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

项目总结/摘要 青少年司法（JJ）是受酒精和其他药物（AOD）使用影响最大的公共服务系统， 这些青年及其家庭和社会的后果是严重的。因此，提供有效的 对JJ青年的干预非常重要。循证实践（EBP） JJ青年的最大成果是以家庭为基础的，但许多社区没有资源支持 他们的交付。在AOD治疗资源稀缺的农村地区尤其如此。此外，即使 当社区可以支持以家庭为基础的EBP时，JJ青少年面临参与治疗的障碍。当然JJ 青年人通常被转诊接受治疗，但数据显示，实际接受治疗的不到五分之一。少年 缓刑/假释官（初级专业人员）是这场危机的前线。这种劳动力遍布全国各地的每个社区， 国家和日常接口与JJ青年试图取得积极成果。然而，初专干事往往面临 转诊治疗的选择有限;此外，他们没有时间或培训来提供全面的， 以家庭为基础的EBP。因此，初级专业人员试图用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取得的成功有限（例如，结构性制裁）。一个战略，实现 在资源匮乏的农村地区，如果无法部署全面的EBP，则可以获得更好的结果，称为任务转移，包括 将下游的任务重新分配给培训较少的土著劳动力。重要的是，审查表明， JJ青少年的主要EBP有一个共同的变化机制：父母的激活。因此， 以家庭为基础的EBP不能被任务转移，也许这些EBP的中心变化机制（父母 激活）可以转移到下游，以加强初级专业人员的做法。JJ领导人已经引用了改进的父母 参与是首要任务，但它也是JJ系统面临的最具挑战性的问题之一。 幸运的是，在儿科医疗服务中，有一种有效的干预措施，称为父母激活（PA） 包括医疗服务提供者的具体任务，以更好地参与和激励高危儿童的父母， 青年PA已经由临床医生和辅助专业人员提供。因此，这种医疗保健服务的进步 可供初级专业人员使用，以激发家长的积极性，并取得更积极的JJ青年成果。拟议 一项阶梯楔形分组随机试验调查了32个农村县初专干事对PA的使用和影响。 目的是：（1）确定初专干事在联合司法部门内提供方案援助的能力，（2）审查方案援助的影响 （3）审查实施成果，通过阶段评估 在JJ服务系统中的PA，包括JPO内部上下文变量，这些变量可能 影响执行。在国家行为医疗服务体系正在努力 为了满足JJ青年的需求，全国各地的JPO，特别是农村社区的JPO， 通过使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.