Behavioral Incentives to Increase Caregiver Engagement in Juvenile Drug Courts
Phase: NA
Conditions: Substance Abuse
Sponsor: Medical University of South Carolina

 
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BEHAVIORAL INCENTIVES TO INCREASE CAREGIVER ENGAGEMENT IN JUVENILE DRUG COURT 
NCT03051997 
 
 
PRINCIPAL INVESTIGATOR:  
Dr. Phillippe B. Cunningham 
 
Medical University of South Carolina 
 
College of Medicine 
 
176 Croghan Spur Road Suite 104 
 
Charleston, South Carolina 29407-7555 
 
(843) 876-1840 
 
(843) 876-1840 
 
cunninpb@musc.edu 
 
 
Dr. David Ledgerwood 
 
Wayne State University School of Medicine 
 
Psychiatry & Beh. Neuroscience 
 
2761 E. Jefferson Avenue 
 
Detroit, Michigan 48207-4105 
 
(313) 993 -1380 
 
dledgerw@med.wayne.edu 
 
 
CO- or SUB-INVESTIGATORS: 
Dr. Stacy R. Ryan 
 
Baylor University  
 
Address: 801 Washington Ave, 8th Floor, Waco, TX 76701 
 
Phone # 
 
Email: Stacy_Ryan@Baylor.edu 
 
 
Dr. Sharon L. Foster 
 
Alliant International University 
 
10455 Pomerado Road 
 
San Diego, California 92131-1799 
 
(858) 635-4858 
 
fosterbarton@aol.com 
 
 
Dr. Colleen A. Halliday-Boykins 
 
Medical University of South Carolina 
 
176 Croghan Spur Road suite 104 
 
Charleston, South Carolina 29407-7555 
 
(843) 876-1800 
 
hallidca@musc.edu 
 
 

 
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Dr. Debra M. Kawahara 
 
Alliant International University 
 
CA School of Prof. Psychology 
 
10455 Pomerado Road 
 
San Diego, California 92131-1799 
 
(858) 635-4613 
 
dkawahara@aliant.edu 
 
 
Dr. Michael R. McCart 
 
Medical University of South Carolina 
 
176 Croghan Spur Road Suite 104 
 
Charleston, South Carolina 29407-7555 
 
(843) 792-4415 
 
mccartm@musc.edu 
 
 
Dr. Jeff Randall 
 
Medical University of South Carolina 
 
176 Croghan Spur Road Suite 104 
 
Charleston, South Carolina 29407-7555 
 
(843) 876-1816 
 
randallj@musc.edu 
 
FUNDING AGENCY: 
National Institute on Minority and Minority Health Disparities  
 
PROTOCOL VERSION:  
 
 
    9/6/2017  
 

 
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Synopsis 
 
Title 
Behavioral Incentives to Increase Caregiver Engagement in Juvenile Drug Court 
Study Duration 
08/16 – 02/21 
Study location(s) 
Bexar County Juvenile Drug Court and Affiliated Treatment Cites 
Objectives 
Although juvenile drug court has emerged as a promising model for reducing 
the cycle of drug use, crime, and delinquency among youth, the effectiveness of 
drug courts, as well as adolescent drug treatment, is often compromised by the 
lack of caregiver engagement (attendance and active participation). The current 
study will use an efficacious behavioral intervention, contingency management, 
to reinforce caregiver engagement in both juvenile drug court and adolescent 
drug treatment.   
Specific aims include:  
Aim 1: Evaluate whether caregivers receiving incentives for attendance and 
participation in juvenile drug court and adolescent drug treatment show greater 
attendance and participation in juvenile drug court and adolescent drug 
treatment relative to caregivers not receiving incentives (i.e., juvenile drug court 
treatment as usual. 
Aim 2: Examine whether youth whose caregivers receive incentives have 
greater reductions in drug use and criminal re-offending relative to youth 
receiving treatment as usual. 
Aim 3: Examine whether caregiver attendance and participation explain 
condition-related changes in youth drug use and criminal offending. 
Secondary Aim:  
Aim 4: Determine the acceptability and feasibility/disseminability challenges of 
the caregiver contingency management parent engagement strategy for parent 
participants, drug treatment providers, and juvenile drug court personnel 
(judges, court liaison officers/juvenile drug court coordinators).
Number of Subjects 
180 
Main Inclusion/Exclusion 
Criteria 
To increase external validity of study findings, and consistent with the aim of 
conducting implementation research if the present results are promising, and 
because our previous juvenile drug court study found that outcomes were not 
moderated by demographic characteristics or co-occurring psychiatric disorders, 
 caregivers and adolescents will be included regardless of co-morbid mental 
health problems (i.e. ADHD, conduct disorder, depression, anxiety disorder), 
with the exception of thought disorder (i.e. schizophrenia, autism), suicidality or 
mental retardation. Eligible primary caregivers of any adolescent (aged 13-17) 
served by the Bexar County Juvenile Drug Court must be willing to participate in 
treatment. 

 
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TABLE OF CONTENTS 
 
Synopsis ............................................................................................................................................. 
 
1.0  Background and Rationale ......................................................................................................... 
 
2.0  Research Objectives ................................................................................................................... 
 
3.0  Subject Selection and Recruitment ........................................................................................... 
3.1  Inclusion Criteria ...................................................................................................................... 
3.2  Exclusion Criteria ..................................................................................................................... 
 
4.0  Research Design & Methods ...................................................................................................... 
 
5.0  Study Visits ................................................................................................................................. 
 
6.0  Risks and Benefits....................................................................................................................... 
 
7.0  Statistical Analysis ...................................................................................................................... 
 
8.0  Data Management & Privacy/Confidentiality ........................................................................... 
 
9.0  Data & Safety Monitoring .......................................................................................................... 
 
10.0  References ................................................................................................................................ 
 
Appendices ........................................................................................................................................ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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1.0 
BACKGROUND AND RATIONALE 
Juvenile Drug Courts Increasingly Used with Substance Abusers. There were 268 juvenile 
drug courts (JDCs) in operation by December, 2003,26 which grew to 476 as of June, 2013 (National 
Institute of Justice). Over a 6-year period, state appropriations for drug courts grew 35% and federal 
appropriations increased over 250%.27 The number of and funding for JDCs are expected to continue 
growing as they increasingly become the intervention of choice for dealing with substance abusing 
juvenile offenders. 
          Mixed Evidence of JDC Effectiveness. JDCs have proliferated despite mixed evidence of their 
effectiveness. Reviews and meta-analyses have reported only modest effect sizes and slight reductions in 
recidivism among program participants.2,3,4,5  One primary factor that may account for the variability in 
effect sizes in drug court outcomes is the lack of parental involvement (i.e., caregiver participation). 
Family involvement in JDC improves adolescent drug treatment attendance, increases submission of 
negative drug screens, and leads to fewer judicial sanctions.8 However, juvenile offenders enrolled in JDC 
often attend court by themselves, and when family members do attend their responses are often rated as 
fair or poor.8  
           A major emphasis of the present study is to examine a caregiver incentive program (caregiver 
contingency management, CCM) to enhance caregiver engagement, with the goal of improving youth 
JDC outcomes. Because practical interventions are the most likely to be widely implemented, adding an 
easy-to implement parent engagement intervention to a promising JDC intervention permits assessment of 
whether this caregiver intervention can enhance JDC effects. It is important from both conceptual and 
methodological perspectives to assess the results of CCM when added to JDC procedures that have 
consistent guidelines for caregiver participation Evaluating the effects of CCM when added to JDC in 
comparison to treatment as usual (TAU) permits evaluation of the additive effect of the caregiver 
component, above and beyond the mandates imposed by JDC. In addition, we will examine whether 
improved caregiver participation in JDC contributes significantly to reductions in youth drug use 
outcomes, and whether caregiver engagement explains reductions in youth drug use when compared with 
TAU. 
          Importance of Family Engagement in JDC. When caregivers are involved in JDC, outcomes 
improve. Salvator et al.8 found that family involvement in JDC led to improved adolescent drug treatment 
attendance, increased submission of negative urine drug screens, and fewer judicial sanctions. These 
results should not be surprising: the role of family variables in the etiology and maintenance of adolescent 
substance abuse is well established, and risk factors that characterize families of youths in JDC are no 
exception.20,21 Although some adolescent-focused drug treatments can reduce drug use and criminal 
offending,22 family-based drug treatments are superior to other treatment modalities.23 For example, in 
randomized controlled clinical trials, family-based treatments for adolescent substance abuse have been 
found to be more effective than other treatments in retaining youth in treatment, reducing youth drug 
abuse, and mitigating co-occurring emotional/behavioral problems associated with drug use.23 To be 
effective, however, families must attend and actively participate in implementing treatment strategies 
known to impact adolescent problem behavior. The only study we are aware of documenting family 
involvement in drug court8 indicated that 69% of the offenders had a family member appear in court at 
least once (over the course of 12 months) and family members typically only attended 40% of the 
sessions. Results from this non-randomized study are quite concerning as these same researchers found 
family participation in drug court was a critical factor in improved outcomes.8 
            Rationale for CM to Increase Caregiver Engagement in JDC. Contingency Management 
(CM) is based on behavior learning theories, and is one of the most extensively researched, best validated 
interventions in the field of substance abuse treatment.28,29,30 For treatment resistant adult populations, an 
extensive literature provides strong evidence that CM is efficacious in promoting treatment attendance,13 
participation14 and retention,25 and improving completion of treatment related activities such as 
medication compliance15 and competing behaviors that are incompatible with drug use (e.g., family 
activities, employment).16 As such, CM is ideally suited to engage parents in JDC and treatment activities 
shown to decrease adolescent drug use (e.g., parental supervision of the youth). Incentives or rewards to 

 
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increase parent participation in treatment have been used in parenting prevention and intervention 
studies,31,32,33 but seldom outside this context. 34  
            We are aware of only two studies that have used CM to increase parent participation in their 
child’s drug treatment. Researchers33,34 used CM to motivate parents of marijuana abusing adolescents to 
actively participate in various treatment components (attend therapy, attend mid-week urine testing 
appointments, implement a self-monitoring contract, homework, administer breathalyzer tests, etc.) as 
part of a larger package of interventions that also included CM for adolescent drug use. Despite improved 
adolescent drug use outcomes, the impact of parent attendance and participation above and beyond 
adolescent CM was not examined. Prize-based CM35,36,37,38, developed by Petry et al.17 and utilized by Co-
PI Ledgerwood12 will be used in the present study to reinforce caregiver engagement. Prize-based CM has 
been effective with several different substance abusing populations, including cocaine dependent and 
methadone maintained opioid dependent patients,14,15,16 and alcohol dependent17 and nicotine dependent 
individuals. Prize-based CM has also been applied to treatment engagement outcomes such as treatment 
attendance,12,39 and has been efficacious when implemented by community therapists working 
independently of research personnel.12,36 Several studies have used prize-based CM to encourage both 
adult12,13,37,38,40 and adolescent41 substance abusers to complete treatment-related activities consistent with 
treatment goals (other than abstinence and treatment attendance). For example, prize-based CM has 
demonstrated effectiveness in improving antiretroviral therapy adherence40 and increasing completion of 
pre-arranged activities among attendees of a HIV drop-in center.13 One study examining prize-based CM 
for participation in family activities found greater engagement to be associated with longer treatment 
retention, longer duration of abstinence and greater reductions in family conflict.42  
            Thus, the general feasibility and effectiveness of prize-based CM has been demonstrated. 
Furthermore, prize-based CM approaches are comparable to other CM treatments (e.g., voucher 
approaches) in efficacy.43,44 Nevertheless, no studies have examined the application of this approach to 
caregivers in a JDC setting. This novel application of an effective treatment provides an innovative and 
disseminable approach for addressing the important issue of improving youth JDC outcomes. 
           Advantages of Using CM in a JDC Context. CM and its variations have strong empirical support 
when implemented with adults and in contexts other than drug court. Several published reviews in the 
area of adolescent substance abuse45,46,47,48,49,50,51,52 and from the adult substance abuse treatment 
literature49,53 support the effectiveness of behavior therapy approaches that include close monitoring of 
substance use and use of incentives. A meta-analysis found that CM had the largest effect sizes of 
psychosocial interventions for substance use disorders.53 The ultimate goal of this proposal is to enhance 
the effectiveness of JDCs across the nation by facilitating the integration of low-cost evidence-based 
services that can be readily provided by clinicians in community settings. 
 
