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Youth in sub-Saharan Africa are at high risk of substance use yet lack access to appropriate interventions. The goal of this project was to evaluate the feasibility of a definitive trial to explore efficacy of a peer-delivered single-session brief intervention (SSBI) for youth with substance use in Kenya. Seventy youth aged 15-24 years with moderate risk substance use were randomized to SSBI or to psychoeducation. Data was collected at baseline and month three. Primary outcomes: Feasibility criteria, e.g., study participation rate, proportion of participants willing to be randomized, and study completion rate. Strategies for recruitment in a future trial were collected using focus group discussions with the youth at month three. Secondary outcomes: (i) Change in substance use (Alcohol, Smoking & Substance Use Involvement Screening Test for Youth [ASSIST-Y] questionnaire), depression (Patient Health Questionnaire [PHQ-9]), anxiety (Generalized Anxiety Disorder [GAD-7 scale]), and quality of life (World Health Organization-Quality of Life Brief Version [WHO-QOL BREF]) scores between baseline and month 3; (ii) Fidelity to the intervention assessed using fidelity checklists. This pilot met most of the predefined minimum requirements for feasibility. For instance, 96.9% of those meeting eligibility criteria consented to participate (benchmark was 80%), and 100% of those who consented were willing to be randomized to either study arm. Youth reported that young people who use substances can be most effectively recruited from community settings. The SSBI showed a small effect on reducing total ASSIST-Y (Standardized Mean Difference [SMD] -0.33 95% Confidence Interval [CI] -0.83,0.16) scores in the intervention group compared to the control. There was a moderate improvement in the quality of life for the intervention group compared to the control (SMD -0.41 CI -0.91,0.09). The intervention had no effect on depression (SMD 0.23 CI -0.27,0.72) and anxiety symptoms (SMD 0.70 CI 0.19,1.2) at month 3. It is feasible to conduct a randomized controlled trial of a peer-delivered SSBI for youth with moderate risk substance use in Kenya. ClinicalTrials.gov NCT05545904 Registration date: 16/09/2022, https://clinicaltrials.gov/study/NCT05545904.

Introduction Rates of substance use are high among youth involved in the legal system (YILS); however, YILS are less likely to initiate and complete substance use treatment compared to their non legally-involved peers. There are multiple steps involved in connecting youth to needed services, from screening and referral within the juvenile legal system to treatment initiation and completion within the behavioral health system. Understanding potential gaps in the care continuum requires data and decision-making from these two systems. The current study reports on the development of data dashboards that integrate these systems’ data to help guide decisions to improve substance use screening and treatment for YILS, focusing on end-user feedback regarding dashboard utility. Methods Three focus groups were conducted with n  = 21 end-users from juvenile legal systems and community mental health centers in front-line positions and in decision-making roles across 8 counties to gather feedback on an early version of the data dashboards; dashboards were then modified based on feedback. Results Qualitative analysis revealed topics related to (1) important aesthetic features of the dashboard, (2) user features such as filtering options and benchmarking to compare local data with other counties, and (3) the centrality of consistent terminology for data dashboard elements. Results also revealed the use of dashboards to facilitate collaboration between legal and behavioral health systems. Conclusions Feedback from end-users highlight important design elements and dashboard utility as well as the challenges of working with cross-system and cross-jurisdiction data. Highlights End-user feedback on data dashboards improved its usability and acceptability. Cross-system data harmonization was a primary challenge to dashboard development. Dashboards with multi-system data facilitated cross-system collaboration and decision-making.

Background This study explored the rewards and difficulties of raising an adolescent and investigated parents’ level of interest in receiving guidance from healthcare providers on parenting and adolescent health topics. Additionally, this study investigated whether parents were interested in parenting programs in primary care and explored methods in which parents want to receive guidance. Methods Parents of adolescents (ages 12–18) who attended an outpatient pediatric clinic with their adolescent were contacted by telephone and completed a short telephone survey. Parents were asked open-ended questions regarding the rewards and difficulties of parenting and rated how important it was to receive guidance from a healthcare provider on certain parenting and health topics. Additionally, parents reported their level of interest in a parenting program in primary care and rated how they would like to receive guidance. Results Our final sample included 104 parents, 87% of whom were interested in a parenting program within primary care. A variety of parenting rewards and difficulties were associated with raising an adolescent. From the list of parenting topics, communication was rated very important to receive guidance on (65%), followed by conflict management (50%). Of health topics, parents were primarily interested in receiving guidance on sex (77%), mental health (75%), and alcohol and drugs (74%). Parents in the study wanted to receive guidance from a pediatrician or through written literature. Conclusions The current study finds that parents identify several rewarding and difficult aspects associated with raising an adolescent and are open to receiving guidance on a range of parenting topics in a variety of formats through primary care settings. Incorporating such education into healthcare visits could improve parents’ knowledge. Healthcare providers are encouraged to consider how best to provide parenting support during this important developmental time period.

