Increasing Family Engagement and Treatment Initiation Through Family Assessment, Motivation, and Linkage Intervention (FAMLI)

The proposed study will test the integration of existing tools applied to juvenile justice (JJ) populations and examine the feasibility, acceptability, and preliminary efficacy of a caregiver-youth intervention aimed at increasing substance use (SU) treatment initiation. The Family Assessment, Motivation, and Linkage Intervention (FAMLI) is an adaptive intervention that incorporates three evidence-based components:

1) assessment of motivation and linkage-related barriers with personalized feedback
2) Mapping-Enhanced Counseling (MEC) for improving readiness for change and interpersonal communication
3) Active Linkage (AL) for addressing logistical barriers to service initiation

Using a Sequential Multiple Assignment Randomized Trial (SMART), 80 youth- caregiver dyads will be randomly assigned to receive an initial dose (two one-hour sessions) of either MEC or AL. After 30 days, participants will be classified as Responders (one or more services initiated) or non-responders (no service initiation).

Responders will receive encouragement to continue SU services, but no further MEC or AL; non-responders will be randomized to one of two interventions: an additional dose (two one-hour sessions) of the initial intervention (MEC or AL) or a different dose (two one-hour sessions of the other). The specific aims are to:

1) integrate and adapt appropriate evidence-based intervention components as a dyadic intervention approach for JJ youth and caregivers
2) test the feasibility, acceptability, and optimal configuration of the dyadic intervention components and the protocol used to evaluate effectiveness (including feasibility of recruitment, implementation, and measurement)
3) preliminarily explore whether:
a) an initial dose of MEC or AL is sufficient for promoting early initiation
b) an additional dose of MEC or AL or a change in dose is more effective for non-responders
c) which component sequence is most effective for non-responders

Primary outcomes consider both youth and caregiver measures. For the youth, measures consist of documenting youth initiation of assessment or counseling and counseling attendance. Caregiver measures are comprised of documenting caregiver attendance at assessment, first counseling session, and/or family sessions.

Secondary outcomes include both youth and caregiver attitudes (problem recognition and desire for help), normative beliefs (SU norms), perceived control (stressors and obstacles), and youth SU (self-report corroborated by urinalysis results).

The proposed study addresses the sizeable gap in service receipt among JJ youth by addressing family engagement and focuses on improving motivation to change, linkage to services, and treatment engagement.