Perceptions of professionals regarding interventions involving family members responsible for justice-involved youth with substance use disorders in santiago, chile.

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University of Groningen

Perceptions of professionals regarding interventions involving family members responsible for

justice-involved youth with substance use disorders in santiago, chile.

Lobato Concha, Mónica; Sanderman, Robbert; Soto, Marcela; Metiffogo, Decio; Hagedoorn,

Mariet

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International Journal of Drug Policy

DOI:

10.1016/j.drugpo.2020.102996

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Citation for published version (APA):

Lobato Concha, M., Sanderman, R., Soto, M., Metiffogo, D., & Hagedoorn, M. (2021). Perceptions of

professionals regarding interventions involving family members responsible for justice-involved youth with

substance use disorders in santiago, chile. International Journal of Drug Policy.

https://doi.org/10.1016/j.drugpo.2020.102996

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InternationalJournalofDrugPolicy87(2021)102996

ContentslistsavailableatScienceDirect

International

Journal

of

Drug

Policy

journalhomepage:www.elsevier.com/locate/drugpo

Research

Paper

Perceptions

of

professionals

regarding

interventions

involving

family

members

responsible

for

justice-involved

youth

with

substance

use

disorders

in

Santiago,

Chile.

Mónica

Lobato

a,∗

_,

_Robbert

_Sanderman

a,b

_,

_Marcela

_Soto

c

_,

_Decio

_Mettifogo

c

_,

_Mariët

_Hagedoorn

a a University of Groningen;University Medical Center Groningen, Health Psychology Section, FA12, P.O. Box 196, 9700 CE, Groningen, Netherlands

b Department of Health Psychology, Health & Technology, University of Twente, Enschede, Netherlands c Universidad de Chile, Facultad de Ciencias Sociales, Departamento de Psicología, Santiago, Chile

a

r

t

i

c

l

e

i

n

f

o

Keywords:

Justice-involved youth Substance use disorder Professionals’ perceptions Family intervention Qualitative research

a

b

s

t

r

a

c

t

Background:Elicitingprofessionals’experiencesofcurrentdrugtreatmentprogrammescanleadtoimprovements

oftheseyouth-centredprogrammesthroughtheinvolvementoftheconcernedyouths’families.Weexplored

perceivedbarriersamongstprofessionalsconcerninginterventionsincorporatingparentsorguardiansresponsible

forjustice-involvedyouthwithsubstanceusedisorders.

Methods: Weconductedsemi-structuredin-depthinterviewswithfourteenfemaleandfourmaleprofessionals,

eachrepresentingoneofeighteenprogrammesundertheChileanNationalDrugTreatmentProgramme(2016–

2017),whoweretaskedwithcontactingand/orinterveninginthefamiliesofjustice-involvedyouth.

Subse-quently,weperformedtraditionalcontentanalysis.

Results: Theprofessionalsidentiﬁedfourkeybarriersimpedinginterventions:(1)parents’non-adherencetothe

treatmentandissuesrelatingtotheirrolefulﬁlment;(2)tensionswithintheprogrammedesignthatconstrainthe

families’involvementintheinterventions;(3)thelackofasupportiveprofessionalnetworkoﬀering

interven-tionsthatcomplementdrugtreatment;(4)theproblematicanddangerouslivingcontextsofthesefamiliesthat

discouragefamilyinvolvement.Additionally,professionalsidentiﬁedinterventionneedsforimprovingtreatment

outcomes.

Conclusions: Thenegativeperceptionsofprofessionalsregardingtheinterventionsaswellasfamiliesandfamily

contextsofjustice-involvedyouth,andthelackofsupportfromotherprogrammes,inducedfeelingsof

hopeless-nessandpessimismamongsttheprofessionalsregardingtheeﬀectivenessoftheChileanNationalDrugTreatment

Programme.Itisessentialtoconsiderprofessionals’perspectivesnotonlytobeneﬁtfromtheirexpertise,butalso

toassesswhethertheirperspectivesmayhindertheimplementationofchangeswhenattemptingtoinnovate

drugtreatmentmodalitiesaimedatimprovingtheiroutcomes.

Introduction

Substance use disorders have become an increasing concern worldwide because of associated health, social and legal problems (Hogue, Henderson, Becker & Knight, 2018; Keaney et al., 2011;

Kopak,Chen,Haas&Gillmore,2012;Rigteretal.,2013;vanderPol etal.,2017).Althoughglobaldruguserateshaveremainedstablein recentyears(about5.6%ofindividualsagedbetween15and64years usedrugs),morethan10%ofdrugusersareestimatedtosuﬀerfrom drugusedisordersthatrequiretreatment(UNODC,2018b).Moreover therisksofusing drugsanddevelopingasubstanceuse disorderare

∗_{Corresponding}_author.

E-mailaddress:m.e.lobato.concha@umcg.nl(M.Lobato).

higheramongstyoungpeople(UNODC,2018a).Druguseratesarealso higher amongstjustice-involvedyouth(40–70%)compared withthis rateforthegeneralyouthpopulation(Schubert,Mulvey&Glasheen, 2011; Young, Dembo & Henderson,2007). ACochraneReview con-ductedtoassesstheeffectivenessofinterventiontrialsamongst drug-usingoffenders(youthandadults)revealedthattheyhadlimited suc-cessinreducingself-reporteddruguseandonlysomesuccessin reduc-ingre-incarcerationrates (Perry etal., 2014).Furthermore,although studieshaveshownthatthetreatmentofadolescentswithasubstance usedisorderismoreeffectivewhentheirfamiliesareincluded(Hogue &Liddle,2009;vanderPoletal.,2017),familiesareonlyincludedin aminorityofsuchinterventionsofjustice-involvedyouth(Youngetal., 2007). Additionally, it is not known whetherprofessionals working withinyouth-centredprogrammeswouldbewillingtoincorporatethe familieswithintheseinterventionsandwhattheyperceiveasbarriers

https://doi.org/10.1016/j.drugpo.2020.102996

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Fig.1. OrganizationoftheNationalDrugTreatmentProgrammeforJustice-InvolvedYouth.JIYaresenttodrugtreatmentbythejusticesystemwhentheoﬀence

committedwasrelatedtodrugused.Treatmentissuppliedbypublicandprivateproviders(treatmentteams)thateverytwoyearsapplyforpublicfundscoming

fromtheNationalServiceforthePreventionandRehabilitationofDrugandAlcoholUse(SENDA).

thatcouldimpedetheinclusionoffamilies.Ourstudywasaimedat in-vestigatingwhetherprofessionalsworkingwithjustice-involvedyouth inChilearereceptivetotheinclusionofneworcomplementary family-orientatedinterventionsbasedontheirexperiencesofinteractingwith thefamilymembersof justice-involvedyouthandtheirbeliefsabout workingwiththesefamilies.

