Temple University, Department of Criminal Justice, 1801 N Broad Street, Philadelphia, PA 19122, United States.
Temple University, Department of Criminal Justice, 1801 N Broad Street, Philadelphia, PA 19122, United States.
Drug Alcohol Depend. 2022 Aug 1;237:109513. doi: 10.1016/j.drugalcdep.2022.109513. Epub 2022 May 28.
Previous research on youth involved in the juvenile legal system (JLS), who have higher substance use prevalence than other adolescents, has focused on treatment outcomes post-initiation. Scant research has examined factors affecting treatment initiation following JLS referral. The current work addresses this gap by estimating net impacts of state, site, and client attributes on initiating treatment.
Mixed effects logistic regression models analyzed data from the Behavioral Health Services Cascade framework of the JJ-TRIALS project for 5325 youth records from 22 sites across six states, using weighted hot deck imputation to address missing data. The analysis permitted estimating net impacts of individual factors while controlling for state variation factors and separating out within-state site variation.
Rates of treatment initiation varied significantly across sites. About 63% of outcome variation arose from site and state disparities. The odds of initiating treatment were 127% higher for youth under a higher supervision level compared to youth under low supervision. Race and ethnicity were significantly associated with initiation, with Black and Hispanic youth having 44% and 42% lower odds of initiating treatment, respectively.
Individual factors, including race, ethnicity, and level of supervision, significantly differed in treatment initiation, controlling for between-state variation and allowing between-site-within-state effects to operate separately. A deeper understanding of factors shaping initiation may help behavioral health and JLS agencies to develop strategies to increase initiation for referred youth. This is the first study delineating individual, cross-program, and between-state variation in treatment initiation among referred youth.
先前的研究表明，青少年司法系统（JLS）中的青少年比其他青少年有更高的物质使用流行率，这些研究主要关注的是启动后治疗的结果。几乎没有研究探讨影响 JLS 转介后治疗启动的因素。目前的工作通过估计州、地点和客户属性对治疗启动的净影响来弥补这一空白。
使用混合效应逻辑回归模型分析了来自 JJ-TRIALS 项目的行为健康服务级联框架中的 5325 名青年记录的数据，该框架来自六个州的 22 个地点，使用加权热甲板插补来解决缺失数据问题。该分析允许在控制州差异因素的同时，估计个体因素的净影响，并分离出州内地点差异。
治疗启动率在各地点之间存在显著差异。大约 63%的结果差异来自于地点和州之间的差异。与低监督水平的青年相比，处于更高监督水平的青年接受治疗的可能性高 127%。种族和民族与治疗启动显著相关，黑人青年和西班牙裔青年接受治疗的可能性分别低 44%和 42%。
控制州间差异并允许州内地点间效应分别运作后，个体因素，包括种族、民族和监督水平，在治疗启动方面存在显著差异。深入了解影响启动的因素可能有助于行为健康和 JLS 机构制定策略，增加转介青年的启动率。这是第一个研究在接受转介的青少年中，个体、跨项目和州间差异的治疗启动的研究。
