Telehealth Services for Adolescent Women Involved in Juvenile Justice: A Pilot Study during COVID-19

Background: The involvement of female adolescents in the juvenile justice system has risen dramatically in recent decades with female youth now constituting 30% of the juvenile justice population. Research has documented multiple, overlapping and elevated health risks among this population compared to the general population, including sexually transmitted diseases, pregnancy, substance use and mental health disorders. In addition to health-related risks, these young women are likely to display overlapping risk behaviors that suggest the importance of bundled programming (multiple health and mental health targets) to increase the breadth and efficacy of services in an opportunistic manner. The juvenile justice system continues to be ill-equipped in addressing these complex and often gender-specific needs, and even when services are beneficial, access is often limited. Telehealth has been identified as a promising method for the delivery of mental health care for youth, however there are a dearth of studies of the application of this technology with youth who may be receiving diversion or community-based services through the juvenile justice system. The aim of this Stage 1a pilot study was to assess the feasibility and acceptability of the Choices-Teen intervention with female youth 14-17 using Telehealth during the COVID-19 pandemic.

Methods: This mixed-methods pilot study assessed the feasibility and accessibility of the Choices-Teen intervention using Telehealth, as well as feedback on the use of an electronic daily journal and a mobile health application prototype for future intervention testing. While the initial intention was to assess delivery of 2 of the 4 sessions using Telehealth, COVID-19 restrictions precluded this leading to a full Telehealth delivery. Female youth 14-17 were recruited from community probation units and assessed for eligibility of risk of substance-exposed pregnancy. Five youth were recruited and completed the Telehealth Usability Questionnaire (pre/post), the Client Satisfaction Questionnaire-8 (post), and open-ended interview questions (post). The intervention – which has previously demonstrated feasibility, acceptability and promise in a prior study – was delivered by a PhD level interventionist trained in Choices-Teen and Motivational Interviewing. The intervention and data were collected using HIPPA compliant videoconferencing software. Data were analyzed by examining frequency of responses and a thematic analysis of interview responses. Thematic analysis was conducted by the research team to ensure consistency of coding.

Results: Young women reported high levels of usefulness, ease of use interface quality, interaction quality, reliability and satisfaction with Telehealth, as well as high levels of satisfaction with the Choices-Teen intervention delivered via a Telehealth platform. When compared with in-person services, most suggested a combination of both in-person and Telehealth sessions and were favorable about the proposed mHealth application and the online daily journal. Most expressed high levels of comfort with Telehealth and no concerns with privacy, although one did not like being on camera.

Implications: Telehealth appears to be a feasible and acceptable intervention delivery platform for youth involved in juvenile justice settings. After establishing an in-person connection, this technology may reduce service barriers for youth.