Program and policy development

A policy development process should be undertaken before program implementation. This helps agency personnel evaluate possible options and then select those that are best suited for a particular program. It also is important to develop policies that allow enough flexibility for future changes that may be needed.

Written policies are important to:

  • Safeguard the agency, clients, and staff.
  • Clarify staff and program expectations.
  • Ensure program consistency, credibility, replication, and support.

It is crucial to include significant stakeholders in the program development process. At the least, agency administrative and line personnel need to be incorporated. Other important persons to involve will vary from one jurisdiction to another, but careful consideration must be given to including them in the planning process.

At least 10 areas should be covered in the policy document for a drug use identification program:

  • The purpose and philosophy of the program.
  • The legal authority and limitations of the program.
  • Selection of juveniles to participate in the program.
  • Drug use identification methodologies and procedures.
  • Staff duties and responsibilities related to the program.
  • Economic and human resource issues.
  • Intervention strategies.
  • Interagency coordination.
  • Program evaluation and dissemination of results.
  • Public relations.

Each of these areas is explored briefly in the following pages.

Program purpose and philosophy

A clear statement of purpose is vital in establishing an effective program. A statement of the purpose of the program should include:

  • What is to be accomplished through the implementation of a program to screen juveniles for substance abuse.

  • A brief summary of the methods for accomplishing the purpose.

  • The persons or organizations responsible for various elements of the program.

  • The time period within which certain tasks or events are to occur.

  • Any objectives or activities not to be pursued through the program (e.g., the results of drug testing will not be used to bring additional legal charges against youth).

To be effective, the purpose of a substance abuse identification program must be in concert with the agency mission, and implementation methods must be constructed to help accomplish this purpose. It may include the program mission elements included in the "balanced approach," namely, community protection, accountability, competency development, and individualized assessment (Maloney, Romig, and Armstrong, 1988). Equally important is ensuring that the way in which results of drug screenings are to be used is in accord with the agency's mission and program purpose. For example, there will be discord if the program purpose and agency mission stress treatment and rehabilitation of youth, but the way in which drug test results are used is solely punitive.

Legal authority and program limitations

Agencies developing a substance abuse identification program must investigate legislation, regulations, and case law regarding drug testing. Legal liability that might result from failing to detect and treat illicit drug use should be considered.

Authorization to screen youth for illicit drug use should come from State legislation, especially when urinalysis is used. However, few States have enacted such legislation. If legislative authority is not available, court orders may be sought to allow drug testing. Agency-based policies with administrative support also may be developed. Agencies should work to establish appropriate policies at the highest level possible. The goal should be to establish policies and procedures that are consistent with State legislation and case law and, therefore, are legally defensible if challenged by youth, their families, or staff (American Probation and Parole Association, 1992).

If State statutes do not exist, the basis for legally testing juveniles could depend on their status in the juvenile justice system. There are different legal standards for pre- and postadjudicated youth.

Testing preadjudicated youth. Preadjudicated youth are entitled to all the rights and protections afforded any youth in the community. The constitutionality and legal basis for urine drug testing of juveniles in detention is summarized in the following statement prepared by the ACA/IBH project (1991:1).

The issue of constitutionality of urine collection and testing in detention facilities hinges on what use is made of the test results. Test results can be used with confidence as part of a case management plan, just like other information from a medical examination. When an initial health screen reveals evidence of diabetes or a sexually transmitted disease (STD), the detention facility is obligated to devise a plan for treatment. This principle holds for urine test results. On the other hand, if testing is used to file charges and prosecute, there is a potential for legal challenge.

Although laws in many jurisdictions may not specifically deal with drug testing, the authority to implement a drug-testing program may be inferred from other laws. For example, the Code of the District of Columbia (where there is an extensive drug-testing program for juveniles) contains the following three provisions that, interpreted broadly, allow for requiring youth in detention to undergo urinalysis (American Correctional Association/Institute for Behavior and Health, 1995):

  • Physical examinations of youth are permitted. Drug testing is considered within the definition of "physical examinations" allowed by this law.

  • A preliminary determination of the need for supervision is mandated. Because the determination of illegal drug use would generally justify the need for supervision, testing to detect drug use may be viewed as an essential part of the intake process.

  • A determination must be made about the necessity of detaining a juvenile for his/her protection or the protection of others. Substance abuse would be among those factors considered when assessing the need to keep a youth in detention.

The District of Columbia Superior Court has determined these three statutory provisions are sufficient to conclude that preadjudicatory drug testing is appropriate. Only local jurisdictions can determine whether their particular statutes would support preadjudicatory drug testing (American Correctional Association/Institute for Behavior and Health, 1995). The ACA/IBH (1995) project advises "[p]re-adjudication testing should be approached cautiously." It may be wise to make drug testing voluntary for preadjudicated youth, as was done in the three ACA/IBH project sites. However, to encourage voluntary compliance with testing, youth should be informed fully and carefully about the testing program. They should be advised that the results will not be used to bring new legal charges against them or to justify punitive measures (American Correctional Association/Institute for Behavior and Health, 1995).

