Brief Family-Based Cannabis Use Intervention for Youth With Early Juvenile Justice Involvement

Overview

The goal of this randomized clinical trial is to learn if a brief family-based intervention in effective in reducing cannabis use and delinquency in youth participating in juvenile diversion. The main questions it aims to answer are: Hypothesis 1: the intervention will be (a) feasible, as evidenced by enrollment rates (\> 80%), follow-up rates (\> 80%), and withdrawal rates (\< 20%); and (b) acceptable, as evidenced by \> 80% of treatment evaluation ratings in the highest two Likert rating categories and positive exit interview feedback. Hypothesis 2: those parents in the experimental condition, as compared to the active comparison psychoeducation condition, will evidence greater improvement over time in the hypothesized family-level mechanisms proposed in the intervention (i.e., parenting practices and parent well-being) as well as in youth-level outcomes, including cannabis use, recidivism, and HIV/STI risk. Researchers will compare the family-based treatment to parenting psychoeducation. Caregiver and youth participants will complete measures relevant to primary outcomes and putative mechanisms at baseline, 3-month, and 6-month follow-ups.

Approximately 50% of youth with early juvenile justice system (JJS) involvement (i.e., diverted youth with less severe or first-time arrest histories) screen positive for cannabis use.Cannabis use is especially problematic for youth with early JJS involvement, given research suggesting that cannabis use is linked with continued and chronic involvement in the JJS. Moreover, cannabis use among justice-involved youth (JIY) is also associated with other consequences, including HIV/STI risk behaviors (e.g., lack of condom usage). Early JIY who use cannabis also differ from youth without justice involvement, such that they are more likely to belong to marginalized communities and also evidence worse family functioning. Thus, this population warrants specialized interventions targeting cannabis use and associated consequences. To date, the most effective cannabis and other substance use interventions for youth in the JJS are largely intensive, personalizable family-based models (e.g., multisystemic therapy), which also have documented efficacy in reducing the risk for HIV/STIs and long-term criminal involvement. However, these models were intended for youth with serious juvenile justice involvement and, thus, early JIY are rarely referred to these services.21 Such models are also likely overly intensive for treating cannabis use among early JIY. Despite evidence suggesting parenting practices, parent well-being, and family functioning are linked to cannabis use, delinquency, and HIV/STI risk behaviors for early JIY, there is a concerning lack of family-based services addressing cannabis use and other risk behaviors specifically developed for early JIY. Therefore, there is still a need for family-based interventions for early JIY. However, these interventions should be briefer in nature, so that they can be implemented as part of a larger continuum of care within the JJS. The primary goal of this NIDA-funded K23 research project is to adapt an existing evidence-based family-based intervention to families of early JIY who screen positive for cannabis use. The proposed 6-session, modular, family-based intervention will be delivered via telehealth and primarily focus on changing parent behaviors, consistent with prior family-based interventions for the present population.The modules will focus on: 1) psychoeducation delivered in motivational interviewing style (e.g., encouraging caregivers' role in preventing substance use), 2) parenting practices (e.g., supervision, managing peer relations), and 3) parent well-being (e.g., increasing social support). Family intervention strategies across these modules will be adapted from existing evidence-based interventions and personalized to best meets each youth and parents' clinical needs (consistent with NIDA Goal 2.3). Our objective will be to understand the initial efficacy of the intervention in treating adolescent cannabis use and other important, related outcomes (e.g., HIV/STI risk behaviors) through a pilot randomized clinical trial (RCT). Primary aim. Evaluate the acceptability, feasibility, and initial family-level mechanisms and youth substance-use related outcomes of a brief, family-based intervention for early justice-involved youths. A pilot RCT (N = 60) will be conducted in which youth and families will be randomized to either the proposed family-based intervention or parent psychoeducation. The youth and their primary caregiver will participate in these conditions via telehealth and will complete follow-up assessments at 3 and 6 months. H1: the intervention will be (a) feasible, as evidenced by enrollment rates (\> 80%), follow-up rates (\> 80%), and withdrawal rates (\< 20%); and (b) acceptable, as evidenced by \> 80% of treatment evaluation ratings in the highest two Likert rating categories and positive exit interview feedback. H2: is that those parents in the experimental condition, as compared to the active comparison psychoeducation condition, will evidence greater improvement over time in the hypothesized family-level mechanisms proposed in the intervention (i.e., parenting practices and parent well-being) as well as in youth-level outcomes, including cannabis use, recidivism, and HIV/STI risk.