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CASE VIGNETTE 'J.T.' is a 16-year-old cisgender male patient who was referred to an outpatient adolescent substance use treatment program after being treated at a local emergency department (ED) following [...]

Objective: The measurement of readiness to change has become common practice in alcohol and drug treatment of both adults and adolescents. Nevertheless, there is relatively little research on the validity of measures of readiness to change among treated adolescents. The purpose of this study was to compare three measures of readiness to change marijuana use commonly used in clinical research and practice with adolescents: the Readiness Ruler, the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; Factors 1 and 2, Recognition and Taking Steps, respectively), and a staging algorithm. Method: The participants were 174 adolescents presenting for intensive outpatient alcohol and drug treatment who reported current marijuana use at the initial assessment. Evidence for concurrent validity was assessed by computing simple correlations among readiness measures, and correlations of each readiness measure with marijuana involvement (percentage of days abstinent in the last 30 days, problem severity score, and marijuana abuse and dependence symptom count [based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria]) at both the initial/baseline assessment and at a 6-month follow-up assessment. Evidence for predictive validity was based on the results of multilevel regression models of the readiness measures in predicting frequency of marijuana use, symptoms, and problems at 6 months from the initial readiness assessment and then in predicting marijuana use, symptoms, and problems at 12 months from the readiness assessment at 6 months. Results: The results showed evidence for good concurrent and predictive validity for the ruler, the staging algorithm, and Taking Steps but poor evidence for the validity of Recognition. The ruler emerged as the measure with the most clinical utility when brevity and ease of administration are taken into account. Conclusions: Research and clinical implications of the findings are discussed. (J. Stud. Alcohol Drugs, 72, 592-601, 2011), AMONG ADOLESCENTS 1N THE UNITED STATES, marijuana is by far the illicit drug used most often (Substance Abuse and Mental Health Services Administration, 2009). Moreover, marijuana often is the most [...]

BACKGROUND: School psychologists are some of the most likely personnel to deliver mental health services, including substance abuse, in school settings, but there is limited research on the perceived competence of school psychologists to address student substance abuse concerns. The 3 aims of this study were to determine how school psychologists perceive their training in 9 competence areas related to student substance abuse and to identify which training areas they indicate as being most needed to address student substance and which substances they perceive as being the most common in their schools. METHODS: A descriptive survey study was conducted with a national sample of 210 school psychologists working in high schools. Data were analyzed using analysis of variance to test for differences between competency areas; descriptive statistics and correlation analyses were employed to determine key training areas for school psychologists. RESULTS: Findings indicated that school psychologists varied in their ratings of perceived competence to address student substance abuse concerns. Participants identified screening and assessment, consultation, and individual interventions as the most important areas for future training. CONCLUSIONS: School psychologists need and want more training for working with students who use or abuse substances. Implications for pre-service and in-service training are discussed and directions for future research are provided. Keywords: school psychology; substance abuse; professional preparation; high schools., INTRODUCTION There is no doubt that mental health services are needed for students in schools today. In recent years, many in the field have called upon school psychologists to address [...]

Whereas the treatment outcome research literature for adolescent alcohol and other drug abuse has shown recent advances (R. J. Williams, S. Y. Chang, & Addiction Centre Adolescent Research Group, 2000), significant knowledge gaps remain. A. E. Kazdin (2001) recently observed that one of the key questions for the field is to identify if client characteristics meaningfully mediate or moderate treatment outcome. There is support from the adolescent clinical literature that internalizing and externalizing personality subtypes are related to the onset and course of youth substance use disorders (D. B. Clark & O. G. Bukstein, 1998). The study extends this literature by examining the association of drug use behaviors outcome and subtyped adolescents (internalizers and externalizers; n = 141) who sought treatment at a 12-Step program. The analysis also includes a community-based control group (n = 94). Specifically, we examined the association of subtype and treatment retention and short-term (Year 1) and long-term (Year 4 and Year 5.5) drug involvement outcomes. Externalizers consistently showed poorer outcomes, including poorer treatment retention and greater drug use and drug disorder symptoms at each follow-up point. The treatment implications of the study are discussed. Keywords: Adolescent drug abuse; Personality traits; Long-term outcome

