 Qualitative findings Besides the statistical results just reported, project staff also collected other information through site visits, telephone conversations, correspondence, and open-ended questions on a survey administered to the staff in some sites. This qualitative information is summarized in the following categories: staff, youth, parents, community, agency, patterns of use, testing procedures, and intervention. Frequently, more than one site reported these findings and the individual sites are not identified. An effective drug identification program has many key players, including the agency staff, the youth, their parents, and other community stakeholders. These all merit examination, starting with the staff, as their full and conscientious participation in a program is vital. Many sites reported that staff members initially were resistant or fearful about the idea of drug testing the youth for whom they had responsibility. Usually, they discovered these fears were unfounded once the program was under way, and most staff members became enthusiastic supporters of the drug-testing program. Staff members' initial fears related to their interaction with the youth at the time of specimen collection. Some feared the youth might react negatively by refusing to be tested, throwing the urine at them, or becoming violent in other ways. After several months of testing, staff members had not experienced any adverse reactions by youth, and they became less apprehensive and more supportive of the testing program. Another, more pragmatic, concern for staff members was the amount of their time required to implement a drug-testing program. Although this issue was mentioned by staff members in only one detention center, it was frequently a concern of juvenile probation staff who were required to test youth periodically throughout their time on probation. Staff cited large caseloads, heavy responsibilities for recordkeeping, and the additional paperwork involved in conducting drug testing as barriers to their effective implementation of the program. Despite this, most staff members agreed the program was worthwhile. In some smaller agencies, staff members sometimes had the flexibility to make adjustments that helped them manage the additional responsibilities. For example, staff members of one agency reported that they shifted staff assignments to ensure that both male and female officers were available in the office on days drug tests were conducted. Time constraints also were a problem. In some cases, agency administrators did not have time to oversee the program closely enough. Consequently, staff who made mistakes or did not fully participate in the program did not receive timely feedback and correction. Sites that included line personnel in the planning stages of the drug-testing program generally found that staff members were more supportive of the program. Sometimes, staff members who were not involved in the program's initial development did not have a clear understanding of the benefits of testing and, therefore, were less committed to it. Some agencies that discovered this problem provided additional training for staff members, which increased commitment to the program. Several agencies reported that staff who participated in the program changed their attitudes toward it as they experienced its benefits. For example, staff members felt they worked better with an individual youth when they had better information about the youth's substance abuse. Programs also found that drug testing provided collective information to staff about drug use patterns among youth in the community and that this helped them work with both groups and individual youth. As mentioned earlier, youth generally cooperated with the testing programs, and in cases in which testing was voluntary (preadjudication or not a court-ordered condition of probation), most youth agreed to be tested. Drug testing is a powerful tool for helping break through youth's denial about their substance abuse. Often, youth who thought a drug test would show positive results admitted substance abuse. Occasionally, after such admissions, the drug test actually showed negative results because the level of drug that remained in the youth's system was at or below a test's cutoff level. Sometimes, a drug-testing program can be critical for a youth. As staff learned about the effects of various drugs and the symptoms of withdrawal, they could identify youth whose behavior or physical conditions were consistent with drug use or drug withdrawal. In one reported incident, a youth was transported to a hospital for medically managed detoxification when his drug test showed significant amounts of phencyclidine (PCP), cocaine, and marijuana in his system and his behavior included screaming, head banging, and possible hallucinations. Several sites reported very supportive responses from parents about the drug-testing program. With the evidence from urinalysis that their children were using drugs, some parents were more receptive to treatment and other interventions. Other parents commented that the tests confirmed their suspicions. One probation site allowed some parents to take alcohol test kits home to use with their children during weekends, as alcohol would not remain in a youth's system long enough to be tested the following week. This site also required parents of youth in the drug-testing program to participate in an initial education/orientation program. Staff reported receiving both written and verbal appreciation from parents. In some cases, parents of youth who were not in the program requested that their sons or daughters be included in it. Substance abuse affects an entire community, and a drug-testing program has the potential to create support and concern throughout the community. Several sites reported the program received media coverage when they issued a press release. Juvenile judges and other members of the juvenile justice system generally reported that they were aware of and supportive of the drug-testing program. Staff members at one site commented that the testing program had strengthened the agency's relationship with the mental health (treatment) agency in the community. However, in at least two sites, lack of community or juvenile justice system support seriously impeded the beginning of the program. In one county-based program, personnel received necessary approval from judges and agency administrators but failed to involve county administrators who funded the agency. County government leaders finally approved the program, but its start was delayed. In another site, law guardians (lawyers appointed to represent the child throughout the court process) objected