Abstract
BackgroundJustice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs.ObjectiveTo counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth—PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs.MethodsStaff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules.ResultsParticipants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training.ConclusionsOverall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP.
Highlights
Over 700,000 children and adolescents were arrested in the United States in 2019 [1], and African American and Latinx populations were disproportionately represented [2]
Participants demonstrated increases in HIV and sexually transmitted infection (STI) knowledge (t10=3.07; P=.01), and were very satisfied with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training
Justice-involved youth report elevated rates of mental health problems [3,4,5,6], substance misuse [7,8,9,10,11,12,13,14,15,16,17,18,19,20], and risky sexual activity [11,21], and compared to non-justice–involved peers, they are more likely to test positive for sexually transmitted infections (STIs) [22]
Summary
Over 700,000 children and adolescents were arrested in the United States in 2019 [1], and African American and Latinx populations were disproportionately represented [2]. Few evidence-based programs (EBPs) exist for justice-involved adolescents, and those that have demonstrated efficacy go largely unused [29,30]. According to the CFIR, EBPs may be seen as too complex to deliver (ie, intervention characteristics) [31], not an agency priority (ie, outer setting) [36], or difficult to integrate into the justice setting and ongoing programming (ie, implementation processes) [37]. The costs and staff time required to train in the EBPs are often viewed as prohibitive, especially in light of high staff turnover as is commonly observed in justice settings (ie, inner setting) [38]. Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Justice-involved youth experience increasing health disparities despite the availability of EBPs
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