Testing postadjudicated youth. The rights of adjudicated juveniles within the justice system are diminished because of their age and legal status. Several constitutional rights afforded most citizens may be curtailed for youth, such as the right to vote. Privileges that are legally controlled, such as driving vehicles and purchasing alcohol and tobacco, also are restricted for youth. In addition, those found guilty of crimes may lose their freedom or have conditions placed on it. Conditions placed on postadjudicated youth must be (Del Carmen and Sorensen, 1988):

  • Constitutional.
  • Clear.
  • Reasonable.
  • Reasonably related to the protection of society and/or the rehabilitation of the individual.

Challenges to drug testing have focused on five constitutional rights (Del Carmen and Sorensen, 1988) described below:

The right against unreasonable search and seizure. Urinalysis is equivalent to a search for illicit drugs and involves procedures that invade privacy to collect body fluids for analysis. To be constitutional, such a search must be reasonable and based on a rational belief that it is necessary.

The right to due process. Certain procedures must be followed before people can be deprived of their freedom. Challenges to urinalysis on the grounds of violation of due process have usually been unsuccessful. Certain standards should be met, however. The tests used must be accurate and meet scientific standards acceptable to courts. When a legal procedure, such as revocation of probation, is based solely on the evidence of urinalysis, the methodology used must have a high degree of accuracy. Often, courts require a second, confirmatory test before finding there is sufficient evidence to prove illicit drug use and limit the offender's liberty.

Chain-of-custody procedures are another important factor in due process. If procedures are not tight, tampering with the specimen or test results could occur and make them invalid for legal use. Therefore, specimens must be properly sealed, labeled, and stored; documentation of all who handle specimens and reports of results should be maintained. Additionally, specimens from positive tests should be retained in case of possible legal challenges. (A sample chain-of-custody form is included in the appendix.)

The right to confrontation and cross-examination. When used for legal proceedings, results of urinalysis can be challenged based on hearsay evidence. This occurs if the laboratory personnel who actually conducted the test are not present to provide testimony; therefore, the accused person cannot confront and cross-examine the witness who is testifying against him or her. However, these challenges generally have not been sufficient to deter use of urinalysis. Courts have concluded the rights of offenders were not violated because of exceptions to the hearsay rule. Business records, reliability, and trustworthiness of a laboratory are factors considered in excluding a requirement for direct cross-examination.

The right to equal protection. This clause ensures individuals cannot be treated differently unless legal justification exists. With substance abuse, differential treatment is based on an illegal activity, not race, sex, or socioeconomic differences. Because drug screening is reasonably related to the detection, treatment, and/or prevention of substance abuse, it is a justifiable condition.

The right against self-incrimination. The constitutional protection against self-incrimination applies to testimony given in court rather than to physical evidence. Because urinalysis is a form of physical self-incrimination (similar to submitting to fingerprinting or appearing in a lineup) it falls outside the domain of constitutional protection. The use of urinalysis does not require the person to confess to substance abuse, an action that would constitute self-incrimination.

The type of legal proceeding in question largely determines whether a constitutional claim is upheld. Such a claim is more often upheld in criminal trials, because guilt must be proved beyond any reasonable doubt. Constitutional claims fail more often in revocation hearings, because the question of guilt relies on the preponderance of evidence.

When examining challenges to drug testing, it has been found that urinalysis, if conducted properly, does not infringe upon the constitutional rights of offenders. Recommended practices include (Del Carmen and Sorensen, 1988):

  • Imposing drug screening only when it is reasonably related to the rehabilitation of the individual and in such cases where the person's delinquent behavior could be attributed to substance abuse.

  • Determining whether or not a confirmatory test is required.

  • Ensuring that those administering drug tests are trained and properly qualified.

  • Following strict chain-of-custody procedures, including sealing, labeling, storing, and documenting transfer of specimens.

  • Saving samples with positive results until the time for all possible legal challenges has elapsed.

  • Having clearly written policies and procedures for drug screening and for responses to positive findings.

Confidentiality is another important legal issue. Federal laws protect the privacy of persons receiving alcohol and drug abuse prevention and treatment services (Alcohol, Drug Abuse, and Mental Health Administration, 1987). State laws may also address confidentiality; these should be researched before implementing a program. Policies and procedures related to confidentiality of drug testing should address the following areas:

  • The youth's right to privacy.

  • The person(s) to whom, and under what circumstances, information may be released.

  • The type of information that may and may not be shared.

  • The process and forms for obtaining permission to release information.

  • The consequences for unauthorized disclosure of information.

  • The precautions to be taken in collecting and aggregating data to ensure the confidentiality of individual youth.

Selection of juveniles to participate in a drug-testing program

The ACA/IBH project (1991:7) recommends "[e]ach juvenile who is detained and subject to an intake process should receive a drug test as a routine part of admission." The testing should occur either when the youth undergoes initial health screening or when he or she showers and changes clothing before entering the general population (American Correctional Association/Institute for Behavior and Health, 1991). Detention centers may decide that initial testing at intake is sufficient. Others also conduct unannounced, random testing of all juveniles in a facility on a particular day (American Correctional Association/Institute for Behavior and Health, 1995). This might be appropriate if juveniles have left the facility on furloughs and/or if there is any possibility that contraband has been brought into the center.

