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We explored clinical outcomes among adolescents in juvenile drug court (JDC) by ethnoracial or gender identity, economic security, and mental health problems. Self‐report and drug testing data were obtained through a randomized control trial (RCT) with 101 adolescents in JDC at four time points (i.e., baseline, 3‐month immediate post, 6‐month follow‐up, and 12‐month follow‐up). Participants who identified as an adolescent girl and who were identified as having a mental health disorder demonstrated significant increases in talking about HIV 12 months after completing the intervention. Sexual risk behaviors increased for girls, Black, and Latine youth and decreased among adolescents with mental health problems. Marijuana use did not differ over time by identity. Programing that targets risk behaviors, including substance use and seemingly unrelated risk behaviors like risky sexual behavior, is warranted in addition to mental health services to improve health outcomes of adolescents with a history of juvenile legal system involvement. [ABSTRACT FROM AUTHOR]

Addressing substance use disorder (SUD) requires intricate solutions, usually involving several organizations within a complex institutional environment. Alcoholics Anonymous (AA) shares the recovery ecosystem with other organizations, is ubiquitous across communities, and is notably inexpensive as an intervention; yet the exact nature of the connections between AA and other organizations in the recovery ecosystem is underexplored. Explore relationships AA has with other recovery ecosystem organizations and guide future research. Data were gathered via ethnographic participant observations, which were triangulated and contextualized via semi-structured interviews with key informants and archival documents. Though AA does not formally link itself with other organizations, findings point toward strong relationships at the individual level and of an informal nature. Individual members who also have affiliation with other organizations (e.g., legal institutions, treatment services) create bridges, enabling efficient solving of complex issues. Services wishing to leverage AA (or other mutual-aid) attendance will likely benefit from fostering informal relationships with individual AA members, including lowering barriers to disclosure of recovery status, and contacting local AA service elements capable of making these connections. Similarly, research to advance community-level SUD services and the knowledge-base would benefit from incorporating and partnering with people in recovery. [ABSTRACT FROM AUTHOR]

Background: Risky sexual behaviour (RSB) is a serious public health problem for adolescents. We examined whether a contingency management intervention implemented by juvenile probation officers (JPOs) targeting substance use also impacted RSB. Methods: A total of 218 adolescents on probation were randomly assigned to contingency management or to probation as usual. Results: The substance use intervention delivered by JPOs reduced rates of RSB over time (β = −0.32, P = 0.041 at 6 months; β = −0.32, P = 0.036 at 9 months). Conclusions: Adolescents receiving a substance use intervention from JPOs demonstrated reduced/prevented RSB. Interventions targeting single risk behaviour s in juvenile probation populations should measure changes in other risk behaviour s. Under-resourced communities lacking clinicians might consider JPOs delivering interventions. This study aimed to address risky sexual behaviour among adolescents. We tested the effectiveness of a contingency management intervention by juvenile probation officers, primarily designed to address substance use, on reducing risky sexual behaviour among 218 adolescents on probation. Findings indicated this intervention reduced risky sexual behaviour over time. Interventions focused on individual risk behaviour s among adolescents on probation populations can have positive ripple effects, evidencing a possible approach for underserved communities lacking clinician access. [ABSTRACT FROM AUTHOR]

Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief strategic family therapy. In addition to summarizing the theoretical and clinical bases of these treatments, their results in efficacy and effectiveness trials are examined with particular emphasis on any demonstrated capacity to achieve favorable outcomes when implemented by real-world practitioners in community practice settings. Special attention is also devoted to research on purported mechanisms of change as well as the long-term sustainability of outcomes achieved by these treatment models. Importantly, we note that the developers of each of the models have developed quality assurance systems to support treatment fidelity and youth and family outcomes; and the developers have formed purveyor organizations to facilitate the large-scale transport of their respective treatments to community settings nationally and internationally.

The 12-month cost-effectiveness of juvenile drug court and evidence-based treatments within court were compared with traditional Family Court for 128 substance-abusing/dependent juvenile offenders participating in a 4-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost-effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes. (Contains 2 tables.)

This study was a cross-cultural replication of a study that investigated therapist adherence to behavioral interventions as a result of an intensive quality assurance system which was integrated into Multisystemic Therapy (MST). Thirty-three therapists and eight supervisors were block randomized to either an Intensive Quality Assurance or a Workshop Only condition. Twenty-one of these therapists treated 41 cannabis-abusing adolescents and their families. Therapist adherence and youth drug screens were collected during a 5-month baseline period prior to the workshop on contingency management and during 12 months post workshop. The results replicated the previous finding that intensive quality assurance enhanced therapist adherence over workshop, to cognitive-behavioral techniques, but not to contingency management. While the clinical impact of such quality assurance remains to be demonstrated, cannabis abstinence increased as a function of time in therapy, and was more likely with stronger adherence to contingency management, but did not differ across quality assurance interventions. (Contains 1 figure and 4 tables.)

