Engaging Criminal Legal System-involved Young Adults Through Supportive Employment: Cross-system Referral And Linkage To Address Overdose Risk, Suicide, And Behavioral Health Problems

About This Grant

Rates of overdose (OD), suicide, substance use (SU) and mental health (MH) problems are elevated among young adults involved in the criminal legal system (YACL). The majority of YACL are under community supervision (probation or parole) and live in communities where risk for OD post-release is substantial, and SU and MH treatment must be obtained from resource-limited behavioral health systems. Although many YACL would benefit from treatment, both structural and individual-level obstacles limit treatment uptake. Indeed, YACL frequently deny a need for treatment and prioritize employment over treatment/recovery. As such, 80- 90% of YACL needing treatment do not receive community-based services. Interventions that address treatment access and reduce YACL’s OD and suicide risk and SU/MH problems are urgently needed. Therefore, we propose to tailor e-Connect -- our efficacious system-level intervention designed to improve identification of suicide risk, SU and MH problems, increase referrals and increase treatment uptake for adolescents on probation -- for YACL by integrating OD risk screening and integrating peer support for YACL to create e-ConnectYA. We will capitalize on an established, nationwide, evidence-based employment training program designed specifically for criminal-legal system involved individuals, to deliver e-ConnectYA, accessing an otherwise hard-to-reach and disengaged population and harnessing the motivation associated with employment program participation to engage YACL with unmet treatment needs in services. Guided by the GPM and EPIS frameworks, this 5-year study will first tailor e-Connect to accommodate the needs of YACL to create e-ConnectYA (Aim 1). In Aims 2 and 3, we will use a type 1 hybrid effectiveness-implementation stepped-wedge trial design in n=6 CEO sites across 6 states to examine the effectiveness of e-ConnectYA. Sites will be randomized to one of 3 waves of active intervention. We will compare at the site-level e- ConnectYA with care-as-usual (baseline) CEO staff practice on (i) YACL SU/MH treatment initiation (any, MOUD, stimulant; primary outcome); (ii) employment; (iii) recidivism; and (iv) OD/SIB mortality risk (exploratory outcome). In Aim 3, we will examine e-ConnectYA implementation (uptake, feasibility, fidelity, acceptability, sustainability). We will document the process of implementation, comparing advancement through implementation stages across the 6 sites, and we will explore the role of site differences and other EPIS and GPM derived factors on implementation completion to inform scale-up of e-ConnectYA beyond CEO to other supportive employment programs/models.