InChile,wheredrug use rates arehighamongstjustice-involved youth (70%), the national drug treatment programme for justice-involvedyouthentailsayouth-centredratherthanafamily-centred de-sign(MinisteriodeSalud,2006).Thisprogrammewaslaunchedin2007 (Fig.1)asacomponentofajuvenilejusticesystem(Corporación OP-CIÓN&UNICEF,2009).DruguseisnotacrimeperseinChile,withthe exceptionofdruguseinpublicplaces(MinisteriodelInterior,2005). However, in cases where the crimescommitted relate todrug use, thejuvenilejusticelawprovidesforacomplementarysentence, entail-ingtheparticipation oftheoﬀenderina drugtreatmentprogramme (MinisteriodeJusticia,2005).Thesanctiondelegatemayalso stipu-lateattendanceofadrugtreatmentprogrammeintheinterventionplan presentedtothecourtthatprovidesguidanceonthefulﬁlmentofthe sanction(Lobato,2008).

Thenationalguidelinesforimplementingthenational drug treat-ment programme, which are based on a child development-centred approach, incorporate comprehensive diagnostics and interventions (MinisteriodeSalud,2006).However,adecadeaftertheprogramme’s implementation,formalassessmentsof its eﬀectivenessremaintobe conducted.Moreover,thereisnoevidencesuggestingthatitsoutcomes are any better than those of other international youth-centred pro-grammes for justice-involved youththat have achieved limited suc-cess.Notably,theChileannationalguidelinesforimplementingthe na-tionaldrugtreatmentprogrammedeclaretheimportanceofinvolving thefamiliesofjustice-involvedyouthintheirdrugtreatment.However, withtheexceptionofabriefreferencetoseveraltherapeutic modali-tiesthathavebeenfoundeﬀective(i.e.,familytherapy, multidimen-sionalfamilytherapyandfunctionalfamilytherapy), neitherthe

na-tionalguidelinesnorthesupplementaryguidelinespresentclinical guid-anceonworkingwiththeyouths’families(CONACE,2008).Moreover, despitereportedgapsinthenationaldrugtreatmentprogramme identi-ﬁedbyonestudyconductedatitsinception(Lobato,2008),the guide-lines havenot been updated in thelast decade. Given thefocuson youthin theChileanprogramme, each teamdecides whetherornot theywillimplementany(complementary)interventionsinvolvingthe families.Consequently,independentassessmentsoftheprogrammeare needed.

Inthecontextofthisyouth-centreddrugtreatmentprogrammefor justice-involvedyouth,itiscriticaltoascertainwhethertheconcerned professionalsarereceptivetoneworcomplementaryinterventions in-volvingthefamilies.Despitethelikelihoodofprofessionalsbeingaware oftheneedforhealthandsubstanceusedisorderinterventions,their associated perceptions(e.g.,stereotypes andjudgmentalattitudes to-wardspatients)constituteapotentialbarrieraﬀectingthe implementa-tionoftheseprogrammes(Adams,2008;Vorilhonetal.,2014).Thus,it isnecessarytoascertainprofessional’sworkingexperienceswithin ex-istingyouth-centreddrugtreatmentprogrammesbeforeattemptingto improvethemthroughtheinvolvementof thefamilies.Ouraimwas toexploreprofessionals’experiencesofinteractingwithfamily mem-bersofjustice-involvedyouth,theirbeliefsandthebarriersthey per-ceived regarding interventionsthat includedfamilymembers within a youth-centred programmatic approach for treating substance use disorder.

Methods

Participantselection

Weappliedapurposivesamplingmethodtoselectparticipantsfor ourstudy.Eligibilitycriteriawereasfollows:(1)professionalsworking inanoutpatientdrugtreatmentprogrammeforjustice-involvedyouth fromtheMetropolitanRegion,(2)professionalshavingdirectcontact

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M. Lobato, R. Sanderman, M. Soto et al. International Journal of Drug Policy 87 (2021) 102996 Table1

Socialcontextofintervieweddrugtreatmentteams.

Research ethics committees a

Municipality Inhabitants b_{(under 18 years old)} _{Poverty by}

income c_(%) Multi dimentional poverty rate d_(%) Interviewed drug treatment teams e Number of JIY per month f

MHS North Recoleta 157,851 (41,041) 13.9 26.2 1. Talita Kum Joven 29

Quilicura 210,410 (66,700) 7.8 18.5 2. Ágora Quilicura 20

MHS West Renca 147,151 (47,235) 8.5 26.2 3. Solidaridad 18

Pudahuel 230,293 (67,936) 7.8 20.5 4. Ágora Pudahuel 30

Lo Prado 96,249 (25,987) 4.3 ∗ _19.7∗ _{5. Pierre Dubois} ₁₇

MHS Central Santiago 404,495 (61,483) 5.9 11.6 6. Ágora Santiago

Centro

19 7. Ágora Santiago

Poniente

18

Maipú 521,627 (141,361) 5.2 12.5 8. Ágora Maipú Oriente 18

9. Ágora Maipú Poniente

18

MHS South Lo Espejo 98,804 (28,357) 11.2 ∗ _26.7∗ _{10. Caleta Sur} ₁₈

San Bernardo 301,313 (99,735) 9.2 22.0 11. CTA Orión 34

12. Los Morros 27

MHS South East La Pintana 177,335 (61,890) 13.9 42.4 13. El Castillo 25

Puente Alto 568,106 (173,840) 8.0 27.1 14. Amancay 25

15. CEIF Puente Alto 10

La Florida 366,916 (97,600) 3.1 17.0 16. Ágora La Florida 17

La Granja 116.571 (32,873) 7.2 24.5 17. CAID La Granja 23

MHS East (Adults & children)

La Reina Peñalolén 92,787 241,599 (24,589) (70,789) 4.3 ∗ 4.8 9.4 ∗ 20.7 18. Ágora La Reina-Peñalolén 18 .

a_The_public_health_system_in_Santiago_is_divided_into₆_Metropolitan_Health_Services_(MHS).

b_The_information_provided_here_correspond_to_the_census_carried_out_in_2017._The_information_between_brackets_refers_to_the_inhabitants_under₁₈_years_old_in

themunicipality.

c_Poverty_by_income_(data_from₂₀₁₅₎_is_the_percentage_(%)_of_the_inhabitants_of_the_municipality_who_have_less_than_$172_United_States_Dollars_per_month.

ThepovertybyincomepercentagefortheMetropolitanregionwas7.1%,witharangeof0.6%−14.5%.

d_{Multidimentional}_poverty_rate_(data_from₂₀₁₅₎_is_an_index_that_includes_diﬀerent_dimensions:_education,_health,_housing,_job_placement,_social_security,_and

socialcohesion.ThemultidimentionalpovertyratefortheMetropolitanregionwas20.9%,witharangeof4.6%−42.4%.

e_Numbers_indicate_the_location_on_the_map_of_the_Metropolitan_region_(Santiago)_beneath_the_table.

f_Number_of_{justice-involved}_youth_(JIY)_that_can_be_cared_for_per_month_by_a_team,_according_to_the_project_approved._The_standard_time_for_a_treatment_for_a

JIYis24months.

