Behavioral Incentives to Increase Caregiver Engagement in Juvenile Drug Courts

 描述(由申请人提供)：有药物滥用问题的少年犯代表了一个庞大的、服务不足的群体，他们面临着持续的有害后果和对他们自己、他们的家庭、他们的社区和社会的长期代价的高风险。此外，有很高比例的少年犯在成年前继续滥用药物和从事犯罪活动。虽然少年司法干预措施--少年毒品法庭已成为减少青少年吸毒、犯罪和犯罪循环的一个有希望的模式，但其有效性的证据各不相同。可能影响药物法庭效力的一个重要因素是，照顾者缺乏对初级保健中心程序的参与，以及伴随而来的青少年药物治疗。将循证激励计划纳入JDCS，以增加照顾者的参与度，可能会提高他们在减少青少年吸毒和犯罪再犯罪方面的有效性。广泛的研究支持家庭在青少年药物滥用的病因、维持和治疗中发挥的关键作用。尽管以家庭为基础的青少年药物滥用干预已被证明优于其他治疗方式，但父母必须参加治疗并以有意义的方式参与，才能实现这些优越的结果。这项R01第二阶段随机临床试验将检验以奖品为基础的应急管理(CM)干预在增加JDC和青少年药物治疗中照顾者参与度(出席和参与)方面的有效性。这种照顾者CM干预(CCM)将与毒品法庭照常治疗(TAU)进行比较。参加少儿发展中心的180名青少年将与一名家长/照顾者一起被随机分配到照常治疗或CCM治疗。重复测量分析将考察CCM对JDC照顾者敬业度测量的影响。分析还将审查护理者参与度的提高是否有助于减少青少年药物使用(尿毒筛查)和犯罪活动。这项研究的结果预计将证明CCM程序在提高照顾者在JDC和青少年药物治疗中的出勤率和参与度方面的有效性，以及在药物法庭和常规护理之外的效果。如果有效，CCM方法最终可能被用来加强少年司法干预的成果，从而减少这一有希望的少年司法干预措施所服务的少年犯的药物使用和累犯率。因此，该项目在潜在的公共卫生影响和减少刑事司法系统成本方面具有重要意义。此外，拟议的研究极具创新性，因为它是首批将CM治疗应用于JDC的研究之一，采用了一种设计为易于在JDC范围内实施的方法，并首次研究了CM在提高JDC过程中家长参与度方面的效果。

 DESCRIPTION (provided by applicant): Juvenile offenders with substance abuse problems represent a large and underserved population that is at high risk for persistent deleterious outcomes and long-term costs for themselves, their families, their communities and society. Moreover, a high percentage of juvenile offenders continue to abuse substances and engage in criminal activity into adulthood. Although one juvenile justice intervention, Juvenile Drug Court (JDC), has emerged as a promising model for reducing the cycle of drug use, crime and delinquency among youth, evidence of its effectiveness is variable. One important factor that may compromise drug court effectiveness is lack of caregiver engagement in JDC processes and concomitant adolescent drug treatment. Incorporating evidence-based incentive programs in JDCs to increase caregiver engagement may improve their effectiveness in reducing youth drug use and criminal re-offending. An extensive body of research supports the critical role that families play in the etiology, maintenance, and treatment of adolescent substance abuse. Although family-based interventions for adolescent substance abuse have been shown to be superior to other treatment modalities, parents must attend treatment and participate in meaningful ways for these superior outcomes to be realized. This R01 Stage II randomized clinical trial will examine the efficacy of a prize-based contingency management (CM) intervention for increasing caregiver engagement (attendance and participation) in JDC and adolescent drug treatment. This caregiver CM intervention (CCM) will be compared with drug court treatment as usual (TAU). One hundred and eighty youth enrolled in JDC will be randomly assigned along with a parent/caregiver to treatment as usual or CCM. Repeated measures analyses will examine the effects of CCM on measures of caregiver engagement in JDC. Analyses will also examine whether improved caregiver engagement contributes to reductions in youth substance use (urine drug screens) and criminal activity. Results from this study are predicted to demonstrate the effectiveness of CCM procedures for increasing caregiver attendance and participation in JDC and adolescent drug treatment above and beyond drug court and usual care. If effective, the CCM approach may ultimately be used to enhance JDC outcomes, thereby reducing substance use and recidivism in juvenile offenders served by this promising juvenile justice intervention. Thus this project has high significance in terms of potential public health impact and reduction in criminal justice system costs. Further, the proposed study is highly innovative because it is among the first to apply CM treatment to JDC, uses an approach designed to be easy to implement within the JDC context, and the first to examine the efficacy of CM for enhancing parental engagement in the JDC process.