A Pilot Trial of a Network Intervention for Youth After Incarceration

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).

Study Overview

• Status: Terminated
• Conditions: Health Care Utilization; Youth Incarceration
• Intervention / Treatment: Behavioral: Whole Person Care (WPC) Reentry Program - Pre & Post Release services

Detailed 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.

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90012
      • Los Angeles County Jails

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 24 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion criteria for youth exiting the adult justice system:

• Recipient of WPC pre-release reentry intervention (determined by Los Angeles County)
• Ages 18-24
• Fluent in English or Spanish

Exclusion criteria for youth exiting the adult justice system:

• Not receiving WPC pre-release reentry intervention (determined by Los Angeles County)
• Severe cognitive delay
• Unable to complete surveys in English or Spanish

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Whole Person Care (WPC) Reentry Program - Post-Release; In partnership with LA County Health Agency, Dr. Barnert is adapting the successful Transitions Clinic model developed for reentry adults, to assist recently incarcerated transition age youth link to needed health services and reduce substance use disorder relapse and recidivism. This adaption is informed by Dr. Barnert's prior research on the needs of incarcerated adolescents. The intervention, called the "Whole Person Care (WPC) Reentry Program" will consist of community health workers (i.e. network coaches) who are formerly incarcerated and formally trained in care coordination and social network coaching, who interact with justice-involved transition age youth pre- and post-release to increase youths' engagement in community SUD and mental health services. Participants in this branch will include youth exiting the adult justice system (ages 18-24) who receive PRE- and POST-release WPC services.	Behavioral: Whole Person Care (WPC) Reentry Program - Pre & Post Release services; Social network intervention to provide care coordination and social support during youth reentry before release and post-release from jail.
No Intervention: Control; Participants in the control arm will receive PRE-release services only from Whole Person Care. They will not receive the POST-release WPC community health worker intervention. Participants in this branch will include youth exiting the adult jail system (ages 18-24).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of Past-month (30-day) Marijuana Use	Self-reported frequency of past-month (30-day) marijuana use	3 months post-release
Frequency of Past-month (30-day) Alcohol Use	Self-reported frequency of past-month (30-day) alcohol use	3 months post-release

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of Past-month (30-day) Marijuana Use	Self-reported frequency of past-month (30-day) marijuana use	9 months post release
Frequency of Past-month (30-day) Alcohol Use	Self-reported frequency of past-month (30-day) alcohol use	9 months post release
Recidivism	Re-arrest since release (self-report and administrative/probation data)	3 months post-release
Recidivism	Re-arrest since last survey (self-report and administrative/probation data)	9 months post release
Receipt of Behavioral Health Services	receipt of behavioral since release (self-report and verified by administrative/probation data)	3 months post-release
Receipt of Behavioral Health Services	receipt of behavioral since last survey (self-report and verified by administrative/probation data)	9 months post-release
Mental Health	self-reported presence of diagnosis of a mental health disorder (will be verified by administrative/probation data)	3 months post release
Mental Health	self-reported presence of diagnosis of a mental health disorder at follow-up (will be verified by administrative/probation data)	9 months post release
Substance Use Disorders	self-reported presence or diagnosis of substance use disorder at follow-up (will be verified by administrative/probation data)	3 months post release
Substance Use Disorders	self-reported presence or diagnosis of substance use disorder at follow-up (will be verified by administrative/probation data)	9 months post release
Medications	self-reported medication or prescription at follow-up (will be verified by administrative/probation data)	3 months post release
Medications	self-reported medication or prescription at follow-up (will be verified by administrative/probation data)	9 months post release
Delinquency	number of arrest since release (will be verified by administrative/probation data)	3 months post release
Delinquency	number of arrest since last survey (will be verified by administrative/probation data)	9 months post release
Attitudes Towards WPC Reentry Intervention (WPC Reentry Participant Response Tool)	Liked intervention; recommend to a friend. Assessed via WPC Reentry Participant Response Tool. Includes 3 items, assessed via 7-point Likert scale.	3 months post release
Attitudes Towards WPC Reentry Intervention (WPC Reentry Participant Response Tool)	Liked intervention; recommend to a friend. Assessed via WPC Reentry Participant Response Tool. Includes 3 items, assessed via 7-point Likert scale.	9 months post release
Psychiatric Hospitalizations	psychiatric hospitalizations since release (self-report and health records data)	3 months post release
Psychiatric Hospitalizations	psychiatric hospitalizations since last survey (self-report and health records data)	9 months post release

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Investigators: Principal Investigator: Elizabeth S Barnert, MD, MPH, University of California, Los Angeles

Study record dates

Study Major Dates

• Study Start (Actual): March 2, 2020
• Primary Completion (Actual): December 16, 2021
• Study Completion (Actual): October 31, 2023

Study Registration Dates

• First Submitted: May 18, 2018
• First Submitted That Met QC Criteria: June 1, 2018
• First Posted (Actual): June 14, 2018

Study Record Updates

• Last Update Posted (Actual): March 27, 2024
• Last Update Submitted That Met QC Criteria: February 29, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: K23DA045747-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is not a plan to make IPD available to other researchers. The participants, justice-involved youth, are a vulnerable population and we do not currently have permission to share their IPD.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No