Background Substance use disorders are prevalent among youth in sub-Saharan Africa (SSA), yet treatment resources are scarce. Peer provider delivered brief interventions (BIs) represent an affordable and potentially scalable strategy for addressing youth substance use disorders. The goal of this study is to assess the acceptability of a peer provider delivered substance use BI from the perspective of youth in Kenya. Methods We conducted qualitative semi-structured interviews with youth participants ( n  = 25) to explore acceptability of a substance use BI. Youth were participants in a two-arm mixed-methods pilot randomized controlled trial (RCT) investigating the feasibility of a peer provider delivered single-session substance use BI for youth aged 15–24 years with moderate-risk substance use. The semi-structured interviews were conducted three months after the BI was delivered and were guided by the Theoretical Framework of Acceptability (TFA). Qualitative data were analyzed through thematic analysis. Results We interviewed 25 of 38 participants in the BI arm, 18 males and 7 females; 15 were ages 18–24 years, and 10 ages 15–17 years. Affective attitude : Most youth reported that they enjoyed the session content and enjoyed interacting with the peer provider. Burden : Most youth felt that it was easy to understand the session and participate in it. Perceived effectiveness : Most of the youth perceived the intervention to be effective in helping them reduce substance use and improve their well-being. Ethicality : All youth perceived that the counselling session fit in with their goals and values. Intervention coherence : Most youth understood the overall goal of the intervention. They reported that the goal of the intervention was to help youth stop substance use, and to bring about behavior change. Opportunity costs : Some youth reported that they had to forgo other activities to attend the session, such as work, school, sports, gaming, visiting family, or house chores. Self-efficacy : Most youth felt confident about being able to cut down or stop using substances following the intervention. Conclusion and recommendations Our findings indicate that the peer provider delivered single-session substance use BI was acceptable to youth. The youth recommended that follow-up sessions be provided to ensure sustained behavior change. This study supports the utility of the TFA in exploring acceptability of a substance use intervention from the perspective of young people. Trial registration NCT05545904 Registration date 16/09/2022 Registry ClinicalTrials.gov https//clinicaltrials.gov/study/NCT05545904.

Background Nearly 9 out of 10 youth who die by suicide visit health care settings in the year prior to their death. Given the opportunity of primary care to screen for youth suicide risk, past research has focused on understanding provider attitudes toward screening and barriers to screening implementation. However, research has not robustly examined how providers utilize information gathered from screening tools. Therefore, the aim of this qualitative study was to outline existing suicide protocols and characterize attitudes and practices toward youth suicide risk screening and subsequent triage. Methods Youth-serving primary care providers and clinic staff working at clinics in one Midwest health network participating in a randomized control trial implementing integrated behavioral health care were contacted via email by a research assistant. Nineteen individuals participated in 30-minute, semi-structured interviews regarding attitudes and practices toward youth suicide risk screening in primary care. Interviews were transcribed and analyzed using consensus deductive and inductive coding. Results Existing clinic workflow largely pertained to screening administration. Participants discussed the intention to universally screen pediatric patients using the Patient Health Questionnaire (PHQ)-2 for sick visits, which served as gate questions for the PHQ-9. For well child visits, clinics implemented universal PHQ-9 screeners. Participants were largely not aware of standardized processes, including brief suicide risk assessment, use of consultation services, or risk triage decision-making. Interviews described themes of attitudes toward youth suicide screening, primary care protocols, risk triage decision-making, and barriers and facilitators to youth suicide risk screening. Overall, providers and clinic staff expressed overwhelming confidence in administering screens, which was considered within their scope of practice. Confidence, however, wavered when providers discussed their ability and/or comfort determining follow-up steps, providing brief interventions, and connecting youth to behavioral health services. Conclusions Results emphasize that without adequate behavioral health assessment and intervention post-screening, primary care providers face significant burden managing suicide risk, which was often felt outside their scope of practice. Developing and adapting intervention models within primary care (e.g., integrated care models) are crucial next steps.

BackgroundIndividuals with mental illness and co-occurring substance use disorders often rapidly cycle through the justice system with multiple arrests. Therefore, is it imperative to examine the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention.MethodsWe linked police arrest and clinical care data at the individual level to conduct a retrospective cohort study of all individuals arrested in 2016 in Indianapolis, Indiana. We classified arrestees into three levels: 1 arrest, 2 arrests, or 3 or more arrests. We included data on clinical diagnoses between January 1, 2014 and December 31, 2015 and classified mental health diagnoses and substance use disorder (SUD) based on DSM categories using ICD9/10 diagnoses codes.ResultsOf those arrested in 2016, 18,236 (79.5%) were arrested once, 3167 (13.8%) were arrested twice, and 1536 (6.7%) were arrested three or more times. In the 2 years before the arrest, nearly one-third (31.3%) of arrestees had a mental health diagnosis, and over a quarter (27.7%) of arrestees had an SUD diagnosis. Most of those with a mental health or SUD diagnosis had both (22.5% of all arrestees). Arrestees with multiple mental health (OR 2.68, 95% CI 2.23, 3.23), SUD diagnoses (OR 1.59, 95% CI 1.38, 1,82), or co-occurring conditions (1.72, 95% CI 1.48, 2.01) in the preceding 2 years had higher odds of repeat arrest.ConclusionsOur findings show that linked clinical and criminal justice data systems identify individuals at risk of repeat arrest and inform opportunities for interventions aimed at low-level offenders with behavioral health needs.