For youth on probation or receiving aftercare services following incarceration, the question of whom to test becomes more complex. Drug testing can be used as an effective supervision tool for youth engaged in substance abuse. However, drug testing can be costly in terms of supplies, processing costs, and staff time. Therefore, careful decisionmaking is called for to make the program cost effective by selecting appropriate juveniles to participate.

Some agencies do an initial screening of all youth entering probation or other community corrections services. This may involve a combination of assessment instruments and techniques, drug recognition techniques, and/or urinalysis. Other agencies base drug testing on a youth's previous criminal record or other indicators of illicit drug use and test only those with a substance abuse history.

After such screening processes, youth who appear to have an ongoing substance abuse problem may enter the program for continuing drug testing. Program guidelines should be flexible enough to allow youth to enter the program if a new or recurring substance abuse problem is noted. Similarly, if youth are tested over time and there is no indication of ongoing substance abuse, they should be released gradually from the drug-testing program.

Drug use identification methodologies and procedures

Three methods of identifying substance-abusing youth are practical within the juvenile justice system. Combining all three is considered the best approach. Each is described briefly in the following pages.

Assessment instruments and techniques. Assessment procedures can be used to:

  • Distinguish alcohol and drug users from nonusers.
  • Make initial treatment recommendations.
  • Make case management decisions.
  • Provide information for a continuum of services.

Assessment may occur at any stage in the youth's movement through the juvenile justice system. Coordination of assessment strategies and sharing of information are vital to ensure youth receive the continuum of services they need.

Three assessment methods identify youth who are using alcohol and other drugs. Each is described briefly in the following paragraphs.

Investigation of existing information. Reviewing existing records will provide information about substance abuse and delinquency histories, education experiences and status, medical history, family situation, and other areas. Juvenile justice, medical, school, social service, and other records provide valuable information that will evoke questions for further investigation.

Self-reports and client and collateral interviews. Although an offender's statement should not be relied upon as a sole indicator of alcohol and other drug involvement, there are therapeutic benefits to confronting a youth with questions about use of chemicals. Interviews with the juvenile go beyond self-reports/statements made by the youth and probe for more comprehensive information. Collateral interviews involve gathering information from individuals who are, or have been, closely associated with the youth. Areas to be explored include the history and status of the youth's substance abuse and delinquency, mental status, treatment, family, education, medical problems and needs, and any positive support systems in the youth's life.

Assessment instruments. This area includes a wide range of tools that can aid practitioners in identifying substance-abusing youth and planning for effective interventions. Standardized interviews must be conducted according to a prescribed style using a preestablished list of questions. Therefore, the interviewer is restricted from freely probing beyond conflicting or superficial answers. Structured interviews allow the interviewer more flexibility, but they require more experience in working with youth and greater expertise in interviewing. The interviewer is expected to probe beyond vague or conflicting responses in order to uncover more information. The juvenile takes self-administered tests, which require some motivation and reading ability to be completed accurately. They eliminate interviewer bias and can be scored and quantified easily. For youth who have difficulty speaking directly about themselves, these tests provide an indirect and, possibly, less threatening method of self-disclosure.

Several factors must be considered when selecting assessment instruments, including:

  • Ease of use.

  • Expertise and scoring time required to administer and score the instrument.

  • Necessity of staff training and whether it is available.

  • Possibility of bias.

  • Validity of the instrument (Does it accurately measure what it intends to measure?).

  • Reliability of the instrument (Does it produce stable results regardless of the influence of fluctuating or extraneous factors?).

  • Credibility of the instrument (Is it accepted among practitioners and members of the judiciary? Has it been normed with a population of juvenile offenders?).

  • Motivation level and verbal and reading skills required of the youth to be assessed.

  • Propensity for the instrument to be manipulated.

  • Average cost.

Once collected, assessment information must be integrated, evaluated, and used appropriately in making decisions about the youth and his or her substance abuse. A client management classification system may be used to guide case management decisionmaking. It also is important that assessment data be compiled in a format that is most useful to all who will have responsibility for intervening with the youth. A management information system, whether automated or manual, is important for this purpose.

There are several advantages, and some disadvantages, of using assessment instruments and techniques. The greatest advantage of assessment procedures is their ability to gather information about chemical use other than current or very recent use that can be detected through drug recognition techniques or urinalysis. In developing an effective intervention plan, this kind of long-term data can be very helpful. Many assessment approaches also allow for gathering information about the social context of a youth's substance abuse problems. When, where, why, and with whom they use alcohol and other drugs can be important information for case management purposes.

The disadvantages of assessment procedures include the time involved in completing a thorough assessment. Some assessment tasks and the administration of some instruments also require staff with advanced skills or special training.

Drug recognition techniques. Drug recognition techniques were developed originally by the Los Angeles Police Department to help law enforcement officers identify drug-impaired motorists in a traffic arrest situation. The Orange County, CA, Probation Department later applied and adapted the techniques for use in community corrections settings, using their findings to expand the period for detecting illicit drug use.

Drug recognition techniques are systematic and standardized evaluation techniques for detecting signs and symptoms of substance abuse. All the areas evaluated are observable physical reactions to specific types of drugs. Three key elements in the process are:

  • Verifying that the person's physical responses deviate from normal.

