Evaluation of Treatments for Homeless Youths

Evaluation of Treatments for Homeless Youth: CRA, MET and Case Management

Youth who leave home for the streets are at significantly more risk for a multitude of problems, yet little research is available to guide treatment intervention efforts with this population. Studies document high rates of substance use, HIV risk, mental health problems, teenage pregnancy and criminality. Research to date examining homeless, street living youth has been primarily descriptive; less effort has been directed towards developing and evaluating treatment interventions for this group. The majority of homeless youth do not receive substance abuse treatment, with one study reporting that only 15% of street living youth report ever receiving mental health services. The effectiveness of the Community Reinforcement Approach (CRA) with street living youth was studied in our recently completed Stage 1 trial. The proposed study is a Stage II clinical trial examining outcome of CRA individual therapy as compared to two interventions commonly employed, yet little researched, with this group. All clients will be randomized to one of three theoretically distinct interventions: (1) CRA therapy, (2) Motivational Enhancement Therapy (MET), or (3) Case Management (CM). The relative effectiveness of these interventions will be evaluated at 3, 6, and 12 months post-baseline. The Social Ecology Theory of Development (Bronfenbrenner, 1979) guides our change hypotheses and intervention. Proposed change mechanisms (mediators) for each intervention will be evaluated. Differential treatment response as a function of ethnicity, gender, age, sexual orientation and abuse (moderators) will be investigated to better understand the interventions. The study will also examine how, if at all, treatment engagement, retention and expectations impact youth response to the three treatments. Information gained through this project may help address the gap in our understanding of how best to effectively intervene with a group at high risk for continuing health and psychological problems.

Study Overview

• Status: Completed
• Conditions: Substance Abuse
• Intervention / Treatment: Behavioral: Community Reinforcement Approach (CRA) + HIV prevention; Behavioral: Case Management + HIV Prevention; Behavioral: Motivational Enhancement Therapy (MET) + HIV prevention

• Study Type: Interventional
• Enrollment (Actual): 270
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Columbus, Ohio, United States, 43210
      • The Ohio State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 20 years (ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Youth are between the ages of 14-20.
2. Youth have plans to remain in the Columbus areas for at least 12 months.
3. Youth meets abuse or dependence DSM-IV criteria for Psychoactive Substance Use or Alcohol disorder, as assessed by the computerized diagnostic interview schedule for children (CDISC, Shaffer, 1992).
4. Youth agrees to participate in the assessment and treatment intervention.
5. Youth meets criteria for homelessness as defined by DHHS.

Exclusion Criteria:

1. Evidence of unremitted psychosis or other condition which would impair their ability to understand and participate in the intervention or consent for research participation (as determined by CDISC).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: CRA + HIV prevention	Behavioral: Community Reinforcement Approach (CRA) + HIV prevention; 12 sessions of the CRA and 2 sessions of HIV prevention.
ACTIVE_COMPARATOR: Case Management + HIV prevention	Behavioral: Case Management + HIV Prevention; 12 sessions of case management and 2 sessions of HIV prevention.
ACTIVE_COMPARATOR: MET + HIV prevention	Behavioral: Motivational Enhancement Therapy (MET) + HIV prevention; 2 sessions of MET and 2 sessions of HIV prevention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Substance Use	Percentage of substance use days in prior three months.	Three months
Substance Use	Percentage of substance use days in prior three months	Six months
Substance Use	Percentage of substance use days in prior six months	Twelve months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
HIV Risk	Frequency of condoms use in prior three months.	Three months
HIV Risk	Frequency of condoms use in prior three months.	Six months
HIV Risk	Frequency of condoms use in prior six months.	Twelve months
Depressive Symptoms	Beck Depression Inventory - II (BDI-II) total score, range from 0 (no depresion)to 63 (severe depression)	Three months
Depressive Symptoms	Beck Depression Inventory - II (BDI - II) Range from 0 (no depression) to 63 (severe depression)	Six months
Depressive Symptoms	Beck Depression Inventory - II (BDI-II) total score, range from 0 (no depression)to 63 (severe depression)	Twelve months

Collaborators and Investigators

• Sponsor: Ohio State University
• Collaborators: National Institute on Drug Abuse (NIDA)

Study record dates

Study Major Dates

• Study Start: September 1, 2006
• Primary Completion (ACTUAL): December 1, 2010
• Study Completion (ACTUAL): June 1, 2012

Study Registration Dates

• First Submitted: June 11, 2010
• First Submitted That Met QC Criteria: June 11, 2010
• First Posted (ESTIMATE): June 14, 2010

Study Record Updates

• Last Update Posted (ESTIMATE): April 16, 2013
• Last Update Submitted That Met QC Criteria: April 12, 2013
• Last Verified: April 1, 2013

More Information

Terms related to this study

• Keywords: Homelessness; Substance abuse; HIV risk behavior
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: 2005B0078; R01DA013549 (NIH)