The criminal justice system in alcohol use treatment: a nationwide analysis of racial disparities in treatment referral and completion.

BACKGROUND: Alcohol use and the criminal justice (CJ) system have long been integrally connected in the United States and have both disproportionally impacted Communities of Color. Despite this connection, scholarly literature has largely focused on substance use as a whole, and little literature has examined the influence of race on CJ referral to alcohol treatment and treatment outcomes. METHODS: A total of 749,349 cases from the treatment episodes dataset discharge were used in the current study. A series of ANOVA and logistic regression analyses were conducted to examine the impact of race on (i) likelihood of referral to alcohol treatment by the CJ system and (ii) the association between CJ referral and treatment completion. RESULTS: Results revealed significant disparities in both who is referred to alcohol treatment by the CJ system and the association of that referral to treatment completion. Notably, American Indian/Alaska Native people were significantly more likely than people of all other races to be referred by the CJ system. However, American Indian/Alaska Native people showed the smallest association between CJ referral and treatment completion. CONCLUSIONS: Contrary to previous literature, findings showed that referral of and positive association between CJ referral and treatment completion are not equal across people of different races. Taken together, these results highlight continued racial inequities in the role of the CJ system in alcohol treatment and the unique potential for non-CJ-related treatment to best serve people combatting alcohol use disorder.

"Give up your mic": Building capacity and sustainability within community-based participatory research initiatives.

Community-based participatory research (CBPR) partnerships strive to promote community capacity building and sustainability, yet initiatives often suffer when grants or relationships with academic partners end. To address these concerns, researchers hoping to develop truly sustainable CBPR partnerships should consider factors that promote the development of community capacity and, ultimately, independence. In this first-person account, using perspectives gathered from FAVOR, a Connecticut-based family-led advocacy organization and an academic researcher, we examine the practices and experiences of the members of a CBPR partnership focused on using community voice to inform changes in the state's children's behavioral health system of care. These practices ultimately led to FAVOR developing the necessary skills to assume full ownership of the community data-gathering initiative, ensuring that the initiative would be sustained. Through the perspectives of five FAVOR staff and an academic researcher, we describe the factors that contributed to the organization being able to develop the capacity to independently continue their community data-gathering initiative, including description of the training process and staff members' perspectives on training, autonomy, community value, and lessons learned. We use these stories and experiences to provide recommendations for other partnerships striving to promote capacity building and sustainability through community ownership of the research process.

Needs of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis.

Objective: Access to wraparound care coordination within systems of care (SOC) is increasing nationwide for youth with emotional and behavioral disorders and their families. Though wraparound care coordination serves a broad population of youth who experience a variety of complex needs, less is known about the impact of wraparound services based on these specified needs. Using latent class analysis, the current study aimed to first identify classes of youth based on their presenting needs and then examine the impact of class membership on treatment experiences and outcomes at baseline and six-month follow-up. Method: Caregiver-reported data from 1,243 youth enrolled in wraparound care coordination services within a statewide SOC were used. Latent class analysis was used to determine classes of youth needs and regression results examined whether baseline characteristics, child and family team meeting characteristics, mental health outcomes, and perceptions of care differed based on identified classes. Results: Results revealed five distinct classes of youth needs: Behavioral Needs, ADHD-related Behavior Needs, Educational Needs, Mental Health Needs, and Multi-Needs. Overall participants saw improvement in all follow-up outcomes. Significant between-class differences were also found in all outcome categories measured. Conclusion: The current results further solidify the benefits of comprehensive wraparound care within a SOC. Additionally, understanding youth's needs and their impact on treatment services allows for more targeted care for youth and their families.

Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis.

Objective: Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up. Method: Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined. Results: Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up. Conclusion: Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.

Sexual minority disparities in opioid and benzodiazepine misuse among adults with opioid use disorder.

