Technology Access and Perceptions of Telehealth Services Among Young Adults Involved in the Court System.

PURPOSE: This study examined access to technology and telehealth among young adults (ages 18-24) who were court-involved and were recruited from an alternative sentencing program in New York City. METHODS: Using sequential mixed methods design, we examined demographic factors linked with access to technology and perceived usefulness of the Internet among n = 321 young adults who were court-involved (75% male, 65% African American, 35% Latinx). We then conducted in-depth interviews with 27 young adults to elicit first-person account of their access to, interest in, and experience with technology and telehealth. RESULTS: Although most participants had access to a phone with a data plan, a substantial proportion reported inconsistent access to the technology critical to telehealth. Certain young adults were more likely to lack consistent access to the technology needed for telehealth, including Black young adults, males, those with less than a high school diploma, those with a history of homelessness, and those who had difficulties paying for basic necessities. Qualitative interviews revealed that most had a strong self-efficacy using technology, while distrust of technology, inexperience with and skepticism of telehealth, low perceived need for care, and medical mistrust were common significant barriers in this underserved population. DISCUSSION: Findings underscored the critical need to address medical mistrust and increase access to and utilization of care among young adults who are court-involved. Results can inform the development and implementation of interventions designed to improve accessibility and acceptability of telehealth.

E-Connect: Linking probation youth at risk for suicide to behavioral health services.

OBJECTIVE: Youth involved in the justice system (YIJ) have higher rates of suicidal thoughts and behaviors (STB) and associated behavioral health (BH) problems, yet lower levels of service use compared to youth in the general population. This study examined the efficacy of e-Connect, a digital clinical decision support system (CDSS), at improving STB risk identification, referral, and linkage to BH services by probation officers. As the intervention spanned pre- and post-COVID-19 shutdown periods, we also examined the disruption in public agencies' service provision on study outcomes. METHOD: Administrative record data (1,488 youth, ages 10-18 years, 56% male, 56% White) allowed examination of differences between care-as-usual (baseline) and e-Connect in screening, identification of STB and BH problems, referral, and treatment initiation. RESULTS: Compared to care-as-usual, probation officers using e-Connect were over five times as likely to identify YIJ with STB (adjusted odds ratio [aOR] = 5.86; 95% confidence interval, CI [3.24, 11.7]) and over 11 times more likely to refer YIJ in need of BH services to treatment (aOR = 11.04; 95% CI [6.54, 19.43]). In turn, youth referred to treatment via e-Connect were nearly 17 times more likely to initiate (aOR = 16.92; 95% CI [9.17, 32.60]). Results remained unchanged during the pre- and post-COVID-19 shutdown periods. CONCLUSION: e-Connect is one of the first digital STB screening, referral, and linkage-to-service systems that use CDSS technology to successfully assist probation officers in linking youth on their caseload to treatment. Such an approach may support identification of STB and cross-systems linkage in other youth-serving organizations, such as schools, that increasingly manage youth BH problems with minimal clinical support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis.

BACKGROUND: Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. METHODS: Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants' ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians' responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). RESULTS: We identified two classes of clinicians: "Higher MFS" and "Lower MFS," and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. CONCLUSION: This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.

Patterns and contexts of polysubstance use among young and older adults who are involved in the criminal legal system and use opioids: A mixed methods study.

INTRODUCTION: Opioid prevention and treatment programs tailored to young adults involved in the criminal legal system are rare. We examined profiles of polysubstance use among younger and older adults involved in the criminal legal system who use opioids, and explored their experiences and motivations related to substance use. Information gleaned can inform the adaptation of existing programs and the development of novel approaches for young adults in the criminal legal system. METHODS: Using a sequential mixed methods design we 1) quantitatively identified typologies of polysubstance users among adults aged 18-24 (n = 92) and those age 25 and over (n = 27) involved in the criminal legal system who use opioids, using latent class analysis and 2) qualitatively explored differences in personal motivations, cultural influences, and psychosocial contexts of substance use by class. RESULTS: Our quantitative results supported a three-class typology: the majority of participants were in Class I (73 %, n = 87) and reported using primarily alcohol and marijuana. Participants in Classes II (15 %, n = 18) and III (12 %, n = 14) endorsed distinct and complicated polysubstance use profiles. Further, participants in Classes I and III were significantly younger than those in Class II. Qualitative analysis allowed us to understand associations between patterns of use, motivations, and contexts among young and older adults, comparing across classes. CONCLUSIONS: Our results highlight the importance of attending to the needs of subpopulations based on age and use patterns to adapt and develop targeted treatment and prevention programs for high-risk adults involved in the criminal legal system.