This nonexperimental study used mixed-effects regression models to examine relations among supervisor adherence to a clinical supervision protocol, therapist adherence, and changes in the behavior and functioning of youths with serious antisocial behavior treated with an empirically supported treatment (i.e., multisystemic therapy [MST]) 1 year posttreatment. Participants were 1,979 youths and families treated by 429 clinicians across 45 provider organizations in North America. Four dimensions of clinical supervision were examined. Mixed-effects regression model results showed that one dimension, supervisor focus on adherence to treatment principles, predicted greater therapist adherence. Two supervision dimensions, Adherence to the Structure and Process of Supervision and focus on Clinician Development, predicted changes in youth behavior. Conditions required to test hypothesized mediation by therapist adherence of supervisor adherence effects on youth outcomes were not met. However, direct effects of supervisor and therapist adherence were observed in models including both of these variables. (Contains 2 figures.)

This study investigated relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and youth criminal charges on average 4 years posttreatment. Participants were 1,979 youth and families treated by 429 therapists across 45 provider organizations. Results showed therapist adherence predicted significantly lower rates of youth criminal charges independently and in the presence of organizational variables. Therapist perceptions of job satisfaction and opportunities for growth and advancement relative to the organizational average predicted youth criminal charges, as did organizational average levels of participation in decision making. These associations washed out in the presence of adherence, despite the fact that job satisfaction and growth and advancement were associated with adherence. (Contains 1 table, 1 figure and 1 footnote.)

Research examining the relationship between internalizing symptoms and antisocial behaviors has generally been cross-sectional in design. Thus, although extant data have substantiated a strong correlation between internalizing symptoms and antisocial behaviors, few studies have focused on describing the nature of the co-occurrence over time. This study examined the relation between growth in internalizing symptoms and longitudinal patterns of antisocial behavior in a sample of 283 inner-city males and their caregivers assessed as part of a longitudinal developmental risk study. Participants were assessed annually in four waves. Non-offenders and escalating offenders had lower levels of internalizing problems at wave 1 than did chronic minor and serious-chronic-violent offenders. Results revealed a developmental trend of decreasing internalizing problems across study years for most participants, as would be expected, with adolescents participating in serious, chronic, and violent patterns of antisocial behavior displaying greater internalizing problems than those participating in stable patterns of less serious or no antisocial behavior. Further, when there was escalation of seriousness and frequency of antisocial behavior, there also was increased internalizing problems relative to non-escalating juveniles. Results are discussed in the context of developmental psychopathology.

The development and evaluation of effective strategies for transporting evidence-based practices to community-based clinicians has become a research and policy priority. Using multisystemic therapy programs as a platform, an experimental design examined the capacity of an Intensive Quality Assurance (IQA) system to promote therapist implementation of contingency management (CM) for adolescent marijuana abuse. Participants included 30 therapists assigned to Workshop Only (WSO) versus IQA training conditions, and 70 marijuana-abusing youths and their caregivers who were treated by these clinicians. Analyses showed that IQA was more effective than WSO at increasing practitioner implementation of CM cognitive-behavioral techniques in the short-term based on youth and caregiver reports, and these increases were sustained based on youth reports. On the other hand, IQA did not increase therapist use of CM monitoring techniques relative to WSO, likely because of an unanticipated ceiling effect. Both sets of findings contribute to the emerging literature on the transport of evidence-based practice to real-world clinical settings. (Contains 1 table and 2 figures.)

The successful nationwide transport and evaluation of Multisystemic Therapy (MST) programs in Norway is described. This description is provided within the context of the nation's movement towards the adoption of evidence-based practices (EBPs) during the past decade, the conduct of a multisite randomized clinical trial to examine the effectiveness of MST in Norway, and the development of a center for effectively implementing and researching EBPs for child and adolescent problems. Data on Norwegian adolescent substance use, treatment, and research is summarized. Finally, challenges that have been addressed and overcome in achieving the large-scale adoption and implementation of MST are presented from the context of innovation diffusion. System-level barriers and strategies regarding funding, practice norms, local ownership, engaging stakeholders, geography, referral gatekeepers, and risk assessment are noted, as are practitioner level barriers and strategies regarding language, cultural appropriateness, caseload and compensation issues, and background and skill deficits. The Norwegian approach, in many ways, serves as an excellent model for importing and sustaining EBPs on a large-scale basis.

A unique application of the Many-Facet Rasch Model (MFRM) is introduced as the preferred method for evaluating the psychometric properties of a measure of therapist adherence to Contingency Management (CM) treatment of adolescent substance use. The utility of psychometric methods based in Classical Test Theory was limited by complexities of the data, including: (1) ratings provided by multiple informants (i.e., youth, caregivers, and therapists), (2) data from separate research studies, (3) repeated measurements, (4) multiple versions of the questionnaire, and (5) missing data. Two dimensions of CM adherence were supported: adherence to Cognitive Behavioral components and adherence to monitoring components. The rating scale performed differently for items in these subscales, and of 11 items evaluated, eight were found to perform well. The MFRM is presented as a highly flexible approach that can be used to overcome the limitations of traditional methods in the development of adherence measures for evidence-based practices. (Contains 3 figures and 1 table.)

