Computerized Stage-Matched Intervention for Juvenile Offenders

Study Overview
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Brief Summary
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Juvenile crime imposes enormous costs on victims, on society, and on juvenile offenders themselves. However, research assessing the efficacy of interventions for young offenders show, on average, only small effects on recidivism, substance abuse, and other behavioral outcomes. A major problem with existing interventions is that they tend to neglect individual differences in motivation and readiness to make positive changes. In earlier research, we used an empirically validated model of behavior change, the Transtheoretical Model (TTM, the stage model), and expert system technology to develop the Rise Above Your Situation program (RAYS), a prototype of a multimedia computerized tailored intervention designed as an adjunct to traditional juvenile justice programs. The intervention delivers assessments and individualized feedback matched to readiness to stay out of trouble with the law and quit alcohol and drugs. At the end each session the program also generates a helpgiver report that summarizes the youth's feedback and presents concrete, easy-to-implement strategies helpgivers can use to reinforce stage-matched concepts. In the current research, the goals are to complete development of the computerized tailored intervention; develop training and other support materials for helpgivers; and assess the efficacy of the intervention package in a randomized clinical trial involving 700 medium- to high-risk court-involved juveniles aged 13-17 recruited by 54 probation officers randomly assigned to treatment or standard care. Primary outcomes will be criminal recidivism and substance abuse abstinence at 6 and 12 months follow-up.

Detailed Description
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Fifty-four probation officers employed by the Iowa's Juvenile Court Services agreed to participate in the study and to be randomly assigned to treatment or standard care. A Multiattribute Utility Measurement Approach (Graham, Flay, Johnson, Hansen, & Collins, 1984) was used to ensure that probation officers assigned to the two conditions were approximately equivalent on level of education, years of experience working with juvenile offenders, number of hours of training on the TTM, and confidence using the TTM in their work. Probation officers were responsible for recruiting moderate- and high-risk youth on probation, and delivering baseline assessment sessions and intervention sessions. However, local project site coordinators were available to provide assistance, as needed. Computerized follow-up assessments and urine drug testing at 6 and 12 months follow-up are being administered by trackers at a time and place that is convenient for the youth. Study protocols include best practices (Scott, 2004) for maximizing retention at follow-up in research involving high-risk populations.

Official Title
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Computerized Stage-Matched Intervention for Juvenile Offenders

Conditions
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Delinquency, Substance Abuse

Intervention / Treatment
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* Behavioral: RAYS Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Juvenile offenders: Score in the moderate- to high-risk range on the short-form Iowa Delinquency Assessment Age 13 to 17 at the time of recruitment Able to understand and read English Probation officers: Employed by Iowa Juvenile Court Services Work with moderate- to high-risk youth

Ages Eligible for Study
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Minimum Age: 13 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: RAYS intervention<br>In addition to standard care, participants receive three monthly online RAYS sessions, each followed by a one-on-one discussion with the probation officer | Behavioral: RAYS Intervention<br>* The Rise Above Your Situation program (RAYS) is a multimedia computer-tailored intervention that relies on the Transtheoretical Model of Behavior Change (TTM) and expert system technology to deliver assessments, feedback, printed reports, and helpgiver reports with intervention ideas. Helpgivers (probation officers in this case) use the reports to guide 1/2 hour follow-up discussions to reinforce intervention ideas and provide support.<br>|
| No Intervention: Standard care<br>Participants receive standard care from the probation officer | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Criminal recidivism based on self-report | Assessed using the General Crime Scale (GCS) of the Global Appraisal of Individual Needs (GAIN) | 12 months follow-up | 
| Criminal recidivism based on official records | Data will be provided by the Iowa Division of Criminal and Juvenile Justice Planning (CJJP) | 12 months follow-up | 
| Substance use abstinence based on self-report | Among youth who screened positive for substance abuse and/or dependence at baseline, assessed using the Substance Frequency Scale (SFS) from the GAIN | 12 months follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total count of criminal behavior based on self-report | Assessed using the General Crime Scale (GCS) of the Global Appraisal of Individual Needs (GAIN) | 12 months follow-up | 
| Stage of change for staying out of trouble with the law | Assessed using a self-report Transtheoretical Model of Behavior Change (TTM) stage of change measure developed by the PI | 12 months follow-up | 
| Emotional distress | Assessed using the 5-item Internalizing Disorder Screener (IDScr) of the GAIN Short Screener | 12 months follow-up | 
| Substance use frequency | Among youth who screened positive for substance abuse and/or dependence at baseline, assessed using the Substance Frequency Scale (SFS) from the GAIN | 12 months follow-up | 
| Substance-related problems | Among youth who screened positive for substance abuse and/or dependence at baseline, assessed using the Substance Problem Scale (SPS) from the GAIN | 12 months follow-up | 
| Stage of change for quitting alcohol and drugs | Among youth who screened positive for substance abuse and/or dependence at baseline, assessed using a self-report Transtheoretical Model of Behavior Change (TTM) stage of change measure developed by the PI | 12 months follow-up | 
| Abstinence confirmed by urine drug testing | Among youth who screened positive for substance abuse and/or dependence at baseline | 12 months follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transtheoretical Model, Stages of change, Computer-tailored intervention, Delinquency, Substance abuse, Juvenile offender, Juvenile justice, Rise Above Your Situation (RAYS) program