Browsing by Subject "Juvenile justice"
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Item Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities(Elsevier, 2021) Aalsma, Matthew C.; Aarons, Gregory A.; Adams, Zachary W.; Alton, Madison D.; Boustani, Malaz; Dir, Allyson L.; Embi, Peter J.; Grannis, Shaun; Hulvershorn, Leslie A.; Huntsinger, Douglas; Lewis, Cara C.; Monahan, Patrick; Saldana, Lisa; Schwartz, Katherine; Simon, Kosali I.; Terry, Nicolas; Wiehe, Sarah E.; Zapolski, Tamika C. B.; Pediatrics, School of MedicineBackground: Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. Methods/design: ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. Discussion: Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.Item Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers(Springer Nature, 2024-06-21) O’Reilly, Lauren M.; Schwartz, Katherine; Brown, Steven A.; Dir, Allyson; Gillenwater, Logan; Adams, Zachary; Zapolski, Tamika; Hulvershorn, Leslie A.; Aalsma, Matthew; Pediatrics, School of MedicineBackground: Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. Methods: Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). Results: Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. Conclusions: These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.Item Caregiver and Juvenile Justice Personnel Perspectives on challenges and importance of caregiver engagement and the potential utility of a peer navigator program in the Juvenile Justice System(BMC, 2023-08-05) Dir, Allyson L.; Pederson, Casey; Khazvand, Shirin; Schwartz, Katie; Wiehe, Sarah E.; Aalsma, Matthew C.; Psychiatry, School of MedicineBackground: For youth involved in the juvenile justice (JJ) system, caregiver involvement and engagement in the system is crucial for youth development and outcomes of JJ cases; however, there are challenges to establishing positive/productive partnerships between caregivers and JJ representatives. The current project examines perspectives of caregivers and JJ personnel regarding facilitators and barriers to establishing JJ-caregiver partnerships, as well as their perceptions of the use of a caregiver navigator program to support caregivers of system-involved youth. Results are used to inform development of a caregiver navigator program to support caregivers and help them navigate the JJ system. Results: Semi-structured interviews were conducted with caregivers of youth involved in JJ (n = 15, 53% White, 93% female), JJ personnel (n = 7, 100% White, 50% female), and JJ family advisory board members (n = 5, 100% Black, 100% female). Caregivers reported varying experiences across intake/arrest, court, and probation processes. Positive experiences were characterized by effective communication and feeling supported by JJ. Negative experiences related to feeling blamed and punished for their child's system involvement and feeling unsupported. JJ interviews corroborated caregiver sentiments and also illustrated facilitators and barriers to JJ-caregiver partnerships. Both JJ personnel and caregivers endorsed potential benefits of a peer-based caregiver navigator program to provide social, informational, and emotional support. Conclusion: Continued work is needed to improve JJ-caregiver partnerships and use of a peer-based navigator program has the potential to address barriers to caregiver engagement in the JJ system.Item Conduct disorder symptoms and illicit drug use in juvenile justice involved youth: The reciprocal relationship between positive illicit drug use attitudes and illicit drug use(Taylor & Francis, 2018-07-03) Kolp, Haley M.; Hershberger, Alexandra R.; Sanders, Jasmyn; Um, Miji; Aalsma, Matthew; Cyders, Melissa A.; Psychology, School of ScienceConduct disorder (CD) symptoms cooccur at high rates with illicit drug use in juvenile justice involved youth, which results in poorer outcomes; however, research has not identified where best to intervene in this relationship, limiting the identification of modifiable risk factors to reduce negative effects of CD symptoms. Two mediation models were examined to investigate the potential for CD symptoms to influence a reciprocal relationship between illicit drug use and positive drug attitudes, controlling for age, gender, and race. Data were examined for 245 juvenile justice involved youth (mean age = 15.46, SD = 1.30, range 12-18, 64.9% Black, 80.4% male) who completed court-ordered psychological assessments. Findings indicate: (1) Positive attitudes toward illicit drug use significantly mediated the relationship between CD symptoms and illicit drug use (β = 0.16, CI 0.09-0.27; test for indirect effect z = 4.17, p < .001) and (2) illicit drug use significantly mediated the relationship between CD symptoms and positive attitudes toward illicit drug use (β = 0.20, CI 0.12-0.32; test for indirect effect z = 4.87, p < .001). Overall, the present study suggests that CD symptoms impart risk for illicit drug use both indirectly, through more positive attitudes toward illicit drug use, and directly, which further strengthens positive attitudes toward illicit drug use.Item Family and Peer Influences on Substance Attitudes and Use among Juvenile Justice-Involved Youth(Springer, 2019-02) Zapolski, Tamika C. B.; Clifton, Richelle L.; Banks, Devin E.; Hershberger, Alexandra; Aalsma, Matthew; Psychology, School of ScienceJuvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation.Item A Mixed-Methods Investigation of the Implications of Substance Use Disorder Stigma for Justice-Involved Youth(2023-08) Johnson-Kwochka, Annalee V.; Salyers, Michelle; Cyders, Melissa; Zapolski, Tamika; Aalsma, MathewObjectives: Compared to youth without justice-involvement, justice-involved youth are more likely to experience substance use disorders. Yet, few justice-involved youth receive appropriate, evidence-based treatment for substance use disorders. Although there are numerous barriers to the accessibility of appropriate