Steven Belenko1, Danica Knight2, Gail A Wasserman3, Michael L Dennis4, Tisha Wiley5, Faye S Taxman6, Carrie Oser7, Richard Dembo8, Angela A Robertson9, Jessica Sales10. 1. Temple University, 1115 Polett Walk, Philadelphia, PA 19122, United States. Electronic address: sbelenko@temple.edu. 2. Texas Christian University, 3034 Sandage Avenue, Fort Worth, TX 76129, United States. Electronic address: d.knight@tcu.edu. 3. Columbia University, 1051 Riverside Drive, Unit 78, New York City, NY 10032, United States. Electronic address: wassermg@nyspi.columbia.edu. 4. Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61701, United States. Electronic address: mdennis@chestnut.org. 5. National Institute on Drug Abuse, 6001 Executive Boulevard, Room 5191, Bethesda, MD 20892, United States. Electronic address: wileytr@nida.nih.gov. 6. George Mason University, 4087 University Drive, 4100, MSN 6D3, Fairfax, VA 22030, United States. Electronic address: ftaxman@gmu.edu. 7. University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, United States. Electronic address: Carrie.oser@uky.edu. 8. University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States. Electronic address: rdembo@usf.edu. 9. Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States. Electronic address: Angela.robertson@ssrc.msstate.edu. 10. Emory University, Rollins School of Public Health, 1518 Clifton Road, Room 570, Atlanta, GA 30322, United States. Electronic address: jmcderm@emory.edu.
Abstract
OVERVIEW: Substance use and substance use disorders are highly prevalent among youth under juvenile justice (JJ) supervision, and related to delinquency, psychopathology, social problems, risky sex and sexually transmitted infections, and health problems. However, numerous gaps exist in the identification of behavioral health (BH) problems and in the subsequent referral, initiation and retention in treatment for youth in community justice settings. This reflects both organizational and systems factors, including coordination between justice and BH agencies. METHODS AND RESULTS: This paper presents a new framework, the Juvenile Justice Behavioral Health Services Cascade ("Cascade"), for measuring unmet substance use treatment needs to illustrate how the cascade approach can be useful in understanding service delivery issues and identifying strategies to improve treatment engagement and outcomes for youth under community JJ supervision. We discuss the organizational and systems barriers for linking delinquent youth to BH services, and explain how the Cascade can help understand and address these barriers. We provide a detailed description of the sequential steps and measures of the Cascade, and then offer an example of its application from the Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System project (JJ-TRIALS), a multi-site research cooperative funded by the National Institute on Drug Abuse. CONCLUSION: As illustrated with substance abuse treatment, the Cascade has potential for informing and guiding efforts to improve behavioral health service linkages for adolescent offenders, developing and testing interventions and policies to improve interagency and cross-systems coordination, and informing the development of measures and interventions for improving the implementation of treatment in complex multisystem service settings. Clinical Trials Registration number - NCT02672150.
OVERVIEW: Substance use and substance use disorders are highly prevalent among youth under juvenile justice (JJ) supervision, and related to delinquency, psychopathology, social problems, risky sex and sexually transmitted infections, and health problems. However, numerous gaps exist in the identification of behavioral health (BH) problems and in the subsequent referral, initiation and retention in treatment for youth in community justice settings. This reflects both organizational and systems factors, including coordination between justice and BH agencies. METHODS AND RESULTS: This paper presents a new framework, the Juvenile Justice Behavioral Health Services Cascade ("Cascade"), for measuring unmet substance use treatment needs to illustrate how the cascade approach can be useful in understanding service delivery issues and identifying strategies to improve treatment engagement and outcomes for youth under community JJ supervision. We discuss the organizational and systems barriers for linking delinquent youth to BH services, and explain how the Cascade can help understand and address these barriers. We provide a detailed description of the sequential steps and measures of the Cascade, and then offer an example of its application from the Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System project (JJ-TRIALS), a multi-site research cooperative funded by the National Institute on Drug Abuse. CONCLUSION: As illustrated with substance abuse treatment, the Cascade has potential for informing and guiding efforts to improve behavioral health service linkages for adolescent offenders, developing and testing interventions and policies to improve interagency and cross-systems coordination, and informing the development of measures and interventions for improving the implementation of treatment in complex multisystem service settings. Clinical Trials Registration number - NCT02672150.
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