Adoption of Family-Driven Behavioral Health Services in the Juvenile Justice System Restricted; Files Only
Piper, Kaitlin (Spring 2023)
Abstract
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
About this Dissertation
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