Trichomonas Vaginalis Infections Among Youth in Detention in the Southeastern United States

Most juvenile detention facilities do not screen for Trichomonas Vaginalis (TV) despite being the most common parasitic STI. We aimed to assess TV prevalence and risk factors among young women in a large urban juvenile detention center. We evaluated a retrospective cohort from April to December 2016. Youth submitted an intake urine sample for gonorrhea and chlamydia testing; we tested remnant urine for TV. Outcomes included prevalence of TV and risk factors for infection. A total of 1009 samples were collected, 374 from young women ages 13 - 17 years old. Among females, 8% tested positive for TV with co-infection of either gonorrhea, chlamydia or both occurring in 12/29 (41%) patients. Compared to youth without TV females with TV were more likely to be African American (76%) and report symptoms (41%) (p<0.05). In our study population, prevalence of TV was 8%. As nearly half of those with TV were asymptomatic, we recommend routine screening among this population.

Prevalence and Management of Sexually Transmitted Infections in Correctional Settings: A Systematic Review

Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions-managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)-can counteract structural racism in healthcare.

Sexting and Behavioral Health in First-time Justice-Involved Adolescents

Objectives

We examined the prevalence of sexting, related motivations, demographics, and association with behavioral health problems among justice-involved adolescents.

Hypotheses

We hypothesized positive associations between sexting and sexual risk, substance use, delinquency, and mental health problems.

Methods

Participants were 307 community-supervised justice-involved adolescents with a first-time offense (Mage =14.50 years, 44.6% female) and their caregivers. Adolescents answered questions on technology use and sexting by sending, receiving, or forwarding sexually suggestive text messages and images (pictures or videos). They also completed measures of recent (past 4-month) sexual activity, unprotected sex, cigarette, alcohol, marijuana, and other drug use, and delinquency; current trauma symptoms, internalizing problems, and adaptive functioning.

Results

Prevalence of sexting were 37.7% (lifetime overall; 17.0% sent texts; 17.4% sent images) and 29.5% (past-year overall; 12.8% sent texts; 13.6% sent images). Sexts were commonly sent as presents to partners, in response to sexts received, or to have fun. "Sexters" were older than "non-sexters" and more likely to identify as lesbian, gay, bisexual, or questioning. Past-year sexting was significantly associated with recent sexual activity; unprotected sex; alcohol use and days of use; marijuana and other drug use; delinquency and variety of delinquent acts; and elevated trauma symptoms and internalizing problems.

Conclusions

Sexting is prevalent among adolescents with a first-time offense and co-occurs with multiple behavioral health needs. Intervention for this population may be informed by routinely assessing sexting in community settings. Familiarity with local reporting laws could help clinicians navigate the legal implications of sexting among adolescents with existing justice-system involvement.

Effectiveness of Functional Family Therapy in a Non-Western Context: Findings from a Randomized-Controlled Evaluation of Youth Offenders in Singapore

This study is the first to evaluate Functional Family Therapy (FFT) in a non-Western culture. The effectiveness of FFT was examined in relation to three proximal outcomes relevant to youth offender rehabilitation: (i) mental well-being, (ii) family functioning, and (iii) probation completion. 120 youth probationers (Mage  = 16.2, SD = 1.33) were randomly assigned to receive either standard probation services-Treatment-As-Usual (TAU; n = 57)-or FFT in addition to TAU (FFT; n = 63). Data on psychometric measures of mental well-being and family functioning were obtained at (i) preprogram, (ii) postprogram, and (iii) at the end of probation. Probation completion data were obtained from casefile records. Mean mental well-being scores of the FFT group improved from pre- to post-treatment, and gains were maintained at follow-up. However, there was a nonsignificant trend for the FFT group showing higher rates of reliable change and clinical recovery on the mental well-being scale. There were no group differences in family functioning scores over time. However, there was a significant trend for the FFT group showing higher rates of reliable change and clinical recovery on the family functioning scale. Probation completion rates were 88.9% and 70.2% for the FFT and TAU groups, respectively. Youth in the FFT group were significantly more likely to complete probation successfully. The results support FFT's effectiveness in Singaporean youth offenders. At a broader level, the study findings support the cross-cultural effectiveness of FFT in, and transportability to, a non-Western culture.