This study introduces an observational measure of fidelity in evidence-based practices for adolescent substance abuse treatment. The Therapist Behavior Rating Scale--Competence (TBRS-C) measures adherence and competence in individual cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse. The TBRS-C assesses fidelity to the core therapeutic goals of each approach and also contains global ratings of therapist competence. Study participants were 136 clinically referred adolescents and their families observed in 437 treatment sessions. The TBRS-C demonstrated strong interrater reliability for goal-specific ratings of treatment adherence, and modest reliability for goal-specific and global ratings of therapist competence, evidence of construct validity, and discriminant validity with an observational measure of therapeutic alliance. The utility of the TBRS-C for evaluating treatment fidelity in field settings is discussed. Keywords: Treatment fidelity; Therapist competence; Adolescent substance use; Cognitive--behavioral therapy; Family therapy

Objective: Many adolescents engage in polydrug use: however, little is known about whether alcohol and other drug problems show similar posttreatment trajectories of change. We examined concurrent patterns of change for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, symptoms related to the use of alcohol, marijuana, and other drugs and identified predictors of the most common cross-drug patterns of change. Method: Adolescents (N = 542) recruited from addictions treatment were assessed at baseline and at 1-and 3-year follow-up. Latent class mixture modeling identified trajectories for alcohol, marijuana, and other-drug symptoms. Latent class analysis identified cross-drug patterns of change and was used to examine conduct disorder and depression as predictors of cross-drug patterns of change. Results: For alcohol users, three improving groups (72%), stable-low (19%) and stable-high (6%) groups, and groups with increasing trajectories (3%) were identified. For marijuana users, an asymptomatic class (23%), two improving classes (46%), stable-low (13%) and stable-high (13%) classes, and a class with an increasing trajectory (4%) were found. For users of other drugs, groups with asymptomatic (57%), improving 120%), increasing (12%), and stable-high (11%) trajectories were identified. Latent class analysis of cross-drug patterns of change identified three subtypes representing generally concordant cross-drug patterns of change and one subtype that involved stable-high marijuana problems, decreasing alcohol problems, and increasing other-drug problems. Conduct disorder was associated with greater persistence of substance problems. Conclusions: The majority of treated adolescents had similar cross-drug patterns of change for alcohol, marijuana, and other drugs; however, exceptions exist. Furthermore, adolescents with co-occurring psychopathology may benefit from continuing intervention, because they tend to report more persistent posttreatment substance-related problems., ADOLESCENTS SHOW DIVERSE PATTERNS of change following addictions treatment, typically represented by stable-low, stable-high, improving, or worsening trajectories of substance involvement. Most published studies of treated adolescents have reported short-term [...]

Alcohol, tobacco, and illicit drug use among adolescents in the United States continues to be a serious public health challenge. A variety of outpatient treatments for adolescent substance use disorders have been developed and evaluated. Although no specific treatment modality is effective in all settings, a number of promising adolescent interventions have emerged. As policy makers try to prioritize which programs to fund with limited public resources, the need for systematic economic evaluations of these programs is critical. The present study attempted a cost-effectiveness analysis of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. The results indicated that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4- and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost-effective. However, this study encountered numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation. These challenges are explained and recommendations are proposed to guide future economic evaluations in this area. Keywords: Cost-effectiveness analysis; Adolescent substance use interventions; Substance use disorders; Adolescent treatment outcomes; Behavioral and family-based interventions

As the field follows recommendations to introduce standardized assessments on substance, mental, and behavioral problems, a consistent picture has emerged that co-occurring disorders are common, that there is heterogeneity in the type of disorder, and that the pattern varies by age. This study examines the prevalence of self-reported substance use and mental health problems, the pattern of comorbidity, and how both vary by age among people presenting to substance abuse treatment. Data are from 4,930 adolescents and 1,956 adults admitted to substance abuse treatment in multisite studies who were assessed with the Global Appraisal of Individual Needs and categorized into five age groups: Keywords: Comorbidity; Substance abuse treatment; Internalizing and externalizing problems; Adolescents; Adults