This article expands the review of psychosocial treatments for adolescents with disruptive behavior (DB), published previously by this journal. That earlier review focused on DB treatment studies published 1966–2014; the current paper updates the evidence base by incorporating DB treatment studies published 2014–2021. A literature search and screening process identified 63 new studies for inclusion in this updated review. The 63 new studies were combined with 86 studies from the prior review and evaluated using Journal of Clinical Child and Adolescent Psychology level of support criteria, which classify studies as well established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on the evidence. In total, 3 well-established, 7 probably efficacious, and 10 possibly efficacious treatments for adolescents with DB were identified. Further, 52 treatments were classified as experimental and 22 treatments were determined to have questionable efficacy. There continues to be a large body of literature building the evidence base for treatments of adolescent DB. With a few exceptions, treatments falling into the top three evidence levels utilized more than one theoretical approach, enhancing each treatment's ability to target DB from multiple angles. Key advances include broad representation of various demographic groups, countries of origin, treatment settings, and provider types in this body of research. Despite these advances, more research is needed to address key gaps in the field, including the need for more studies on treatments tailored to adolescents with DB who are not yet involved with the juvenile justice system. [ABSTRACT FROM AUTHOR]

This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1 = 178, N2 = 274) and therapists (N1 = 87, N2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.

Studied how participation in street violence as part of criminal/delinquent behavior relates to violence within dating or marital relationships. Found that subjects were more likely to report use of violence in relationships if they were also participating in violence as part of other criminal behavior. However, half the 141 subjects had not participated in either type of violence. (Author/SD)

There is a significant gap in research examining the prevalence of problem behaviors among youth involved in the juvenile justice system in rural areas. The current study sought to address this gap by exploring the behavioral patterns of 210 youth who were on juvenile probation in predominantly rural counties and who were identified as having a substance use disorder. First, we examined the correlation among 7 problem behaviors representing different forms of substance use, delinquency, and sexual risk-taking and 8 risk factors related to recent service utilization, internalizing and externalizing difficulties, and social support networks. Then, we used latent class analysis (LCA) to identify distinct behavioral profiles based on the observed problem behaviors. LCA identified a 3-class model representing distinct groups labeled Experimenting (70%), Polysubstance Use + Delinquent Behaviors (24%), and Diverse Delinquent Behaviors (6%). Finally, we assessed differences (i.e., ANOVA, χ2) in each risk factor across the behavioral profiles. Important similarities and differences in the association among the problem behaviors, behavioral profiles, and the risk factors were revealed. These findings underscore the need for an interconnected behavioral health model within rural juvenile justice systems that is able to address youths' multidimensional needs including criminogenic, behavioral, and physical health needs. [ABSTRACT FROM AUTHOR]

Probation is a common sanction for youth substance users, and as such, juvenile probation officers (JPOs) shoulder much of the burden for treatment and rehabilitation. To improve youth outcomes and alleviate some of the burden, JPOs may seek parental involvement in the probation and substance use desistance processes. Using focus group data, we analyzed JPO perceptions of the role parents play in contingency management (CM)—an incentive system designed to produce and reward decreased substance use—and whether they perceived any value in CM. We found that most JPOs perceived parental involvement as critical to the success of both substance use treatment and CM for youth. Our findings also suggest JPOs found parental involvement in CM valuable given that CM was employed on nonstudy clients and future clients. This has implications for the practicality and sustainability of CM as a youth probation intervention. [ABSTRACT FROM AUTHOR]

Evidence-based practices and programs (EBPs) have been adopted in juvenile probation agencies nationwide to maximize the number of successful probation cases. However, various pragmatic studies have found that JPOs are not yielding the expected benefits when compared to efficacy studies. Using focus group and survey data, the current study sought to increase our understanding of the gap between pragmatic and efficacy studies in juvenile probation settings by examining JPOs' perceptions and utilization of EBPs. The findings suggest that JPOs are misunderstanding how to use EBPs in daily practice, leaving them with negative perceptions of EBPs. Implications for improving JPO understanding and use of EBPs are discussed. [ABSTRACT FROM AUTHOR]

In bridging the science-to-service gap, effective yet practical strategies are needed for supporting practitioner implementation of evidence-based treatments. The development and preliminary evaluation of an adherence monitoring system to support clinician fidelity to an evidence-based treatment for substance-abusing adolescents was tested for community-based practitioners. Session tapes were monitored for adherence to a family-based approach to contingency management for 27 practitioners during baseline, postworkshop, and follow-up periods. Approximately half of the practitioners were randomized to receive intensive quality assurance following a family-based contingency management workshop as part of a larger study. Findings supported the clinical feasibility of the developed system as well as the face and content validity, reliability, and concurrent validity. Future directions are discussed in light of these results, including instructions for the use of the developed system to efficiently train clinicians to adequate fidelity. Keywords: clinician adherence, audiocoding, adolescent substance use, contingency management

Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family‐based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014–April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well‐established, 11 probably efficacious, and 7 possibly efficacious family‐based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family‐based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns. [ABSTRACT FROM AUTHOR]