  • Ruling out a cause that is not drug related.

  • Using diagnostic procedures to determine the category or combination of substances that are likely to cause the impairment.

A skilled practitioner can determine, with a high degree of accuracy, whether a youth has used some substances recently. Drug recognition techniques include the identification of the category of chemical substances ingested, although it is not possible to identify specific drugs within a classification. These techniques can determine whether a youth currently is under the influence of substances or has used a particular drug or combination of drugs within 72 hours of ingestion. However, it is not possible to determine the amount of the substance consumed.

Using drug recognition techniques is cost efficient because they often can eliminate the need for costly urinalysis by screening out those youth who do not show symptoms of current or recent substance use. This does not mean these youth have not used illicit drugs; however, if the symptoms are not apparent through drug recognition techniques, it is unlikely there is a sufficient quantity of most drugs, or their metabolites, left in the body for urinalysis to produce a positive test result. (Marijuana and PCP may be exceptions, as low levels sometimes can be detected through urinalysis for as long as 3 to 4 weeks.) Initial training for staff to become proficient in using these techniques can be costly, but once the staff are trained, ongoing expenses are minimal.

Use of drug recognition techniques provides immediate results with which to confront youth. These techniques are minimally intrusive in detecting illicit drug use, compared with the collection of body fluids required for urinalysis. The process is systematic and standardized, reducing the possibility of bias or error by trained staff.

Not all categories of drugs are equally detectable using drug recognition techniques, and the specific drugs ingested cannot be determined. Thus, the techniques used alone may not be conclusive in determining the exact substance used or in detecting the effects of illicit drugs that have minimal influence on the physical responses measured by the techniques.

There are 12 steps in the drug recognition process:

  • Drug history.
  • Breath alcohol test.
  • Divided-attention psychophysical tests.
  • Medical questions and initial observations.
  • Examination for muscle rigidity.
  • Examination for injection sites.
  • Examination of vital signs.
  • Darkroom examination.
  • Examination of the eyes.
  • Youth's statements and additional observations by staff.
  • Opinions of the evaluator.
  • Toxicological examination.

It is imperative that practitioners be well trained in using these techniques and that each step be followed precisely to preserve the credibility and integrity of the drug recognition process.

Chemical testing. Chemical testing is the most physically intrusive and the most expensive of the three methods of identifying illicit drug use; however, it is also the most accurate. Several scientific methods are available for detecting illicit drug use in individuals, including urinalysis, blood analysis, hair analysis, and saliva tests. However, saliva and breath analysis for alcohol, and urinalysis for drugs other than alcohol, are the methods currently recommended because they are reliable and relatively inexpensive compared with other methods of chemical testing.

Immunoassay tests generally are used for initial tests, and they are considered reliable for detecting the presence of illicit drugs in a person's system. These tests depend on naturally occurring reactions between antibodies and antigens. A specific antibody can be produced to react with a particular antigen, such as a drug. A "tag" is chemically attached to a sample of the illicit drug to be detected.

Immunoassay procedures vary primarily in the tag used to produce the reaction. The following immunoassay methods of urinalysis have been developed. Often, the type of tag used to produce the chemical reaction is reflected in the name of the test:

  • Radioimmunoassay (RIA).
  • Latex agglutination immunoassay (LAIA).
  • Enzyme immunoassay (EIA).
  • Fluorescence polarization immunoassay (FPIA).
  • Kinetic interaction of microparticles in solution (KIMS).
  • Ascent multi-immunoassay (AMIA).

During an immunoassay process, the reagent (the tagged drug), the urine, and the antibody are combined. The tagged drug and the untagged drug (if present in the urine) compete for binding sites with the antibody. If a sufficient concentration of drug is in the urine, little of the tagged drug can bind with the antibody. The results will indicate the amount of tagged drug that either was or was not bound with the antibody. These results are compared with a sample containing a known amount of a drug to determine whether the urine contained a measurable amount of the substance.

Immunoassay tests provide qualitative results that indicate the presence or absence of a chemical relative to a certain cutoff level. However, except for the RIA method used primarily by the military, which provides quantitative results, they cannot indicate the actual amount of the illicit drug in the system or when it was ingested.

Chromatography methods of urinalysis extract the drug from the urine in a concentrated form. This is then processed by laboratory instruments using heat or liquids, causing the drug metabolites to separate. These methodologies include gas chromatography/mass spectrometry (GC/MS), gas chromatography (GC), and high-performance liquid chromatography (HPLC). They are the only other procedures providing a quantitative reading of the level of drugs in one's system. GC/MS is considered the "gold standard" of urinalysis testing, and although it is the most expensive, it is often used to confirm positive results of initial tests. Thin-layer chromatography (TLC) was one of the earliest methods developed, but it has been found to be extremely unreliable and is not recommended for use in the criminal or juvenile justice system (Bureau of Justice Assistance, 1990).

Breath analysis is the most commonly used and most cost-effective method of detecting levels of alcohol intoxication. Because alcohol evaporates quickly from urine, urinalysis generally is not used to test for alcohol.

