Clinical Trial Details
— Status: Terminated
Administrative data
| NCT number |
NCT03556618 |
| Other study ID # |
K23DA045747-01 |
| Secondary ID |
|
| Status |
Terminated |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
March 2, 2020 |
| Est. completion date |
October 31, 2023 |
Study information
| Verified date |
February 2024 |
| Source |
University of California, Los Angeles |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
A vicious cycle exists between adolescent substance use disorders and youth incarceration.
Re-wiring adolescent social networks during community reentry after incarceration can
potentially break the cycle of adolescent substance use and youth incarceration. Social
networks influence adolescent substance use and delinquent behavior, yet little is known
about how to intervene on social networks to improve health. Community reentry is a key
opportunity to re-set youths' social networks and re-direct high-risk youth toward a
healthier, more supportive network that can foster drug abstinence and reduce recidivism. The
investigators hypothesize that an adult who has successfully navigated reentry can guide
youth to rewire their social network by encouraging pro-social relationships, troubleshooting
basic barriers to healthcare and social services, and helping create linkages to substance
use and mental health treatment services. The goal of this study is to measure the impact of
a pilot intervention to address two key barriers to accessing behavioral health treatment
among recently incarcerated youth: poor care coordination and need for more positive support
from the social network. The proposed study intervention, the Whole Person Care (WPC) Reentry
Program, is based on the successful adult Transitions Clinic model, and is being adapted for
delivery to transition age youth (TAY) by community partners in the Los Angeles County
justice system. WPC community health workers (coaches) will provide recently released inmates
a formerly incarcerated adult role model who provides care coordination and social support to
facilitate access to needed health services, and who actively intervenes to guide TAY youth
toward pro-social peers and adults. The investigators propose a pilot longitudinal study of
WPC, using a community-partnered participatory research approach. The primary outcome will be
reductions in adolescent substance use in response to the intervention (Aim 1). Secondary
outcomes will test whether the intervention increases receipt of behavioral health services,
decreases recidivism and mental health symptoms, and improves school and work engagement (Aim
2). Finally, the investigators will examine social networks as a potential mechanism by
measuring whether youth receiving the intervention report healthier social networks (lower
proportion of peers engaging in risky behaviors and a higher number of supportive adults)
than control youth (Aim 3).
Description:
A vicious cycle exists between adolescent substance use disorders (SUD) and youth
incarceration. Untreated SUD, often comorbid with mental health problems, contribute
substantially to youth incarceration. Among 51,000 US youth detained annually, 50-88% have
SUD. Incarceration itself can exacerbate existing mental health disorders and contribute to
future substance use. Following incarceration, reentry back into the community of peers and
adults is a challenging juncture and a high risk period for re-engaging in substance use.
Finally, relapse on substance use leads to recidivism. Within 3 years of release, 75% of
adolescents are re-arrested, with highest risk among youth with SUD.
Re-wiring adolescent social networks during reentry can potentially break the vicious cycle
of adolescent substance use and youth incarceration. Social networks powerfully influence
adolescent substance use and delinquent behavior, yet little is known about how to intervene
on social networks to improve health. In the investigators prior research, the investigators
found that incarcerated youth value relationships with supportive adults and peers who can
help them succeed in school and stay out of trouble. Most express plans to "stay clean" from
drugs and stay away from peers who encourage substance use and delinquent behaviors. Yet,
during reentry, many youth re-engage with their previous network of risky peers. Why? The
investigators have found that upon reentry, youth who lack sufficient social supports and
positive role models default back to previous risky social networks, reinforcing further
substance use and other risky behaviors. Community reentry is a key opportunity to re-set
social networks and re-direct high-risk youth toward a healthier network that can foster drug
abstinence and reduce recidivism. Having an available and supportive adult role model can be
transformative for youth after incarceration. The investigators hypothesize that an adult who
has successfully navigated reentry can actively guide youth to re-wire their social network
by encouraging pro-social relationships, troubleshooting basic barriers to healthcare and
social services, and creating linkages to SUD and mental health services, to disrupt the
viscous cycle.
This community-partnered study seeks to measure the impact of an innovative pilot
intervention, the Whole Person Care (WPC) Reentry Program, a network community health worker
(i.e. coach) intervention that addresses two key challenges for recently incarcerated
transition age youth (TAY): poor care coordination in the "behavioral health cascade" and
need for more positive support from the social network. Los Angeles (LA) County has the
largest adult and juvenile justice systems in the US and has implemented the WPC Reentry
Program to enhance linkages to community behavioral health services. WPC is based on the
successful Transitions Clinic model, an intervention with demonstrated efficacy in linking
recently incarcerated adults to needed healthcare and improving health outcomes. The model
has yet to be implemented for reentry TAY, but has the potential to be transformative at the
critical developmental stage of adolescence, when peer social networks are highly dynamic and
youth behaviors can affect lifelong trajectories. WPC community health workers will receive
formalized training modeled after the adult Transitions Clinic approach and will serve as a
formerly incarcerated adult role model who provides care coordination and social support to
facilitate access to needed behavioral health services. Tailored for reentry youth, WPC will
also include a social network component whereby coaches are trained to actively guide youth
toward pro-social peers and adults. Dr. Barnert has been working closely with LA County and
this study capitalizes on a unique opportunity to rigorously study WPC. The investigators
hypothesize that (1) WPC will reduce adolescent SUD and recidivism and (2) WPC will
demonstrate positive associations with other key markers of healthy reentry (e.g., improved
mental health). The investigators further hypothesize that shifts towards healthier social
networks will mediate these relationships, a potential mechanism the investigators will test.
The investigators propose a pilot longitudinal study of WPC, using a community-partnered,
participatory research approach. Specific aims are to:
1. Measure the impact of the WPC network coach intervention targeting recently incarcerated
youth on decreasing rates of 30-day use and risky use of marijuana, alcohol, and other
drug use.
2. Test whether the WPC network coach intervention decreases recidivism, increases receipt
of behavioral health services, improves mental health, and enhances school and work
engagement.
3. Examine whether recently incarcerated youth receiving the WPC intervention report
healthier social networks (lower proportion of peers engaging in risky behaviors and a
higher number of supportive adults) than those not receiving the intervention.
