The Effects of Client Change Talk on Risky Sexual Behavior

描述（由申请人提供）：本文件是为了响应NIDA PAR-10-021艾滋病科学跟踪研究过渡奖（R03），题为“客户改变语言对青少年危险性行为的影响”。25岁以下的人，特别是那些与司法系统有关的人，感染包括艾滋病毒在内的性传播感染的风险更高。降低这一人群性风险的方法取得了有限的成功，目前尚不清楚青少年是否能从已被证明对成年人有效的干预措施中受益。一种显示出希望的方法是动机访谈（MI），这是一种指导，以客户为中心的方法，用于治疗有问题的健康行为。在MI中，最受实证支持的行动机制是“改变谈话”，即来访者在会话中自发地承诺改变他们的问题行为。接受过心梗培训的临床医生采用特定的策略来承认、引出和加强这种改变谈话，目标是增加其频率和强度。已经建立了一条因果链，将治疗师的言语、来访者的改变谈话和成人随后的健康结果联系起来。本研究将使用动机性访谈技巧代码来量化一项正在进行的涉及犯罪的青少年的客户改变语言。父母研究的参与者被随机分配到MI或行为技能训练（BST）状态，两者都有两次干预，间隔一周，分别在3个月和6个月进行随访评估。在这项研究中，对客户语言进行编码，提供了从两种治疗方法（MI和BST）的随机对照试验中测量变化语言的机会。我们将在196个疗程的样本中量化客户语言，每种情况98个疗程。父母研究的结果测量包括对过去30天内的性行为和药物使用情况进行时间线跟踪调查。将从3个月和6个月的随访中评估效果，预计在3个月时治疗效果最大。以前没有研究成功地将客户语言编码应用于青少年性风险的研究。这一次要分析将通过使用青少年样本并比较两种治疗条件下的效果来测试在成人人群中形成的因果链，这种方法将通过证实或挑战客户改变语言对青少年的影响来指导临床实践。

DESCRIPTION (provided by applicant): This submission is designed in response to NIDA PAR-10-021 AIDS-Science Track Award for Research Transition (R03), titled "The effects of client change language on adolescent risky sexual behavior." People under age 25, and those involved with the justice system in particular, are at heightened risk for sexually transmitted infections including HIV. Approaches to reduce sexual risk this population have had limited success, and it remains unclear whether adolescents can benefit from interventions that have been proven effective in adults. One approach that has shown promise is motivational interviewing (MI), a directive, client- centered method employed in the treatment of problematic health behaviors. The mechanism of action with the most empirical support in MI is "change talk", spontaneous within-session commitments by clients to change their problem behavior. Clinicians trained in MI employ specific tactics to acknowledge, elicit, and strengthen this change talk, with the goal of increasing its frequency and strength. A causal chain has been established linking therapist speech, client change talk, and subsequent health outcomes in adults. This study will use the Motivational Interviewing Skill Code to quantify client change language from an ongoing study of criminally- involved adolescents. Participants in the parent study are randomized to either MI or a behavioral skills training (BST) condition, both of which have two intervention sessions one week apart, with follow-up assessments at three and six months. Coding client language in this study presents the opportunity to measure change language from a randomized controlled trial of two treatments: MI and BST. We will quantify client language in a sample of 196 treatment sessions, 98 from each condition. Outcome measures in the parent study include a time-line follow-back querying sexual behavior and substance use over the previous 30 days. Effects will be evaluated from both the 3- and 6-month follow-ups, with the maximal effect of treatment expected at 3 months. No previous study has successfully applied client language coding to the study of adolescent sexual risk. This secondary analysis will test a causal chain developed in adult populations by using an adolescent sample and comparing those effects in two treatment conditions, an approach that will guide clinical practice by either corroborating or challenging the effects of client change language in adolescents.