Juvenile Offender HIV Prevention and Drug Abuse Services

描述（由申请人提供）：响应RFA-DA-09-007，我们建议进行一项随机临床试验，以确定一种综合的、以家庭为基础的干预措施的临床有效性、变化的调节因素和机制，以及经济影响，该干预措施同时针对接受少年司法日治疗计划的少年犯的HIV/ std相关风险行为、药物滥用、犯罪、逮捕和心理健康结果的变化。250名在学校青少年司法日治疗机构登记的有物质使用障碍的性活跃青少年将构成研究样本。符合条件的青少年将被随机分配到实验干预中。日常治疗多维家庭治疗- hiv （DT-MDFT-HIV）或日常治疗服务（DT-SAU）。这项研究的特点在于它的设置，一个青少年司法管理的日间治疗项目，以及实验干预在同时减少多种青少年问题——与艾滋病毒相关的风险行为、药物滥用和犯罪行为方面的承诺。针对这些问题领域的干预措施通常是单独提供的，这使得青少年司法、成瘾治疗和卫生系统中的服务碎片化问题长期存在。鉴于高风险性行为、药物滥用和犯罪之间的经验关系；需要新的服务提供系统，能够有效地提供综合干预措施，使残疾青年人数增加；此外，需要创新的青少年司法替代居住安置和监禁，拟议的研究有可能成功解决紧迫的公共卫生、公共安全和研究优先事项。这项研究有四个目的：(1)临床结果-比较基于家庭和基于群体的干预措施对艾滋病毒风险/性病发病率、吸毒、犯罪和心理健康结果的影响；(2)结果调节因子-确定更全面和综合的实验干预措施MDFT-HIV是否对更严重损害的青少年更有效；(3)结果调节因子-确定MDFT-HIV的假设作用机制是否介导了结果随时间的变化。(4)经济分析-评估和比较MDFT-HIV和SAU对社会和少年司法系统的经济成本、收益和成本效益。多个时间点（入院、3、6、12和24个月的随访）、多领域和方法评估方法以及潜在生长曲线建模技术将用于检验关于青少年和家庭随时间变化的研究假设。该研究通过提供关于对艾滋病毒感染高风险的滥用药物的少年犯进行有效和成本效益干预的新知识，具有改善干预和服务提供系统的重大潜力。公共卫生相关性：该研究在青少年日间治疗设置中测试了一种创新的、综合的、全面的基于家庭的干预措施，同时针对青少年罪犯的毒品问题、hiv相关风险行为、犯罪和心理健康功能。这项研究有可能通过解决青少年司法系统中与服务分散、缺乏有效服务和过度依赖机构阻止犯罪有关的差距，为这些多重受损青少年提供全面有效的服务，从而产生新的知识。政策制定者和临床管理者可以利用这些发现来指导卫生保健政策的决策和实施临床有效和经济上可行的干预措施。

DESCRIPTION (provided by applicant): Responding to RFA-DA-09-007, we propose to conduct a randomized clinical trial to determine the clinical effectiveness, moderators and mechanisms of change, and economic impact of an integrative, family-based intervention that concurrently targets changes in HIV/STD-associated risk behaviors, drug abuse, delinquency, arrest and mental health outcomes for juvenile offenders committed to a juvenile justice day treatment program. 250 sexually active youths with documented substance use disorders enrolled in a school-based, juvenile justice day treatment facility will comprise the study sample. Eligible youths will be randomized to the experimental intervention. Day Treatment Multidimensional Family Therapy-HIV (DT-MDFT-HIV) or Day Treatment Services as Usual (DT-SAU). This study is distinguished by its setting, a juvenile justice administered day treatment program, and by the experimental intervention's promise in simultaneously reducing multiple adolescent problems-HIV-associated risk behaviors, drug abuse, and criminal behavior. Interventions targeting each of these problem areas are typically delivered separately, perpetuating well documented problems of service fragmentation in juvenile justice, addictions treatment, and health systems. Given the empirically-established relationships among high risk sex, drug abuse, and delinquency; the need for new service delivery systems that can efficiently deliver comprehensive interventions to multiply impaired youths; and the need for innovative juvenile justice alternatives to residential placement and incarceration, the proposed study has the potential to successfully address an urgent public health, public safety, and research priority. The study has four aims: (1) Clinical Outcomes - to compare the effects of the family-based and the group-based interventions on HIV risk/STD rates, drug use, delinquency and mental health outcomes, (2) Moderators of Outcome - to determine if the more comprehensive and integrated experimental intervention, MDFT-HIV, is more effective with more severely impaired youths, (3) Mediators of Outcome - to determine if hypothesized mechanisms of action of MDFT-HIV mediated changes in outcomes over time, and (4) Economic Analyses - to evaluate and compare the economic costs, benefits, and cost effectiveness to society and to the juvenile justice system of MDFT-HIV and SAU. A multiple time point (intake, 3, 6, 12, and 24 month follow-up), multiple domain and method assessment approach and latent growth curve modeling techniques will be used to examine study hypotheses regarding adolescent and family change over time. The study has significant potential to improve interventions and service delivery systems by providing new knowledge about effective and cost-efficient interventions for drug abusing juvenile offenders at high risk for HIV infection. PUBLIC HEALTH RELEVANCE: The proposed study tests an innovative, integrative, and comprehensive family-based intervention within a juvenile day treatment setting that concurrently targets drug problems, HIV-associated risk behaviors, delinquency, and mental health functioning of juvenile offenders. The study has the potential to yield new knowledge about how to offer comprehensive effective services for these multiply impaired teens by addressing gaps in the juvenile justice system related to service fragmentation, lack of effective services, and over-reliance on institutionalization to deter crime. Policy makers and clinical administrators may use these findings to guide decisions about health care policy and implementation of clinically effective and economically viable interventions.