Linking a Pediatric Healthcare Advance with a Task-Shifting Approach to Optimize Juvenile Justice Outcomes

将儿科医疗保健进步与任务转移方法联系起来，以优化青少年司法结果

• 批准号: 10569115
• 负责人: Michael R McCart
• 金额: $ 70.18万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10569115
• 关键词: Address; Adolescent; Adult; Affect; Alcohol consumption; Alcohols; Appointment; Attitude; Behavior; Certification; Cessation of life; Child health care; Client; Climate; Clinical; Cluster randomized trial; Code; Collaborations; Communities; County; Data; Data Collection; Data Sources; Diffusion of Innovation; Drug usage; Evidence based practice; Evidence based treatment; Face; Family; Funding; Goals; Health; Health Care Research; Health Services; Health system; Indigenous; Infrastructure; Intake; Intervention; Justice; Link; Marijuana; Measures; Medical; Methods; Modeling; Outcome; Outcome Assessment; Parents; Patients; Pattern; Performance; Pharmacotherapy; Phase; Population; Positioning Attribute; Provider; Public Health; Recording of previous events; Reporting; Research; Residential Facilities; Resource-limited setting; Resources; Risk; Rural Community; Sampling; Scientific Advances and Accomplishments; Services; Societies; Source; Standardization; Structure; Surveys; System; Time; Training; Vertebral column; Work; Youth; acronyms; adolescent alcohol and drug use; adolescent drug use; alcohol abuse therapy; alcohol and other drug; antisocial behavior; archived data; barrier to care; behavior change; behavioral health; burnout; cluster randomized design; contingency management; cost; cost efficient; effective intervention; evidence base; health care service; hybrid type 2 trial; implementation outcomes; improved; improved outcome; innovation; juvenile delinquent; juvenile justice system; outpatient programs; parole; premature; prescription opioid; probation; probationer; rate of change; recidivism; rural area; rural counties; rural setting; service providers; substance use treatment; success; tool; unintended pregnancy

PROJECT SUMMARY/ABSTRACT Juvenile justice (JJ) is the public service system most impacted by alcohol and other drug (AOD) use in youth, and outcomes for these youth, their families, and society are grave. Thus, delivery of effective interventions with JJ youth is of considerable importance. The evidence-based practices (EBPs) with the strongest outcomes for JJ youth are family-based, but many communities do not have the resources to support their delivery. This is particularly true in rural areas where AOD treatment resources are scarce. Further, even when communities can support a family-based EBP, JJ youth face barriers to treatment participation. Indeed, JJ youth are routinely referred for treatment, but data indicate less than 1 in 5 actually receive treatment. Juvenile probation/parole officers (JPOs) are on the front line of this crisis. This workforce is in every community across the nation and routinely interfaces with JJ youth to try to achieve positive outcomes. However, JPOs often face limited options for treatment referrals; further, they do not have the time or training to deliver one of the full-scale, family-based EBPs. As a consequence, JPOs try to manage the behavior of their probationers with a small menu of youth-based interventions that have limited success (e.g., structured sanctions). One strategy for achieving better outcomes in low-resourced, rural settings that cannot deploy a full-scale EBP, called task-shifting, involves redistribution of tasks downstream to an indigenous workforce that has less training. Importantly, reviews indicate that the leading EBPs for JJ youth share a common change mechanism: activation of parents. Thus, while the family-based EBPs cannot be task-shifted, perhaps the central change mechanism of these EBPs (parent activation) can be shifted downstream to enhance JPO practice. JJ leaders already cite improved parent engagement as a top priority, but it is also one of the most challenging problems facing the JJ system. Fortuitously, within pediatric healthcare services, there is an effective intervention called parent activation (PA) comprised of concrete tasks by healthcare service providers to better engage and motivate parents of at-risk youth. PA has been delivered by clinicians and also by paraprofessionals. Thus, this healthcare service advance might be primed for use by JPOs to activate parents and achieve more positive JJ youth outcomes. The proposed stepped-wedge cluster randomized trial investigates the use and impact of PA by JPOs across 32 rural counties. Aims are to: (1) determine the capacity of JPOs to deliver PA within JJ services, (2) examine impact of PA delivery on de-identified family outcomes, and (3) examine implementation outcomes, assessed via the Stages of Implementation Completion, for PA in the JJ service system, including JPO inner context variables that might impact implementation. In a context where the nation’s behavioral healthcare service system is struggling to meet the needs of JJ youth, JPOs across the nation, and particularly in rural communities, are positioned to make a large impact via use of an advance from pediatric healthcare services.

项目摘要/摘要 少年司法（JJ）是受酒精和其他药物（AOD）使用最大的公共服务系统 这些年轻人，他们的家庭和社会的年轻人以及成果是严重的。那，有效的交付 与JJ青年的干预至关重要。循证实践（EBP） JJ青年的强劲成果是基于家庭的，但是许多社区没有资源来支持 他们的交付。在AOD治疗资源稀缺的农村地区尤其如此。进一步，甚至 当社区可以支持基于家庭的EBP时，JJ青年将面临治疗参与的障碍。确实，JJ 通常会转介青年进行治疗，但数据表明少于五分之一的人实际接受治疗。少年 缓刑/假释官（JPO）处于这场危机的前线。这个劳动力在每个社区中 国家并经常与JJ青年互动，试图取得积极的成果。但是，JPO经常面对 治疗转诊的选择有限；此外，他们没有时间或培训来提供全面的一个， 基于家庭的EBP。结果，JPO试图通过小菜单来管理试验器的行为 基于青年的干预措施的成功有限（例如结构化制裁）。实现的一种策略 在无法部署全尺度EBP的低资源，粗糙设置中的更好结果，称为任务转换，涉及 将任务的重新分配到培训较少的土著劳动力队伍。重要的是，评论表明 JJ青年的领先EBP具有共同的变化机制：父母的激活。那，而 基于家庭的EBP不能进行任务迁移，也许是这些EBP的核心变化机制（父母 激活）可以在下游转移以增强JPO实践。 JJ领导人已经引用了改善父母 参与作为重中之重，但这也是JJ系统面临的最挑战的问题之一。 幸运的是，在小儿医疗保健服务中，有一种有效的干预措施称为父母激活（PA） 医疗保健服务提供商完成具体任务，以更好地互动和激励性的父母 青年。 PA是由临床医生和专业人士交付的。那，这项医疗保健服务的进步 JPO可能会使用启示来激活父母并获得更积极的JJ青年成果。提议 阶梯式北方群集随机试验调查了JPO在32个农村县对PA的使用和影响。 目的是：（1）确定JPO在JJ服务中提供PA的能力，（2）检查PA的影响 通过取消识别的家庭成果交付，（3）通过阶段进行评估的考试实现结果 实施完成，用于JJ服务系统中的PA，包括JPO内在上下文变量可能 影响实施。在国家行为医疗保健服务系统正在努力进行的情况下 满足JJ青年的需求，全国的JPO，尤其是在农村社区的需求， 通过使用小儿医疗保健服务的进步来产生很大的影响。