U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention

Juvenile Accountability Incentive Block Grants Program

John J. Wilson, Acting Administrator May 2000

From the Administrator Ten Steps for Implementing This OJJDP Bulletin offers spe- cific information to assist those seeking to establish an effective a Program of Controlled substance abuse testing pro- gram. For example, the advan- Substance Testing of Juveniles tages and disadvantages of several testing methods are described, and sample budgets Ann H. Crowe and Linda Sydney for testing programs conducted This Bulletin is part of OJJDP’s Juvenile hold juvenile offenders accountable for their in various settings are provided. Accountability Incentive Block Grants behavior. An indepth description of the Suggested readings and re- (JAIBG) Best Practices Series. The basic JAIBG program and a list of the 12 program source organizations are also premise underlying the JAIBG program, purpose areas appear in the overview Bulletin included. initially funded in fiscal year 1998, is that for this series. The testing approach described young people who violate the law need to be in this Bulletin was recom- held accountable for their offenses if society is Major Steps for Program to improve the quality of life in the Nation’s mended in the companion Ju- Implementation venile Accountability Incentive communities. Holding a juvenile offender Block Grants Best Practices “accountable” in the juvenile justice system This Bulletin is a companion to the Bulletin Developing a Policy for means that once the juvenile is determined JAIBG Bulletin Developing a Policy for Controlled Substance Abuse Testing to have committed law-violating behavior, Controlled Substance Testing of Juveniles of Juveniles. Written by the same by admission or adjudication, he or she is (Crowe and Sydney, 2000) and presents a held responsible for the act through conse- detailed discussion of a 10-step process, authors, the latter Bulletin pro- quences or sanctions, imposed pursuant to shown in figure 1, for developing and vides an overview of substance law, that are proportionate to the offense. implementing a substance-testing pro- abuse testing, sets forth testing Consequences or sanctions that are applied gram. Although these steps are pre- indicators, and summarizes sub- swiftly, surely, and consistently, and are sented independently, in practice they stance abuse trends. graduated to provide appropriate and effec- are likely to overlap, with final determi- It is my hope that these Bulle- tive responses to varying levels of offense nations about policies and procedures in tins will serve as a foundation seriousness and offender chronicity, work one area contingent on decisions made for building successful sub- best in preventing, controlling, and reducing at other points during the process. stance abuse testing programs. further law violations. John J. Wilson In an effort to help States and units of local Step 1: Involve Key Acting Administrator government develop programs in the 12 pur- Stakeholders pose areas established for JAIBG funding, Several principal roles should be repre- Bulletins in this series are designed to present sented in the decisionmaking tasks of the most up-to-date knowledge to juvenile program development. These can be justice policymakers, researchers, and practi- discussed in three categories: tioners about programs and approaches that will affect the organization and staff ■ Who will be tested. Figure 1: Steps for of the agency implementing it. ■ Who is responsible. Developing a When both managers and staff are Substance-Testing involved, they are more likely to ■ When testing will occur. Program support the effort. They also can ■ How results will be used, includ- provide key insights about the op- ing what treatment resources will eration of the program, other staff Involve key stakeholders. be used. and juveniles’ reactions to it, and possible problems to avoid. ■ What objectives are not to be pur- Determine program purpose. sued through the program. (For ex- ■ Other juvenile justice system stake- ample, if results of tests are to be holders who will not be involved used for case management, and not directly with administering the drug- Investigate legal issues. for punitive purposes, this should testing program, but whose support be stated clearly.) and views on drug testing will be im- Identify youth to be tested. portant to the program, should be in- The purpose statement must coincide cluded in the planning process. These with the agency’s mission. For a bal- may consist of law enforcement per- anced approach to juvenile justice, Select methodology. sonnel, judges, prosecuting and de- agencies should incorporate and place fense attorneys, paroling authority equal emphasis on the following three representatives, and court administra- elements (Maloney, Romig, and Decide how to use results tors. The appropriate mix of these Armstrong, 1988): representatives will depend on the and arrange for adequate ■ Community protection. agency(ies) implementing drug test- and appropriate treatment. ing and the other juvenile justice ■ Accountability of youth. agencies that might be affected by it. ■ Competency development of youth. ■ Community representatives also Develop written policies Similar balance in the purposes of should be included as appropriate. and procedures. substance testing also is appropriate. For example, substance abuse treat- ment providers working with youth Substance testing can be used for the Obtain funding. should be included. Family and following: caregivers are also critically impor- ■ Assessment and treatment. Sub- tant. Others to consider are person- stance testing is used to identify nel from education, social welfare, Develop staff. youth whose use of alcohol and and healthcare organizations; techni- other drugs requires treatment and cal experts; academicians; parents’ or to monitor their progress in treat- citizens’ groups; and delegates from Evaluate the program. ment (Pretrial Services Resource possible funding sources (e.g., busi- Center, 1998). nesses and the faith community). ■ Health and safety assessment. This Step 2: Determine is particularly important when youth ■ Agency personnel should include enter programs directly from the administrators, managers, and line Program Purpose community (such as in detention or personnel of the agency that will be It is essential to carefully consider and after furloughs from residential administering the drug-testing pro- clearly articulate the purpose of the facilities). If youth have abused sub- gram. Testing programs are most substance-testing program. Without a stances, they may need medical care likely to be developed in detention, clear goal in mind, other decisions will or special supervision to ensure their corrections, probation, residential, be more difficult. A purpose statement own and others’ safety. Some drugs and aftercare agencies. Administra- should describe briefly: can cause life-threatening effects; tors must make important deci- withdrawal from some drugs also ■ What is to be accomplished by sub- sions about agency resources, while can be dangerous. managers and line personnel will stance testing. ■ Case planning. Results of substance implement the program. Input ■ How it will be done. from all is vital. Any new program testing may be used as part of the

2 information needed to process youth or agency’s policies and procedures afforded any youth in the community. through the juvenile justice system. document. Statutory support for Nonetheless, there is a rationale for con- They may be a factor in determining testing is preferred, as it provides ducting testing of preadjudicated youth whether a youth should be released the maximum legal protection for in a detention program, as stated by the from detention and what sanctions agencies and practitioners carrying American Correctional Association and and treatment are needed. out the program. Institute for Behavior and Health, Inc. (ACA/IBH) project (1991a, p. 1): ■ Compliance monitoring and super- ■ Court or paroling authority or- vision. Youth may be ordered by the ders. Court or paroling authority The issue of constitutionality of court to abstain from using alcohol orders for adjudicated youth may urine collection and testing in or other psychoactive substances. direct that the youth submit to sub- detention facilities hinges on Substance testing is necessary to en- stance testing. Courts or paroling what use is made of the test re- force these judicial orders. This does authorities should impose such a sults. Test results can be used not necessarily mean that youth condition where substance testing with confidence as part of a must be severely punished if they could facilitate the rehabilitation of case management plan, just like use drugs, but it gives juvenile jus- the youth or where alcohol or other other information from a medi- tice personnel information they need drug use is related to the youth’s cal examination. When an ini- for case management (Mieczkowski delinquent behavior. (This provision tial health screen reveals evi- and Lersch, 1997; Pretrial Services does not apply to preadjudicated dence of diabetes or a sexually Resource Center, 1998). youth, whose situation is discussed transmitted disease (STD), the later.) Although it is preferred that detention facility is obligated to ■ Epidemiological analysis. Substance courts or paroling authorities im- devise a plan for treatment. testing helps juvenile justice pro- pose conditions for substance test- This principle holds for urine fessionals learn the incidence and ing, they should make those orders test results. On the other hand, prevalence of substance abuse and flexible enough for the agency or if testing is used to file charges the types of chemicals being abused practitioner to determine the fre- and prosecute, there is a poten- in the communities they serve. quency of testing. tial for legal challenge. The results provide information for planning and evaluation ■ Agency policy. All agencies conduct- Agencies should note that statutory (Mieczkowski and Lersch, 1997). ing substance testing should have authority still is preferable when con- written policies that clearly state the sidering testing of preadjudicated Step 3: Investigate purpose for testing and identify the youth. Sometimes laws do not specifi- juveniles who will be subject to test- cally authorize drug testing, but au- Legal Issues ing (e.g., all juveniles, those juveniles thority may be inferred from other laws. Legal issues require research at the with a history of drug use, youth For example, the Code of the District local and State levels. The areas dis- with court orders for testing). of Columbia contains the following cussed in this Bulletin generally pre- three provisions that are interpreted The testing program is most defen- vail, but they may vary according to broadly to allow for urine drug test- sible if all three sources of authority local and State statutes or regulations ing of youth in detention (ACA/IBH, are in place. In the absence of statu- and emerging case law. Having the 1991b, 1995): tory authority, both court or paroling help of legal counsel in drafting and authority orders and agency policies ■ Physical examinations of youth are reviewing policies is advised. are recommended. permitted. Drug testing is consid- ered within the definition of “physi- Authority To Test Testing Preadjudicated Youth cal examinations” allowed by this Examine the agency’s authority to law (D.C. Code 16–2315). Because of their age and status, adju- test early in the development of drug- dicated youth’s rights are diminished ■ A preliminary determination of the testing policies. Authority to test gen- in some respects. Being minors, they need for supervision is mandated erally comes from one or more of the cannot vote, drive vehicles, or legally (D.C. Superior Court Rules 102 and following three sources: purchase alcohol or tobacco, and as a 103). Because the determination of ■ Statutes. State or local statutes may result of their adjudication, they may illegal drug use generally justifies mandate, permit, or prohibit prac- lose their freedom or have restrictions the need for supervision, testing to tices related to substance testing placed upon it. However, until youth detect drug use may be viewed as an of juveniles. Any such legislation have been adjudicated, they are en- essential part of the intake process. should be cited in the jurisdiction titled to all the rights and protections

