Symposia
Criminal Justice / Forensics
Casey A. Pederson, Ph.D.
Indiana University School of Medicine
Indianapolis, Indiana
Allyson Dir, Ph.D.
Assistant Professor of Psychiatry
Indiana University School of Medicine
Indianapolis, Indiana
Brigid Marriott, Ph.D.
Postdoctoral Fellow
Indiana University School of Medicine
Indianapolis, Indiana
Zachary Adams, Ph.D.
Assistant Professor of Psychiatry and Clinical Psychology
Indiana University
Carmel, Indiana
Matthew Aalsma, Ph.D.
Professor of Pediatrics
Indiana University School of Medicine
Indianapolis, Indiana
Background: Despite a high need for substance use disorder (SUD) treatment, many barriers exist to connecting juvenile justice system (JJS)-involved youth to evidence-based care. Most youth within the JJS receive community supervision, and, thus, must seek treatment in the community. Yet only 50% of youth within the JJS needing SUD treatment initiate community-based care. One promising alternative to community-based treatment referrals is integrating effective SUD treatment into JJS settings. Using data from a pilot project, we aim to explore the feasibility of providing evidence-based SUD services within the JJS.
Methods: Two masters-level JJS case workers participated in training and ongoing weekly supervision in Teen Intervene, a 2 to 3 session manualized motivational interviewing (MI) and cognitive behavioral treatment (CBT) for mild to moderate SUD. Case workers recorded their sessions with youth and uploaded their recordings (n = 5) to an automated fidelity monitoring program (Lyssn), which coded sessions for adherence to MI and CBT principles. To understand the extent to which these case workers were able to match the care provided by community-based clinicians, an analogous sample (n=36 sessions) of five master’s level therapists trained in MI+CBT was obtained.
Lyssn provides ratings of MI fidelity, including empathy (range 1-5), collaboration (range 1-5), overall, MI proficiency (range 1-12), % usage of open-ended questions, % therapist talk time, and a ratio of reflections to questions. CBT fidelity ratings were rated on a scale of 0-6 and included skills in agenda setting, homework, guided discovery, focusing on key cognitions and behaviors, determining a strategy for change, and developing an understanding of the client.
Results: Correlations revealed interventionist background (i.e., JJS caseworkers or community therapist) was unrelated to almost all fidelity ratings (rs = -.14 - .27, p > .05), suggesting that community and JJS based providers were equally adherent to principles of MI and CBT. Interventionist background was associated with % of open-ended questions (r = .36, p = .02), such that JJS providers asked more open-ended questions compared to community therapists (47.8% vs. 44.9%).
Conclusions: Findings from this small pilot project provide preliminary evidence for integrating SUD treatment into the JJS. Harnessing opportunities to engage youth in the JJS setting may eliminate barriers encountered in the transfer of care to community settings. Limitations and future directions for this work will be discussed.