Multidimensional Family Therapy HIV/STD Risk-Reduction Intervention: An Integrative Family-Based Model for Drug-Involved Juvenile Offenders

Authors


  • This study was funded under a cooperative agreement from the U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse (NIH/NIDA). The authors gratefully acknowledge the collaborative contributions by federal staff from NIDA, members of the Coordinating Centers (University of Maryland at College Park, Bureau of Governmental Research, and Virginia Commonwealth University; George Mason University), and the nine Research Center grantees of the NIH/NIDA CJ-DATS Cooperative (Brown University, Lifespan Hospital; Connecticut Department of Mental Health and Addiction Services; National Development and Research Institutes, Inc., Center for Therapeutic Community Research; National Development and Research Institutes, Inc, Center for the Integration of Research and Practice; Texas Christian University, Institute of Behavioral Research; University of Delaware, Center for Drug and Alcohol Studies; University of Kentucky, Center on Drug and Alcohol Research; University of California at Los Angeles, Integrated Substance Abuse Programs; and University of Miami Miller School of Medicine, Center for Treatment Research on Adolescent Drug Abuse). The contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH/NIDA or other participants in CJ-DATS. We thank the research and clinical teams who implemented the DTC Study: Craig Henderson, Linda Alberga, Rocio Ungaro, Gayle Dakof, and Dana Becker, and MDFT therapists Jacqueline Santana, Doris Perdomo-Johnson, Alessandra Marotti, Tim Leverone, Denise Auffant, Isolda Alonso Cardenas, Christine Garrison, and Daphna Bowman deserve special recognition; our collaborators, at Here's Help in Miami-Dade and Pinellas, and in the juvenile detention centers and juvenile courts of Miami-Dade and Pinellas Counties, Florida. Finally, thanks and gratitude go to the parents and adolescents who participated in this study.

concerning this article should be addressed to Howard A. Liddle, Department of Epidemiology and Public Health, Center for Treatment Research on Adolescent Drug Abuse, University of Miami Miller School of Medicine, 1120 NW 14th Street Stc. 1019, Miami, FL 33136, USA. E-mail: hliddle@med.miami.edu

Abstract

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (http://www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.

Abstract

Los jóvenes implicados en asuntos de drogas muestran conductas con índices sumamente altos de riesgo de contraer VIH/ETS. Sin embargo, las intervenciones existentes diseñadas para reducir dichas conductas de riesgo rara vez han tenido como objetivo a estos adolescentes vulnerables, y muchos enfoques se centran en el cambio a nivel individual, sin prestar atención a las influencias de la familia y el entorno. Aquí describimos un nuevo modelo de prevención del VIH/ETS basado en la unidad familiar que incorpora grupos multifamiliares centrados en el VIH/ETS dentro de un tratamiento del abuso de drogas y la delincuencia para adolescentes basado en pruebas, Multidimensional Family Therapy (MDFT; Liddle, Dakof & Diamond, 1991). El enfoque ha sido evaluado en una prueba clínica aleatoria en múltiples emplazamientos con jóvenes que tuvieron problemas con la justicia en los Estudios del Tratamiento del Abuso de Drogas de la Justicia Penal de NIDA (http://www.cjdats.org, NIDA's Criminal Justice Drug Abuse Treatment Studies). Los resultados preliminares basales hasta 6 meses son prometedores. Describimos la investigación sobre el riesgo familiar y los factores protectores para los problemas de conducta de los adolescentes, y ofrecemos un fundamento para los enfoques basados en la familia a fin de reducir el riesgo de contraer VIH/ETS que tiene este sector de la población. Describimos el desarrollo y la implementación de la Intervención para la Reducción de Riesgos de VIH/ETS mediante Terapia Familiar Multidimensional (MDFT-HIV/STD por sus siglas en inglés) en cuanto al uso de grupos multi-familiares y su integración en la MDFT estándar, así como ejemplos clínicos. La importancia potencial de este trabajo de desarrollo de intervenciones empíricas es alta; la MDFT-HIV/STD es el primer modelo que trata la prevención del VIH/ETS, muy ignorada hasta el momento, y las necesidades de salud sexual de los delincuentes menores de edad y consumidores de drogas dentro del contexto de una intervención orientada a la familia y basada en pruebas empíricas.
Palabras clave: prevención del VIH/ETS, delincuentes menores de edad, adolescentes consumidores de drogas, terapia familiar multidimensional.
Translator's Note: *Virus de Inmunodeficiencia Humana y Enfermedades de Transmisión Sexual

Abstract

Drug and juvenile justice involved youths show remarkably high rates of HIV/STD risk-behaviors. However, existing interventions aimed at reducing adolescent HIV-risk behavior have rarely targeted these vulnerable young adolescents, and manyapproaces focuson individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multi-family groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT; Liddle, Dakof & Diamond, 1991). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in NIDA's Criminal Justice Drug Abuse Treatment Studies (http://www.cjdats.org). Preliminary baseline to 6 month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD Risk-Reduction Intervention (MDFT-HIV/STD) in terms of using multi-family groups and their integration in standard MDFT and also a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.
inline image HIV/AIDS prevention, juvenile offenders, adolescent substance abuse, multidimensional family therapy

Abstract

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