JMIR Publications

ABSTRACT

Background:

Detained adolescents exhibit high rates of behavioral health (i.e., substance use, mental health) needs, yet few receive treatment during detention or community re-entry. Once adolescents are released into the community, caregivers must mobilize significant resources and overcome barriers to facilitate their treatment engagement. Parenting stress is often heightened during this period of forced separation and the re-entry transition. Parenting stress is associated with greater perceived barriers to treatment and, for those adolescents who do begin treatment, less therapeutic change, and premature treatment dropout. Interventions designed specifically to support caregivers of detained adolescents in managing their own stress while navigating the juvenile legal system are urgently needed, and mobile health interventions offer promising scalable approaches. RAISE is a web-based application that was co-designed with caregivers of detained adolescents, aimed at reducing caregiver stress and promoting post-release behavioral health services utilization for adolescents.

Objective:

This study aims to evaluate the effectiveness of RAISE in reducing caregiver stress and promoting adolescent behavioral health services utilization following release from detention.

Methods:

A randomized controlled trial with 60 caregivers of currently detained adolescents (ages 12-17 years) across the United States will be conducted. Caregivers will be recruited through passive (e.g., flyers) and active (e.g., provider referral) techniques. Caregivers will be randomized to RAISE (intervention) or to receive an informational brochure (comparison) and invited to complete self-assessment questionnaires at baseline and 3- and 6-month follow-up time points. The fully automated RAISE intervention includes an 8-week stress reduction intervention, self-monitoring and affirmational SMS messaging, and resources related to navigating the juvenile legal system. Assessments include empirically supported measures of parenting stress, mindful parenting, parenting self-efficacy, adolescent services use, motivation for youth treatment, caregiver behavioral health, sociodemographics, and RAISE usability (intervention only). Caregivers in both conditions will be asked to participate in a semi-structured qualitative exit interview at the 3-month (post-intervention) time point.

Results:

We propose enrollment of 60 caregivers by April 2025, final data collection by September 2025, and submission of main findings for publication in December 2025. Descriptive statistics will examine issues related to recruitment, randomization, assessment, retention, and ratings of application usability. Independent samples t-tests and chi-square analyses will determine if randomization was successful based on multiple background variables; group differences will be accounted for in outcome analyses. Linear and logistic regression analyses will be used for outcome analyses, with an intent to treat design; analyses will include intervention group as a predictor and control for baseline level of the outcome, application usage, and demographic characteristics. Potential moderators and mediators of intervention effects will also be explored.

Conclusions:

This study will be the first to produce empirical evidence regarding the impact of a mobile health, stress reduction intervention co-designed with caregivers of detained adolescents. Findings will be informative for legal systems regarding how best to support caregivers while adolescents are detained and the impact of reducing caregiver stress on adolescents’ linkage to behavioral health services following their release into the community. Clinical Trial: The following trial is registered with clinicaltrials.gov (NCT05032742).