Substance-Related DisordersADAPTNCT04499079
Alliances to Disseminate Addiction Prevention and Treatment (ADAPT)
A study testing Learning Health System in people with Substance-Related Disorders and Recidivism, run by Indiana University at 1 site in United States.
Trial summary
Youth involved in the juvenile justice system (YJJ) bear a disproportionate burden of the addiction crisis. YJJ substance use (SU) is extremely prevalent, with a third of YJJ meeting criteria for a substance use disorder (SUD). The investigators seek to address the national addiction crisis at its epicenter. Read more about this study
- Who is it for?
- Ages 11 years and older
- Conditions the study is for
- Substance-Related Disorders, Recidivism, Opioid-Related Disorders
- What is being tested?
- Learning Health System
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 7,316 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Jun 2020to 30 Nov 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 11 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
ADD AGENCY PERSONNEL CRITERIA
Youth Inclusion Criteria:
- Reside in a participating county assigned to receive the LHS intervention
- Utilized any local CMHC service during the 24-month intervention period
- Age 11 to 22 years old
Youth Exclusion Criteria:
- N/A
Trial locations and contacts
1 site in 1 country.
United States1 site
Indiana University School of Medicine
Indianapolis, Indiana, 46202
About this study
Official title: Alliances to Disseminate Addiction Prevention and Treatment (ADAPT): A Statewide Learning Health System to Reduce Substance Use Among Justice-Involved Youth in Rural Communities
Youth involved in the juvenile justice system (YJJ) bear a disproportionate burden of the addiction crisis. YJJ substance use (SU) is extremely prevalent, with a third of YJJ meeting criteria for a substance use disorder (SUD). The investigators seek to address the national addiction crisis at its epicenter.
Despite their high need for SUD services, and the proliferation of evidence-based interventions to reduce SU, YJJ are rarely connected to needed, high-quality SU care. A care cascade model highlights gaps in YJJ achieving the full continuum of SUD care (i.e., SUD risk identification, treatment referral, treatment initiation, and treatment engagement). YJJ on community supervision/probation face a unique problem accessing SUD services; while the courts or probation may identify YJJ need for SUD care, YJJ must receive care through healthcare agencies in the community. The primary goal of the project, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT) is to address this and other gaps along the care cascade for YJJ. The investigators will accomplish this goal by creating alliances between the juvenile justice system (JJ) agencies and community mental health centers (CMHCs) in eight Indiana counties.
Read more
ADAPT takes a two-pronged approach. First, the investigators will employ a Learning Health System (LHS) to develop collaborative alliances between JJ agencies and CMHCs, organizations that traditionally operate independently. Second, the investigators will present local Cascade data during continuous quality improvement cycles within the LHS alliances. By offering agency representatives an opportunity to view and discuss, for example, the local rate at which YJJ with SUD risk are initiating CMHC SU services, the investigators will facilitate development of tailored, local solutions to improve the Cascade for each county's YJJ.
To maximize long-term sustainability of ADAPT's JJ-CMHC alliances, the investigators will conduct this research in collaboration with leaders from an existing statewide initiative, the Juvenile Detention Alternatives Initiative (JDAI). JDAI is a juvenile justice reform effort that utilizes data-driven decision-making and is implemented in almost 300 counties across the US. If this project is successful, the JDAI infrastructure and support for this research will inform sustainment and expansion across Indiana and the nation.
The investigators hypothesize that ADAPT - novel LHS alliances using Cascade data to implement localized solutions to YJJ receiving evidence-based addictions care - will positively impact SU and recidivism outcomes over time. The investigators seek to complete the following specific aims:
AIM 1: Implement LHS alliances between JJ agencies and CMHCs. The investigators will establish LHS alliances: novel, collaborative partnerships between JJ agencies and CMHCs.
AIM 2: Generate and track local solutions to address gaps in the Cascade for YJJ in rural Indiana counties. Quantifying local Cascade data will enable JJ agencies and CMHCs to suggest and implement tailored, evidenced-based interventions, which will be tracked through LHS quality improvement cycles.
AIM 3: Assess implementation outcomes and processes. We will assess implementation outcomes, such as system alliance, among JJ and CHMC personnel using mixed methods.
AIM 4: Assess the impact of ADAPT. Conduct a stepped wedge cluster randomized controlled trial to assess the impact of LHS alliances on the Cascade for YJJ. We will analyze administrative data linked across JJ and health systems to assess the long-term, community-wide effects of ADAPT on public health and safety outcomes (e.g., lower rates of SU-related outcomes and criminal recidivism).
