Defining quality indicators for practices, instruments, and programs across the JJ-TRIALS behavioral health services cascade

In order to address JJ-TRIALS goals of: a) improving behavioral health services for
youth with substance use problems; and b) advancing the investigation of implementation
efforts in the field of behavioral health, the JJ-TRIALS Workgroup on Evidence-Based
Practices (EPA) was first charged with defining quality indicators for practices and
programs. We limited that effort to programs, practices, and instruments relevant
to the steps in the Behavioral Services Cascade (Screening, Referral and Linkage,
Assessment, Prevention and Psychosocial Treatment) for five identified clinical problem
areas (Substance use, Mood disorder, ADHD, Trauma exposure, HIV risk). Problem areas
were selected as those of moderate prevalence among adolescents in community justice
systems with problem substance use. Quality indicators were consistent with the AACAP
Practice Parameters Clinical Standard, as reflecting either “rigorous empirical evidence”
or “overwhelming clinical consensus” (American Academy of Child and Adolescent Psychiatry,
2013). In a series of directed literature reviews, we catalogued evidence-based programs
and instruments addressing these problem areas that had been identified as most strongly
supported by existing systematic reviews (e.g., SAMHSA, 2011) and then categorized
them into tiers, based on their applicability for JJ-TRIALS efforts (e.g., number
of TRIALS problem areas addressed, administration format, delivery setting, inclusion
of family collaterals). These reviews identified 18 psychometrically sound screening
instruments (3 tiers), 16 sound assessment instruments (4 tiers), 43 EB prevention
programs (3 tiers), and 39 EB treatment programs (3 tiers). While the evidence base
regarding programs that focus on cross-system linkage (e.g., from screening in a probation
setting, with a subsequent referral to a behavioral health provider) is less established,
EPA was able to designate three tiers of such programs, defined both by their soundness
and their applicability to juvenile justice community settings. As a second set of
quality indicators, we considered core content components (that may cut across particular
instruments or programs). For assessment, these included eight elements essential
for clinical treatment planning for adolescents (e.g., family relationships, readiness
for change: American Society of Addiction Medicine, 2013). For treatment programs,
these included treatment modalities identified as effectively addressing one or another
of the TRIALS problem areas (e.g., CBT; Chorpita, et al., 2011). A final quality indicator
for assessment and treatment considered procedural elements (that relate to how an
instrument or program is used by a service provider), such as manualization, staff
training, and fidelity monitoring (e.g., Brannigan, 2004; Howell Lipsey, 2012).
EPA workgroup products will be incorporated into future JJ-TRIALS training efforts;
they will be used to generate menus of high-quality instrument and program options
to help juvenile justice partners and the behavioral health agencies with which they
collaborate to set implementation goals for participation in JJ-TRIALS.