∗_Rates_were_obtained_indirectly,_using_the_average_of_the_range_where_the_municipality_was_rated.

withparentsorguardiansresponsibleforjustice-involvedyouthenroled inadrugtreatmentprogrammeand(3)membershipofthetreatment teamforatleast12monthspriortotheinterview.

Inthecaseof outpatienttreatment,programmesforsmallgroups of youthareimplemented in residentialzones inhabited bymost of theseyouth(Table1).Theinterventionsareledbythreemembersof aprofessionalteamcomprisingapsychologist,asocialworkeranda re-habilitationspecialistassignedtothesameindividual.Complementary interventionsareconductedbyotherprofessionalswithintheteam(a

psychiatrist, anoccupationaltherapist,ageneralphysician,ateacher andapsycho-pedagogue)(CONACE,2004).

At thetimeofdatacollection, 24outpatientdrug treatment pro-grammes were being implemented under the Chilean national drug treatment programmefor justice-involvedyouthin theMetropolitan RegioninChile.Eighteenprogrammesacceptedtheinvitationto par-ticipateinthestudy,andtheremainingsixteamsdeclinedforinternal reasons(e.g.,anongoingevaluationbeingimplementedbythenational drug treatmentprogramme).Theprincipalinvestigatorpresentedthe

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studytotheteamattheworkplaceofeachof theprogrammes. Sev-eralmeetingswereconductedinApril2015.Afterthetreatmentteams hadagreedtoparticipate,theteamdirectorwasaskedtoindicatewhich professionalsmettheselectioncriteria.Thisprocedurewasfollowed be-causetheteamscomprisedsmallgroupsofprofessionals,withjustoneor twoprofessionalsusuallyhavingdirectcontactwiththeyouths’parents orguardians.Informedconsentforinterviewswasobtained telephoni-callyfromeachoftheselectedprofessionals(18intotal;14women,4 men;9socialworkers,5psychologistsand4others),allofwhomagreed toparticipate.

Interviewsanddatacollection

In-depthsemi-structuredinterviewswereconductedin May2015 bytheprincipalinvestigator,whohasabachelor’sdegreeanda mas-ter’sdegreeinpsychologyfromtheUniversityofChile.Thestudy’saim andtheinterviewoutlinewerediscussedwithstaff atthedrug treat-mentdepartmentof theNationalService forthePrevention and Re-habilitationofDrugandAlcoholUse(SENDA).Theinterviewoutline wasassessedbytwoprofessionalswhohadformerlyworkedwithyouth withindrugtreatmentprogrammes.Discussiontopicscoveredthe char-acteristics(structureandfunctionality)ofjuveniles’families,theroleof familiesofjustice-involvedyouthinthedrugtreatmentprocess, inter-ventionsinvolvingfamilies,theoutcomesoftheseinterventions, barri-erspertainingtotheoutcomesandwhatwasrequiredformore effec-tiveimplementationoftheprogrammes.Inadditiontoprovidingtheir verbalagreement,theprofessionalsprovidedwritteninformedconsent priortobeinginterviewedandreceivednopaymentforparticipating inthestudy.Professionalswereinterviewedinaprivateroomattheir workplace.Theinterviews,whichwereaudio-recorded,lastedbetween 48and107min.Saturationwasreachedbythe16thinterview,withno newinformationobtainedforthefinaltwointerviews(17and18).

Dataanalysis

Theaudiorecordings weretranscribed verbatim bytrained inter-viewers,followingtheJeffersontranscriptionguidelinesadaptedfor re-searchinthesocialsciences(BassiFollari,2015).Toensureanonymity, thetranscriptswereassignedindividualnumberspriortothedata anal-ysis.Audiofilesandfulltranscriptswereencryptedbeforetheywere stored,andthetranscriptswereanonymisedbeforetheywereimported intoATLAS.ti7.5.16(2012),asoftwareprogrammeusedforqualitative dataanalysis.AllanalyseswereconductedinSpanishusingtraditional contentanalysis(Helgevold&Moen,2005).Thus,duringthefirst cod-ingcycle,codeswerecreatedanddefineddeductively(basedontopics fromtheinterviewoutline)andinductively(basedontheinterviewees’ responses)(Saldaña,2009).Thefirstcodingcyclewasperformedline bylinebytwoindependentcoders(MLandMS),andeachcoded in-terviewwasreviewed.Beforeaninterviewwascoded,newlyemerging codesinallofthepreviousinterviewswerechecked.Thesecondcoding cyclewasperformedinfourstepsbythreeindependentcoders(ML,MS andDM).Initially,the265first-cyclecodeswereorganisedaccording tothetentopicsintheinterviewoutline.Subsequently,26codes unre-latedtothetopics(youths’profilesandinterventions)wereidentified. Next,subgroupsofthefirst-cyclecodeswereformedbasedonaffinities incontentrelatingtoeach topic.Lastly, 42s-cycle codescomprising thesesubgroupsoffirst-cyclecodeswerecreated.Allofthedecisions takenateachstepwerediscussed.Areliabilityratingwasnotused be-causetheaimwastoreachaconsensus,discussingandclarifyingeach differenceuntilthegroupmembersunanimouslyagreedonthe appro-priateuseofcodes(Harry,Sturges&Klingner,2005).Fourfurthersteps wereimplementedinvolvingthesamethreeindependentcoders.Firstly, second-cyclecodesrelatedtotheresearchquestionwereselected. Sec-ondly, thetopics of the non-relatedsecond-cycle codes were identi-fied(e.g.,howprofessionalsinteractwiththeyouths’families).Thirdly, the29selectedsecond-cyclecodesweregroupedaccordingtocontent

affinity.Lastly,weformulatedfivethemesrelatingtothesegroupsof second-cyclecodes,whichwereorganizedintothreelevelsforabetter understanding(Table2):(a)attheindividuallevel‘familieswhere in-terventionwasdifficult,(b)atthesystemiclevel‘tensionsentailedin theprogrammedesign’and‘thelackofaprofessionalsupportnetwork’, and(c)atthestructurallevel‘problematicanddangerouscontexts.’The fifththemewasrelatedtointerventionneeds(acodetreeispresented inTableAinthesupplementalmaterial).Asummaryoftheresultswas sharedwiththeparticipantsandtheirteamsupervisors,whovalidated them.Themes,sub-themes,codes(firstandsecondcycles)and quota-tionsusedinthisarticleweretranslatedintoEnglishbyaprofessional translator,withguidinginputsfromthefirstauthor.

