Family Connect: The Pilot Test of a Cross-Systems Behavioral Health Treatment Referral and Linkage Intervention for Youth on Probation

• Author: Katherine S. Elkington,Gail Robson,Corianna E. Sichel,Jacqueline Lee,Gail A. Wasserman
• DOI: http://doi.org/10.1177/00938548221121130
• Published date: 01 January 2023
• Date: 01 January 2023
• Subject Matter: SPECIAL THEMED SECTION: Transformative Areas in Juvenile Justice

CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 1, January 2023, 22 –39.

DOI: https://doi.org/10.1177/00938548221121130

Article reuse guidelines: sagepub.com/journals-permissions

© 2022 International Association for Correctional and Forensic Psychology

22

FAMILY CONNECT

The Pilot Test of a Cross-Systems Behavioral

Health Treatment Referral and Linkage

Intervention for Youth on Probation

KATHERINE S. ELKINGTON

Columbia University and New York State Psychiatric Institute

GAIL ROBSON

CORIANNA E. SICHEL

JACQUELINE LEE

GAIL A. WASSERMAN

Columbia University

Despite high rates of substance use, youth involved in the juvenile justice system are unlikely to be linked to the treatment

services they need. Family Connect is a flexible, family-focused, linkage intervention developed to address multilevel barri-

ers and increase youth engagement in care through the introduction of a linkage specialist. We describe the components of

Family Connect and present findings from the intervention pilot test comparing 18 youth–caregiver dyads to 95 historical

controls on referral, attending intake and initiating treatment. Results indicated preliminary support for Family Connect as an

approach to increase cross-systems linkage and access to behavioral health care. Findings also suggested support for the

feasibility of the intervention and indicated that justice-involved youth and their caregivers found the intervention to be

acceptable. In addition to discussing our findings in the context of recent justice reforms, and the importance of improving

access to treatment, we make recommendations to inform a future trial of Family Connect.

Keywords: juvenile justice; substance use; mental health; families; services use; adolescent

Youth involved in the juvenile justice system (YIJ) have substantially higher rates of

substance use (SU) and disorders (SUD) compared with youth in the general popula-

tion. In the United States, 28% of youth report any past-year SU, and over 10% have a SUD

AUTHORS’ NOTE: This research was supported by a grant from the National Institute of Drug Abuse

(R34DA039316 PI: K.S. Elkington). Correspondence concerning this article should be addressed to

Katherine S. Elkington, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia

University and New York State Psychiatric Institute, 1051 Riverside Drive, Mail Unit 78, New York, NY

10032; e-mail: ke2143@cumc.columbia.edu.

1121130CJBXXX10.1177/00938548221121130Criminal Justice and BehaviorElkington et al. / FAMILY-BASED TREATMENT LINKAGE INTERVENTION

research-article2022

Elkington et al. / FAMILY-BASED TREATMENT LINKAGE INTERVENTION 23

(Johnston et al., 2003; Merikangas et al., 2010). SUDs are even more common among YIJ:

between 25% and 50% report a disorder (McClelland et al., 2004; Teplin et al., 2012, 2021;

Yurasek et al., 2021), and an estimated 70% of arrested juveniles have prior drug involve-

ment (Belenko & Logan, 2003; Zhang, 2004). Adolescent SU is a risk factor for SUD in

adolescence (Winters & Lee, 2008) and adulthood (Stone et al., 2012), and SU problems in

YIJ contribute to their continued involvement with the justice system (Hoeve et al., 2013;

Teplin et al., 2021; Wibbelink et al., 2017) as well as other poor outcomes such as HIV/STIs

(Elkington et al., 2008), violence (Elkington et al., 2015) and early mortality (Teplin et al.,

2014). The well-established overlap between justice involvement and SU, as well as evi-

dence to suggest treatment reduces recidivism in these youth (Cuellar et al., 2004), indicates

that identifying and treating their substance use is a crucial public health concern (Cuellar

et al., 2004; Henggeler & Sheidow, 2012; Hoeve et al., 2013).

A recent national survey of probation agencies across 20 states revealed that 64%

screened for behavioral health problems (Scott et al., 2019). However, despite the avail-

ability of evidenced-based substance use treatment for adolescents, between 50% and 90%

of YIJ with substance use treatment need do not receive services even after they are identi-

fied as in need of treatment (Johnson et al., 2004; Wasserman et al., 2021; White et al.,

2019), suggesting cross-systems referral and linkage are key points for intervention. This is

particularly true for some youth, such as those from racial/ethnic groups who are less likely

to be referred to and receive services than White YIJ (Dalton et al., 2009; Maschi et al.,

2008; White, 2019).

Probation departments have become critical justice settings in which to implement pro-

grams that close the treatment gap for YIJ with SU problems via cross-system linkage and

enrollment in services. As an initial point of contact for over half of U.S. youth entering the

juvenile justice system after arrest (Office of Juvenile Justice and Delinquency Prevention,

2020), probation departments are well-positioned to reach large numbers of youth who

would otherwise remain disconnected from the treatment system. However, because proba-

tion agencies typically do not offer SU services (Scott et al., 2019), youth on probation typi-

cally must move from the justice system to the community behavioral health system for SU

treatment. Thus, effective cross-system linkage is an essential component of service uptake

for these youth.

There are numerous system/organizational-, staff-, and youth/family-level factors that

cause YIJ to “get lost” in the process referral from the justice to the treatment system

(Gopalan et al., 2010; Stiffman et al., 2001). Within probation settings, poorly developed

or absent referral and linkage procedures and limited interagency collaboration can

increase the likelihood that youth do not make the transition across systems (Darlington

et al., 2005; Elkington et al., 2020; Stiffman et al., 2001). Moreover, probation staff may

have an incomplete knowledge of the behavioral health system or have had negative

experiences with referral and cross-system collaboration (Stiffman et al., 2004), which

can have ramifications for referral practices. Staff perceptions of youth’s treatment need,

gender, and race/ethnicity (Farmer et al., 2003; Lopez-Williams et al., 2006; Teplin

et al., 2005) have all been shown to affect probation officer (PO) screening and referral

behaviors (Wasserman et al., 2008). At the family level, factors such as perceived need

for treatment, stigma, family stress, and distrust of systems (Elkington et al., 2020;

Gopalan et al., 2010; McKay & Bannon, 2004; Teplin et al., 2005) are significantly asso-

ciated with limited service use and engagement. These findings suggest that an approach