Vocational Outcomes for Youth With Substance Abuse Problems and High HIV Risk

描述（由申请人提供）：拟议的研究旨在测试一种有希望的策略，以改善已确定有药物滥用问题或有此类高风险的青少年的职业和就业结果。从个人和社会的角度来看，这些年轻人长期后果不佳的风险非常高。这项为期6个月的就业计划名为CRAFT项目（社区恢复学徒培训），旨在培训高危青年，并将他们安置在住宅建筑行业就业。重要的是，CRAFT是由住宅建筑商协会运营的，该协会是全国住宅建筑商协会的教育部门，与全国几乎所有地方建筑协会都有正式的联系。在整个培训过程中，CRAFT参与者都与当地雇主保持联系。CRAFT的初始测试使用康涅狄格州现有的多系统治疗（MST, Henggeler et al., 1998）项目作为评估平台，在验证的早期阶段有几个优势（例如，减少“噪音”，提供综合服务，治疗物质使用）。具体来说，120名15至18岁的青少年表现出严重的反社会行为，并有确定的药物滥用问题或此类问题的高风险，将随机分为CRAFT组和教育常规组（EAU）。在这两种情况下，根据标准的MST协议，治疗师将支持职业教练（在CRAFT条件下）或学校人员（在EAU条件下）的努力，以提高青少年在学校和职业方面的表现。随访将在项目完成后的2年内进行。这项研究有三个主要目的。目标1：评估CRAFT改善参与者就业和收入的能力。假设CRAFT参与者在治疗后和随访时的每小时工资比EAU参与者高得多的就业率（以工作天数衡量）。目的2：检查CRAFT与物质使用减少和社会心理功能增加的关联程度。两种治疗条件下的参与者预计在治疗期间表现出心理社会功能的改善。由于参与就业有望促进社会心理结果的进一步改善，CRAFT参与者在治疗后获得额外的收益，而EAU参与者则假设只保持治疗收益。目的3：评估CRAFT效应的可能调节因素（如犯罪史、症状学）。对于CRAFT条件下的参与者，剂量效应也将被检查。

DESCRIPTION (provided by applicant): The proposed study aims to test a promising strategy for improving vocational and employment outcomes for adolescents with identified substance abuse problems or at high risk for such. These youths are at very high risk for poor long-term outcomes from both personal and societal perspectives. The 6- month employment program, Project CRAFT (Community Restitution Apprenticeship-Focused Training), is designed to train and place high-risk youths in employment within the residential building industry. Importantly, CRAFT is operated by the Home Builders Institute, which is the educational arm of the National Association of Home Builders and has formal linkages with virtually all local building associations across the nation. CRAFT participants are connected with local employers throughout the course of training. This initial test of CRAFT uses existing multisystemic therapy (MST, Henggeler et al., 1998) programs in Connecticut as the platform for the evaluation, which has several advantages at this early stage of validation (e.g., reducing "noise," providing integrated services, treating substance use). Specifically, 120 15- to 18-year old adolescents presenting serious antisocial behavior and with identified substance abuse problems or at high risk for such will be randomized to CRAFT versus education as usual (EAU) conditions. In both cases, the therapists, per standard MST protocols, will be supporting the efforts of the vocational instructor (in the CRAFT condition) or school personnel (in the EAU condition) at enhancing youth school and vocational performance. Follow-up will be conducted through 2 years post program completion. This study has three primary aims. Aim 1: To evaluate the capacity of CRAFT to improve participant employment and earnings. CRAFT participants are hypothesized to have considerably higher rates of employment (measured by days employed) at a higher hourly wage than their EAU counterparts at posttreatment and follow-up. Aim 2: To examine the extent to which CRAFT is associated with decreases in substance use and increases in psychosocial functioning. Participants in both treatment conditions are expected to demonstrate gains in psychosocial functioning during treatment. Because participation in employment is expected to facilitate further improvement in psychosocial outcomes, CRAFT participants are hypothesized to experience additional gains following treatment while EAU participants are hypothesized to only maintain treatment gains. Aim 3: To evaluate possible moderators (e.g., criminal history, symptomatology) of CRAFT effects. For participants in the CRAFT condition, dosage effects will also be examined.