 Why Reinforce Caregivers? There are several practical reasons to reinforce caregiver 
attendance and participation. First, poor caregiver participation often compromises effective empirically 
supported treatments,55 resulting in continuing substance abuse and criminal offending. Second, the 
substantial resources devoted to developing effective interventions are literally wasted when families do 
not engage in these interventions. For example, in a study of drug abusing adolescents, only 250 families 
out of 650 initial contacts came in for a screening interview; of these only 145 completed intake 
procedures; and of these only 72 completed treatment.56 Third, most EBTs for antisocial behavior require 
considerable effort on the part of caregivers to attend sessions and implement behavior change strategies 
(e.g., responding consistently to misbehavior, monitoring the youth’s whereabouts). The stress associated 
with managing a difficult child can undermine caregivers’ motivation to undertake these efforts. Finally, 
because CCM is relatively simple to apply, a wide range of professionals can implement CCM with high 
fidelity. In sum, CCM has the potential to a) improve parent attendance and participation,9 essential 
ingredients of effective intervention with substance-using youth, b) improve drug court outcomes, c) 
lower societal cost (in terms of reductions in re-offending and victim suffering, and incarceration), and d) 
be integrated into JDC and other real-world practice settings. 
 
2.0 
STUDY OBJECTIVES 

 
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The previous section highlighted the need for practical, easy-to-implement ways of improving 
caregiver participation in JDC and youth drug treatment.  An extensive literature provides strong evidence 
that CM is efficacious with both youth and adults in promoting drug abstinence,10,11 treatment 
attendance12,13 and participation,14 and completion of treatment related activities such as medication 
compliance15 and competing behaviors that are incompatible with drug use (e.g., family activities, 
employment16). The purpose of the proposed study is to evaluate the effects and acceptability of Prize CM 
procedure17 designed to reinforce caregivers’ engagement in JDC and their child’s drug treatment 
(Caregiver CM; CCM).   If successful, this study will provide important information that can be used to 
reduce youth offending and drug use, and importantly, inform clinical care practices in the emerging field 
of JDCs. Specific aims of this study include: 
Aim 1: Evaluate whether caregivers receiving prize incentives (CCM) for attendance and 
participation in JDC and adolescent drug treatment show greater attendance and participation in JDC and 
adolescent drug treatment relative to caregivers not receiving CCM (i.e., JDC TAU). 
Hypothesis 1: We predict that caregivers who receive CCM will have higher rates of 
attendance/participation in JDC and in therapy than will TAU caregivers.  
Aim 2: Examine whether youth whose caregivers receive prize incentives (CCM) have greater 
reductions in drug use and criminal re-offending relative to youth receiving TAU. 
Hypothesis 2: We predict that youth in the CCM condition will experience greater reductions in drug use 
and less re-offending. 
Aim 3: Examine whether caregiver attendance and participation explain condition-related 
changes in youth drug use and criminal offending. 
Hypothesis 3: We predict that caregiver engagement in drug court processes and adolescent drug 
treatment activities will be associated with stronger reductions in adolescent drug use and other problem 
behavior, which do not specifically focus on caregiver engagement.  
Aim 4. Determine the acceptability and feasibility/disseminability challenges of the CCM parent 
engagement strategy for parent participants, drug treatment providers, and JDC personnel (judges, court 
liaison officers/juvenile drug court coordinators). This aim is exploratory, so no hypotheses are offered.  
 
3.0 
SUBJECT SELECTION, RECRUITMENT, AND ENROLLMENT 
3.0.1 
SUBJECT SELECTION  
 
 Given the aims of this study, this protocol includes 4 populations of participants (1) youth 
involved in juvenile drug court, (2) caregivers of youth involved in juvenile drug court, (3) counselors 
providing substance abuse treatment services to youth involved in juvenile drug court, and (4) juvenile 
drug court personnel. The targeted enrollment is 180 youth and their families (the total number of 
caregivers for each youth enrolled could be greater than or equal to 1). We estimate that 374 youth and 
caregivers will complete the study.  We will enroll up to 24 pilot cases (24 youth-caregiver pairs) for 
therapists training. The targeted enrollment for counselors is 8. The targeted enrollment for juvenile drug 
court personnel is 15. This study population will include children and may include pregnant women and 
prisoners. To follow is justification for including these vulnerable populations, specific benefit to their 
inclusion, and additional protections. 
 
Justification for the participation of children as research subjects. The importance of the 
knowledge to be gained from this study lies in its compatibility with our national efforts to 
address the problems of adolescent substance use and maximize the benefits of juvenile drug 
court.  The focus of this study is on whether providing incentives to caregivers participating in 
their adolescent’s drug treatment and drug court proceedings is related to improved drug court 
outcomes among youth.  This study is significant in that information about whether incentives 
may be used to effectively engage caregivers will be used for larger scale dissemination efforts.  
 
Specific benefit to including children. There are anticipated benefits to children assigned to the 
intervention procedure and to children assigned to treatment as usual. The potential benefit of the 

 
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intervention is that caregivers may engage in their youth’s drug treatment and drug court 
proceedings, leading to improved behavioral and emotional outcomes among youth in the 
caregiver contingency management group.   Caregivers and youth may experience greater 
closeness and/or family involvement because of the nature of the contingency intervention. 
Among youth in the control group, responding to questionnaires that monitor mood and behaviors 
may lead to spontaneous changes due to self-reflection.   
The anticiapted benefit from monitoring procedures in treatment as usual that is likely to 
contribute to the well being of children is that  caregivers and adolescents will complete 
questionnaires and interviews during and after the intervention. This monitoring procedure 
includes questions about mood and behaviors. Having the opportunity to self-reflect can lead to 
self-initiated behavioral changes.  Also, this monitoring procedure also includes an interview 
about thoughts and feelings about the treatment process as well as about the drug court process.  
Having the opportunity to provide feedback about treatment and the drug court process presents 
an opportunity that is typically not available. This could offer reflief to participants in both 
groups. 
  
 
Additional protections to participating children. Protections for children participating in this study 
will include provisions for soliciting the assent of the children, methods for evaluating dissent of 
the children, and procedures for re-consenting subjects when he/she reaches 18 years of age.   
 
Provisions for soliciting assent: Upon approach to determine eligibility, caregivers will give 
verbal consent prior to initiating the screening questions.  After completing the screening 
questions with the caregiver, written consent (parent) and assent (adolescent) for participation in 
the study will be obtained by study staff.  Informed consent and assent will be obtained in a 
private place.  Participants will be informed that their information is kept confidential.  During 
the consent/assent process, parent(s) and adolescents will be provided information about study 
procedures and the risks associated with participating.  As with any research study, it will be 
communicated with caregivers and adolescents that participation is voluntary and participants are 
free to withdraw from the study at any time, either at the parent's or adolescent's request.  It will 
be explained to the adolescents that participation is voluntary even if parents provide consent.  
Adolescents will be given multiple opportunities during the study to assent and dissent.  The 
consent/assent form will provide a thorough description of the purpose of the study, the 
requirements, time commitment, and risks of participation.  Documentation of informed 
consent/assent will include a signed copy of the consent/assent form, where the adolescent, 
caregiver, and researcher sign their names and date the form.  A copy of the completed 
consent/assent form will be provided to the parent and adolescent.  Additionally, at each follow-
up assessment, research staff will review the study procedures, risks, and reaffirm consent/assent. 
  
 
Description of how parental consent will be obtained: Key personnel will obtain informed 
consent/assent from both the adolescent participant and their caretaker in a private area.  The 
consent/assent forms thoroughly describe the purpose of the study, requirements of participation, 
recruitment methods, length of participation, risks, and the compensation provided in exchange 
for participation.  Prior to signing the consent form, the study staff member will answer any 
questions about participation, and a witness to the consent (who is not a study staff member) will 
be introduced to the adolescent and their caretaker.  In private (without study staff present), the 
witness will inquire whether the adolescent and caretaker understand the study or have any 
questions.  The witness, the adolescent and their caretaker, and the study staff member will each 
sign the consent form, including the date and time of signature.  The participants will be provided 
a copy of the signed consent form and encouraged to ask questions at any time thereafter.  All 
investigators have completed training in protection of human research subjects.  Documentation 
of informed consent includes a signed copy of the consent form, where the adolescent, caretaker, 

 
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and researcher sign their names and date the consent.  A copy of the completed consent form will 
be provided to the caretaker of each participant.  Prior to any assessments, all questions about the 
study that are raised by the caretaker or adolescent participant will be answered before the 
consent/assent forms are signed.  The consent form will contain details on who to contact in case 
of an adverse event, details on how to reach the PI, and how to contact the Institutional Review 
Board to register a complaint.  
 
Methods for evaluating dissent: Dissent will be evaluated based on non-attendance at assessment 
and or follow-up visits, poor eye contact, lack of interest, and verbal expression of not wanting to 
participate.  In such cases, the participant would be interviewed individually and confidentially by 
research staff to confirm whether or not he/she wants to continue participation.  Participants will 
be reminded that they can voluntarily end their participation at any time with no penalty to 
themselves or their family. 
  
Justification for the participation of pregnant women. The proposed research involves a 
behavioral intervention, which does not include a focus on behaviors related to pregnancy or the 
fetus. Nineteen percent of target youth participants are expected to be female, and approximately 
85% of caregiver participants are expected to be female; and 50% of counselors and juvenile drug 
court personnel are expected to be women.   Excluding participants based on pregnancy status 
would bias our sample.  
 
 
Specific benefit to including pregnant women. The benefit to pregnant youth and caregivers is 
that the intervention or observations as part of treatment as usual will offer symptom relief and 
reduction for the teen and greater parent-child relationship for the caregivers.  The only risk of the 
research is breach of confidentiality for the pregnant woman. 
 
 
Additional protections to participating pregnant women.  Pregnant women will be granted the 
same level of protection as provided in other areas of this protocol given that the risk for 
participation is not above that of other participants. 
 
Justification for the participation of prisoners. This study seeks to test whether providing 
incentives to caregivers involved in treatment with their juvenile drug court involved youth leads 
to better outcomes among youth. There may be times when youth are arrested and detained 
during the course of our study. In these cases, we will seek permission to complete follow-up 
visits at the detention facility. The ability to complete follow-up assessments on time, would help 
us to better determine whether and to what extent our incentive program is related to improved 
health and well-being among youth at high-risk for detention. 
  
Specific benefit to including prisoners. As noted above, participants will not be prisoners at intake, 
but some may become prisoners depending on their drug court adjudication. As such continued 
participation during detention allows for the youth and the caregiver to be exposed to protocol 
procedures, which has the benefits detailed above. 
  
Additional protections to participating prisoners. In the present study, juvenile drug court staff 
members and probation officers may have knowledge that a family is participating in the present 
study, but will not know the reasons for study non-participation (e.g., declined vs. ineligible). We 
will work with juvenile drug court and probation staff to ensure they understand that 1) study 
participation must be separate from drug court participation and probation, 2) families have the 
right to decline study participation, and 3) declining study participation should, in no way, 
influence the care/services received from the drug court or probation. Each participating family 
(youth and caregiver) will be informed that the drug court and probation officer have been told that 

 
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their participation in the study should not impact on any decisions made regarding drug court, 
probation or adjudication. 
 
3.0.2 
RECRUITMENT AND ENROLLMENT  
 
Caregivers and Youth. Bexar county drug court supervisors and drug court probation officers, 
study therapists, or research assistants will identify potentially eligible families who are participating in 
drug court. These families will be given cursory information about the study (see study script and 
brochure) and asked if they wish to receive more in depth information from a research assistant. For those 
who agree to receive more in depth information from a research assistant, the probation officer will 
complete a study referral form (see attached form). This referral form will be hand delivered or emailed in 
a password protected file to research assistants. Research assistants will then approach the family  before 
or after a drug court session, upon enrollment at their treatment facility, or research assistants will contact 
the family by phone and inform them about the study.  Families expressing continued interest will be 
screened for eligibility by research assistants.  Among eligible families that agree to participate, research 
assistants will explain the study more fully, answer questions, and obtain signed informed consent 
(caregiver)/ assent (youth) in a private place convenient for the family. Caregiver consent and youth 
assent will emphasize that the family is entitled to services from the provider organization and juvenile 
drug court regardless of their participation in the research. 
 
Therapists. Protocol therapists recruited from organizations that are contracted to provide services 
with the Bexar County Juvenile Drug Court will deliver the caregiver contingency management protocol. 
 Within these organizations, therapists who completed a two-day workshop (and have pre-post training 
assessment measures [Knowledge of CM Principles, CCM Training Questionnaire] on caregiver 
contingency management will be invited to participate in this study during a site engagement visit after 
IRB approval. At this visit, therapists will be informed of the study and knowledge of the protocol will be 
monitored (JDC Therapist Protocol Quiz). 
 