Critical Factors Influencing Interorganizational Relationships Between Juvenile Probation and Behavioral Health Agencies

Although interorganizational relationships (IORs) are essential to the effective delivery of human services, very little research has examined relationships between juvenile justice agencies and behavioral health providers, and few studies have identified the most critical organizational and individual-level characteristics influencing IORs. Across 36 sites, juvenile probation officials (n = 458) and community behavioral health providers (n = 91) were surveyed about characteristics of their agencies, themselves, and IORs with each other. Generalized Linear Mixed Models were used to analyze the data. The strongest predictors included Perceived Organizational Support and individual Adaptability. Implications for research, theory and practice are discussed.

Screening and Brief Intervention for Psychiatric and Suicide Risk in the Juvenile Justice System: Findings from an Open Trial

Court-involved non-incarcerated (CINI) youth endorse higher rates of lifetime suicide ideation (SI) and attempts than youth in the community. Brief intervention programs to address SI and related psychiatric symptoms upon entry into the juvenile justice system are rare. The current study reports the results of a pilot trial on a brief, coping intervention for CINI youth. Fifteen CINI youth (and caregivers) were eligible for participation based on youth report of SI or endorsing symptoms on a mental health screening tool. Youth completed a Coping Plan intervention with a master's-level counselor and received a 1-week follow-up call. Follow-up assessments were conducted at 1 and 3-months post-intervention. Participants were also interviewed about intervention acceptability. About half of the sample screened into the study based on SI and half screened in based on psychiatric symptoms on the Anxious/Depressed and Angry/Irritable subscales of the MAYSI-2. A reduction in SI and psychiatric symptoms was observed at 3-months post-intervention. Youth and caregivers reported the brief coping intervention was useful. This study highlights that intervening with youth with SI and psychiatric symptoms upon entry into the juvenile justice system can be successfully conducted with a population who historically has difficulty accessing mental health resources.

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre-post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous-unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents' report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls' mental health and family functioning in particular. The study's results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.

Using Arousal Suppression Exercises to Decrease Inappropriate Sexual Arousal in Detained Adolescent Males: Three Clinical Demonstrations

Reyes, Vollmer, and Hall (2011) found that 2 arousal suppression strategies, 1 of which involved counting backward from 100 to 0, decreased sexual arousal for 2 male sex offenders with intellectual disabilities. In the current clinical study, we taught 3 adolescent males who had been adjudicated for illegal sexual behavior to self-report arousal when they were presented with sexually arousing visual stimuli. Based on the procedures in the Reyes et al. (2011) study, we taught participants to count backward from 100 to 0 when they verbally reported a criterion level of sexual arousal in the presence of visual media. Subsequently, we gradually faded therapists' instructions for 2 participants until they independently used the arousal suppression exercise. Results showed that each participant's self-reported sexual arousal decreased upon implementation of treatment relative to baseline. Decreased sexual arousal continued even under conditions of faded therapist instructions for 2 participants. The relative merits of using self-report measures are discussed.

The Association Between Admiration of Antisocial Peers and Past 30-Day Opioid Misuse Among Justice-Involved children

AIM

Prevention of illicit or nonmedical opioid use, called opioid misuse (OM) is a key public health concern that requires research on the factors that influence OM initiation among high-risk populations. Justice-involved children (JIC) have more risk factors and fewer resources. Antisocial peers have been linked to adolescent substance abuse and delinquency. However, the association between the admiration of antisocial peers and OM among JIC has not yet been studied. This study hypothesizes that admiration of antisocial peers will be associated with a higher likelihood of OM among Florida JIC.

METHODS

Cross-sectional data on 79,960 JIC from the Florida Department of Juvenile Justice (FLDJJ) were examined. To test the hypothesis, bivariate and multivariate logistic regression analyses were employed. The multivariate models controlled for gender, race, age in 2007, family income, history of mental health, history of depression, and optimism.

RESULTS

Nearly 2.7% of the sample met the criteria for past 30-day OM, and over 75% of those current users admired or somewhat admired their antisocial peers. Compare to JIC who did not admire their antisocial peers, those who had some admiration of antisocial peers were 2.39 times more likely to misuse opioids in the past 30-days and those who admired their antisocial peers were 4.40 times more likely to meet the criteria for past 30-day OM.

CONCLUSIONS

Cultivating positive peer interactions and providing positive peer role models may help to reduce illicit opioid use among JIC.

