My long-term career goal is to be an independent investigator in adolescent substance use, solving key barriers to health for justice-involved and other high-risk youth. My short-term (five year) career goal is to gain skills in social networks, adolescent substance use, and randomized trials, while gathering pilot data for an R01 to robustly test the proposed intervention. I will combine formal coursework, learning from my mentorship team and community partners, and research activities that fill these critical training gaps while positioning me for an R01 submission in year 3 of the proposed award. My research to date and review of the literature have convinced me that a vicious cycle exists between adolescent substance use disorders and youth incarceration. Re-wiring adolescent social networks during community reentry after incarceration can potentially break the vicious cycle of adolescent substance use and youth incarceration. Social networks powerfully influence adolescent substance use and delinquent behavior, yet little is known about how to intervene on social networks to improve health. Community reentry is a key opportunity to re-set youths' social networks and re-direct high-risk youth toward a healthier, more supportive network that can foster drug abstinence and reduce recidivism. We hypothesize that an adult who has successfully navigated reentry can actively guide youth to rewire their social network by encouraging pro-social relationships, troubleshooting basic barriers to healthcare and social services, and helping create linkages to substance use and mental health treatment services. The goal of this community-partnered study is to measure the impact of an innovative pilot intervention to address two key barriers to accessing behavioral health treatment among recently incarcerated youth: poor care coordination and need for more positive support from the social network. The proposed study intervention, the Youth Aftercare & Reentry Program (YARP), is based on the successful adult Transitions Clinic model, and is being adapted for delivery to youth by our community partners in the Los Angeles County juvenile justice system. YARP network coaches will provide recently released youth a formerly incarcerated adult role model who provides care coordination and social support to facilitate access to needed health services, and who actively intervenes to guide youth toward pro-social peers and adults. We propose a pilot longitudinal, randomized study of YARP, using a community-partnered participatory research approach. The primary outcome will be reductions in adolescent substance use in response to the intervention (Aim 1). Secondary outcomes will test whether the intervention increases receipt of behavioral health services, decreases recidivism and mental health symptoms, and improves school and work engagement (Aim 2). Finally, we will examine social networks as a potential mechanism by measuring whether youth receiving the intervention report healthier social networks (lower proportion of peers engaging in risky behaviors and a higher number of supportive adults) than control youth (Aim 3).
Re-wiring adolescent social networks during community reentry after incarceration can potentially break the vicious cycle of adolescent substance use and youth incarceration. We propose a pilot longitudinal, randomized study of a network coach intervention designed to link recently incarcerated youth to behavioral health treatment services and promote healthier social networks. Through the project, I will gain research skills in social networks, adolescent substance use, and randomized trials, and gather pilot data for an R01 to robustly test the intervention.
