Learning Health Systems and Substance Use Care Cascade Achievement Among Justice-Involved Youth: A Cluster-Randomized...

Area of Science:

• Public Health
• Health Services Research
• Substance Use Disorders

Background:

• Adolescents in the youth legal system (YLS) have high rates of substance use and disorders (SU/D) but low engagement with community-based behavioral health services.
• A care cascade framework highlights system-level deficits in connecting these youths to necessary treatment.

Purpose of the Study:

• To evaluate the effectiveness of a cross-system learning health systems (LHS) intervention in improving SU/D care cascade outcomes for YLS-involved youth.

Main Methods:

• A cluster-randomized, stepped-wedge trial involving 8 counties over 9-month intervals.
• LHS teams, comprising juvenile probation and mental health representatives, applied continuous quality improvement principles.
• Linked administrative YLS and Medicaid data were used to track 5731 adolescents (aged 11-17) from arrest through March 2025.

Main Results:

• The LHS intervention significantly reduced the time between arrest and SU/D risk screening (HR, 1.67).
• Significant improvements were observed in reducing the time from arrest to service initiation and engagement, particularly for youth arrested later in the study.
• The study tracked cascade steps including screening, identification, referral, initiation, and engagement in services.

Conclusions:

• The learning health systems (LHS) intervention effectively improved the timeliness of the SU/D care cascade for adolescents involved with the youth legal system (YLS).
• This model demonstrates a successful strategy for integrating legal and behavioral health systems to address critical care gaps.