Juvenile drug court personnel. Personnel who provided a letter of support (or the individual now 
holding the position) will be provided with full details of the grant, be provided with the opportunity to 
express necessary changes to protocol, and consented during a site engagement visit after IRB approval. 
 
All participants will be consented in-person and in a private location at juvenile probation, their 
treatment facility, or an agreed upon location in the community by a research assistant trained in 
obtaining consent or by the site investigator (Dr. Stacy Ryan).  Additionally, families will be consented 
according to the procedures discussed above.  All participants will be given as much time as they need to 
consider whether to participate in the research study. We will minimize the perception of undue influence 
or coercion by ensuring participants understand that participation is voluntary and will not impact their 
participation in drug court (families) or jobs at their organizations (therapist and juvenile drug court 
personnel). This assurance will be stated in the consent form and restated at follow-up visits. 
 
Participants will be allowed to withdrawal at any point during the study.  Participants who wish to 
withdraw from the study will be contacted for a study exit assessment.  Should participants wish not to 
engage in the study exit assessment, they will be withdrawn without the assessment and no further contact 
will be made.  Participants will keep any incentives and gifts earned up to that point. 
 
3.0.3 
INCLUSION/EXCLUSION CRITERIA 
 
Study Population Being 
Recruited 
Inclusion Criteria: 
Exclusion Criteria: 
Youth involved in juvenile 
drug court 
Involved in juvenile drug court 
Ages 13-17 years old at enrollment 
Teen willing to participate  
At least one caregiver willing to 
participate in treatment 
Live in San Antonio
Diagnosed with intellectual disability 
or autism spectrum disorder. 
 

 
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Fluent in English or Spanish 
Caregivers of youth involved 
in juvenile drug court 
Caregivers of youth involved in 
juvenile     drug court 
Caregiver willing to participate 
Lives in San Antonio 
Fluent in English or Spanish
Diagnosed with intellectual disability 
or autism spectrum disorder 
Counselors providing 
substance abuse treatment 
services to youth involved in 
juvenile drug court 
Counselor providing substance abuse 
treatment to an adolescent involved in 
drug court  
N/A 
juvenile drug court personnel  
Juvenile drug court supervisors and 
probation officers working in Bexar 
County Juvenile Drug Court 
N/A 
 
3.0.4 
RANDOMIZATION PROCESS 
 
Caregivers and youth willing to participate will be consented and either complete study entry 
assessments and randomization or will be consented and then scheduled for an appointment for 
completion of study entry assessments and randomization at a more convenient time.  Caregivers and 
youth will be randomized to either the caregiver contingency management or treatment as usual group. 
The proposed urn randomization procedure is a randomization method that aims to achieve balance across 
groups on factors that, if unaddressed, could bias estimates of the intervention effect. There is an 
exception to the randomization procedure.  Some families will be placed into the caregiver contingency 
management group for the purpose of training therapists prior to receiving randomized participants.  
 
4.0 
RESEARCH DESIGN & METHODS   
Design Overview:  
A well-specified intervention, Contingency Management, will be adapted to reinforce caregiver 
participation in drug court (CCM).  We propose a randomized clinical trial examining the utility of 
caregiver contingency management to increase caregiver engagement in juvenile drug court and 
adolescent drug treatment activities. The proposed study follows a 2 (treatment type: Drug Court plus 
treatment as usual (TAU); Drug Court and TAU plus Caregiver CM [CCM] x 10 (time: pretreatment 
[T0], 1-month [T1], 2-month [T2], 3-months [T3], 4-month [T4], 5-month [T5], 6-months [T6], 9-months 
[T7], 12-months [T8], and 18-months [T9-six months post-juvenile drug court involvement]) factorial 
design, with random assignment of 180 caregivers/youths to one of the two treatment conditions. 
Repeated measures of caregiver and youth functioning will be collected at pre-treatment (T0), and each of 
the post-randomization time points (T1 – T9). We choose a randomized trial because this is the most valid 
way to test the efficacy of our proposed intervention.  We choose the follow-up time line to measure 
short-term and long-term maintenance of change.  Our randomization procedure will help mitigate bias 
across the treatment groups, providing groups that are equally distributed across a number of 
characteristics known to influence outcomes.  
Study Timeline:  
The first 6 months of the project have been devoted to start up activities that have included hiring 
and training research assistants; finalizing data collection protocols; finalizing the CM manual, obtaining 
informed consent from JDC personnel and stakeholders, and collecting the first wave of drug court 
stakeholder measures during site visits (a more detailed project timeline, goals, and responsibilities can be 
found in the Budget Justification). Months 7 through 42 of the proposed study will involve data collection 
and CCM implementation. Months 42 through 54 will focus on completing data collection and data 
cleaning; and months 54 through 60 will be devoted to data analyses and manuscript preparation.   
Measures: 
As shown more extensively in the attached Schedule of Assessment table, different sets of 
measures will be collected at different time intervals (weekly, monthly, quarterly, and annually).  

 
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Measures will assess caregiver participation in JDC and adolescent drug treatment, youth 
outcomes, therapist fidelity, and descriptive and moderator variables. To enhance construct validity most 
constructs will be measured from multiple sources (e.g., caregiver report, youth report, therapist report, 
JDC personnel, archival records) using reliable and valid instrumentation. A copy of each measure is 
included with this protocol submission.  
Caregiver Participation Measures.  Multiple measures and multiple informants will be used to 
assess caregiver participation in JDC weekly status hearings and treatment sessions. Caregiver attendance 
in JDC will be independently recorded by the JDC supervisors or research assistant using the 
Parent/Caregiver Drug Court Attendance Form and collected weekly at drug court. Differences 
between research assistants and supervisor reports will be reconciled using court records. Drug court 
records will also be reviewed for caregiver and youth attendance and unexcused absences at drug court 
sessions. Quality of caregiver participation in drug court will be recorded using the Juvenile Drug Court 
Caregiver Participation Ratings form, which will be completed by a research assistant.  Barriers to 
Drug Court participation will be measured using the Barriers to Drug Court Participation measure, 
which will be completed by the caregiver. Similarly, caregiver attendance at youth treatment sessions will 
be recorded by therapists and measured as a percent of scheduled sessions using the Caregiver 
Contingency Management Session Tracking Sheet (CM Group) or Caregiver Treatment as Usual 
Session Tracking Sheet (Treatment as Usual Group); Barriers to Treatment participation will be 
measured using the Barriers to Treatment Participation measure, which will be completed by the 
caregiver. See the schedule of assessments table below for timing of assessment.  
Implementation fidelity. The 12-item Contingency Management Competence Scale (CMCS) 
assesses fidelity to prize-based CM procedures. The CMCS has good inter-rater reliability, internal 
consistency, discriminant, concurrent and predictive validity in substance abusing outpatients. In the 
present study, the CMCS will be used to rate CCM audiotapes. Initially, 100% of audiotapes will be 
reviewed to establish inter-rater reliability. Subsequently, the CMCS will be used to assess treatment 
fidelity.  Treatment implementation will also be measured using the Caregiver Contingency 
Management tracking sheet, which will be completed by the therapist. The Caregiver Contingency 
Management tracking sheet will track number of prize draws provided to families at each session and 
the associated activities.  To maintain balance across the treatment groups, a comparable measure will be 
given to the treatment as usual group, Caregiver Treatment as Usual session tracking sheet. 
Adolescent substance use outcome measures. Adolescent substance use will be assessed through 
two well validated methods -- youth self-reports and biological indices. (1) While youth are under the 
supervision of juvenile probation, Urine Drug Screen Results will be obtained from juvenile probation. 
Screened substances will include Amphetamine, Benzodiazepine, Cocaine, Marijuana, 
Methamphetamine, MDMA, Oxycodone, Opiate, Methadone, PCP, and Barbiturates.   When families are 
discharged from the supervision of juvenile probation, Urine Drug Screens will be collected and 
screened for Amphetamine, Benzodiazepine, Cocaine, Marijuana, Methamphetamine, MDMA, 
Oxycodone, and Opiate. (2) Several scales from the Global Appraisal of Individual Needs (GAIN) will 
be used to measure self-reported youth substance use and substance related problems. These include the 
Substance Abuse Index/Substance Dependence and Substance Problem Scales, which assess DSM-IV-TR 
criteria for substance abuse and dependence as well as lower severity symptoms; the Recovery 
Environment Risk and Social Risk subscales that have predicted substance-related problems in a 
longitudinal study with substance abusing youths; and the GAIN Substance Frequency Scale, which 
assesses youth substance use for the past 90 days and has good reliabilities and sensitivity to change. 
Importantly, this latter scale is highly associated with results from both the Form-9087 and urine testing.  
(3) In addition, drug court graduation rates will be tracked using the Parent/Caregiver Drug Court 
Attendance Form as an indication of reduced drug use. 
Adolescent problem behavior outcome measures. We will assess problematic behavior across 
three areas: problematic behavior on a broad scale, criminal activity specifically, and incarceration: (1) 
Archival records maintained by state juvenile justice authorities will be used to examine youths’ 
involvement in the juvenile justice system with regard to charges, arrests, adjudication, and incarceration. 

 
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In addition, because youths 16 years and older can be waived to adult court for new arrests, adult arrest 
records will be obtained for such youths. (2) The 47-item Self-Report Delinquency Scale (SRD) will 
assess youth involvement in delinquent acts (both status and index offenses) during the past 90 days. The 
SRD includes an overall general delinquency scale and subscales pertaining to person offenses (e.g., 
assault) and property offenses (e.g., vandalism), and is considered one of the best validated self-report 
delinquency measures.  
Adolescent mental health outcome measure.  Mental health functioning will be measured based 
on parent report and youth report: (1) Child Behavior Checklist (caregiver report) and (2)  the 12-item 
Brief Problem Checklist (BPC) provides an efficient and highly reliable and valid measure of youth 
internalizing and externalizing symptoms from caregiver and youth perspectives.  
Measures of treatment acceptability.  Interviews and questionnaires will be used to gather 
qualitative and quantitative data on treatment acceptability issues. The 47-item Survey of Counselor’s 
Perceptions of Incentive Programs (SCPIP) measures the attitudes of treatment providers towards the 
use of tangible incentives and social incentives in the treatment of substance abuse problems. The SCPIP 
has been used with professionals involved in drug treatment including program administrators, program 
directors, and medical staff. The SCIPP will be completed by JDC personnel at the start of CCM and 
yearly, thereafter. A modified version of the SCIPP (that will be piloted during start-up) will be 
completed by caregivers and youth at baseline and end of CCM. In addition, caregivers and youth will 
complete the Client Satisfaction Questionnaire-8 (CSQ), which evaluates perceptions of the therapist 
and treatment. The Caregiver Satisfaction with Caregiver Contingency Management (CCM) measure 
(CM group only) will also be collected to gather data on caregivers who participated in the Contingency 
Management (CM) group assessing caregiver’s perspective of the CCM program – this measure will be 
collected at Month 5, or end of treatment, whichever comes first.  
Refinement of intervention/assessment protocols. Research assistants will conduct semi-
structured exit interviews (Qualitative Interview- Caregiver, Qualitative Interview- Therapist, 
Qualitative Interview- Youth, Qualitative Interview- Drug Court) with the caregivers, youths, 
therapists, and JDC personnel to assess their perceptions of intervention components, study procedures, 
and suggestions for research and intervention refinement. Therapists and JDC personnel will be asked 
about their views of CCM during each year of clinical implementation. Youth and caregivers will be 
interviewed separately and asked about their general opinions of drug court and CCM procedures at the 
conclusion of treatment. Analysis of the qualitative exit interview data will inform the refinement of CCM 
in terms of intervention content and delivery and will be used to plan dissemination efforts. We will 
collect semi-structured exit interviews from a subset (20%, n=36; randomly selected throughout the 
study) of families regardless of intervention attendance or treatment success. All exit interviews will 
follow semi-structured interview guides and be conducted in accord with standard qualitative procedures 
(e.g., allowing the interviewer to elaborate on relevant and important issues that emerge during the 
interview). Interviews will be audio recorded, transcribed, and analyzed using grounded theory qualitative 
methods. Given the cyclical nature of data collection and analysis in qualitative research, the guides may 
change during data collection to incorporate questions raised by emerging themes and issues in the 
interviews. Dr. Kawahara (Co-I) will participate in developing the interviews and overseeing their 
analysis, drawing from her substantial experience conducting qualitative research using grounded theory 
methods and teaching qualitative methods of inquiry.   
Control Measures. To control for the quality of the relationship with the therapist (CCM, TAU) as 
a potential confound,  caregivers, youth, and therapists will complete the 36-item Working Alliance 
Inventory (WAI), which measures three aspects of the therapeutic alliance; emotional bond, agreement 
on goals, and agreement on tasks. The WAI will be completed monthly during active treatment. To assess 
and control for other services the youth may receive besides research treatment conditions the caregiver 
will be asked during the monthly assessments if the youth received mental health or substance abuse 
services beyond TAU.   
Additional Measures.  These instruments will be used to describe the sample; some will be 
examined in supplemental analyses as possible moderators of outcomes. (1) Demographics and Service 

 
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Utilization Survey completed by caregivers and Demographics forms completed by therapists, youth, 
and drug court personnel , (2) The presence of substance use disorders and specific psychiatric co-
morbidities (e.g., anxiety, mood, disruptive behavior disorders) will be assessed by research staff using 
scales from the Global Appraisal of Individual Needs-Initial (GAIN-I), (3) The self-report version of 
the Addiction Severity Index (ASI), (4) The widely-used 21-item Beck Depression Inventory-2nd 
Edition (BDI-II) will assess caregiver depression, (5) Homework Rating Scale will assess parent 
compliance with homework, (6) Parent-Adolescent Sexual Communication scale will assess parent and 
adolescent perception of the quality and quantity of sexual communication, (7) Termination 
Questionnaire will provide information about why a family left treatment and will be completed by study 
therapists, and (8) Choice Questionnaire (Kirby Delay Discounting) measure, will provide information 
about impulsive choice – a personal characteristic CM interventions attempt to augment.   
 