The cutoff level is the amount of drug or metabolite that must be in the specimen for a test to show a positive result. A positive test indicates the amount of drug present is above the cutoff level; negative results show there is no drug or the amount is below the cutoff level. The cutoff level is usually measured in nanograms per milliliter (ng/ml), and recommended cutoff levels for illicit drug categories have been developed by the Division of Workplace Programs, Center for Substance Abuse Prevention (CSAP) (see table 4). Cutoff levels for confirmation tests are generally set lower than those for initial tests (see table 5). Agencies are encouraged to establish cutoff levels consistent with those recommended by the U.S. Department of Health and Human Services (HHS) guidelines (Substance Abuse and Mental Health Services Administration, 1994), as they are more likely to be accepted by courts if the results of drug tests are challenged.

Table 4: Recommended Cutoff Levels for Initial Tests

Cannabinoids* 50 ng/ml
Cocaine* 300 ng/ml
Opiates* 300 ng/ml
Amphetamines/Methamphetamines* 1,000 ng/ml
PCP* 25 ng/ml
Benzodiazepines** 100 ng/ml
Barbiturates** 300 ng/ml
Methadone** 300 ng/ml

*U.S. Department of Health and Human Services Mandatory Guidelines for Testing Levels.

**Cutoff levels for these drugs are not included in the HHS guidelines because they may be legally prescribed. The cutoff levels cited are those recommended by the scientific community.

Sources: Federal Register. 59(11): 29922.

American Probation and Parole Association. 1992. Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Table 5: Recommended Cutoff Levels for Confirmation Tests

Cannabinoids* 15 ng/ml
Cocaine* 150 ng/ml
Opiates* 300 ng/ml
Amphetamines/Methamphetamines* 500 ng/ml
PCP* 25 ng/ml
Benzodiazepines** 250 ng/ml
Barbiturates** 250 ng/ml
Methadone** 250 ng/ml

*U.S. Department of Health and Human Services Mandatory Guidelines for Testing Levels.

**Cutoff levels for these drugs are not included in the HHS guidelines because they may be legally prescribed. The cutoff levels cited are those recommended by the scientific community.

Sources: Federal Register. 59(11): 29922.

American Probation and Parole Association. 1992. Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

It is important that agencies conducting urinalysis have well-defined policies and procedures for doing so. Following are some issues that should be considered in developing policies. The documents listed in the references and suggested readings section of this Summary are sources of additional information on these topics.

Frequency of testing. Staff and monetary resources can be wasted if tests are conducted more often than necessary. However, testing should occur with sufficient frequency to ensure there is a reasonable opportunity to detect youth who are using illicit drugs. Policies should establish minimum frequencies for testing (e.g., once per week; three times per month). These should be flexible enough that personnel could test any youth if circumstances so dictated. For example, a youth whose behavior seems erratic might be tested before the next random test time occurs.

Because different drugs of abuse stay in the body for varying lengths of time, ranging from a few hours to several days (see table 6), it is helpful to know the youth's drug(s) of choice to decide how often he or she should be tested. Many programs test youth initially and periodically during their time in the program for a broad range of illicit drugs, but most of the time they test only for those substances the youth has been known to use. Another factor to consider is the youth's progress in the program. Initially, testing may be performed much more often, with testing frequency being reduced for youth whose results are consistently negative. A response to the youth should always be made following testing, whether the results are positive or negative. A realistic appraisal of staff tasks also is important. Thus, caseloads and other responsibilities of staff must be considered when deciding how often to test.

Table 6: Approximate Duration of Detectability of Selected Drugs*

Drug Duration of
Drug Detectability
Alcohol Very Short**
Amphetamine 2-4 days
Methamphetamine 2-4 days
  • Most types
2-4 days
  • Phenobarbital
Up to 30 days
Benzodiazepines Up to 30 days
Cocaine metabolities 12-72 hours
Methadone 2-4 days
(heroin, codeine, morphine)
2-4 days
Cannabinoids (marijuana)
  • Casual use
2-7 days
  • Chronic use
Up to 30 days
Phencyclidine (PCP)
  • Casual use
2-7 days
  • Chronic use
Up to 30 day

*These provide only general guidelines. Many variables should be considered in interpreting duration of detectability. These include drug metabolism and half-life, the youth's physical condition, the youth's fluid balance and state of hydration, and the route and frequency of ingestion.

**The period of detection depends on the amount consumed. Approximately 1 ounce of alcohol is excreted per hour.

Source: Division of Workplace Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

Scheduled and random testing. Some agencies conduct testing at set times, while others advise youth that they are subject to testing at any time. Scheduling tests can help staff members organize their tasks and time efficiently. However, when juveniles know they will be tested at certain times, they may learn to schedule their substance abuse accordingly to avoid detection. Therefore, random testing is generally recommended.