Ethicalconsiderations

Thisresearchwaspartofawiderstudyonfamilyfactorsrelatedto substanceusedisordersofjustice-involvedyouthundergoingdrug treat-ment.Ethicalapprovalwasobtainedfromsevenresearchethics com-mitteesbecausethepublichealthsystemintheMetropolitanRegionis dividedintosixgeographicalareas,eachwithitsowncommittee. More-over,onecommitteeisdividedintotwosub-committees,respectively coveringstudiesinvolvingindividualsbelowandabove18years.

Results

Despitetheirdifferentbackgrounds,professionalsworkingindrug treatmentprogrammesforjustice-involvedyouthencounteredcommon difficultieswhenapproachingfamiliesregardingthefourthemes,which wereorganizedin threelevels.There isalsoafifththemerelatedto needsforimprovinginterventions.

A.Barriersperceivedattheindividuallevel Theme1.Familieswhoseinterventionisdiﬃcult

Professionalsmost frequentlymentioneddifficultiesregardingthe familiesofjustice-involvedyouth.Thefrequencyofthesereferenceswas relatednotonlytothistopic’soccurrenceintheinterviewsbutalsoto thenumberofaspectsrelatedtofamilydifficultiesthattheymentioned. Professionalsidentifiedbarriersinthefollowingtwokeyareas.

a.Difficultfamiliesthatdonotadheretothetreatment.‘Family’ activi-tiesorinterventionswereusuallyonlyattendedbyonefamilymember. Therespondentsstatedthatmaleparentalfiguresrarelyparticipatein thejuveniles’treatment,andthosewhodomostly viewtheirroleas providingforthefamily’slivingexpenseswhilethemother(orfemale figure)isheldresponsibleforthechildren’supbringing.Therefore,in most cases, themothersattendthetreatment,withgrandmothers or auntsattendingintheirabsence.

Whentheteamsidentifysomeonewithinthefamilywhocanfulfil theroleofaresponsibleadult,theyusuallyfaceresistancefromthese individualsregardingtheirparticipationintheprogramme.According totheprofessionals,thereasonstheyprovidefornon-participationare lackoftime(toomanydailyworkinghours,includingweekends), as wellasjoblocationsthatarefarawayfromthetreatmentsiteandfrom theirownhomes.Theprofessionalsalsoidentifiedseveralotherreasons whyparentsoradultsmaynotwanttoengageintheprocess.Theyare notwillingtoattendtheprogrammeiftheirjuvenileoffspringisnot at-tendingit,ortheymaygenerallylackacommitmenttobeinginvolved inthelivesoftheiroffspring.Theprofessionalsperceivedresignationto thejuveniles’situationamongstthoseparentsorresponsibleadultswho didattendtheprogramme.Familiesoftenlackhopethattheirjuvenile offspringcanchangebecausetheyhavepreviouslyattempted unsuccess-fullytostopusingdrugs.

Inmanycases,thoseteamsthathavedesignedinterventions involv-ingthefamiliesobservedthattheparentsorresponsibleadultswerenot willingtomakepersonalchanges.Theynotedthattheseindividuals usu-allydonotperceiveanyassociationbetweentheirparentalbehaviour

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M. Lobato, R. Sanderman, M. Soto et al. International Journal of Drug Policy 87 (2021) 102996 Table 2 Themes according to individual, systemic, and structural levels. Type of theme Theme Indi vidual l e ve l Sy st emic l e ve l St ru ct u ra l le ve l Barriers Fa m il ie s wher e int e rv ention is difficult - Fa m il ie s that do no t adher e to the tr eatment - Pr oblems re la te d to we a k par e nt al ro le s Pr ogr a m design - Barriers re la te d to the design and im plement a tion of the pr ogr a mmes that hinder e d pr of essionals’ perf o rmance (e.g., no t comple te te a m s and high turno v er ra te ) Support ne tw or k - Barriers re la te d to the ne tw or k (e.g., lac k of int e gr ation of the jus tice, social and health sy st ems) Pr oblematic and dang er ous cont e xt - Influence of the par e nt s´ fa mil y cont e xt - Influence of juv eniles’ be h av io u r - Influence of the neighbour h ood cont e xt Not bar riers Ne e d s - Wo rk in g conditions, int e rv ention design and public policy functioning

and/orthefamily’sfunctionalityandthejuvenile’sbehaviour. Conse-quently, theyarenotinterested infacing,speaking oreventhinking abouttheirownproblems(becausethejuveniles,andnotthey,arein treatment).This viewwasexpressedbyamalepsychologist ‘…some-timestherearefamiliesthatsay“Well,ifI’mnotthesickperson,that’s him,youneedtocallhim,hehastogo,it’snothingtodowithme”’ (Interviewee8:male,psychologistintheprogrammefor4years).

b.Problemsrelatedtoweakparentalroles.Therespondentsidentified ineffective orweakparentingskillswithin thesefamiliesasbarriers. Owing tothese weakparentingskills, identifyingpriorities(or even possibilities)forinterveningin thesefamilieswascomplicated.They frequentlymentionedthatthenormativesystemiseitherpolarisedor ineffective.Familiesdonotestablishrulesbecausetheydonotwantto be liketheirownparentsortheyfeel guiltyaboutnotbeing stay-at-homeparents.Alternatively,iftherearerules,thenthereareno conse-quencesforbreakingtheserules.Further,parentsrarelymonitortheir juvenileoffspringbecausetheydonotknowhowtodosowhenthey themselvesarenotathome.Fewfamiliesdemonstratingweakparental rolessustainedroutinesindailyfamiliallife,suchassharedactivities (e.g.,eatingtimesoroutdooractivities)orassignedresponsibilitiesat home(e.g.,washingdishesandtidyingbedrooms).Thus,juveniles usu-allynotengageinactivitiesathome.

Furthermore, according to the professionals, many parents or guardiansexternalisetheresponsibilityofthejuveniles’upbringingand itsconsequencesforotherfamilymembers.Manyofthemarenot pro-vidingtheprotectivefunctionexpectedofthem,asconﬁrmedbytheir explicitclaimsthattheyarenotresponsibleforwhatjuvenileoﬀspring dobecausetheydonotknowwhattheyaredoing.Moreover,the re-spondentsnotedthattheseparentsprimarilyattributeresponsibilityto thejuveniles,arguingthattheyaretheoneswhohavedecidednotto gotoschoolandnottohelpoutathome;theyhavethemselvescreated alloftheproblemsconfrontingthem.

Theprofessionalsperceivedmanyoftheseparentstobe incompe-tentintermsofraisingyouth.Theysuggestedthatapossible reason wasoverwhelmpromptedbyanexcessivenumberoftaskstobe accom-plished.Thisissueisparticularlysalientwhenthefather(ormaleﬁgure) isabsentwithinthefamily,leadingtoadoublingofthematernalrole (i.e.,workingtobringinmoneyandraisingthechildren).Another fre-quentlycitedreasonisparents’orguardians’untreatedmentalhealth problems(i.e.,druguseanddepression).