5.0 STUDY ACTIVITIES 
  
Study Entry Assessment (Time 0). Research assistants will meet with families at an agreed upon location 
to complete study entry assessments. During this assessment, youth will provide demographic 
information and complete interviews and questionnaires that assess substance use (Brief Problem 
Checklist, Global Appraisal of Individual Needs), mental health symptoms (Brief Problem Checklist, 
Self-Report of Delinquency, Global Appraisal of Individual Needs), criminal activity (Self-Report 
Delinquency), sexual behavior (demographics form),  sexual communication patterns with their caregiver 
(Parent-Adolescent Sexual Communication – Adolescent Version) and impulsivity (Choice 
Questionnaire); and the teen’s most urine drug screen results to the study entry assessment date will be 
obtained from probation.  
 
At the same visit, caregivers will provide demographic information and service utilization history; 
complete interviews and questionnaires about their teen’s behavior (Child Behavior Checklist), mental 
health symptoms (Child Behavior Checklist), impulsivity (Choice Questionnaire); and their own 
perception of incentive programs (Perception of Incentive Programs). Parents will also provide 
information about their own substance use history (Addiction Severity Index), mental health symptoms 
(Beck Depression Inventory), and communication patterns with their child about sex (Parent-Adolescent 
Sexual Communication – Caregiver Version) 
 
Research assistants will meet with juvenile drug court personnel at juvenile probation offices to have 
juvenile drug court personnel provide demographic information and complete a questionnaire about their 
perception of incentive programs (Perceptions of Incentive Programs). 
 
Selected therapists will provide demographic information and complete a questionnaire about their 
perception of incentive programs (Perceptions of Incentive Program). This information will be collected 
by research assistants prior to therapist’s training.  
 
Study Months 1 through 4. During study months 1 – 4, caregivers in the CCM group will engage in 
treatment as they normally would plus the prize-based contingency management intervention with the 
therapist at the provider agency. Caregivers in the TAU group will engage in treatment as they normally 
would with the therapist at the provider agency only.   
 
Once a month (for 4 months), caregivers and youth in both groups will be asked to complete survey’s 
online through RedCap. If the program is not working, caregivers and youth will complete study 
assessments using paper forms (or offered the opportunity to complete by phone with a research 
assistant). During these assessments, families  will complete measures of therapeutic alliance (Working 
Alliance Inventory) and questionnaires that assess substance abuse and mental health symptoms in youth 
(Brief Problem Checklist; except in Month 3 for caregivers). Caregivers will also complete measures 

 
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assessing perception of quality/quantity of assigned homework (Homework Rating Scale).  Youth will 
also either provide a sample for drug screen testing or the most recent results will be obtained by juvenile 
probation. Additional assessments will be given to the caregivers in-person to assess adolescent’s 
substance use and mental health symptoms (Child Behavior Checklist, Month 3 only;) since the last visit; 
and youth will be given the Global Appraisal of Individual Needs and the Self-Report Delinquency Scale 
as additional measures at Month 3 only. In months 1 and 3 only, caregivers will complete the Barriers to 
Treatment Participation; and in month 3 (or month 4 if family is still enrolled in drug court during month 
3) caregivers will also complete Barriers to Drug Court Participation.  In month 4 only, caregivers will 
complete the Choice Questionnaire. 
 
Study therapists will complete the Working Alliance Inventory, rating the caregiver and the youth and the 
Homework rating scale. During this time, Therapists in the CCM and TAU groups will also complete the 
Session Tracking sheets on a weekly basis. 
 
Research assistants will rate caregiver participation weekly during months 1-4. 
 
Follow-up Visits (Months 5, 6, 9, 12, and 18 months after study entry). Youth will complete Brief 
Problem Checklist, Self-Report Delinquency Scale, and Global Appraisal of Individual Needs at all 
months post-study entry. In addition, the Parent-Adolescent Sexual Communication – Youth Version, 
Client Satisfaction Questionnaire-Clinic Version, Client Satisfaction Questionnaire-JDC Version, 
Working Alliance Inventory-Youth measure, and qualitative interview will only be completed at Month 5. 
At all follow-up visits, youth will also provide a urine sample to be tested for drugs of abuse or the most 
recent results obtained by Juvenile Probation will be collected. Caregivers will complete the Child 
Behavior Checklist measure at all months post-study entry. At Month 5 only, caregivers will complete the 
Beck Depression Inventory, Addiction Severity Index, Perceptions of Incentive Programs, Homework 
Rating Scale-Caregiver, Working Alliance Inventory, the Client Satisfaction Questionnaire-Clinic 
Version, the Client Satisfaction Questionnaire-JDC Version, the Caregiver Satisfaction with Caregiver 
Contingency Management (CM group only) and the Qualitative Interview. At Month 6, the Parent-
Adolescent Sexual Communication-Caregiver Version will be administered. 
 
At the 5th month, therapists treating youth in both groups, will complete a questionnaire that assesses 
reasons for termination. Therapists will also complete the Working Alliance Inventory-Therapist Report 
on Caregiver, Working Alliance Inventory-Therapist Report on Youth, and the Homework Rating Scale-
Therapist. Yearly, therapists and juvenile drug court personnel will also complete a qualitative interview 
about their opinions of juvenile drug court and how caregiver incentives may have influenced drug court 
proceedings and outcomes. All follow-up visits will be completed by a research assistant with families at 
an agreed upon location. 
 
If a caregiver or youth are unable to complete a measure at the prescribed visit, the assessment will be 
attempted at the next study visit.  
 
Compensation. Caregivers in both groups will receive a $25  gift card at the their study entry visit and at 
their 3, 6, 9, 12, and 18 month assessments for completion of study related forms, questionnaires, and 
interviews.  Caregivers in both groups will also receive at $5 gift card once a month during the time of the 
CCM intervention (4 months) each time they complete the monthly online assessment (or phone 
interviews). Caregiver have the potential to earn a total of $170 worth of gift cards for participating. 
Caregivers assigned to the CCM group, may also earn up to $737.10 in prizes (see more details below).  
 
Youth in both groups will receive a $25 gift card at the their study entry visit and at their 3, 6, 9, 12, and 
18 month assessments for completion of study related forms, questionnaires, and interviews.   Youth in 
both groups will also receive a $5 gift card once a month during treatment for a total of 4 month each time 

 
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they complete the monthly online assessments (or phone interviews). Youth have the potential to earn a 
total of $170 worth of gift cards for participating. 
 
Provider organizations will be issued a sponsor provided check to cover therapist effort related to study 
procedures.  The organization will receive yearly checks that cover a percentage of therapist’s salary for 
time spent on this project. The amount of this check will vary depending on individual therapists’ juvenile 
drug court caseload.  Compensation will be mailed directly to the treatment facility. 
 
The juvenile probation department will receive sponsor issued checks in the among of $10,000 per year 
for having juvenile drug court personnel participate; and $300 per year for the juvenile drug court 
supervisor’s collection of information on the caregiver’s drug court attendance.   This is part of the 
contract for services. Compensation will be mailed directly to the juvenile probation department.   
 
Intervention specifications: 
 
Treatment as Usual.   All participants will receive TAU regardless of whether they also receive CCM. 
The CCM protocol was designed as a flexible intervention that can either stand alone or be added to usual 
clinical practice. Given JDC’s treatment contracts with the Center for Healthcare Services (CHS), Family 
Services Association (FSA), and Elite Counseling caregivers and youth will be receiving treatment as 
usual from either CHS, FSA, or Elite Counseling.  CHS and Elite use the Cannabis Youth Treatment 
(CYT) project protocol and the parent group focuses on support and substance use education (modeled 
after the Family Support Network protocol). The theoretical orientation of the CYT treatment is 
cognitive-behavioral theory.  Groups focus on promotion of abstinence from drugs and alcohol, 
anger/stress management, conflict resolution, identifying triggers, relapse prevention, and decision-
making skills. At the FSA, uses the home-based Multidimensional Family Therapy (MDFT) approach.   
MDFT includes a mix of individual therapy for the adolescent, interventions with the parent, and family-
based sessions.  Individual therapy with the adolescent is cognitive-behavioral based and focuses on 
helping teens build skills in (1) identifying links between their feelings and thinking patterns, (2) using 
effective communication strategies, (3) using problem solving skills, (4) using anger and impulse control 
skills, and (5) building social competence. The parent interventions focus on rebuilding the caregiver-
parent relationship by working to increase parental commitment and involvement with their adolescent. 
Sessions also focus on supporting parents in consistent and appropriate limit setting, regular monitoring 
of activities and school performance.  Family-based sessions focus on changing the parent-child 
interaction patterns and may involve other family members. 
 
Caregiver Contingency Management (CCM). In addition to receiving the TAU described above, caregiver 
participants will receive prize draws similar to those developed and used by Petry et al. for engaging in 
verifiable activities consistent with their adolescents’ successful completion of the JDC program during 
the time the youth is actively involved in JDC and substance abuse treatment. Specific activities that may 
be reinforced include: attendance at drug court status hearings; accompanying the teen to probation 
meetings; participating in scheduled home visits; attendance to the youth’s drug treatment sessions; 
attendance at mental health provider meetings; attending groups for parents of youth with substance abuse 
issues; and completing other verifiable treatment-related activities. Some additional planned activities that 
may not be directly related to JDC, but nevertheless could positively enhance the teen’s outcomes, might 
include:  the parent attending one’s own treatment or mutual support group (in the case where the 
caregiver is also in recovery); meeting with the youth’s teachers to enhance his/her educational support; 
enrolling in and attending a parenting class; attending or engaging in pro-social activities with the youth 
(e.g., enrolling the youth in a sport or arts program, engaging in a family outing with the youth). All 
activities should meet the goals of (directly or indirectly) enhancing caregiver participation in the JDC 
and/or treatment process. Caregivers will receive escalating chances for tangible reinforcers each week 
for completing up to 3 of the activities agreed upon by the caregiver and the therapist. Activities must be 

 
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agreed upon by the CCM therapist and the caregiver a priori each week. It is expected that these activities 
will vary from week to week and from family to family. For example, adolescents will not have court 
dates every week and clinicians occasionally cancel substance abuse treatment sessions (making it 
impossible for the family to attend). Thus, we plan some flexibility around reinforced activities while also 
requiring that the activities reinforced must be related to drug court outcomes. Importantly, regardless of 
the activities planned, the therapist and caregiver must establish an a priori way to verify that the activity 
was completed.  The verification will be required for the caregiver to receive reinforcement. The specific 
activities reinforced will be documented and tracked each week by the CCM therapist in collaboration 
with the caregiver. Caregivers will be allowed escalating numbers of draws from a prize-urn for 
completing the pre-arranged and verified target activities. The CCM prize-urn will be implemented by the 
therapist once per week. Following the initial session with the CCM therapist, the caregiver will receive 
one draw from a prize-urn for each successfully completed activity (up to three).  For each subsequent 
session in which the caregiver completes the target activities, the number of draws will increase by one, 
and keep increasing weekly up to a maximum of five draws per behavior on any one occasion. Thus, it 
would be possible for caregivers to reach a maximum of 15 draws per week. If the caregiver does not 
meet an agreed upon target (e.g., does not attend JDC, drug treatment, or does not complete homework 
assignments), he/she will not receive a prize draw and the number of draws will be reset to one for each 
target behavior at the next session. Thus, although caregivers may receive reinforcement for one or two 
completed behaviors (out of a possible three), failure to complete three assigned behaviors will result in a 
reset of prize draws for the next session. The only exception to this rule will be if the caregiver: 1) 
experiences an event that is out of his/her control that prevented completion of the target behavior (e.g., 
documented family emergency or cancelled court date); and 2) he/she was unable to reach the CCM 
therapist to arrange for another activity. “Excused misses” will not result in a reset of prize draws. The 
prize-urn in the present study is similar to the one used in two recent studies of adults in substance abuse 
treatment. It will be filled with 500 slips of paper, with 50% (250) not resulting in a prize (“good job”), 
175 (35.0%) small prizes (worth about $1), 74 (14.8%) large prizes (worth $20), and one (.2%) jumbo 
prize (worth $100). Thus, the average value of each prize draw is $3.51, and a caregiver who participates 
for 16 weeks can earn up to a maximum average of $737.10 in prizes. 
 