- Conditions
- Substance-Related Disorders, Recidivism, Opioid-Related Disorders, Substance Use, Criminal Behavior
- Being tested
- Learning Health System
- Keywords
- Juvenile Justice Behavioral Health Services Cascade
- Medical subject headings
- Substance-Related Disorders, Recidivism, Opioid-Related Disorders, Criminal Behavior
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Learning Health SystemOther
This is a system-level intervention designed to improve collaboration among personnel from the juvenile and behavioral healthcare systems.
| Study group | Role | What they receive |
|---|---|---|
| Youth involved in the juvenile justice system, Pre-Implementation | No intervention | Probation Practice as Usual: Data are collected regarding youth involvement in the juvenile justice system during standard probation practice before implementation of the Learning Health System. |
| Juvenile Justice and Community Behavioral Health Agency Personnel | Experimental | Participating counties receive a system-level intervention, a Learning Health System, designed to improve youth connection to substance use treatment by revewing local data and testing local solutions with continuous quality improvement cycles. Receives: Other: Learning Health System |
| Youth involved in the juvenile justice system, Post-Implementation | No intervention | While Juvenile Justice and Community Behavioral Health Agency Personnel will be experiencing the learning health system intervention and changing local practices that could impact youth outcomes, the study is not designed to intervene directly with youth in the juvenile justice system pre- or post-intervention. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Collaboration
Cultural Exchange Inventory
Measured: 3 years
Substance Use Treatment Need Identification
treatment need identified through locally-selected substance use risk screeners
Measured: 10 years
Referral to Substance Use Treatment Services
juvenile probation officers entered recorded a service referral within the local data management system
Measured: 10 years
Initiation of Substance Use Services
participant attendance at one behavioral health outpatient visit or intake
Measured: 10 years
Engagement in Substance Use Services
participant attendance at one additional behavioral health outpatient visit within 60 days of treatment initiation
Measured: 10 years
Recidivism
Rate of re-offense
Measured: 10 years
Substance use related health outcomes
Hospital and emergency department visits related to substance use
Measured: 10 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Aug 2020
- Study start1 Jun 2020
- Primary completion30 Nov 2025
- Study completion30 Nov 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Substance-Related DisordersStudies of the same condition, open and under way.
- More trials run by Indiana UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 7,316 participants (actual)
Sponsor and investigators
- Lead sponsor
- Indiana University
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Drug Abuse (NIDA)
- Responsible party
- Principal investigator, Matthew Aalsma, Indiana University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04499079
- Sponsor's protocol ID
- 1910282231
- Other IDs
- UG1DA050070
- Acronym
- ADAPT
- Status last verified
- Aug 2026
- First submitted
- 30 Jul 2020
- Last updated
- 13 Aug 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
O'Reilly LM, Dir A, Schwartz K, Kim Y, Borowiecki M, Taylor B, Adams ZW, Zapolski T, Hulvershorn L, Aalsma MC. Organizational readiness and program sustainability within juvenile justice and community mental health: the mediating role of cross-system collaboration. Implement Sci Commun. 2026 Apr 10;7(1):99. doi: 10.1186/s43058-026-00919-w.
PubMed 41964039Aalsma MC, Schwartz K, Sun D, O'Reilly LM, Brown SA, Monahan PO, Saldana L, Wiehe SE, Zapolski TCB, Hulvershorn LA, Adams ZW, Dir AL. Learning Health Systems and Substance Use Care Cascade Achievement Among Justice-Involved Youth: A Cluster-Randomized Stepped-Wedge Clinical Trial. JAMA Netw Open. 2026 Feb 2;9(2):e2558222. doi: 10.1001/jamanetworkopen.2025.58222.
PubMed 41665903O'Reilly L, Dir A, Schwartz K, Brown S, Ouyang F, Monahan P, Adams Z, Zapolski T, Hulvershorn L, Aalsma M. A descriptive analysis of substance use screening among youth involved in the legal system in eight counties. Addict Sci Clin Pract. 2025 Oct 21;20(1):84. doi: 10.1186/s13722-025-00609-3.
PubMed 41121197O'Reilly L, Sun D, Schwartz K, Gillenwater L, Dir A, Monahan P, Aarons GA, Saldana L, Adams Z, Zapolski T, Hulvershorn L, Aalsma MC. Impact of learning health systems on cross-system collaboration between youth legal and community mental health systems: a type II hybrid effectiveness-implementation trial. Implement Sci Commun. 2024 Dec 24;5(1):142. doi: 10.1186/s43058-024-00686-6.
PubMed 39719625Ahrens K, Blackburn N, Aalsma M, Haggerty K, Kelleher K, Knight DK, Joseph E, Mulford C, Ryle T, Tolou-Shams M. Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative. Prev Sci. 2023 Oct;24(Suppl 1):99-110. doi: 10.1007/s11121-023-01566-6. Epub 2023 Jul 1.