CHOICES-TEEN: Reducing Substance-Exposed Pregnancy and HIV among Juvenile Justice Adolescent Females

OBJECTIVE

The feasibility and acceptability of CHOICES-TEEN - a 3-session intervention to reduce overlapping risks of alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP) and HIV - was assessed among females in the juvenile justice system.

METHODS

Females 14-17 on community probation in Houston, Texas were eligible if presenting with aforementioned health risks. Outcome measures - obtained at one- and three-months post baseline - included the Timeline Followback, Client Satisfaction Questionnaire-8, session completion/checklists, Working Alliance Inventory-Short, and open-ended questions. Twenty-two participants enrolled (82% Hispanic/Latina; mean age=16).

RESULTS

The results suggest strong acceptability and feasibility with high client satisfaction and client/therapist ratings, 91% session completion, and positive open-ended responses. All youth were at risk at baseline, with the following proportions at reduced risk at follow-up: AEP (90% 1-month; 71.4% at 3-months; TEP (77% of smokers (n=17) at reduced risk at 1-month; 50% at 3-months); and HIV (52.4% 1-month; 28.6% at 3-months).

The Prospective Impact of Family Functioning and Parenting Practices on Court-Involved Youth's Substance Use and Delinquent Behavior

Court-involved youth exhibit high rates of psychiatric symptoms, substance use, and delinquency, yet little is known about the contributing roles of caregiver and family factors. The current study examined whether family functioning and parental monitoring mediate the relationship between caregiver and youth psychiatric symptoms (at first court contact) and youth substance use and delinquency (two years later). Participants were 400 first-time offending court-involved youth (M_age = 14.5 years; 57.3% male; 45.6% non-Latinx White, 42.0% Latinx) and an involved caregiver (M_age = 41.0 years; 87.2% female; 53.0% non-Latinx White, 33.8% Latinx). Structural equation modeling revealed that caregiver and youth psychiatric symptoms were prospectively associated with worse family functioning, which was in turn related to higher levels of youth delinquency and greater likelihood of substance use. The results support the notion of addressing the needs of justice-involved youth and families holistically rather than treating youth as "the problem" in isolation.

Family-Based HIV and Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes

This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.

Adapting and implementing an evidence-based treatment with justice-involved adolescents: the example of multidimensional family therapy

For over four decades family therapy research and family centered evidence-based therapies for justice-involved youths have played influential roles in changing policies and services for these young people and their families. But research always reveals challenges as well as advances. To be sure, demonstration that an evidence-based therapy yields better outcomes than comparison treatments or services as usual is an accomplishment. But the extraordinary complexity embedded in that assertion feels tiny relative to what we are now learning about the so-called transfer of evidence-based treatments to real world practice settings. Today's family therapy studies continue to assess outcome with diverse samples and presenting problems, but research and funding priorities also include studying particular treatments in nonresearch settings. Does an evidence-based intervention work as well in a community clinic, with clinic personnel? How much of a treatment has to change to be accepted and implemented in a community clinic? Perhaps it is the setting and existing procedures that have to change? And, in those cases, do accommodations to the context compromise outcomes? Thankfully, technology transfer notions gave way to more systemic, dynamic, and frankly, more family therapy-like conceptions of the needed process. Implementation science became the more sensible, as well as the theoretically and empirically stronger overarching framework within which the evidence-based family based therapies now operate. Using the example of Multidimensional Family Therapy, this article discusses treatment development, refinement, and implementation of that adapted approach in a particular clinical context-a sector of the juvenile justice system-juvenile detention.

Effects of Institutional Confinement for Delinquency on Levels of Depression and Anxiety among Male Adolescents

Youth within the juvenile justice system report higher rates of mental illnesses than their peers. This study tested whether institutional confinement increases levels of depression and anxiety among male adolescents. We examined heterogeneous trajectories of depression and anxiety from ages 11 to 14 for 510 male adolescents. Youths who were first placed in custody at age 15 (treatment group) were matched with control boys (no official arrest or reported confinement during adolescence) within each trajectory group using a propensity score matching procedure. Matches were found for 37 pairs for depression and 34 pairs for anxiety. There were no significant differences between the confined and control groups in levels of depression or anxiety at age 16. More research is needed to identify aspects of the juvenile justice system that may positively or negatively affect youth's mental health status.