title: The Juvenile Justice Behavioral Health Services Cascade: A new framework for measuring unmet substance use treatment services needs among adolescent offenders.
abstract: Substance use and substance use disorders are highly prevalent among youth under juvenile justice (JJ) supervision, and related to delinquency, psychopathology, social problems, risky sex and sexually transmitted infections, and health problems. However, numerous gaps exist in the identification of behavioral health (BH) problems and in the subsequent referral, initiation and retention in treatment for youth in community justice settings. This reflects both organizational and systems factors, including coordination between justice and BH agencies.
  
  
  
  This paper presents a new framework, the Juvenile Justice Behavioral Health Services Cascade ("Cascade"), for measuring unmet substance use treatment needs to illustrate how the cascade approach can be useful in understanding service delivery issues and identifying strategies to improve treatment engagement and outcomes for youth under community JJ supervision. We discuss the organizational and systems barriers for linking delinquent youth to BH services, and explain how the Cascade can help understand and address these barriers. We provide a detailed description of the sequential steps and measures of the Cascade, and then offer an example of its application from the Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal System project (JJ-TRIALS), a multi-site research cooperative funded by the National Institute on Drug Abuse.
  
  
  
  As illustrated with substance abuse treatment, the Cascade has potential for informing and guiding efforts to improve behavioral health service linkages for adolescent offenders, developing and testing interventions and policies to improve interagency and cross-systems coordination, and informing the development of measures and interventions for improving the implementation of treatment in complex multisystem service settings. Clinical Trials Registration number - NCT02672150.
authors.affiliation: Temple University, 1115 Polett Walk, Philadelphia, PA 19122, United States. Electronic address: sbelenko@temple.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Belenko
authors.affiliation: Texas Christian University, 3034 Sandage Avenue, Fort Worth, TX 76129, United States. Electronic address: d.knight@tcu.edu.
authors.forename: Danica
authors.initials: D
authors.lastname: Knight
authors.affiliation: Columbia University, 1051 Riverside Drive, Unit 78, New York City, NY 10032, United States. Electronic address: wassermg@nyspi.columbia.edu.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Wasserman
authors.affiliation: Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61701, United States. Electronic address: mdennis@chestnut.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Dennis
authors.affiliation: National Institute on Drug Abuse, 6001 Executive Boulevard, Room 5191, Bethesda, MD 20892, United States. Electronic address: wileytr@nida.nih.gov.
authors.forename: Tisha
authors.initials: T
authors.lastname: Wiley
authors.affiliation: George Mason University, 4087 University Drive, 4100, MSN 6D3, Fairfax, VA 22030, United States. Electronic address: ftaxman@gmu.edu.
authors.forename: Faye S
authors.initials: FS
authors.lastname: Taxman
authors.affiliation: University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, United States. Electronic address: Carrie.oser@uky.edu.
authors.forename: Carrie
authors.initials: C
authors.lastname: Oser
authors.affiliation: University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States. Electronic address: rdembo@usf.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Dembo
authors.affiliation: Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States. Electronic address: Angela.robertson@ssrc.msstate.edu.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Robertson
authors.affiliation: Emory University, Rollins School of Public Health, 1518 Clifton Road, Room 570, Atlanta, GA 30322, United States. Electronic address: jmcderm@emory.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Sales
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007604:Juvenile Delinquency; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*; D020380:Needs Assessment / Q000458:organization & administration / Q000592:standards*; D019966:Substance-Related Disorders / Q000628:therapy*
keywords: Barriers to treatment access; Continuum of services; Delinquent youth; Evidence-based practices; Juvenile justice; Substance abuse treatment