Juvenile Detention to Community Life (DTC)

The fundamental objective of the proposed study is to develop and test an innovative two-stage, cross-systems family-based intervention for substance abusing juvenile offenders. The first stage of the experimental treatment is provided for youths in juvenile detention settings. Stage two of the intervention occurs after the offender is released to the community. Participants are randomized to one of two study conditions: the cross-systems family-based intervention (Multidimensional Family Therapy-Cross Systems (MDFT-CS), or 2) Enhanced Services as Usual (ESAU). Both conditions incorporate HIV prevention in detention and we will also examine the effects of a family-based HIV/STD prevention module beyond the impact of a standard HIV/STD education intervention delivered in detention by including ongoing HIV/STD intervention in MDFT-CS following release from detention. There are five aims of the proposed study. These aims relate to: 1) Intervention development and implementation; 2) Clinical effectiveness; 3) Impact of HIV/AIDS/STD prevention; 4) Comparative benefit-costs; and 5) Systems-level impact

This study will employ a fully randomized (2 conditions) by 9 assessment points (baseline, discharge from detention, and 3, 6, 9, 18, 24, 36 and 42 months following detention discharge), repeated measures intent-to-treat design with multiple dependent variables. 154 males and females (85 participants from Miami Dade Regional Juvenile Detention Center and 85 from Pinellas Juvenile Detention Center) who meet the study eligibility criteria will be randomized to one of the two treatment conditions. The study will also include a 6-month pilot phase. During this phase, the MDFT detention intervention and cross-systems collaboration protocols will be developed; the existing treatment manual will be revised; the MDFT-CS with family-based HIV prevention module and standard HIV education intervention will be developed; family therapists will be trained in the MDFT intervention (including HIV/STD module); the MDFT-CS intervention will be piloted; the assessment battery will be piloted; the protocols, manual, and training package will be revised and finalized; research staff will be trained on all procedures and protocols; and data management procedures will be developed. During Stage 1, adolescents in all intervention conditions will receive standard detention services, which include education and health care. In addition, youth assigned to the ESAU condition will receive the standard mental health and substance abuse services offered in the detention (mainly psychoeducational in nature). Youth assigned to the MDFT-CS intervention will not receive standard mental health/substance abuse services provided by the detention center, as these youth will be assigned a MDFT therapist who will address their mental health and substance abuse issues needs. Experimental Treatment: Multidimensional Family Therapy-Cross Systems (MDFT-CS). In Stage 1 (in detention) MDFT-CS, the experimental treatment, consists of two major components: standard initial/engagement work with parents in the home and with adolescents in detention (both conducted weekly for the duration of the adolescents stay in detention), plus a state-of-the-art HIV education prevention module based on CDC-endorsed strategies. The in-detention MDFT will be delivered by therapists employed by the University of Miami/ Center for Treatment Research on Adolescent Drug Abuse (CTRADA) who will continue to treat the youth and family after release from detention. In Stage 2, the experimental treatment includes the standard MDFT components (4 overall change units/targets: adolescent, parent, family interaction, and functioning of the family members vis a vis relevant extrafamilial social systems such as school and juvenile justice). Enhanced Services as Usual (ESAU). In Stage 1 (in detention), ESAU includes two major components - standard drug treatment services that are delivered by detention staff, and state-of-the-art HIV education prevention intervention delivered to all participating youth. In Stage 2, community drug treatment providers deliver high quality drug treatment on an outpatient basis. To minimize heterogeneity within the comparison condition, and in order to provide better service and treatment tracking opportunities, the study will only use one community based treatment agency to deliver ESAU per locale at each Research Center. All measures selected are psychometrically strong, sensitive to change, and have been used widely in adolescent substance abuse treatment studies.

In Stage 1 (in detention) Multidimensional Family Therapy Cross-Systems (MDFT-CS) consists of two major components: standard initial/engagement work with parents in the home and with adolescents in detention, plus a state-of-the-art HIV education prevention module. In Stage 2, MDFT-CS includes the standard MDFT components: 1) interventions with the adolescent, 2) interventions with the parent, 3) interventions to improve the parent-adolescent relationship, 4) interventions with other family members, and 5) interventions with external systems.

In Stage 1 (in detention) ESAU includes two major components: standard drug treatment services delivered by detention staff, and state-of-the-art HIV education prevention intervention. In Stage 2, community drug treatment providers deliver high quality drug treatment on an outpatient basis.

Standard initial/engagement work in the home and detention, plus a state-of-the-art HIV education prevention module as well as standard MDFT which assesses and intervenes in five domains: 1) Interventions with the adolescent, 2) interventions with the parent, 3) interventions to improve the parent-adolescent relationship, 4) interventions with other family members, and 5) interventions with external systems.

Standard drug treatment services in detention and state-of-the-art HIV education prevention intervention, as well as outpatient drug treatment provided by community drug treatment providers

Timeline Follow-Back Method of Drug and Alcohol Use, Urine analyses for Drug Use, Personal Experiences Inventory and the Adolescent Diagnostic Interview-Light will be used to measure substance use.

National Youth Survey Self-Report Delinquency Scale and the Juvenile/Criminal Justice records will be used to measure delinquency

Timeline Followback of Sexual Risk Behaviors, Urine Analyses for Sexually Transmitted Diseases (STDs) and HIV Testing.

Inclusion Criteria: Be between the ages of 13 and 17 Be incarcerated in a juvenile detention facility at intake Endorse substance abuse problems on the MAYSI or other intake forms Have at least one parent figure willing/able to participate in the intervention and research assessments Provide informed consent to participate in the study Exclusion Criteria: Mental retardation or pervasive developmental disorders Psychotic features Current suicidality defined as Ideation + Plan + High intention to carry out plan High risk to receive long-term residential placement directly from detention

Liddle HA, Dakof GA, Henderson C, Rowe C. Implementation outcomes of Multidimensional Family Therapy-Detention to Community: a reintegration program for drug-using juvenile detainees. Int J Offender Ther Comp Criminol. 2011 Jun;55(4):587-604. doi: 10.1177/0306624X10366960. Epub 2010 Apr 28.

Marvel F, Rowe CL, Colon-Perez L, DiClemente RJ, Liddle HA. Multidimensional family therapy HIV/STD risk-reduction intervention: an integrative family-based model for drug-involved juvenile offenders. Fam Process. 2009 Mar;48(1):69-84. doi: 10.1111/j.1545-5300.2009.01268.x.

Rowe CL, Wang W, Greenbaum P, Liddle HA. Predicting HIV/STD risk level and substance use disorders among incarcerated adolescents. J Psychoactive Drugs. 2008 Dec;40(4):503-12. doi: 10.1080/02791072.2008.10400656.

Rowe CL, Alberga L, Dakof GA, Henderson CE, Ungaro R, Liddle HA. Family-Based HIV and Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes. Fam Process. 2016 Jun;55(2):305-20. doi: 10.1111/famp.12206. Epub 2016 Feb 16.