Diversity Supplement: Linking a Pediatric Healthcare Advance with a Task-Shifting Approach to Optimize Juvenile Justice Outcomes

项目摘要/摘要 少年司法(JJ)是受酒精和其他毒品(AOD)使用影响最大的公共服务系统 这些青年、他们的家庭和社会的结果是严重的。因此，交付有效的 对JJ青年进行干预具有相当重要的意义。循证实践(EBPS)与 对于JJ青少年来说，最大的结果是以家庭为基础，但许多社区没有资源来支持 他们的送货服务。在农村地区尤其如此，那里的AOD治疗资源稀缺。更远的，甚至 当社区可以支持以家庭为基础的EBP时，JJ青年在参与治疗方面面临障碍。事实上，JJ 年轻人通常会被转介接受治疗，但数据显示，真正接受治疗的不到五分之一。少年 缓刑/假释官(JPO)处于这场危机的第一线。这支队伍遍布世界各地的每个社区 日本政府经常与JJ青年进行接触，以期取得积极成果。然而，初级警务人员经常面临 治疗转诊的选择有限；此外，他们没有时间或培训来提供全面的 以家庭为基础的EBPS。因此，初级警察试图通过一个小菜单来管理缓刑犯的行为 以青年为基础的干预措施收效甚微(如有组织的制裁)。实现以下目标的一项战略 在资源匮乏、无法部署全面EBP的农村环境中，更好的结果称为任务转移，涉及 将任务重新分配给受过较少培训的本土劳动力。重要的是，评论表明 JJ青少年的主要EBP共享一个共同的变化机制：父母的激活。因此，虽然 以家庭为基础的EBP不能进行任务转移，这可能是这些EBP(父母)的中心变化机制 激活)可以转移到下游，以加强初级专业干事的做法。JJ领导已经引用了改进的父母 参与是最高优先事项，但这也是联合司法系统面临的最具挑战性的问题之一。 幸运的是，在儿科保健服务中，有一种有效的干预措施，称为父母激活(PA) 由医疗保健服务提供商更好地接触和激励高危父母的具体任务组成 青春年华。PA已由临床医生和辅助专业人员接生。因此，这项医疗服务的进步 可能会被初级警察组织用来激活父母，实现更积极的JJ青年成果。建议数 阶梯-楔形整群随机试验调查了32个农村县的初级官员使用PA的情况及其影响。 目标是：(1)确定JPO在JJ服务中交付PA的能力；(2)检查PA的影响 交付未确定的家庭结果，以及(3)检查通过各阶段评估的执行结果 JJ服务系统中的PA的实现完成情况，包括可能 影响实施。在国家行为医疗服务系统正在努力 为了满足JJ青年的需求，全国各地的初级警察，特别是农村社区的初级警察，定位于 通过利用儿科医疗保健服务的进步产生巨大影响。

PROJECT SUMMARY/ABSTRACT Juvenile justice (JJ) is the public service system most impacted by alcohol and other drug (AOD) use in youth, and outcomes for these youth, their families, and society are grave. Thus, delivery of effective interventions with JJ youth is of considerable importance. The evidence-based practices (EBPs) with the strongest outcomes for JJ youth are family-based, but many communities do not have the resources to support their delivery. This is particularly true in rural areas where AOD treatment resources are scarce. Further, even when communities can support a family-based EBP, JJ youth face barriers to treatment participation. Indeed, JJ youth are routinely referred for treatment, but data indicate less than 1 in 5 actually receive treatment. Juvenile probation/parole officers (JPOs) are on the front line of this crisis. This workforce is in every community across the nation and routinely interfaces with JJ youth to try to achieve positive outcomes. However, JPOs often face limited options for treatment referrals; further, they do not have the time or training to deliver one of the full-scale, family-based EBPs. As a consequence, JPOs try to manage the behavior of their probationers with a small menu of youth-based interventions that have limited success (e.g., structured sanctions). One strategy for achieving better outcomes in low-resourced, rural settings that cannot deploy a full-scale EBP, called task-shifting, involves redistribution of tasks downstream to an indigenous workforce that has less training. Importantly, reviews indicate that the leading EBPs for JJ youth share a common change mechanism: activation of parents. Thus, while the family-based EBPs cannot be task-shifted, perhaps the central change mechanism of these EBPs (parent activation) can be shifted downstream to enhance JPO practice. JJ leaders already cite improved parent engagement as a top priority, but it is also one of the most challenging problems facing the JJ system. Fortuitously, within pediatric healthcare services, there is an effective intervention called parent activation (PA) comprised of concrete tasks by healthcare service providers to better engage and motivate parents of at-risk youth. PA has been delivered by clinicians and also by paraprofessionals. Thus, this healthcare service advance might be primed for use by JPOs to activate parents and achieve more positive JJ youth outcomes. The proposed stepped-wedge cluster randomized trial investigates the use and impact of PA by JPOs across 32 rural counties. Aims are to: (1) determine the capacity of JPOs to deliver PA within JJ services, (2) examine impact of PA delivery on de-identified family outcomes, and (3) examine implementation outcomes, assessed via the Stages of Implementation Completion, for PA in the JJ service system, including JPO inner context variables that might impact implementation. In a context where the nation’s behavioral healthcare service system is struggling to meet the needs of JJ youth, JPOs across the nation, and particularly in rural communities, are positioned to make a large impact via use of an advance from pediatric healthcare services.