Becauseoftheabove-mentionedproblems,theprofessionalsdeemed thattherolesoftheadultswithinthesefamiliesdemonstratedpoor func-tionality(ordysfunctionality)andwerebelowtherequiredsocial stan-dards.Inmanycases,juvenileswerecompelledtoassumeparentalroles, assumingapositionofpowerwithinthefamilyfromanearlyage. Con-sequently,theirparentswerenolongerabletocontrolthem.

[thereareseveralparentaldiﬃculties]fromtheestablishmentofclear, [to]consolidatedandconsistentnorms.Fortheparentalunittoreally workasaunit,theremustbenodisagreements...eh,thataﬀectionhas nothingtodowiththeboundaries,boundariesdon’tcauseanyharm.[As wellasotherproblems]Rangingfromproblem-solvingwiththeirchild, imaginingthechildasachild,notasapartner,assupportorasafriend, ...many[children]assumetheroleofaparent… (Interviewee18:female psychologistintheprogrammeforayearandahalf)

B.Barriersperceivedatthesystemiclevel

Theme2.Tensionsentailedintheprogrammedesign

Professionalsreportedbarriersinthedesignandimplementationof theprogrammesthathinderedtheirperformance.Drugtreatmentsare collectively designedbyateamthatincludesapsychologist,asocial worker,arehabilitationspecialist,apsychiatristandanoccupational therapist.However,theteamsareoftennotcomplete,thus overburden-ingotherteammembers.Therespondentsindicatedthatthereisahigh turnoverrateamongsttheprofessionalsandthatuncertaintiesrelating

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toemployment(contractsforjustoneortwoyears)aswellas complex-itiesrelatingtothefieldandthetargetpopulationmakeitdifficultto findreplacements.Thissituationcreatesfrustrationandcausesburnout amongsttheprofessionals.

Themodelsortheoriesusedtosupportinterventionsseemtobein tensionwithpractice.Onegroupofinterviewedprofessionalscouldnot identifyaworkingmodelortheory,implyingthattheydowhatthey learnedtododuringtheirprofessionaltraining.However,anothergroup thatidentiﬁedatheoreticalframeworkstatedthatthetheorieswerenot adequateforworkingwiththesefamilies,astheydonotapplytoallof thediﬀerenttypesoffamiliesthattheyworkwith.Moreover,theydo notintegratealloftheimportantelementsthatextendbeyondsubstance usedisorder.Forinstance,whenfamiliesliveinariskyandvulnerable context,thisrealityexceedstheinterventions,andmanyprofessionals reportedactingaccordingtocommonsense.

Ihaveheardtestimoniesfrommumswhohavelockedtheirchildrenin theirroomssotheycan’tgoout.Andtheysaytome,“Sir,Idon’tknow ifIamdoingtherightthing”.Itoldher,“look,youknow,ifIweren’t atherapistandhada childlikethis,Iwould lockhimup too”... . becauseitisdesperationif[theneighbourhood]isfullofdrugs.It’sfull [ofthem]andnobodydoesanything.(Interviewee2:malesocialworker intheprogrammefor3years)

Professionalsalsofacedifficulties withrespect totheoverall sys-temdesign.Forexample,insufficientsitesforinterventionsentailing theprovisionofdetoxificationprogrammesforjuveniles.Theyalso ex-periencedifficultiesassociatedwiththeirspecificprogrammes,suchas theinabilitytoadjustfamilyinterventionsaccordingtothefamilies’ availabletimes.Fromtheinterviewees’responses,itappearsthatthe programmesdonotcloselymatchthefamilies’profiles.Someofthem feltthattheprogrammetimingsdidnotaccommodatethefamilies’ sit-uations,giventheirobservationsthatnoteveryfamilymemberisready tochangeatthesametime;alongerinterventionperiodisrequired. Thus,eventhoughalloftheprofessionalssupportedchange,theyfelt despondentandhadlimitedexpectationsofchange occurringwithin thesefamilies.Theynotedthattheyhavehadtoadjusttheir expecta-tionsto“feasible” ratherthan“big” changesthatseemedtobeoutof reach.

Theme3.Lackofaprofessionalsupportnetwork

Giventhecomplexproﬁlesoffamiliesandjuveniles,theteamsneed tocoordinatewithotherprogrammesintheimplementationof comple-mentaryinterventions.However,theprofessionalsperceivedalackof integrationofthejustice,socialandhealthsystemsthatapplydiﬀerent approachesforunderstandingandinterveninginthesefamilies.Thus, theylackedsupportfortheirdrugtreatmentinterventions.

According to the respondents, professionals within other pro-grammesarenotpreparedtoreceiveandworkwiththesefamilies.This isacriticalissuebecausetheseotherprogrammescouldpotentially fa-cilitateorconstraindrugtreatmentprogrammes,becauseofinadequate servicesofferedtothesefamilies(e.g.,nodrugtreatmentprogrammes targetingwomen)ornon-adjustmentoftheinterventiontothefamilies’ needs(e.g.,insufficienttimeslotsavailableforappointmentswithina depressiontreatmentprogramme).Therefore,theteamsneedtoinvest timeandeffortintraining otherprofessionalsworkingin other pro-grammestoobtainacomprehensiveunderstandingandtoadjusttheir interventionsaccordingtothesefamilies’profiles.

Wehavethepossibilityofworkingwiththehealthnetwork...torefer thegirlsmorethananything,andthemumsformentalhealthcases,let’s say,depression...Theproblemisthatonmanyoccasions,thefamily doesn’tadheretothetreatment....Thesemothersarethebreadwinners; thereforeitisdiﬃcultforthemtoleavetheirworkplacetogototherapy. (Interviewee9:femalesocialworkerintheprogrammefor5years)

Moreover,professionalswereuncomfortablewiththecoercive judi-cialcontext.Theybelievedthatthelinkbetweendrugtreatmentand

thejusticesystem,asperceivedbythefamilies,wasnotconduciveto adherencetothetreatmentbecausethefamiliesviewedthetreatment programmesascoerciveinterventions.Inaddition,professionals work-ingwithinthejusticesystemneitherexplaintothefamilieshowthe drugtreatmentworksnordotheyprovideanymotivational interven-tionpriortosendingjuvenilesfordrugtreatment.

C.Barriersperceivedatthestructurallevel Theme4.Problematicanddangerouscontext

The professionals perceived the families’ context as constraining theirinvolvementandasanobstacletoachievingbettertreatment out-comes.Thiscontextentailsthenextthreesub-contexts.

a.Influenceoftheneighbourhoodcontext.Whiletheconditionsand contextsofthefamilywerenotuniform,severalofthemlivedin dan-gerousenvironmentswheredruguseandcrimeareprevalent.Onthe onehand,theseriskyandvulnerableenvironmentswereviewedbythe respondentsasimpoverishedareaslocatedatadistancefromthecity centreandthuscomplicateaccesstopublicservices(i.e.,healthand so-cialservices).Suchareasreflecthighlevelsofsocio-culturaldeprivation andexclusionandapoorqualityoflife.Ontheotherhand,theseareas aremorepronetomicro-traffickingandcriminalgangsthatattract ju-veniles.