Implementation strategies to promote measurement-based care in schools: evidence from mental health experts across the USA.

BACKGROUND: Despite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers' use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. METHODS: A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on "go-zone" graphs and compared across providers and researchers to identify top-rated strategies. RESULTS: The initial 33 strategies were rated as "relevant" or "relevant with changes" to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; on a scale of 1 to 5, importance ratings (3.61-4.48) were higher than feasibility ratings (2.55-4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: (1) assess for readiness and identify barriers and facilitators; (2) identify and prepare champions; (3) develop a usable implementation plan; (4) offer a provider-informed menu of free, brief measures; (5) develop and provide access to training materials; and (6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, providers reported higher feasibility of train-the trainer approaches than researchers, and researchers reported higher importance of monitoring fidelity than providers. CONCLUSIONS: The education sector is the most common setting for child and adolescent mental health service delivery in the USA. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents, and their families. This empirically derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.

Perceiving fairness in an unfair world: System justification and the mental health of girls in detention facilities.

Psychologists in the helping professions have long accepted the idea that cognitions have implications for mental health and wellbeing. Community psychologists have further established the importance of context and systems in the etiology of mental health problems. In this paper, we argue that as a discipline that prioritizes social justice, community psychology should consider associations between cognitions about structural and systemic inequality and individual mental health, particularly in marginalized populations. As one illustration of this argument and its complexities, we asked if and to what degree mental health was concurrently associated with adolescents' beliefs in societal fairness (i.e., system-justifying beliefs), attending to gender differences. Our findings were informed by a sample of 196 adolescents residing in detention facilities (49.50% girls; 51.75% Black/Caribbean, 21.68% multiracial; 15.38% Hispanic/Latine; 27.98% LGBTQ+). These youth represent an understudied group in the research literature addressing fairness beliefs and their influence on wellness. Results suggested that boys were more likely to endorse societal fairness compared to girls, but these beliefs were unrelated to their mental health. However, we found a significant gender moderation such that girls who perceived society to be fair reported lower levels of internalizing and externalizing mental health problems. We discuss implications for theory, research, and intervention.

A role for social media? A community-based response to guns, gangs, and violence online.

Social media represents a relatively novel environment for prevention efforts targeting youth gun and gang violence, and associated trauma. The aim of this study is, therefore, to present findings from a novel intervention designed to complement existing, community-based violence prevention efforts. In doing so, we focus on the role of adult empathy in the relationships between youth and the adult credible messengers (CMs) who deliver the program. Guided by the purpose of complementarity, our mixed methods data analyses combine insights gained from CM's quantitative reports of 145 instances of risky online behavior with qualitative analyses of three focus groups addressing their experiences. Results underscore the complexities of social media as a context with the potential to simultaneously contribute to, and serve to prevent, trauma. Results also indicate that empathic concern and perspective taking were important in informing the type of intervention tactics employed by CMs. Relatedly, CM's perspective taking mattered not only in their responses to risky and/or trauma-related content, but also in their identification of some relevant social media posts.

Factor structure of the critical consciousness scale in juvenile legal system-involved boys and girls.

The Critical Consciousness Scale (CCS) is a recently developed and validated measure for use with low-income, diverse adolescents. However, research on the psychometric properties of this scale with juvenile legal system-involved youth is lacking. This study examines the psychometric properties of the critical reflection subscales of the CCS in a cross-sectional sample of 206 youth (48% girls) involved in the juvenile legal system to investigate (a) the factor structure of the critical reflection subscales of the CCS compared to existing adolescent samples, and (b) the extent to which critical reflection demonstrates measurement equivalence between boys and girls. Findings indicate (a) congruence with the previous literature on critical reflection but for system-involved girls, and (b) a difference in the structural relationships between perceived inequality and egalitarianism by gender. This study contributes to the nascent, psychometric literature on measures of critical consciousness in an underrepresented and unique adolescent population.

Examining the functions of women's violence: Accommodation, resistance, and enforcement of gender inequality.

The present study contributes to the literature on the consequences of social inequality through a qualitative examination of the social functions and meanings of violence in the lives of 20 marginalized women. All of the women in the sample were at some point court involved and were victims, as well as perpetrators, of violence. Findings indicate a need to expand the extant theory to address enforcement (i.e., strengthening) of status level, social inequities (e.g., gendered power disparities), adding to the accommodation/resistance paradigm. Consistent with scholarship conceptualizing violence as contextual and gender as a socio-structural variable, results support the need to better understand the ways in which contexts of gendered inequality - and inequality in general - may promote processes through which survivors of violence accommodate, resist, and enforce oppression. Implications for research and practice related to social inequality are discussed.

