Adoption of Family-Driven Behavioral Health Services in the Juvenile Justice System Restricted; Files Only

Piper, Kaitlin (Spring 2023)

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Family engagement in youth’s behavioral health care (e.g., including families in services and decisions related to the care of their child) is linked to increased treatment initiation and sustainment, as well as improved treatment outcomes among justice-involved youth. Although evidence-based family engagement strategies and frameworks, like Family-Driven Care (FDC), have been successfully implemented in many child-serving settings, like pediatric healthcare, the JJ system’s unique context and history creates challenges for building equitable family-staff relationships. Specifically, JJ systems are struggling to create spaces for trusting relationships with families due to the punitive nature of the system, power differentials between staff and families, and a culture that historically minimized the role of families, blamed and shamed families for their child’s behavior, and excluded families from decisions. To overcome these challenges, there is a need for context-specific guidance for mitigating barriers to integrating family engagement practices and FDC principles into the JJ setting. To address this gap, we conducted a theoretically-informed, mixed methods study, involving 140 leaders and staff from 61 JJ agencies across the state of Georgia, to identify contextual, multi-level factors related to the adoption of FDC principles and family engagement strategies in the JJ setting. Specifically, in aim 1, we conducted a mixed methods evaluation to understand the current level of adoption of each FDC domain across agencies in Georgia, and we assessed adoption variability by staff and agency characteristics. In aim 2, we conducted in-depth qualitative interviews with 16 JJ key informants (including leaders and staff from multiple JJ sectors such community services, reentry services, behavioral health, and education) to understand multi-level barriers, facilitators, and recommendations for engaging families in the JJ setting. Lastly, in aim 3, we utilized implementation-focused constructs from the Consolidated Framework for Implementation Research (CFIR) to quantitatively and qualitatively assess determinants of the adoption of FDC principles and strategies across JJ agencies in Georgia. Findings from this mixed methods dissertation will inform the scale-up of family-driven behavioral health programs in Georgia’s juvenile justice system and may inform implementation of this high priority intervention in systems nationally.

Table of Contents

Study Aims. 1

Chapter 1: Background and Significance. 6

Behavioral health needs of justice-involved youth. 6

Addressing behavioral health in the juvenile justice setting. 7

The behavioral health need-treatment gap among justice-involved youth. 9

Need for family engagement in youth services in the juvenile justice setting. 10

History of family engagement paradigms. 11

Figure 1: Ten guiding principles of family-driven care. 16

The challenge and opportunity of family-driven care in the juvenile justice setting. 16

Table 1. Family engagement strategy domains, definitions, and example applications. 19

Review of family engagement strategies utilized in juvenile justice systems. 20

Methods for integrating family-driven care into the juvenile justice system.. 28

Context of the juvenile justice system in Georgia. 30

References. 31

Chapter 2: Aim 1. 56

Abstract 56

Introduction. 58

Table 1. Family-Driven Care Domains, Definitions, and Example Applications. 63

Methods. 64

Study Design. 64

JJ System Context 64

Participant Recruitment 65

Measures and Data Collection. 66

Data Analysis. 68

Results. 68

Identifying and Involving Families. 70

Informing Families. 71

Collaborative Decision Making and Care Planning. 73

Family Diversity and Inclusion. 74

Organizational Feedback and Policy Change. 76

Family Peer Support 78

Logistical Support 79

Family Health and Functioning. 81

Table 2. Distribution of Survey Responses across Family-Driven Care Domains and Strategies. 84

Table 3. Relationships between Participant Characteristics and Family-Driven Care Implementation. 86

Discussion. 90

References. 101

Appendix. 118

Appendix 1. Mixed Methods Data Comparison Matrix. 118

Appendix 2. Relationships between Participant Characteristics and Family-Driven Care Domain Implementation. 127

Chapter 3: Aim 2. 132

Abstract 132

Introduction. 134

Methods. 137

Study Design. 137

JJ System Context 137

Sample and Recruitment 138

Data Collection. 139

Data Analysis. 140

Results. 140

Participant Characteristics. 140

Barriers to Family Engagement 141

Figure 1. Staff-identified multi-level barriers, facilitators, and recommendations for family engagement in JJ settings. 142

Facilitators to Family Engagement 147

Recommendations to Enhance Family Engagement 152

Discussion. 156

References. 164

Chapter 4: Aim 3. 173

Abstract 173

Introduction. 175

Methods. 180

Study Design. 180

JJ System Context 180

Participant Recruitment 181

Measures and Data Collection. 182

Table 1. Description of Variables and Measures. 183

Analysis. 189

Results. 191

Survey Results. 191

Table 2. Survey Descriptive Characteristics and Bivariate Statistics (n=140) 192

Table 3. Model Building for Family-Driven Care Outcome (n=140) 194

Table 4. Model Building for Family Engagement Strategies Outcome (N=140) 195

Qualitative Interview Results. 196

Discussion. 202

References. 210

Appendices. 223

Appendix 1. Descriptive Statistics of all survey items. 223

Appendix 2. Correlation Matrix of CFIR Constructs and Outcomes. 230

Chapter 5: Discussion. 231

Summary of Study Findings. 231

Overall Themes. 234

Strengths and Limitations. 241

Implications for Future Research and Practice. 243

Conclusions. 248

References. 250

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