Using Goal Achievement Training in juvenile justice settings to improve substance use services for youth on community supervision

Abstract Background The link between substance use and involvement in the juvenile justice system has been well established. Justice-involved youth tend to have higher rates of drug use than their non-offending peers. At the same time, continued use can contribute to an elevated risk of recidivism, which leads to further, and oftentimes more serious, involvement with the juvenile justice system. Because of these high rates of use, the juvenile justice system is well positioned to help identify youth with substance use problems and connect them to treatment. However, research has found that only about 60% of juvenile probation agencies screen all youth for substance involvement, and even fewer provide comprehensive assessment or help youth enroll in substance use treatment. Method This paper describes an integrated training curriculum that was developed to help juvenile justice agencies improve their continuum of care for youth probationers with substance use problems. Goal Achievement Training (GAT) provides a platform for continuous quality improvement via two sessions delivered onsite to small groups of staff from juvenile justice and behavioral health agencies. In the first session, participants are taught to identify goals and goal steps for addressing identified areas of unmet need (i.e., screening, assessment, and linkage to treatment services). In the second session, participants learn principles and strategies of data-driven decision-making for achieving these goals. This paper highlights GAT as a model for the effective implementation of cost-efficient training strategies designed to increase self-directed quality improvement activities that can be applied to any performance domain within juvenile justice settings. Efforts to monitor implementation fidelity of GAT within the specific context of the juvenile justice settings are highlighted. Discussion Challenges to setting the stage for process improvement generally, as well as specific hurdles within juvenile justice settings are discussed, as are next steps in disseminating findings regarding the fidelity to and effectiveness of GAT in this unique context. Trial registration Clinical Trials Registration number – NCT02672150

Embedding Patients, Providers, and Community Stakeholders in Research to Improve Transgender Health

Background/Aims: The Institute of Medicine in its 2011 report highlights unique health challenges facing the transgender community. Evaluations of outcomes for medical gender reassignment (more appropriately termed “gender confirmation”) are rare and of low quality. The literature on treatment-related quality of life is limited and little is known about the long-term effects of contra-sex hormones on the risk of age-related chronic conditions. The Study of Transition, Outcomes & Gender (STRONG) research program will provide critical information about morbidity and mortality following gender confirmation treatments. It will also assess the comparative effectiveness of gender confirmation therapies for improving quality of life and alleviating gender dysphoria. The multidisciplinary STRONG research team includes investigators from five institutions. Members of the transgender community and health professionals who care for transgender individuals are an integral part of the team and are directly involved in all aspects of this research program including refinement of research questions, development of methods and content for data collection, and evaluation and dissemination of results. Methods: We identified the population of transgender individuals enrolled in the Veterans Administration and Kaiser Permanente health plans in Georgia and Northern and Southern California with a combination of validated ICD codes and keyword string searches. To evaluate mortality and morbidity, we will conduct an electronic medical record-based retrospective cohort study. To assess quality of life and other patient reported outcomes, we will conduct an online cross-sectional survey. Online and in-person focus groups with transgender stakeholders will guide data collection and interpretation of results. Results: ICD codes and keywords identified nearly 15,000 individuals. These preliminary findings indicate the STRONG program will represent the largest cohort of transgender individuals to date and the first such research effort in the United States. Six in-person focus groups have been completed with six more in progress. The study survey has been developed, programmed and pretested via online focus groups. Discussion: The STRONG research program will help close the health disparities gap for the transgender community through increasing scientific knowledge. The research findings will provide guidance to clinicians and policy makers in the care they provide to this sizeable, but underserved, community

Embedding Patients, Providers, and Community Stakeholders in Research to Improve Transgender Health

Background/Aims: The Institute of Medicine in its 2011 report highlights unique health challenges facing the transgender community. Evaluations of outcomes for medical gender reassignment (more appropriately termed “gender confirmation”) are rare and of low quality. The literature on treatment-related quality of life is limited and little is known about the long-term effects of contra-sex hormones on the risk of age-related chronic conditions. The Study of Transition, Outcomes & Gender (STRONG) research program will provide critical information about morbidity and mortality following gender confirmation treatments. It will also assess the comparative effectiveness of gender confirmation therapies for improving quality of life and alleviating gender dysphoria. The multidisciplinary STRONG research team includes investigators from five institutions. Members of the transgender community and health professionals who care for transgender individuals are an integral part of the team and are directly involved in all aspects of this research program including refinement of research questions, development of methods and content for data collection, and evaluation and dissemination of results. Methods: We identified the population of transgender individuals enrolled in the Veterans Administration and Kaiser Permanente health plans in Georgia and Northern and Southern California with a combination of validated ICD codes and keyword string searches. To evaluate mortality and morbidity, we will conduct an electronic medical record-based retrospective cohort study. To assess quality of life and other patient reported outcomes, we will conduct an online cross-sectional survey. Online and in-person focus groups with transgender stakeholders will guide data collection and interpretation of results. Results: ICD codes and keywords identified nearly 15,000 individuals. These preliminary findings indicate the STRONG program will represent the largest cohort of transgender individuals to date and the first such research effort in the United States. Six in-person focus groups have been completed with six more in progress. The study survey has been developed, programmed and pretested via online focus groups. Discussion: The STRONG research program will help close the health disparities gap for the transgender community through increasing scientific knowledge. The research findings will provide guidance to clinicians and policy makers in the care they provide to this sizeable, but underserved, community