Increasing Caregiver Engagement in Juvenile Drug Courts

National Institute on Minority Health and Health Disparities (NIMHD), Wayne State University, Alliant International University, Baylor University

The purpose of this study is to test a prize-based contingency management intervention for increasing caregiver engagement in juvenile drug court and adolescent drug treatment, and for achieving the ultimate outcomes of reduced substance use and delinquent behavior among drug court-involved youth.

Juvenile offenders with substance abuse problems represent a large and underserved population that is at high risk of deleterious outcomes and long-term costs for themselves, their families, communities, and society. Moreover, a high percentage of substance abusing adolescents continue to abuse substances and engage in criminal activity into adulthood. Although one juvenile justice intervention, Juvenile Drug Court (JDC), has emerged as a promising model for reducing drug use and delinquency among youth, its effectiveness is variable. Drug court outcomes may be compromised by the lack of caregiver engagement in JDC processes and adolescent drug treatment. Incorporating easily implemented evidence-based incentive programs in JDCs might improve their effectiveness in reducing youth drug use and re-offending. An extensive body of research supports the critical role that families play in the etiology, maintenance, and treatment of adolescent substance abuse. Although family-based interventions for adolescent substance abuse have been shown to be superior to other treatment modalities, parents must attend treatment and participate in meaningful ways for these superior outcomes to be realized. This randomized clinical trial will examine the efficacy of a prize-based contingency management intervention for increasing caregiver engagement (attendance and participation) in JDC and adolescent drug treatment. This caregiver contingency management intervention (CCM) will be compared with drug court treatment as usual (TAU). Increased caregiver participation is predicted to improve adolescent outcomes (decreased drug use and delinquent behavior). One hundred and eighty youth enrolled in JDC will be randomly assigned along with a parent/caregiver to TAU or CCM. Analyses will examine measures of caregiver engagement in JDC as well as youth substance use (urine drug screens) and delinquent activity. Results from this study will demonstrate the effectiveness of CCM procedures for increasing caregiver attendance and participation in JDC and adolescent drug treatment above and beyond drug court and usual care. If effective, the CCM approach may ultimately be used to enhance JDC outcomes, thereby reducing substance use and recidivism in juvenile offenders served by this promising juvenile justice intervention.

This group will receive a caregiver contingency management intervention plus the standard outpatient substance abuse treatment services provided at JDC.

In addition to receiving JDC treatment as usual described below, caregiver participants will receive prize draws for engaging in activities consistent with their adolescents' successful completion of the JDC program during the time the youth is actively involved in JDC and substance abuse treatment. Specific activities that may be reinforced include: attendance at drug court hearings; accompanying the youth to probation meetings; participating in home visits; attendance at the youth's drug treatment sessions; attendance at mental health provider meetings; attending groups for parents of youth with substance abuse issues; and completing other verifiable treatment-related activities. All activities will meet the goals of (directly or indirectly) enhancing caregiver participation in the JDC and/or treatment process. Caregivers will receive escalating chances for tangible reinforcers each week for completing up to 3 of the activities agreed upon by the caregiver and the therapist.

Standard outpatient substance abuse treatment services that a young person would receive while participating in JDC.

Changes from baseline to 18 months post-baseline in Youth Urine Drug Screens (measured at 0, 3, 5, 6, 9, 12, and 18 months).

Number of positive drug screens from toxicology testing with youth for tetrahydrocannabinol (THC), amphetamines, methamphetamines, opiates, cocaine, benzodiazepines, MDMA, and oxycodone.

Changes from baseline to 18 months post-baseline in Youth Substance Use Frequency and Problems (measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 months).

Frequency of substance use and substance-related problems self-reported by youth on the Global Appraisal of Individual Needs.

Changes from baseline to 18 months post-baseline in Youth Delinquent Behaviors (measured at 0, 3, 5, 6, 9, 12, and 18 months).

Changes from Baseline to 18 months post-baseline in caregiver reports on Youth Internalizing Symptoms and Externalizing Behaviors (measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 months).

Frequency of youth's internalizing symptoms and externalizing behaviors measured with the Child Behavior Checklist (caregiver report).

Changes from Baseline to 18 months post-baseline in youth reports on Youth Internalizing Symptoms and Externalizing Behaviors (measured at 0, 1, 2, 3, 4, 5, 6, 9, 12, and 18 months).

Frequency of youth's internalizing symptoms and externalizing behaviors measured with the Brief Problem Checklist (youth report).

Frequency and severity of substance use problems self-reported by caregivers on the Addiction Severity Index.

Frequency and severity of depressive symptoms self-reported by caregivers on the Beck Depression Inventory.

Changes from baseline to post-treatment in Therapist-Family Working Alliance (measured at 1, 2, 3, and 4 months, as well as post-treatment).

Levels of alliance during treatment reported by therapists, caregivers, and youth on the Working Alliance Inventory.

Changes from baseline to post-treatment in Caregiver Treatment Attendance and Activity Completion (measured at 1, 2, 3, and 4 months, as well as post-treatment).

Frequency of caregiver attendance at their youth's substance use treatment sessions and completion of therapeutic activities reported by therapists on the Session Tracking Sheet.

Frequency of caregiver attendance at their youth's JDC sessions reported by JDC personnel on the JDC Attendance Form.

Levels of satisfaction with substance use treatment and JDC reported by caregivers and youth on the Client Satisfaction Questionnaire.

Ratings by caregivers on perceptions of incentive-based interventions as measured by the Provider Survey of Incentives.

Changes from baseline to 36 months post-baseline in Therapist and JDC Personnel Perceptions of Incentive Programs (measured at 0, 12, 24, and 36 months).

Ratings by therapists and JDC personnel on perceptions of incentive-based interventions as measured by the Provider Survey of Incentives.

Changes from baseline to 36 months post-baseline in Therapist and JDC Personnel Attitudes Toward Incentive Programs (measured at 0, 12, 24, and 36 months).

Therapist and JDC personnel attitudes toward incentive programs as measured during qualitative interviews.

Inclusion Criteria for youth: Involved in juvenile drug court Aged 13-17 years Youth is willing to participate At least one caregiver is willing to participate in the youth's treatment Fluent in English or Spanish Exclusion Criteria for youth: Diagnosed with intellectual disability or autism spectrum disorder Inclusion Criteria for caregivers: Caregiver of youth involved in juvenile drug court Caregiver is willing to participate Fluent in English or Spanish Exclusion Criteria for caregivers: Diagnosed with intellectual disability or autism spectrum disorder Inclusion Criteria for therapists: Providing substance abuse treatment to a youth in juvenile drug court Exclusion Criteria for therapists: None Inclusion Criteria for Juvenile Drug Court Personnel: Personnel working in juvenile drug court Exclusion Criteria for Juvenile Drug Court Personnel: None

Ledgerwood DM, Cunningham PB. Juvenile Drug Treatment Court. Pediatr Clin North Am. 2019 Dec;66(6):1193-1202. doi: 10.1016/j.pcl.2019.08.011.