Preventing Opioid Use Among Justice-involved Youth As They Transition to Adulthood Leveraging Safe Adults (LeSA)
- Conditions
- Opioid UseSubstance Use
- Interventions
- Behavioral: Trust-based Relational Intervention TrainingBehavioral: Trust-based Relational Intervention In-Home Structured CoachingBehavioral: Trust-based Relational Intervention In-Home Responsive Coaching
- Registration Number
- NCT04678960
- Lead Sponsor
- Texas Christian University
- Brief Summary
Across the US, substance use is a significant public health concern, with juvenile justice (JJ)-involved youth representing a particularly vulnerable population. The current study proposes to adapt and test an intervention Trust-based Relational Intervention® (TBRI®) for preventing initiation and/or escalation of opioid misuse among older adolescents involved in the JJ system. Successful completion of study aims will provide information on TBRI's utility for older JJ adolescents, barriers and facilitators of sustainment, and provide training and implementation support for sustainment in participating facilities.
- Detailed Description
Across the US, substance use (SU) is a significant public health concern, with an estimated 11.1 million misusing prescription opioids. Rates of opioid use disorders (OUDs) have increased exponentially, with 60% of overdoses attributed to heroin and illicit synthetics (such as Fentanyl). Although opioid use among youth is low compared to adults, experimentation and regular use increases later in adolescence as youth transition to adulthood. Juvenile justice (JJ)-involved youth represent a particularly vulnerable population, as they often experience mental health disorders, dysfunctional family/social relationships, and complex trauma, placing them at greater risk for SU and substance use disorders (SUDs). To ensure that these youth do not become another opioid statistic, innovative and effective prevention interventions are needed. The investigators propose to adapt and test an intervention for preventing initiation and/or escalation of opioid misuse among older JJ-involved adolescents. The target enrollment group will be youth aging out of JJ (15-18 years at study enrollment) who are transitioning to their communities after a period of detainment in a secure treatment or correctional facility. Trust-based Relational Intervention® (TBRI®; a relational, attachment-based intervention that promotes emotional regulation through interaction with responsive adults) will be adapted as a prevention intervention targeting youth at risk for SU (especially non-medical use of opioids). Safe adults (e.g., parent/guardian, extended family member) will be trained in behavior management techniques for empowering youth to appropriately express their needs, connecting them with others in pro-social ways, and correcting or reshaping undesirable behavior. The proposed Effectiveness/Implementation study will examine both the effectiveness of TBRI for preventing opioid misuse and the comparative utility of three support formats: (1) TBRI Training only, (2) TBRI Training + Structured Coaching, or (3) TBRI Training + Responsive Coaching (triggered by the youth's need/risk). A total of 360 youth/safe adult dyads will be recruited from 9 participating JJ facilities over a 3-year period, and followed for 18 months post-release (15 youth-adult dyads/year per facility). This design enables a comparison of TBRI versus Standard Reentry Practice (SRP; using a stepped-wedge design where each facility serves as its own control) plus a randomized control trial comparing 3 TBRI support formats. This study will also examine barriers and facilitators of TBRI sustainment. Ninety JJ staff (10 from each agency) will provide input annually via focus groups and surveys. TCU will work with administrators and staff at each JJ facility to implement a sustainment plan, which will include developing in-house TBRI expertise (i.e., staff training and implementation assistance). Successful completion of study aims will provide a test of the adapted intervention and will facilitate sustainment by providing training and implementation support to participating facilities.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 360
For the effectiveness component,
- Youth ages 15-18 at study enrollment
- Being disposed to community supervision (i.e., probation) following a minimum of 2 months in the secure residential JJ facility
- No indication of active suicide risk
- Being able to identify one safe adult that is willing to participate in the study.
For the implementation component:
• All staff with direct care or supervisory responsibilities within and outside the facilities (i.e., officers supervising youth after release) working with TCU on the LeSA project.
- Youth outside the age range described above
- Active suicide risk at the time of recruitment
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description TBRI Training only Trust-based Relational Intervention Training Youth/safe adult dyads participate in 9 TBRI caregiver modules (caregivers only), 9 youth modules (youth only), and 4 Nurture Groups (caregiver and youth joint role-play activities) prior to youth's release. After the youth's release, they would receive phone support (only when requested by the caregiver or youth). TBRI Training + TBRI In-Home Structured Coaching Trust-based Relational Intervention Training Youth/safe adult dyads participate in 9 TBRI caregiver modules (caregivers only), 9 youth modules (youth only), and 4 Nurture Groups (caregiver and youth joint role-play activities) prior to youth's release. After youth's release, trained TCU TBRI Practitioners provide coaching sessions to youth/safe adult dyads in which they meet 4 times (once monthly) over the first 4 months following release. TBRI Training + TBRI In-Home Structured Coaching Trust-based Relational Intervention In-Home Structured Coaching Youth/safe adult dyads participate in 9 TBRI caregiver modules (caregivers only), 9 youth modules (youth only), and 4 Nurture Groups (caregiver and youth joint role-play activities) prior to youth's release. After youth's release, trained TCU TBRI Practitioners provide coaching sessions to youth/safe adult dyads in which they meet 4 times (once monthly) over the first 4 months following release. TBRI Training + TBRI In-Home Responsive Coaching Trust-based Relational Intervention In-Home Responsive Coaching Youth/safe adult dyads participate in 9 TBRI caregiver modules (caregivers only), 9 youth modules (youth only), and 4 Nurture Groups (caregiver and youth joint role-play activities) prior to youth's release. After youth's release, trained TCU TBRI Practitioners provide coaching sessions to youth/safe adult dyads. They meet a minimum of 2 times during the first 2 months after release. Starting from Month 3, TBRI Practitioners would provide additional coaching when requested or when a research assistant (RA) identifies a need for additional coaching sessions. TBRI Training + TBRI In-Home Responsive Coaching Trust-based Relational Intervention Training Youth/safe adult dyads participate in 9 TBRI caregiver modules (caregivers only), 9 youth modules (youth only), and 4 Nurture Groups (caregiver and youth joint role-play activities) prior to youth's release. After youth's release, trained TCU TBRI Practitioners provide coaching sessions to youth/safe adult dyads. They meet a minimum of 2 times during the first 2 months after release. Starting from Month 3, TBRI Practitioners would provide additional coaching when requested or when a research assistant (RA) identifies a need for additional coaching sessions.
