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

拘留社区模式的长期成果和经济影响

• 批准号: 7894972
• 负责人: CYNTHIA Lyn ROWE
• 金额: $ 56.92万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2012-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7894972
• 关键词: AIDS prevention; Accounting; Address; Administrator; Adolescence; Adolescent; Adult; Alcohol or Other Drugs use; Area; Behavior; Childhood; Chronic; Clinical; Clinical Trials; Communities; Community Trial; Cost-Benefit Analysis; Costs and Benefits; County; Criminal Justice; Data; Drug abuse; Drug usage; Early treatment; Effectiveness; Effectiveness of Interventions; Evaluation; Family; Family psychotherapy; Follow-Up Studies; Foundations; Funding; Grant; Growth; HIV; HIV Infections; HIV/STD; Health; Health Policy; Home environment; Human immunodeficiency virus test; Impairment; Imprisonment; Incidence; Intake; Intervention; Intervention Studies; Justice; Knowledge; Laboratories; Life; Link; Long-Term Effects; Longitudinal Studies; Measures; Mental Health; Mental disorders; Methods; Modeling; National Institute of Drug Abuse; Nature; Outcome; Parents; Participant; Pharmaceutical Preparations; Phase; Policy Maker; Population; Prevention approach; Progress Reports; Randomized; Randomized Controlled Trials; Recruitment Activity; Relapse; Relative (related person); Research; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Sampling; Scientist; Services; Site; Societies; System; Techniques; Teenagers; Testing; Time; Work; Youth; adolescent drug abuse; adolescent drug use; anti social; base; career; clinical effect; compare effectiveness; cost; cost effective; cost effectiveness; criminal behavior; design; detention center; economic evaluation; economic impact; experience; follow up assessment; follow-up; high risk; high risk sexual behavior; improved; innovation; intervention effect; juvenile delinquent; juvenile justice system; medical specialties; parent project; peer; post intervention; public health relevance; recidivism; service intervention; therapy design; treatment effect; trial comparing; young adult

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.

描述（由申请人提供）：鉴于儿童和青少年时期吸毒、犯罪以及危险性行为所带来的严重且往往是终生的后果，许多人认为早期干预对于阻止这些破坏性问题的发展至关重要。以家庭为基础的治疗在青春期药物滥用和犯罪方面显示出强大的短期效果，但其对成年早期的长期影响的证据有限。这项研究建立在 NIDA 资助的刑事司法药物滥用治疗研究 (CJDATS)“社区拘留”(DTC) 研究的有希望的初步结果的基础上。 DTC 研究开发并测试了基于家庭的创新综合干预措施——多维家庭治疗 (MDFT) 与强化照常服务 (ESAU) 对在押青少年罪犯以及他们返回社区时的短期（长达 9 个月）效果的比较。母项目的现有数据显示，MDFT 对青少年吸毒、犯罪和艾滋病毒相关风险因素有很强的初步影响，因此，进一步研究干预措施影响青少年进入青年期轨迹的潜力似乎是下一步的关键。目前的研究拟对 154 名 DTC 参与者在拘留释放后 2 年、3 年、4 年和 5 年的一系列结果以及可能影响这些长期结果的保护因素进行全面评估。还提出了一项全面的经济评估，以检查 MDFT 与 ESAU 的长期效益和成本以及成本效益。该研究的最后一个方面涉及检查 5 年随访期间重复的治疗发作和监禁如何与长期干预效果相互作用并帮助解释长期干预效果。该研究有四个目的：(1) 比较多维家庭治疗 (MDFT) 与常规强化服务 (ESAU) 在减少吸毒、犯罪行为、逮捕和监禁、性传播疾病和艾滋病毒感染、艾滋病毒相关危险行为、精神健康问题以及促进少年拘留中心招募的青少年样本中的保护因素方面的长期有效性； (2) 检查保护因素（家庭、同伴、教育/职业功能）与拘留后五年期间的结果之间的关系； (3) 评估和比较 MDFT 和 ESAU 的少年司法系统对社会和青少年司法系统的长期经济成本、效益和成本效益； (4) 检查重复治疗和监禁对从青春期到成年早期的目标结果的累积影响。多领域和方法评估方法，包括实验室确认的艾滋病毒和性病发病率和物质使用测试，以及潜在生长曲线建模技术，将用于检验有关青少年随时间变化的研究假设。该研究为艾滋病毒高危吸毒青少年罪犯提供了关于全面、综合干预措施的长期有效性和成本效益的新知识，具有改善干预措施和服务提供系统的巨大潜力。公共卫生相关性：纵向研究证实，青少年司法系统中的许多青少年在成年后都经历过长期吸毒、犯罪、与艾滋病毒/性传播疾病相关的不良健康后果和精神健康障碍，但严重缺乏旨在阻止这些破坏性轨迹的干预措施的长期有效性的证据。拟议的研究测试了对被拘留和社区青少年进行创新的、基于家庭的综合干预措施的长期有效性和经济影响，具有巨大的潜力，可以产生关于综合有效服务对多重障碍青少年的长期影响的新知识。这些发现可能提供新的知识：（1）临床科学家可以用来进一步开发针对参与少年司法系统的青少年的综合干预措施，（2）政策制定者和临床管理者可以用来指导有关医疗保健政策的决策以及临床有效和经济上可行的干预措施的实施。