BACKGROUND AND OBJECTIVES: Sexual minority individuals demonstrate disparate rates of substance use. Research suggests that bisexual women are vulnerable to substance use disorders when compared to other sexual minority groups. This study explored differences in prevalence of past-year alcohol use disorder (AUD) with and without concurrent past-year opioid and/or benzodiazepine misuse. METHODS: The present study utilized responses from the National Survey on Drug Use and Health (NSDUH) public dataset between the years 2015-2019 (N = 16,002) to examine the association between sexual orientation and concurrent misuse of opioids and/or benzodiazepines among individuals with past-year AUD, stratified by sex. RESULTS: Bisexual females demonstrated higher rates of concurrent opioid and benzodiazepine use compared to all other groups. Although there was no association between sexual orientation and concurrent substance use patterns among males, female respondents with past-year AUD endorsing past-year misuse of opioids and benzodiazepines, both alone and in combination, were more likely to be bisexual compared to heterosexual. Lesbians were less likely to endorse concurrent misuse of opioids and benzodiazepines compared to bisexual females. DISCUSSION AND CONCLUSIONS: In a national sample, bisexual females demonstrated higher odds of risky concurrent substance use patterns. Identifying sexual minority individuals who exhibit elevated risk of co-occurring alcohol, opioid, and/or benzodiazepine misuse is an important step to targeted prevention efforts and allocation of resources to combat rising overdose deaths. SCIENTIFIC SIGNIFICANCE: For the first time, this study explored risky concurrent alcohol, opioid, and benzodiazepine misuse patterns among individuals of different sexual orientations.

Telehealth resources and utilization interest among women who sell sex: An explanatory sequential mixed methods study.

Objective: Among a sample of women who sell sex (WSS), we examined unmet health needs, resources for telehealth, utilization interest, and attributes associated with interest in using telehealth. Study design: Explanatory sequential mixed methods. Methods: WSS (N = 52) completed a fixed choice survey and focus group (N = 6, 26 individuals) from drop-in centers serving WSS. Chi-square/t-tests and results from the survey data informed the semi-structured focus group interview guide. Thematic analysis of focus group data was conducted to identify themes. Results: Over half (58 %) of participants expressed interest in using telehealth; however, some lack the necessary resources for use. While 60 % of participants own mobile phones and 46 % have access to a computer, only 35 % have a secure, private space for telehealth appointments. Interest in telehealth was higher among participants who self-identified as having high risk for HIV compared to low risk for HIV (79 % versus 46 %, p = 0.024), and among those considering PrEP for HIV prevention versus not considering PrEP (68 % versus 32 %, p = 0.046). Focus group participants preferred face-to-face encounters for complex medical concerns but expressed interest in telehealth for improved access to healthcare providers for routine care and mental health. Conclusion: Incorporating telehealth into community organizations could be one strategy to address health inequities experienced by WSS. Access to resources, including technology and safe spaces may be well-accepted if offered at trusted community organizations. Such accessibility addresses a gap in care for WSS and paves the way for new avenues for HIV prevention, mental health support, and research related to unmet health needs among WSS.

Termination From Substance Use Disorder Treatment in the United States: Residential and Outpatient Settings.

OBJECTIVE: As rates of noncompletion in substance use treatment remain high and consequences of noncompletion can be severe, research regarding individual and environmental factors associated with specific types of discharge is crucial. The current study used data from the Treatment Episodes Dataset-Discharge (TEDS-D) 2015-2017 in the United States to investigate the impact of social determinants of health on discharge from treatment due to termination by the treatment facility in both outpatient/intensive outpatient and residential treatment settings. METHOD: A multinomial logistic regression was conducted examining the likelihood of discharge due to termination compared with discharge because of dropout or incarceration. RESULTS: Results revealed differences in termination based on treatment setting, race, income, criminal justice referral, and mental health diagnoses, among others. Broadly across settings, people of color were significantly more likely to be terminated from treatment than to drop out compared with their White counterparts. Further, with little exception, individuals with less financial security (i.e., those who were unemployed, those with low/no income, those with no insurance) were less likely to drop out and more likely to be discharged due to termination across treatment settings. CONCLUSIONS: The results of the current study further solidify the need for nuanced examination of the reason individuals do not complete substance use treatment and extend the impact of social determinants of health to involuntary termination from substance use treatment.

