背景:大多数涉及司法的青年在社区环境中受到监督,其中评估和与药物使用(SU)治疗服务的联系不一致且支离破碎。只有1/3的青年与一个确定的SU需要接受治疗转诊和更少的启动服务。因此,改善识别和与治疗的联系需要少年司法(JJ)和行为健康(BH)机构之间的协调。本研究检查了两种捆绑实施干预策略对改善SU治疗启动的比较有效性。订婚,以及在社区环境中监督的参与司法的青年的持续护理。探索,准备工作,实施,可持续性(EPIS)是研究设计和实施干预组件选择/时机的概念框架,BHServicesCascade充当概念和衡量框架,用于识别和解决服务接收中的差距。
方法:关于法律系统中青少年干预措施的更大的少年司法转化研究(JJ-TRIALS)的一部分,这项研究涉及多站点,成组随机对照试验,其中将中心配对,然后随机分配接受核心(BHServices级联和数据驱动决策;支持目标选择的培训团队)或核心+增强(实施团队的外部促进)干预组件.在五个研究阶段(基线,预随机化,早期实验,后期实验,维护)。由JJ和BH员工组成的实施团队协作确定了BHCascade的目标,并使用数据驱动的决策来实施变更。
结果:结果表明,随着时间的推移,相对于基线,核心干预组件在增加服务接收方面是有效的,但核心和核心+增强条件之间的差异不显着。核心+增强站点的服务启动时间较短,当提供(实施团队的)外部促进时,发生了更深的级联渗透。服务系统之间的变化程度和性质存在很大差异。
结论:研究结果表明早期EPIS阶段的重要性,证明在形成探索和准备阶段提供的策略在服务接收方面产生了一些改善,而以实施为重点的活动在使年轻人沿着喀斯喀特走得更远方面产生了逐步的改善。
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.