CHOICES-TEEN: Efficacy of a Bundled Risk Reduction Intervention for Young Women Involved in Juvenile Justice (Parrish & von Sternberg, M-PI)
National Institutes of Health, NIDA
Adolescent females in juvenile justice settings engage in multiple health risk behaviors that place them at risk for HIV and pregnancy affected by alcohol and marijuana. Specifically, they engage in frequent sexual risk behaviors, placing them at risk of pregnancy, STIs and HIV, while also using marijuana, and alcohol. With nearly half of U.S. pregnancies being unplanned, females unaware of their pregnancy will continue to drink or use marijuana during the early and critical weeks of gestation, which places them at risk of substance-exposed pregnancy. The long-term goal of this proposed line of research is to develop efficient and opportunistic interventions that reduce the risk of substance-exposed pregnancy (SEP) and HIV/STIs for justice involved female youth. Therefore, the overall objective of this study is to test the efficacy of CHOICES-TEEN (CT) for reducing the risks of SEP and HIV/STI in young women involved in community probation or diversion programs. CT was adapted from the CHOICES preconception intervention and its shorter version, CHOICES-PLUS, which have a robust history of efficacy in reducing the risk of alcohol and tobacco-exposed pregnancy with high-risk adult women. CT utilizes Motivational Interviewing (MI), which has demonstrated significant promise with adolescents and criminal justice populations. Our recent pilot study (R03DA034099; CHOICES-TEEN; CT-P), in which we adapted CHOICES for teens and tested its feasibility with youth on community probation, produced promising results. CT was modified based on this pilot work to 1) focus on marijuana (reported by 89% in CT-P study) rather than tobacco given the low prevalence and sporadic nature of nicotine use reported by the teens; 2) add a mobile health application to increase engagement with the daily journal and; 3) incorporate a post-CT self-regulation component targeting behavioral processes of change (POC). This study will move the field vertically by elucidating important factors influencing youth health behavior change, while testing an intervention designed to reduce individual and societal costs for this high risk, underserved adolescent population. The next logical step is to conduct a rigorous RCT to assess the efficacy of this gender-responsive, tailored bundled risk reduction intervention for young, primarily minority, women involved in a community-based juvenile justice diversion or probation program. A stage II behavioral intervention efficacy trial will:
Primary Aim: Test the efficacy of CHOICES-TEEN (CT) on reducing the risk of substance-exposed pregnancy (SEP) and HIV/STI among high-risk female youth involved with the juvenile justice system by reducing alcohol use, increasing marijuana cessation, reducing pregnancy risk, and increasing condom use.
Aim 2: Test the efficacy of CT, compared to AC, in increasing cognitive self-regulation abilities
Aim 3: Test proposed intervention mediators/mechanisms of action for CT overall and by race/ethnicity
Aim 4: Test the moderating effect of initial readiness to change on risk of SEP and risk of HIV/STI. If efficacious, CT is readily scalable and has the potential for dissemination not only to juvenile justice settings, but to a wealth of settings that serve young adolescent women at risk of substance-exposed pregnancies and HIV/STI.
SEARCH Homeless Services Research Partnership
Partnering with SEARCH Homeless Services in Houston, the project seeks to develop a programmatic evaluation template for annual reporting purposes and to work on research/evaluation projects that are designed to improve programming and disseminate research findings to share lessons learned and programmatic/intervention outcomes. As a contracted research scientist and evaluator, Dr. Parrish and her team provides evaluation expertise and conducts research and program evaluation with SEARCH Homeless Services’ early childhood education program (House of Tiny Treasures); a restorative community empowerment program (Coming Home) that brings congregations, volunteers, SEARCH staff and formerly chronically homeless individuals together in community; and the Family First program that serves families dealing with homelessness; among other projects. This work allows Dr. Parrish to continue to be involved in community-based practice in the local community.