Training and Treatment Fidelity. Strong treatment fidelity is critical to internal validity of the study, and 
well-developed protocols will be used. An expert in CM (Dr. Randall) and prize-based CM procedures 
(Co-PI Ledgerwood) will provide training and ongoing quality assurance support for therapists in CCM 
using protocols that we used in geographically distant sites with out-of-state therapists. Training: CCM. 
Providers at the participating organizations and others interested in and around the San Antonio area will 
receive training in caregiver contingency management. Training will be based on procedures from a 
recent NIH funded study designed to train community clinicians to effectively administer CM. Dr. 
Ledgerwood (Co-PI) will conduct two half-day trainings that include didactic instruction on CCM, 
demonstration of procedures for monitoring and tracking target behaviors, practice role-play exercises, 
and developing homework and clinical tasks for caregivers to complete. Before and after completing the 
CCM didactic training, the therapist will complete a 15-item test that assesses general knowledge about 
contingency management and behavior therapy principles. Therapist that are selected to participate (i.e., 
willingness to participate and those who work at the identified participating providers) will receive 
additional training about the specifics the study protocol and will be asked to complete an additional 
multiple choice-test that assesses therapist understanding of the specific protocol procedures of the 
present study. Selected therapist must successfully complete role-play tests with either Dr. Randall or Dr. 
Ledgerwood to ensure he or she can administer CCM effectively. The role plays will provide brief 
descriptions about scenarios in which the therapists are expected to demonstrate specific skills relevant to 
CCM (e.g., describe treatment to a caregiver; provide increasing reinforcement to a caregiver who meet 
the behavioral targets for the week). CM experts (study PIs and Co-Investigators) will rate audiotapes of 
the role-plays using the Contingency Management Competence Scale (CMCS). Initially, raters will 
establish interrater reliability, and minimum coefficients of .80 will be required for acceptable ratings. 

 
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The therapist must obtain scores of at least 80% on relevant objective tests and minimum average scores 
of 4/7 on the role-play tests before being eligible to treat study participants. Therapists will implement the 
conditions with 1-2 closely-supervised pilot cases prior to beginning treatment with study participants. 
Ongoing supervision.  Dr. Randall will provide quarterly 1-day booster trainings for protocol therapists in 
areas identified as presenting difficulties in adherence or achieving clinical outcomes. Protocol therapists 
will also receive telephone consultation from Dr. Randall approximately once per week. These calls focus 
on promoting adherence to CCM components and developing solutions to difficult clinical problems (e.g., 
developing strategies for helping caregivers effectively communicate with the court and adhere to judicial 
recommendations, designing plans to overcome youth barriers encountered in drug treatment).   Ongoing 
Assessment of Fidelity to CCM. To ensure ongoing fidelity to the prize-based CM procedures, CM 
experts and or RAs will rate 25% of all audio-recorded sessions (randomly selected within condition) for 
fidelity using the CMCS observational rating system described by Co-PI Dr. Ledgerwood and 
colleagues.84 In the case that the therapists’ ratings fall below a minimum average score of 4/7, or if there 
are precipitously low scores on any specific aspect of CM (e.g., therapist never assesses desire for prizes), 
we will conduct additional training with the therapist until his/her ratings have reached an acceptable 
level. 
 
 
Please see the attached “Schedule of Assessments” for more information about which procedures occur at 
a visit. 
 
6.0 RISKS & BENEFITS 
 
Caregivers and Youth Risks related to the assessments include those that are less likely (less than 5-20 
subjects out of 100) and Not Serious:  
 
(1) Coercion. Several steps will be taken to make sure study participants do not feel coerced into 
participating in this research study: (a) all researchers who have contact with participants will 
have completed training courses in how to protect people who are in research studies, (b) if 
caregivers or youth indicate an unwillingness to be in this study, caregivers and youth will be 
allowed to withdraw from the study, and (c) all researches will make sure that the people working 
in juvenile drug court will not attempt to influence the caregiver or youth’s participation, beyond 
providing the initial referral. 
 
(2) Embarrassment. Selected research assistants and all investigators have been trained in how to 
help participants not to feel embarrassed while serving as a study participant. To help particpants 
not feel embarrassed while in the study: (a) research staff will be carefully chosen and trained by 
the investigators; (b) participants will be reminded throughout this study that they can stop being 
in this study at any time; and (c) if problems do come up, the site Investigator (Dr. Stacy Ryan) or 
the Site Coordinator will arrange to meet with participants to talk about the problems. 
 
(3) Discomfort. During the interview, there may be times when a particpant feels a little 
uncomfortable or has some negative emotions because of what is being talked about.  However, it 
is expected that the feeling(s) will be no more than what people feel on a daily basis from similar 
topics, discussions, situations, and/or interactions. 
 
(4) Disclosure. For youth, results from the surveys, observations, interviews, and urine drug test 
could be shared with caregiver(s) should they ask to view their youth’s responses. If caregiver(s) 
requests to see their youth’s responses or results, we will meet with the caregiver(s) first to 
discuss their concerns and give suggestions for methods that will address their concerns and be 
more helpful immediately and in the long term. After this meeting, if your caregiver(s) still wish 

 
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to review their youth’s results, the site coordinator will meet with the youth and the caregiver 
together to help there be a discussion of the information that is helpful for the youth. 
 
 
Juvenile Drug Court Personnel Risks related to the assessments include those that are less likely (less than 
5-20 subjects out of 100) and Not Serious: 
 
(1) Discomfort. While answering questions or during the interview, participants may become 
uncomfortable answering questions or feel increased emotions because of what is being asked or 
discussed.  If participants feel uncomfortable answering questions, one of the investigators will 
speak with the participant to help clarify doubts. Participants responses will be kept confidential 
and they will be told that they do not have to answer questions that make them feel 
uncomfortable. However, it is expected that the feeling(s) will be no more than the usual level 
that individuals experience on a daily basis from similar topics, discussions, situations, and/or 
interactions. 
 
Therapists’ Risks related to the assessments include those that are less likely (less than 5-20 subjects out 
of 100) and Not Serious: 
 
(1) Discomfort. While answering questions or during the interview, participants may become 
uncomfortable answering questions or feel increased emotions because of what is being asked or 
discussed.  If participants feel uncomfortable answering questions, one of the investigators will 
speak with the participant to help clarify doubts. Participants responses will be kept confidential 
and they will be told that they do not have to answer questions that make them feel 
uncomfortable. However, it is expected that the feeling(s) will be no more than the usual level 
that individuals experience on a daily basis from similar topics, discussions, situations, and/or 
interactions. 
(2) Increased stress.  Taking part in a research study as a research therapist might feel stressful at 
times because participants will be asked to complete forms, paperwork, and participate in an 
interview that you would not otherwise complete for a family in treatment.  If participants feel 
burdened by study related procedures, questionnaires, and/or interview, one of the investigators 
will speak with the participant to help resolve stress.  As part of this study, the time required to 
complete the procedures, paperwork, and interview is compensated as described in the 
compensation section above. 
 
Caregivers and Youth, Juvenile Drug Court Personnel, and Therapists Risks that are Rare (less than 5 
subject out of 100) and Serious: 
 
(1) Breach of confidentiality. It is possible in a rare situation that there may be a violation of 
participant confidentiality.  However, the researchers have taken steps to make sure this does not 
happen such as keeping audio recordings and all research materials in a secure, locked location 
and coding materials with numbers rather than names 
 
7.0 STATISTICAL ANALYSIS 
The research and measurement design leads to a two level data structure with repeated 
measurements of youth and caregiver outcomes (level-1) nested within youth/caregiver (level-2). 
Accordingly, the data will be analyzed using mixed-effects regression models (MRMs). This highly 
flexible approach accommodates several features of the proposed outcomes, including variability in the 
number and spacing of measurements within and between participants, a variety of outcome distributions, 
and potential for linear, non-linear, and discontinuous patterns of change over time.  

 
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Individual trajectories. Prior to modeling, the observed trajectory of each youth/caregiver on each 
outcome will be plotted using “spaghetti plots.” This will illustrate sample variability in trajectories over 
time, within and between youth/caregiver, and will inform subsequent model specification.  
Model building & estimation. The data will be analyzed using MRMs. This approach provides a 
variety of options for modeling change over time, including linear, non-linear, and phase-specific (e.g., 
during-treatment, post-treatment) patterns of change. Prior to analysis, each outcome will be graphically 
and descriptively evaluated to determine the best distribution for modeling. The model building approach 
detailed by Singer and Willett will be used to specify fixed and random effects. First, a fully 
unconditional model will be estimated to determine the proportion of within- and between-subject 
outcome variance. Second, at the repeated measurements level, and informed by the spaghetti plots, 
growth terms (e.g., linear, quadratic) will be specified to explain the within-subject variance. These terms 
will be computed using participants’ actual assessment dates, tailoring the model to the observed spacing 
of measurements.100 Third, the effect of CCM will be modeled by an uncentered, dichotomous indicator 
(i.e., CCM = 1, TAU = 0) at youth/caregiver level (i.e., level-2), and cross-level interaction effects will be 
specified between the CCM indicator and the level-1 growth term(s). Before estimating the final model, 
fixed effect indicators will be included to test for systematic differences across therapists, providers, and 
districts/judges, and if identified, differences will be statistically controlled in the final model. The 
analyses will use an intention-to-treat approach, with youth/caregivers retained in the research 
measurement portion of the study independently of participation in the intervention. The models will be 
performed using HLM software.101 Significance tests for variance components will be based on the 
likelihood ratio test, tests for fixed effects will be based on the Wald test (i.e., β / SE), and 95% CIs will 
be computed to reflect the magnitude and precision of the effects. 
Aim 1: Evaluate whether caregivers receiving prize incentives (CCM) for attendance and 
participation in JDC and adolescent drug treatment show greater attendance and participation in JDC and 
adolescent drug treatment relative to parents not receiving CCM (i.e., JDC TAU). The data for evaluating 
this aim have a unique structure – caregivers will have different numbers of opportunities for attendance 
and participation. MRMs, however, readily accommodate this feature. The data will be structured with 
multiple scheduled dates for each youth/caregiver, and for each date, a value of 0 or 1 will reflect the 
attendance and participation status. The dichotomous attendance and participation outcomes will be 
modeled using a Bernoulli outcome distribution with a logit link function and Laplace approximation of 
the maximum likelihood function.102 For each outcome, the level-1, level-2, and cross-level terms will be 
specified as described above. This formulation will compare CCM and TAU on their change over time in 
attendance and participation. Of note, if the model building steps reveal low within-caregiver variability 
in attendance and participation, an unconditional level-1 model will compare CCM and TAU on the 
overall average level of attendance and participation. 
Aim 2: Examine whether youth whose caregivers receive prize incentives (CCM) have greater 
reductions in drug use and criminal re-offending relative to youth receiving treatment as usual (TAU). 
Aim 2 will be evaluated using a series of two-level MRMs with repeated measurements of drug use and 
antisocial behavior (level-1) nested within youth (level-2). For urine drug screens (UDSs), the number 
and spacing of measurements will vary both within and across youth. For the GAIN subscales and SRD, 
there will be six measurements per youth, scheduled to occur at 0, 3, 6, 9, 12, and 18 months following 
baseline. The archival criminal charge data, which will be comprised of charge dates within youth, will be 
evaluated to determine the most appropriate modeling approach. For instance, if charges occur 
infrequently, the outcome could be the total count of charges during the 18 month period, evaluated using 
a single-level generalized linear model with a negative binomial outcome distribution. Alternatively, if 
charges occur more frequently, the outcome could be specified as the count, or any occurrence, during 
time periods that correspond to the research measurements. The models for Aim 2 will test for differences 
between CCM and TAU on the drug use and antisocial behavior outcomes at baseline and in the rate 
(and/or acceleration) of change over time.  
Aim 3: Examine whether caregiver attendance and participation explain condition-related 
changes in youth drug use and criminal offending. Aim 3 will be tested using the product of coefficients 

