The Impact of Juvenile Drug Treatment Courts on Substance Use, Mental Health, and Recidivism: Results from a Multisite Experimental Evaluation.

Juvenile Drug Treatment Courts (JDTC) emerged in the mid-1990s as a potential solution to concern about substance use among youth in the juvenile justice system (JJS). Despite substantial research, findings on the JDTC effectiveness for reducing recidivism and substance use remain inconsistent, hampered by methodological problems. In 2016, the Office of Juvenile Justice and Delinquency Prevention published research-based JDTC Guidelines for best practices, and funded technical assistance for implementation and a multisite national outcomes study among JDTCs implementing the Guidelines. Ten sites were originally selected for this study, with a JDTC and Traditional Juvenile Court (TJC) participating. In two sites, moderate- to high-risk youth were randomized to JDTC or TJC, and in eight sites, a regression discontinuity design assigned moderate- to high-risk youth to JDTC, and other youth to TJC. Findings from four sites with sufficient cases and follow-up rates indicated that JDTCs reduced cannabis use, increased access to mental health services, and reduced recidivism. However, the effects were small to moderate, with positive impacts mainly observed among high-risk youth. The impacts of JDTCs may have been attenuated because Guidelines implementation was inconsistent across courts, and some TJCs implemented elements of the Guidelines, blurring the distinction between JDTCs and TJCs.

The impact of Juvenile Drug Treatment Courts (JDTC) implementing Federal Evidence-Based Guidelines on recidivism and substance use: multisite Randomized Controlled Trial (RCT) and Regression Discontinuity (RDD) Designs.

BACKGROUND: Juvenile drug treatment courts (JDTC) have struggled to define themselves since their inception in 1995. Early courts followed a format similar to adult drug courts, but these did not address the unique needs of juveniles, which led to the creation of 16 Strategies by a consensus panel of practitioners and researchers. But, like the first JDTCs, research with courts following these strategies failed to provide convincing evidence that this "model" was associated with significant reductions in recidivism or drug use. More recently, a new set of evidence-based guidelines were developed through meta-analyses commissioned by the Office of Juvenile Justice and Delinquency Prevention (OJJDP, 2016). METHOD: OJJDP provided funding for a rigorous multi-site evaluation of the guidelines. This study protocol paper for the Juvenile Drug Treatment Court (JDTC) Guidelines Cross-Site Evaluation presents research designs for the comparison of youth outcomes from 10 JDTCs compared with 10 Traditional Juvenile Courts (TJCs) in the same jurisdictions. Two sites opted into a randomized controlled trial (RCT) and eight sites chose to follow a regression discontinuity design (RDD). Youth data are captured at baseline, and at 6- and 12-month follow-ups using an interview comprised of several standardized assessments. The youths' official records also are abstracted for recidivism and substance use information. The degree to which the evidence-based guidelines are implemented at each site is assessed via an in-depth court self-assessment collected at baseline and again 2 years later and via structured site visits conducted once during implementation. DISCUSSION: As a field-based trial, using both RCT and RDD designs, findings will provide important, policy-relevant information regarding the implementation of the OJJDP evidence-based guidelines, including the degree to which JDTCs adopted and/or modified these practices, their relative impact on recidivism and substance use, as well as the degree to which JDTCs differ from TJCs. Specific inferences may be drawn about whether following or not following specific guidelines differentially impact youth outcomes, yielding recommendations about the translation of this information from research-to-practice for potentiating the broader adoption of these guidelines by JDTCs nationwide. CLINICAL TRIALS REGISTRATION: This was not an NIH supported trial. The funder, OJJDP/NIJ, instead required publishing the design with even more information at https://www.ojp.gov/ncjrs/virtual-library/abstracts/juvenile-drug-treatment-court-jdtc-guidelines-cross-site-evaluation .

Gender differences in substance use, mental health, and criminal justice involvement of adolescents at treatment entry and at three, six, twelve and thirty month follow-up.

