV/STD intervention in MDFT-CS following release from detention. There are five aims
      of the proposed study. These aims relate to: 1) Intervention development and implementation;
      2) Clinical effectiveness; 3) Impact of HIV/AIDS/STD prevention; 4) Comparative
      benefit-costs; and 5) Systems-level impact
    

Detailed description: 
      This study will employ a fully randomized (2 conditions) by 9 assessment points (baseline,
      discharge from detention, and 3, 6, 9, 18, 24, 36 and 42 months following detention
      discharge), repeated measures intent-to-treat design with multiple dependent variables. 154
      males and females (85 participants from Miami Dade Regional Juvenile Detention Center and 85
      from Pinellas Juvenile Detention Center) who meet the study eligibility criteria will be
      randomized to one of the two treatment conditions.

      The study will also include a 6-month pilot phase. During this phase, the MDFT detention
      intervention and cross-systems collaboration protocols will be developed; the existing
      treatment manual will be revised; the MDFT-CS with family-based HIV prevention module and
      standard HIV education intervention will be developed; family therapists will be trained in
      the MDFT intervention (including HIV/STD module); the MDFT-CS intervention will be piloted;
      the assessment battery will be piloted; the protocols, manual, and training package will be
      revised and finalized; research staff will be trained on all procedures and protocols; and
      data management procedures will be developed.

      During Stage 1, adolescents in all intervention conditions will receive standard detention
      services, which include education and health care. In addition, youth assigned to the ESAU
      condition will receive the standard mental health and substance abuse services offered in the
      detention (mainly psychoeducational in nature). Youth assigned to the MDFT-CS intervention
      will not receive standard mental health/substance abuse services provided by the detention
      center, as these youth will be assigned a MDFT therapist who will address their mental health
      and substance abuse issues needs.

      Experimental Treatment: Multidimensional Family Therapy-Cross Systems (MDFT-CS). In Stage 1
      (in detention) MDFT-CS, the experimental treatment, consists of two major components:
      standard initial/engagement work with parents in the home and with adolescents in detention
      (both conducted weekly for the duration of the adolescents stay in detention), plus a
      state-of-the-art HIV education prevention module based on CDC-endorsed strategies. The
      in-detention MDFT will be delivered by therapists employed by the University of Miami/ Center
      for Treatment Research on Adolescent Drug Abuse (CTRADA) who will continue to treat the youth
      and family after release from detention. In Stage 2, the experimental treatment includes the
      standard MDFT components (4 overall change units/targets: adolescent, parent, family
      interaction, and functioning of the family members vis a vis relevant extrafamilial social
      systems such as school and juvenile justice).

      Enhanced Services as Usual (ESAU). In Stage 1 (in detention), ESAU includes two major
      components - standard drug treatment services that are delivered by detention staff, and
      state-of-the-art HIV education prevention intervention delivered to all participating youth.

      In Stage 2, community drug treatment providers deliver high quality drug treatment on an
      outpatient basis. To minimize heterogeneity within the comparison condition, and in order to
      provide better service and treatment tracking opportunities, the study will only use one
      community based treatment agency to deliver ESAU per locale at each Research Center.

      All measures selected are psychometrically strong, sensitive to change, and have been used
      widely in adolescent substance abuse treatment studies.
    

Intervention name(s): Multidimensional Family Therapy Cross-Systems; Enhanced Services as Usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Standard initial/engagement work in the home and detention, plus a state-of-the-art HIV education prevention module as well as standard MDFT which 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.; Standard drug treatment services in detention and state-of-the-art HIV education prevention intervention, as well as outpatient drug treatment provided by community drug treatment providers
Other intervention name(s): MDFT-CS; ESAU
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Juvenile Offenders; HIV/STD Prevention; Adolescent Substance Abuse; Multidimensional Family Therapy