- Primary Outcome Measures
Name Time Method Youth days to opioid (and other substance use) initiation 15 months Initiation to opioid and other substance use (e.g., alcohol, marijuana, methamphetamine) over 15 months follow-up in days, measured by the scale of Timeline follow-back, Substance Use Involvement (i.e., during the past 30 days, how many days did you use alcohol or drugs; developed by the HEAL Prevention Cooperative), urinalysis results. Scores: 0-450 days; a higher score indicating a better outcome.
Youth months to opioid (and other substance use) initiation 15 months Initiation to opioid and other substance use over 15 months follow-up in months, monthly check-ins (any opioid use; any alcohol, other drug use in the past month). Scores: 0-15 months; a higher score indicating a better outcome.
Youth substance use severity 15 months Opioid use and other substance use (e.g., alcohol, marijuana, methamphetamine) over 15 months; measured by TCU Drug Screen 5 and TCU Drug Screen 5 - Opioid Supplement. Scores: 0-11, a higher score indicating a worse outcome.
- Secondary Outcome Measures
Name Time Method Self-regulation (youth) - emotion regulation 15 months Difficulties in Emotion Regulation. Scores: 1-5, a higher score indicating a worse outcome
Anxiety (both youth and caregivers) 15 months Assessed by the General Anxiety Disorder (GAD) -7. Scores: 0-3, a higher score indicating a worse outcome.
Depression (both youth and caregivers) 15 months Assessed by the Patient Health Questionnaire (PHQ). Scores: 0-3, a higher score indicating a worse outcome.
Self-efficacy (youth) 15 months Two items (developed by the HEAL Prevention Cooperative) assessing how confident participants not misuse prescription or heroin in the next 30 days. Scores: 0-4, a higher score indicating a better outcome
Behavioral problems (youth) 15 months Behavioral problems in the areas of peer problems, hyperactivity, emotional problems, and conduct problems, assessed by the Strength and Difficulties Questionnaire. Scores: 0-40, a higher score indicating a worse outcome
Self-regulation (youth) - positive and negative urgency 15 months TCU Adolescent Thinking Forms (TCU THK); Scores: 10-50; a higher score indicating a worse outcome
Self-regulation (youth) - executive functioning 15 months Barkley Deficits in Executive Functioning Scale-Child and Adolescent Short Form. Scores: 1-4, a higher score indicating a worse outcome.
Social exposure to alcohol, marijuana, heroin, and prescription opioids (youth) 15 months Four items, developed by the HEAL Prevention Cooperative, to assess social exposure to alcohol, marijuana, heroin, and prescription opioids (i.e., how often the adult who is most important to the participant drink alcohol or use marijuana, heroin, and prescription opioids). Scores: 0-3, a higher score indicating a worse outcome
Prosocial behavior (youth) 15 months Prosocial behavior is assessed by the Prosocial subscale of the Strength and Difficulties Questionnaire. Scores: 0-10, a higher score indicating a better outcome.
Self-regulation (youth) - delayed discounting 15 months Delay Discounting Task; Scores: 1-13; a higher score indicating a better outcome
Pain (both youth and caregivers) 15 months Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain domain. Scores: 0-3, a higher score indicating a worse outcome.
Youth and caregiver relationship 15 months Assessed by the Experiences in Close Relationships. Scores: 1-7, a higher score indicating a worse outcome.
Monthly check-ins on behavioral misconduct (youth) 15 months Monthly check-ins asking any truancy, trouble with the law during the last month. Scores: 0 (no) or 1 (yes, being involved in the behavioral misconduct).
Monthly check-ins on anxiety, depression, and stress in the relationship with caregiver/safe adult (youth) 15 months Monthly check-ins asking any increase in anxiety, depression, or stress in the relationship with caregiver/safe adult. Scores: 0 (no) or 1 (yes, there is an increase in the past month).
Family relationship 15 months Assessed by the Family Assessment Device. Scores: 1-4, a higher score indicating a better outcome.
Trial Locations
- Locations (11)
Illinois Youth Center - Chicago
🇺🇸Chicago, Illinois, United States
Illinois Youth Center - Pere Marquette
🇺🇸Grafton, Illinois, United States
Illinois Youth Center- Harrisburg
🇺🇸Harrisburg, Illinois, United States
Illinois Youth Center- Warrenville
🇺🇸Naperville, Illinois, United States
Illinois Youth Center - St. Charles
🇺🇸St. Charles, Illinois, United States
Grayson County Juvenile Center/Boot Camp
🇺🇸Denison, Texas, United States
Texas Monarch Academy for Girls/Rite of Passage
🇺🇸Denison, Texas, United States
Williamson County Juvenile Services
🇺🇸Georgetown, Texas, United States
Lake Granbury Youth Services/Rite of Passage
🇺🇸Granbury, Texas, United States
Harris County Youth Village
🇺🇸Houston, Texas, United States
Collin County Juvenile Probation Services
🇺🇸McKinney, Texas, United States