This exploratory/development proposal (R21) will further the development of the Prime Time Project, an intervention that addresses the specific needs of a group of adolescents at extremely high risk of poor outcomes: low-income African American youth with a history of substance abuse, emotional disturbance, and criminal involvement. The Project targets two major impediments to reducing violent crime in our communities: youth substance use and emotional dysregulation. The Prime Time Project begins by implementing a manualized and well-tested, ecologically-based intervention, Multisystemic Therapy (MST). This intervention has demonstrated ability to reduce criminal involvement in delinquent youth. The intervention has not been shown to reduce adolescent substance use, nor has its effectiveness been demonstrated for delinquents with co-occurring substance abuse and psychiatric disorders. Through conducting preliminary studies, the investigators have learned that this population is particularly challenging to engage and to treat. The unique components of the Prime Time Project include embedding within the MST framework two individual-level enhancements that address these co-occurring problems. The enhancements are based on Dialectical Behavioral Therapy (DBT), a tested intervention that has been developed by psychologist Dr. Marsha Linehan at the University of Washington. The first enhancement involves pre-treatment engagement and motivational strategies to increase retention in treatment. The second enhancement addresses the youth's emotional disturbance using a DBT cognitive-behavioral skills-training approach. As steps in the development of this psychosocial treatment model, the specific aims of this project are to carry out three activities: 1. Complete the Prime Time Treatment Manual that will operationalize and standardize the treatment protocol. 2. Develop an adherence study protocol. 3. Conduct a pilot outcome trial to 1) assess the ability of the intervention to produce short-term gains as reflected in increased motivation to engage in intervention, reduced substance use, increased ability to regulate emotions, reduced criminal activity, increased school engagement and increased cost-effectiveness, 2) monitor our success in implementing the proposed study methods, and 3) Calculate power estimates for designing a larger randomized controlled trial. If these activities affirm our ability to implement a manualized intervention with this target population and our ability to study the effects of the intervention, we will continue developing the Prime Time Project and conduct further trials of its effectiveness. One of the innovative aspects of this Project is the effort to identify and treat within a mental health framework a population of minority youth whose behavior has traditionally and increasingly been labeled and sanctioned as criminal. As such, this development project addresses a number of priorities set forth in Healthy People 2000, including improving the health of low income and minority populations, reducing alcohol and marijuana use by youth, reducing the prevalence of mental disorders, and decreasing the occurrence of interpersonal violence.
