Improving Substance Use Services for Juvenile Justice-Involved Youth: Complexity of Process Improvement Plans in a Large Scale Multi-site Study

Becan, Jennifer E.; Fisher, Jacqueline Horan; Johnson, Ingrid Diane; Bartkowski, John P.; Seaver, Robert; Gardner, Sheena; Aarons, Gregory A.; Renfro, Tiffaney L.; Muiruri, Roxanne; Blackwell, Lindrell; Piper, Kaitlin; Wiley, Tisha R. A.; Knight, Danica K.

doi:10.1007/s10488-019-01007-z

Cited by 15 publications

(8 citation statements)

References 44 publications

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“…Sites within a state were paired based on the number of youth aged 10–19 in the general population in the county and the total JJ caseload size; the pair were randomized to one of three start dates. The study was divided into discrete phases that were aligned with the EPIS model to monitor implementation achievements (Aarons et al, 2011 ; Becan et al, 2020 ): Exploration (E; T1 Baseline), Preparation (P; T2 Pre-Randomization), Implementation (I; T3 Early Experiment, T4 Late Experiment), and Sustainment (S; T5 Maintenance). The baseline period (T1) lasted 9 to 18 months depending on the site; all other study phases were 6-months in duration.…”

Section: Methodsmentioning

confidence: 99%

“…Each interagency workgroup was expected to use their site feedback report prepared by research staff to develop and implement plans to better identify youth with substance use problems, and link and retain them in appropriate services to achieve clinical improvement. The interagency workgroups had flexibility in the goals they selected (see Becan et al, 2020 for the types of process improvement plans developed by JJ-TRIALS sites).…”

Section: Methodsmentioning

confidence: 99%

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Impact of implementation interventions to improve substance use service delivery on recidivism among justice-involved youth

et al. 2023

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Substance use disorders (SUD) are prevalent among justice-involved youth (JIY) and are a robust predictor of re-offending. Only a fraction of JIY with substance use problems receive treatment. This paper describes the impacts of system-level efforts to improve identification and referral to treatment on recidivism of JIY. A cluster randomized trial involving 20 county juvenile justice agency sites across 5 states was used to implement an organizational intervention (Core vs Enhanced) to juvenile justice staff and community-based treatment providers, working with 18,698 JIY from March 2014 to August 2017. Recidivism rates over four study time periods were examined. Logistic regression was used to predict recidivism as a function of site, need for SUD services, level of supervision, time, organizational intervention, and time x intervention interaction terms. Results indicated that Enhanced sites showed decreased levels of recidivism compared to Core-only sites, where it increased over time. Additionally, need for SU services, level of supervision, and site were significant predictors of reoffending. Findings suggest the potential value of facilitation of juvenile justice agency efforts to increasing identification of and referral to SUD services of JIY in need of such services for reducing further contact with the legal system.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of implementation interventions to improve substance use service delivery on recidivism among justice-involved youth

et al. 2023

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“…The study protocol has been previously published [ 19 ]. All sites received Core implementation intervention activities which included the creation of implementation teams involving representatives from JJ and at least one BH agency, training on the Cascade (provided to agency leadership, team members, and staff with direct youth contact) [ 5 ], support for goal selection (based on site-specific feedback reports) [ 40 ], and training on applying DDDM [ 41 ]. Implementation teams in Core sites were encouraged to apply these strategies on their own.…”

Section: Methodsmentioning

confidence: 99%

The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth

Knight

Belenko

Dennis

et al. 2022

BMC Health Serv Res

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Background Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt. Methods Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change. Results Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems. Conclusions Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

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“…The study protocol has been previously published (19). All sites received Core implementation intervention activities which included the creation of implementation teams involving representatives from JJ and at least one BH agency, training on the BH Cascade (provided to agency leadership, team members, and staff with direct youth contact) (5), support for goal selection (based on sitespeci c feedback reports) (40), and training on applying DDDM (41). Implementation teams in Core sites were encouraged to apply these strategies on their own.…”

Section: Methodsmentioning

confidence: 99%

The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth

Knight

Belenko

Dennis

et al. 2022

Preprint

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Background: Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt.Methods: Part of a larger Juvenile Justice-Translational Research for Adolescents in the Justice System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 juvenile justice community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of justice and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change.Results: Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems. Conclusions: Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade. Trial registration: ClinicalTrials.gov; NCT02672150; Date of registration: 2/3/2016 (retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT02672150

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Improving Substance Use Services for Juvenile Justice-Involved Youth: Complexity of Process Improvement Plans in a Large Scale Multi-site Study

Cited by 15 publications

References 44 publications

Impact of implementation interventions to improve substance use service delivery on recidivism among justice-involved youth

Impact of implementation interventions to improve substance use service delivery on recidivism among justice-involved youth

The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth

The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth

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