Data on 8307 youths in 33 sites undergoing intake during the Baseline period were used to examine contributions of youth, staff, agency, and county characteristics to identify BH needs and linkage to community services. Approximately 70% of youths were screened, and more than half were in need of treatment services. Among those in need of services, only about a fifth were referred to treatment. Multivariate multilevel regression analyses identified an array of contributors to service-related outcomes, with youth’s level of supervision among the strongest predictors. With only a fifth of youth with identified substance use needs referred to treatment, the results highlighted the importance of BH and JJ implementing for systematic methods to enhance referral and service use.

Data on nearly 30,000 youth records from 16 matched pairs of sites in 7 states were analyzed to examine changes in Cascade retention from Baseline. It was found that, overall, 68.1% of youth were screened for substance use, 47.0% were in need of treatment, and 15.1% were referred to treatment (26.1% of those in need). These percentages remained relatively stable during the study. The percentage of youth in need of treatment who were actually referred, a key Cascade outcome indicator, increased from 23.4% at baseline to 29.3% after the intervention. Analyses of Cascade outcomes after referral to treatment are ongoing.

Results were mixed in terms of the additional impacts of the Enhanced intervention on Cascade outcomes. There was a greater increase in referral relative to baseline in the Enhanced compared with Core sites, but more decay during the Sustainment period in the Enhanced sites. Looking at the matched pairs of sites with referral data, in six pairs the Enhanced site showed a greater improvement in the percentage of youth in need referred to treatment, in five pairs the Core site showed greater improvement, and in four pairs there was no difference. Analyses of the Enhanced condition effects on Cascade outcomes after referral to treatment are ongoing. Analyses are continuing to determine the youth, staff, agency, and contextual factors that were associated with improved rates of referral, initiation, engagement, and continuing care.

Baseline youth records were used to examine the length of time that it took for youth to be screened and referred to treatment. Screening was completed within 30 days for over three-quarters (76%) of youth who were screened. The high rates of screening may reflect state juvenile justice policies that require screening at intake. However, although youth determined to be in need of treatment should ideally be referred to treatment as quickly as possible, we found that less than half of referred youth received the referral within 30 days of initial screening. Youth under closer levels of supervision were less likely to be referred within 30 days, possibly a result of delays associated with the adjudication process. Youth supervised in agencies where staff had larger caseloads were also less likely to be referred within 30 days of screening. Older youth were more likely to be referred within 30 days of screening.

Do staff perceptions of the value of best practices increase over time, and are increases more pronounced in Enhanced sites? 492 staff from 36 JJ agencies were surveyed about the perceived importance and use of best practices in five substance use practice domains: screening, assessment, standard referral, active referral, and treatment support. Structural equation models indicated that supervisory encouragement and organizational innovation/flexibility were associated with greater individual adaptability. Adaptability (willingness to try new ideas, use new procedures, adjust quickly to change), was positively correlated with importance ratings which were positively associated with reported use of best practices. Analyses are ongoing of attitudinal change over time across the sample as a whole and comparing Core and Enhanced conditions.

The objectives of the survey were to 1) describe the U.S. characteristics and interactions of the JJ community supervision (CS) agencies, their primary behavioral healthcare (BH) provider and their primary judge (PJ) and 2) how they were changing over time. In a national probability sample of counties, surveys were completed with 94% (645/684) in wave 1 and 83% (563/678). Findings were disseminated by feedback reports, presentations, webinars, and published articles (4 done and 4 more under way). The significant results that emerge from this work include: 1) youth referred from CS to the BH programs represent a more severe sub- group of youth under community supervision; 2) There are well established cross-system relationships for assessment and referral for substance use and mental health treatment, but less so for substance use or HIV prevention services; 3) Most CS agencies refer youth to BH providers for these services, which typically utilize more highly trained staff using evidenced based practices provided to a majority of the youth served; 4) More intensive substance use and mental health treatment, aftercare, and recovery support services were limited in availability; 5) PJ view standardized screening and clinical assessment for substance use and mental health needs as more valuable than what they typically get for recidivism; 6) Staff across the sample are interested in a wide range of additional training or technical assistance.

The overall goal of the HIV pilot was to examine the feasibility, acceptability, potential sustainability, and determine the preliminary effect of an implementation intervention designed to increase probation-involved youths’ access to and uptake of HIV testing by strengthening partnerships between the probation agency and the local department of health (DOH), or HIV/STI community based organization (CBO) in six counties. Five of 6 participating sites were able to facilitate health and JJ partnerships; 3 developed on-site HIV/STI education and testing protocols, and 2 developed education and referral protocols. Four of 5 sites successfully implemented their protocols. Across the 3 sites that implemented on-site HIV/STI education and testing protocols, 98.5% of youth who were offered agreed to a behavioral risk.