treatment, research also suggests that it is difficult to engage justice-involved youth in treatment even when it is available and accessible. It is possible that substance use disorder stigma, or negative attitudes towards youth with substance use disorders, may contribute to low treatment accessibility, and make it more difficult for justice-involved youth to engage with available treatment. Few researchers have examined substance use disorder stigma among this population. The purpose of this study was to 1) explore the nature of substance use disorder stigma among justice-involved youth, at multiple ecological levels and 2) examine the role of substance use disorder stigma in limiting the accessibility of and engagement in treatment and justice-involved youth’s engagement in treatment. Methods: Participants (n = 44 youth-guardian dyads) were referred to the study by juvenile probation departments in two Indiana counties. In addition, 66 system personnel participants who work with justice-involved youth with substance use disorders were recruited from community mental health centers and juvenile probation departments in rural and suburban Indiana counties. All participants completed survey measures of substance use disorder stigma and familiarity with substance use; youth-guardian dyads also provided information about the youth’s substance use history and treatment utilization. A subset of participants (n = 9 youth, 11 guardians, 12 system personnel) completed qualitative interviews, providing perspectives on substance use disorder stigma and the role of stigma in discouraging treatment. Using analysis of covariance, multiple regression analyses, and qualitative grounded theory analysis, I explored the nature of stigma toward justice-involved youth with substance use disorders and examined the impact of stigma on treatment accessibility and engagement. Results: For aim 1, as hypothesized, public stigma (assessed by survey data) varied significantly according to participant role and specific substance, with guardians endorsing greater stigma than system personnel. All participants expressed greater negative emotions towards youth with opioid use disorder compared to marijuana use disorder. Interview data revealed particularly nuanced attitudes about marijuana use. Contrary to expectations, youth reported little self-stigma. Both youth and guardians described limited knowledge of problematic substance use. For aim 2, interview data suggests that youth and guardians may identify more stigma associated with seeking treatment for problematic substance use than with using substances. All participants reported that perceived stigma has improved in recent years, and that youth feel more comfortable discussing their substance use. However, guardians identified family attitudes about behavioral health treatment as negatively impacting engagement among youth. In addition, system personnel reported that stigma continues to limit the accessibility of youth SUD treatment. Discussion: Youth endorsed lower than expected levels of self-stigma with no difference by primary substance type; this may have been affected by youth’s limited understanding of problematic substance use and lower than expected heterogeneity in substance use type among participants. Consistent with prior research, self-stigma was directly related to the severity of mental health symptoms. The high prevalence of public stigma among guardians of JIY with SUDs suggests that parents and guardians would benefit from interventions to better support their caregiving experiences. All participants identified complex attitudes about marijuana use, suggesting that the increasing public acceptability and endorsement of marijuana as a helpful substance may complicate treatment seeking when use becomes problematic. Although youth did not conceptualize self-stigma as a barrier to treatment, given that the primary substance used in this study was marijuana, these results may be complicated by changing societal attitudes about marijuana in particular. Qualitative perspectives from guardians and system personnel suggest that substance use disorder stigma may limit both the accessibility of treatment and youth’s likelihood to engage with treatment; this may depend on type of substance used. Particularly for the participants in this study, extremely limited treatment accessibility posed the largest barrier to evidence-based substance use disorder treatment for adolescents, making it difficult to accurately assess the role of stigma in actual treatment use. Finally, findings suggest that measuring substance use disorder stigma may be dependent on participants’ ability to accurately identify problematic substance use. It may also be important to refine both qualitative and quantitative measurement of stigma specifically with adolescents. Limitations and suggestions for future research are discussed.Item Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment(BMC, 2020-10-08) Johnson-Kwochka, A.; Dir, A.; Salyers, Michelle P.; Aalsma, Matthew C.; Psychology, School of ScienceBackground Substance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model. Methods In this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS). Results Organizationally, staff from community mental health centers reported more “red tape” and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions. Conclusions While both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.Item The point of diminishing returns in juvenile probation: Probation requirements and risk of technical probation violations among first-time probation-involved youth(American Psychological Association, 2021) Dir, Allyson L.; Magee, Lauren A.; Clifton, Richelle L.; Ouyang, Fangqian; Tu, Wanzhu; Wiehe, Sarah E.; Aalsma, Matthew C.; Psychiatry, School of MedicineTechnical probation violations are common among probation-involved youth, and across many jurisdictions, may result