Substance Use and HIV Among Justice-Involved Youth: Intersecting Risks

Tolou‐Shams, Marina; Harrison, Anna J.; Hirschtritt, Matthew E.; Dauria, Emily; Barr‐Walker, Jill

doi:10.1007/s11904-019-00424-x

Cited by 22 publications

(8 citation statements)

References 72 publications

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“…Our analysis suggests that disadvantaged groups in need of MAT, especially those groups impacted by CJ-involvement, may have more opportunities to access a broader range of services in expansion states. Promoting the adoption of Medicaid expansion in states that have not implemented it, as well as strengthening existing programs in expansion states, are potential ways to improve health outcomes among CJ-involved individuals who often have multiple intersecting health exposures [ 48 – 51 ]. Research from San Francisco’s Transitions Clinic Network has demonstrated that tailoring substance use treatment services to the unique needs of CJ-involved individuals is effective in improving health outcomes and reducing recidivism [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Tailoring services in opioid treatment programs for patients involved in America’s criminal justice system: national associations and variation by state and Medicaid expansion status

Pro

Montgomery

Zaller

2021

Subst Abuse Treat Prev Policy

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Background Opioid treatment programs (OTPs) are the primary source of medication-assisted treatment (MAT) for many individuals with opioid use disorder, including poor and uninsured patients and those involved in the criminal justice (CJ) system. Substance use treatment services that are tailored to the unique needs of patients often produce better outcomes, but little national research has addressed characteristics associated with whether OTPs offer services specifically tailored to community members involved in the CJ system. Medicaid expansion under the Affordable Care Act has broadly strengthened MAT services, but the role of expansion in supporting MAT services that are specifically tailored towards CJ-involved populations remains unknown. Moreover, it is unknown whether the availability of tailored services varies between Medicaid expansion states. Methods We used the 2019 National Survey of Substance Abuse Treatment Services to identify OTPs in the US (n = 1679) and whether they offered services specifically tailored for CJ-involved patients. We used logistic regression to model the association between OTPs offering tailored services and state Medicaid expansion status, adjusted for state-level opioid overdose and community supervision rates. Results Nationally, only a quarter of OTPs offered services tailored to CJ populations, and the majority of OTPs (73%) were located in Medicaid expansion states. Compared to OTPs in non-expansion states, OTPs in expansion states demonstrated nearly double the odds of offering tailored services (adjusted odds ratio = 1.90, 95% confidence interval = 1.41–2.57, p < 0.0001). The predicted probability of offering tailored services varied by state; probability estimates for all expansion states were above the national mean, and estimates for all non-expansion states were below the national mean. Conclusion Our findings reiterate the role of Medicaid in promoting the adoption of comprehensive OTP services for CJ-involved populations. However, the proportion of OTPs that offered tailored services was relatively low, pointing to the need to continually strengthen Medicaid services and coverage.

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Section: Discussionmentioning

confidence: 99%

Tailoring services in opioid treatment programs for patients involved in America’s criminal justice system: national associations and variation by state and Medicaid expansion status

Pro

Montgomery

Zaller

2021

Subst Abuse Treat Prev Policy

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“…Juvenile offenders who abuse drugs have more severe delinquent behavior, are more likely to recidivate, and are more likely to continue offending into adulthood (Schubert, Mulvey, & Glasheen, 2011; Wibbelink, Hoeve, Stams, & Oort, 2017). Additionally, substance use in juvenile offenders is linked to worse educational, vocational, and health outcomes (Chassin, Mansion, Nichter, & Losoya, 2014; Schubert et al, 2011; Tolou-Shams, Harrison, Hirschtritt, Dauria, & Barr-Walker, 2019; Zajac et al, in press). Up to three-quarters of detained youth meet criteria for at least one behavioral health disorder, the most common being substance use disorders (Teplin et al, 2013; Schubert et al, 2011).…”

mentioning

confidence: 99%

Capacity of juvenile probation officers in low-resourced, rural settings to deliver an evidence-based substance use intervention to adolescents.

Sheidow¹,

McCart²,

Chapman³

et al. 2020

Psychology of Addictive Behaviors

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Substance use is a major public health problem with a host of negative outcomes. Justice-involved youth have even higher risks and lack access to evidence-based interventions, particularly in rural communities. Task-shifting, or redistribution of tasks downstream to an existing workforce with less training, may be an innovative strategy to increase access to evidence-based interventions. Initial findings are presented from a services research trial conducted primarily in rural communities in which an existing workforce, juvenile probation/parole officers (JPOs), were randomized either to learn and deliver contingency management (CM) or to continue delivering probation services as usual (PAU). This study used the prevailing version of CM for adolescents, that is, family-based with behavior modification and cognitive behavioral components. Data included JPOs’ self-reports, as well as audio-recorded youth/family sessions with JPOs rated by expert and trained observational coders. Data also included ratings from a comparison study in which therapists were trained and supervised by experts to deliver CM to justice-involved youth/families. Results showed JPOs can feasibly incorporate CM into their services. When adherence of CM JPOs was compared against CM therapists, JPOs delivered significantly more cognitive behavioral components of CM and similar levels of behavior modification components of CM. These findings suggest that JPOs can be leveraged to provide evidence-based substance use interventions like CM in similar, or even greater, capacities to clinically trained therapists. This task-shifting approach could dramatically expand service access for these high-risk youth, particularly in rural areas where substance use services are limited or nonexistent.

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“…Most evidence-based practices for HIV services in justice-involved populations have either been developed for younger youth (Tolou-Shams et al, 2019 ) or delivered for adults in (locked) correctional settings (Belenko, Hiller, et al, 2013 ; Belenko, Visher, et al, 2013 ; Elkington et al, 2016 ). Recent data from juvenile community supervision agencies noted that approximately two-thirds do not offer any HIV/STI related services (Elkington et al, 2020 ), either on-site or via referral to community-based partners.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to addressing system level linkages and service integration within ASPs, better interventions are needed to address HIV and SU among JIYA. Existing HIV prevention interventions for justice-involved youth show variable efficacy (Tolou-Shams, Harrison, Hirschtritt, Dauria, & Barr-Walker, 2019 ) and are largely developed for younger youth (< 18 years). Similarly, SU brief interventions have largely been developed for adolescent and general adult populations, rather than young adults (Mitchell, Gryczynski, O'Grady, & Schwartz, 2013 ; Sommers et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

A study protocol for a randomized controlled trial of a cross-systems service delivery model to improve identification and care for HIV, STIs and substance use among justice-involved young adults

et al. 2020

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Background Justice-involved young adults (JIYA) aged 18–24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers. Methods MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months. Discussion This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.

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Substance Use and HIV Among Justice-Involved Youth: Intersecting Risks

Cited by 22 publications

References 72 publications

Tailoring services in opioid treatment programs for patients involved in America’s criminal justice system: national associations and variation by state and Medicaid expansion status

Tailoring services in opioid treatment programs for patients involved in America’s criminal justice system: national associations and variation by state and Medicaid expansion status

Capacity of juvenile probation officers in low-resourced, rural settings to deliver an evidence-based substance use intervention to adolescents.

A study protocol for a randomized controlled trial of a cross-systems service delivery model to improve identification and care for HIV, STIs and substance use among justice-involved young adults

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