Improving Outcomes for Adolescents at High-Risk of Poor Social, Economic and Health Outcomes

Anthony Shakeshaft

Introduction: Adolescents exposed to multiple, co-occurring risk factors experience disproportionately high rates of harm, and Indigenous adolescents are over-represented in this population. Despite this, little is known about effective interventions: our published systematic review found only 2% of published studies were evaluations, of which half were methodologically weak. This presentation will: i) describe an intervention for high-risk adolescents using the principles of complex interventions (called BackTrack); ii) describe a process of developing an evaluation framework and integrating it into the delivery of routine services; and iii) report the individual, community, and economic outcomes of the intervention.

Method: Evidence-based measures of substance use, resilience, psychological distress, suicide ideation, health, employment, education and crime were embedded into the routine intake procedure of a program for adolescents experiencing multiple, co-occurring risk factors. This program has had over 600 high-risk young people as participants since its inception in 2006. Post-test data were collected at 3 months. Community benefit was measured using routinely collected police incident data, analysed using a multiple baseline evaluation design, which is a type of stepped wedge evaluation. This design has been adapted by the presenter and colleagues specifically because of its suitability for being embedded into routine practice. Economic benefit was estimated using a cost-benefit analysis, including a discrete choice experiment with 300 randomly selected community members to estimate the value that local communities place on having the program in their community.

Results: The majority of the young people in BackTrack programs are aged 15-18, of whom 50% are Indigenous Australians. Almost all program participants reported multiple, co-occurring risk factors, most frequently: illicit drug use, crime, and suicide ideation. Outcome data show statistically significant reductions for individual participants, in their rates of substance use, suicide ideation, psychological distress and involvement in crime. At the community level, the multiple baseline evaluation showed statistically significant reductions in rates of crime involving young people in each of five communities, which occurred at the point of the commencement of the intervention in each community. The discrete choice experiment showed the community wholeheartedly supports BackTrack as a way to combat youth crime, relative to increasing police numbers, even if it is more expensive to implement. The economic analysis shows a positive cost-benefit ratio of 7:1, meaning it returns $7 in economic benefits for every $1 invested.

Conclusion: This evaluation illustrates a successful process of integrating research into the delivery of routine services for high-risk young people. The presenter has recently received further competitive grant funding to embed the evaluation into similar programs across Australia and in Canada.

This abstract was submitted to the 2017 Society for Prevention Research Annual Meeting.