to administration of drug identification measures to the youth they represented unless the charges against the youth were directly related to drugs. Although program personnel had provided assurances to the contrary, the law guardians expressed concern that the results of assessments and tests would be used to bring new charges against their clients or that positive findings would result in harsher consequences for youth when their cases were disposed. This site had to limit the implementation of the program to youth who had drug-related charges. However, because of this problem, the issue of drug testing has been reported to the State legislature for study. All of the agencies that participated as drug-testing demonstration sites for the two projects have continued their programs, indicating that they feel the programs are worthwhile. However, several agencies reported problems that had to be addressed. Most of these concerns were directly or indirectly related to agency resources. Some reported funding limitations for an ongoing program. Other concerns included the need for greater administrative support of the program and more supervision of staff members conducting the program. Some programs also identified a need for more skills and training of program staff members to ensure their quality. A drug-testing program in one agency sometimes affects related agencies. One detention center site reported that probation officers affiliated with the same court increased their use of drug testing for juveniles they supervised because of the initial information about youth provided by the detention program. Patterns of use Several sites reported that the drug-testing program provided useful information about drug use patterns of youth in the community. Some sites found that although youth rarely admitted drug use, the rates of positive results were quite high. Others found that some youth admitted using particular classes of drugs for which sites could not test. One agency found a high incidence of positive tests for PCP associated with youth who lived in a particular area of the community. They advised police of this pattern to increase enforcement efforts in that part of town. Some agencies found associations between positive tests and various types of delinquent behaviors by youth (e.g., shoplifting, burglary, vandalism, assault, armed robbery, and status offenses). Staff members in several sites reported that the results of drug testing helped them understand the possible rates and patterns of drug use among all youth they might encounter. Sites that participated in both projects reported that some testing procedures had to be modified as the program progressed. For example, one site reported that staff members had difficulty accurately reading results of the onsite noninstrument test kits. However, after instituting the use of a timing device, they were satisfied they were getting more accurate results. Another site reported many youth who refused to be tested. However, closer examination revealed that sometimes information about a youth's admission of drug use, a youth's inability to provide a sample, and staff's decisions not to conduct the testing at intake were miscoded as refusals on the data collection form. When coding errors were corrected and other problems were addressed with staff, the percentage of refusals declined from 22 percent at their highest level to 4.2 percent during the final month of the demonstration project. Some agencies found they had to change the frequency of testing for it to be effective in their settings. One probation agency began testing weekly but, because of limited staff, had to change to testing twice monthly. On the other hand, some juvenile probation sites were not testing frequently enough to detect and deter drug use among their juveniles. They were encouraged to increase testing to a minimum of every 2 weeks. Sites also found that when tests were administered randomly and frequently enough, they became an effective deterrent to substance abuse. A significant problem noted in several sites was the inability to test for some drugs that youth admitted using. For example, one site reported that many youth admitted using amphetamines, but the volume was not high enough to warrant purchasing reagents for testing that drug, because these reagents have a very short shelf life. In other cases, youth may have been using classes of drugs, such as inhalants, for which practical, inexpensive testing was not available. Identifying substance-abusing youth is insufficient. After identification, intervention must occur. Intervention may include various treatment modalities (usually provided by community treatment agencies) and responses by juvenile justice personnel. Many agencies reported that their communities had insufficient treatment resources to meet the needs of drug-involved youth. This tended to be the case especially in smaller communities and rural areas. However, some used the information gained from the testing program to work with other community stakeholders to increase treatment options. Formal treatment is not the only alternative to respond to a positive test. Juvenile justice personnel also can intervene. Onsite testing and laboratory testing with same- or next-day return of results can be very useful in facilitating immediate confrontation of youth who are using illicit drugs. Most of the demonstration sites established policies stipulating that positive findings of illicit drug use would not be used to bring new charges against a youth. Many policies even stipulated that positive test results would not be used to return a youth to court for a probation violation, although others used test results as a last alternative if other interventions did not work. However, juvenile justice staff implementation of immediate rewards, praise for negative test results (clean screens), and consequences for positive tests can be useful in helping youth make choices about future substance abuse. Some programs required drug-involved youth to attend drug education programs provided by the agency. Individual probation officers can verbally confront youth, increase their level of supervision, drug test more frequently, impose earlier curfews, place a youth on home detention, or require community service because of ongoing positive drug tests. Similarly, for negative tests, staff members can decrease testing frequency and supervision levels and provide other rewards, such as activities, attention, and praise. Whatever methods are chosen, effective programs should provide consistent and immediate responses to both positive and negative test results.
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