Long-term Outcomes and Economic Impact of the Detention to Community Model

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DESCRIPTION (provided by applicant): Given the severe and often life-long consequences linked to drug abuse, criminal involvement, and risky sexual behavior in childhood and adolescence, early intervention is considered by many to be crucial to halt the progression of these devastating problems. Family-based treatments have shown strong short-term outcomes on drug abuse and delinquency in adolescence, yet evidence for their long-term effects into young adulthood is limited. This study builds upon promising preliminary findings of the NIDA-funded Criminal Justice Drug Abuse Treatment Studies (CJDATS) "Detention to Community" (DTC) study. The DTC study developed and tested short-term (up to 9 month) effects of an innovative and integrative family-based intervention, Multidimensional Family Therapy (MDFT) in comparison to Enhanced Services as Usual (ESAU) among young offenders in detention and as they returned home to the community. Existing data from the parent project show strong preliminary effects of MDFT on youths' drug use, delinquency, and HIV-associated risk factors, thus further study of the interventions' potential to impact youths' trajectories into young adulthood seems a critical next step. The current study proposes to conduct comprehensive assessments of the 154 DTC participants on a range of outcomes at 2, 3, 4, and 5 years post-detention release, as well as protective factors that may influence these long-term outcomes. A comprehensive economic evaluation is also being proposed to examine the long-term benefits and costs and cost effectiveness of MDFT vs. ESAU. A final aspect of the study concerns the examination of how repeated treatment episodes and incarcerations during the 5-year follow-up period may interact with and help account for long-term intervention effects. The study has four aims: (1) To compare the long-term effectiveness of Multidimensional Family Therapy (MDFT) vs. Enhanced Services as Usual (ESAU) in reducing drug use, criminal behaviors, arrests and incarcerations, STD and HIV infection, HIV-associated risk behaviors, and mental health problems and promoting protective factors among a sample of youths recruited in juvenile detention centers; (2) To examine the relationship between protective factors (family, peer, educational/vocational functioning), and outcomes during the five-year post-detention period; (3) To evaluate and compare the long-term economic costs, benefits, and cost effectiveness to society and to the juvenile justice system of MDFT and ESAU; and (4) To examine the cumulative effects of repeated treatment episodes and incarcerations on targeted outcomes from adolescence into young adulthood. A multiple-domain and method assessment approach, including laboratory confirmed tests of HIV and STD incidence and substance use, and latent growth curve modeling techniques will be used to examine study hypotheses regarding adolescents' change over time. The study has significant potential to improve interventions and service delivery systems by providing new knowledge about the long-term effective and cost-efficiency of comprehensive, integrative interventions for drug abusing juvenile offenders at high risk for HIV. PUBLIC HEALTH RELEVANCE: Longitudinal studies confirm that many adolescents in the juvenile justice system experience chronic drug abuse, criminal involvement, HIV/STD-associated adverse health outcomes, and mental health disorders well into adulthood, however evidence for the long-term effectiveness of interventions designed to halt these devastating trajectories is sorely lacking. The proposed study, which tests the long-term effectiveness and economic impact of an innovative, integrative family-based intervention for juveniles in detention and in the community, has significant potential to yield new knowledge about the long-term effects of comprehensive effective services for multiply impaired teens. These findings may provide new knowledge that: (1) clinical scientists can use to further develop integrative interventions for youths involved in the juvenile justice system, and (2) policy makers and clinical administrators can use to guide decisions about health care policy and implementation of clinically effective and economically viable interventions.