Study to evaluate VOICES intervention

Adolescent girls often have a different path into the juvenile justice system than boys.

Often, they are arrested and remanded to custody for less serious offenses like truancy, running away and shoplifting, said Marina Tolou-Shams, Ph.D., a psychologist at the Bradley Hasbro Children’s Research Center and Rhode Island Hospital in Providence, R.I..

“Girls’ pathways into the system are also often relational in nature, such as interpersonal violence and prostitution,” said Tolou-Shams, also associate professor of psychiatry and human behavior at the Alpert Medical School at Brown University and director of the Rhode Island Family Court Mental Health Clinic.

This situation is one of the reasons a drug-use intervention specifically designed for girls called VOICES is widely used across the country, she said. But no study has looked at how effective the gender-specific program is – until now.

Tolou-Shams has been awarded a $2 million, five-year grant from the National Institute on Drug Abuse to study the efficacy of VOICES with court-involved, non-incarcerated girls in Rhode Island who use illicit substances.

“There is not a single shred of data behind the VOICES intervention even though it’s so widely disseminated,” she said. “People are so thirsty for gender-responsive approaches to substance abuse and other risk behavior reduction for girls.”

Tolou-Shams said VOICES is one of a few gender-responsive drug use treatments available for adolescent girls. It’s used in juvenile justice residential centers, schools, outpatient, and juvenile diversion settings, she said. Other intervention programs do not specifically focus on boys but offer services for all juveniles.

“Many of the kids in the system have at least one instance of trauma exposure, whether they are girls or boys,” she said. “However, girls have gender-specific increased risks associated with trauma. For example, we know that girls are at increased risk for sexual abuse victimization relative to boys, which puts them at increased risk for engaging in these other behaviors.”

VOICES was created by Stephanie Covington, Ph.D., at the Center for Gender and Justice in California to address the unique needs of adolescent girls, said a news release on the study.

“It is a strengths-based curriculum that incorporates a variety of therapeutic approaches, including psycho-education, cognitive-behavioral and expressive arts with a goal of empowering girls to discover their ‘true self’ and live happy and healthy lives,” said the release. “Girls in the program use interactive journaling as a tool to build empowerment.”

Tolou-Shams said the program “focuses on gender-specific issues that we know connect to risk or protective factors for girls in terms of their drug use.” That could include, for example, mother-daughter relationships.

The VOICES program is 18 sessions of 90 minutes of hands-on projects and discussions. Sessions focus on healthy relationships, body image, self-esteem, the impact of the media on risk behavior, and other issues. “There is a lot that is focused on gender empowerment and assertive communication specifically from the perspective of being a young woman,” Tolou-Shams said.

The team of researchers is in the first phase of the study, which will look at VOICES’
ability to reduce drug use and sexual risk behaviors as compared to other community-based programs. The study includes Covington and researchers at Bradley Hasbro Children’s Research Center and the University of California at Los Angeles.

So far, 18 girls have been enrolled in the pilot phase of the study. The next phase will enroll and follow 200 girls between the ages of 12 and 18 who are involved in the Rhode Island Family Court.

Girls enter the study after being diverted from incarceration, typically first-time offenders, Tolou-Shams said. Of the 200, half will go through the VOICES program and half will go through other community-based interventions.

Researchers will look at the effect of VOICES on drug and alcohol use, HIV and STD risk behaviors, psychiatric symptoms and recidivism, according to the release.

They expect the program to reduce substance use and sexual risk behaviors, Tolou-Shams said.

Because VOICES is already widely used, results of the trial “can have an immediate impact on practice,” she said.