Forexample,herethereareentiresettlementsthatareimmersedincoca paste...thatare,let’ssay...thathavebecomereallya...asettlement ofzombies,of...ofpeoplethat,ineveryotherhouse,traﬃcdrugs;that islucrativeforthem.Andalsohowtheyusethe...theboysassoldiers tosellthedrugs,doyougetme?It’sareallyperversesocialcircle,and thatiswhatweworkwith’.(Interviewee4:femalesocialworkerinthe programmefor3years)

Theseenvironmentsnotonlymakeitdiﬃcultforparentstobelieve thattheirchildrencanchangebuttheyalsomakeprofessionals’ inter-ventionsinthefamilies’homescomplexanddangerous.

b.Influenceoftheparents’familycontext.Professionalsheldthatitis difficulttochangethebehaviouralpatternsofjuvenilesthataredeeply rootedinthefamiliesoforiginoftheirparentsoroftheguardians be-causethey arerepetitive,ultimatelyinducing thejuveniles’drug use problem. There arevariouspatterns,notablyviolentfamily relation-ships(i.e.,physicalpunishmentsusedtotrainchildrenand/or physi-cal violencebetweenparents)that commonlyoccur, especiallywhen thechildrenareyoung.Thus,juvenileslearntoreactviolentlyto prob-lems,andparentstrytoavoidconflictwiththeirchildren.Asecond patternentailsdruguseamongstasignificantproportionofadults. Fur-ther,someadultsarealsoinvolvedincriminalactivities(robberiesand micro-trafficking),andthispatternmayberepeatedacrossgenerations.

...thefamilies,wereadolescent-fathersormothers-,veryyoung.Eh,and theirpastisthesame.Theyhadaviolentdad,anunconcernedmother. Ehm,theysaythat,thattheirpastwasthesame.Theyalso,since ado-lescence,wereusingdrugs,stealing,andtheirparentswerealsovery vio-lent,notveryaﬀectionate,theydidn’tsetanyboundaries....[It’s]like atrans-generationalthing’.(Interviewee16:femalepsychologistinthe programmefor2.5years)

Thus,parentseitherdonotperceivetheirchildren’sdrug useand criminal activities as a problem (because these behaviours are nor-malised)ortheyarehabituated(resigned)totheseproblems.

c.Influenceofjuveniles’behaviour.Theprofessionalsalsofeltthatthe complexity ofthejuveniles’profilesmakesthesechildrendifficultto manageandcreatesstressfortheirparents.Thus,manyadultsare re-luctanttocontinuetohelporsupporttheirchildren.Theprofessionals notedthatjuveniles’druguseandcriminalactivitieshaveincreasedin thelastseveralyears.Inaddition,juvenilesareusinganewclassof sub-stances,benzodiazepines,thatinducemoreviolentreactions. Addition-ally,theyareusingdrugsatearlierageswhentheylackawarenessof as-sociatedproblems.Thus,juvenilesarecommittingmoreviolentcrimes.

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M. Lobato, R. Sanderman, M. Soto et al. International Journal of Drug Policy 87 (2021) 102996 It’saproblem[forparents]whenthey[thechildren]usealcohol,crack,

cocapaste,cocaine,andnon-prescriptiondrugsbecausethisgeneratesa lotofproblemsatabehaviourallevel;problemsatarelationshiplevel. Thechildrenspendalotoftimeonthestreet.Therearesomethatsleep alldayandgooutatnight....[Theparents]areworriedwhentheir childrenareslim,whentheyhavetogooutandﬁndthematnight,when thechildrencutthemselves.(Interviewee6:femalefamilycounsellorin theprogrammefor9years)

Moreover, problematic juveniles’ proﬁles not only include drug use but also several other problems, such as physical and mental healthproblems,riskysexualbehaviours,sexualabuse,schooldropout and/or a history of major violations of children’s rights not only within the family but also within the public system (schools and the health, social services and family justice systems). When juve-nileslosealloftheirfamilysupport,theyoftenenduplivingonthe streets.

D.Themesnotrelatedtobarriers Theme5.Interventionneeds

Apartfromtheabove discussedbarriers,the professionals identi-fiedelementsthatcouldhelpthemtoachievebetterresultswhen work-ingwithjustice-involvedjuveniles’familiesinthreemainareas: work-ingconditions,interventiondesignandpublicpolicyfunctioning. Bet-terworkingconditionsentailtheinclusionofallofthenecessary re-sources(financial,humanandmaterial)andgreateremployment sta-bility(i.e.,apermanentemploymentcontract).Animproved interven-tiondesignentailsaworkingmodelthatisadjustedtofitfamilies’ pro-filesalongwithclearguidelinesforfamilyinterventions,thedesignof whichshouldtakeaccountoftheprofessionals’experience.Moreover, therespondents feltthatthey lackedthenecessaryexpertise and in-dicatedaneed for morespecialised trainingaswell asa systemfor trainingnewprofessionalstofulfiltherequirementsofdrugtreatment programmes.

It’srelatedtothestructureoftheteams;beingabletohavemorestable humanresources....[It’slike]thethreemainprofessionalgroupsare beingputonthestand,andtheotherprofessionalswhooﬀer complemen-tarysupport[arenot]stable....[Andweneedto]receivemoretraining inthisarea,theteamsmayhavemoretools.Iftheteamshadmoretime toreﬂect...Becausetherearemanythings,manyemergenciesthatwe needtoattendto.(Interviewee15:femalesocialworkerworkinginthe programmefor1year)

Moreeffectivepublic policyimplementationwould entailthe in-troduction of effective family interventions from the outset, better coordination amongst public programmes (on many occasions, they over-interveneortheirinterventionsreflectcontradictoryperspectives). Moreover,therespondentsfeltthatingeneral,thestateshouldassume amoreproactiveroleintheimplementationofpublicpolicies(e.g.,not outsourcingdrugtreatmentprogrammes).

Discussion

Insum,we foundthateventhough someprofessionals identiﬁed onlyjustice-involvedyouthastheirdirectpatients,severalothers de-clared that thefamilies’ involvement is critical when working with youngpeopleundergoingdrugtreatment.However,theyperceived dif-ﬁcultiesinfourareaswhenattemptingtoapproachthesefamiliesand todevelopanytypeofrelationorinterventionwiththem.Inaddition, they perceiveda need toimprovetheir current practiceswiththese families.