Adolescents engaged in substance abuse treatment manifest a rate of cigarette smoking approximately four times higher than that of youth in the general population (~80% vs. 20%) and a high rate of smoking persistence into adulthood. Although there has been a shift toward the implementation of no-smoking policies in substance abuse treatment programs, few studies have examined the relation between cigarette-smoking bans and key clinical outcomes. The current study examined the medical charts of all adolescents (N = 520) admitted to the only adolescent hospital-based substance abuse treatment program in the northern two thirds of the province of British Columbia, Canada. During the span of the study period (March 2001--December 2005), the treatment site moved from a partial smoking ban to a total smoking ban, and then retreated to partial smoking ban. The total smoking ban was not associated with a lower proportion of adolescent smokers seeking treatment at the facility or a lower treatment completion rate among smokers. Total smoking bans do not appear to be an obstacle for adolescent smokers seeking residential substance abuse treatment, nor do total smoking bans appear to compromise the treatment completion rates of smokers in comparison to nonsmokers. Despite these null findings, the effective implementation of smoke-free policies in adolescent substance abuse treatment programs requires not only large-scale organizational change but also the transformation of current commonly held beliefs about tobacco dependence in addictions treatment and recovery communities. Keywords: Smoking bans; Adolescents; Substance abuse treatment; Nicotine dependence; Alcohol abuse; Drug abuse

As adolescents have entered substance abuse treatment programs in greater numbers than ever before [Substance Abuse Mental Health Services Administration, 2004. Substance abuse treatment by primary substance of abuse. (http://www.oas.samhsa.gov/ dasis.htm#teds2). Retrieved September 2004], increasing numbers of young adults are beginning college in 12-step recovery. Unfortunately, with social contexts organized around excessive alcohol consumption, colleges may be the most difficult place through which to control drinking behaviors, let alone remain abstinent. This study used data collected during 2004 and 2005 to describe members of the largest collegiate recovery community in the United States. Included in this study are the following: a description of the program that supports the community, the methods and measurements used to collect data, and results describing the substance use history and characteristics of the community members (N = 82). Collected at a large southwestern university, the data provide drug and alcohol counselors, treatment providers, school administrators, and researchers with the first description of a large collegiate recovery community. Keywords: Addiction; Recovery; Treatment; Substance use; College

This study examined the extent to which organizational context predicted use of consensus-based elements of effective substance abuse treatment practices with juvenile offenders. Participants were either directors of substance abuse treatment programs located in residential facilities (institutional sample) or directors of community-based treatment agencies providing services to adolescents in their home communities (community sample). The two settings differed significantly in the number and types of effective practices they were using. Community programs were more likely to have staff qualified to deliver substance abuse treatment, involve families in treatment, and assess their treatment outcomes. In contrast, institutional programs were more likely to provide comprehensive services. Resources dedicated to training, internal support for new programming, and network connectedness with non-criminal-justice facilities were associated with greater use of effective practices. These findings highlight the importance of establishing corrections-community partnerships designed to promote continuity of care for juvenile offenders. Keywords: Substance abuse; Juvenile justice; Organizational characteristics; Effective treatment practices; Consensus panels

Many adolescents use alcohol and drugs (AODs); however, most do not seek help because of stigma or confidentiality concerns. Providing services in settings that teens frequent may decrease barriers. We examined the feasibility of adapting a brief motivational intervention (MI) for high-risk adolescents (age 12-18 years) in a primary care (PC) setting by conducting small feedback sessions with adolescents, parents, and clinic staff, and pilot testing the MI with adolescents. Findings from feedback sessions indicated that clinic staff thought teens would not talk about AOD use. In contrast, adolescents reported that they would talk about their AOD use; however, they were afraid of being judged. Parents were also concerned that the PC provider might be judgmental. Feedback from the MI pilot indicated that teens were willing to talk about their AOD use and indicated readiness to change. Findings suggest that providing a brief MI in a PC setting is a viable approach for working with high-risk youth. Keywords: Adolescents; Drug and alcohol use; Motivational intervention; Primary care

In the first phase of a two-part treatment development study, families with a treatment-resistant drug-abusing adolescent (n = 42) were offered 12 sessions of Community Reinforcement and Family Training (CRAFT). This parent-focused intervention was designed to help parents facilitate their adolescents' entry into treatment, to support adolescents' subsequent behavior change, and to improve parent and family functioning. In the second phase, successfully engaged adolescents (n = 30) were offered 12 sessions of a multicomponent individual cognitive-behavioral therapy (CBT) targeting substance use and related problem behaviors. For parents and adolescents, measures were collected on pretreatment and posttreatment, with an additional follow-up assessment for parents at 3 months after treatment. Parents on CRAFT intervention experienced a significant reduction in negative symptoms, and 71% of parents were successful in engaging their resistant youths in treatment. The CBT intervention for engaged youths was associated with a statistically significant, but not clinically significant, reduction in marijuana use. Keywords: Adolescents; Substance abuse; Treatment engagement; CRAFT; Treatment outcome