 
Version: 2017 09 06 
 
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test for mediation and intervening variable effects reviewed by MacKinnon et al. (2002) and extended to 
multilevel applications by Krull and MacKinnon. For each outcome, the statistical test for mediation will 
be based on the estimation of two coefficients and their standard errors. These coefficients will be 
obtained from models that control for the level of therapeutic alliance, isolating the unique mediating 
effect of caregiver attendance and participation. The first coefficient (α), controlling for therapeutic 
alliance, represents the effect of CCM on caregiver attendance and quality of participation. The second 
coefficient (β), controlling for therapeutic alliance and the effect of CCM, represents the effect of 
caregiver attendance and quality of participation on youth drug use and antisocial behavior. Following 
estimation of these paths, the significance test will be conducted using asymmetric bootstrapped standard 
errors and confidence intervals for the product of coefficients (i.e., α×β) using the approach developed by 
MacKinnon and colleagues and implemented in the program PRODCLIN. Because the proposed 
mediators and outcomes follow longitudinal processes, a longitudinal formulation of the mediation model 
just described will be applied – the parallel process latent growth curve mediation model (e.g., Cheong et 
al.). This model will be implemented in Mplus software.  Alternative longitudinal specifications, as 
detailed by MacKinnon, will also be considered.  
Evaluation of Secondary/Exploratory Aim 4: Determine the acceptability and 
feasibility/disseminability challenges of the CCM parent engagement strategy and of YCM for parent 
participants, drug treatment providers, and JDC personnel. There are no inferential statistical analyses 
associated with Aim 4. Qualitative interviews will be recorded on audiotape, transcribed for analysis, and 
analyzed using traditional qualitative analysis (constant comparative method), in which categories and 
themes emerge during the analysis. The team will use a standard text retrieval and indexing software 
(NVivo) to facilitate the team in organizing and analyzing the data. This approach will yield conceptual 
dimensions rather than quantitative categories, and will highlight themes within and across interviews. At 
least three individuals will examine the data to permit triangulation of key themes across evaluators. 
Attrition & missing data. Youth will be retained in the research portion of the study 
independently of participation in the clinical intervention according to ITT principles (e.g., Nich & 
Carroll). This strategy, along with the successful participant tracking and retention protocols used in 
FSRC research, will minimize the amount of missing data. However, some data will inevitably be 
missing. The methods recommended by Schafer and Graham will be used to evaluate missing data 
assumptions and determine the best analytic strategy. A three-step approach will be used: First, for a 
small proportion of missing data and evidence that they are Missing at Random (MAR), the available data 
will be analyzed using the maximum likelihood-based estimation procedures described above. Second, for 
a non-trivial amount of missing data and evidence that they are MAR, multiple imputation for repeated 
measurements will be used to generate complete data. Third, if there is evidence of a non-random missing 
data mechanism (i.e., NMAR), pattern mixture models will be used to evaluate and control the effect of 
the missing data pattern in the models. 
 
 
 
8.0 
DATA MANAGEMENT & PRIVACY/CONFIDENTIALITY 
 
Use of identifiers with private 
information
 
 
List of identifiers 
 
 
Looked at by 
research team 
 
 
Recorded on 
an enrollment 
log, subject 
list, key list, or 
stored in a 
database
 
Recorded on 
data collection 
tools (CRFs, 
surveys, 
spreadsheets, 
etc.)
 
Recorded 
on 
specimen 
containers 
 
Shared 
with 
others 
(outside 
research 
team)
 
Stored after 
study 
completed 
Names 
☒ 
☒ 
☐ 
☐ 
☐ 
☒ 

 
Version: 2017 09 06 
 
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a study code that is linked to the 
individual’s identity using a key 
that is only accessible by the 
researcher
N/A 
☒ 
☒ 
☒ 
☐ 
☒ 
Address 
☒ 
☒ 
☒ 
☐ 
☐ 
☒ 
Dates (except year) 
☒ 
☒ 
☒ 
☒ 
☐ 
☒ 
Phone or Fax numbers 
☒ 
☒ 
☒ 
☐ 
☐ 
☒ 
E-mail addresses 
☒ 
☒ 
☒ 
☐ 
☐ 
☒ 
- Biometric Identifiers, including 
finger and voice prints  
- Full face photographic images 
and any comparable images 
☒ 
Specify: 
Results of 
urine screens 
& audio 
recordings 
☒ 
Specify: 
Results of 
urine screens 
& audio 
recordings 
☒ 
Specify: 
Results of 
urine screens 
& audio 
recordings 
☐ 
Specify: 
      
☐ 
Specify: 
      
☒ 
Specify: 
results of 
urine 
screens & 
audio 
recordings
All study related 
measures/assessments  
☒ 
 
☒ 
 
☒ 
 
☐ 
Specify: 
☐ 
Specify: 
☒ 
Specify:  
Any other pre-existing unique 
identifying number, 
characteristic, or code: Number 
associated with juvenile and/or 
adult arrest records   
☒ 
☒ 
☒ 
☐ 
☐ 
☒ 
 
 
Coding Plan
 
Describe the method that will 
be used to create and assign a 
unique study code to the data
A unique study identifier will be assigned to each participant corresponding to the 
order of their enrollment 
Describe the method that will 
be used to create and assign a 
unique study code to the 
specimens
The subject’s ID will be used for labeling urine specimens. See above for how 
subject IDs will be assigned. 
 
What is the format of the key? 
☐Paper 
☒Electronic 
Who will have access to the 
key? 
Access to this data is limited to study staff with IRB approval for working on this 
protocol.  Study staff will access identified data for the purpose of data entry and 
analyses.  Study staff requires access to identified data to conduct and monitor the 
study.   
Where will the key be stored 
and how will it be protected? 
 
Location(s): All results and data will be filed using this identifier, and the 
codebook (linking the identifier to the participant's name) will be stored in a 
double password protected file on a university sponsored server that is HIPAA 
compliant.  Data entry and database management will be done in an ongoing 
manner by project staff using a web-based data entry and project management tool 
(REDCap) hosted by a university on a password protected server that is password 
compliant.  This interface will provide password protected, secure (128 bit SSL) 
data entry and project management tools.   
 
Describe confidentiality measures: All staff will be trained in Human Subjects 
Protection.  There are a series of procedures in place to protect the confidentiality 
of the participants.  Biological specimens (urine samples) and psychiatric screening 
exams, drug-use information, behavioral and psychometric data will be obtained 
solely for research purposes.  Individuals who elect to participate will be assigned 

 
Version: 2017 09 06 
 
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V3 
 
an identification number.  PHI will not be transferred to another institution 
(detailed in the consent form). This transfer will only occur via a secure server that 
is double password protected.  Only IRB approved study staff (who have been 
granted access) at the institution will have access to the data.
 
 
Data / Specimen Storage Plan 
☒ 
Paper data 
Data are designed to be captured using electronic means.  
However, there may be instances when paper forms are 
necessary.  Paper forms will be handled in one two ways:  
(1) Immediately scanned into RedCap (see below) and 
attached as a PDF file to a participant’s study record. 
The remaining hard copies will be destroyed using a 
shredder. Upon entry into RedCap the paper forms are 
stored in a double password protected encrypted server. 
(2) Paper copies will be mailed, signature required, to the 
Site PI (Dr. Ryan) at Baylor. Upon arrival at Baylor, 
the paper forms will be entered into RedCap and then 
stored in HIPAA compliant, locked filing cabinets, 
housed within locked offices in the department of 
Psychology and Neuroscience.  
☒ 
Electronic data 
 
A MUSC (see coordinating center information below) 
laptop with encryption will be used to administer some of 
the research questionnaires. Data will be collected via the 
Research Electronic Data Capture (REDCap; a data 
collection tool) and managed using SPSS. Data quality 
will be ensured by real-time data validation in REDCap 
and standard data cleaning procedures in SPSS. This study 
will use REDCap hosted at the Medical University of 
South Carolina (MUSC; a collaborating site; and PI of the 
Sponsor Protocol) and is a secure (128 bit SSL), web-
based application designed exclusively to support data 
capture for research studies. 
 
Other research questionnaires will be hand entered into 
REDcap by research staff using desktop computers 
plugged into the Baylor server. 
 
Voice recordings and participant tracking logs will be 
stored on Box hosted by Baylor. Non-identifying 
information obtained via voice recording and tracking logs 
will be uploaded to Box at MUSC, a collaborating site and 
PI of the Sponsor Protocol. Box is a MUSC approved 
online file sharing system that is a secure and HIPAA 
compliant way to organize and store data.  MUSC has 
signed a “business associate agreement (BAA) with Box 
that provides additional security safeguards for sharing 
protected data. 
☒ 
Specimens 
Biological specimens (urine samples) will be obtained 
solely for research purposes. Urine samples will be tested 

 
Version: 2017 09 06 
 
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for drugs of abuse immediately and then the collection 
cups and testing strips will be disposed of immediately.  
☒ 
Long-term storage (following completion of 
the study and inactivation of IRB approval) 
      
Data will be stored in RedCap, the Box, and Baylor 
protected servers.
 
Sharing of Research Data/Specimens to Entities Outside Baylor University 
Entity 
 
 
Identifiabl
e materials 
Limited 
Data Set 
(i.e. may 
include 
elements of 
dates, city, 
state, zip)
Non-
identifiable 
materials 
Describe how the materials will be transferred 
from one location to another.   
 
Viewed 
Transferred 
Viewed 
Transferred 
Viewed 
Transferred 
☒ 
Coordinating 
Center: 
Medical 
University of 
South 
Carolina 
 
 
 
 
☒ 
 
☒ 
 
☒ 
 
☒ 
 
Describe: Data will be collected via and entered into 
the Research Electronic Data Capture (REDCap) 
hosted at the Medical University of South Carolina 
(MUSC) and is a secure (128 bit SSL), web-based 
application designed exclusively to support data 
capture for research studies.  Additionally, data will 
be stored on the Box hosted at MUSC. The box is a 
MUSC approved online file sharing system that is a 
secure and HIPPA compliant way to organize and 
store data.  MUSC has signed a “business associate 
agreement (BAA) with Box that provides additional 
security safeguards for sharing protected data. 
☒ 
Other sites, 
investigators 
or 
collaborators 
participating 
in this study. 
Specify:   
Alliant 
International 
University, 
Wayne State 
University 
  
 
 
 
 
☒ 
 
☒ 
 
☒ 
 
☒ 
 
Describe: Collaborators participating in this study 
will have access to the same REDCap and Box 
described above. Collaborating institutions are 
deferring to MUSC for IRB review.  
 
 
Study Intervention(s)  
 
Study Intervention(s) 
 
 
 
 
Routine or 
Research 
Only 
 
# 
encounters 
per subject 
Who will administer the intervention? 
Research 
Team 
Study Site 
Employees  
 
Commerci
al Source 
Other 
Caregiver Contingency 
Research 
16 
☐ 
X 
☐ 
Providers at 

 
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V3 
 
Management 
Center for 
Health Care 
Services, 
Family 
Services 
Association, 
and Elite 
Counseling 
where 
therapist are 
also study 
participants
 
Laboratory/Specimen collection 
Laboratory procedures 
 
 
 
 
# 
Procedures 
(per 
subject) 
Who is performing the lab procedure
Research 
Team 
Study Site 
Employees/Services 
 
 
Obtain 
specimen 
Perform the 
analysis 
Urine Specimens  
      
Up to 6 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University
Research 
assistant 
affiliated 
with Baylor 
University
 
 
 
 
 
 
 
 
 
ALL Other Research Activities 
Activities, Procedures, 
Services, Surveys, 
Chart Reviews, Tests, 
etc. 
 