A.Individuallevel

Althoughtheprofessionalsgenerallyagreedon theimportanceof workingwithjustice-involvedyouth’sfamiliesandexpressedtheir

will-ingnesstodoso,theiroverallperceptionregardingthesefamilieswas verynegative, basedontheirbeliefthatnot muchcanbe donewith them.Additionally,becausethefamiliesarenotperceivedasthemain targetsoftheirinterventions,someprofessionals(andteams)donot at-tempttoinvolveandworkwiththefamiliesinthetreatmentprocess. Previousstudiesonimplementingguidelinesfordrugusehavefound thatprofessionals’personalvaluesmayleadtojudgmentalor moralis-ingvaluesthatunderminetheimplementationofresearch-based inter-ventionguidelines(Adams,2008;Andraka-Christou&Capone,2018;

Lin,Lan,Li&Rou,2018;Vorilhonetal.,2014).Inthepresentstudy, theinterviewedprofessionalspresentedalonglistofdeficitsthey per-ceivedintheparents.Thisconveyedtheimpressionthattheydidnotfeel preparedtoundertakefamilyinterventions.Thisperceptionmayalso beindicativeofabarriertoimplementingany(new)guidelinefor inte-gratingfamilieswithininterventionsfocusingonjustice-involvedyouth. Inlightofstudiessuggestingthattheeffectiveimplementationof pro-grammeguidelinesisassociatedwithprofessionals’feelingsof respon-sibility,confidenceandself-efficacy(Harris&Yu,2016;Ramos, Sebas-tian,Murphy,Oreskovich&Condon,2017),onestrategyforovercoming thisbarriermaybetoenhancesuchattributesinhealthproviders. Fur-ther,atrainingprogrammethataddressesprofessionals’attitudesand subjectivenormsmaybehelpfulforovercomingtheirnegative percep-tionsabouttheirpatients(Choo,DeMayo&Sun,2018;Friedmannetal., 2015).

B.Systemiclevel

Thedesignofthenationaldrugtreatmentprogrammealsopresents challengesforprofessionals.Theguidelinesdonotincludeclinical guid-anceforworkingwithfamilies.Thus,theteamsapplytheirown frame-workstodeterminewhattodoandhowtodoit.Someteamsuse mod-elstoincorporatefamilies,butmanyoftheseteamsdonotknowhow toimplementthesemodelsintopractice,statingthat‘modelsdonot fitthesefamilies’profiles’(Padwa&Kaplan,2018).Othersdonotuse anymodelstoaddressthefamilycomponent(i.e.,theprofessionalsdo notbelieveinmodels;Adams,2008).Itisnoteworthythata feasibil-itystudyonadaptingafamilyinterventionforyoungpeoplemisusing drugsshowedthattheconceptoffamilywasconsideredchallenging,as thisgroupofyoungpeopleusuallyhavefamiliesthatdonotconform tothetraditionalfamilycompositionoftwoparentsandtheirchildren. Consequently,itmaybedifficulttoimplementthetraditionalsystemic familyapproachthatentailsanentirenuclearfamilyinsuchsituations (Watsonetal.,2017).Additionally,anincompleteteam(e.g.,one lack-ingasocialworkerorpsychologist)createsaburdenontheotherteam memberswhoarenon-expertsintasksrelatedtothefamilies.Moreover, thetreatmentofjustice-involvedyouthwithsubstanceusedisordersis acomplexanddemandingjobthatisassociatedwithhighlevelsofstaff turnoverwithinteams,ashasbeenseeninotherdemanding interven-tionsettings (Szerman etal.,2014).These difficultiesalsoaffect the professionals’ perceptionsabouttheirabilitiestoworkwiththis pop-ulation.Asnotedbyseveralparticipants,theyhadtolowertheir ex-pectationsabouttheirpatientsandtheirfamiliesbeingabletochange becausethesehighpersonalexpectationswerenotmetintheirdaily practice. Researchershavedemonstratedtheimportanceofproviding trainingontheuseofmodelsorguidelinesanditseffectivenessin over-comingthesebarriers(Adams,2008;Andraka-Christou&Capone,2018;

Friedmannetal.,2015;Harris&Yu,2016;Ramosetal.,2017). Thebarriersidentiﬁedbyparticipantsinthisstudyrelatedtothe es-tablishmentofaneﬃcientprofessionalnetworkwithtwoprincipal ob-jectives.Ontheonehand,participantssometimesdidnotknowaboutor haveaccesstothenecessarycomplementaryinterventionstowhichthey couldrefertheirpatients.Alternatively,evenwhensuchprogrammes existed, thesewerenot preparedtoreceivepatientsundergoing sub-stance usedisordertreatment.Theteams experiencedthis barrieras being overwhelming,becausetheyfeltcompelled toimplementsuch interventionsbythemselves,orassumedthattherewouldbepatients

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withunmetneeds whowould impacton theinterventions that pro-fessionalsimplement(e.g.,amotherwithadruguse problembutno treatmentprogramtoreferherto).Ontheotherhand,participantsfelt thatthecontradictoryaimsandmodels,forinstanceofsanction dele-gateswithinthejuvenilejusticesystem,orthelackofknowledgeand stigmatisationofthispopulationfromotherteamsalsohadanegative impacton theirinterventions.Previousstudieshavealsoshown that diﬃcultiesassociatedwiththeintegrationofprogrammesresultfrom alackofcommunityresources andsupportaswell astheambiguity ofinterventionsthatinvolvediﬀerent goals,stigmatisation,or exclu-sionduetofailuretoadherencetoassessmentcriteria(Adams,2008;

Gust& McCormally, 2018; Ramos etal., 2017). These barriersmay be overcome by developingsupportive exchanges between agencies, providingtraining inservicedelivery andaddressingthe valuesand beliefs of the personnel implementing complementary interventions (Adams,2008).

C.Structurallevel

Amorecomplex barriermayrelatetothefamilies’environments orcontexts,whichcannotbechangedbytheteams;rather,they con-stitute the framework within which they implement treatment pro-grammes.Theprofessionalsidentifiedmanyfactorsthatnegatively in-fluence theirinterventions. This contextinduced theirnegative feel-ingsregardingtheirwork,suchashopelessness,powerlessnessand frus-tration.Previousstudieshaveshownthatnegativefeelingsmay con-tributetoconflictsthatinfluenceprofessionals’judgmentsandcoping responses, making itdifficult for them todecide how totreat their patients (Deans & Soar, 2005).Moreover, negative feelingsmay in-crease the risk of burnout (Schulte, Meier, Stirling & Berry, 2010). The current literature does not explore professionals’ negative feel-ings relatingtothecontextsof theirinterventions.Nevertheless, the findingsofstudiesonprofessionalsengagedinhighlydemanding psy-chologicalandsocialinterventions(e.g.,thoseinvolvinghospicecare, traumasurvivorsandterminallyillpatients) mayprovevaluable.An importantfindingofthesestudiesisthatself-careandburnout preven-tionstrategiesconstituteakeypillarrelatingtoprofessionals’mental health (Alkema, Linton & Davies, 2008; Azar, 2000; Killian, 2008;

Riordan&Saltzer,1992).

