Processes of referral to substance use treatment among justice-involved youth on probation: a mixed methods study

Justice-involved youth (JIY) on community supervision have a high prevalence of substance use compared to the general adolescent population. A significant percentage of JIY meet the criteria for a substance use disorder; however, only a small percentage receive any treatment. Referral rates for those in need of treatment are low, especially for JIY within the community. There has been little research focusing on the processes of referral and understanding how referral decisions are made. The referral process for JIY requires two systems, probation and behavioral health, to work together in the best interests of youth clients. Given the prevalence of substance use disorders among JIY on probation and the lack of treatment options, it is crucial to reduce unmet service needs and increase our understanding of the referral process. A conceptual model of the decision-making process for referral was developed to provide a framework to examine this process for JIY in need of treatment using a mixed methods approach. Using both quantitative and qualitative data from the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) several research questions were addressed to better understand these processes and how they differ across sites. The quantitative data based on administrative youth records focused on individual- and agency-level characteristics that influenced the likelihood of a referral for youth in need while the qualitative data, based on group interviews with probation and treatment staff, examined organizational systems factors such as communication and collaboration and family engagement among site staff to better understand how referral decisions are conducted. Quantitative analyses found that there is significant outcome variation across sites for youth being referred in need versus those not referred. Race, gender, supervision level, detention status, and having an AOD charge significantly predicted in the likelihood of youth being referred. Qualitative findings revealed several key domains related to the conceptual model including family engagement, insurance status, and inter-agency communication and collaboration. The qualitative findings also added nuance to some of the agency-level characteristics of the quantitative findings demonstrating the importance of the mixed method approach. The mixed methods findings also validated and enhanced the steps in the conceptual model in aiding to understand the referral process. This study is one of the first to examine the referral process for JIY on probation in depth using a mixed methods approach. As such, this research has important policy and theoretical implications regarding substance use treatment and the referral process for JIY. The findings are important given that referral rates are low and improving the referral process for youth in need of treatment is crucial to reduce poor health- and justice-related outcomes.