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）：青少年中的酒精和其他药物（AOD）滥用是一个主要的公共卫生问题，导致显着的负面结果和非凡的长期成本。在司法系统中，青年滥用AOD的比率是没有司法参与的青年的两倍。此外，滥用AOD的青少年罪犯从事更严重的犯罪行为，并在成年后继续犯罪，他们从事艾滋病毒/性传播疾病风险行为的比例令人震惊。因此，向少年犯广泛提供有效的AOD干预措施具有相当重要的意义。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社区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，他们不太可能得到循证干预。鉴于这一情况，显然需要创新战略，以改善少年犯对滥用兴奋剂的循证做法的利用。因此，拟议的研究的首要目的是增加青少年司法系统中的青少年获得这种基于证据的做法（应急管理[CM]）的机会。这项研究利用并扩展了调查小组在少年司法环境中的CM功效，交付和技术转让方面的工作，以及与少年司法合作的30多年。我们认为，由于少年感化主任与其监管下的青少年罪犯有密切的参与和经常接触，因此，他们是向青少年提供以证据为本的AOD实践的理想人选。此外，变革管理是初专干事学习和实施的理想方法，因为它相对于其他面向青年的AOD循证做法而言，具有高度的具体性和较低的复杂性。此外，初专干事通过频繁的生物筛查定期监测其缓刑犯的药物使用情况，并根据结果采取相应措施，使变革管理与初专干事的工作保持一致。拟议的研究随机36初级警务人员2条件：CM与控制（通常的初级警务人员服务），然后随机504 AOD滥用青少年缓刑犯在这2个条件。这项研究将提供（1）初级专业人员提供滥用滥用AOD干预的可行性证据，（2）临床疗效的初步证据 初专干事作为服务提供者[处理使用AOD、犯罪活动和艾滋病毒/性传播感染风险行为的临床公共卫生后果]，以及（3）确定初专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确的公共卫生需要，以改善和扩大在少年司法系统中的AOD滥用干预措施的交付。最终的结果将是减少AOD的使用和其他公共卫生相关的行为（即，犯罪行为、艾滋病毒/性传播感染性风险行为）。

 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.