Abstract：
BACKGROUND: Emerging adults (EAs) in the criminal legal system are at high risk for substance use and related negative outcomes. EAs also have low levels of engagement in treatment services, a pattern exacerbated for those living in rural communities. This pilot study investigated implementation outcomes of task-shifting an evidence-based substance use intervention, via a developmentally targeted program, provided by probation officers (POs) to selected EA clients.
METHODS: Ten POs recruited from two counties in Oregon who provide services to rural clients were trained and supported in delivering contingency management for EAs (CM-EA) to 17 EAs on their current caseloads. The pilot took place entirely during the COVID-19 pandemic. POs submitted session audiotapes and checklists from meetings with participating EA clients and participated in focus groups. EA clients completed baseline interviews and agreed to have their adult criminal records collected. Ten semi-structured interviews were completed with probation/parole administration and staff from four rural counties across three states highly impacted by the opioid epidemic about the barriers and facilitators for delivering a program like CM-EA in their offices.
RESULTS: Based on self-reports and observational coding, POs demonstrated fidelity and adoption as they delivered all CM-EA components and engaged in CM-EA quality assurance protocols. Penetration was demonstrated by the selection of EAs reflecting the demographics of their local offices (i.e., White, non-Hispanic, balanced across sex), struggling with polysubstance use, and primarily holding felony convictions. Emerging themes from focus groups and interviews revealed feasibility, acceptability, and appropriateness of CM-EA, including use with clients not currently in the research program and reported intentions to continue CM-EA use. Barriers for future use include those found for the delivery of other programs in rural areas such as resource limitations.
CONCLUSIONS: There is initial support for the implementation outcomes related to task-shifting a program like CM-EA to POs, particularly those serving rural clients, to increase access to evidence-based substance use services for EAs. Future research with larger samples and multiple follow-ups will allow for effectiveness testing and further program refinement for this high-priority population.
METHODS: Ten POs recruited from two counties in Oregon who provide services to rural clients were trained and supported in delivering contingency management for EAs (CM-EA) to 17 EAs on their current caseloads. The pilot took place entirely during the COVID-19 pandemic. POs submitted session audiotapes and checklists from meetings with participating EA clients and participated in focus groups. EA clients completed baseline interviews and agreed to have their adult criminal records collected. Ten semi-structured interviews were completed with probation/parole administration and staff from four rural counties across three states highly impacted by the opioid epidemic about the barriers and facilitators for delivering a program like CM-EA in their offices.
RESULTS: Based on self-reports and observational coding, POs demonstrated fidelity and adoption as they delivered all CM-EA components and engaged in CM-EA quality assurance protocols. Penetration was demonstrated by the selection of EAs reflecting the demographics of their local offices (i.e., White, non-Hispanic, balanced across sex), struggling with polysubstance use, and primarily holding felony convictions. Emerging themes from focus groups and interviews revealed feasibility, acceptability, and appropriateness of CM-EA, including use with clients not currently in the research program and reported intentions to continue CM-EA use. Barriers for future use include those found for the delivery of other programs in rural areas such as resource limitations.
CONCLUSIONS: There is initial support for the implementation outcomes related to task-shifting a program like CM-EA to POs, particularly those serving rural clients, to increase access to evidence-based substance use services for EAs. Future research with larger samples and multiple follow-ups will allow for effectiveness testing and further program refinement for this high-priority population.
摘要：
背景：刑事法律体系中的新兴成年人（EA）面临使用药物和相关负面结果的高风险。EA对治疗服务的参与度也很低，对于生活在农村社区的人来说，这种模式加剧了。这项试点研究调查了任务转移基于证据的物质使用干预措施的实施结果，通过一个有发展针对性的计划，由缓刑官(PO)提供给选定的EA客户。
方法：从俄勒冈州的两个县招募的为农村客户提供服务的十个PO接受了培训和支持，以在其当前的案件量中为17个EA提供EA（CM-EA）的应急管理。试点完全是在COVID-19大流行期间进行的。PO从与参与EA客户的会议中提交了会议录音带和清单，并参加了焦点小组。EA客户完成了基线访谈，并同意收集其成人犯罪记录。来自三个州的四个农村县的缓刑/假释管理人员和工作人员完成了十次半结构化访谈，这些人员受到阿片类药物流行的严重影响，涉及在其办公室提供CM-EA等计划的障碍和促进者。
结果：基于自我报告和观察编码，PO在交付所有CM-EA组件并参与CM-EA质量保证协议时表现出了保真度和采用率。通过选择反映其当地办事处人口统计的EA（即，白色,非西班牙裔,性别平衡)，与多物质的使用作斗争，主要持有重罪。焦点小组和访谈的新兴主题揭示了可行性，可接受性,和CM-EA的适当性，包括与目前未在研究计划中的客户一起使用，并报告了继续使用CM-EA的意图。未来使用的障碍包括在农村地区提供其他计划的障碍，例如资源限制。
结论：对于将CM-EA等项目转移到PO的任务相关的实施结果，有初步的支持，特别是那些为农村客户服务的人，增加对EA循证物质使用服务的访问。未来更大样本和多次随访的研究将允许对这一高度优先人群进行有效性测试和进一步的方案改进。
方法：从俄勒冈州的两个县招募的为农村客户提供服务的十个PO接受了培训和支持，以在其当前的案件量中为17个EA提供EA（CM-EA）的应急管理。试点完全是在COVID-19大流行期间进行的。PO从与参与EA客户的会议中提交了会议录音带和清单，并参加了焦点小组。EA客户完成了基线访谈，并同意收集其成人犯罪记录。来自三个州的四个农村县的缓刑/假释管理人员和工作人员完成了十次半结构化访谈，这些人员受到阿片类药物流行的严重影响，涉及在其办公室提供CM-EA等计划的障碍和促进者。
结果：基于自我报告和观察编码，PO在交付所有CM-EA组件并参与CM-EA质量保证协议时表现出了保真度和采用率。通过选择反映其当地办事处人口统计的EA（即，白色,非西班牙裔,性别平衡)，与多物质的使用作斗争，主要持有重罪。焦点小组和访谈的新兴主题揭示了可行性，可接受性,和CM-EA的适当性，包括与目前未在研究计划中的客户一起使用，并报告了继续使用CM-EA的意图。未来使用的障碍包括在农村地区提供其他计划的障碍，例如资源限制。
结论：对于将CM-EA等项目转移到PO的任务相关的实施结果，有初步的支持，特别是那些为农村客户服务的人，增加对EA循证物质使用服务的访问。未来更大样本和多次随访的研究将允许对这一高度优先人群进行有效性测试和进一步的方案改进。