3 ■ A determination must be made discussed below (Del Carmen and rather than to racial, gender, socio- about the necessity of detaining a Sorensen, 1988): economic, or other differences. Drug juvenile for his or her protection or screening is reasonably related to ■ Right against unreasonable search the protection of others. Substance detecting, treating, and preventing and seizure (fourth amendment). abuse is among the factors consid- substance use and, therefore, is a Urine testing is equivalent to a ered when assessing the need to reasonable requirement. search for illicit drugs and includes keep a youth in detention (D.C. invasive procedures to collect body ■ Right against self-incrimination Superior Court Rule 106). fluids. To ensure that it meets this (fifth amendment). Defendants are The District of Columbia Superior constitutional test, the “search” protected against self-incrimination Court determined these statutory and must be reasonable and based on a when they give testimony in court. regulatory provisions were sufficient rational belief that it is necessary. Urinalysis, however, is a form of to enter into a memorandum of under- physical evidence (similar to finger- ■ Right to due process (fifth and standing that allows for drug testing printing or appearing in a lineup). fourteenth amendments). Before a of preadjudicated youth. Jurisdictions Therefore, it is not included in this youth is deprived of liberty, certain should approach preadjudication constitutional protection. Substance procedures must be followed. Tests testing cautiously and explore testing does not require a youth to must be accurate and meet scientific jurisdiction-specific laws to deter- confess to drug use. standards acceptable to courts. A mine whether present statutes support second confirmatory test may be preadjudicatory testing (ACA/IBH, necessary before limiting a youth’s Challenges to Drug Testing 1995). freedom. Chain-of-custody proce- Substantial case law supports sub- dures involving specimens also are stance testing,1 but only a few cases Voluntary Testing vital. There must be safeguards are specifically related to substance Where legislation does not support against the possibility of tampering testing of juveniles. Those cases are testing, agencies may elect to make with the specimen or test results, or summarized briefly:2 testing voluntary, especially at the they may be invalid for legal use. ■ In re C.J.W., 727 P. 2d 870 (Colo. Ct. preadjudication phase. In a voluntary (Chain-of-custody procedures are App. 1986). A juvenile failed to program, agencies should obtain in- discussed later.) Specimens from submit to urine testing, which was formed consent from youth (and possi- positive tests should be kept in case a condition of probation, but she bly their parents in some States) before of possible legal challenges. admitted this failure to the proba- testing. Informed consent includes ■ Right to confrontation and cross- tion officer. The court held that knowledge of the following: examination (fifth amendment). hearsay testimony of the probation ■ Specimen collection process. If the personnel who actually con- officer was admissible to establish duct tests are not present to pro- that the juvenile violated condi- ■ Use that will be made of test vide testimony, the potential for tions of probation. results. challenging results on the basis ■ In re Jimi A., 257 Cal. Rptr. 147 (Cal. ■ Consequences of testing positive. of hearsay evidence exists. These Ct. App. 1989). A juvenile disturbed challenges usually have not suc- ■ Confidentiality provisions. ceeded, as courts have allowed ex- ■ Right to legal counsel, if applicable. ceptions to the hearsay rule. The 1 For a review of drug-testing case law, refer to Drug business records, reliability, and Testing Guidelines and Practices for Juvenile Probation and This information should be given to Parole Agencies, developed by the American Probation trustworthiness of a laboratory are youth orally and in writing. Youth and Parole Association (APPA) and published by the factors a judge might rely upon U.S. Department of Justice, Office of Justice Programs, should then sign a statement con- when excluding the testimony of Office of Juvenile Justice and Delinquency Prevention, firming that they understand the 1992. Summaries of 62 cases are presented and classi- staff member(s) who administered information and give their consent to fied for easy reference in this document. the test(s) from the hearsay rule. 2 participate in testing. If the testing Some other recent court challenges to drug testing ■ that are not specific to juvenile offenders include: program is voluntary, youth should not Right to equal protection (four- Alston v. State, 646 So.2d 184 (Fla. Sup. Nov. 1994); be penalized for refusing to be tested. teenth amendment). Under the Bryant v. State, 622 So.2d 620 (Fla. Dist. App. Aug. Constitution, individuals cannot be 1993); Peterson v. State, 623 So.2d 637 (Fla. Dist. App. Sept. 1993); Stevens v. State, 900 S.W. 2d 348 (Tex. App. Constitutional Issues treated differently unless such treat- July 1995); United States v. Stephens, 65 F.3d 738 (U.S. Regarding Testing ment is legally justified. In detecting 8th Cir. Sept. 1995); Garcia v. State, 661 So.2d 1313 (Fla. substance abuse, different treatment Dist. A.P. Nov. 1995); United States v. Grandlund, 71 F.3d Challenges to drug testing usually re- is related to alleged illegal activity 507 (U.S. 5th Cir. Dec. 1995); Brock v. State, 667 So.2d late to the five constitutional rights 1014 (Fla. Dist. A.P. Feb. 1996).

4 the peace and committed a battery decided these were broad enough has applied for or received any on school property. The defendant to include chemical testing. alcohol or other drug-related had a history of admitted substance services—including diagnosis, Del Carmen and Sorensen (1988) say abuse and had no parental supervi- treatment or referral for treat- conditions of probation, to be valid, sion in the evening hours. A condi- ment—from a covered program.3 must be constitutional, clear, reasonable, tion of probation required the defen- The restrictions on disclosure and reasonably related to the protection dant to submit to random drug apply to any information, of society or the rehabilitation of the testing. The court held this condition whether or not recorded, that individual. They make the following was appropriate, given the youth’s would identify the youth as an recommendations for implementing a background of substance abuse and alcohol or other drug user, either drug-testing program: lack of parental supervision. directly or by implication. ■ Impose drug screening only when (Brooks, 1990, p. iv) ■ In the Interest of C.P., 217 (Ga. A.P. it is reasonably related to public 1995 505). A juvenile was adjudi- The purpose of the confidentiality laws safety concerns or the rehabilita- cated for violating probation terms preventing disclosure of (written or tion of the individual and in such imposed for possessing alcohol. oral) information that would identify a cases where the person’s delin- She appealed, but the court held person receiving alcohol or drug treat- quent behavior could be attributed that possession of alcohol was a ment is to promote participation in to drug use. delinquent act and upheld the treatment and related programs. Pro- court-ordered probation. ■ Determine whether a confirmatory grams should establish policies and test is required. procedures for confidentiality. Some of ■ ALJ v. State of Wyoming, 836 P. 2d these confidentiality concerns are more 307 (Wyo. 1992). A youth attended a ■ Ensure that those administering likely to apply to treatment providers party during which he pointed a drug tests are trained and properly than to juvenile justice agencies; how- gun at others and was adjudicated qualified, whether they are agency ever, juvenile justice personnel must for reckless endangerment. He was staff or employees of a laboratory. consider these confidentiality issues placed on 3 years’ probation and ■ Follow strict chain-of-custody pro- and be aware of the restraints under required to submit to random cedures, including sealing, label- which treatment providers must work. chemical testing, among other ing, storing, and documenting the things. The youth contested this Policies and procedures about confi- transfer of specimens. condition on the grounds that it dentiality for drug testing should violated his right to be free from ■ Save samples with positive results address: unreasonable searches and seizures. until the time for all possible legal ■ The youth’s right to privacy. The court ruled that fourth amend- challenges has elapsed. ment protections that apply to adult ■ The person(s) to whom and the ■ Have clearly written policies and probationers do not necessarily ap- circumstances under which infor- procedures for drug screening and ply to juvenile probationers. They mation may be released. for responses to positive findings. held it was within the court’s dis- ■ The type of information that may cretion to allow a probation officer and may not be shared. to search a juvenile without reason- Confidentiality ably suspecting a probation viola- Programs implementing substance ■ The process and forms for obtaining tion exists. There are differences in testing should examine present poli- permission to release information.4 the rights of juveniles at the adjudi- cies, State and local statutes, and case catory stage (due process and fair law on confidentiality to ensure that 3 Covered programs include those that are federally treatment) and at the dispositional the program complies with them. assisted, both directly and indirectly. Indirect forms of stage. By statute, Wyoming re- Some special considerations apply Federal aid might include tax-exempt status or fund- quires that the court do what is best when substance abuse services are ing from State or local governments that originated with the Federal Government (Brooks, 1990). for public safety, preservation of provided. Two Federal laws and sev- 4 A sample consent form for release of information and families, and the welfare of the eral Federal regulations affirm these a statement regarding redisclosure of information may child. This allows the court to im- confidentiality rights (42 U.S.C., § 290 be found in Legal Issues for Alcohol and Other Drug-Use pose conditions for counseling, dd-3 and ee-3 and 42 CFR Part 2). Prevention and Treatment Programs Serving High-Risk treatment, or other programs to rec- Youth, written by M.K. Brooks and published by the The Federal confidentiality laws U.S. Department of Health and Human Services tify the problems contributing to (HHS), Substance Abuse and Mental Health Services and regulations protect any infor- delinquency. The appellate court Administration (SAMHSA), Office for Substance mation about a youth if the youth Abuse Prevention, 1990.

5 ■ The consequences for unautho- and when behavior or evidence who test positive for drug use. rized disclosure of information. (e.g., discovery of contraband) It doesn’t make any program- suggests they may have used matic sense to test somebody ■ The precautions to be taken when chemicals. for drug use unless you’re go- collecting and aggregating data ing to do something with the to ensure the confidentiality of ■ During aftercare or parole. Youth results. So, in part, it will de- individual youth. who have been in placement usu- pend upon the capacity of the ally are supervised during their State or local government to reintegration into the community. Step 4: Identify Youth To use those results in a meaning- This may be a time when they are ful way. Be Tested vulnerable to resuming substance Selection of youth to participate in a use, and testing can provide substance-testing program will be needed information for personnel Step 5: Select based, in part, on the agency and the supervising them. Awareness that Methodology purpose for testing. Testing could be testing will occur may also serve as conducted at every point in the juvenile a deterrent when youth are decid- Testing Technology justice continuum. For example, the ing on drug usage. Many youth There are several technologies avail- following illustrates options for testing released from placement may able to test for substances, and new juveniles: need ongoing substance abuse ones are emerging rapidly. Develop- treatment and relapse prevention ■ At intake to detention. All youth ing substance-testing policies requires in the community, and substance could be tested to detect possible making informed choices about the testing provides a method of health or safety concerns, to help most accurate, cost-effective, and monitoring their compliance in considering (with other factors) practical methodology. Several tech- and progress. which youth might be released be- nologies presently available or in de- fore adjudication with minimal The JAIBG legislation requires that velopment are summarized in tables risk to themselves or the commu- States or local units of government 1 through 6. nity, and to assist in making case develop a “policy of controlled sub- Technologies for substance testing plans for treatment, supervision, stance testing for appropriate cat- have changed rapidly during the past or placement. egories of juveniles within the juve- 25 years, and developments are ongo- nile justice system.” However, it ■ During probation supervision. Pro- ing. Urine testing for alcohol and other leaves the responsibility of deter- bation agencies might adopt policies drugs of abuse and breath or saliva mining which groups of youth are to test every youth at intake to pro- testing for alcohol use are presently considered “appropriate” for testing bation or limit testing to those with the most practical and cost-effective to the States and local agencies. As court orders for testing. Testing methods available for juvenile justice. John J. Wilson, Deputy Administra- should be adjusted to the case situa- Thus, this Bulletin focuses primarily tor of State and Local Programs for tion on an ongoing basis. For ex- on urinalysis for illicit drug use. How- OJJDP, stated (Mattingly, 1998, p. 14): ample, if a youth tests negative ever, new technologies likely will pro- several times, stopping or dimin- We will let the State and local vide more comprehensive and precise ishing drug testing should be con- governments make the deter- information as they emerge and be- sidered. On the other hand, if a mination of what the appropri- come more generally used. They also youth who was not previously sub- ate categories of juveniles are. may be able to detect new drugs of ject to testing begins showing signs Our research shows that most abuse better and more quickly than of substance abuse (e.g., declining drug testing occurs as a result present methods. Thus, reviewing cur- grades, absenteeism, getting in of local policies and so I expect rent information about technology de- trouble), initiating testing should be that whether there is drug test- velopment is very important for juve- deliberated. ing at the local level will vary nile justice practitioners involved in not only from State to State, substance testing (Mieczkowski and ■ In residential placement. Testing but also within the State. The Lersch, 1997; Pretrial Services Re- in a residential facility might be determination of who should source Center, 1998). done when youth are admitted, be tested will depend, in part, when they have been away from Immunoassay tests that detect spe- upon what kind of program the facility (e.g., furloughs, work cific drug metabolites in urine when interventions are available or release) and might have had ac- they react with antibodies that are can be developed for juveniles cess to psychoactive substances,