Many adolescents entering substance abuse treatment have coexisting mental health problems and are criminally involved. Examination of the complexities of substance use, mental health, and criminal justice involvement along with changes in these issues following treatment is needed. This study includes 941 males and 266 females enrolled in seven drug treatment programs located in geographically diverse areas of the United States. Comparisons between males and females at treatment entry and three, six, 12 and 30 months later were examined with regard to substance use, mental health, and criminal justice involvement. Results indicate that females showed significantly greater severity in substance use, problems associated with use, and mental health related variables at intake while males had significantly more days on probation/parole. With respect to change over time, the rate of change in mental health and days on probation/parole differed between the sexes. Results indicate that while rate of change is different for males and females on most variables, there was positive change following treatment for both groups with regard to substance use, mental health, and probation/parole status. The high severity levels of females at intake calls for gender-specific outreach and identification along with gender-specific treatments.

Participant characteristics and HIV risk behaviors among individuals entering integrated buprenorphine/naloxone and HIV care.

OBJECTIVE: This study was part of a national, multisite demonstration project evaluating the impact of integrated buprenorphine/naloxone treatment and HIV care. The goals of this study were to describe the baseline demographic, clinical, and substance use characteristics of the participants and to explore HIV transmission risk behaviors in this group. METHODS: Nine sites across the United States participated. Data obtained by interview and chart review included demographic information, medical history, substance use, and risk behaviors.We performed a descriptive analysis of patient characteristics at entry and used logistic regression to evaluate factors associated with 1) unprotected anal or vaginal sex; and 2) needle-sharing within the previous 90 days. RESULTS: Three hundred eighty-six individuals were included in the study: 303 (78.5%) received buprenorphine/naloxone; 41 (10.6%) received methadone; and 42 (10.9%) received another form of treatment. The analysis of risk behaviors was limited to those in the buprenorphine group (n = 303). Among those reporting vaginal or anal sex in the previous 90 days, 24% had sex without a condom. Factors significantly associated with unprotected sex were: having a partner; female gender; and alcohol use in previous 30 days. A total of 8.9% of participants shared needles in the previous 90 days. Factors significantly associated with needle-sharing were: amphetamine use; marijuana use; homelessness; and anxiety. CONCLUSIONS: Addressing transmission risk behaviors is an important secondary HIV prevention strategy. In addition to treatment for opioid dependence, addressing other substance use, social issues, particularly housing, and mental health may have important implications for reducing HIV transmission in HIV-infected opioid-dependent patients.

Supporting Healthy Alternatives through Patient Education: a theoretically driven HIV prevention intervention for persons living with HIV/AIDS.

In the third decade of the HIV/AIDS epidemic, empirically based HIV transmission risk reduction interventions for HIV infected persons are still needed. As part of a Health Resources Services Administration/Special Projects of National Significance initiative to increase prevention services among HIV infected persons, we implemented SHAPE (Supporting Healthy Alternatives through Patient Education). SHAPE is a behavioral HIV prevention intervention delivered to HIV infected persons receiving primary medical care at El Rio Health Center in Tucson, Arizona. The SHAPE intervention is based on Kalichman's "Healthy Relationships for Men and Women Living with HIV-AIDS." The intervention is interactive and uses a video discussion intervention format where educational activities, movie clips, and discussions are used to provide participants with information and skills to increase their comfort in disclosing their HIV status and in reducing HIV transmission. This paper describes the intervention in sufficient detail to replicate it in other settings.

The DNA sequence and analysis of human chromosome 14.

Chromosome 14 is one of five acrocentric chromosomes in the human genome. These chromosomes are characterized by a heterochromatic short arm that contains essentially ribosomal RNA genes, and a euchromatic long arm in which most, if not all, of the protein-coding genes are located. The finished sequence of human chromosome 14 comprises 87,410,661 base pairs, representing 100% of its euchromatic portion, in a single continuous segment covering the entire long arm with no gaps. Two loci of crucial importance for the immune system, as well as more than 60 disease genes, have been localized so far on chromosome 14. We identified 1,050 genes and gene fragments, and 393 pseudogenes. On the basis of comparisons with other vertebrate genomes, we estimate that more than 96% of the chromosome 14 genes have been annotated. From an analysis of the CpG island occurrences, we estimate that 70% of these annotated genes are complete at their 5' end.