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

描述（由申请人提供）：考虑到儿童和青少年时期与药物滥用、犯罪和危险的性行为有关的严重且往往是终身的后果，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少年吸毒和犯罪方面显示出强有力的短期效果，但其对青年成年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）“从拘留到社区”（DTC）研究的有希望的初步发现的基础上。DTC研究开发并测试了一种基于家庭的创新综合干预——多维家庭治疗（MDFT）的短期（长达9个月）效果，并将其与“常规强化服务”（ESAU）相比较，对在押和重返社区的年轻罪犯进行了研究。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有很强的初步影响，因此，进一步研究干预措施对青少年进入青年期轨迹的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性因素进行全面评估。一项全面的经济评估也被提议来检查MDFT与ESAU的长期利益和成本以及成本效益。研究的最后一个方面是检查在5年的随访期间，反复的治疗事件和监禁是如何相互作用的，并有助于解释长期干预的效果。本研究有四个目的：(1)比较多维家庭治疗（MDFT）与常规强化服务（ESAU）在减少青少年吸毒、犯罪行为、逮捕和监禁、性病和艾滋病毒感染、艾滋病毒相关危险行为、心理健康问题和促进保护因素方面的长期效果；(2)检查保护性因素（家庭、同伴、教育/职业功能）与拘留后5年期间的结果之间的关系；(3)评估和比较MDFT和ESAU对社会和少年司法系统的长期经济成本、效益和成本效益；(4)研究从青春期到青年期反复治疗和监禁对目标结果的累积效应。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，以及潜在增长曲线建模技术来检验关于青少年随时间变化的研究假设。该研究提供了关于长期有效和成本效益的综合综合干预措施的新知识，具有改善干预措施和服务提供系统的重大潜力，这些干预措施是针对艾滋病毒高风险的吸毒少年犯的。公共卫生相关性：纵向研究证实，许多青少年在少年司法系统中经历了长期药物滥用、犯罪参与、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，直到成年，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。拟议的研究测试了一种创新的、以家庭为基础的综合干预措施对在押青少年和社区青少年的长期有效性和经济影响，具有重大的潜力，可以产生关于综合有效服务对多重受损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)临床科学家可以使用进一步开发青少年参与少年司法系统的综合干预措施；(2)政策制定者和临床管理者可以使用指导卫生保健政策的决策和实施临床有效和经济可行的干预措施。

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.