6 formulated to respond to that sub- stance are generally used as the initial Table 1: Hair Analysis urine test in juvenile justice settings Summary (Mieczkowski and Lersch, 1997). The Drugs and drug metabolites remain in the hair shaft indefinitely. Thus, testing hair chemical reaction produced between provides an extended view of a person’s history of using substances. The period the antibody and the drug or drug for which substances can be detected depends on the length of hair (Robinson and metabolite in the specimen causes a Cargain, 1998). It generally costs between $50 and $100 to screen and confirm the change in the test medium and can be five drug classes through hair testing (Jackson and Borrowman, 1998). measured to determine the presence of a drug in the sample. If a change is Substances Tested noted, it is compared with the change All types of illicit substances can be tested. However, tests for marijuana have caused by a known quantity of the been inconsistent. Hair analysis also has not been useful in detecting some substance (calibrator). This known opiates, especially codeine (Mieczkowski, 1995; Mieczkowski, 1997). quantity of the substance is set as the cutoff for measuring the presence of Benefits a substance with the test. If the re- ■ Specimen collection is easy and noninvasive. sponse indicates that the cutoff ■ Preservation, storage, and transportation of samples is relatively easy. amount (or a greater quantity of the ■ Drug use history can be detected. substance) is present, it is a positive ■ test. If the amount present is lower The amount of drugs detected can be quantified (but the amount ingested than the cutoff (or none is present), cannot be quantified). the test is negative (Robinson and Disadvantages Cargain, 1998). ■ It takes time for the drug metabolites to enter the hair shaft, so hair analysis Immunoassay tests are used only to may not detect the most recent drug use. measure the presence or absence of ■ Washing and manipulation of hair (e.g., permanents, coloring) may affect the substances (qualitative measure) concentration of drugs in hair, but sensitive tests still can detect the presence and are not accurate for determin- of substances. ing the quantity of drug in the ■ Results may be subject to influences related to race, environment, and sex sample. There are several types differences. For instance, hair pigment may alter the amount of a drug ab- of immunoassay tests that vary sorbed in hair. In some cultures, hair has significant meaning, and cutting it primarily according to the type may cause distress. of material the manufacturers use ■ Hair length affects the period of detection. Shaving may make detection to produce the reaction. difficult, although hair from any part of the body may be used for testing. A study reported in 1991 compared ■ Presently, hair samples must be sent to laboratories for analysis, so it may take the accuracy and suitability of vari- longer for results of tests to be available. ous technologies for use in the ■ There are a limited number of laboratories that can test hair. criminal justice system. The re- ■ Hair testing is more expensive than urine testing. search concluded that “thin-layer chromatography performed poorly Sources for lists: Jackson and Borrowman, 1998; Mieczkowski, 1995; Mieczkowski and Lersch, 1997; Pretrial Services Resource Center, 1998; Robinson and Cargain, 1998. in identifying the presence of illegal drugs,” but “no one type of immu- noassay is consistently superior in on a surface where they separate Gas chromatography/mass spec- identifying positive and negative from each other and the molecules trometry (GC/MS) uses two testing urine specimens” (Visher form distinctive patterns or bands. procedures. This method is highly and McFadden, 1991, p. 3). An early form of this method, thin- accurate and considered the “gold Chromatography works on the prin- layer chromatography (TLC) was standard” in urinalysis methodolo- ciple that molecules of different sub- slow and required interpretation gies. It also is the most expensive stances move at different rates. This by expert technicians (Crowe and method because it is an elaborate movement creates characteristic pat- Schaefer, 1992; Mieczkowski and and time-consuming procedure. terns that can be differentiated from Lersch, 1997). Chromatography Therefore, it is only practical for each other. In a chromatography test, methods indicate the quantity of confirmation of positive results concentrated substances are placed a substance in the sample. when this is legally required.

7 should be identified and contracted Table 2: Breath Analysis to perform any necessary confirma- Summary tory tests. Breath analysis is used widely to detect alcohol use. The quantity of alcohol in the breath an individual exhales is directly related to the quantity of alcohol in the Onsite Instrument-Based Testing person’s blood (Milgram, 1990). Testing instruments can be purchased or leased for use at an agency for initial Substances Tested immunoassay tests. These instruments Alcohol. can test for one drug at a time or for a group of drugs. Staff who operate these Benefits machines must be trained and must ■ The level of alcohol use can be detected. follow the manufacturer’s suggested ■ The procedure is noninvasive. procedures for operation. The instru- ■ Results are displayed immediately. ments must be calibrated regularly as directed by the manufacturer to ensure ■ Courts have upheld breath analysis results. test accuracy. Policies and procedures ■ Per-test costs are low, although initial purchase of the device is costly. should include methods for monitoring each aspect of the testing process to Disadvantages ensure quality control. Further, safety ■ Only very recent use of alcohol (within a few hours) can be detected. precautions for conducting the tests ■ The results do not indicate the frequency or duration of alcohol use. should be incorporated in agency poli- ■ The initial cost of the device is expensive. cies. Results should be available rela- ■ tively quickly with this type of testing; Only one person (staff) can use the instrument at a time. however, sometimes it is more practical Sources for lists: Crowe and Schaefer, 1992; Jackson and Borrowman, 1998. and cost effective to run tests only when there are enough specimens to use all of the instrument’s capacity Onsite or Offsite Testing leave the juvenile justice agency for (Crowe and Schaefer, 1992).6 The testing process may be con- processing. The agency and the labo- ducted in three ways: ratory should enter into a written Onsite Noninstrument-Based Tests contract specifying the laboratory’s Several manufacturers have devel- ■ By a certified laboratory. testing equipment, staff qualifica- oped portable test devices that are tions, chain-of-custody practices, and ■ By using an onsite instrument variously called kits, handheld tests, other procedures. The laboratory operated by trained personnel. or point-of-contact tests. These tests should have in place procedures for can analyze for a single drug, and ■ By using onsite noninstrument- quality control to ensure the accuracy, some are available that will detect based tests (small kits or handheld validity, precision, performance, and several drugs at the same time. They devices) at the point of contact reliability of the tests. Sending speci- are suitable for initial testing and pro- with the youth. mens to a laboratory will require a vide qualitative results (the drug is longer time to obtain results, but the Several factors should be considered present or not found in the sample). turnaround time should be limited to when selecting the most appropriate The cutoff levels for these tests are 72 hours or less (Crowe and Schaefer, process for a particular jurisdiction set by the manufacturers and usually 1992).5 Usually a commercial labora- or program. Costs, staff training, are consistent with government and tory service will be used, but in some and the time it takes to obtain results industry standards. Staff training is communities, there may be a possibil- are some of the important areas to very important when using these de- ity of obtaining services through a consider. vices. Manufacturer’s instructions for criminal justice or healthcare agency operation should be strictly followed. laboratory. Even if an agency plans to Laboratory Testing An advantage of this method is the do initial testing onsite, a laboratory Using a laboratory to complete the tests usually requires a contract for 6 See “Establishing Juvenile Justice Onsite Instrument- 5 services. This demands excellent See “Contracting for Drug Testing Services” in Drug Based Drug Testing for Initial Drug Testing” in Drug Testing Guidelines and Practices for Juvenile Probation and chain-of-custody procedures because Testing Guidelines and Practices for Juvenile Probation and Parole Agencies for additional details about using labo- Parole Agencies for additional information on this type the specimen and the results will ratory services for testing (APPA, 1992). of testing (APPA, 1992).

