Substance Use Disorders
Conditions
Keywords
evidence-based practice implementation, system change, interagency collaboration, substance use, treatment services, data-driven decision making, juvenile justice, adolescents, justice-involved youth, cluster randomized trial
Brief summary
This is a multi site experiment to evaluate the impact of various strategies for increasing the use of evidence based screening, assessment and linkage to substance use treatment. All sites collect baseline data and receive a core intervention. Half are then randomly assigned to get an additional year of coaching to facilitate implementation.
Detailed description
Background: The Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study is a cooperative implementation science initiative involving the National Institute on Drug Abuse, six Research Centers, a Coordinating Center, and Juvenile Justice Partners representing seven U.S. states. The pooling of resources across Centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, coproducing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. Methods/design: The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in 7 states. Core strategies for promoting change are compared to an Enhanced strategy that incorporate all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment. Primary Research Questions: 1. Does the Core and/or Enhanced Intervention reduce unmet need by increasing Cascade retention related to screening, assessment, treatment initiation, engagement and continuing care? 2. Does the addition of the Enhanced Intervention components further increase the percentage of youth retained in the Cascade relative to the Core components? 3. Does the addition of the Enhanced Intervention components improve service quality relative to Core sites? 4. Do staff perceptions of the value of best practices increase over time, and are increases more pronounced in Enhanced sites?
Sponsors
National Institute on Drug Abuse (NIDA)
Columbia University
Emory University
Mississippi State University
Temple University
Texas Christian University
University of Kentucky
Chestnut Health Systems
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Pairs of sites were optimally randomize based on 10,000 trials to the two conditions by the coordinating center. The assignment (to core or core+enhanced) was not revealed to the local research center or site until after completion of the core. Thus it is double blind.
Intervention model description
Staff from 34 juvenile community supervision agencies were observed for a 6 month baseline period than trained over 4 months on using a behavioral health service cascade model to screen, identify, and refer youth to substance use treatment. Half the sites were randomized to 12 additional months of facilitation. Sites were then monitored for an additional 4 month maintenance phase.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Specific site inclusion criteria include: (a) ability to provide youth service records, (b) service to youth under community supervision, (c) access to treatment provider(s) if treatment is not provided directly by the JJ agency, (d) participation in requisite intervention training/activities,(e) minimum average case flow of 10 youth per month, (f) minimum of 10 staff per site, and (g) a senior JJ staff member who agrees to serve as site leader/liaison during the study. Study sites are geographically dispersed and were identified by state JJ agencies (and not selected for particular substance use or related BH service needs). Youth inclusion criteria include: all youth entering the juvenile justice system during the period within the exception of those who are already in treatment at the time that they are referred to the juvenile justice agency. Staff inclusion criteria include: all staff actively working with the youth under community supervision in the site with exclusion only of higher level administrative or regional staff over multiple units..
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Service Cascade: % Referred to Substance Use Treatment | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the number of youth referred to substance use treatment divided by the number of youth identified as need of substance use treatment. |
| Staff Perception: Value of Evidenced Based Substance Use Treatment | 120 weeks | Calculated from staff surveys at juvenile justice and substance use treatment agencies as the average staff ranking of the perceived value of using of evidence-based substance use treatment services. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Service Cascade: % In Need of Substance Use Treatment | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the number of youth identified (via screening, clinical assessment or other sources) as In Need of Substance Use Treatment divided by the number of youth entering the juvenile justice system. |
| Service Cascade: % Initiating Substance Use Treatment | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the number of youth Initiating Substance Use Treatment within 90 days of referral divided by the number referred to treatment from the juvenile justice system. |
| Service Cascade: % Engaged in Substance Use Treatment | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the number of youth Engaged in Substance Use Treatment for 6 weeks or more weeks divided by the number initiating treatment. |
| Service Cascade: % With Substance Use Treatment Continuing Care | 120 weeks | number of youth Continuing to receive substance use treatment services forCalculated from juvenile justice and substance use treatment agency records as the 90 days or more divided by the number initiating treatment. |
| Service Quality: Timing of Screening or Clinical Assessment | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the mean days from entry into the justice system to the first of screening or clinical assessment for substance use problems. |
| Service Cascade: % Screened for Substance Use Problems | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the number of youth Screened for substance use problems divided by the number of youth entering the juvenile justice system. |
| Service Quality: Number of Evidence Based Practices | 120 Weeks | Based on agency surveys and youth records from juvenile justice and substance use treatment agencies, the number of steps using 1 or more evidenced based practices in each of the following steps along the service cascade: screening, clinical assessment, referral, substance use treatment. |
| Staff Perception: Value of Evidenced Based Screening | 120 weeks | Calculated from staff surveys at juvenile justice and substance use treatment agencies as the average staff ranking of the perceived value of using of evidence-based screening. |
| Staff Perception: Value of Evidenced Based Clinical Assessment | 120 weeks | Calculated from staff surveys at juvenile justice and substance use treatment agencies as the average staff ranking of the perceived value of using of evidence-based clinical assessment. |
| Staff Perception: Value of Evidenced Based Substance Use Prevention | 120 weeks | Calculated from staff surveys at juvenile justice and substance use treatment agencies as the average staff ranking of the perceived value of using of evidence-based substance use prevention. |
| Staff Perception: Value of Evidenced Based HIV Risk Prevention | 120 weeks | Calculated from staff surveys at juvenile justice and substance use treatment agencies as the average staff ranking of the perceived value of using of evidence-based HIV Risk prevention. |
| Service Quality: Timing of Substance Use Treatment Initiation | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the mean days from referral to and initiation of substance use treatment. |
| Service Cascade: % Clinically Assessed for Substance Use Problems | 120 weeks | Calculated from juvenile justice and substance use treatment agency records as the number of youth Clinically Assessed for substance use problems divided by the number of youth entering the juvenile justice system. |
Countries
United States
Outcome results
None listed