PubMed 37393415
Study at a glance
From the registry record, last updated by the sponsor on 13 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Alliances to Disseminate Addiction Prevention and Treatment (ADAPT): A Statewide Learning Health System to Reduce Substance Use Among Justice-Involved Youth in Rural Communities
- ClinicalTrials.gov ID
- NCT04499079
- Acronym / sponsor ID
- ADAPT / 1910282231
- Conditions
- Substance-Related Disorders, Recidivism, Opioid-Related Disorders, Substance Use, Criminal Behavior
- Keywords
- Juvenile Justice Behavioral Health Services Cascade
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 7,316 participants (actual)
- Lead sponsor
- Indiana UniversityUniversity, hospital or other
- Collaborators
- National Institute on Drug Abuse (NIDA)
- Study start
- 1 Jun 2020 (actual)
- Primary completion
- 30 Nov 2025 (actual)
- Study completion
- 30 Nov 2025 (actual)
- First posted
- 5 Aug 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Youth involved in the juvenile justice system (YJJ) bear a disproportionate burden of the addiction crisis. YJJ substance use (SU) is extremely prevalent, with a third of YJJ meeting criteria for a substance use disorder (SUD). The investigators seek to address the national addiction crisis at its epicenter.
Despite their high need for SUD services, and the proliferation of evidence-based interventions to reduce SU, YJJ are rarely connected to needed, high-quality SU care. A care cascade model highlights gaps in YJJ achieving the full continuum of SUD care (i.e., SUD risk identification, treatment referral, treatment initiation, and treatment engagement). YJJ on community supervision/probation face a unique problem accessing SUD services; while the courts or probation may identify YJJ need for SUD care, YJJ must receive care through healthcare agencies in the community. The primary goal of the project, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT) is to address this and other gaps along the care cascade for YJJ. The investigators will accomplish this goal by creating alliances between the juvenile justice system (JJ) agencies and community mental health centers (CMHCs) in eight Indiana counties.
ADAPT takes a two-pronged approach. First, the investigators will employ a Learning Health System (LHS) to develop collaborative alliances between JJ agencies and CMHCs, organizations that traditionally operate independently. Second, the investigators will present local Cascade data during continuous quality improvement cycles within the LHS alliances. By offering agency representatives an opportunity to view and discuss, for example, the local rate at which YJJ with SUD risk are initiating CMHC SU services, the investigators will facilitate development of tailored, local solutions to improve the Cascade for each county's YJJ.
To maximize long-term sustainability of ADAPT's JJ-CMHC alliances, the investigators will conduct this research in collaboration with leaders from an existing statewide initiative, the Juvenile Detention Alternatives Initiative (JDAI). JDAI is a juvenile justice reform effort that utilizes data-driven decision-making and is implemented in almost 300 counties across the US. If this project is successful, the JDAI infrastructure and support for this research will inform sustainment and expansion across Indiana and the nation.
The investigators hypothesize that ADAPT - novel LHS alliances using Cascade data to implement localized solutions to YJJ receiving evidence-based addictions care - will positively impact SU and recidivism outcomes over time. The investigators seek to complete the following specific aims:
AIM 1: Implement LHS alliances between JJ agencies and CMHCs. The investigators will establish LHS alliances: novel, collaborative partnerships between JJ agencies and CMHCs.
AIM 2: Generate and track local solutions to address gaps in the Cascade for YJJ in rural Indiana counties. Quantifying local Cascade data will enable JJ agencies and CMHCs to suggest and implement tailored, evidenced-based interventions, which will be tracked through LHS quality improvement cycles.
AIM 3: Assess implementation outcomes and processes. We will assess implementation outcomes, such as system alliance, among JJ and CHMC personnel using mixed methods.
