Texas Christian University, 2901 University Drive, TCU Box 298921, Fort Worth, TX 76129, Texas, USA.
BMC Public Health. 2021 Nov 20;21(1):2133. doi: 10.1186/s12889-021-12127-3.
Juvenile justice (JJ) youth are at high risk of opioid and other substance use (SU), dysfunctional family/social relationships, and complex trauma. The purpose of the Leveraging Safe Adults (LeSA) Project is to examine the effectiveness of Trust-Based Relational Intervention® (TBRI®; leveraging family systems by providing emotional and instrumental guidance, support, and role modeling) in preventing opioid and other SU among youth after release from secure residential facilities.
An effectiveness-implementation Hybrid Type 1 design is used to test the effectiveness of TBRI for preventing non-medical use of opioids among JJ-youth (delayed-start at the site level; a randomized controlled trial at participant level) and to gain insight into facility-level barriers to TBRI implementation as part of JJ re-entry protocols. Recruitment includes two samples (effectiveness: 360 youth/caregiver dyads; implementation: 203 JJ staff) from nine sites in two states over 3 years. Participant eligibility includes 15 to 18-year-olds disposed to community supervision and receiving care in a secure JJ facility, without active suicide risk, and with one caregiver willing to participate. Effectiveness data come from (1) youth and caregiver self-report on background, SU, psychosocial functioning, and youth-caregiver relationships (Months 0, 3, 6, 12, and 18), youth monthly post-release check-ins, and caregiver report on youth psychological/behavioral symptoms, and (2) JJ facility records (e.g., recidivism, treatment utilization). Fidelity assessment includes post-session checklists and measures of TBRI strategy use. Collected four times over four years, implementation data include (1) JJ staff self-report on facility and staff characteristics, use of trauma-informed care and TBRI strategies, and (2) focus groups (line staff, leadership separately) on use of trauma-informed strategies, uptake of new interventions, and penetration, sustainment, and expansion of TBRI practices.
The LeSA study is testing TBRI as a means to empower caregivers to help prevent opioid use and other SU among JJ-youth. TBRI's multiple components offer an opportunity for caregivers to supplement and extend gains during residential care. If effective and implemented successfully, the LeSA protocol will help expand the application of TBRI with a wider audience and provide guidance for implementing multi-component interventions in complex systems spanning multiple contexts.
ClinicalTrials.gov NCT04678960 ; registered November 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04678960 .
青少年司法（JJ）青少年有很高的阿片类药物和其他物质使用（SU）、功能失调的家庭/社会关系和复杂创伤的风险。Leveraging Safe Adults (LeSA) 项目的目的是研究基于信任的关系干预®（TBRI®；通过提供情感和工具指导、支持和角色扮演，利用家庭系统）在从安全住宿设施释放后预防青少年滥用阿片类药物和其他物质的有效性。
使用有效性-实施混合 1 型设计来测试 TBRI 预防 JJ 青少年非医疗使用阿片类药物的有效性（现场水平延迟启动；参与者水平的随机对照试验），并深入了解设施层面实施 TBRI 的障碍作为 JJ 重新进入协议的一部分。招募包括在两个州的九个地点的 360 名青少年/照顾者对和 203 名 JJ 工作人员，为期 3 年。参与者的资格包括 15 至 18 岁，被安置在社区监督下，在安全的 JJ 设施中接受护理，没有活跃的自杀风险，并且有一名愿意参与的照顾者。有效性数据来自（1）青少年和照顾者自我报告的背景、SU、心理社会功能和青少年-照顾者关系（0 个月、3 个月、6 个月、12 个月和 18 个月）、青少年每月发布后检查和照顾者报告的青少年心理/行为症状，以及（2）JJ 设施记录（例如，累犯、治疗利用情况）。保真度评估包括会议后检查表和 TBRI 策略使用的衡量标准。四年来收集了四次，实施数据包括（1）JJ 工作人员自我报告的设施和工作人员特征、创伤知情护理和 TBRI 策略的使用情况，以及（2）关于使用创伤知情策略、新干预措施的采用以及 TBRI 实践的渗透、维持和扩展的焦点小组（一线工作人员、领导层分别）。
LeSA 研究正在测试 TBRI 作为一种使照顾者有能力帮助预防 JJ 青少年使用阿片类药物和其他物质的方法。TBRI 的多个组成部分为照顾者提供了一个机会，以补充和扩展他们在住宿期间的收益。如果有效并成功实施，LeSA 方案将有助于将 TBRI 应用于更广泛的受众，并为在跨越多个环境的复杂系统中实施多组件干预措施提供指导。
ClinicalTrials.gov NCT04678960；2020 年 11 月 11 日注册；https://clinicaltrials.gov/ct2/show/NCT04678960。
