Increasing Caregiver Engagement in Juvenile Drug Courts

Behavioral Incentives to Increase Caregiver Engagement in Juvenile Drug Courts

Status

Completed

Phases

Unknown

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03051997

Enrollment

Registered

2017-02-14

Start date

2017-10-13

Completion date

2024-12-12

Last updated

2026-08-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Substance Abuse

Brief summary

The purpose of this study is to test a prize-based contingency management intervention for increasing caregiver engagement in juvenile drug court and adolescent drug treatment, and for achieving the ultimate outcomes of reduced substance use and delinquent behavior among drug court-involved youth.

Detailed description

Juvenile offenders with substance abuse problems represent a large and underserved population that is at high risk of deleterious outcomes and long-term costs for themselves, their families, communities, and society. Moreover, a high percentage of substance abusing adolescents 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 drug use and delinquency among youth, its effectiveness is variable. Drug court outcomes may be compromised by the lack of caregiver engagement in JDC processes and adolescent drug treatment. Incorporating easily implemented evidence-based incentive programs in JDCs might improve their effectiveness in reducing youth drug use and 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 randomized clinical trial will examine the efficacy of a prize-based contingency management intervention for increasing caregiver engagement (attendance and participation) in JDC and adolescent drug treatment. This caregiver contingency management intervention (CCM) will be compared with drug court treatment as usual (TAU). Increased caregiver participation is predicted to improve adolescent outcomes (decreased drug use and delinquent behavior). One hundred and eighty youth enrolled in JDC will be randomly assigned along with a parent/caregiver to TAU or CCM. Analyses will examine measures of caregiver engagement in JDC as well as youth substance use (urine drug screens) and delinquent activity. Results from this study will 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.

Interventions

BEHAVIORALCaregiver Contingency Management + Usual Drug Court Treatment

In addition to receiving JDC treatment as usual described below, caregiver participants will receive prize draws for engaging in activities consistent with their adolescents' successful completion of the JDC program during the time the youth is actively involved in JDC and substance abuse treatment. Specific activities that may be reinforced include: attendance at drug court hearings; accompanying the youth to probation meetings; participating in home visits; attendance at the youth's drug treatment sessions; attendance at mental health provider meetings; attending groups for parents of youth with substance abuse issues; and completing other verifiable treatment-related activities. All activities will meet the goals of (directly or indirectly) enhancing caregiver participation in the JDC and/or treatment process. Caregivers will receive escalating chances for tangible reinforcers each week for completing up to 3 of the activities agreed upon by the caregiver and the therapist.

BEHAVIORALUsual Drug Court Treatment

Standard outpatient substance abuse treatment services that a young person would receive while participating in JDC.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

13 Years to 89 Years

Healthy volunteers

Inclusion criteria

for youth: * Involved in juvenile drug court * Aged 13-17 years * Youth is willing to participate * At least one caregiver is willing to participate in the youth's treatment * Fluent in English or Spanish

Exclusion criteria

for youth: * Diagnosed with intellectual disability or autism spectrum disorder Inclusion Criteria for caregivers: * Caregiver of youth involved in juvenile drug court * Caregiver is willing to participate * Fluent in English or Spanish

Design outcomes

Primary

Measure	Time frame	Description
Number of Participants With Positive Urine Drug Screens at 5 Months Post-baseline	Baseline to 5 months	This measure reflects the number of positive urine drug screens for THC, amphetamines, methamphetamines, opiates, cocaine, benzodiazepines, MDMA, and oxycodone collected from youth participants. Assessed at baseline and 5 months; data reported for 5-month time point
Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline, 5 months	The GAIN Substance Frequency Scale assesses frequency of substance use over the past 90 days. Scores range from 0 (no use) to 90 (daily use). Higher scores indicate greater substance use severity.