Addressing the science-service gap, we examined in this study the amenability of a large heterogeneous sample of community-based therapists in the state mental health and substance abuse treatment sectors to learn about an evidence-based practice (EBP) for adolescent substance abuse (i.e., contingency management [CM]) when such learning was supported administratively and logistically. Leadership in most (44 of 50) public sector agencies supported practitioner recruitment, and 432 of 543 eligible practitioners subsequently attended a 1-day workshop in CM. Workshop attendance was predicted by organizational factors but not by practitioner demographic characteristics, professional background, attitudes toward EBPs, or service sector. Moreover, the primary reason for workshop attendance was to improve services for adolescent clients; the primary barriers to attendance, for those who did not attend, were practical in nature and not due to theoretical incompatibility. The findings demonstrate a considerable amount of interest practitioners showed in both the substance abuse and mental health sectors in learning about an EBP. Keywords: Substance abuse; Adolescents; Contingency management; Evidence-based practice

Few systematic studies have examined the characteristics of substance abuse treatment programs serving adolescents. An expert panel recently identified nine key elements of effective adolescent substance abuse treatment. We measured the percentage of treatment programs in the United States with at least 10 adolescent clients on a given day that reported these elements using data from the 2003 National Survey of Substance Abuse Treatment Services. This first look into the characteristics of facilities serving significant numbers of adolescents indicates that many facilities may be lacking in components considered important. The most significant measured potential areas for improvement occurred in the areas of including mental health as well as medical issues in comprehensive assessments and developing curricula to meet the developmental and cultural needs of clients. On a more encouraging note, many facilities were conducting discharge planning and providing aftercare, although the specifics of these services were not determined. Keywords: Adolescents; Substance abuse treatment; N-SSATS; Treatment effectiveness; Comorbid illness

The challenges and opportunities of group treatment for adolescents with substance use disorders (SUD) are analyzed in the wake of the argument that aggregation of adolescents who exhibit problem behavior into groups for treatment, also called 'deviancy training', might produce harmful effects on all participants. It is suggested that adolescent group therapy should be continued since deviancy training has no evidence.

In this study, we assessed the feasibility and effectiveness of the Adolescent Cannabis Check-Up (ACCU), a brief intervention for young cannabis users. For this initial feasibility study, we used an uncontrolled pre-test/post-test design. Participants were cannabis users aged between 14 and 19 years (n = 73) and concerned parents (n = 69). The intervention comprised an individual assessment session followed 1 week later by a session of personalized feedback delivered in a motivational interviewing style. An optional third session that focused on skills and strategies for making behavioral change was offered. Of the entire sample of cannabis users, 78% reported voluntarily reducing or stopping their cannabis use during the 90 days to follow-up and 16.7% reported total abstinence during this time. In addition, significant reductions were found on measures of both quantity and frequency of use and dependence. These reductions were maintained at 6-month follow-up. Clearly, these preliminary fundings must be interpreted with caution given the study design and absence of a control group. The ACCU was, however, able to attract and retain young cannabis users who were not necessarily interested in change. The approach was acceptable to young people and associated with reductions in cannabis use. It appears to be a model that warrants further research in early and brief interventions for this population. Keywords: Cannabis; Brief intervention; Youth; Motivation

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.07.002 Byline: Yifrah Kaminer Keywords: Adolescent; Substance abuse; Antisocial behavior; Group therapy; Treatment Abstract: Group intervention has been the most commonly employed treatment modality for adolescents with substance use disorders (SUD). Evidence has been accumulating in support for the efficacy of diverse forms of group therapy that have been utilized with adolescents. It has been argued however, that aggregation of youths who display problem behavior into group interventions may, under some conditions, produce iatrogenic effects on all participants. This assertion known also as 'deviancy training' and its presumed effect on treatment outcomes has created a barrier to progress regardless of the fact that it has not been tested or empirically supported in heterogeneous groups of adolescents treated for SUD. It is imperative to optimize group intervention while considering how to prevent, reduce and control, potentially iatrogenic effects associated with the aggregation of antisocial youths in heterogeneous groups. The main objective of this review is to address the challenges and opportunities regarding group treatment of adolescent SUD. Author Affiliation: Alcohol Research Center, Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington Connecticut 06030-2103, United States Article Note: (footnote) [star] The preparation of this article was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism. The author acknowledges the contribution of Dr Michael Dennis to the conceptualization of the paper.

