Title: RISKIT-CJS Pragmatic randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a multi-component intervention to reduce substance use and risk-behaviour in adolescents engaged with the criminal justice system.
Funder: Department of Health and Social Care

Abstract: Aim: Mixed method, two-arm randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the RISKIT-CJS intervention in reducing substance use in young people in criminal justice settings. Setting: Youth Offending Teams in 3 geographical locations; South-East, London, North East England. Participants: Adolescents aged 13-17 years engaged with youth offending teams who score 2 or more for substance use on the ASSET tool. Intervention: RISKIT a multi-component intervention that addresses substance use and risk-taking behaviour including both group and individual work components. The intervention is delivered by trained, experience young peoples' substance use workers. The group intervention is provided in addition to treatment as usual and delivered in two half-day sessions over consecutive weeks and the combination of individual and group interventions is delivered over a four week period. Control: Treatment as usual as provided in the participating YOT. This will range from no intervention to referral for intervention from specialist services. Outcomes: Our primary outcome is percent days abstinent from substance use, 12 months after randomisation assessed using the Time Line Follow Back Method. Secondary outcomes include mental health wellbeing (WEMWBS), Strengths and Difficulties (SDQ) readiness to change (RCQ-TV), self-efficacy (SCQ) and criminal activity. Economic outcomes will be assessed using costs of intervention delivery and resources used from a health, social care and criminal justice perspective. Process will be assessed through recording interventions delivered and an assessment of intervention fidelity. Qualitative outcomes will be assessed through a combination of telephone semi-structured interviews with service providers and commissioners. Participant experiences will be explored using a purposive sample of participants at the end of the intervention and by employing participatory research approaches to enable participants to explore, analyse and interpret elements of intervention delivery. Assessments: Assessments will be conducted at baseline and then again at 6 and 12 months, face to face, with a trained researcher. Sample size: In order to maintain the efficiency of the study and minimise the associated costs we plan to allocate participants to control and intervention groups differentially, with twice as many participants allocated to the control arm as to the intervention arm. We aim to recruit 567 participants over a 12-month period with the aim of assessing at least 396 of these at the 12-month assessment. This will provide allow us to assess for an effect size difference of 0.3 or more between the groups in terms of percent days abstinent and mental wellbeing with 80% power within 95% confidence levels.

Lay abstract: There is a body of research that provides clear evidence that young people are more at risk of harm from substance use than adults. The developing brain is more susceptible to the effects of alcohol and drugs and adolescents are more likely to develop harmful and dependent drug use in a shorter time than adults. The impact of alcohol and drug use in adolescence can have life long implications, increasing the chances of experiencing physical and mental health issues and social problems. Young people who have committed an offence are far more likely to be using alcohol and drugs than other young people and there is clear evidence that their use of drugs is associated with their criminal activity. Many young offenders are managed in the community and there is evidence that these young people are more at risk of suffering negative consequences of drug and alcohol use. While the youth justice system routinely looks for signs of problematic drug use in this population access to treatment to address their use can be difficult and many of those in need do not receive any treatment. The RISKIT programme was developed to address the underlying issues associated with adolescence risk-taking. Taking risks is normal in adolescence but some take too many risks that are detrimental to their health and wellbeing. RISKIT was developed in association with adolescents and is designed to employ methods of treatment that young people said they needed and they felt would be useful. RISKIT uses small groups of young people to discuss and address common issues and also uses individual sessions to address individual needs. Evidence from our work in schools and criminal justice suggests that this approach is not only feasible to do with young people but that young people are willing to engage with the process. In addition, those that participate in the RISKIT programme are more likely to reduce their alcohol and drug use and manage their risk taking behaviour in a more appropriate ways leading to reductions in unprotected sex and criminal activity, all of which have implications for the future wellbeing of young people. In this study we plan to implement the RISKIT programme in youth offending teams to provide treatment for those who are most at risk of negative consequences associated with the use of alcohol and drugs. In order to assess the impact of the RISKIT programme we will conduct a scientific study where some young people will be offered the programme and some will not. In order to ensure the results of the study are related to the programme we will decide who receives the programme at random. In order to assess whether the programme works we will ask all of the young people in the study to provide information at the start of the study and then again 6 and 12 months later, we will assess this information for each group to make decisions about the effect of the RISKIT-CJS programme. In addition we will calculate the cost of the programme and the potential savings to health, social care and criminal justice services to assess the cost implications of the programme. A further element of the study will assess the programme from the perspective of young people themselves, looking at their experiences of what elements of the programme they felt useful or not. If the programme does benefit young people we will also explore how we could implement it in routine service to enable access for a wide variety of young people in the criminal justice system.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE