Jeff Randall

Juvenile Drug Court: Enhancing Outcomes by Integrating Evidence-Based Treatments.

Evaluated the effectiveness of juvenile drug court for 161 juvenile offenders meeting diagnostic criteria for substance abuse or dependence and determined whether the integration of evidence-based practices enhanced the outcomes of juvenile drug court. Over a 1-year period, a four-condition randomized design evaluated outcomes for family court with usual community services, drug court with usual community services, drug court with multisystemic therapy, and drug court with multisystemic therapy enhanced with contingency management for adolescent substance use, criminal behavior, symptomatology, and days in out-of-home placement. In general, findings supported the view that drug court was more effective than family court services in decreasing rates of adolescent substance use and criminal behavior. Possibly due to the greatly increased surveillance of youths in drug court, however, these relative reductions in antisocial behavior did not translate to corresponding decreases in rearrest or incarceration. In addition, findings supported the view that the use of evidence-based treatments within the drug court context improved youth substance-related outcomes. Clinical and policy implications of these findings are discussed.

Psychiatric comorbidity and the 16-month trajectory of substance-abusing and substance-dependent juvenile offenders.

OBJECTIVES To examine the concurrent correlates of internalizing and externalizing disorders among substance-abusing and substance-dependent juvenile offenders and to determine the association between psychiatric comorbidity and psychosocial functioning of the youths 16 months later. METHOD Participants were 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. A multisource measurement battery was used to assess drug use, criminal activity, family relations, peer relations, school functioning, and out-of-home placements. RESULTS Comorbidity for externalizing disorders was associated with high rates of antisocial behavior and predicted worse 16-month outcomes than substance abuse alone or substance abuse with comorbid internalizing disorders. For criminal activity and drug use, the presence of internalizing disorders buffered the deleterious effect of externalizing disorders on substance-abusing and substance-dependent juvenile offenders. CONCLUSIONS Even in substance-abusing delinquents, a population already extreme in antisocial behavior, the presence of externalizing disorders indicates high risk for deterioration.

Statewide Adoption and Initial Implementation of Contingency Management for Substance Abusing Adolescents

Four hundred thirty-two public sector therapists attended a workshop in contingency management (CM) and were interviewed monthly for the following 6 months to assess their adoption and initial implementation of CM to treat substance-abusing adolescent clients. Results showed that 58% (n = 131) of the practitioners with at least one substance-abusing adolescent client (n = 225) adopted CM. Rates of adoption varied with therapist service sector (mental health vs. substance abuse), educational background, professional experience, and attitudes toward treatment manuals and evidence-based practices. Competing clinical priorities and client resistance were most often reported as barriers to adopting CM, whereas unfavorable attitudes toward and difficulty in implementing CM were rarely cited as barriers. The fidelity of initial CM implementation among adopters was predicted by organizational characteristics as well as by several demographic, professional experience, attitudinal, and service sector characteristics. Overall, the findings support the amenability of public sector practitioners to adopt evidence-based practices and suggest that the predictors of adoption and initial implementation are complex and multifaceted.

Changing the Social Ecologies of Adolescent Sexual Offenders: Implications of the Success of Multisystemic Therapy in Treating Serious Antisocial Behavior in Adolescents

Current treatment models for adolescent sexual offenders are individually oriented and have limited empirical support. These models may not be effective in reducing recidivism because they do not address the multiple factors (i.e., individual, family, peer, school) related to sexual offending. Multisystemic therapy (MST), an ecologically based treatment model that addresses multiple determinants of behavior, has proven effective with chronic, violent nonsexual offenders in several randomized trials. Preliminary research also indicates promise for MST with sexual offenders. This article: (a) presents empirical support for use of an ecological approach with adolescent sexual offenders based on a multidetermined etiology, (b) provides a theoretical and clinical description of MST, and (c) describes a recent adaptation of MST that maintains the ecological emphasis of MST and integrates important conceptualizations from the literature on adolescent sexual offending.