8 immediacy of results; tests can be per- formed while the youth watches. The Table 3: Sweat Analysis tests also can be used outside the Summary agency, such as on home visits. The body constantly discharges waste through sweat. By placing an absorption However, agencies should consider pad on the skin, sweat and the components it contains can be collected and ana- and develop protocols for all testing lyzed. The patch may be worn for a period of from a few days to about 2 weeks that include consideration of staff (Baer and Booher, 1994). and youth safety (Crowe and Sweat analysis technologies are still in development and are not used widely. In Schaefer, 1992).7 the future, patches may be designed to include a microelectronic chip that will give immediate results and detect the specific date on which particular sub- Accuracy and Validity of Onsite stances were used (Mieczkowski and Lersch, 1997). Drug Testing Roughly, costs are $7 for a patch, up to $15 for an initial screening, and up to To rate the performance of onsite $22 for a confirmation test (Jackson and Borrowman, 1998). testing methods, the test results are compared with the results obtained Substances Tested when the same specimen is tested Marijuana, cocaine, amphetamines, barbiturates, opiates, phencyclidine, using laboratory instruments, usu- benzodiazepines. ally GC/MS. When a specimen has a Benefits negative result using the onsite test ■ device and a negative result in sub- Specimen collection is relatively noninvasive, and the patches are easier to sequent testing by GC/MS it is con- collect, handle, store, and transport than urine. sidered a true negative. If the “nega- ■ The period for which drugs may be detected is about 2 weeks (compared with tive” specimen tests positive by GC/ much shorter periods for most drugs when tested by urinalysis). Sweat analy- MS, it is considered to be a false sis also offers the ability to detect drug intake for as long as the youth is wear- negative. When a specimen has a ing the patch. positive result by the test device and ■ Use of sweat patches allows for more flexibility in scheduling testing, and as it a positive result by GC/MS, it is con- is worn continuously, it reduces the potential for youth to plan their substance sidered a true positive. A specimen use to avoid detection. that tests positive with an onsite test- ■ Patches are designed so tampering with them is apparent. ing device and subsequently tests ■ Secretion of drugs and/or metabolites through sweat is not affected by negative by GC/MS is considered consuming water or other substances. a false positive. ■ Although sweat analysis costs more than urinalysis, it may be more cost False positives and false negatives are effective because it can be conducted less often. more likely to occur with specimens Disadvantages in which the drug concentration is at or near the cutoff levels. With those ■ It takes time for enough sweat to accumulate for analysis. Therefore, immedi- specimens, the varying sensitivities of ate detection of recent substance use is not feasible. the testing methods can produce the ■ There are no proficiency testing programs for administrators. Thus, accuracy differing results. It is thus more accu- of results may be questioned. rate to refer to the testing result as an Sources for lists: Baer and Booher, 1994; Jackson and Borrowman, 1998; Mieczkowski and Lersch, 1997. unconfirmed positive when the pres- ence of the drug was accurately de- tected but the quantity was inaccu- of true positives and true negatives Laboratory testing can detect the rately determined. The likelihood is increases. different molecular structure of that most specimens in field situa- cross-reacting agents and can deter- Onsite drug testing results can also tions will not have drug concentra- mine if an adulterant has been added be affected by food such as poppy tions near the cutoff levels. With drug to the specimen in an effort to mask seeds and foods containing hemp concentrations noticeably above or the test result. Therefore, unless the derivatives and by over-the-counter below the cutoff levels, the number person being tested admits to using products such as some cold medica- drugs after a positive test result, tions consumed by the individual be- 7 positive test results should be con- See “Establishing Onsite Non-Instrument-Based ing tested. Results can also be Drug Testing” in Drug Testing Guidelines and Practices firmed by a laboratory test, prefer- affected by products added to the for Juvenile Probation and Parole Agencies for additional ably GC/MS. information on this type of testing (APPA, 1992). urine specimen after urination.

9 To ensure the greatest accuracy when using onsite testing devices, it Table 4: Saliva Testing is advisable to establish protocols for Summary collection and testing that minimize the Tests of saliva have been used to detect recent drug and alcohol use numbers of false positives and false (Mieczkowski and Lersch, 1997). The presence of the substances is identified negatives. Suggested procedures are: through a chemical reaction between saliva and the reagents in the test. Various ■ Appropriately identify the person tests may give either qualitative results (i.e., substance is present) or quantitative being tested. results (i.e., the amount of substance present). Costs of testing saliva for alcohol are minimal. However, the cost of testing ■ Observe all specimen collections. saliva for other substances is similar to the cost of blood tests, often ranging ■ Follow appropriate chain-of- from $50 to $200 depending on the type and number of analyses (Jackson and custody procedures. Borrowman, 1998). ■ Obtain information from manufac- Substances Tested turers of onsite test devices on the Alcohol, cocaine, cannabinoids, opiates. foods or products that may affect their test results. Benefits ■ ■ Require youth to report consump- This method does not pose a privacy issue and is considered noninvasive. tion of any prescribed or over-the- ■ Testing is not difficult for the administrator because the specimens are readily counter medication or use of any available. of the identified food products. Disadvantages ■ Prohibit consumption of identified ■ There are no proficiency testing programs to determine the accuracy of this cross-reacting foods, over-the-counter testing method and the results it produces. medication, or other products. ■ Scientists do not yet fully understand the biological functions and attributes of ■ Check urine samples for adulterants. saliva. Therefore, saliva testing should be used in conjunction with a confir- matory test of urine or blood for illicit substances. ■ Conduct confirmation testing when positive test results are disputed. Sources for lists: Jackson and Borrowman, 1998; Mieczkowski, 1997; Mieczkowski and Lersch, 1997. Table 5: Blood Analysis Determine Which Drugs To Test For Summary If possible, initial urine tests should Testing of blood is one of the most accurate methods of detecting substances that cover a variety of drugs based on in- have been ingested. It is most commonly used in medical settings and for forensic purposes, such as postmortem investigations. It also is frequently used to test for formation about the substances most driving under the influence of psychoactive substances. Costs range from $50 to commonly abused in a particular lo- $200 (Jackson and Borrowman, 1998). cality and, if the youth is cooperative, his or her drug use history. These Substances Tested tests might identify a combination of Alcohol and all illicit substances. several of the following: Benefits ■ Marijuana. ■ Results are accepted by courts for criminal justice purposes. ■ Cocaine. Disadvantages ■ Amphetamines. ■ Invasive procedures are required to collect samples. ■ Barbiturates. ■ Specialized training for drawing blood samples is required. ■ Opiates. ■ Storing and transporting samples requires special procedures. ■ Phencyclidine (PCP). ■ Lack of proficiency testing programs and accreditation of many laboratories can make results questionable. ■ Benzodiazepines. Source for lists: Jackson and Borrowman, 1998. Depending on the timeframe, it also might be advisable to test for alcohol

10 youth for the psychoactive effect Table 6: Urine Testing they induce. Testing for inhalants Summary becomes more complex because each substance produces different anti- Urine testing is presently the most practical and widely used technology for test- bodies. Some laboratory tests are ing for illicit substances among youth in the juvenile justice system. available for the more frequently Costs vary according to the type of tests, onsite or laboratory testing, number of abused components of inhalants, but tests conducted by an agency, and other factors. For onsite instrument-based others require much more sophisti- tests, the cost is about $1 to $2 per test for each drug tested (not including the cated chemical analysis. cost of equipment). For onsite noninstrument (handheld) test kits, the cost ranges from $2 to $5 for each drug tested. For laboratory testing, costs range from $2 to $20 for each drug tested (Pretrial Services Resource Center, 1998). Step 6: Decide How To Substances Tested Use Results and Arrange Marijuana, cocaine, amphetamines, barbiturates, opiates, phencyclidine, for Adequate and benzodiazepines, alcohol. Appropriate Treatment Benefits Juvenile Justice Response ■ It is the most cost-effective methodology presently in common use. The use of results of drug testing ■ It is less invasive than blood testing. should be determined by the agency ■ Urine tests are very accurate and generally accepted by courts. mission and the substance-testing pro- ■ Results can be available very quickly, especially when using onsite testing gram purpose. A response should be methods. given every time a youth is tested. When test results are positive for drug Disadvantages use, referral for assessment and treat- ■ To be confident of accurate testing, specimen collection should be observed, ment, a system of graduated sanctions, which is invasive and sensitive. or both, should be in place. By the ■ Requires physical facilities for sample gathering. same token, when results are negative, a supportive response is needed to ■ Has a short window of detection, as drugs or their metabolites stay in the body a relatively short time. Thus, testing must be conducted frequently to reinforce continued abstinence. monitor drug use. A youth’s time perspective is differ- ■ Special storage and transportation practices are required. ent from that of an adult. Youth are ■ It will not indicate the amount, frequency, or duration of drug use. more likely to be present- than future- focused and to discount the future Sources for lists: Crowe and Schaefer, 1992; Jackson and Borrowman, 1998. consequences of their present behavior. Thus, it is important to respond to youth as soon as possible after they use. This would be most appropriate ever, the more drugs included in have been tested so they are more at times such as detention intake, the test, the more expensive it be- likely to connect their actions with con- return of the youth to a facility after comes. Where funds are very lim- sequences. Drug Testing Guidelines rec- a furlough or a runaway episode, ited, the panel may be restricted to ommends that juveniles be confronted and staff visits with youth on proba- the most commonly seen drugs, with test results within 72 hours after tion and parole at home or other with the knowledge that others they are obtained and that the period places in the community. Alcohol may be missed. for responding should never exceed does not stay in the system long, and When youth are tested on an ongo- 7 days (American Probation and Parole testing is usually not indicated if the ing basis, urinalysis may be limited Association [APPA], 1992). With onsite youth has not had recent access to to their drug(s) of choice; however, instrument- or noninstrument-testing alcoholic beverages. if possible, a full panel should be technologies, responses can be given At intake to the program, screening given occasionally to ensure that almost immediately. Responses to for multiple drugs gives the most youth are not changing drugs to youth also must be appropriate for helpful information for juvenile avoid detection. their developmental level. justice personnel to use in planning Various ordinary household and Nonadjudicated youth who test posi- for the needs of the youth. How- other substances are inhaled by tive upon entering detention should