This study examined participant characteristics and treatment response among substance-abusing adolescents who received outpatient treatment (N=305, 70.2% adolescent male, 55.3% White, 33.1% Latino, average age of 16 years). Chart reviews were performed on existing intake and discharge assessments between 1999 and 2003 from two Matrix Institute on Addictions treatment clinics. Analyses comparing methamphetamine (meth)-using (n = 90) and non-meth-using (n = 215) adolescents revealed that adolescent females and older youth were more likely to use meth. Meth users reported greater psychosocial dysfunction and higher rates of substance use at treatment discharge compared with non-meth users. Suicidal ideation and substance use during treatment were predictors of early treatment dropout among the total sample. Meth-using adolescents may need enhanced treatment programming, because they appear to present for treatment with higher levels of dysfunction. Implications are discussed in terms of developing strategies that minimize drug use and maximize treatment response among substance-abusing adolescents. Keywords: Adolescents; Methamphetamine; Treatment response

Mindfulness-based therapies may be useful in treating various disorders. This study tests the reliability and validity of a new mindfulness measure, explores the relation between mindfulness and spirituality and investigates the relationship between mindfulness and/or spirituality and alcohol and tobacco use among college undergraduates.

The effectiveness of adolescent substance abuse treatment has been repeatedly demonstrated, but specific treatment approaches have rarely been sufficiently documented to permit replication. This study evaluated the effectiveness of a manual-guided, outpatient, group-based treatment program for adolescents (N = 194) who were mild-to-moderate substance abusers. In addition to evaluating the group-based treatment model, the study was designed to compare the effectiveness of two approaches to preparing youth to engage in treatment, whereby adolescents received one of two types of treatment induction, either motivational interviewing or counseling overview. Self-reported pretreatment substance use and criminal behaviors were compared with these behaviors 6 and 12 months following treatment entry using a General Linear Mixed Model analytic approach that controlled for the effects of potential confounding variables and examined individual and program factors that might explain treatment response. Participants significantly reduced marijuana use at 6 months, and these reductions were largely sustained at 12 months. No changes in alcohol use or criminal involvement were obtained. Further examination of marijuana use indicated differential treatment response based on participants' emotional abuse history, family satisfaction, school adjustment, and pretreatment substance use frequency. This treatment approach appears promising for marijuana-abusing youth. Keywords: Adolescents; Marijuana abuse; Outpatient treatment; Substance abuse; Treatment outcome

Juvenile drug courts (JDC) emerged in response to a perceived need to intervene more effectively in the substance abuse-delinquency cycle. The influx of drug and alcohol offenders, lack of other juvenile justice system interventions, and positive experiences with adult drug courts helped drive interest in adapting the drug court model for juveniles. This article: (1) provides an overview of substance use and the juvenile justice system; (2) describes the current status of JDC programs; and (3) proposes a model for planning, implementing and evaluating JDCs based on adolescent drug use and treatment research as well as current JDC models. The lack of science-based JDC models and empirically sound JDC evaluations has limited the effectiveness of JDCs. The proposed model is designed to create a new generation of JDCs that maximizes the effectiveness of local resources and delivers research-based interventions to youth and families impacted by substance abuse and delinquency. Keywords. Juvenile drug courts; Adolescent substance abuse; Delinquency; Risk and protective factors; Program planning

The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes., INTRODUCTION Adolescent drug treatment admissions increased by 46% during the 5 years beginning in 1993 (1). This surge in admissions has been driven chiefly by the juvenile justice system, which [...]

Most of the youth involved in the juvenile justice system meet the criteria for a mental health disorder, substance use disorder, or both (1). However, the juvenile justice system traditionally [...]

