SOCIAL WORK CASE ANALYSIS PROBLEM-SOLVING PROCESS

Social Work Case Analysis Problem-Solving Process

Social Work Case Analysis Problem-Solving Process

Evidence-based HIV prevention approaches with adolescents have been almost exclusively targeted toward the individual level, and most are delivered in peer groups. However, several reviews have concluded that individual-level interventions have been unable to sustain behavioral changes, thus more comprehensive and powerful interventions are urgently needed. Recognizing the importance of parents as the primary sexuality educators and influences for their children, family context has emerged as a prominent focus for researchers and health educators (DiClemente, Crosby, & Salazar, 2006; Donenberg et al., 2006).

Family-based interventions currently have the most consistent empirical support in the treatment of challenging problems such as adolescent drug abuse and delinquency (Williams & Chang, 2000), yet high-risk sexual behavior remains an underdeveloped and insufficiently addressed target problem with these interventions. Families are critically important in shaping adolescents' decision-making skills and involvement in high-risk behaviors, and they are a potential source of influence in HIV prevention and intervention. For Donenberg et al. (2006), families influence adolescents' HIV risk in four ways: (a) instrumental characteristics (parental monitoring, control); (b) affective parenting behavior (warmth, support); (c) parental attitudes about sex; and (d) parent-teen communication. Accordingly, family-based HIV prevention interventions generally target inadequate monitoring, parent-adolescent conflict, and parental disengagement, all of which have been consistently associated with the constellation of behaviors associated with HIV/STD risk. Family-based HIV prevention also aims to facilitate supportive family relationships and parent-adolescent communication, which significantly reduce HIV risk.

The few existing family-based HIV prevention programs in school and community settings show significant outcomes in HIV-associated risk factors, including increases in condom use, parent-adolescent communication and skills, parenting skills (Murray, Berkel, Brody, Gibbons, & Gibbons, 2007), decreased illicit drug use (Prado et al., 2007), and intent to or engagement in sexual activity. Additionally, family-based approaches can be delivered over a range of ages (11-18), settings, delivery formats, and have been successfully adapted for different cultural groups (e.g., Prado et al., 2007). However, none of these interventions have been developed for or tested with youths in juvenile justice settings, and they have generally focused only on changing HIV-associated risk behaviors. There are strong recommendations from public health experts about the importance of concurrently addressing substance abuse, HIV risk, and criminal activity among juvenile offenders .

To address these gaps in the existing research on comprehensive family-based interventions to reduce drug abuse, delinquency, and HIV/STD risk among incarcerated youths, the "Detention to Community" study was initiated as part of the NIDA Criminal Justice Drug Abuse Treatment Studies cooperative research program. This study is a two-site randomized trial, which tests a cross-systems, family-based, drug abuse, delinquency, and HIV/STD intervention for juvenile offenders in detention and as they return home. HIV/STD-focused multifamily groups were embedded within an established family-based adolescent substance abuse and delinquency treatment, multidimensional family therapy. MDFT was considered a promising approach for this kind of intervention development based on its demonstrated efficacy in a series of randomized clinical trials in reducing substance use and delinquency with ...