Improving Access to Substance Abuse Evidence-Based Practices for Youth in the Justice System: Strategies Used by JPOs

 描述(由申请人提供)：青少年滥用酒精和其他药物(AOD)是一个重大的公共卫生问题，导致严重的负面后果和非同寻常的长期成本。在司法系统中，青年滥用AOD的比率是未参与司法的青年的两倍。此外，虐待AOD的青少年罪犯从事更严重的犯罪并在成年后继续犯罪，他们参与艾滋病毒/性传播感染性行为的比率令人震惊。因此，广泛获得并向少年犯提供有效的AOD干预措施是相当重要的。不幸的是，在满足涉及司法的青年的治疗需求方面存在重大挑战。虽然少年犯通常被转介到以社区为基础的提供者那里接受治疗，但能够获得这种治疗的不到五分之一。此外，对于能够克服障碍并与服务提供者接触的青年和家庭来说，他们不太可能得到基于证据的干预。鉴于此，显然需要采取创新战略，以改善少年犯获得滥用AOD的循证做法的机会。因此，拟议研究的首要目的是增加少年司法系统中的青年获得这种循证做法(应急管理)的机会。这项研究利用并扩展了调查小组在青少年司法环境中的CM功效、交付和技术转让方面的工作，以及与青少年司法30多年的合作。我们假设，少年感化主任(JPO)是向青少年提供AOD循证实践的理想位置，因为他们密切参与并经常与他们监督下的青少年罪犯接触。此外，CM是初级警务人员学习和实施的理想方法，因为与其他以AOD为基础的青年循证做法相比，CM具有高度的针对性和较低的复杂性。此外，初级警察通过频繁的生物筛查定期监测缓刑人员的物质使用情况，并根据结果实施后果，使CM与初级警察的工作保持一致。这项拟议的研究将36名JPO随机分为两种情况：CM和对照(通常的JPO服务)，然后在这两种情况下随机选择504名AOD虐待青少年见习者。这项研究将提供(1)JPOS提供AOD滥用干预的可行性的证据，(2)临床疗效的初步证据 作为服务提供者的初级警察干事[处理使用AOD、犯罪活动和艾滋病毒/性传播感染性危险行为的临床公共卫生后果]，以及(3)确定初级警察干事提供此类服务需要克服的任何障碍。这一应用的主要动机是明显的公共卫生需要，以改进和扩大青少年司法系统中AOD滥用干预措施的提供。最终结果将是减少这些高危青少年使用AOD和其他与公共卫生有关的行为(即犯罪行为、艾滋病毒/性传播感染的性危险行为)。

 DESCRIPTION (provided by applicant): Alcohol and other drug (AOD) abuse among adolescents is a major public health problem resulting in significant negative outcomes and extraordinary long-term costs. The rates of AOD abuse among youth in the justice system are twice the rates among youth without justice involvement. Further, youth offenders who abuse AOD engage in more severe delinquency and continue offending as adults, and their rate of engagement in HIV/STI sexual risk behaviors is alarming. Therefore, widespread access and delivery of effective AOD interventions to juvenile offenders is of considerable importance. Unfortunately, significant challenges exist for meeting the treatment needs of justice-involved youth. Although juvenile offenders are routinely referred to community-based providers for treatment, less than 1 in 5 are able to obtain such treatment. Further, for youth and families who are able to overcome barriers and engage with service providers, it is unlikely that they will receive an intervention that is evidence-based. In light of this context, innovative strategies clearly are needed to improve juvenile offenders' access to evidence-based practices for AOD abuse. Thus, the overriding purpose of the proposed study is to increase the access to such an evidence- based practice (Contingency Management [CM]) among youth in the juvenile justice system. This study leverages and extends the investigative team's work in CM efficacy, delivery, and technology transfer in juvenile justice settings, as well as 30+ years of collaboration with juvenile justice. We posit that juvenile probation officers (JPOs) are in an ideal position to delier an AOD evidence-based practice to youth because of their intensive involvement and frequent contact with the youth offenders under their supervision. Further, CM is ideal for JPOs to learn and implement because it is highly specified and low in complexity relative to other AOD evidence-based practices for youth. Also, JPOs regularly monitor their probationers' substance use via frequent biological screens and implement consequences based on results, making CM consistent with JPOs' work. The proposed research randomizes 36 JPOs to 2 conditions: CM versus control (usual JPO services), and then randomizes 504 AOD abusing adolescent probationers across those 2 conditions. This research would provide (1) evidence for the feasibility of JPOs to deliver an AOD abuse intervention, (2) initial evidence of clinical efficacy for JPOs as service delivery providers [to address clinical public health outcomes of AOD use, criminal activity, and HIV/STI sexual risk behaviors], and (3) identify any barriers that would need to be addressed for JPOs to deliver such services. The primary motivation for this application is the clear public health need for improving and expanding delivery of AOD abuse interventions in the juvenile justice system. The ultimate outcome would be decreased AOD use and other public health-related behaviors (i.e., criminal behaviors, HIV/STI sexual risk behaviors) among these high-risk adolescents.