Secondary

Measure	Time frame	Description
Changes From Baseline to 18 Months Post-baseline in Youth Arrests, Charges, and Convictions.	Baseline to 18 months	Number of youth arrests, charges, and convictions measured via official arrest records.
Changes From Baseline to 18 Months Post-baseline in Youth Delinquent Behaviors (Measured at 0, 3, 5, 6, 9, 12, and 18 Months).	Baseline to 18 months	Frequency of delinquent behaviors self-reported by youth using the Self-Report Delinquency Scale.
Changes From Baseline to 18 Months Post-baseline in Caregiver Reports on Youth Internalizing Symptoms and Externalizing Behaviors (Measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 Months).	Baseline to 18 months	Frequency of youth's internalizing symptoms and externalizing behaviors measured with the Child Behavior Checklist (caregiver report).
Changes From Baseline to 18 Months Post-baseline in Youth Reports on Youth Internalizing Symptoms and Externalizing Behaviors (Measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 Months).	Baseline to 18 months	Frequency of youth's internalizing symptoms and externalizing behaviors measured with the Brief Problem Checklist (youth report).
Changes From Baseline to Post-treatment in Caregiver Substance Use Problems.	Baseline through treatment completion, an average of 4 months	Frequency and severity of substance use problems self-reported by caregivers on the Addiction Severity Index.
Changes From Baseline to Post-treatment in Caregiver Depressive Symptoms.	Baseline through treatment completion, an average of 4 months	Frequency and severity of depressive symptoms self-reported by caregivers on the Beck Depression Inventory.
Changes From Baseline to Post-treatment in Therapist-Family Working Alliance (Measured at 1, 2, 3, and 4 Months, as Well as Post-treatment).	Baseline through treatment completion, an average of 4 months	Levels of alliance during treatment reported by therapists, caregivers, and youth on the Working Alliance Inventory.
Changes From Baseline to Post-treatment in Caregiver Treatment Attendance and Activity Completion (Measured at 1, 2, 3, and 4 Months, as Well as Post-treatment).	Baseline through treatment completion, an average of 4 months	Frequency of caregiver attendance at their youth's substance use treatment sessions and completion of therapeutic activities reported by therapists on the Session Tracking Sheet.
Changes From Baseline to the End of JDC Involvement in Caregiver Attendance at JDC Sessions.	Baseline through the end of JDC involvement, an average of 12 months	Frequency of caregiver attendance at their youth's JDC sessions reported by JDC personnel on the JDC Attendance Form.
Rates of Treatment Completion.	Up to 4 months on average	Rates of youth treatment completion reported by therapists using the Treatment Termination Form.
Levels of Satisfaction With Treatment and JDC.	Up to 4 months on average	Levels of satisfaction with substance use treatment and JDC reported by caregivers and youth on the Client Satisfaction Questionnaire.
Changes From Baseline to Post-treatment in Caregiver Perceptions of Incentive Programs.	Baseline through treatment completion, an average of 4 months	Ratings by caregivers on perceptions of incentive-based interventions as measured by the Provider Survey of Incentives.
Changes From Baseline to 36 Months Post-baseline in Therapist and JDC Personnel Perceptions of Incentive Programs (Measured at 0, 12, 24, and 36 Months).	Baseline to 36 months	Ratings by therapists and JDC personnel on perceptions of incentive-based interventions as measured by the Provider Survey of Incentives.
Reports at Post-treatment on Youth and Caregiver Attitudes Toward Incentive Programs.	Up to 4 months on average	Youth and caregiver attitudes toward incentive programs as measured during qualitative interviews.
Changes From Baseline to 36 Months Post-baseline in Therapist and JDC Personnel Attitudes Toward Incentive Programs (Measured at 0, 12, 24, and 36 Months).	Baseline to 36 months	Therapist and JDC personnel attitudes toward incentive programs as measured during qualitative interviews.

Countries

United States

Contacts

PRINCIPAL_INVESTIGATORPhillippe Cunningham, Ph.D.

Medical University of South Carolina

PRINCIPAL_INVESTIGATORDavid Ledgerwood, Ph.D.

Wayne State University

STUDY_DIRECTORStacy Ryan, Ph.D.

The University of Texas Health Science Center at San Antonio

Participant flow

Pre-assignment details

This study enrolled adolescent-caregiver dyads. The reported enrollment (n=53) reflects dyads. Outcome and adverse event data were collected only for adolescents unless otherwise noted. Counts represent dyads. Individual counts for adolescents and caregivers were not separately tracked for milestones.

Participants by arm

Arm	Count
Caregiver Contingency Management + Usual Drug Court Treatment (Adolescents) This group will receive a caregiver contingency management intervention plus the standard outpatient substance abuse treatment services provided at JDC. Baseline Measures is for the adolescent participants	32
Usual Drug Court Treatment (Adolescents) This group will receive the standard outpatient substance abuse treatment services provided at JDC. Baseline Measures is for the adolescent participants	21
Total	53

Baseline characteristics

Characteristic	Caregiver Contingency Management + Usual Drug Court Treatment (Adolescents)	Total	Usual Drug Court Treatment (Adolescents)
Age, Continuous	15.46 Years STANDARD_DEVIATION 1.4	15.46 Years STANDARD_DEVIATION 1.4	15.46 Years STANDARD_DEVIATION 1.4
Race (NIH/OMB) American Indian or Alaska Native	1 Participants	2 Participants	1 Participants
Race (NIH/OMB) Asian	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Black or African American	11 Participants	16 Participants	5 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	1 Participants	1 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	2 Participants	7 Participants	5 Participants
Race (NIH/OMB) White	17 Participants	27 Participants	10 Participants
Region of Enrollment United States	32 participants	31 participants	21 participants
Sex: Female, Male Female	11 Participants	14 Participants	3 Participants
Sex: Female, Male Male	21 Participants	39 Participants	18 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 32	0 / 21
other Total, other adverse events	1 / 32	0 / 21
serious Total, serious adverse events	3 / 32	3 / 21

Outcome results

Primary

Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.