Neighborhood Solutions for Neighborhood Problems: An Empirically Based Violence Prevention Collaboration

Youth antisocial behavior is influenced, in part, by neighborhood context. Yet, rather than attempting to ameliorate factors contributing to youth antisocial behavior, service dollars are primarily devoted to expensive and often ineffective out-of-home placements. This article describes the development and implementation of a collaborative partnership designed to empower an economically disadvantaged neighborhood to address violent criminal behavior, substance abuse, and other serious antisocial problems of its youth while maintaining youth in the neighborhood. Through a collaboration between a university research center and neighborhood stakeholders, services are being provided to address the key priorities identified by neighborhood residents, and extensive efforts are being made to develop family and neighborhood contexts that are conducive to prosocial youth behavior.

Adapting multisystemic therapy to treat adolescent substance abuse more effectively

The article illustrates an adaptation of multisystemic therapy (MST) coupled with community reinforcement plus vouchers approach (CRA) to treat adolescent substance abuse and dependency. Key features of CRA enable the MST therapist and adolescent caregiver to more specifically detect and address adolescent substance use. These features include frequent random urine screens to detect drug use, functional analyses to identify triggers for drug use, self-management plans to address identified triggers, and development of drug avoidance skills. To highlight the integration of MST and CRA in treating substance abusing or dependent adolescents, a case example is provided. Prior to the case example, an overview of clinical and program features of MST and substance-related outcomes is presented.

The Outcomes and Costs of an Interagency Partnership to Serve Maltreated Children in State Custody

The primary objective of the Charleston Collaborative Project (CCP) was to develop and implement a clinical and cost-effective interagency collaboration that provided a single point of entry and a seamless system for providing services. The CCP successfully developed such a system with collaboration among 1 private and 3 state agencies that serve maltreated children taken into custody. Although implementation of the collaborative was not optimal, the available evidence does not support the view that the CCP was more effective than Current Services at improving child and caregiver functioning, increasing family reunification, or decreasing use of out-of-home care. When a comprehensive range of costs is considered, evidence suggests that the CCP produced modest cost savings. The lack of favorable clinical findings is consistent with treatment effectiveness literature pertaining to community-based mental health services. Policy implications are outlined.

Predicting nonresponse to juvenile drug court interventions.

Using data from a recent randomized clinical trial involving juvenile drug court (JDC), youth marijuana use trajectories and the predictors of treatment nonresponse were examined. Participants were 118 juvenile offenders meeting diagnostic criteria for substance use disorders assigned to JDC and their families. Urine drug screen results were gathered from weekly court visits for 6 months, and youth reported their marijuana use over 12 months. Semiparametric mixture modeling jointly estimated and classified trajectories of both marijuana use indices. Youth were classified into responder versus nonresponder trajectory groups based on both outcomes. Regression analyses examined pretreatment individual, family, and extrafamilial predictors of nonresponse. Results indicated that youth whose caregivers reported illegal drug use pretreatment were almost 10 times as likely to be classified into the nonresponder trajectory group. No other variable significantly distinguished drug use trajectory groups. Findings have implications for the design of interventions to improve JDC outcomes.

Beyond Treatment Effects: Predicting Emerging Adult Alcohol and Marijuana Use Among Substance-Abusing Delinquents

Secondary analyses of a randomized clinical trial examined the effects of 4 putative risk factors and 2 protective factors in predicting drug use among 80 emerging adults treated 5 years earlier for delinquency and alcohol and/or marijuana use disorders. Frequency of marijuana use and the number of comorbid psychiatric disorders in adolescence predicted cannabis use in emerging adulthood. Increasing academic competence at high levels of social competence predicted less marijuana use. At emerging adulthood, greater use of alcohol and marijuana were associated with both criminality and psychopathology.

Multisystemic Therapy for Externalizing Youth

Externalizing problems are multidetermined and related to individual, family, peer, school, and community risk factors. Multisystemic therapy (MST) was originally developed to address these risk factors among youth with serious conduct problems who are at-risk for out-of-home placement. Several decades of research have established MST as an evidence-based intervention for adolescents with serious clinical problems, including serious offending, delinquency, substance abuse, and parental physical abuse and neglect. This article presents an overview of the clinical procedures and evidence base of MST for externalizing problems as well as 2 adaptations: MST for Substance Abuse and MST for Child Abuse and Neglect.