Observed specimen collection. To avoid the possibility of specimens being adulterated or otherwise tampered with, urination should be observed by a staff member who is the same sex as the youth. There are two ways youth may attempt to taint a urine sample: by ingesting something before giving the sample or by adding something to the specimen after it leaves the body. Examples of substances youth might try to ingest before a drug test include large quantities of water, acidic liquids (such as lime or lemon juice or vinegar), diuretics, pectin, and oriental tea. Water, bleach, toilet bowl cleaner, and soap are examples of substances youth might try to add to a specimen during or after urination. Most of these substances will not affect the accuracy of most drug tests unless the amount of drug remaining in the youth's system is already very close to the cutoff level. Test manufacturers also have taken steps to design tests that detect adulterants or ensure specimens are brought to the proper pH level before they are analyzed. Another ploy some youth might use if not supervised is to substitute a specimen they have taken earlier or one from another individual. A substitution should be easily detectable by the temperature of the sample; some collection cups now have temperature strips to ensure the sample is consistent with body temperature. Youth also might make a sample useless by punching a hole in the collection cup. Because of all these possibilities, it is recommended that collection of specimens be observed to rule out any potential for adulteration, switching of samples, or tampering with collection cups.

Chain of custody. There must be a record of the whereabouts and persons handling the urine specimen and test results at all times. This includes documentation of the specimen collection; handling, storage, transportation, and testing; and dissemination of results. All drug-testing specimens, supplies, and equipment should be kept in a locked storage area.

Onsite testing or contracting for services. There are both instruments and field kits that can be used by agency personnel to conduct initial immunoassay tests. If used according to manufacturer's directions, these provide accurate qualitative results. However, it is also possible to contract with a laboratory to analyze the specimens collected from youth. Volume of testing, staff time, training level for processing tests, the time required to obtain results, and the availability of laboratories will be factors to consider in selecting either onsite or laboratory services. Some programs use a combination of onsite and laboratory testing. For example, they may conduct initial tests onsite and, if necessary, send positive tests to a laboratory for confirmation. Using commercial laboratories, health departments, and forensics laboratories might be explored.

Safety measures. One aspect of safety includes procedures for handling and testing urine specimens. There are no known cases of transmission of HIV through laboratory contact with urine. However, it is wise for personnel to take standard precautions when handling urine to protect themselves from any potential disease transmission. Safety procedures should include wearing rubber gloves, lab coats, and goggles.

Safety measures also should be employed to protect the specimens. Therefore, rules should include no smoking, eating, or drinking in the area where specimens are stored or handled. No food should be in the same refrigerator with specimens.

Safety concerns also should be related to the youth in the program. Staff should be trained to identify the possible withdrawal symptoms or side effects of chemical use that might endanger a youth's health and safety. Some substances may lead to erratic behavior that could endanger the youth or others. Staff should know how to intervene appropriately if these are noticed. If youth have injected drugs, it may be important for them to receive counseling and testing for HIV/AIDS and other blood-borne infections.

Finally, safety also refers to the development of guidelines for staff and youth when revealing positive results to juveniles. When working with potentially violent youth, staff should be trained to use designated procedures in case of an emergency.

Quality assurance and quality control. Steps should be taken by agency personnel or laboratories to document the accuracy and reliability of the testing program regularly. Without such measures, the program may be subject to legal liability issues.

Report of results. Onsite noninstrument tests will yield virtually instant results. However, onsite instrument and laboratory testing procedures will take longer. For youth, timely responses to their behavior are important. The type of agency and the way results will be used also will affect how soon results may be needed. For detention programs, results may be needed before the youth goes to court. Thus, the ACA/IBH (1995:4) project recommends "[s]pecimen collection should take place during the intake process, and testing should occur before the pre-hearing or within 48 hours of detention." Initial information also is needed for case planning. The APPA Guidelines (1992:49) state the turnaround time for receiving a report of results "should be 72 hours or less from the time the specimen reaches the laboratory until the results are received by agency personnel."

Confirmation. A positive result may be confirmed in three ways: a statement of admission by the youth, a second test using the same methodology, or a second test using a different methodology. For legal proceedings, especially if a youth's freedom may be limited, a second test using a different methodology may be necessary. Confirmation by GC/MS is required in some jurisdictions because it is the most accurate test. If results are going to be used for treatment planning or for internal program procedures, the other methods of confirmation may be acceptable.

Responding to results. Unless a response follows every test administered, youth may receive an unintended message that drug testing is simply procedural and does not have much impact. Chemical testing, assessments, and drug recognition techniques are tools available to juvenile justice agencies and practitioners to identify and monitor substance abuse among youth. The most critical element of any program is how the results are used to intervene with the youth. This will be discussed in greater detail later in this document.

Staff duties and responsibilities related to the program

New programs entail additional responsibilities for staff. Including staff in the planning process and addressing their concerns throughout is likely to result in better cooperation with the program.

It is also important to clearly define staff responsibilities and qualifications for implementing screening procedures. In addition to possessing job-specific knowledge and skills, all personnel should be committed to the highest standards of ethical behavior. Providing appropriate initial and ongoing staff training is vital. Planners can facilitate effective teamwork and staff cohesion by:

  • Involving staff in the decisionmaking process.

  • Setting clear, achievable goals and objectives for the program and communicating them effectively to the staff.

  • Establishing effective procedures for conducting the program.

  • Maintaining constructive communication among team members.

  • Allowing the team latitude to solve problems and grow with their responsibilities.

  • Providing training programs to help members perform their duties proficiently.

  • Recognizing and rewarding excellent job performance and allowing the team to share in the success of the program.

Economic and human resource issues

In developing new programs, agencies must consider the following costs and benefits:

  • Tangible cost factors. These include the calculated costs for each type of screening procedure and for intervention methods to be used. In addition to staff time, these costs include supplies and equipment or laboratory fees.

