Legal outcomes of task-shifting contingency management for youth substance use to rural probation officers: Secondary results from a randomized clinical trial.

OBJECTIVE

Youth substance use disorder is a significant problem in rural communities, yet treatment access is negligible. Task-shifting evidence-based treatments to juvenile probation officers (JPOs) may help, but could increase surveillance and thus be iatrogenic for legal outcomes. Task-shifting contingency management (CM) to JPOs was examined for increased youth legal system consequences.

METHOD: Data were from a randomized clinical trial that randomized 32 JPOs in Idaho to probation as usual (PAU) or family-based CM integrated into probation. Then, 160 youth with substance use disorder on probation were randomized to JPOs delivering PAU or JPO-delivered CM. Legal system records (charges and detentions) spanning 18 months before and after randomization were obtained for each youth from the state database.

RESULTS

For CM and PAU groups, respectively, 32.6% versus 51.4% had at least one charge postrandomization, 22.1% versus 20.3% had at least one detention, and median charge count was 0.0 (interquartile range, 0.0-1.0) versus 1.0 (interquartile range, 0.0-2.0). Intent-to-treat generalized linear mixed effects models nested youth within JPOs. Groups did not differ on charge count (event rates = 1.12; 95% CI [0.29, 4.36]) or likelihood of detention (OR = 1.54; 95% CI [0.65, 3.65]). However, CM youth had a significantly lower likelihood of receiving a charge (OR = 0.42; 95% CI [0.21, 0.83]), with a predicted probability of 31% (95% CI [21%, 42%]) versus 52% for PAU (95% CI [40%, 63%]).

CONCLUSIONS

Youth legal system consequences do not worsen when JPOs deliver CM. The likelihood of a new charge actually decreases when JPOs deliver CM. Task-shifting CM for youth substance use to JPOs could increase treatment access in rural communities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).