In the US, over half of youth involved in the juvenile justice system meet criteria for substance use disorder (SUD). Further, SUD is a consistent predictor of recidivism. Thus, significant improvements are needed to assure that justice-involved youth who meet criteria for SUD are screened and referred to care, especially in rural settings. ADAPT, an ongoing, statewide project, employs a learning health system (LHS) model to implement evidence-based practices (EBPs) to develop and improve alliances between juvenile justice (JJ) and community mental health centers (CMHCs). We assessed collaboration, “alliance,” between these systems.
The LHS alliance was assessed with self-report surveys distributed to personnel at 8 county sites. These included the cultural exchange inventory (CEI) measure to assess the process of exchanges in knowledge (beliefs about the process of implementing EBPs), and outcomes of those exchanges (beliefs about the outcome of interagency collaboration), to assess the alliance between JJ and CMHCs.
Pre-implementation surveys indicated a significant difference between CMHC respondents (CEI Output M=3.55, SD=1.53) compared to JJ respondents (M=2.89, SD=1.57) about the outcomes of the exchange of ideas [t(190)=2.13, p=0.03]. Both CMHC (CEI Process M=3.93, SD=1.45) and JJ participants (CEI Process M=3.84, SD=1.96) reported similar beliefs about the process of idea exchange t(119)=0.27, p=0.78). Further, participants from low rurality counties (i.e., more urban) reported less favorably to beliefs about the outcomes of collaboration (CEI Output M=3.16, SD=1.62) compared to medium rurality county participants [M=3.76, SD=1.39; t(120)=2.03, p=0.04]. Thus, we find a difference in perception of collaboration both between systems and between counties of varying rurality.
These findings help capture the current barriers to collaboration that exist between JJ and CMHCs before implementation of the LHS framework. Understanding these barriers between systems is essential to better cultivate interagency alliances to improve care for justice-involved youth with SUDs.
Sources of Support
This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health, and in part by UG1DA050070 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
© 2022 Published by Elsevier Inc.