Preventing Opioid Use Among Justice-Involved Youth as They Transition to Adulthood: Leveraging Safe Adults (LeSA)

项目概要/摘要 在美国，物质使用（SU）是一个重要的公共卫生问题。阿片类药物使用障碍的发生率 呈指数级增长，60%的过量归因于海洛因和非法合成物。虽然阿片类药物的使用 与成年人相比，年轻人中的使用率较低，在青春期后期， 青年向成年过渡。涉及少年司法的青年是一个特别脆弱的群体， 因为他们经常经历心理健康障碍，功能失调的家庭/社会关系， 创伤，使他们在SU和物质使用障碍（SUD）的风险更大。为了确保这些年轻人 为了避免成为另一个类阿片统计数据，需要采取创新和有效的预防干预措施。我们 建议调整和测试干预措施，以防止阿片类药物滥用的开始和/或升级， 与JJ有关的年长青少年。目标入组人群为JJ以外的青少年（16 - 18岁）， 在安全的治疗或教养设施中被拘留一段时间后，向其社区过渡。 基于信任的关系干预®（TBRI®）;一种基于关系、依恋的干预， 通过与有反应的成年人互动进行情绪调节）将被改编为预防干预措施 针对有SU风险的青少年（特别是阿片类药物的非医疗用途）。安全的成年人（例如，父母/监护人）将 接受行为管理技术培训，使青年能够适当地表达自己的需求， 以亲社会的方式将他们与他人联系起来，纠正或重塑不良行为。的 拟议的有效性/实施研究将分三个阶段进行。第一阶段将采用 JJ青年TBRI，制定干预手册和研究方案，检查适应的可接受性 干预，并测试拟议研究方案的可行性（例如，青年招聘（Youth Recruitment） 作为这一阶段的一部分，将征求15个青年/安全成人配对的反馈意见。第二阶段将检查 TBRI预防阿片类药物滥用的有效性和三种支持形式的比较效用：（1） 仅TBRI培训，（2）TBRI培训+结构化辅导，或（3）TBRI培训+响应式辅导 （由青年的需要/风险引发）。将从6个参与者中招募总共360名青年/安全成年人配对 JJ设施，并在释放后随访18个月（20个青少年-成人配对/年， 设施）。该设计使得能够比较TBRI与SRP（使用阶梯楔设计，其中每个 设施作为其自身的对照）加上比较3种TBRI支持形式的随机对照试验。3期 将研究TBRI维持的障碍和促进因素。60名强生员工（每个机构10名）将提供 每年通过重点小组和调查提供投入。TCU将与强生各工厂的管理人员和工作人员合作， 实施可持续发展计划，其中包括发展内部TBRI专业知识（即，工作人员培训和 执行援助）。成功完成研究目标将提供对适应性干预的测试 并将通过向参与的设施提供培训和执行支助，促进维持能力。

Project Summary/Abstract Across the US, substance use (SU) is a significant public health concern. Rates of opioid use disorders have increased exponentially, with 60% of overdoses attributed to heroin and illicit synthetics. Although opioid use among youth is low compared to adults, experimentation and regular use increases later in adolescence as youth transition to adulthood. Juvenile justice (JJ)-involved youth represent a particularly vulnerable population, as they often experience mental health disorders, dysfunctional family/social relationships, and complex trauma, placing them at greater risk for SU and substance use disorders (SUDs). To ensure that these youth do not become another opioid statistic, innovative and effective prevention interventions are needed. We propose to adapt and test an intervention for preventing initiation and/or escalation of opioid misuse among older JJ-involved adolescents. The target enrollment group will be youth aging out of JJ (16-18 years) who are transitioning to their communities after a period of detainment in a secure treatment or correctional facility. Trust-based Relational Intervention® (TBRI®; a relational, attachment-based intervention that promotes emotional regulation through interaction with responsive adults) will be adapted as a prevention intervention targeting youth at risk for SU (especially non-medical use of opioids). Safe adults (e.g., parent/guardian) will be trained in behavior management techniques for empowering youth to appropriately express their needs, connecting them with others in pro-social ways, and correcting or reshaping undesirable behavior. The proposed Effectiveness/Implementation study will be conducted in 3 phases. Phase 1 will adapt elements of TBRI for JJ youth, develop intervention manuals and study protocols, examine the acceptability of the adapted intervention, and test the feasibility of the proposed study protocol (e.g., agency and youth recruitment). Feedback from 15 youth/safe adult dyads will be solicited as part of this phase. Phase 2 will examine both the effectiveness of TBRI for preventing opioid misuse and the comparative utility of three support formats: (1) TBRI Training only, (2) TBRI Training + Structured Coaching, or (3) TBRI Training + Responsive Coaching (triggered by the youth’s need/risk). A total of 360 youth/safe adult dyads will be recruited from 6 participating JJ facilities over a 3-year period, and followed for 18 months post-release (20 youth-adult dyads/year per facility). This design enables a comparison of TBRI versus SRP (using a stepped-wedge design where each facility serves as its own control) plus a randomized control trial comparing 3 TBRI support formats. Phase 3 will examine barriers and facilitators of TBRI sustainment. Sixty JJ staff (10 from each agency) will provide input annually via focus groups and surveys. TCU will work with administrators and staff at each JJ facility to implement a sustainment plan, which will include developing in-house TBRI expertise (i.e., staff training and implementation assistance). Successful completion of study aims will provide a test of the adapted intervention and will facilitate sustainment by providing training and implementation support to participating facilities.