in detention or residential placement. The current study examined prevalence of technical violations occurring during one's first probation period, the average time to technical violation, and individual-level and justice-related factors related to technical violations among probation-involved youth in a juvenile justice system. We analyzed electronic criminal records of 18,289 probation-involved youth following their first arrest (68.7% male, 53.9% Black, Mage=15.2). Technical violation was defined as a violation resulting from a non-criminal incident. We examined effects of charge severity, probation conditions (e.g., electronic monitoring) and program referrals (e.g., mental health) on likelihood of technical violation utilizing survival analysis stratified by race. Across 18,289 youth, 15.3% received a technical violation during their first probation; Black youth violated more quickly compared to White youth (log-rank test p<.001). In multivariate survival analyses, the hazard for time to technical violation was higher for Black youth compared to white youth (p<.001), males (p=.04), and younger youth (p<.001). Youth assigned to more probation requirements violated more quickly. Electronic monitoring and education, mental health, and drug programs were associated with shorter time to violation, controlling for race, ethnicity, and charge severity. Black youth violate more quickly compared to White youth. Across all youth, assignment to more probation requirements increased risk of technical violation and shorter time to violation. Despite the benefit of probation interventions, system-level efforts are needed to help youth adhere to probation requirements and successfully complete probation.Item Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology(Taylor and Francis Online, 2019-01-08) Banks, Devin E.; Hershberger, Alexandra R.; Pemberton, Taylor; Clifton, Richelle L.; Aalsma, Matthew C.; Zapolski, Tamika C. B.; Psychology, School of ScienceBackground: Adolescent cannabis use is associated with increased risk for psychological problems, with evidence for more severe problems among youth who use cannabis in combination with other substances (i.e., polysubstance use). Juvenile offenders engage in both cannabis use and polysubstance use at higher rates than the general adolescent population. Yet, limited research has examined the relationship between cannabis poly-use (e.g., cannabis and alcohol use) and functional or psychological problems among juvenile offenders. Objectives: The current study addresses this gap by examining the association of polysubstance use of cannabis compared to cannabis only use with cognitive functioning, psychological distress, and substance-related problems among juvenile detainees. Methods: Participants were 238 detained youth ages 12–18 (80.4% male, 77.3% non-White) who completed assessments of substance use, intellectual functioning, psychological symptoms, and substance-related problems. Youth were also assessed by a clinical psychologist for substance use disorder. Results: Four cannabis-use typologies were identified; cannabis and alcohol use was the largest class, followed by cannabis only use, cannabis, alcohol and other drug use, then cannabis and other drug use. Polysubstance use was associated with lower scores on measures of intellectual functioning, more externalizing and internalizing symptomology, and more substance-related problems relative to cannabis only use. However, the relationship between polysubstance use and problems varied by typology. Conclusions: Findings suggest that justice-involved youth engaged in polysubstance use may be at greater need for concurrent academic, affective, and behavioral support in their rehabilitation and transition back to the community.Item Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative(Springer, 2023) Ahrens, Kym; Blackburn, Natalie; Aalsma, Matthew; Haggerty, Kevin; Kelleher, Kelly; Knight, Danica K.; Joseph, Elizabeth; Mulford, Carrie; Ryle, Ted; Tolou-Shams, Marina; Pediatrics, School of MedicineYouth involved in the legal system (YILS) experience rates of opioid and substance use disorders (OUD/SUDs) and overdose that is well above those in the general population. Despite the dire need, and the existing programs that focus on treatment of these problems in YILS, research on opioid initiation, and OUD prevention, including feasibility and sustainability, are severely limited. We present four studies testing interventions that, while not necessarily novel as SUD treatments, test novel structural and interpersonal strategies to prevent opioid initiation/OUD precursors: (1) ADAPT (Clinical Trial No. NCT04499079) provides real-time feedback using community-based treatment information system data to create a more effective mental health and SUD treatment cascade to prevent opioid use; (2) HOME (Clinical Trial No. NCT04135703) provides youth experiencing homelessness, including YILS, with direct access to shelter in independent living without prerequisites as an opioid initiation prevention strategy; (3) LeSA (Clinical Trial No. NCT04678960) uses the Trust-Based Relational Intervention® to equip YILS and their caregivers with self-regulatory and communication skills during the transition from secure confinement to reduce opioid initiation/re-initiation; and (4) POST (Clinical Trial No. NCT04901312) tests two interventions integrating interpersonal/drinking and drug refusal skills, case management, and goal setting among YILS in transitioning out of secure detention as opioid initiation prevention strategies. We discuss early implementation barriers and facilitators, including complexities of prevention research with YILS and adaptations due to COVID-19. We conclude by describing anticipated end products, including implementation of effective prevention interventions and integration of data from multiple projects to address larger, multi-site research questions.