Targeting HIV Risk Behaviors in Juvenile Drug Court-Involved Youth

The overriding purpose of this study is to develop and test an intervention for reducing
substance use and risky sexual behaviors among youth involved in juvenile drug court.
Juvenile drug court provides an excellent setting in which to pursue the key study
objectives by providing access to a well identified high risk population. Second, in
addition to frequent judicial oversight, juvenile drug courts include several features that
can enhance intervention effectiveness, sustainability, and potential for adoption. In
addition, the fact that all juvenile drug courts have community-based treatment components
and that such courts have been disseminated nationwide suggests the possibility of eventual
widespread adoption if the proposed intervention is effective. The proposed intervention
integrates evidence-based protocols for contingency management (CM) for substance abusing
youth and family engagement strategies, with an evidence-informed family systems
intervention for sexual risk originally developed to address substance use and sexual risk
behaviors in HIV+ youth. These three interventions will be integrated into an efficient
intervention that, if effective, can be amenable to adoption by juvenile drug courts.
Following protocol development and beta testing, 160 drug court youth and their families
will be randomized to the experimental intervention condition (Risk Reduction Therapy for
Adolescents or "RRTA") versus Drug Court with Community Services (DC) conditions. Key
outcomes will be assessed through 18-months post-baseline using a multi-method approach that
will include assessment of substance use, risky sexual behaviors, criminal behavior, and
participation in HIV counseling and testing services. Specific aims include: 1: Adapt
existing intervention and training protocols into a single, efficient RRTA intervention,
beta test this RRTA protocol with four youth in juvenile drug court and their families, and
revise treatment and research protocols accordingly; 2: Conduct a randomized trial with 160
youth in juvenile drug court and their families to examine youth-level intervention effects
(i.e., on substance use, sexual risk behavior, HIV counseling and testing, delinquent
behavior) in comparison to DC through 18- months post referral and assess intervention
fidelity. 3. If results suggest a positive RRTA treatment effect, revise the intervention
and training protocols in preparation for an effectiveness study and extended follow-up
study. Importantly, the proposed study will (1) consider the multiple levels of influence on
juvenile drug use, criminal justice involvement, and HIV risk behaviors, (2) integrate a
drug abuse and HIV prevention intervention for youth in the criminal justice system with
drug-related offenses, (3) address health disparities by targeting a primarily minority
population of youth, and (4) increase referrals to HIV testing and counseling of drug
court-involved youth. This study is designed to reduce HIV risk by addressing the potent
interaction of drug use and risky sexual behaviors in drug court youth with evidence-based
treatment components to maximize the likelihood of reversing these youths' adverse
behavioral trajectories.

Inclusion Criteria:

- enrolled in juvenile drug court or pre-enrollment status

- residing with permanent caregiver

- youth and caregiver fluent in English