Engagement of Young Adolescent Women in Cell Phone Use for Adjunct mHealth Application and Telehealth: A Usability Study. PI: Parrish
Funding Source: Grant Me the Wisdom Foundation
Given the wide use of technology by youth and its potential for boosting the efficacy of existing youth health risk interventions, research has supported the promise of mobile technologies in increasing intervention engagement, bolster health behavior change, and offer individual level support for longer periods of time than is feasible with traditional interventions. In the U.S., 97% of young adults have smartphones, making this mode of intervention delivery especially sensible. Moreover, the widespread adoption of such technologies – in particular the use of Telehealth often provided using cell phones – has increased dramatically during COVID-19, heightening the need to further understand the efficacy and implementation of remote services. In particular, as juvenile justice services are evolving toward the use of individualized risk assessments, diversion, and community-based services, Telehealth and mHealth technology can help increase the feasibility of service delivery by providing more convenient service access for these youth. This is particularly important given disparities in service access among justice-involved youth in the community compared with those who are detained. Research on the use of Telehealth by both master’s level clinicians and physicians has suggested that it is as effective as face-to-face delivery and it yields high levels of satisfaction across ages, presenting problems, and populations. However, there is a paucity of research on the use of Telehealth and mHealth applications with young women involved in the juvenile justice system. This current usability study will provide CIPA filtered, standardized cell phones to all 218 young women 14-17 participating in the intervention arm of a large randomized controlled trial to assess usability of the cell phone, Telehealth and the CHOICES-TEEN mHealth application. The young women will have access to the cell phones, the intervention mHealth application, and a hotspot provided through the cell phone service over a three-month period. The results from this study will inform future technology research and practice with this population. As such, the aims for this study include:
Aim 1: Assess young women’s use of the CHOICES-TEEN mHealth application by measuring content engagement and time engaged within this mHealth application.
Aim 2: Assess usability and satisfaction with the CHOICES-TEEN mHealth application and Telehealth using the CSQ-8, standardized usability scales, the Telehealth Usability Questionnaire, and open-ended questions.
BRIDGE: Behavioral Health in Developing and Growing Health Education and Training Certificate Program (Scott & Madden, PI/PD; Parrish, Evaluator)
Health Resources Services Association (HRSA)
The goal of the Baylor BRIDGE Training and Certificate Program, titled “Behavioral Health in Developing and Growing Health Education Training and Certificate Program, is to recruit, train and support a diverse group of social work emerging professionals in evidence-based, interdisciplinary behavioral health practices with youth and emerging adults. This program provides stipend support for advanced year MSW students at the Garland School of Social Work (GSSW) at Baylor University campuses in Waco and Houston, Texas to engage in courses, internship training, and didactic workshops focused on the best practices and established models in integrated behavioral health with an emphasis on delivery in community health primary care and consideration of pediatric patient needs. This program will also provide continuing education and support to current professionals serving our community partner organizations where students complete internship training through an annual continuing education webinar series and IBH education consultation services available upon request. All of these educational opportunities, both for MSW students and community partners, will be delivered by a multidisciplinary team of professionals – health psychologists, physicians, nurses, social workers – with extensive experience in integrated behavioral health. This team is led by two social work faculty with extensive integrated behavioral health experience and training as well as expertise in considerations for youth behavioral health needs. The proposed program can potentially train 108 MSW students and hundreds of current behavioral health professionals in the Waco and Houston communities over four years using culturally and linguistically responsive IBH models that effectively decrease barriers to populations that often do not have access to behavioral health care. The GSSW will engage in preparing these students for career placement after graduation, and provide additional career development support through networking, job coaching and interview consultation. In addition, students who opt to enroll in the Spanish-speaking track of the BRIDGE program will engage in a medical and behavioral Spanish language development curriculum (coached by a Baylor University faculty member in the Department of Modern Foreign Languages who specializes in medical Spanish and translation). Research shows that behavioral health professionals who are bilingual often provide more work tasks than their mono-lingual colleagues (Kaiser Family Foundation, 2016); therefore, in addition to additional stipend funding, these students will receive specialized faculty mentoring and support to help prepare them for entry into this demanding part of the workforce.