PROJECT SUMMARY Youth who are involved in the juvenile justice system (YJJ) are at particular risk for opioid-related harms, given their high rates of mental health and substance use disorders (SUDs) compared to youth who have never been arrested. Although evidence-based interventions (EBIs) for SUDs exist, few youth in general, and YJJ specifically, access EBIs. This is a particular difficulty in rural settings, where shortages of behavioral health specialists, limited access to transportation and other resources, and recruitment and retention challenges present additional barriers to behavioral health care. This difficulty is compounded during the opioid crisis, as adolescent use of opioids is more prevalent in rural areas where opportunities for substance use treatment are severely lacking. Indiana, specifically, ranks 46th in number of behavioral health treatment providers per individuals suffering addictions. The funded parent grant, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT), seeks to improve the clinical efficacy of treatment for rural YJJ. Specifically, the parent grant employs a Learning Health System model to develop alliances between the juvenile justice system and community mental health centers (CMHCs) in 8 rural counties and implement a bundled treatment approach to improve use of EBIs for SUDs. This Diversity Supplement proposes to expand this work in two ways. First, we will characterize EBIs for SUDs in rural CMHCs, including the services provided and the workforce involved. We will conduct qualitative interviews with staff and leaders at rural CMHCs to identify specific strategies used to implement EBIs for SUDs in rural settings, describe the providers involved and their roles in implementing these tasks, and define the rationale for the identified service-delivery model. Second, we will compare the youth SUD services provided and the workforce involved across more rural and less rural settings. Using linked administrative data from juvenile justice agencies, CMHC visits, and Medicaid insurance claims in participating counties, we will describe service and workforce variables relevant to the implementation of EBIs for SUDs, and compare SUD services between less rural and more rural areas. The results of this project will provide a fuller picture of current SUD treatment practices and guide future EBIs in rural settings. Specifically, results will inform future task-shifting model of care research to leverage lay health workers, case managers, and peer recovery coaches in the delivery of EBIs with fidelity in rural CMHCs.

PROJECT NARRATIVE We seek to learn about substance use services for youth within rural community mental health centers, with a special focus on youth involved in the juvenile justice system. We will use interviews with community mental health center staff and administrative data from juvenile justice, Medicaid insurance claims, and center visits to describe what youth substance use services are provided and by whom, as well as compare services between less rural and more rural areas. Knowledge about current services will inform future research seeking to improve access to and quality of substance use services for youth in rural areas.