Introduction: Evidence suggests that people who inject drugs often begin their drug use and injecting practices in adolescence, yet there are limited data available on the HIV epidemic and the responses for this population. The comprehensive package of interventions for the prevention, treatment and care of HIV infection among people who inject drugs first laid out in 2009 (revised in 2012) by World Health Organization, United Nations Office of Drugs and Crime and Joint United Nations Programme on HIV/AIDS, does not consider the unique needs of adolescent and young people. In order to better understand the values and preferences of young people who inject drugs in accessing harm reduction services and support, we undertook a series of community consultations with young people with experience of injecting drugs during adolescence. Methods: Community consultations (4–14 persons) were held in 14 countries. Participants were recruited using a combined criterion and maximum variation sampling strategy. Data were analyzed using collaborative qualitative data analysis. Frequency analysis of themes was conducted. Results: Nineteen community consultations were organized with a total of 132 participants. All participants had experienced injecting drugs before the age of 18. They had the following age distribution: 18–20 (37%), 21–25 (48%) and 26–30 (15%). Of the participants, 73.5% were male while 25.7% were female, with one transgender participant. Barriers to accessing the comprehensive package included: lack of information and knowledge of services, age restrictions on services, belief that services were not needed, fear of law enforcement, fear of stigma, lack of concern, high cost, lack of outreach, lack of knowledge of HCV/TB and lack of youth friendly services. Conclusions: The consultations provide a rare insight into the lived experiences of adolescents who inject drugs and highlight the dissonance between their reality and current policy and programmatic approaches. Findings suggest that harm reduction and HIV policies and programmes should adapt the comprehensive package to reach young people and explore linkages to other sectors such as education and employment to ensure they are fully supported and protected. Continued participation of the community of young people who inject drugs can help ensure policy and programmes respond to the social exclusion and denial of rights and prevent HIV infection among adolescents who inject drugs., Introduction While the age distribution of the 12.7 million people who inject drugs globally is unknown [1], evidence suggests that people who inject drugs begin their injecting practices at a [...]

Introduction: There is a strong evidence base that the stigma, discrimination and criminalization affecting adolescent key populations (KPs) aged 10–17 is intensified due to domestic and international legal constructs that rely on law‐enforcement‐based interventions dependent upon arrest, pre‐trial detention, incarceration and compulsory “rehabilitation” in institutional placement. While there exists evidence and rights‐based technical guidelines for interventions among older cohorts, these guidelines have not yet been embraced by international public health actors for fear that international law applies different standards to adolescents aged 10–17 who engage in behaviours such as selling sex or injecting drugs. Discussion: As a matter of international human rights, health, juvenile justice and child protection law, interventions among adolescent KPs aged 10–17 must not involve arrest, prosecution or detention of any kind. It is imperative that interventions not rely on law enforcement, but instead low‐threshold, voluntary services, shelter and support, utilizing peer‐based outreach as much as possible. These services must be mobile and accessible, and permit alternatives to parental consent for the provision of life‐saving support, including HIV testing, treatment and care, needle and syringe programmes, opioid substitution therapy, safe abortions, antiretroviral therapy and gender‐affirming care and hormone treatment for transgender adolescents. To ensure enrolment in services, international guidance indicates that informed consent and confidentiality must be ensured, including by waiver of parental consent requirements. To remove the disincentive to health practitioners and researchers to engaging with adolescent KPs aged 10–17 government agencies and ethical review boards are advised to exempt or grant waivers for mandatory reporting. In the event that, in violation of international law and guidance, authorities seek to involuntarily place adolescent KPs in institutions, they are entitled to judicial process. Legal guidelines also provide that these adolescents have influence over their placement, access to legal counsel to challenge the conditions of their detention and regular visitation from peers, friends and family, and that all facilities be subject to frequent and periodic review by independent agencies, including community‐based groups led by KPs. Conclusions: Controlling international law specifies that protective interventions among KPs aged 10–17 must not only include low‐threshold, voluntary services but also “protect” adolescent KPs from the harms attendant to law‐enforcement‐based interventions. Going forward, health practitioners must honour the right to health by adjusting programmes according to principles of minimum intervention, due process and proportionality, and duly limit juvenile justice and child protection involvement as a measure of last resort, if any., Introduction It is well settled that adolescent key populations (KPs) face heightened health risks as a result of law and policy barriers to accessing HIV treatment, diagnostic and prevention services [...]

KIDS of North Jersey is a treatment center for substance-abusing teenagers and young adults in River Edge, NJ, that emphasizes the participation of patients' families as essential to recovery. KIDS seeks to ensure that this strong family support will continue until these young people achieve addiction-free maturity in their mid-20s. The facility's program of family treatment comprises five steps: the breaking of parental denial, temporarily freeing the young people from family environment, dealing with issues and resentments, developing detachment and attaining a healthful lifestyle.