Evaluation of Treatments for Homeless Youths

Study Overview
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Brief Summary
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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.

Official Title
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Evaluation of Treatments for Homeless Youth: CRA, MET and Case Management

Conditions
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Substance Abuse

Intervention / Treatment
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* Behavioral: Community Reinforcement Approach (CRA) + HIV prevention
* Behavioral: Case Management + HIV Prevention
* Behavioral: Motivational Enhancement Therapy (MET) + HIV prevention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Youth are between the ages of 14-20. Youth have plans to remain in the Columbus areas for at least 12 months. 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). Youth agrees to participate in the assessment and treatment intervention. 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).

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CRA + HIV prevention<br> | Behavioral: Community Reinforcement Approach (CRA) + HIV prevention<br>* 12 sessions of the CRA and 2 sessions of HIV prevention.<br>|
| Active Comparator: Case Management + HIV prevention<br> | Behavioral: Case Management + HIV Prevention<br>* 12 sessions of case management and 2 sessions of HIV prevention.<br>|
| Active Comparator: MET + HIV prevention<br> | Behavioral: Motivational Enhancement Therapy (MET) + HIV prevention<br>* 2 sessions of MET and 2 sessions of HIV prevention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Substance Use | Percentage of substance use days in prior three months. | Three months | 
| Substance Use | Percentage of substance use days in prior three months | Six months | 
| Substance Use | Percentage of substance use days in prior six months | Twelve months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| HIV Risk | Frequency of condoms use in prior three months. | Three months | 
| HIV Risk | Frequency of condoms use in prior three months. | Six months | 
| HIV Risk | Frequency of condoms use in prior six months. | Twelve months | 
| Depressive Symptoms | Beck Depression Inventory - II (BDI-II) total score, range from 0 (no depresion)to 63 (severe depression) | Three months | 
| Depressive Symptoms | Beck Depression Inventory - II (BDI - II) Range from 0 (no depression) to 63 (severe depression) | Six months | 
| Depressive Symptoms | Beck Depression Inventory - II (BDI-II) total score, range from 0 (no depression)to 63 (severe depression) | Twelve months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Substance abuse, Homelessness, HIV risk behavior