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Nelson V, Wood J, Belenko S, Pankow J, Piper K. Conditions of successful treatment referral practices with justice-involved youth: Qualitative insights from probation and service provider staff involved in JJ-TRIALS. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209358. [PMID: 38548060 PMCID: PMC11162925 DOI: 10.1016/j.josat.2024.209358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/09/2024] [Accepted: 03/23/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Compared to the general U.S. adolescent population, young people involved in the juvenile justice system are at greater risk of experiencing substance use (SU) issues. There are critical opportunities across the juvenile justice continuum, at points of interface with community-based treatment services, to screen and assess for SU issues, identify unmet treatment needs, and refer those in need to treatment. The treatment referral process is, however, complex, and contingent on a seamless nexus between juvenile justice operations and the wider treatment provider landscape. Given the lack of successful SU referrals among justice-involved youth and the variable referral rates across jurisdictions, this study's aim is to provide a qualitative, explanatory understanding of the conditions that together contribute to successful referring practices. METHODS The study is based on an analysis of a qualitative dataset comprising focus group data with probation and community-based behavioral health treatment staff working in 31 sites in 6 different states as part of the clustered randomized trial of an organizational change intervention known as JJ-TRIALS (Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System). The data contain respondents' narratives on the achievements, successes, and challenges with implementing the intervention. The data were analyzed through a combination of strategies to identify the conditions that both facilitate and impede referral processes between probation offices and community-based SU treatment providers. RESULTS Participants across sites discussed the positive impacts that the JJ-TRIALS intervention had on their improved ability to communicate, collaborate, and collect data. From the interviews, seven main conditions were observed to contribute to successful SU treatment referral practices: (1) communication (inter-organizational); (2) collaboration; (3) data-driven practices; (4) family engagement; (5) institutionalized policy and referral documentation; (6) efficient referral policies and procedures; and (7) suitable and accessible system of treatment providers. CONCLUSION Findings highlight the value of a holistic understanding of successful treatment referrals for justice-involved youth and help inform research and practice efforts to identify and measure the many dimensions of referral-making at the interface of juvenile probation and behavioral health services.
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Affiliation(s)
| | | | | | - Jen Pankow
- Texas Christian University, United States of America
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Sichel CE, Elkington KS. Transforming systems mistrust and poor communication to improve behavioural health care uptake among youth on probation. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:347-349. [PMID: 37680040 PMCID: PMC10841382 DOI: 10.1080/17538068.2023.2253620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Corianna E Sichel
- Columbia University Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA
| | - Katherine S Elkington
- Columbia University Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA
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Ryan ME, Elkington KS, Sarapas C, Sichel C, Taxman F, Dennis ML, Wasserman GA. Evaluating e-Connect: Mitigating Race by Gender Disparities in Behavioral Health Referral Among Youths on Probation, Northeast United States, 2019. Am J Public Health 2023; 113:1267-1270. [PMID: 37797280 PMCID: PMC10632848 DOI: 10.2105/ajph.2023.307417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Addressing the behavioral health needs of youths involved in the justice system is key to reducing recidivism risk and preventing long-term system involvement. However, rates of treatment referral and initiation remain low, especially among minoritized youths and boys. The e-Connect System, a digital, clinical decision support system, addresses this problem by increasing rates of behavioral health treatment referral and initiation rates among youths on probation. In this study, we examine whether e-Connect helps improve equity in referral and treatment initiation outcomes. (Am J Public Health. 2023;113(12):1267-1270. https://doi.org/10.2105/AJPH.2023.307417).