The GAIN Substance Frequency Scale assesses frequency of substance use over the past 90 days. Scores range from 0 (no use) to 90 (daily use). Higher scores indicate greater substance use severity.

Time frame: Baseline, 5 months

Arm	Measure	Group	Value (MEAN)	Dispersion
Caregiver Contingency Management + Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline - Days drunk or high whole day	2.56 score on a scale	Standard Deviation 6
Caregiver Contingency Management + Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline - Days of marijuana use	4.26 score on a scale	Standard Deviation 9.3
Caregiver Contingency Management + Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline - Days of alcohol use	0.63 score on a scale	Standard Deviation 1.63
Caregiver Contingency Management + Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Month 5 - Days drunk or high whole day	0.72 score on a scale	Standard Deviation 2.4
Caregiver Contingency Management + Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Month 5 - Days of marijuana use	1.11 score on a scale	Standard Deviation 3.2
Caregiver Contingency Management + Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Month 5 - Days of alcohol use	0.63 score on a scale	Standard Deviation 1.8
Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Month 5 - Days of marijuana use	4.54 score on a scale	Standard Deviation 8.4
Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline - Days drunk or high whole day	8.03 score on a scale	Standard Deviation 10.3
Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Month 5 - Days drunk or high whole day	4.08 score on a scale	Standard Deviation 7.6
Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline - Days of marijuana use	12.69 score on a scale	Standard Deviation 13.3
Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Month 5 - Days of alcohol use	1.46 score on a scale	Standard Deviation 2.3
Usual Drug Court Treatment	Frequency of Substance Use and Substance-related Problems Self-reported by Youth on the Global Appraisal of Individual Needs.	Baseline - Days of alcohol use	2.85 score on a scale	Standard Deviation 4.8

Primary

Number of Participants With Positive Urine Drug Screens at 5 Months Post-baseline

This measure reflects the number of positive urine drug screens for THC, amphetamines, methamphetamines, opiates, cocaine, benzodiazepines, MDMA, and oxycodone collected from youth participants. Assessed at baseline and 5 months; data reported for 5-month time point

Time frame: Baseline to 5 months

Arm	Measure	Value (NUMBER)
Caregiver Contingency Management + Usual Drug Court Treatment	Number of Participants With Positive Urine Drug Screens at 5 Months Post-baseline	18 participants
Usual Drug Court Treatment	Number of Participants With Positive Urine Drug Screens at 5 Months Post-baseline	13 participants

Secondary

Changes From Baseline to 18 Months Post-baseline in Caregiver Reports on Youth Internalizing Symptoms and Externalizing Behaviors (Measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 Months).

Frequency of youth's internalizing symptoms and externalizing behaviors measured with the Child Behavior Checklist (caregiver report).

Time frame: Baseline to 18 months

Secondary

Changes From Baseline to 18 Months Post-baseline in Youth Arrests, Charges, and Convictions.

Number of youth arrests, charges, and convictions measured via official arrest records.

Time frame: Baseline to 18 months

Secondary

Changes From Baseline to 18 Months Post-baseline in Youth Delinquent Behaviors (Measured at 0, 3, 5, 6, 9, 12, and 18 Months).

Frequency of delinquent behaviors self-reported by youth using the Self-Report Delinquency Scale.

Time frame: Baseline to 18 months

Secondary

Changes From Baseline to 18 Months Post-baseline in Youth Reports on Youth Internalizing Symptoms and Externalizing Behaviors (Measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 Months).

Frequency of youth's internalizing symptoms and externalizing behaviors measured with the Brief Problem Checklist (youth report).

Time frame: Baseline to 18 months

Secondary

Changes From Baseline to 36 Months Post-baseline in Therapist and JDC Personnel Attitudes Toward Incentive Programs (Measured at 0, 12, 24, and 36 Months).

Therapist and JDC personnel attitudes toward incentive programs as measured during qualitative interviews.

Time frame: Baseline to 36 months

Secondary

Changes From Baseline to 36 Months Post-baseline in Therapist and JDC Personnel Perceptions of Incentive Programs (Measured at 0, 12, 24, and 36 Months).

Ratings by therapists and JDC personnel on perceptions of incentive-based interventions as measured by the Provider Survey of Incentives.

Time frame: Baseline to 36 months

Secondary

Changes From Baseline to Post-treatment in Caregiver Depressive Symptoms.

Frequency and severity of depressive symptoms self-reported by caregivers on the Beck Depression Inventory.