11 not be punished. A drug test at arrest collaborative working relationships to More trained clinicians are needed to or intake to detention should be used best meet the needs of the youth they provide specialized treatment services, for assessment and diagnosis. Positive both serve. Interagency agreements and more case managers are needed to results provide the basis for referring between juvenile justice agencies and coordinate community resources and youth for further assessment and treatment providers are crucial for en- monitor issues involving other social treatment. suring appropriate treatment resources systems, such as treatment, primary for substance-abusing youth. medical and mental health care, educa- At the time of admission to a juvenile tion, and family services. There are few justice program or facility, all youth national examples of a system coordi- should be told the possible therapeu- Need for Substance Abuse nating all services needed to provide a tic, incentive, or punitive responses Treatment for Youth continuum of treatment services for that will occur following every test. It is difficult to compare the need for youth. Using a systematic program to Examples of graduated responses that treatment among youth with the rate identify the number of substance-using could be used for positive tests in- of treatment availability. There is no and -abusing youth lays the foundation clude the following: national treatment system for adoles- for the next step in building a national cents and, therefore, national data ■ Participation in drug education system for treating adolescents. Com- collection and analysis are largely un- programs. prehensive programs for drug testing available. However, the 1997 National will document the need for adequate ■ Participation in discussions about Household Survey on Drug Abuse and appropriate substance abuse treat- his or her substance abuse behavior. estimates more than 8.2 percent of ment for those youth who are identi- youth ages 12 to 17 need drug abuse ■ Increased frequency of drug testing. fied as needing such services. treatment—that is, approximately ■ Increased contact with a probation 1,887,000 of the 23 million adolescents or parole officer or other staff. in the Nation (Substance Abuse and Effective Treatment for Mental Health Services Administra- Adolescents ■ Earlier curfew or loss of other tion [SAMHSA], 1998b). The survey Adolescent substance abusers are privileges. also estimates 9.5 million persons more difficult to treat than adult sub- ■ Community service or other work need treatment for illicit drug abuse, stance abusers. The pressures created assignments. but that in any year, only 2.1 million by physical, hormonal, and emotional receive it in a specialized facility. It is changes produce stressors that are ■ Home or facility restriction. estimated that the current national magnified by typical adolescent de- ■ Probation or parole violation deter- treatment system, designed primarily velopmental drives for individuality, mination or facility disciplinary for adults, can treat 50 percent of per- separation, autonomy, and social procedures. sons with the most severe addiction. acceptance. Lacking life experience, In a system able to treat only 50 per- youth often have difficulty controlling Possible responses to negative results cent of those most needing treatment, their impulses or making appropriate include the following: triage decisions are influenced by decisions. Chemical dependence in- ■ Verbal praise. who is the most needy and priority is tensifies the behavior problems asso- often given to adults who are chroni- ciated with adolescent development ■ Positive notes to parents. cally and severely addicted. It is im- and simultaneously delays emotional ■ Rewards (e.g., movie tickets, skat- portant to note that these data do not development. Substance-abusing ado- ing passes, fast-food coupons). include adolescents and adults need- lescents are frequently members of ing treatment for alcohol abuse. dysfunctional families in which there ■ Privileges and activities (e.g., later are no appropriate role models or curfews, drug-free parties). support. An estimated 7 million chil- 8 Most of this section was contributed by Roberta Messalle, Office of Evaluation, Scientific Analysis dren are growing up with at least Substance Abuse Treatment and Synthesis, Center for Substance Abuse Treatment one substance-abusing parent, and for Juveniles8 (CSAT). It was developed from material presented in approximately 38 percent of all CSAT publications. References used include Screening Juvenile justice professionals should and Assessment of Alcohol and Other Drug Abusing Adoles- child abuse cases have parental sub- be able to recognize the need for cents, HHS Publication No. (SMA) 95–3058, SAMHSA, stance abuse as a factor. These mul- 1995; Guidelines for the Treatment of Alcohol and Other Drug tiple disorders—mental, medical, substance abuse assessment or treat- Abusing Adolescents, HHS Publication No. (SMA) 93– ment and serve as brokers to obtain 2010, SAMHSA, 1993; and Treatment for Alcohol and Other and developmental—interfere with needed services. Juvenile justice and Drug Abuse: Opportunities for Coordination, HHS Publica- the progress and effectiveness of treatment professionals should establish tion No. (SMA) 94–2075, SAMHSA, 1994. treatment. For that reason, the most

12 successful treatment for any adoles- includes a case management begin. Available modalities should cent is based on an assessment of plan that oversees the following include: each contributing factor and is de- elements: ■ Substance abuse education and signed for that individual. ■ Planning for treatment, estab- drug testing for persons assessed Treatment begins with a diagnosis. lishing agency coordination, as having no history of abuse or Substance abuse is a disease of the and implementing reporting dependence and therefore having brain that is expressed in behavioral procedures. no withdrawal symptoms. ways and occurs in a social context ■ Brokering treatment and other ■ Weekly outpatient treatment in- (Bigelow, 1995). Unlike other health services to ensure continuity as cluding pharmacological interven- conditions, substance abuse is highly the client progresses through tions (e.g., naltrexone, methadone); individualized and complex, grounded treatment and program treatment includes group therapy in each individual’s biological and psy- completion. and help building life, cognitive, chological makeup, and influenced by and anger-management skills. each individual’s unique experiences of ■ Monitoring and reporting the social development and functioning. client’s progress using a sched- ■ Intensive outpatient treatment for However, like all other health disorders, ule that ensures reporting back persons abusing substances and effective treatment for substance abuse to the referral source on a fre- having additional problems requir- begins with a trained professional’s quent and consistent basis. ing structured therapy and weekly careful diagnosis of the causes and outpatient treatment, including ■ Supporting the client by identi- symptoms of the condition. pharmacological interventions. fying problems. Other components of an effective ■ Intensive residential treatment for ■ Advocating for the client with treatment strategy. Effective treat- persons experiencing acute intoxi- legal, treatment, social service, ment for substance abuse includes cation and withdrawal, having medical, and mental health the following elements: medical or psychiatric disorders, systems. or needing assistance to provide ■ Screening—a quick gathering and ■ Monitoring through urinalysis, for their immediate needs. This sorting of preliminary information breath analysis, or chemical usually is hospital-based treatment used to determine if a person has testing for relapse to substance that requires short- or long-term substance abuse problems, mental abuse. residential services. It also may health disorders, or infectious dis- include therapeutic communities, eases and to ascertain if a clinical ■ Protecting the confidentiality of a more behaviorally based inter- assessment is needed. a client’s treatment records, vention usually targeting fairly consistent with Federal and ■ Drug testing—part of a structure for hardcore drug abusers. State regulations regarding the holding participants accountable right to privacy. In addition to these treatment ap- while also allowing a flexible but proaches, self-help or 12-step programs finite response to substance abuse. Treatment modalities and compo- may also be beneficial. These organiza- nents. A continuum of treatment op- ■ Intake and assessment—an tions involve mutual help among peers tions should be available to provide indepth collection of detailed in- experiencing similar problems. Alco- the services most appropriate to the formation concerning, but not lim- holics Anonymous (AA) was the first treatment needs of each youth and ited to, a youth’s substance abuse and is the best known of these pro- family. Detoxification is not a treat- and treatment history, current grams, but many others exist. Mem- ment modality, but it may be a neces- conditions, emotional and physi- bers of AA believe (as do many others, sary first step in the treatment pro- cal health, family status, social including the National Institute on cess. Detoxification provides medical roles, victimization, education, Drug Abuse) that addiction is a disease and supportive services needed to al- and criminal history. that can never be cured; however, they leviate the short-term symptoms of maintain that the progression of the ■ Patient-oriented treatment plan— physical withdrawal from chemical disease can be arrested and describe a course of action developed by a dependence, including physical dis- those in remission as recovering alco- licensed substance abuse counselor comfort, cravings, and mood changes holics (Doweiko, 1990). If used with or mental health professional that (Institute of Medicine, 1990; Office of adolescents, these programs need to includes various milestones for National Drug Control Policy, 1990). be tailored to meet their specific devel- evaluating the progress and success Once symptoms of craving and with- opmental needs. of the treatment. The treatment drawal are controlled, treatment can

13 Patient-oriented treatment compo- health care to treat any physical health Step 7: Develop Written nents. Treatment should be designed problems, including HIV/AIDS. 9 to respond to each patient’s specific Policies and Procedures Relapse prevention methods. Sub- configuration of causes with an array Policies help to formulate a course of stance abuse and addiction are of “wraparound” services. For ex- action that determines the way spe- chronic disorders that are prone to ample, several of the following ser- cific decisions are made. There are recur. Effective treatment includes vices may be needed by youth: several key issues that must be ad- special counseling to prevent or dressed by substance-testing poli- ■ Counseling involving and limit relapse and creates a structure cies and procedures. strengthening the family unit. of incentives and sanctions that re- spond to episodes of relapse. ■ Preventive and primary health Scheduled and Random care and health education. Special Concerns About Testing ■ Mental health services for co- Treatment for Youth Some agencies may schedule testing occurring substance abuse and of youth at specific points in the Adolescents are in a stage of intense mental health disorders. system’s process: physical, hormonal, and developmen- ■ Specialized treatment for girls tal change that presents challenges ■ At intake to detention. (addressing, for example, victimi- to the effectiveness of treatment for ■ Following any furlough from a zation issues, pregnancy, and substance abuse. Just as services must residential placement. childcare). be specialized for them, there are sev- ■ ■ Remedial assistance for educa- eral pitfalls to avoid when planning a At intake to probation. treatment program for adolescents, tional deficits or disabilities. However, for ongoing substance test- including the following: ■ Group counseling interventions. ing, random specimen collection is ■ Limiting assessment to substance recommended. Random or unsched- ■ Treatment that is sensitive to ra- abuse alone and thus excluding uled testing reduces the possibility cial, ethnic, cultural, and social the diagnosis of contributing disor- that youth will attempt to schedule minority issues. ders that may complicate or inter- their drug use to avoid detection. ■ Employment training or counseling. fere with treatment. ■ Frequency of Testing ■ Practical life skills including re- Standardizing treatment and not fusal and avoidance skills and in- considering adolescent develop- Youth should be tested randomly and dependent living skills training. mental stages; the specific needs frequently enough to detect and deter created by the age, gender, eth- illicit drug use. Agency resources ■ Housing for the homeless or those nicity of the youth; or co-occurring and a youth’s drug(s) of choice will needing a drug-free environment. disorders of the adolescent sub- influence how often testing occurs. ■ Liaison with other social service stance abuser. Some drugs typically remain in the agencies or support groups (e.g., ■ Using adult criteria for treatment victim support, assistance for services that do not consider the 9 This section highlights some of the important areas HIV/AIDS patients). psychological and clinical needs to consider in developing policies and procedures for substance testing. For more details on these and other ■ Cognitive skill development for created by the developmental policy issues, consult Drug Testing Guidelines and Prac- stages of adolescents. tices for Juvenile Probation and Parole Agencies, published managing stress, anger, violence, by the U.S. Department of Justice, Office of Justice and antisocial behaviors. ■ Ignoring evidence that family- Programs, Office of Juvenile Justice and Delinquency focused services for adolescents Prevention (APPA, 1992). Suggested forms to use with Medical interventions. The diagnostic a substance abuse testing program may be found in assessment may show the need for have more successful outcomes Drug Identification and Testing in the Juvenile Justice other medical care, which is provided than those that focus only on in- System (Crowe, 1998) and Drug Testing Guidelines and dividual youth. This does not ne- Practices for Juvenile Probation and Parole Agencies onsite or through arrangements with (APPA, 1992). References used to develop this section other healthcare facilities, such as gate that family management include American Probation and Parole Association pharmacotherapeutic interventions skills may have contributed to the (1992), Drug Testing Guidelines and Practices for Juvenile adolescent’s addictive disorder Probation and Parole Agencies, Washington, DC: U S. (medications) to block cravings associ- Department of Justice, Office of Justice Programs, ated with addictions or treat underly- and that possible solutions could Office of Juvenile Justice and Delinquency Prevention; strengthen the family unit. and Crowe, A.H., and Schaefer, P.J. (1992), Identifying ing psychiatric disorders and primary and Intervening with Drug-Involved Youth, Lexington, KY: American Probation and Parole Association.