  • Intangible cost factors. These are expenses that could occur, such as a potential lawsuit. Such costs are often avoidable through implementation of thoroughly researched, comprehensive, and clearly written policies and procedures.

  • Tangible benefits. These are the calculated amounts that can be saved by establishing a program. This might include money saved by diverting some youth from incarceration facilities and to more appropriate placement in treatment programs.

  • Intangible benefits. These are predictable but immeasurable savings that may occur because of a new program, such as lower healthcare costs, fewer motor vehicle accidents, reduced theft and vandalism, and other related areas.

Program planners and administrators should strive to obtain needed resources for a drug-testing program while containing costs as much as possible. In addition to agency budgets, there are other sources for funding programs, including:

  • Federal, State, and local grants and funding programs.
  • Agency collaboration.
  • Resource sharing.
  • Fundraising.
  • User fees.

With careful planning and oversight, drug screening may prove less expensive than some might presume. Possible strategies for cost containment include:

  • Reducing the number of youth to be drug tested by using assessments and drug recognition techniques to prescreen them.

  • Using random rather than scheduled urinalysis.

  • Encouraging youth to admit illicit drug use rather than undergo testing.

  • Enlisting the help of student trainees or volunteers to assist staff.

  • After initial assessments, testing only when appropriate (e.g., youth with substance abuse histories or related offenses; youth with recent behavioral changes).

  • Testing with sufficient frequency to detect illicit drug use, but scheduling the frequency of testing according to the drug use habits of the youth (i.e., determine which chemicals stay in the system longer and test for these less frequently).

  • Using the least expensive method of testing appropriate (e.g., if test results are to be used only for treatment planning or supervision of the youth, less expensive immunoassay tests giving a qualitative result should be sufficient).

  • Using confirmation testing only when necessary (e.g., when a youth denies use or when results will be used for court proceedings).

Intervention strategies

Identifying alcohol- and drug-involved juveniles is only the first step in a successful program. Programs need to consider intervention strategies at three possible levels.

  • The individual level focuses on the young person who has engaged in illegal behavior and has been identified as using psychoactive substances. Interventions are intended to correct specific behaviors or treat underlying needs and problems resulting in delinquency and substance abuse.

  • The environmental level includes factors intertwined with the developmental process, such as family, peers, community, religious affiliation, and school experiences. Creation of environments that will reinforce prosocial behavior is an important goal. Family interventions, positive peer group approaches, placement of youth in healthier environments, and changing disorganized communities are possible intervention approaches at this level.

  • The societal level contains the broader context of conditions that often impinge upon environmental circumstances and individual options, including poverty, minority status, employment opportunities, and access to healthcare. Social problems contribute to individual, family, and community distress. Such problems are of longstanding duration and take considerable effort to alleviate. However, agencies and practitioners can contact elected officials, stay informed about social conditions and political processes, vote, and conduct research to add to the knowledge base that can be used to make informed policy decisions.

Case management of individual youth is often the primary task of juvenile justice practitioners. Intervention strategies used with substance-abusing youth may differ depending on where they are in the juvenile justice process. For preadjudicated youth in detention centers, intervention may focus primarily on using information to develop an effective case plan to help the youth stop abusing substances. For an adjudicated youth on probation, these same intervention tasks are appropriate, but drug testing can also be used as a supervision tool to monitor compliance with probation conditions. Youth who are not in compliance may receive graduated sanctions with treatment interventions to help them control their behavior. Usually, drug test results of pre- or postadjudicated youth are not used to bring new drug-related charges against them.

Six elements in the case management model (National Center for Juvenile Justice, 1991) are described briefly in the following paragraphs.

Case assessment and classification is the foundation of good case management. Both the needs of individual youth and available resources must be assessed.

Case planning includes analyzing available data, setting priorities, and matching the treatment to the needs of the youth. The case plan will address community risk, youth responsibility, substance abuse issues, youth development, and family and environmental problems. The case plan should include goals, objectives, timeframe, criteria for successful completion, persons responsible for specific tasks, and expected benefits to the youth.

Performance of services includes both treatment and supervision strategies that may vary in level and intensity depending on individual needs of youth. Specific supervision strategies may correspond with the components of the balanced approach in juvenile justice (Maloney, Romig, and Armstrong, 1988). Strategies for community protection might include providing security to control the source of the illicit drug supply or monitoring substance use among juveniles. Strategies related to accountability might be adult supervision of juveniles performing community service, counseling, changes in program status, and restitution or service to victims. Achieving competency development requires treatment combined with education stressing social, vocational, and life skills development.

Treatment matching includes an assessment of the needs, problems, and characteristics of individual youth, program types and elements, and resources available. Treatment programs for youth may include therapeutic communities, outpatient programs, 12-step programs, day treatment, residential and hospital-based programs, detoxification programs, and, rarely, pharmacotherapy. Within these programs, various treatment modalities often included are drug education, individual therapy, group therapy, positive peer influence, family therapy, and cognitive behavior interventions. Various new approaches being implemented include boot camps, afterschool programs, therapeutic adventure programs, partial hospitalization and day treatment or intensive treatment programs, halfway houses, and supervised independent living programs.

