Family‐Based HIV and Sexually Transmitted Infection Risk Reduction for Drug‐Involved Young Offenders: 42‐Month Outcomes

Abstract

This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.

Multidimensional Family Therapy: Evidence Base for Transdiagnostic Treatment Outcomes, Change Mechanisms, and Implementation in Community Settings

“…Site B did not show differences by intervention condition either among sexual abstainers or those who were sexually active at intake. STI incidence did not differ by condition at either site, yet the significant reduction between intake and 9 months and lower than baseline levels across 42‐month follow‐ups is encouraging given that STIs generally rise during these critical years (Rowe et al., ).…”

“…Youth in both conditions and at both sites significantly reduced rates of unprotected sex acts and Sexually Transmitted Infections (STI) incidence from intake to 9 months. Rowe et al (2016) report that across conditions and sites, youth in these relatively intensive treatments maintained lower than baseline levels of STI incidence at the three-and-ahalf-year follow-up. The study also provides some support for the efficacy of a family-based intervention to reduce STI and HIV risk for substance-involved young offenders.…”

“…Rowe et al. () report that across conditions and sites, youth in these relatively intensive treatments maintained lower than baseline levels of STI incidence at the three‐and‐a‐half‐year follow‐up. The study also provides some support for the efficacy of a family‐based intervention to reduce STI and HIV risk for substance‐involved young offenders.…”

Parent Psychological Distress: A Moderator of Behavioral Health Intervention Outcomes among Justice‐Involved Adolescents

“…In both RCTs, adolescents with greater symptom severity and comorbidity displayed greater improvement in substance use after receiving MDFT relative to other adolescent‐focused interventions (i.e., individual CBT and enhanced usual services; Henderson, Dakof, Greenbaum, & Liddle, ). MDFT also significantly reduced RSB relative to enhanced usual services at one of two study sites, where adolescents had greater number of lifetime arrests, substance dependence, and comorbid psychiatric diagnoses, and higher rates of family substance use and criminality (Rowe et al., ). Research suggests that the effects of MDFT on adolescent abstinence from substance use are mediated by improvement in parent monitoring of adolescents’ activities and peers (Henderson, Rowe, Dakof, Hawes, & Liddle, ).…”

Outcomes of a family-based HIV prevention intervention for substance using juvenile offenders

“…Despite that these youth commonly use substances (including before and during sexual activity) very few interventions target both substance use and HIV risk. With the exception of one other intervention (Multidimensional Family Therapy) that demonstrated long-term reductions in the number of adolescent unprotected sex acts (Marvel, 2009; Rowe et al, 2016), to our knowledge, there have been no other published studies that incorporate family-based intervention for HIV/STI prevention for substance using juvenile offenders. The need to develop family-based HIV prevention interventions has received increasing attention because of studies highlighting important family structure and process correlates of adolescent HIV risk (Elkington et al, 2014; Perrino, Gonzalez-Soldevilla, Pantin, & Szapocznik, 2000).…”