Matt Aalsma

Justice-involved youth at risk of substance use disorders focus of IU research

Among youth who have been involved in the criminal justice system, drug overdose is a leading cause of death, second only to homicide. Although a number of practices have been shown to be effective in helping teens avoid or overcome substance use disorders, such programs have rarely been provided to justice-involved youth, and these youth are less likely than other teens to access any type of substance use services.

Matt Aalsma’s project, through IU’s Responding to the Addictions Crisis Grand Challenge, is the first initiative to bring together screening for drug use with training for case managers and counselors to identify justice-involved youth at risk of substance use disorders and help them access appropriate care.

Beginning with Indiana’s Tippecanoe and Wayne counties, Aalsma, professor of pediatrics and psychology in the IU School of Medicine, aims to help at-risk youth avoid drug addiction and take positive steps to improve their lives.

"Improving the Substance Use Care Cascade in the Juvenile Justice System" is designed to reach justice-involved youth at the time when they are most motivated to make changes: when they are first brought to an intake facility by law enforcement officers.

Prior research has demonstrated that young people view arrest and detention as a “crisis event” calling for changes in their behavior, yet this motivation decreases after they return to the community.

To take advantage of this key window, the program will implement screening for drug use at the time of intake and recruit youth who screen positive into one of two evidence-based interventions: Teen Intervene for relatively lower-risk substance use (such as low levels of alcohol and marijuana consumption), and ENCOMPASS for higher-risk behaviors (high levels of alcohol and marijuana consumption and/or any amount of illicit opioid use).

Teen Intervene involves individual in-person sessions with youth and uses the strategies of motivational interviewing, cognitive-behavioral therapy,and self-change principles to help teens chart their own paths toward their goals. ENCOMPASS, a longer-term intervention, builds on similar strategies including motivational enhancement therapy, urine drug screens to reinforce abstinence and access to health care providers who can prescribe medication-assisted treatment if needed to address addiction.

Aalsma’s project will evaluate outcomes to measure whether substance use decreases among participants; youth in the Teen Intervene program who do not appear to be improving on the outcome measures will be reassigned to the ENCOMPASS program.

In addition to bringing screening and intervention together and offering programs for both low- and high-risk groups, another key innovation of the project is training case managers to deliver Teen Intervene. Working with case managers, whose positions require only a bachelor’s degree, helps to overcome the treatment workforce challenge presented by Indiana’s shortage of master’s-level therapists.

The project is also groundbreaking in its involvement of parents and families, who will be recruited for a Family Advisory Group in addition to providing input on how the interventions are working for their individual families.

If the project is successful in reducing substance use and related behaviors among justice-involved youth, Aalsma expects to scale up the project to work with more Indiana counties, potentially making a substantial impact on the number of opioid overdose deaths and the ability of at-risk teens to avoid drug addiction.