Substance Use Clinical Trial
Official title:
Facilitating Adolescent Offenders' Reintegration From Juvenile Detention to Community Life (DTC)
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
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.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Double Blind (Investigator, Outcomes Assessor), Primary Purpose: Treatment
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