AIM 4: Assess the impact of ADAPT. Conduct a stepped wedge cluster randomized controlled trial to assess the impact of LHS alliances on the Cascade for YJJ. We will analyze administrative data linked across JJ and health systems to assess the long-term, community-wide effects of ADAPT on public health and safety outcomes (e.g., lower rates of SU-related outcomes and criminal recidivism).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Youth involved in the juvenile justice system, Pre-Implementation | No intervention | –Probation Practice as Usual: Data are collected regarding youth involvement in the juvenile justice system during standard probation practice before implementation of the Learning Health System. |
| Juvenile Justice and Community Behavioral Health Agency Personnel | Experimental | Other: Learning Health SystemParticipating counties receive a system-level intervention, a Learning Health System, designed to improve youth connection to substance use treatment by revewing local data and testing local solutions with continuous quality improvement cycles. |
| Youth involved in the juvenile justice system, Post-Implementation | No intervention | –While Juvenile Justice and Community Behavioral Health Agency Personnel will be experiencing the learning health system intervention and changing local practices that could impact youth outcomes, the study is not designed to intervene directly with youth in the juvenile justice system pre- or post-intervention. |
Who may qualify
- Ages
- 11 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Learning Health SystemThis is a system-level intervention designed to improve collaboration among personnel from the juvenile and behavioral healthcare systems. | Other | Juvenile Justice and Community Behavioral Health Agency Personnel |
Primary outcome
Collaboration
Time frame: 3 years
Cultural Exchange Inventory
Substance Use Treatment Need Identification
Time frame: 10 years
treatment need identified through locally-selected substance use risk screeners
Referral to Substance Use Treatment Services
Time frame: 10 years
juvenile probation officers entered recorded a service referral within the local data management system
Initiation of Substance Use Services
Time frame: 10 years
participant attendance at one behavioral health outpatient visit or intake
Engagement in Substance Use Services
Time frame: 10 years
participant attendance at one additional behavioral health outpatient visit within 60 days of treatment initiation
Recidivism
Time frame: 10 years
Rate of re-offense
Substance use related health outcomes
Time frame: 10 years
Hospital and emergency department visits related to substance use
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Aug 2026.
- Derived from this study: PubMed 41964039O'Reilly LM, Dir A, Schwartz K, Kim Y, Borowiecki M, Taylor B, Adams ZW, Zapolski T, Hulvershorn L, Aalsma MC. Organizational readiness and program sustainability within juvenile justice and community mental health: the mediating role of cross-system collaboration. Implement Sci Commun. 2026 Apr 10;7(1):99. doi: 10.1186/s43058-026-00919-w.
- Derived from this study: PubMed 41665903Aalsma MC, Schwartz K, Sun D, O'Reilly LM, Brown SA, Monahan PO, Saldana L, Wiehe SE, Zapolski TCB, Hulvershorn LA, Adams ZW, Dir AL. Learning Health Systems and Substance Use Care Cascade Achievement Among Justice-Involved Youth: A Cluster-Randomized Stepped-Wedge Clinical Trial. JAMA Netw Open. 2026 Feb 2;9(2):e2558222. doi: 10.1001/jamanetworkopen.2025.58222.
- Derived from this study: PubMed 41121197O'Reilly L, Dir A, Schwartz K, Brown S, Ouyang F, Monahan P, Adams Z, Zapolski T, Hulvershorn L, Aalsma M. A descriptive analysis of substance use screening among youth involved in the legal system in eight counties. Addict Sci Clin Pract. 2025 Oct 21;20(1):84. doi: 10.1186/s13722-025-00609-3.
- Derived from this study: PubMed 39719625O'Reilly L, Sun D, Schwartz K, Gillenwater L, Dir A, Monahan P, Aarons GA, Saldana L, Adams Z, Zapolski T, Hulvershorn L, Aalsma MC. Impact of learning health systems on cross-system collaboration between youth legal and community mental health systems: a type II hybrid effectiveness-implementation trial. Implement Sci Commun. 2024 Dec 24;5(1):142. doi: 10.1186/s43058-024-00686-6.
- Derived from this study: PubMed 37393415Ahrens K, Blackburn N, Aalsma M, Haggerty K, Kelleher K, Knight DK, Joseph E, Mulford C, Ryle T, Tolou-Shams M. Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative. Prev Sci. 2023 Oct;24(Suppl 1):99-110. doi: 10.1007/s11121-023-01566-6. Epub 2023 Jul 1.
- Individual participant dataSharing planned: No
Related trials for Substance-Related Disorders
Not yet recruiting
Prescribe to Prevent HIV: A Hybrid Trial Helping Addiction Clinics Prevent HIV & Infections Through Safer Drug Use Support
People Who Use Opioids/People With Opioid Use Disorder (OUD)
Enrolling by invitationObservational study
Development of an Interview-Informed Timeline Follow-Back (TLFB) for Opioid Use in the Era of Fentanyl
Substance Use Disorders (SUDs)
Recruiting
Trial Phase: Syndemic Adapted Medly Uganda
Mental Health
RecruitingObservational study
Olfactory Function and Model-Based Behavior in People Living With HIV and SUD
HIV, Substance Use Disorder
Not yet recruiting
Substance Use and Media Preferences
Substance Use Behavior, Cannabis Intoxication
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Learning Health System in people with Substance-Related Disorders and Recidivism, run by Indiana University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 13 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Collaboration (time frame: 3 years). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04499079, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Aug 2026.