Evaluation of Treatments for Homeless Youths
Condition: Substance Abuse
MeSH terms: Substance-Related Disorders
Intervention: Community Reinforcement Approach (CRA) + HIV prevention; Case Management + HIV Prevention; Motivational Enhancement Therapy (MET) + HIV prevention
Intervention description: 12 sessions of the CRA and 2 sessions of HIV prevention.; 12 sessions of case management and 2 sessions of HIV prevention.; 2 sessions of MET and 2 sessions of HIV prevention.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 270.0
Sex: All
Minimum age: 14 Years
Maximum age: 20 Years
Healthy volunteers: No
Keywords: Substance abuse; Homelessness; HIV risk behavior

Summary:

      Youth who leave home for the streets are at significantly more risk for a multitude of
      problems, yet little research is available to guide treatment intervention efforts with this
      population. Studies document high rates of substance use, HIV risk, mental health problems,
      teenage pregnancy and criminality. Research to date examining homeless, street living youth
      has been primarily descriptive; less effort has been directed towards developing and
      evaluating treatment interventions for this group. The majority of homeless youth do not
      receive substance abuse treatment, with one study reporting that only 15% of street living
      youth report ever receiving mental health services. The effectiveness of the Community
      Reinforcement Approach (CRA) with street living youth was studied in our recently completed
      Stage 1 trial. The proposed study is a Stage II clinical trial examining outcome of CRA
      individual therapy as compared to two interventions commonly employed, yet little researched,
      with this group. All clients will be randomized to one of three theoretically distinct
      interventions: (1) CRA therapy, (2) Motivational Enhancement Therapy (MET), or (3) Case
      Management (CM). The relative effectiveness of these interventions will be evaluated at 3, 6,
      and 12 months post-baseline. The Social Ecology Theory of Development (Bronfenbrenner, 1979)
      guides our change hypotheses and intervention. Proposed change mechanisms (mediators) for
      each intervention will be evaluated. Differential treatment response as a function of
      ethnicity, gender, age, sexual orientation and abuse (moderators) will be investigated to
      better understand the interventions. The study will also examine how, if at all, treatment
      engagement, retention and expectations impact youth response to the three treatments.
      Information gained through this project may help address the gap in our understanding of how
      best to effectively intervene with a group at high risk for continuing health and
      psychological problems.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Youth are between the ages of 14-20.

          2. Youth have plans to remain in the Columbus areas for at least 12 months.

          3. Youth meets abuse or dependence DSM-IV criteria for Psychoactive Substance Use or
             Alcohol disorder, as assessed by the computerized diagnostic interview schedule for
             children (CDISC, Shaffer, 1992).

          4. Youth agrees to participate in the assessment and treatment intervention.

          5. Youth meets criteria for homelessness as defined by DHHS.

        Exclusion Criteria:

        1. Evidence of unremitted psychosis or other condition which would impair their ability to
        understand and participate in the intervention or consent for research participation (as
        determined by CDISC).