Police and Transgender and Gender Diverse People in the United States: A Brief Note on Interaction, Harassment, and Violence.

Transgender and gender diverse (TGD) people in the United States continue to face dire rates of police violence and harassment. However, little research has examined this phenomenon using large-scale nationwide data. The current study utilized data from the United States Transgender Survey to examine the prevalence and correlates of police interaction, harassment, and violence among TGD people in the United States. Police harassment and violence types examined included reported incidences of (a) officers using the wrong pronouns, (b) officers asking about an individual's transition, (c) verbal harassment, (d) physical attack, (e) forcing sex to avoid arrest, and (f) unwanted sexual contact from an officer. Results from a weighted sample of 22,456 TGD people revealed that 40.3% reported having interacted with the police in the past year. Among those who interacted with the police in the past year, 45.7% reported experiencing at least one incident of police verbal harassment and 6.1% reported at least one incidence of police physical/sexual violence in the past year. Engaging in sex work was one of the most consistent predictors of police interaction, harassment, and violence. Notably, sex workers were approximately 11 times more likely to report being forced to engage in sex with the police to avoid arrest when compared to non-sex workers. Overall, people of color also reported significantly higher rates of police harassment and violence compared to their White counterparts. Additional correlates included income, educational attainment, and participation in other illegal work. Taken together, the findings of the current study highlight the urgent need for additional examination, intervention, and advocacy to eliminate police harassment and violence against members of the TGD community in the United States.

Police Harassment and Violence against Transgender & Gender Diverse Sex Workers in the United States.

Sex workers continue to experience high rates of abuse and violence around the world. However, information regarding police-perpetrated harassment and violence against transgender and gender diverse (TGD) sex workers in the United States remains extremely limited. The current study is the first known examination of police interaction, harassment, and violence among TGD sex workers in the United States using a large nationwide dataset. Data from 23,372 TGD people were used. Results revealed that sex workers were more likely to experience police interaction, harassment, and violence compared to non-sex workers. Among sex workers with police interaction while doing sex work, 89.2% reported experiencing at least one type of harassment and/or violence. Regression analyses revealed that individuals with no reported income and trans women were more likely to experience multiple types of police harassment/violence. Taken together, TGD sex workers continue to experience alarming rates of interaction, harassment, and violence from police in the United States. Urgent, and effective intervention is needed to eliminate police harassment and violence toward TGD sex workers and provide support for TGD sex workers who survive this violence.

Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders.

OBJECTIVE: Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC. METHODS: This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire. RESULTS: Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care. CONCLUSIONS: Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.

The impact of self-help groups on successful substance use treatment completion for opioid use: An intersectional analysis of race/ethnicity and sex.

INTRODUCTION: Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited. METHODS: Thus, the current study utilized responses from the Treatment Episodes Data Set-Discharges, 2015-2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity. RESULTS: Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one's race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men. CONCLUSIONS: The results of the current study extend the knowledge-base about self-help participation's role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.

Transgender Attitudes and Beliefs Scale (TABS): Validation with a Sample of Self-Identified Christians.

Transgender people suffer from a variety of consequences as victims of anti-transgender prejudice. Christians have been frequently identified as holding negative attitudes toward transgender people; however, there is evidence that these attitudes may be changing. Accurate measurement of attitudes is important in understanding currently held beliefs and to assess potential changes over time. This study tested the validity of the Transgender Attitudes and Beliefs Scale (TABS) for use with the Christian population with a sample of 207 self-identified Christians in the United States. Confirmatory factor analysis (CFA) confirmed the factor structure of TABS: χ2 (374, N = 207) = 821.46, p < 0.001 (normed χ2 = 2.20 < 4); RMSEA = .076 (90%CI = .069; .083), CFI = .926, SRMR = .053. Overall, results suggest that TABS is an appropriate instrument to utilize with the Christian population in the United states.