Examples of specific interventions provided within various detention centers include drug education classes, group or individual counseling/treatment programs, and 12-step programs (e.g., Alcoholics Anonymous and Narcotics Anonymous). Referrals also were made for youth to attend community-based treatment and 12-step programs when they left detention.

Probation programs similarly can develop effective means for intervening with youth who test positive for illicit drugs. For example, some interventions and consequences developed by various programs include:

  • Verbal confrontations/reprimands.
  • Drug education programs.
  • Increased drug testing.
  • Increased contacts with a probation officer.
  • Earlier curfews.
  • Community service assignments.
  • Home restriction.
  • Referral for treatment.
  • Probation violation procedures.

As substance abuse is a chronic, relapsing disorder, relapse prevention should be a component of all intervention strategies. Adolescents are at particularly high risk for relapse because of their developmental stage. Many typical adolescent issues include physical and emotional changes that exacerbate relapse tendencies. Chemical dependency often delays normal development, making it difficult for recovering youth to function in age-appropriate ways. Some youth return to substance abuse as a way of managing the uncomfortable feelings associated with these problems (Bell, 1990).

Relapse is not a sudden event beginning with a return to drug or alcohol use. Rather, there are signs relapse may occur long before the first incidence of renewed substance use. Relapse prevention emphasizes teaching youth to recognize and manage problems that may lead to relapse.

Monitoring and enforcement of supervision and treatment should be proactive, preventive, and consistent. If youth or others involved in the case plan are not in compliance with it, the causes must be assessed. It may be possible to eliminate those causes or revise the case plan to enable those who are responsible to comply.

Recordkeeping is an essential part of the intervention process. Documentation provides data for evaluating a youth's progress and accomplishments or reformulating the case plan if necessary. It also provides information for court reports when needed.

Case closure is important for several reasons. It may be necessary to file a final report or have a youth appear in court to close the case. Recognition of achievements is an important part of the therapeutic process for youth. It is also possible to obtain feedback about services through the case closure process.

Particular considerations may be required when intervening with youth who have special needs. Pregnant or parenting youth, juveniles at risk of HIV infection, youth who are developmentally disabled, and minority youth are among those in need of unique services that must be addressed when case plans are developed or referrals are made.

Interagency coordination

It is not feasible for juvenile justice agencies alone to combat the problem of youth substance abuse successfully. It takes the entire community to ensure that youth develop in a healthy and prosocial way. Therefore, juvenile justice agencies will need to work closely with other agencies and interest groups to meet the needs of youth effectively. Many individuals and organizations (schools, treatment providers, child protection agencies, social services organizations, victim advocacy groups, churches, youth organizations, recreation programs, and businesses) may be involved with the same youth. A program to identify and intervene with substance-abusing youth will be most successful if all these entities can join the identification and intervention process. This may occur formally or informally, but it is important for all who work with youth to share common goals. Task forces, jointly sponsored training conferences, and other communitywide endeavors could be used to enlist the help and support of all important stakeholders.

Sometimes, more structured relationships may be required. For example, it may be necessary to reach formal agreements with treatment agencies that will provide group treatment services to youth in the community or with schools that will provide a drug education course in the detention center. Such agreements should specify what is to be done, by whom, and within what timeframe. They should further specify how vital information will be communicated between juvenile justice agencies and treatment or education programs.

Program evaluation and dissemination of results

Evaluation is a crucial element for program success. Performance-based measures include both process and outcome appraisals designed to assess program results and effectiveness (Boone and Fulton, 1995). Evaluation results can be useful in making needed program modifications. A program proven effective through evaluation is more likely to receive continued funding. Evaluation also can provide data for reporting significant findings to interested parties within and outside the agency.

For each program, an agency-specific, performance-based measurement strategy should be developed. This process should involve key agency stakeholders (including line personnel, supervisors, and administrators) in exploring and developing the following areas (Boone and Fulton, 1995):

  • Agency values that are clearly articulated.

  • A mission statement that reflects agency values and links them to the operation of programs.

  • Program goals that are clear, specific, measurable, practical, and specific to a timeframe.

  • Program activities that support these goals.

  • Performance-based evaluation strategies.

Important steps in the evaluation process include (American Probation and Parole Association, 1991; Boone and Fulton, 1995):

  • Determining which processes and outcomes are to be measured.

  • Selecting an evaluation method, such as descriptive research, before/after studies, and experimental and quasi-experimental research methods.

  • Developing a management information system to collect, aggregate, and retrieve data.

  • Establishing standard procedures and incorporating them into program policies to achieve uniformity and validity.

  • Disseminating evaluation results to inform staff and the community and generate positive support for the program.

Public relations

Information about the program should be shared both within the agency and externally. In-house agency newsletters and reports at staff meetings may be used to share program progress, discuss problem areas, and sustain staff support.

Journal articles, conference presentations, media releases, and agency external reports should emphasize the impact of the program on substance abuse and crime and its implications for juvenile rehabilitation and public safety. Agency policy may need to specify who will have responsibility for developing reports directed to external audiences and responding to any media inquiries.

Drug Identification and Testing in the Juvenile Justice System May 1998