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Justice-involved adolescents (JIA) are at higher risk for opioid misuse (OM) and opioid-related overdose than nonoffending adolescents. Untreated OM can lead to severe consequences (e.g., trauma), which may be harsher for female JIA. Therefore, examining risk and protective factors, such as parental supervision, is essential to identify factors that may impact OM. The current study used a statewide, cross-sectional dataset including 79,960 JIA from the Florida Department of Juvenile Justice. Stratified logistic regression analyses were conducted. Results indicated that JIA who experienced sporadic or inadequate supervision had 2.14 and 3.54 higher odds, respectively, of misusing opioids compared to JIA who experienced consistent supervision. Female JIA who experienced sporadic or inadequate supervision had 2.23 and 3.70 higher odds, respectively, of misusing opioids. Results suggest parental supervision is an important protective factor that should be considered in developing prevention and treatment efforts that serve JIA who misuse opioids, especially females.

It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.

Real-world application and implementation of evidence-based practice continue to be a challenge across multiple sectors, including behavioral health settings. Providing the opportunity for future researchers and practitioners to gain capacity and knowledge through structured experiential learning in implementation science is critical to closing the research to practice gap. The Institute for Translational Research Education in Adolescent Drug Abuse (ITRE) is a graduate certificate program that offers specific coursework, a large-scale service-learning project based in the community, and mentorship related to implementation science research and practice. The purpose of this evaluation was to examine, from the perspective of ITRE scholars, the perceived impact on the development of professional research and practice skills once graduated from the ITRE program. Fifty-eight semi-structured interviews across five cohorts were selected randomly for in-depth thematic analysis (n = 58). Results suggest that the ITRE provides a unique approach grounded in implementation science for building robust and transferable skills for future researchers and practitioners working in a variety of behavioral healthcare settings.

Behavioral health practitioners recognize how critical the process of implementation is to the successful use of evidence-based practices. It is further recognized that implementation is a complex, time-consuming process and that successful implementation often occurs in stages. Capitalizing on a national evaluation examining the implementation of school-based behavioral health (SBBH) services, this project involved an analysis of qualitative interview data to assess the unique barriers and facilitators that arise across time and organizational levels in the implementation of SBBH services. Forty-eight semi-structured telephone interviews were analyzed across 3 years and two organizational levels in seven sites (n = 48). Qualitative analysis identified five major implementation facilitators including communication and collaboration, data utilization, leadership, planning, and training. Major barriers to implementation included systemic state/governmental barriers, workforce shortages, and funding issues. While there were small changes in the relative importance of these facilitators and barriers over time and by organizational level, the most salient barriers and facilitators remained important across all 3 years of the study. Differences across organizational levels included greater emphasis at local levels for facilitators such as training and leadership and a greater emphasis at state levels for state/governmental barriers. Results suggest that while the importance of given facilitators and barriers changes as implementation progresses, the major factors that contribute to implementation are likely to remain unchanged over time. Effective communication/collaboration among stakeholders remains a powerful facilitator across time, and systemic state/governmental barriers remain a potent barrier. Implications for increasing successful integration of behavioral health services in public school settings are discussed.

INTRODUCTION: Opioid misuse remains a chief public health concern in the United States, especially among justice-involved children and adolescents (JIC). Adverse childhood experiences (ACEs) are prevalent among JIC and are associated with a higher risk for opioid misuse. Justice involvement can be harsher for females, who tend to have higher ACE scores and experience more physiological and psychological risk factors than males. However, this study was the first to examine how sex may moderate the link between ACEs and opioid misuse. This study hypothesized that females will have higher odds of opioid misuse than males with equivalent ACEs. METHODS: The study team examined cross-sectional data on 79,960 JIC in the Florida Department of Juvenile Justice from 2007 to 2015. The study measured ACEs using 10 questions from the Positive Achievement Change Tool. Opioid misuse was reported by either self-disclosure, positive urinalysis, or other evidence of opioid consumption within the past 30 days. The team estimated logistic regression, marginal effects, and multiplicative interaction terms to test the hypotheses. RESULTS: JIC with an ACE score of 4 or higher were 2.59 times more likely to misuse opioids than JIC with lower ACE scores. Among JIC with 4 or more ACEs, females had significantly higher odds of opioid misuse than males. CONCLUSION: Reducing exposure to ACEs may decrease the risk for opioid misuse, particularly among females. These findings corroborate trauma-informed and sex-responsive prevention programs in the juvenile justice system.

In the United States, the rising prevalence of opioid addiction has led to an increase in opioid-related overdose deaths and transmission of infectious disease. This resulted in the declaration of a national public health emergency and the need for harm reduction strategies such as syringe exchange. Florida has seen increases in blood-borne diseases and fatal/nonfatal opioid overdoses, yet harm reduction policy integration has been historically limited. To inform policy change, this study explores the perspectives of community members in Manatee County, Florida, on harm reduction services. Six focus groups were conducted with findings centralized around three emergent themes related to the implementation of a syringe exchange program: (a) awareness and acceptability; (b) facilitating factors; and (c) perceived barriers. The results of this qualitative research helped to inform the successful adoption of a local syringe exchange ordinance. Recommendations for community education and engagement regarding harm reduction policy are discussed.

AIMS: Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs’ ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. METHODS: Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). RESULTS: Results revealed participants rated IPAs on the importance scale higher than IPAs on the presence scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. CONCLUSIONS: Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.

Justice-involved adolescents (JIAs) have an increased risk for opioid use disorder and overdose related to opioid misuse (OM). Consequences of untreated OM include recidivism and poor educational outcomes, which can be harsher for female JIA. Therefore, identifying relevant factors and settings that reduce the risk for OM is critical. Schools are a central institution in adolescent development. Drawing on social control theory, JIA with higher levels of school bonding was hypothesized to attenuate risk for OM. Cross-sectional data on 79,960 JIA from the Florida Department of Juvenile Justice were examined. Multivariate and stratified logistic regression analyses were employed. On average, for every one-unit increase in school bonding, JIA had 22%, female JIA had 23%, and male JIA had 22% lower odds of OM. Results suggest school bonding and the school context should be considered in treatment and how this setting may impact OM intervention outcomes among JIA.

It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.

Social and emotional learning (SEL) programs have become increasingly popular during the last 20 years. Although the benefits of SEL programs are significant, the issue of implementation fidelity often arises. The purpose of this study was to assess the impact of implementation fidelity in the Life Skills Training (LST) program implemented with middle school students in a large Florida school district. Three core elements of implementation fidelity were assessed including: (1) adherence; (2) participant responsiveness; and (3) quality of delivery. Student survey data were collected from 4812 students and 104 classrooms in 16 middle schools that participated in the LST program. Multilevel modeling was used to assess the effect of individual-level [gender, race/ethnicity, and socioeconomic status (SES)] and classroom-level characteristics (adherence, participant responsiveness, and quality of delivery) on students’ SEL outcomes measured at posttest. At the individual level, results indicated that students’ race/ethnicity and SES were significantly associated with predicting student SEL outcomes at posttest. At the classroom level, participant responsiveness was significantly associated with predicting student SEL skills at posttest. Findings are discussed in terms of implications for research and practice.

This chapter reviews and discusses research and practice in the fields of behavioral health and public health from the perspective of implementation science, with an emphasis on critical questions researchers and practice professionals must address as they attempt to improve services in the community. This chapter will also focus on the latter stages concerned with moving programs that have been conceptualized and tested under controlled conditions into clinical practices, paying particular attention to the process of implementation, issues in program fidelity, fit, and adaptation and conclude with a discussion of integration and sustainability.