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

描述(申请人提供)：考虑到儿童和青少年时期吸毒、犯罪和危险的性行为所带来的严重的、往往是终身的后果，许多人认为早期干预对于阻止这些毁灭性问题的发展至关重要。以家庭为基础的治疗在青春期的药物滥用和青少年犯罪方面显示出了很强的短期效果，但关于其对青春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)“拘留到社区”(DTC)研究的有希望的初步结果的基础上。DTC研究开发并测试了一种创新的、综合性的以家庭为基础的干预措施--多维家庭治疗(MDFT)与加强照常服务(ESAU)相比，对在押和重返社区的青少年罪犯的短期影响(长达9个月)。来自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的初步影响很强，因此，进一步研究干预措施对青少年进入青壮年轨迹的潜在影响似乎是关键的下一步。目前的研究建议对154名DTC参与者在拘留后2、3、4和5年的一系列结果以及可能影响这些长期结果的保护性因素进行全面评估。还提议进行一项全面的经济评估，以审查MDFT与ESAU的长期效益以及成本和成本效益。这项研究的最后一个方面涉及对5年随访期内反复治疗和监禁如何与长期干预效果相互作用和帮助解释的检查。这项研究有四个目的：(1)比较多维家庭治疗(MDFT)和一如既往的强化服务(ESAU)在减少青少年拘留中心招募的青少年中的吸毒、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和心理健康问题以及促进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)与拘留后五年期间结果的关系；(3)评估和比较MDFT和ESAU对社会和青少年司法系统的长期经济成本、收益和成本效益；以及(4)检查反复治疗和监禁对从青春期到青壮年的目标结果的累积影响。将使用多领域和方法评估方法，包括实验室确认的艾滋病毒和性传播疾病发病率和药物使用测试，以及潜在生长曲线建模技术，以检验关于青少年随时间变化的研究假设。这项研究提供了有关对艾滋病毒高风险的吸毒少年犯进行综合综合干预的长期有效性和成本效益的新知识，因此在改进干预措施和服务提供系统方面具有重大潜力。公共卫生相关性：纵向研究证实，少年司法系统中的许多青少年在成年后都经历了长期药物滥用、犯罪、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毁灭性轨迹的干预措施的长期有效性的证据。这项拟议的研究测试了对在押青少年和社区中的青少年进行创新性、综合性的家庭干预的长期有效性和经济影响，具有重大潜力，可以产生关于为多个受损青少年提供综合有效服务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为青少年司法系统中的青少年制定综合干预措施，以及(2)政策制定者和临床管理人员可以用来指导关于卫生保健政策的决策和实施临床上有效和经济上可行的干预措施。

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.