BJ Risks and Benefits of Participating in Substance Use Treatment-Research: Perspectives of Justice-Involved Families Stacy R. Ryan-Pettes, Ph.D., and Yejin (Sally) Lee Baylor University; Department of Psychology and Neuroscience Introduction . Because justice-involved youth with substance use problems are required to enroll in treatment, recruiting and engaging them into substance use treatment-research poses ethical issues.1 . . . . . Despite commentaries on best practices, research has yet to include empirical data to help guide ethical decision making in behavioral treatment-research with justice-involved youth who are mandated to treatment.2 Empirical data is especially needed for studies that include incentives as part of treatment (e.g., contingency management) or study visits.3 The purpose of this study was to examine the reactions of justice-involved youth who are mandated to drug treatment and their legal guardians to a hypothetical randomized controlled trial that involves contingency management, and compensation for all study visits. Anticipated Themes Risks and benefits independent of treatment condition Treatment condition related risks and benefits Sample selection Methods Recruited from juvenile probation Projected N = 30; Current N = 19 (10 youth, 9 guardians) Design . Qualitative Measures Semi-structure interview following information about a randomized controlled trial involving randomization to services as usual or services as usual plus prize-based contingency management, and study-related assessments. for 18-month period Data Analyses . Line-by-line coding of the first four youth and guardian transcripts by independent raters to develop an initial codebook; raters reached consensus on the emergent codes and definitions for the codes Remaining transcripts were analyzed line-by-line using constant comparative analysis by one rater 25% of transcripts were double-coded by the second rater for reliability, K= .91 . Demographics Guardian Mage = 40.7 (SD = 10.95) Youth Mage = 15.8 (SD = 1.81) Guardian race & ethnicity: White (83.3%); Latinx (0%) Youth race & ethnicity: White (50%); Latinx (67%) Average annual total family income $20,001-$30,000 (50%) Guardian Burden People: 44% Preliminary Results: Risks Time: 100% "And anything else is just too much--especially with a teen's scheduling, extra-curricular, job, and god forbid, probation added all this other stuff." [Male60321, age 32] "It's a big burden. We don't have lots of time." [Female60221, age 39] Cognitive/Emotional Load: 89% "That's a lot. I might not remember everything. Mentally, it wears you out - already feels overwhelming." [Female60921, age 43] Resources: 78% "My car might break down, run out of gas trying to get to you. I got to work." [Female60421, age 31] "I don't know if there could be any benefit with meeting with all these people. Meeting with all these people would probably cause me to give up" [Male60321, age 32] Guardian 56% Parent-Child Conflict "We can't talk to each other; we have that issue. It just depends on his mood and how he's feeling, whether he wants to participate or not." [Female60821, age 45] 89% 20% Legal Parent-Child Conflict Youth 70% "When you explain to them about how you feel, they'll get upset and get mad...more vulnerability and maybe them having "Maybe the treatment is court-ordered and you don't do it and, you know, the child may be punished for not participating." [Female60121, age 45] reactions." [Female606, age 13] Legal "If you don't go to your counseling, it'll be a violation. If I don't go to this counseling, it will be a violation." [Male609, age 15] Preliminary Results B Comparison of the Perceived Risk and Benefit of Placement in the Experimental or Comparison Group: Guardian Risk Paived beneft in Expermental Preved Risk Compon Pekin Expe Perceived Banettin Comparison Parceved Equal Ri neft "Interestingly, all responses were coded under a Moral/values conflict theme. One the one hand, guardians would be excited to be placed in the experimental condition. On the other hand, they expressed feeling uncomfortable with the idea of getting a prize for something they should be doing. Preliminary Results Comparison of the Perceived Risk and Benefit of Placement in the Experimental or Comparison Group: Youth Preliminary Results: Benefits Guardian Youth 78% 89% 90% . Parent-Child Relationship "Both can earn it together. It will be a good thing because that's what I want to be able to do. I want to be able to share with my child." [Male60421, age 34] Resources "We can earn it together. That's what I want to be able to do. I want to be able to share with my child." [Female61021, age 35] 90% Parent-Child Relationship Resources "More time together to "They'll bond." probably go by some food, gas, something for me." [Male609, age 16] [Female602, age 17] "She would be sure to know some things." [Male604, age 17] . Perceived Risk in Comp Perceived Risk in Expermental Equal Perced Risk Bend Parcarved Beneft in Comparson Prived Beneft in Experimental Equal Be Discussion Some of the participant's perceived risks may be addressed with current research recommendations.2 However, other perceived risks are seldom considered (e.g., parent-youth conflict). Participant's reported significant burden related to longitudinal treatment-research and discussed using incentives to meet basic needs. Research is needed to determine the compensation that is optimal for offsetting burden.4 Participant's perceptions of legal risk may influence their decision to stay in treatment-research. Results showed participants perceived more risk associated with placement in the comparison condition and more benefit with placement in the experimental condition. The question of whether it is ethical for a family to be randomized to an intervention arm when they believe the other intervention is best for them needs to be considered.