Juvenile Offender HIV Prevention and Drug Abuse Services
Condition: Risk Behavior; Substance Abuse; Delinquency
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      This study will determine the clinical effectiveness, moderators and mechanisms of change,
      and economic impact of an integrative, family-based intervention that concurrently targets
      change in HIV/Sexually Transmitted Disease (STD)-associated risk behaviors, drug abuse,
      delinquency, arrest and mental health outcomes for juvenile offenders committed to a juvenile
      justice day treatment program.
    

Detailed description: 
      Adolescents committed to three school-based day treatment programs located in Miami-Dade
      County will be randomized to either Day Treatment MDFT-HIV (DT-MDFT-HIV) or Day Treatment
      Program Services as Usual (DT-SAU). Youth in both conditions will be enrolled in day
      treatment, and receive the same type of juvenile justice supervision, participate in the same
      educational, life skills, vocational and recreational programs. They will only differ in the
      type of substance abuse treatment and HIV prevention services received, DT-MDFT-HIV versus
      substance abuse and HIV prevention services currently being provided by the day treatment
      programs. If participants are eligible, they will then be assessed on multiple measures at 5
      time points: intake, 3, 6, 12, and 24 months following commitment to the day treatment
      facility. Data will be analyzed using an intent-to-treat design - adolescents and one parent
      are assessed at all time points and included in data analyses, regardless of the amount of
      treatment received.

      The study has three aims:

      Aim 1: Intervention Effectiveness - To experimentally compare, in a day treatment setting,
      the short and long-term clinical outcomes of the Experimental Intervention - MDFT-HIV
      Integrated intervention (DT-MDFT-HIV) for sexually active drug abusing juvenile offenders
      with Day Treatment Services as Usual (DT-SAU).

      Hypothesis 1a. Youths assigned to DT-MDFT-HIV will show a greater decrease in HIV-associated
      sexual risk behaviors, laboratory-confirmed STD incidence, drug use, arrests and out of home
      placements, and mental health symptoms from baseline assessment through 6 months
      post-baseline than youths in SAU.

      Hypothesis 1b. Youths assigned to DT-MDFT-HIV will show a greater decrease in HIV-associated
      sexual risk behaviors, laboratory-confirmed STD incidence, drug use, arrests and out of home
      placements, and mental health symptoms from 6 months post baseline to 24 months post-baseline
      than youths in SAU.

      Hypothesis 1c. Youths assigned to DT-MDFT-HIV will be more likely to successfully transition
      out of the juvenile justice day treatment program--and return to regular school
      placement--than those assigned to services as usual.

      Aim 2: Moderating Effects - To identify baseline client characteristics that moderate
      intervention outcomes.

      Hypothesis 2. For youths with high baseline levels of co-morbidity, HIV-associated sexual
      risk behaviors, drug use and delinquency, the DT-MDFT-HIV intervention will reduce
      HIV-associated sexual risk behaviors and laboratory-confirmed STD incidence, drug use, and
      arrests and out of home placements more significantly than the DT-SAU condition. For youths
      with low baseline levels of HIV-associated sexual risk behaviors, drug use and delinquency,
      the two interventions will be comparably effective.

      Aim 3: Mechanisms of Action - To identify the mechanisms through which the experimental
      intervention achieves its effects.

      Hypothesis 3a. For youths assigned to DT-MDFT-HIV, reductions in HIV-associated sexual risk
      behaviors and laboratory-confirmed STD incidence will be achieved through (a) increases in
      HIV/STD knowledge and risk-reduction skills, (b) enhanced self-efficacy regarding condom use,
      (c) improved communication and refusal skills with partners, (d) greater perceived peer norms
      supportive of safer sex, (e) open communication with parents about HIV and sexual risk
      behaviors, and (f) more effective parenting and improved family functioning.

      Hypothesis 3b. For youths assigned to DT-MDFT-HIV, reductions in drug use and delinquency
      will be achieved through (a) increases in adolescents' bonding to prosocial peers and
      activities (e.g. school), (b) increases in parents' emotional bonding to their adolescent,
      and improvements in parenting practices, and (c) more positive family environment.
    

Intervention name(s): Day Treatment MDFT-HIV; Day Treatment SAU
Intervention type(s): Other; Other
Intervention description(s): MDFT-HIV is a specialized intervention aimed at reducing risk factors for HIV-associated sexual behaviors. It builds protective behaviors in the adolescent's intrapersonal and interpersonal functioning, as well as those aspects of family functioning to reduce youths' high-risk sexual behavior. For instance, interventions target inadequate monitoring, parent-adolescent conflict, and parental disengagement - behaviors consistently associated with elevated HIV/STD risk. It facilitates positive and supportive family relationships, processes that can significantly reduce HIV/STD risk. Additionally, it aims to promote effective family communication about sexuality and safer sexual behaviors, among the most important protective factors against sexual risk taking behavior.; Substance abuse treatment and HIV prevention services are routinely provided to youth in the day treatment programs. The day treatment programs contract to local substance abuse and mental health providers for these services that are provided both within and outside of the day treatment setting. The intervention's specific features are similar to those found in the literature on outpatient peer-based group treatment for adolescent alcohol abusers (CSAT 1998). Specifically, it is based on a cognitive-behavioral group treatment model (Kaminer et al 1998; Marshall & Marshall 1993), with a comprehensive treatment package including individual counseling and treatment planning.
Other intervention name(s): DT-MDFT-HIV; DT-SAU
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Delinquency; HIV Associated Risk Behavior; Juveniles; Family based treatment; Multidimensional Family Therapy