Oregon Social Learning Center, United States of America; Chestnut Health Systems, Lighthouse Institute, United States of America.
VA Boston Healthcare System, United States of America.
J Subst Use Addict Treat. 2024 Nov;166:209450. doi: 10.1016/j.josat.2024.209450. Epub 2024 Jul 2.
Emerging adults (EAs) in the criminal legal system are at high risk for substance use and related negative outcomes. EAs also have low levels of engagement in treatment services, a pattern exacerbated for those living in rural communities. This pilot study investigated implementation outcomes of task-shifting an evidence-based substance use intervention, via a developmentally targeted program, provided by probation officers (POs) to selected EA clients.
Ten POs recruited from two counties in Oregon who provide services to rural clients were trained and supported in delivering contingency management for EAs (CM-EA) to 17 EAs on their current caseloads. The pilot took place entirely during the COVID-19 pandemic. POs submitted session audiotapes and checklists from meetings with participating EA clients and participated in focus groups. EA clients completed baseline interviews and agreed to have their adult criminal records collected. Ten semi-structured interviews were completed with probation/parole administration and staff from four rural counties across three states highly impacted by the opioid epidemic about the barriers and facilitators for delivering a program like CM-EA in their offices.
Based on self-reports and observational coding, POs demonstrated fidelity and adoption as they delivered all CM-EA components and engaged in CM-EA quality assurance protocols. Penetration was demonstrated by the selection of EAs reflecting the demographics of their local offices (i.e., White, non-Hispanic, balanced across sex), struggling with polysubstance use, and primarily holding felony convictions. Emerging themes from focus groups and interviews revealed feasibility, acceptability, and appropriateness of CM-EA, including use with clients not currently in the research program and reported intentions to continue CM-EA use. Barriers for future use include those found for the delivery of other programs in rural areas such as resource limitations.
There is initial support for the implementation outcomes related to task-shifting a program like CM-EA to POs, particularly those serving rural clients, to increase access to evidence-based substance use services for EAs. Future research with larger samples and multiple follow-ups will allow for effectiveness testing and further program refinement for this high-priority population.
处于刑事法律体系中的成年初期个体（EAs）存在较高的药物使用风险，以及相关的负面后果。此外，他们接受治疗服务的意愿较低，而对于居住在农村社区的成年人来说，这种模式更为严重。本试点研究旨在调查通过发展针对性项目，将一种基于证据的药物使用干预措施转移给缓刑官（POs），从而为特定的 EA 客户提供服务，以实现治疗效果。
从俄勒冈州的两个县招募了 10 名提供农村客户服务的 POs，对他们进行培训并支持其为当前客户群体中的 17 名 EA 提供针对成年人的药物使用干预（CM-EA）。该试点研究完全在 COVID-19 大流行期间进行。POs 提交了与参与 EA 客户的会议的录音带和清单，并参加了焦点小组。EA 客户完成了基线访谈，并同意收集其成年犯罪记录。对来自三个州四个受阿片类药物流行影响严重的农村县的缓刑/假释管理和工作人员进行了 10 次半结构化访谈，以了解在其办公室提供 CM-EA 等项目的障碍和促进因素。
根据自我报告和观察性编码，POs 在提供所有 CM-EA 组成部分和参与 CM-EA 质量保证协议方面表现出了一致性和采用性。通过选择反映当地办公室人口统计学特征（即白人、非西班牙裔、性别平衡）、与多种物质使用作斗争、主要持有重罪定罪的 EA 来证明渗透。焦点小组和访谈的新兴主题揭示了 CM-EA 的可行性、可接受性和适宜性，包括将其用于未参加研究计划的客户以及报告继续使用 CM-EA 的意图。未来使用的障碍包括在农村地区提供其他项目时发现的资源限制等障碍。
初步支持将 CM-EA 等项目转移给 POs 的实施效果，特别是为服务农村客户的 POs，以增加成年初期个体获得基于证据的药物使用服务的机会。未来的研究将纳入更大的样本量和多个随访，以对这一高优先级人群进行有效性测试和进一步的项目改进。