D.Perceivedneeds

Finally,theparticipantsidentifiedneedsthatweredirectlyrelated tothe difficulties they perceived in relation to their workwith the youths’families.Theyrequestedmoretrainingbecausetheyfelt that theylackedadequateskillsforinterveninginthesefamilies.Moreover, theyindicatedthat animproveddesign ofthetreatmentprogramme wasrequiredasitdidnotprovidesufficientguidance.Further,to en-hancesupportobtainedthroughaprofessionalnetwork,theynotedthat improvedcoordinationamongstprogrammeswasneeded.These per-ceivedprogrammedeficitsdonotjustapplytotheseprofessionals.A systematic reviewof the reported attitudesof mental health profes-sionalsworkingwithco-morbiditydiagnoses showedthat profession-alshadanalmostuniversalperceptionofdeficienciesinservicesand invocationaltrainingprogrammes(Adams,2008).Afurtherfindingis thatprofessionalsworkinginthefieldsofmentalhealth,substanceuse disorderanddualdiagnosisusuallymentionareasofimprovement re-latingtotheprovisionoffurthertraining,inter-agencyarrangements, oversight and the need for smaller caseloads (Deans & Soar, 2005;

McGovern,Xie, Segal, Siembab & Drake,2006; Ramos et al., 2017;

Schulte etal., 2010). Therefore,it seems thatwhen workingin de-mandingsettings,professionalsneedongoingtraining,closesupervision andmoreeﬀectiveinter-agencyexchangestoaddressthecomplexityof theseproﬁlesandcontextsandtoavoidburnoutandturnoverwithinthe teams.

Strengthsandlimitationsofthestudy

Thisstudyisthefirsttoseektounderstandprofessionals’ percep-tionsregardingtheinvolvementoffamilieswithindrugtreatment pro-grammestargetingjustice-involvedyouth.Itaddressesacriticalgap, given that no other assessmentshave previously been conducted in Chile sincetheinception ofthenational drugtreatmentprogramme. Additionally,professionalsarekeystakeholderswhoseinvolvementin theprocessofconceptualisingimprovementsintheprogramme guide-linesordesignisessential.However,thisstudyhadsomelimitations. Although we aimed to recruit one professional per outpatient pro-gramme activeinChile’scapitalofSantiagoforthestudy,sixof the teams wereunable toparticipate. However, becausewe coveredall of thesectorswithinthecity,thefamilies’profilesandcontextsmay have been adequately representedwithin the sample. For compara-tive purposes,we included onlyoutpatientprogrammes tomaintain similarprofilesofjustice-involvedyouthattendingthedrugtreatment programmes. Thus,detoxification, inpatienttreatmentandtreatment for justice-involvedyouth in jail wereexcluded. Finally, it is note-worthythatthecontextsandperceptionsofoutpatientteamsinother partsofthecountrymaydifferfromthoseoftheteamslocatedinthe capital.

Practicalimplicationsofthestudy

Althoughthis studywasexplorative,its findings mayprovide in-putsrelatingtooutpatientprogrammesforpolicymakers. Recommen-dationsonelementstobeincorporatedin(national)clinicalguidelines areasfollows:(1)provisionofacleardefinitionoftheconceptof ‘fam-ily’(Watsonetal.,2017)andclarificationonwhetherornotthefamily mustbeincludedwithinspecificinterventions;(2)clearaimsand inter-ventionstobeimplementedwithfamilies;(3)strategiesforpromoting familyadherencetotheprogrammes,whichisacomplexissue,given thefamilies’characteristics;and(4)specificinterventionsfor address-ingtransgenerationalbehaviouralpatterns,astheprofessionals iden-tifiedthisissueasacomplexonewithininterventions.Thefollowing recommendationsrelatetoprogrammeimplementation.Thefirst con-cernsplanninganddesigningtrainingprogrammesthataddress profes-sionals’perceptions,attitudesandbeliefsaboutthesefamiliesin con-junctionwithaddressingmodelsand/orguidelines(Friedmannetal., 2015).Thisprocessshouldbe ofsufficientdurationtoenable profes-sionals totranslatetheory intopractice(Schulteet al.,2010). Addi-tionally, funds andresources should be allocated forthe implemen-tation of apermanent systemofferingclinical support,self-care and burnoutpreventiontotheteams,especiallygiventhestressfulcontexts inwhichtheywork(Alkemaetal.,2008;Killian,2008).Inaddition, we recommend thedevelopment of a system thatfacilitates the in-tegrationofsubstanceusedisordertreatmentprogrammeswithother complementaryprogrammes.Thissystemcouldincludenotonly train-ing programmes for working with this population but itcould also addressthe valuesandbeliefs of staff aboutthis specificpopulation (Adams,2008).

Conclusions

Ingeneral,professionalsworkingindrugtreatmentprogrammesfor justice-involvedyoutharereceptivetotheinclusionof(new) interven-tions targetingtheparentsor responsibleadultswithin these youth-centredprogrammes.Moreover,severalprogrammeshavealready de-velopeddiﬀerentwaysofapproachingandworkingwiththefamilies. However,professionalsevidencedanegativeperceptionofthese fami-liestheirlivingcontextsandoftheinterventionitselfandreportedthat theydidnotreceivesupportfromothercomplementaryprogrammes. Thesebarriersinducefeelingsofhopelessnessandpessimismamongst

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M. Lobato, R. Sanderman, M. Soto et al. International Journal of Drug Policy 87 (2021) 102996

professionals regardingthe eﬀectivenessof the current programmes. Eﬀortstoinnovatethetreatmentmodalities aimed atimprovingthe outcomesmustthereforetakeintoaccountprofessionals’perspectives notonlytoavailoftheirexpertisebutalsobecausetheircurrent per-spectivecouldposeabarriertotheintroductionofanyprogrammatic changes.

Funding

Thisstudywasconductedasthedoctoralstudyoftheﬁrstauthor, whoisbeingsupportedbyascholarshipfromtheChileangovernment. However,thesponsorplayednoroleinanypartofthisstudy.Noother fundingwasobtainedforthisresearch.

DeclarationofInterests

None.

Acknowledgements

WewouldliketothanktheNationalServiceforthePreventionand RehabilitationofDrugandAlcoholUse(SENDA)oftheChilean gov-ernmentforsupportingthis researchaswellastheprogrammesand institutionsthatagreedtoparticipateinthestudy.

Supplementarymaterials

Supplementarymaterialassociatedwiththisarticlecanbefound,in theonlineversion,atdoi:10.1016/j.drugpo.2020.102996.

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