Radicalizing advocacy in service settings: Using structural competency to address tensions between social action and psychological practice.

Although recent years have seen an increase in attention paid to social justice concerns by psychologists, challenges remain in fulfilling the promise of psychology as a discipline that can meaningfully undertake social action. These challenges arise largely due to some persistent contradictions between the typical goals of psychological practice and the tenets of social change. These contradictions include (a) the emphasis of psychological practice on individual and small group change versus the need for social justice endeavors to tackle widespread inequality and oppression; (b) the greater likelihood of psychologists to advocate for clients by helping them to navigate existing systems versus advocating by challenging and dismantling these systems; and (c) aligning ourselves as practitioners, educators, and scientists within oppressive structures versus acknowledging the ways that we uphold, perpetuate, and benefit from such structures. In this article, we argue that the structural competency paradigm can provide a guiding framework for training and practice in psychology that aims to reconcile these tensions. We use the illustrative case of a low-income, minority client struggling with mental health problems, disabilities, and housing instability to demonstrate the complexities of the challenges confronting social justice-minded practitioners and to explore how a structurally competent stance can inform efforts to achieve social change while retaining psychology's investment in positive person-level transformation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Leveraging youths' digital literacies: The E-Responder social media violence interruption model and pilot evaluation.

Increasingly, altercations and arrests have been traced to youths' actions on social media. The present paper describes E-Responder, an intervention developed through a university-community partnership to address three key goals for youth at risk of legal system involvement and firearms-related violence: (1) preventing the escalation of online provocation to in-person violence; (2) supporting youth in enhancing social media self-efficacy; and (3) supporting Violence Prevention Professionals (VPPs), already working with youth, in using social media as a tool to interrupt potential violence and leverage youth's digital citizenship. This paper describes the E-Responder mixed-methods pilot; findings suggest that E-Responder sites identified over 100 instances of risky online behavior (22% high risk) and effectively addressed 97% of these instances. Youth participants reported significantly greater social media self-efficacy over time and compared to matched-comparison youth. Focus group (n = 12) results corroborate these patterns. Implications for future intervention, research, and policy are discussed.

Theorizing Safety Informed Settings: Supporting Staff at Youth Residential Facilities.

Each year approximately 48,000 youth are incarcerated in residential placement facilities (YRFs) in the United States. The limited existing literature addressing the workforce in these settings paints a complicated picture. The YRF workforce is highly motivated to work with legal system involved youth. However, YRF staff report high rates of burnout, job fatigue, and work-related stress. The current paper proposes solutions to persistent problems faced by staff in these settings by integrating literature from criminology, organizational psychology, trauma-informed care, and community psychology. In doing so, we highlight previously overlooked aspects of intervention for trauma-organized settings and respond to recent calls for community psychologists to take a more active role in the adaptation of trauma-informed care in community settings. We conclude by advancing three recommendations, drawn from setting-level theory and inspired by the principles of trauma-informed care, to transform YRFs.

Negotiating Ethical Paradoxes in Conducting a Randomized Controlled Trial: Aligning Intervention Science with Participatory Values.

In this article, we describe ethical tensions we have faced in the context of our work as intervention scientists, where we aim to promote social justice and change systems that impact girls involved in the juvenile legal system. These ethical tensions are, at their core, about resisting collusion with systems of control while simultaneously collaborating with them. Over the course of designing and implementing a randomized controlled trial (RCT) of an ecological advocacy intervention for girls, called ROSES, ethical paradoxes crystalized and prompted us to engage in critical reflection and action toward the aim of moving away from conducting research on legal-system-involved girls and moving toward a more democratic, participatory process of inquiry with girls. Our experience revealed two intertwined paradoxes that ultimately served generative purposes. First, in collaborating with legal system stakeholders, we observed a single story of girls' pathology narrated for girls, without girls, and ultimately internalized by girls. Second, in reflecting critically on the ethical implications of our study design, it became clear that the design was grounded in a medical model of inquiry although the intervention we sought to evaluate was based, in part, on resistance to the medical model. We describe emergent ethical tensions and the solutions we sought, which center on creating counternarratives and counterspaces that leverage, extend, and disrupt our existing RCT. We detail these solutions, focusing on how we restructured our research team to enhance structural competence, shifted the subject of inquiry to include the systems in which youth are embedded, and created new opportunities for former research participants to become co-researchers through formal roles on an advisory board.