BackgroundFor youth involved in the juvenile justice (JJ) system, caregiver involvement and engagement in the system is crucial for youth development and outcomes of JJ cases; however, there are challenges to establishing positive/productive partnerships between caregivers and JJ representatives. The current project examines perspectives of caregivers and JJ personnel regarding facilitators and barriers to establishing JJ-caregiver partnerships, as well as their perceptions of the use of a caregiver navigator program to support caregivers of system-involved youth. Results are used to inform development of a caregiver navigator program to support caregivers and help them navigate the JJ system.ResultsSemi-structured interviews were conducted with caregivers of youth involved in JJ (n = 15, 53% White, 93% female), JJ personnel (n = 7, 100% White, 50% female), and JJ family advisory board members (n = 5, 100% Black, 100% female). Caregivers reported varying experiences across intake/arrest, court, and probation processes. Positive experiences were characterized by effective communication and feeling supported by JJ. Negative experiences related to feeling blamed and punished for their child’s system involvement and feeling unsupported. JJ interviews corroborated caregiver sentiments and also illustrated facilitators and barriers to JJ-caregiver partnerships. Both JJ personnel and caregivers endorsed potential benefits of a peer-based caregiver navigator program to provide social, informational, and emotional support.ConclusionContinued work is needed to improve JJ-caregiver partnerships and use of a peer-based navigator program has the potential to address barriers to caregiver engagement in the JJ system.

Background Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents’ perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. Methods Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. Results A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. Conclusions Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group. Trial registration NCT03363750 ; December 6th, 2017.

Youth involved in the juvenile justice system are more likely to have a substance use disorder and/or suicidality (e.g., suicidal thoughts and behavior) compared to other youth. Although parental support and monitoring may play an important role in youth substance use and suicidality outcomes, the potential mechanisms have not been elucidated. Our purpose was to evaluate the extent to which parental support and monitoring were associated with latent, continuous construct scores of suicidality and substance use and to determine whether youths’ hopelessness may indirectly affect these relationships among a sample of youth referred to the juvenile justice system. The sample included juvenile justice‐referred youth aged 14–17 (N = 77; 69% White, 58% male, 74% non‐Hispanic). The primary predictors of interest were parental support and monitoring, measured by the Parent Support Scale and Parental Monitoring Scale. The primary potential mediator of interest was hopelessness. Linear regression was used to model continuous suicidality and substance use severity scores, measured via a computer adaptive test, on parental support and monitoring. We tested hopelessness as a potential mediator. All analyses controlled for age, sex assigned at birth, race, ethnicity, and family income. After adjustment, parental support was associated with decreased suicidality severity (β = −0.30, p = 0.002). Parent support and monitoring were associated with youth‐reported hopelessness. The indirect mediation effects of hopelessness in the relationship between parental support (β = −0.18 [SE, 1.73]), as well as parental monitoring (β = −0.17 [SE, 0.20]), and suicidality severity were statistically significant. Parental support and youth hopelessness may be important intervention targets for improving and addressing disparities in substance use and suicidality among juvenile justice‐referred youth. Hope‐based interventions may be effectively integrated into existing juvenile justice programs, and their potential to improve both mental health and behavioral outcomes among justice‐involved youth should be examined.

BackgroundJustice-involved youth have higher rates of substance use disorders (SUDs) than the general population. Many do not connect with or complete treatment, leading to recidivism. This qualitative study explores perceptions and barriers to treatment in this population.ResultsJustice-involved youth participating in a larger study focused on access to SUD treatment were interviewed about available treatment and justice system involvement. Twenty-one dyads (youth and a guardian) and 3 individual guardians (total N = 45) were interviewed by phone. Inclusion criteria were youth aged 14–17 involved in the justice system that screened positive for SUD. Youth sample was 43% male. Thematic analysis guided the process. The study was Indiana University Institutional Review Board approved (#1802346939).Data was interpreted within the ecological system theory. Youth barriers included willingness to engage in treatment, time constraints/scheduling conflicts, and low perceived usefulness of treatment. Major guardian themes included high cost of treatment, lack of communication by the justice system about treatment, youth unwillingness or disinterest to engage in treatment, and limited program availability.ConclusionsThe barriers to treatment for justice-involved youth are multifaceted and occur across the spectrum of levels of the ecological system, which include parents, peers, social systems, and cultural elements. Many youth and guardians suggested improvements for their interactions with the juvenile justice system. Further examination is needed of current policy implementation to address these concerns.