14 concentration of creatinine, a sub- Table 7: Approximate Duration of Detectability of Selected Drugs stance eliminated from the body in in Urine urine. Many current drug-testing Drug Duration of Detectability* technologies can measure creatinine and detect youth’s attempts to dilute Amphetamine 48 hours specimens by drinking fluids. Simi- Methamphetamine 48 hours larly, some tests check for specific Barbiturates gravity by measuring the concentra- Short acting 24 hours tion of solid particles in urine to en- sure youth have not diluted or adul- Intermediate acting 48–72 hours terated a specimen (Elbert, 1997). Long acting 7 days or more Additional precautions may be taken Benzodiazepines 3 days (therapeutic dose) to prevent youth from switching or Cocaine metabolites 2–3 days adulterating samples: Methadone 3 days (approximate) ■ Have youth take off jackets, empty Codeine/Morphine 48 hours pockets, and leave purses outside Propoxyphene/Norpropoxyphene 6–48 hours the collection area. Cannabinoids (marijuana) ■ Place a blueing agent in the toilet Single use 3 days to avoid substitution of toilet water Moderate use (4 times weekly) 4 days for the specimen. Heavy use (daily) 10 days ■ Use pH paper to measure the pH Chronic heavy use 21–27 days level or a temperature strip to record the temperature of the specimen. Phencyclidine (PCP) 8 days (approximate) (The temperature should be mea- * These are general guidelines only. Interpretation of the duration of detectability must take into sured within 4 minutes of urination.) account many variables, such as drug metabolism and half-life; the youth’s physical condition, fluid balance, and state of hydration; route of administration; and frequency of ingestion. ■ Keep soap and other chemicals Source: Council on Scientific Affairs. 1987. Scientific issues in drug testing. Journal of the American Medical outside the collection area. Association 257(22):3112. ■ Allow only one observer and one ju- venile to be in the collection area at a system longer than others. Table 7 process from other youth, staff, or the time, and prohibit youthful offenders indicates the approximate duration of public. Youth should be instructed to from participating in the collection of detectability of selected drugs. As the wash their hands and then void into another youth’s sample or having table shows, a youth using marijuana the collection cup within the view of access to testing equipment, supplies, might be tested less frequently than the attending staff member, who storage facilities, or documentation. one who is using amphetamines. should be of the same gender as the youth. The youth also should seal Chain of Custody Specimen Collection the cup and verify on the attached All possible steps should be taken to paperwork that the specimen is theirs. If the person collecting specimens ensure the integrity of youth’s drug test does not personally know each youth Youth may consume enough liquid to results. Chain of custody means proce- being tested, a process for identifica- dilute the sample sufficiently to influ- dures are used to document that the tion of youth should be implemented ence test results. Therefore, if enough specimen collected is that of the in- to ensure the sample is from the ap- of the drug has already been excreted tended youth and the specimen, testing propriate individual. Urine collection so the level is at or near the cutoff, procedures, and results of the tests are should be observed by juvenile justice dilution could be effective in render- handled properly throughout the pro- personnel to avoid the possibility of ing the test negative. Similarly, youth cess. In addition to the specimen collec- youth switching or adulterating could add something to the voided tion procedures already discussed, the specimens. The collection facility specimen that would dilute or change following elements of chain-of-custody should have both a sink and toilet and its chemical composition so the test procedures are needed: should afford privacy for the youth will be inaccurate. The amount of ■ Handling. There should be a record and staff involved in the collection liquid a youth drinks affects the of the whereabouts and names of

15 persons handling the urine speci- ■ Second test using a different barbiturates, and methadone are con- men and test results at all times. methodology. The second test sistent with recommendations by the methodology used must have an scientific community. ■ Storage. Urine specimens should be accuracy rate that is at least as high refrigerated immediately after they If the results of drug tests are chal- as the initial screening instrument, are collected or, if tested immedi- lenged, cutoff levels that are consistent and the cutoff level must be the ately, right after they are tested. Af- with those recommended by the U.S. same or lower. High performance ter testing, negative specimens may Department of Health and Human Ser- liquid chromatography (HPLC) be discarded, but positive samples vices guidelines (SAMHSA, 1998a) are and GC may be used for confirma- should be frozen until all relevant more likely to be accepted by courts. tion tests. However, GC/MS is the court proceedings are completed. most specific and most sensitive ■ Transportation. Packaging and method of urinalysis. Health and Safety transportation procedures should According to the Occupational include secure sealing and identifi- Cutoff Levels Safety and Health Administration cation and should safeguard against (OSHA) of the U.S. Department of The cutoff level is the amount of drug tampering or the possibility of mis- Labor (Clark, 1993), employers must or metabolite that must remain in the identification of specimens. make a determination about jobs specimen for a test to show a positive that involve an occupational risk of ■ Testing. Agency staff or laboratory result. Thus, a positive test means a exposure to bloodborne pathogens personnel testing specimens must youth has an amount of the substance such as HIV and hepatitis. Blood- properly document all steps taken in his or her system that exceeds the borne pathogens are most likely to to analyze the specimen. cutoff level. Negative results indicate be transmitted from an infected to a the youth either has none of the drug ■ Results. Forms and logs should noninfected person through blood- in his or her system or its concentra- be completed to document the in- to-blood or sexual contact. When tion is below the cutoff level. The Di- strumentation used, drugs tested there is a risk of exposure to blood or vision of Workplace Programs, Center for, test results, and cutoff level of semen, vaginal secretions, and other for Substance Abuse Prevention, rec- each test. body fluids containing visible blood, ommends the cutoff levels in table 8 universal precautions should be for initial and confirmation tests for used to minimize the risk; however, Confirmation Tests cannabinoids, cocaine, opiates, am- “universal precautions do not apply If an initial test is positive, it may be phetamines, and methamphetamines. to feces, nasal secretions, sputum, necessary to perform a confirmation Cutoff levels for benzodiazepines, test, especially if serious sanctions will be applied or if the results will be used in court. It may not be necessary Table 8: Recommended Cutoff Levels to perform confirmation tests if results Drug Initial Tests Confirmation Tests are being used solely for case man- * agement and treatment purposes. Cannabinoids 50 ng/ml 15 ng/ml Both costs of testing and legal issues Cocaine* 300 ng/ml 150 ng/ml are considerations when determining Opiates* 2,000 ng/ml 2,000 ng/ml whether to perform confirmation Amphetamine/Methamphetamine* 1,000 ng/ml 500 ng/ml tests. Three types of confirmation * are possible: PCP 25 ng/ml 25 ng/ml Benzodiazepines** 300 ng/ml 250 ng/ml ■ Admission statement. A youth ** signs a statement acknowledging Barbiturates 300 ng/ml 250 ng/ml drug use. Methadone** 300 ng/ml 250 ng/ml ■ Second test using the same meth- * U.S. Department of Health and Human Services Mandatory Guidelines for Testing Levels. odology. A specimen is tested a ** Cutoff levels for these drugs are not included in the HHS guidelines because they may be legally second time with the same test prescribed. The cutoff levels cited are those recommended by the scientific community. method. This is not recommended Sources: Substance Abuse and Mental Health Services Administration (1998), Mandatory Guidelines for Federal Workplace Drug Testing Programs, Washington, DC: U.S. Department of Health and Human Services, if sanctions for a positive test will Substance Abuse and Mental Health Services Administration; American Probation and Parole Association result in loss of liberty. (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.

16 sweat, tears, urine and vomitus un- crisis intervention protocol so staff If it is evident that a youth has less they contain visible blood” [empha- know how to intervene appropriately switched samples or diluted or adul- sis added] (Update, 1988). Several in emergencies. terated the specimen, policies should problems may cause blood in the be in place for responding to the situ- urine, but the most common are kid- Interventions ation. Sometimes such attempts are ney and urinary tract diseases. For addressed as if results would have Besides the policies and procedures girls, menstrual blood also may be- been positive if the person’s own needed for the actual testing process, come mixed with urine. Any urine urine or an uncontaminated or undi- guidelines should be in place for in- containing visible blood should be luted specimen had been available. terventions, including appropriate discarded, and if the cause could be responses to both positive and nega- anything other than menstruation, tive test results. Referrals for Substance Abuse the youth should be referred for Assessment and Treatment medical care. However, if no visible Policy documents should include blood is present in the urine sample, Rewards and Sanctions procedures to be used when youth the risk of infection from bloodborne The general purpose and approach to require referral to other service pro- pathogens, even if one comes in di- responding to youth should be incor- viders for substance abuse assessment rect contact with urine, is considered porated in policy documents, including and treatment. Interagency agreements negligible. No cases of HIV transmis- the requirement that youth receive an should be developed between juvenile sion through laboratory contact with appropriate response for every drug test justice agencies and substance abuse urine have been reported. result. Listing suggested graduated sanctions can be helpful in assisting treatment providers that spell out these For general health and sanitation, staff working with youth to select ap- processes, the requirements of practi- however, personnel should take propriate responses, but these should tioners in each agency, and any spe- standard precautions to protect allow enough flexibility to make them cial concerns of the youth and family/ themselves from possible contact suitable to the particular circumstances caregivers. with urine. Because accidental spills of individual youth. and splashes can be hazardous, it Support of and Cooperation should be standard procedure for If testing is voluntary, it is not appro- With the Treatment Process staff to wear rubber gloves, lab priate to punish or otherwise inter- The policies and procedures document coats, and goggles, as procedures re- vene with youth who refuse to give a should describe interagency agreements quire, when conducting urine testing. specimen. In a voluntary testing pro- gram, youth probably would refuse between juvenile justice agencies and Specimens also should be protected. rather than attempt to adulterate or treatment providers. Policies should Smoking, eating, or drinking should be dilute a specimen. However, where underscore the expectation that juve- prohibited in the area where specimens testing is mandatory, some youth nile justice staff and treatment provid- are stored or handled. No food should may attempt to refuse or to provide ers will work in concert toward the be stored in the same refrigerator with an adulterated or diluted sample, treatment and best interests of the specimens. and policies should be designed for youth. In addition, procedures should stipulate that youth be informed about Because of the strong association be- responding to these situations. For the treatment process. Some programs tween injection drug use and HIV youth who are required to submit to develop a written agreement for youth transmission, youth who have injected drug testing because of probation to sign regarding their role in, respon- drugs may need guidance and assis- or paroling authority orders or pro- sibilities toward, and understanding tance in being tested for HIV. Health gram rules, a refusal to provide a of the treatment process. Important and safety procedures also should be specimen (either by failure to report information to incorporate in discus- developed for working with youth. for collection or by being unable to sions or written agreements with youth Personnel should be able to identify provide a specimen) may be consid- include the following (Aukerman and possible withdrawal symptoms or side ered a violation of program rules or McGarry, 1994): effects of substance abuse that might probation and paroling authority endanger a youth’s health and safety. conditions. However, if a youth is ■ A description of the treatment Erratic behavior that could endanger unable to provide a specimen at the program. the youth or others may be provoked appointed collection time, he or she ■ Types of misconduct and their by some substances. Some youth may should be given a reasonable amount consequences. also become upset when positive re- of time (and liquids) to allow for sults are revealed. There should be a specimen production.

