Preventing Opioid Use Among Justice-Involved Youth as They Transition to Adulthood: Leveraging Safe Adults (LeSA)

(PI: D. Knight)

Across the U.S., with an estimated 11.1 million misusing prescription opioids, substance use is a significant public health concern. Rates of opioid use disorders (OUDs) have increased exponentially, with 60% of overdoses being attributed to heroin and illicit synthetics (such as Fentanyl). Although opioid use among youth is low compared to adults, as youth transition to adulthood, experimentation and regular use increase later in adolescence. Juvenile justice (JJ)-involved youth represent a particularly vulnerable population, as they often experience mental health disorders, dysfunctional family/social relationships, and complex trauma, placing them at greater risk for SU and substance use disorders. To ensure that these youth do not become another opioid statistic, innovative and effective prevention interventions are needed. This project adapts and tests an intervention for preventing initiation and/or escalation of opioid misuse among older JJ-involved adolescents.

The target population focuses on youth between the ages of 15 and 18 who are aging out of juvenile justice centers and transitioning back into their communities after a period of detainment in a secure treatment or correctional facility.

The study uses Trust-Based Relational Intervention® (TBRI® a relational, attachment-based intervention that promotes emotional regulation through interaction with responsive, trained adults). It will be adapted for use as a prevention intervention targeting youth at risk for SU (especially non-medical use of opioids). Safe adults (e.g., parent/guardian, extended family member) will be trained in behavior management techniques for empowering youth to appropriately express their needs, connecting them with others in pro-social ways, and correcting or reshaping undesirable behavior.

Phase 1 adapts elements of the TBRI for JJ-involved youth, develops intervention manuals and study protocols, examines the acceptability of the adapted intervention, and tests the feasibility of the proposed study protocol (e.g., agency and youth recruitment). Feedback from 15 youth/safe adult dyads will be solicited as part of this phase.

Phase 2 examines both the effectiveness of the TBRI® for preventing opioid misuse and the comparative utility of three support formats: (1) TBRI Training only, (2) TBRI Training + Structured Coaching, or (3) TBRI Training + Responsive Coaching (triggered by the youth’s need/risk). A total of 360 youth/safe adult dyads will be recruited from 13 participating JJ facilities over a 3-year period and followed for
18 months post-release. This design enables a comparison of the TBRI versus SRP (using a delayed-start design in which each facility serves as its own control) plus an RCT comparing three TBRI support formats.

Phase 3 examines the barriers and facilitators of TBRI sustainment. One hundred and thirty staff (ten from each JJ agency) provide input annually via focus groups and surveys. TCU will work with administrators and staff at each JJ facility to implement a sustainment plan, which will include developing in-house TBRI expertise (i.e., staff training and implementation assistance). Successful completion of the study aims to test
the adapted intervention and facilitate sustainment by providing training and implementation support to participating facilities.

Project Publications

Knight, D. K., Yang, Y., Joseph, E. D., Tinius, E., Young, S., Shelley, L., Cross, D. R., & Knight, K. (2021). Preventing opioid use among justice-involved youth as they transition to adulthood: Leveraging safe adults (LeSA) protocol paper. BMC Public Health, 21(1), 1-17. DOI: 10.1186/s12889-021-12127-3

Ridenour, T.A., Cruden, G., Yang, Y. et al. Methodological Strategies for Prospective Harmonization of Studies: Application to 10 Distinct Outcomes Studies of Preventive Interventions Targeting Opioid Misuse. Prev Sci (2022).