Preventing opioid use among justice-involved youth as they transition to adulthood: leveraging safe adults (LeSA)

Abstract

Background Juvenile justice (JJ) youth are at high risk of opioid and other substance use (SU), dysfunctional family/social relationships, and complex trauma. The purpose of the Leveraging Safe Adults (LeSA) Project is to examine the effectiveness of Trust-Based Relational Intervention® (TBRI®; leveraging family systems by providing emotional and instrumental guidance, support, and role modeling) in preventing opioid and other SU among youth after release from secure residential facilities. Methods An effectiveness-implementation Hybrid Type 1 design is used to test the effectiveness of TBRI for preventing non-medical use of opioids among JJ-youth (delayed-start at the site level; a randomized controlled trial at participant level) and to gain insight into facility-level barriers to TBRI implementation as part of JJ re-entry protocols. Recruitment includes two samples (effectiveness: 360 youth/caregiver dyads; implementation: 203 JJ staff) from nine sites in two states over 3 years. Participant eligibility includes 15 to 18-year-olds disposed to community supervision and receiving care in a secure JJ facility, without active suicide risk, and with one caregiver willing to participate. Effectiveness data come from (1) youth and caregiver self-report on background, SU, psychosocial functioning, and youth-caregiver relationships (Months 0, 3, 6, 12, and 18), youth monthly post-release check-ins, and caregiver report on youth psychological/behavioral symptoms, and (2) JJ facility records (e.g., recidivism, treatment utilization). Fidelity assessment includes post-session checklists and measures of TBRI strategy use. Collected four times over four years, implementation data include (1) JJ staff self-report on facility and staff characteristics, use of trauma-informed care and TBRI strategies, and (2) focus groups (line staff, leadership separately) on use of trauma-informed strategies, uptake of new interventions, and penetration, sustainment, and expansion of TBRI practices. Discussion The LeSA study is testing TBRI as a means to empower caregivers to help prevent opioid use and other SU among JJ-youth. TBRI’s multiple components offer an opportunity for caregivers to supplement and extend gains during residential care. If effective and implemented successfully, the LeSA protocol will help expand the application of TBRI with a wider audience and provide guidance for implementing multi-component interventions in complex systems spanning multiple contexts. Trial registration ClinicalTrials.govNCT04678960; registered November 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04678960.

Multidisciplinary Strategies for Preventing Opioid Misuse and Escalation by Targeting Mental Health Symptoms and Conditions

“…The study at Texas Christian University (Dr. Knight, PI), Preventing Opioid Use Among Justice-Involved Youth as They Transition to Adulthood: Leveraging Safe Adults (LeSA project) (Knight et al, 2021 ), is focused on prevention intervention strategies that target the risk for substance use among older adolescents aged 15 to 18 who are transitioning from secure juvenile justice residential facilities to their communities. As part of the LeSA project, Texas Christian University is adapting and testing a trauma-informed approach, Trust-Based Relational Intervention ® (Purvis et al, 2013 ).…”

Adaptation of a trauma-informed intervention for youth involved in the legal system

“…Consistent with the three pillars of trauma-informed care [13], TBRI is based on three harmonious and synergistic principles: Connecting, Empowering, and Correcting. As part of the Leveraging Safe Adults (LeSA), TBRI was adapted for JJinvolved families [14]. Given that most youth discharged from secure residential facilities return to existing family/living environments, equipping adults who are responsible for their care with effective tools and support is critical and represents an urgent and potentially transformative prevention/intervention opportunity.…”

“…Substantial adaptations to structure were needed to extend the original group training for caregivers to in-home sessions for individual families. Two coaching options were developed for the LeSA Project: a structured four-session coaching program and a responsive coaching program with no limit to session number [14].…”

“…While early feedback suggests that caregivers and youth found the intervention to be helpful, research is needed to establish the effectiveness of the adapted intervention for improving self-regulation and relationships with caregivers and preventing opioid and other substance use. A delayed-start, randomized control trial is currently underway to examine the added value of TBRI compared to standard reentry practice, the differential effectiveness of three post-discharge TBRI support formats, and the costs associated with TBRI implementation [14].…”

Substances Pathological of Use and Syndrome Z: Medicine D

“…Sd Z is ́ Ó missing link ́ , given that most addictions are secondary, evolving to pathologies (situations of biological lesions and other damage) and other clinical diseases such as metabolic syndrome, addictions, not observed clinically to date, which share common neuronal pathways of the reward system: impulsivity, sexuality, intake of sugar and carbohydrates, substance use and monetary gains [89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104].…”