 
 
 
# Research 
Activities 
(per 
subject) 
Who is performing the activity / service? 
Research 
Team 
Study Site 
Employees/Services 
 
 
Collect 
Perform the 
analysis 
Eligibility Screener 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University
 
 

 
Version: 2017 09 06 
 
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V3 
 
 
Wayne State 
University 
Demographics and 
Service Utilization 
Survey  
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Demographics –Youth 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Demographics – 
Therapist  
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Demographics – Juvenile 
Drug Court 
      
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina
 
 

 
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V3 
 
 
Alliant 
International 
University 
 
Wayne State 
University 
Child Behavior Checklist 
 
6 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Brief Problem Checklist 
– Caregiver 
 
4 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Brief Problem Checklist 
– Youth 
 
10 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Addiction Severity Index 
Self-Report 
 
2 
☒ 
Research 
assistant 
affiliated 
Baylor 
University ; 
 
 

 
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V3 
 
with Baylor 
University 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
Beck Depression 
Inventory-II  
 
2 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Working Alliance 
Inventory – Caregiver  
 
5 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Working Alliance 
Inventory – Youth  
 
5 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University
 
 

 
Version: 2017 09 06 
 
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Working Alliance 
Inventory – Therapist 
Report on Caregiver 
 
5 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Working Alliance 
Inventory – Therapist 
Report on Youth 
 
5 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Caregiver Contingency 
Management Session 
Tracking Sheet  
 
20 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Caregiver Treatment as 
Usual Session Tracking 
Sheet 
 
20 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
 
 

 
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V3 
 
University 
 
Wayne State 
University 
Homework Rating Scale 
– Caregiver 
 
20 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Homework Rating Scale 
– Therapist 
 
20 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Client Satisfaction 
Questionnaire – JDC 
Version 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Client Satisfaction 
Questionnaire – Clinic 
Version 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
 
 

 
Version: 2017 09 06 
 
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V3 
 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
Termination Questions 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Qualitative Interview – 
Caregiver 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Qualitative Interview – 
Therapist 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Qualitative Interview – 
Youth
 
1 
☒ 
Research 
assistant 
Baylor 
University ;
 
 

 
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V3 
 
affiliated 
with Baylor 
University 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
Qualitative Interview – 
Drug Court  
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Self-Report Delinquency 
Scale 
 
6 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
 
Global Appraisal of 
Individual Needs 
 
10 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina
 
 

 
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Alliant 
International 
University 
 
Wayne State 
University 
Youth Urine Drug 
Screen Form 
 
6 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Adherence Measure for 
Rating Audiotapes  
 
20 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
 
Caregiver Contingency 
Management Prize Sign 
Out Sheet  
 
20 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
JDC Therapist Protocol 
Quiz 
 
1 
☒ 
Research 
assistant 
affiliated 
Baylor 
University ; 
 
 

 
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V3 
 
with Baylor 
University 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
Knowledge of CM 
Principles 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Perceptions of Incentive 
Programs – Therapist 
 
2 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Perceptions of Incentive 
Programs – Drug Court 
 
2 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University
 
 

 
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Perceptions of Incentive 
Programs – Caregiver  
 
2 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Parent/Caregiver Drug 
Court Attendance Form 
 
52 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Arrest Records 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Barriers to Drug Court 
Participation 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
 
 

 
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University 
 
Wayne State 
University 
Barriers to Treatment 
Participation 
 
2 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Parent-Adolescent 
Sexual Communication 
 
3 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Juvenile Drug Court 
Caregiver Participation 
Ratings 
 
4-6 (for 
the 
number of 
months an 
individual 
is enrolled 
in drug 
court) 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
Caregiver Satisfaction 
with Caregiver 
Contingency 
Management 
 
1 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
 
 

 
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Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
Choice Questionnaire  
 
2 
☒ 
Research 
assistant 
affiliated 
with Baylor 
University 
Baylor 
University ; 
 
Medical 
University of 
South 
Carolina 
 
Alliant 
International 
University 
 
Wayne State 
University 
 
 
 
12.0 
DATA & SAFETY MONITORING  
 
Subject Safety 
Specify the procedure(s) you will be conducting to assess safety on an ongoing basis.  
 
 
 At each assessment period, youth complete forms that assess mental health symptoms including depression and symptoms of 
depression such as suicidality.  Additionally, substance use involvement is assessed, along with withdrawal symptoms.  Upon 
completion, study staff will examine  these items for participant response to determine whether safety protocols should be 
implemented.  At the first assessment and at the 5 month assessment, similar questions will be asked of the caregiver.  Counselors 
and juvenile drug court personnel will not complete similar questions. 
Monitoring: How often are you collecting the safety data listed above? 
 
 
At each visit for youth, these data are collected on at least one assessment form.  At the first assessment and month 5 assessment for 
caregivers. Research assistants will review  these responses and initiate safety protocols as needed. 
Assessing: How often and who will assess results of the safety data? Describe your plan to ensure that all safety data is timely 
and appropriately assessed for reportable events.  
 
 
Describe plan for reviewing safety data including how often it is assessed? 
 
Research assistants will review the ratings obtained.  For endorsing suicidal thoughts or withdrawal symptoms, 
the RA will notifiy the PI and the PI will interview the participant to assess safety and risk.  Should the interview indicate further 
intervention is necessary, a safety plan will be implemented, parents will be notified (if the particpant is the youth), and referrals or 
an escort for immediate treatment will be provided.
Who is responsible for assessing data for safety?  
 
☒   PI 
☒   Research Team Member 
 
 
Data Integrity 
Describe the specific data elements to be reviewed (e.g., inclusion/exclusion criteria met, accuracy of data transcription, units of 
measure are appropriately recorded, accuracy of calculations).  Also, include who is responsible for confirming the data is 
correct.
 
Time point: 
(Check all that apply)
Information to be reviewed:  
(Complete as applicable)
Who will review the information?  
(Check all that apply)

 
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☒   Each study visit 
 
For youth, ratings on the Global Appraisal of 
Individual Needs and the Brief Problem 
Checklist at months 1, 2, 3, 4, and 5. 
☒   PI 
☒   Research Team Member 
☒   Monthly 
 
At study entry and at the end of the 
intervention, caregiver’s report on the 
Addiction Severity Index and Beck 
Depression Inventory will be reviewed. 
☒   PI 
☒   Research Team Member 
 
 
Study Stopping Rules 
Under what conditions will study treatment be stopped on a single subject? 
 
1) If a participant verbally declines participantion; (2) If a participant passively declines particpation by not providing answers/not engaging 
in study procedures and it is determined that they understand the instructions; (3) If a participant becomes distressed by the intervention and 
concerns are not remediated with counseling.  
Who will make the decision to stop treatment on a single subject?
 
The PI 
Under what conditions will the entire study be stopped? 
 
If a serious adverse event as a result of participation in the study occurs, recruitment will be discontinued until the Data and Safety 
Monitoring Officer has reviewed the information and the participant has received adequate care. Subject recruitment will commence again 
only after the Data and Safety Monitoring Officer has given the investigators the permission to continue. In addition, if during the course of 
the trial new information becomes available about the effects of physical activity intervention for adolescents and caregivers that significantly 
impacts treatment approaches, then the Data Safety Monitoring Officer may review the evidence to make a decision about discontinuing the 
trial.
Who will make the decision to stop the study? 
 
The PI 
Who will monitor and report deviations and adverse events; and what documentation will be used to record these problems 
occurred?
The occurrence of deviations and adverse events will be monitored two ways.  One, the site PI will regularly (weekly) examine the 
database for protocol deviations and research assistant notes indicating an event that could be adverse; (2) research  
assistants will follow a well-established protocol of contacting the site PI immediately when there is a question about whether 
and event qualifies as a deviation or adverse event; (3) the site PI will meet with research assistants weekly to review 
completed assessments and this review will include quires of possible deviations and adverse events. 
 
Deviation or adverse events that seem unclear, will be discussed during weekly investigator calls.  Final reported to the IRB 
will be made by the site investigator.  Final reported to the funder will be made by one of the PIs, Dr. Cunningham or  
Dr. Ledgerwood. 
 
 
All protocol deviation will be reported to the IRB, including (but not limited to): failure to obtain consent form, informed consent ob
the initiation of the study procedures, omitting study procedures required by approved protocol, performing a  
study procedure that is not outlined in the IRB-approved protocol, failure to report an adverse event, enrolling participants 
outside of inclusion criteria, use of unapproved consent form, use of unapproved measures 
 
All adverse events will be reported to the IRB and to the funder, including (but not limited to): any participant distress that 
can be reasonably linked to the study protocol, death, and hospitalization.  
 
10.0 
REFERENCES 
 
26. Brown, S. A. (1989). Life events of adolescents in relation to personal and parental substance 
use. American Journal of Psychiatry, 146, 484-489. 
27. Kirby, K. C., Benishek, L. A., Dugosh, K.L., & Kerwin, M.E. (2006). Substance abuse 
treatment providers’ beliefs and objections regarding contingency management: 
Implications for dissemination. Drug and Alcohol Dependence, 85, 19-27. 

 
Version: 2017 09 06 
 
Page 39 of 45 
V3 
 
2. McLellan, A. T., Luborsky, L., Cacciola, J. I., Griffith, J., Evans, F., Barr, H., & O’Brien, C. 
P. (1985). New data from the Addiction Severity Index: Reliability and validity in three 
centers. Journal of Nervous Mental Disease, 173, 412-423. 
3. Hodgins, D. C., & El-Guebaly, N. (1992). More data on the Addiction Severity Index: 
Reliability and validity with the mentally ill substance abuser. Journal of Nervous and 
Mental Disease, 180, 197-201. 
4. McLellan, A. T., Luborsky, L., Cacciola, J. I., Griffith, J., McGahan, P, & O’Brien, C. P. 
(1988). Guide to the Addiction Severity Index: Background, Administration, and Field 
Testing Results (US Publication No (ADM) 88-1419) Washington DC: U.S. Department 
of Health and Human Services.  
5. Hendricks, V. M., Kaplan, C. D., Van Limbeek, J., & Geerlings. P. (1989). The Addiction 
Severity Index: Reliability and validity in a Dutch addict population. Journal of 
Substance Abuse Treatment, 6, 133-141. 
8. Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. 
Burlington, VT: University of Vermont Department of Psychiatry. 
8. Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. 
Burlington, VT: University of Vermont Department of Psychiatry. 
8. Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. 
Burlington, VT: University of Vermont Department of Psychiatry. 
20. Dennis, M. L., Funk, R., Godley, S. H., Godley, M. D., & Waldron, H. (2004). Cross-
validation of the alcohol and cannabis measures in the Global Appraisal of Individual 
Needs (GAIN) and timeline followback (TLFB; Form 90) among adolescents in 
substance abuse treatment. Addiction, 99, 120-128. 
21. Godlely, M. D., Kahn, J. H., Dennis, M. L., Godley, S. H., & Funk, R. R. (2005). The 
  tability and impact of environmental factors on substance use and problems after 
adolescent outpatient treatment for cannabis abuse or dependence. Psychology of 
Addictive Behaviors, 19, 62-70. 
22. Elliott, D. S., Ageton, S. S., Huizinga, D., Knowles, B. A., & Canter, R. J. (1983). The 
prevalence and incidence of delinquent behavior: 1976-1980 (Tech. Rep. No 26). 
Boulder, CO: Behavioral Research Institute. 
23. Huizinga, D. (1991). Assessing violent behavior with self-reports. In J. S. Miller (ed.), 
Neuropsychology of Aggression. Boston: Kluwer. 
23. Huizinga, D. (1991). Assessing violent behavior with self-reports. In J. S. Miller (ed.), 
Neuropsychology of Aggression. Boston: Kluwer. 
8. Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. 
Burlington, VT: University of Vermont Department of Psychiatry. 
8. Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. 
Burlington, VT: University of Vermont Department of Psychiatry. 
28. Hawks, R. L., & Chiang, C. N. (1986). Urine Testing for Drugs of Abuse. Research 
Monograph #73. National Institute for Drug Abuse: Rockville, MD. 
29. Substance Abuse Testing Committee (1988). Clinical issues in urinalysis of abused 
substances. Clinical Chemistry, 34, 605-632. 
30. Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working 
Alliance Inventory. Journal of Counseling Psychology, 36, 223-233. 
13. Attkisson, C. C., & Greenfield, T.K. (2004). The UCSF Client satisfaction Scales: I. The 
Client Satisfaction Questionnaire-8. In M. Maruish (Ed.), The use of psychological 

