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. 2019 Sep 6;14(1):36.
doi: 10.1186/s13722-019-0161-5.

Implementing risk stratification to the treatment of adolescent substance use among youth involved in the juvenile justice system: protocol of a hybrid type I trial

Matthew C Aalsma  1   2 , Allyson L Dir  3   4 , Tamika C B Zapolski  3   5 , Leslie A Hulvershorn  3   4 , Patrick O Monahan  6 , Lisa Saldana  7 , Zachary W Adams  3   4
Affiliations

Implementing risk stratification to the treatment of adolescent substance use among youth involved in the juvenile justice system: protocol of a hybrid type I trial

Matthew C Aalsma et al. Addict Sci Clin Pract. .

Abstract

Background: Youth involved in the juvenile justice system (YIJJ) have high rates of substance use problems; however, rates of YIJJ engagement in substance use services is low. Barriers to service engagement include lack of appropriate screening and connection to services by the juvenile justice system, as well as lack of resources for delivering evidence-based treatment in community-based settings. To address these barriers, this paper describes a protocol for a type 1 hybrid design to (1) implement universal substance use screening for YIJJ; (2) implement and evaluate the feasibility and effectiveness of a brief, three-session substance use interventions based in motivational interviewing for youth with mild/moderate substance use: Teen Intervene (an individual-based intervention); (3) implement ENCOMPASS, an evidence-based substance use intervention based in motivational enhancement and cognitive behavioral therapy for youth with severe substance use; and (4) evaluate facilitators and barriers to implementing these interventions for mild to severe substance use among YIJJ in community mental health centers (CMHC).

Methods/design: Using a hybrid type 1 clinical effectiveness-implementation design, we will collaborate with CMHCs and juvenile justice in two rural Indiana counties. Guided by the EPIS (exploration, preparation, implementation, sustainability) framework, we will measure factors that affect implementation of substance use screening in juvenile justice and implementation of substance use interventions in CMHCs utilizing self-reports and qualitative interviews with juvenile justice and CMHC staff pre- and post-implementation. YIJJ with mild/moderate substance use will receive a brief interventions and YIJJ with severe substance use will receive ENCOMPASS. We will measure the effectiveness of a brief and comprehensive intervention by assessing changes in substance use across treatment. We anticipate recruiting 160 YIJJ and their caregivers into the study. We will assess intervention outcomes utilizing baseline, 3-, and 6-month assessments.

Discussion: Findings have the potential to improve screening and intervention services for YIJJ.

Keywords: Adolescent substance use; Brief intervention; EPIS; Effectiveness; Hybrid design; Implementation; Justice-involved youth; Screening.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
EPIS implementation model
Fig. 2
Fig. 2
Overview of study design. YIJJ who score 1 or more on the CRAFFT will be recruited for the study. If interested and consent to treatment, they will be assessed to determine risk level. YIJJ identified as high-risk youth will be assigned to complete ENCOMPASS. Low to mid risk youth will be assigned to the brief intervention, Teen Intervene. Following the brief intervention, we will measure treatment response using the BSCQ. YIJJ who score below 70% will be considered “non-responders” and referred to ENCOMPASS
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