17 ■ Information that will be shared be- tween the treatment and juvenile Example 1: Small Detention Center justice agencies. The Eastview Detention Center admits approximately 500 youth each year. It ■ Criteria for successful completion is the policy of the center to drug test each youth at admission as part of the of treatment. physical examination. Only marijuana and cocaine tests are used. There are ■ Results that can and cannot be 10 staff members, and all must know how to collect specimens and adminis- achieved through treatment. ter the onsite test kits. No confirmation tests are required because results are used only for assessment purposes and referral for services. ■ Demands of treatment and recovery. Startup Costs ■ Description of the typical recovery process and information about The youth restrooms will be used, and the nurse’s office has running water relapse. and room to securely store specimens and test supplies. Refrigerator $500 Step 8: Obtain Funding Staff training (2 [8-hour] days x 10 staff @ $8/hour) $1,280 Trainer for 1 day (Training provided by the test Costs manufacturer on the second day.) $350 A paramount concern for agency ad- Substitute staff while others in training $1,024 ministrators and others who must Personal computer, software, and training to use it $3,000 worry about budgets is the cost of drug Other miscellaneous expenses (e.g., trash receptacle, gloves) $100 testing. There are several important Total Startup Costs $6,254 factors to consider. This document provides information for estimating Ongoing Costs (estimated for 1 year)* program costs. However, as each agency or program is different, tests Number of youth tested at admission 500 diverse numbers of youth, and per- Number of tests administered to each youth 1 haps needs to test for different classes Number of drugs tested for 2 of drugs, cost factors must be adjusted Total tests 500 for each locality. (Three examples of Cost per test (two drugs/test) x $6 costs for substance testing in different Total cost for tests $3,000 types of juvenile justice agencies ap- pear on pages 18 to 20.) Supplies, forms, etc. @ $.50/youth $250 Staff time @ 15 minutes/youth @ average salary of $8/hour $1,000 Several types of costs accrue to an Additional utilities Negligible agency or jurisdiction and should be Yearly Cost $4,250 considered in program planning (Crowe and Schaefer, 1992; Pretrial * Estimated costs per test were taken from Pretrial Drug Testing: Overview of Issues and Practices Services Resource Center, 1989, (Pretrial Services Resource Center, 1998). 1998), including: ■ Costs that are constant regardless ■ of methodology used, such as: equipment and analyzing Trainer costs, staff time, and specimens that includes a sink materials for general training of ■ Supplies for collecting speci- with running water to dispose staff in substance-testing poli- mens (e.g., collection cups, rub- of negative specimens; a trash cies and procedures. ber gloves, chain-of-custody receptacle for disposing of used ■ Costs that vary by methodology forms). testing supplies). selected, including: ■ Space and equipment required ■ Utility costs for additional ■ Costs per test for onsite instrument- (e.g., a toilet and sink with run- water used. based testing. Testing a speci- ning water for specimen collec- ■ tion; secure refrigerator and Personnel time for collecting men for a single drug with freezer space for storing speci- specimens and completing nec- these instruments presently mens; if testing is onsite, a se- essary paperwork for chain-of- costs about $1 per test for the cure room for storing testing custody procedures. reagents required (Pretrial

18 Services Resource Center, 1998). Example 2: Medium Residential Facility In addition, there is the initial cost for purchasing the instru- Youthville is a residential treatment program for 35 juveniles. The total ment or ongoing costs for leas- number of youth served each year is about 90. The facility’s policy is to test ing it (these costs often are each youth at admission and again, randomly, following off-grounds activities, negotiable and may be lower if such as home visits, recreation, or work details. Staff estimate that each of the program purchases a cer- the youth will make eight off-grounds trips each, and staff expect to test tain volume of testing supplies the youth about half of the time. Three tests—for marijuana, cocaine, and from the manufacturer). Fur- methamphetamines—will be conducted on each specimen. There are 15 staff ther, it probably will be pru- members who will collect specimens, when needed, and must be trained. dent to purchase a maintenance A laboratory will conduct tests and perform confirmations on positive contract for the machine. Elec- tests. A supervisor and clerical staff member will have responsibility for trical renovations may be shipping specimens and receiving and filing results. required for its proper use, and Startup Costs higher electric utility bills are possible. Additional training No remodeling or additional space is needed. and staff time for the oper- ator(s) of the machine also Refrigerator $500 must be considered. Staff training (1 [8-hour] day x 16 staff @ $9/hour) $1,152 Trainer for 1 day $350 ■ Costs per test for onsite noninstru- Substitute staff while others in training $504 ment-based testing (kits). Prices Computer system not needed because the laboratory currently range from about will keep records of the testing and can furnish $2.50 to $4.50 per individual test information on numbers tested, results, etc. according to Pretrial Services Other miscellaneous expenses (e.g., trash receptacle, gloves) $100 Resource Center (1998). These Total Startup Costs $2,606 usually are less expensive when purchased in larger quantities, Ongoing Costs (estimated for 1 year)* but they may have a limited shelf-life. Thus, an agency Number of youth tested at admission 90 should purchase only the num- Number of tests administered to each youth 1 ber of tests that reasonably can Number of drugs tested for 3 be used before the expiration Total admission tests 90 date. Costs will be greater for Cost per test (three drugs/test) x $10 devices that test for multiple Total cost for admission tests $900 drugs or when several single drug tests are used to detect Number of youth tested randomly 90 multiple drugs. Number of tests administered to each youth (after 50% of eight off-ground trips) 4 ■ Costs per test for laboratory test- Number of drugs tested for 3 ing. These costs may vary markedly depending on the Total random tests 360 volume of testing, the drugs Cost per test (three drugs/test) x $10 tested for, and the laboratory Total cost for random tests $3,600 used. According to Pretrial Ser- Total cost for all tests $4,500 vices Resource Center (1998), the costs can range from about Supplies, forms, etc., will be provided by laboratory. $2 or $3 to $20 for each drug Staff time @ 15 minutes/youth @ average salary of $9/hour $1,013 tested. In addition, there are Additional utilities Negligible costs for shipping specimens Yearly Cost $5,513 to the laboratory. ■ * Estimated costs per test were taken from Pretrial Drug Testing: Overview of Issues and Practices Costs per test for confirmatory (Pretrial Services Resource Center, 1998). testing (usually by a laboratory). Regardless of the initial testing

19 Example 3: Large Juvenile Probation Department The Springfield Probation Department has approximately 1,000 youth on its caseload at any time. Five hundred of those are newly adjudicated cases each year. All youth will be tested for five drugs at intake. Based on history, the department estimates that approximately one-half of the youth use drugs on an ongoing basis. Marijuana and cocaine are the major drugs used, but methamphetamines are a problem occasionally. Tests will be administered randomly three times a month. The department has 30 probation officers who will be required to collect specimens. An onsite instrument will be used for testing, and two officers will be specially trained to use it. Five administrators also will attend training. Confirmation tests will be used for any youth—estimated at about 10 percent—who will go back to court for possible revocation after several consecutive positive tests. Startup Costs No remodeling is necessary, and there is sufficient space to store tests and operate testing equipment. Refrigerator $500 Staff training (1 [8-hour] day x 35 staff @ $12/hour) $3,360 Trainer for 2 days (Training provided in two sessions each for half the staff; no substitute staff needed. Training on use of instrument provided by manufacturer.) $700 Personal computer, software, and training to use it $3,000 Other miscellaneous expenses (e.g., trash receptacle, gloves, safety goggles) $200 Total Startup Costs $7,760

Ongoing Costs (estimated for 1 year)* Number of youth tested at admission 500 Number of tests administered to each youth 1 Number of drugs tested for 5 Total admission tests 500 Cost per test (five drugs/test) x $5 Total cost for admission tests $2,500 Number of youth tested randomly (50% of 1,000-youth caseload) 500 Number of tests administered to each youth (three tests/month) 36 Number of drugs tested for 2 Total random tests 18,000 Cost per test (two drugs/test) x $2 Total cost for random tests $36,000 Total cost for all tests $38,500 Supplies, forms, etc. @ $.35/test (18,500 tests [admission and random] x $.35/test) $6,475 Confirmation tests at laboratory for 10% of randomly tested youth (50 tests x $20/test) $1,000 Staff time @ 15 minutes each for 18,500 tests [admission and random] @ average salary of $12/hour $55,500 Staff to operate instrument @ 3 minutes each for 38,500 drugs tested @ $12/hour $23,100 Maintenance contract on instrument $750 Additional utilities @ $50/month $600 Yearly Cost $125,925

* Estimated costs per test were taken from Pretrial Drug Testing: Overview of Issues and Practices (Pretrial Services Resource Center, 1998).