 
Version: 2017 09 06 
 
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testing for treatment planning and outcome assessment (3rd. Ed.). Mahwah, NJ: Lawrence 
Erlbaum Associates. 
14. Attkisson, C. C., & Greenfield, T. K. (1996). The Client satisfaction Questionnaire (CSQ) 
Scales and the Service Satisfaction Scale-30 (SSS-30). In Sederer L. I. & Dickey B. 
(Eds.), Outcomes Assessment in Clinical Practice (pp. 120-127). Baltimore: Williams & 
Wilkins. 
25. Lyon, J. M., Henggeler, S. W., & Hall, J. A.(1992). The family relations, peer relations, and 
criminal activities of Caucasian and Hispanic-American gang members. Journal of 
Abnormal Child Psychology, 20, 439-449. 
15. Attkisson, C. C., & Zwick, R. (1982). The Client Satisfaction Questionnaire, Psychometric 
properties and correlations with service utilization and psychotherapy outcome. 
Evaluation and Program Planning, 5, 233-237. 
16. Petry, N.M., Alessi, S.M., Ledgerwood, D.M., & Sierra, S. (2010). Psychometric properties 
of the Contingency Management Competence Scale. Drug and Alcohol Dependence, 109, 
167-174. 
31. Martin, D. J., Graske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with 
outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical 
Psychology, 68, 438-450. 
32. Buchan, B. J., Dennis, M. L., Tims, F. M., & Diamond, G. S. (2002). Cannabis use: 
consistency and validity of self-report, on-site urine testing and laboratory testing. 
Addition, 97, 98-108. 
17. Dennis, M. L., Titus, J. C., White, M. K., Unsicker, J. I., & Hodgkins, D. (2003). Global 
Appraisal of Individual Needs: Administration guide for the GAIN and related measures. 
Bloomington, IL: Chestnut Health Systems. 
12. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using 
Multisystemic therapy: An effective alternative to incarcerating serious juvenile 
offenders. Journal of Consulting and Clinical Psychology, 60, 953-961. 
14. Attkisson, C. C., & Greenfield, T. K. (1996). The Client satisfaction Questionnaire (CSQ) 
Scales and the Service Satisfaction Scale-30 (SSS-30). In Sederer L. I. & Dickey B. 
(Eds.), Outcomes Assessment in Clinical Practice (pp. 120-127). Baltimore: Williams & 
Wilkins. 
15. Attkisson, C. C., & Zwick, R. (1982). The Client Satisfaction Questionnaire, Psychometric 
properties and correlations with service utilization and psychotherapy outcome. 
Evaluation and Program Planning, 5, 233-237. 
16. Petry, N.M., Alessi, S.M., Ledgerwood, D.M., & Sierra, S. (2010). Psychometric properties 
of the Contingency Management Competence Scale. Drug and Alcohol Dependence, 109, 
167-174. 
17. Dennis, M. L., Titus, J. C., White, M. K., Unsicker, J. I., & Hodgkins, D. (2003). Global 
Appraisal of Individual Needs: Administration guide for the GAIN and related measures. 
Bloomington, IL: Chestnut Health Systems. 
12. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using 
Multisystemic therapy: An effective alternative to incarcerating serious juvenile 
offenders. Journal of Consulting and Clinical Psychology, 60, 953-961. 
39. No Citation Listed  

 
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12. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using 
Multisystemic therapy: An effective alternative to incarcerating serious juvenile 
offenders. Journal of Consulting and Clinical Psychology, 60, 953-961. 
36. No Citation Listed  
12. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using 
Multisystemic therapy: An effective alternative to incarcerating serious juvenile 
offenders. Journal of Consulting and Clinical Psychology, 60, 953-961. 
 
13. Attkisson, C. C., & Greenfield, T.K. (2004). The UCSF Client satisfaction Scales: I. The 
Client Satisfaction Questionnaire-8. In M. Maruish (Ed.), The use of psychological 
testing for treatment planning and outcome assessment (3rd. Ed.). Mahwah, NJ: Lawrence 
Erlbaum Associates. 
13. Attkisson, C. C., & Greenfield, T.K. (2004). The UCSF Client satisfaction Scales: I. The 
Client Satisfaction Questionnaire-8. In M. Maruish (Ed.), The use of psychological 
testing for treatment planning and outcome assessment (3rd. Ed.). Mahwah, NJ: Lawrence 
Erlbaum Associates. 
9. Achenbach, T. M. (1991b). Manual for the Youth Self-Report & 1991 profile. Burlington, VT: 
University of Vermont Department of Psychiatry. 
10. Schoenwald, S.K., Halliday-Boykins, C. A., & Henggeler, S.W. (2003). Client-level 
predictors of adherence to MST in community service settings. Family Process, 42, 345-
359. 
11. Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M. J., & Pickrel, S. G. (1999). 
Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on 
school attendance at posttreatment and 6-month follow-up. Children’s Services: Social 
Policy, Research, and Practice, 2, 81-93. 
12. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using 
Multisystemic therapy: An effective alternative to incarcerating serious juvenile 
offenders. Journal of Consulting and Clinical Psychology, 60, 953-961. 
13. Attkisson, C. C., & Greenfield, T.K. (2004). The UCSF Client satisfaction Scales: I. The 
Client Satisfaction Questionnaire-8. In M. Maruish (Ed.), The use of psychological 
testing for treatment planning and outcome assessment (3rd. Ed.). Mahwah, NJ: Lawrence 
Erlbaum Associates. 
14. Attkisson, C. C., & Greenfield, T. K. (1996). The Client satisfaction Questionnaire (CSQ) 
Scales and the Service Satisfaction Scale-30 (SSS-30). In Sederer L. I. & Dickey B. 
(Eds.), Outcomes Assessment in Clinical Practice (pp. 120-127). Baltimore: Williams & 
Wilkins. 
15. Attkisson, C. C., & Zwick, R. (1982). The Client Satisfaction Questionnaire, Psychometric 
properties and correlations with service utilization and psychotherapy outcome. 
Evaluation and Program Planning, 5, 233-237. 
16. Petry, N.M., Alessi, S.M., Ledgerwood, D.M., & Sierra, S. (2010). Psychometric properties 
of the Contingency Management Competence Scale. Drug and Alcohol Dependence, 109, 
167-174. 
17. Dennis, M. L., Titus, J. C., White, M. K., Unsicker, J. I., & Hodgkins, D. (2003). Global 
Appraisal of Individual Needs: Administration guide for the GAIN and related measures. 
Bloomington, IL: Chestnut Health Systems. 

 
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17. Dennis, M. L., Titus, J. C., White, M. K., Unsicker, J. I., & Hodgkins, D. (2003). Global 
Appraisal of Individual Needs: Administration guide for the GAIN and related measures. 
Bloomington, IL: Chestnut Health Systems. 
28. Hawks, R. L., & Chiang, C. N. (1986). Urine Testing for Drugs of Abuse. Research 
Monograph #73. National Institute for Drug Abuse: Rockville, MD. 
63. No Citation Listed  
82. No Citation Listed 
12. Henggeler, S. W., Melton, G. B., & Smith, L. A. (1992). Family preservation using 
Multisystemic therapy: An effective alternative to incarcerating serious juvenile 
offenders. Journal of Consulting and Clinical Psychology, 60, 953-961.  
 
 
 
 
 
 
 
 
 
 
 

 
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APPENDIX 1 
 
ASSESSMENT TABLE 
 
Measure 
Respondent 
Study 
Entry 
Month 
1 
Month 2 
Month 
3 
Month 4 
Month 5 
(post) 
Month 
6 
Month 
9 
Month 
12 
Month 
18 
Eligibility Screener 
Caregiver 
 
 
 
 
 
 
 
 
 
 
Demographics –CG  
Caregiver 
X 
 
 
 
 
 
 
 
 
 
Child Behavior Checklist  
Caregiver 
X 
 
 
X 
 
X 
X 
X 
X 
X 
Beck Depression Inventory-II  
Caregiver 
X 
 
 
 
 
X 
 
 
 
 
Addiction Severity Index Self-Report  
Caregiver 
X 
 
 
 
 
X 
 
 
 
 
Working Alliance Inventory – Caregiver 
Caregiver 
 
X 
X 
X 
X 
X 
 
 
 
 
Homework Rating Scale – Caregiver 
Caregiver 
 
X 
X 
X 
X 
X 
 
 
 
 
Choice Questionnaire  
Caregiver 
X 
 
 
 
X 
 
 
 
 
 
Client Satisfaction Questionnaire – JDC Version 
Caregiver 
 
 
 
 
 
X 
 
 
 
 
Client Satisfaction Questionnaire – Clinic Version 
Caregiver 
 
 
 
 
 
X 
 
 
 
 
Qualitative Interview  - Caregiver 
Caregiver 
 
 
 
 
 
X 
 
 
 
 
Brief Problem Checklist – Caregiver 
Caregiver 
X 
X 
X 
 
 
 
 
Perceptions of Incentive Programs - Caregiver 
Caregiver 
X 
 
 
 
 
X 
 
 
 
 
BASELINE Parent-Adolescent Sexual Communication-Caregiver 
Caregiver 
X 
 
 
 
 
 
 
 
 
 
FOLLOW-UP Parent-Adolescent Sexual Communication-Caregiver 
Caregiver 
 
 
 
 
 
 
X 
 
 
 
Barriers to Drug Court Participation 
Caregiver 
 
 
 
X 
X* 
 
 
 
 
 
Barriers to Treatment Participation-Clinic Version 
Caregiver 
 
X 
 
X 
 
 
 
 
 
 

 
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Client Satisfaction Questionnaire – JDC Version for Caregiver 
Caregiver 
 
 
 
 
 
X 
 
 
 
 
Client Satisfaction Questionnaire – Clinic Version for Caregiver 
Caregiver 
 
 
 
 
 
X 
 
 
 
 
Demographics - Youth 
Youth 
X 
 
 
 
 
 
 
 
 
 
Brief Problem Checklist – Youth  
Youth 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Working Alliance Inventory - Youth 
Youth 
 
X 
X 
X 
X 
X 
 
 
 
 
Qualitative Interview  - Youth 
Youth 
 
 
 
 
 
X 
 
 
 
 
Self-Report Delinquency Scale  
Youth 
X 
 
 
X 
 
X 
X 
X 
X 
X 
Global Appraisal of Individual Needs 
Youth 
X 
 
 
X 
 
 
X 
X 
X 
X 
Choice Questionnaire  
Youth 
X 
 
 
 
 
 
 
 
 
 
Global Appraisal of Individual Needs (Section 2 only) 
Youth 
 
X 
X 
 
X 
X 
 
 
 
 
Client Satisfaction Questionnaire – JDC Version for Youth 
Youth 
 
 
 
 
 
X 
 
 
 
 
Client Satisfaction Questionnaire – Clinic Version for Youth 
Youth 
 
 
 
 
 
X 
 
 
 
 
BASELINE Parent-Adolescent Sexual Communication for Youth 
Youth 
X 
 
 
 
 
 
 
 
 
 
FOLLOW-UP Parent-Adolescent Sexual Communication for Youth 
Youth 
 
 
 
 
 
X 
 
 
 
Urine Drug Screen 
Youth 
X 
 
 
X 
 
X 
X 
X 
X 
X 
Demographics - Therapist 
Therapist 
X 
 
 
 
 
 
 
 
 
 
Working Alliance Inventory – Therapist Report on Caregiver  
Therapist 
 
X 
X 
X 
X 
X 
 
 
 
 
Working Alliance Inventory – Therapist Report on Youth 
Therapist 
 
X 
X 
X 
X 
X 
 
 
 
 

 
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Caregiver Contingency Management Session Tracking Sheet (CM 
condition only) 
Therapist 
 
collected weekly during months 1-4 
 
 
 
 
 
Caregiver Treatment as Usual Session Tracking Sheet (treatment as usual 
condition only) 
Therapist 
 
collected weekly during months 1-4 
 
 
 
 
 
Homework Rating Scale – Therapist  
Therapist 
 
X 
X 
X 
X 
X 
 
 
 
 
Termination Questions 
Therapist 
 
 
 
 
 
X 
 
 
 
 
Qualitative Interview  - Therapist 
Therapist 
administered yearly 
Perceptions of Incentive Programs - Therapist 
Therapist 
X 
 
 
 
 
 
 
 
 
 
Demographics – Juvenile Drug Court 
JDC personnel 
X 
 
 
 
 
 
 
 
 
 
Qualitative Interview  - Drug Court 
JDC personnel 
administered yearly 
Perceptions of Incentive Programs – Drug Court 
JDC personnel 
X 
 
 
 
 
 
 
 
 
 
Juvenile Drug Court Caregiver Participation Ratings 
RA 
 
X 
X 
X 
X 
X*