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Affiliation(s)
- Margaret E Ryan
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
| | - Katherine S Elkington
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
| | - Casey Sarapas
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
| | - Corianna Sichel
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
| | - Faye Taxman
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
| | - Michael L Dennis
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
| | - Gail A Wasserman
- Margaret E. Ryan is with New York State Psychiatric Institute, New York, NY. Katherine S. Elkington, Corianna Sichel, and Gail A. Wasserman are with New York State Psychiatric Institute and Columbia University, New York, NY. Casey Sarapas and Michael L. Dennis are with Chestnut Health Systems, Normal, IL. Faye Taxman is with George Mason University, Fairfax, VA
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Elkington KS, Wasserman GA, Ryan ME, Sichel CE, Sarapas C, Dennis ML, Taxman FS. E-Connect: Linking probation youth at risk for suicide to behavioral health services. J Consult Clin Psychol 2023; 91:547-557. [PMID: 37261738 PMCID: PMC10526689 DOI: 10.1037/ccp0000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Youth involved in the justice system (YIJ) have higher rates of suicidal thoughts and behaviors (STB) and associated behavioral health (BH) problems, yet lower levels of service use compared to youth in the general population. This study examined the efficacy of e-Connect, a digital clinical decision support system (CDSS), at improving STB risk identification, referral, and linkage to BH services by probation officers. As the intervention spanned pre- and post-COVID-19 shutdown periods, we also examined the disruption in public agencies' service provision on study outcomes. METHOD Administrative record data (1,488 youth, ages 10-18 years, 56% male, 56% White) allowed examination of differences between care-as-usual (baseline) and e-Connect in screening, identification of STB and BH problems, referral, and treatment initiation. RESULTS Compared to care-as-usual, probation officers using e-Connect were over five times as likely to identify YIJ with STB (adjusted odds ratio [aOR] = 5.86; 95% confidence interval, CI [3.24, 11.7]) and over 11 times more likely to refer YIJ in need of BH services to treatment (aOR = 11.04; 95% CI [6.54, 19.43]). In turn, youth referred to treatment via e-Connect were nearly 17 times more likely to initiate (aOR = 16.92; 95% CI [9.17, 32.60]). Results remained unchanged during the pre- and post-COVID-19 shutdown periods. CONCLUSION e-Connect is one of the first digital STB screening, referral, and linkage-to-service systems that use CDSS technology to successfully assist probation officers in linking youth on their caseload to treatment. Such an approach may support identification of STB and cross-systems linkage in other youth-serving organizations, such as schools, that increasingly manage youth BH problems with minimal clinical support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Faye S Taxman
- Schar School of Policy and Government, George Mason University
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Cioffi CC, Schweer-Collins ML, Leve LD. Pregnancy and miscarriage predict suicide attempts but not substance use among dual-systems involved female adolescents. CHILDREN AND YOUTH SERVICES REVIEW 2022; 137:106494. [PMID: 37089705 PMCID: PMC10118061 DOI: 10.1016/j.childyouth.2022.106494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background To examine the associations between adolescent pregnancy and pregnancy outcomes on substance use and suicide attempts in a sample who is at greater risk for substance use and suicide attempts - those who have been involved with the uvenile justice and child welfare systems. Methods Using a prospective, longitudinal design, we examined the role of adolescent pregnancy outcomes on risk for suicide attempts and substance use among a sample of 166 female adolescents with juvenile justice system and child welfare involvement. Results Of participants, 36% (n = 60) reported at least one adolescent pregnancy with a total of 109 pregnancies reported. Adolescent pregnancy was associated with an increase in later suicide attempts (aOR = 1.68, 95% CI 1.06-2.72). Miscarriage was associated with a 2-fold increase in the likelihood of later suicide attempts, (aOR = 2.12, 95% CI 1.10-4.12). No participants who reported induced abortion (n = 13) reported suicide attempts. Adolescent pregnancy, miscarriage, and abortion were not significantly associated with later substance use (Ps > 0.05). Conclusions Healthcare professionals should conduct routine screening for suicidality in the months following a miscarriage, offer education to caregivers about how to support youth who experience pregnancy loss, provide additional social supports and familiarize themselves with local and virtual behavioral health resources to prevent suicide attempts among female adolescents who are at high risk and experience miscarriage.
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Affiliation(s)
- Camille C. Cioffi
- Corresponding author at: Prevention Science Institute, University of Oregon, 1600 Millrace Drive, Suite 105, Eugene, OR 97403, United States. (C.C. Cioffi)
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Meza JI, Snyder S, Shanholtz C. Equitable suicide prevention for youth impacted by the juvenile legal system. Front Psychiatry 2022; 13:994514. [PMID: 36387003 PMCID: PMC9640731 DOI: 10.3389/fpsyt.2022.994514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is the second leading cause of death for adolescents in the United States. Despite the already alarmingly high rates of suicide attempts among adolescents, youth involved in the juvenile legal system (JLS) are up to three times more likely to have suicide attempts than their peers not impacted by the JLS. This public health crisis is also a matter of health equity, knowing that ethnoracially minoritized youth, mainly Black and Latinx youth, have disproportionate contact with the JLS. In order to disrupt the current elevated rates of suicide among Black and Latinx youth involved in the JLS, there needs to be more concerted efforts to improve assessment and suicide prevention efforts in the JLS. There are various potential touch points of care for suicide prevention and the Sequential Intercept Model (SIM), which outlines community-based responses to the involvement of people with mental and substance use disorders in the criminal justice system, can be used as a strategic planning tool to outline possible equitable interventions across these various touch points. Our purpose is to provide a comprehensive picture of gaps and equitable opportunities for suicide prevention across each intercept of the SIM. We provide recommendations of priorities to promote health equity in suicide prevention for ethnoracially minoritized youth impacted by the JLS.
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Affiliation(s)
- Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Sean Snyder
- Department of Psychiatry, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Caroline Shanholtz
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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