Gender Responsive Substance Use Intervention for Justice-Involved Girls: Lessons Learned from the Voices Real-World Efficacy Trial

Introduction: The VOICES study is an efficacy trial of the gender-responsive VOICES program (a pre-existing already widely disseminated group-based substance use intervention developed by Dr. Stephanie Covington) with a broad range of substance using girls, at risk for or already involved in the justice system. The trial examines post-intervention outcomes of substance use, HIV/STI risk, psychiatric symptom and recidivism. The innovation of our scientific approach is that by testing the efficacy of a pre-existing widely disseminated substance use intervention as currently delivered in the community, findings on outcomes and key insights into mediators and moderators can be applied immediately to current service delivery. However, lessons learned along the way have significantly shifted our understanding of how we conduct these real-world efficacy trials with these girls and justice systems-- and highlighted critical barriers to and facilitators of effectively translating efficacy trial findings into real-world systems’ approaches to delivering the VOICES intervention in the community.

Methods: One hundred and thirty self-identified substance using girls and young women (ages 12-24) who are either at-risk for justice involvement (referred from the schools) or already justice-involved (referred from juvenile probation, diversion and court) will be enrolled. To date, the study has enrolled 92 female participants (46 school-based, 46 justice-involved). Participants are randomized to receive the VOICES or GirlHealth (psychoeducational attention control condition), each of which consists of 12, 1 hour group-based sessions, delivered weekly. Groups are delivered in the schools or in the community (for justice-involved, e.g., at probation offices) by trained study staff facilitators. Participants are assessed (using tablet-based questionnaires) at baseline, 1, 3, 6 and 9 months post-baseline.

Findings: Baseline data suggest that the trial is reaching the intended sample of justice-involved (or at risk for) substance using girls with co-occurring mental health symptoms and sexual risk behavior (e.g., 68% are sexually active, 41% used a condom at last sex and 34% with above clinical cut-off scores on the Brief Symptom Inventory). Examples of organizational and system-level challenges that have impacted the ongoing trial include: system referral gatekeeping (that limits access to girls in need), no single available time and/or community location for girls on probation to attend an outpatient group, multiple family moves, inaccessibility of caregivers for minor girls’ consent, differing youth and school/class schedules, long existing curriculum (originally 18, 90 minute sessions) and reliable reporting of substance use (for eligibility) in the context of justice involvement.

Conclusions: Preliminary efficacy trial outcomes will be discussed in light of these real-world efficacy trial challenges; in particular, how they impact interpretation of trial findings and how they inform next steps in translating findings to the community. Results will inform next steps for implementation science studies of gender-responsive substance use treatment programs for justice-involved girls.