20 method selected, it may be financial cost to the juvenile justice the JAIBG legislation states: “Funds necessary to budget for some agency. received under this program may confirmatory tests. The be expended for such purpose [i.e., Variable factors that must be consid- amount required may depend substance testing].” Some States or ered to determine costs for substance on the program’s policies. localities have drug seizure pro- testing include: Some policies require confir- grams where money and property mation of all positives, others ■ The number of youth to be tested. related to drug trafficking are con- require confirmation only if fiscated. These funds often can be ■ The number of personnel to be results will be used for legal used for combating drug use and trained. purposes, and some confirm might be available for a juvenile only if the youth contests the ■ The frequency of testing. substance-testing program. findings. In some cases, youth ■ Agency collaboration. For ex- are required to pay for confir- Cost Savings ample, agencies can share space, matory tests that also show a One way of minimizing costs is to test pool supplies, and engage in in- positive result, while the youth only as needed. In programs of teragency training and staffing to agency pays if the confirma- ongoing testing, after several negative defray the costs of implementing tion test is negative. tests, the frequency of testing may be the program. ■ Costs for a substance-testing in- reduced or testing may be stopped ■ Resource sharing. It may be pos- formation system. Keeping accu- altogether. Decisions about testing sible to obtain donations of needed rate information about each youth also may be related to the youth’s be- items, such as refrigerators, rubber and the entire testing program is havior, peer associations, and history gloves, testing supplies, and possi- vital. Records can be kept by of drug use and to the nature of the bly even test equipment in exchange hand, but unless the population of offense committed. If testing is ran- for public recognition by the agency. youth to be tested is quite small, dom, it can be done somewhat less record keeping on computers is frequently. Youth also may be encour- ■ Fundraising. Businesses, organiza- likely to save time and yield more aged to admit illicit drug use rather tions, churches, and other commu- accurate and accessible results. than undergo testing. nity entities interested in fighting Costs associated with this may crime, protecting the community, Using volunteers or student interns include software, programming and helping youth could provide within the agency may be another time, hardware, and data entry funding for the program. cost-saving device. Only trained per- time. sonnel should conduct drug testing, ■ User fees. This is not as realistic with ■ Costs for responding to tested but volunteers or interns may be able youth as it is with adults, because youth. As stated previously, there to assist with other time-consuming youth seldom have steady income; should be a response given for tasks that free some of the juvenile however, youth might be required each and every test administered. justice professionals’ time. to provide community service or Much of the time, a verbal re- engage in other work activities in Never economize by collecting speci- sponse praising youth for a nega- exchange for testing. mens but not testing them. This can tive test or counseling and ad- seriously jeopardize the integrity of the monishing them for a positive testing program. If youth know they Step 9: Develop Staff test will be the primary response. should be testing positive but do not However, some programs may Staff involvement and cooperation receive feedback on the test results, want to include rewards for ongo- are vital for implementing any pro- they are more likely to take chances ing negative tests and graduated gram change. Staff roles, attitudes, using drugs. sanctions for ongoing positive and comfort in performing their jobs tests. Rewards could include the may be affected by developing a sub- cost-saving measures of decreas- Sources of Funding stance-testing program. ing the frequency of testing and There are a variety of avenues and Staff resistance to implementing a limiting visits by community su- creative strategies for obtaining funds substance-testing program often is re- pervision personnel. On the other for a testing program, including: lated to program expectations, such as: hand, sanctions such as increased ■ Federal, State, and local grants and ■ testing and supervision or the Additional paperwork to comply funding programs. For example, need for referrals to treatment or with rigorous chain-of-custody other programs may increase the procedures and program evaluation.

21 ■ Observed specimen collection. this may or may not be a full-time ■ Completing all program evaluation responsibility. Responsibilities of the procedures. ■ Confrontation of drug-involved coordinator include, but are not limited youth. to, the following: Staff Training ■ Additional work in managing ■ Assisting in development of policies To successfully implement a testing cases when youth need treatment and procedures for the program. program, staff will need to participate and other services. in training to acquire an array of in- ■ Handling contract negotiations Staff enthusiasm may increase with formation and skills. Training content and renewals for program instru- program benefits, such as: should include: ments and supplies, and recom- ■ More accurate information about mending and implementing ■ Information about adolescent youth to assist in case management changes when needed. drug use. and intervention. ■ Acting as a liaison between con- ■ Effects of various drugs on youth. ■ Drug-testing results to help over- tracting agencies, ensuring that ■ Program purpose and agency come youth’s denial of drug use. contract obligations are fulfilled, mission. and seeing that rendered services ■ Data collected from a drug-testing are satisfactory. ■ Discussion of legal issues. program to document the need for additional treatment resources. ■ Taking steps to solve problems. ■ Testing methodology and how it works. ■ Coordinating training opportunities Staff Empowerment for staff. ■ Use that will be made of results. Staff involvement in the program plan- ■ Making budgetary decisions in ■ Program policies and procedures, ning and development process is rec- compliance with agency policy. such as scheduled or random testing, ommended. Staff at all levels are stake- frequency of testing, observed speci- holders in the program and should be ■ Monitoring legal issues, such as men collection, chain-of-custody included in the process. In addition, court challenges and requirements procedures, confirmation of positive agency administrators can facilitate ef- for testifying. results, cutoff levels, and health and fective teamwork and staff cohesion by: ■ Assisting in evaluating the pro- safety requirements. ■ Working with staff to set clear ob- gram design and implementation ■ Intervention strategies, including jectives and achievable goals for and analyzing results regarding graduated sanctions and rewards. the program. the substance-testing program. ■ Conflict management. ■ Establishing effective procedures Staff of the program will have an array for conducting the program. of responsibilities. The primary ones ■ Program evaluation procedures. include the following: ■ Maintaining constructive commu- nication among team members. ■ Advising youth of the testing pro- Step 10: Evaluate the gram and the procedures that will ■ Allowing the team latitude to Program be taken. solve problems and grow with Although it is the last topic in the pro- their responsibilities. ■ Collecting specimens. gram development process, program evaluation is essential and occurs ■ Providing training programs to ■ Following all chain-of-custody throughout program implementation. help members perform their duties procedures. proficiently. ■ Operating instruments, using test What To Evaluate ■ Recognizing and rewarding excel- kits, or sending specimens to Both process and outcome evaluation lent job performance and allowing laboratories. measures are vital. Process evaluation the team to share in the success of ■ Complying with all procedures to examines the implementation of the the program. maintain quality control. program, while outcome evaluation focuses on the impact of the program. ■ Communicating results to youth and Staff Responsibilities For example, questions that might be handling results properly within the A substance-testing coordinator should answered through a process evalua- agency (e.g., filing, entering in log). be designated to oversee the program. tion include: Depending on the size of the program, ■ Testifying in court, if necessary.

22 ■ Are the intended youth being tested the types of data that should be col- ■ What are the outcomes? at the appropriate frequency? lected on individual youth include ■ Are the outcomes found through the following: ■ Are staff correctly following chain- the evaluation consistent with the of-custody procedures? ■ General identifying information program goals? about the youth (e.g., name, age, ■ How is drug testing affecting the ■ Are there any unintended legal status). staff? outcomes? ■ Substance use history (e.g., types, Questions that might be answered ■ Is the cost of the program appro- amount, and frequency of drugs through outcome evaluation include: priate for the results received? used). ■ How many youth are using drugs, ■ Are the data collected appropriate ■ Treatment history and current and what kinds of substances are and adequate for effective evalua- status (e.g., types of treatment they using? tion and decisionmaking? received, attendance at present ■ Are youth who test positive receiv- treatment program). ■ Are the findings consistent with ing needed assessment and treat- local community data? ■ Drug-testing results (e.g., dates ment services? tested, types of drugs tested for, A management information sys- ■ Are tested youth abstaining from results). tem is necessary for evaluating a using drugs? substance-testing program. The ■ Responses given to drug-testing system may be either manual or au- ■ Is recidivism reduced for youth results. tomated, but it should be capable of who are tested? providing information about the ef- Many other important process and Evaluation Findings fectiveness of the program. It should outcome questions can be answered Collected data can be used in sev- be easy to use, and results should be through evaluation. The specific areas eral ways. This information may be easily retrievable. The agency should to be measured should correspond used to track the services provided establish standard procedures for with the agency mission and the pur- and the progress of an individual staff responsibilities and operation pose and goals of the testing program. youth. Data such as those listed of the management information sys- above can be used to show trends tem. Confidentiality must also be When To Evaluate in drug use and youth responses to considered in designing the input, treatment and juvenile justice inter- storage, and retrieval of information. Evaluation should be built into the ventions. This is useful in assessing testing program and should begin the effectiveness of the current case when the program begins. It is help- Conclusion plan and modifying it if necessary. ful if baseline data can be collected The 10 steps outlined in this Bulletin against which later findings can be Aggregate data also can be used to are important because they can help compared. assess the drug-testing program. agencies reach the ultimate goal of a For example, cumulative data can substance-testing program—helping Data Collection reveal trends in drug use among youth to stop using substances of youth over time, the effectiveness The purpose of the program deter- abuse. The consequences of juveniles’ of treatment services and case mines the data to be collected. Data use of mood-altering substances can plans, and any problems in pro- can be collected through traditional be dire. Substance abuse and delin- gram implementation. paper forms and filing systems, or quency are closely associated. Fur- they can be entered, stored, and Evaluation results should be used ther, substance abuse can strain the retrieved using computers. Selection to make ongoing decisions about user’s peer and family relationships, of a method will depend, in part, on program operations. Evaluation damage his or her physical and emo- the availability of technology, the findings can help to answer these tional health, and even lead to death amount of data to be collected, and questions: by overdose, suicide, or drug-related the expertise and time required by homicide. Creating an effective ■ Are program goals appropriate? staff to use the method. Whichever substance-testing program will method is selected, it is vital that a ■ Are the program’s processes ad- allow agencies to prevent some of systematic process be established for equate and are they being imple- these tragic consequences as they collecting and using the data. Some of mented accurately? accomplish the following:

23 ■ Identify youth needing treatment Aukerman, R.B., and McGarry, P. U.S. Department of Justice, Office and other interventions for sub- 1994. Combining Substance Abuse of Justice Programs, Office of stance abuse. Treatment With Intermediate Sanctions Juvenile Justice and Delinquency for Adults in the Criminal Justice Sys- Prevention. ■ Deter youth’s use of alcohol and tem. Treatment Improvement Proto- other drugs. Crowe, A.H., and Schaefer, P.J. col Series #12. Rockville, MD: U.S. 1992. Identifying and Intervening with ■ Screen for substances that may lead Department of Health and Human Drug-Involved Youth. Lexington, KY: to health and safety problems for Services, Substance Abuse and Men- American Probation and Parole the youth and others. tal Health Services Administration, Association. Center for Substance Abuse Treat- ■ Assist agency staff in making appro- ment. Crowe, A.H., and Sydney, L. 2000. priate case plans and supervising Developing a Policy for Controlled Sub- and monitoring youth’s compliance Baer, J.D., and Booher, J. 1994. The stance Testing of Juveniles. Bulletin. with court orders or program rules. patch: A new alternative for drug Washington, DC: U.S. Department testing in the criminal justice system. Without effective testing, youth in- of Justice, Office of Justice Programs, Federal Probation 58(2):29–33. volved with alcohol and other Office of Juvenile Justice and Delin- drugs may not be discovered and Bigelow, G.E. 1995. President’s com- quency Prevention. opportunities for intervention may ments: Behavior science is fundamen- Del Carmen, R.V., and Sorensen, J.R. be lost. tal to drug abuse research and treat- 1988. Legal issues in drug testing ment. In Problems of Drug Dependence probationers and parolees. Federal 1994: Proceedings of the 56th Annual Sci- References Probation 52:19–27. entific Meeting. The College on Prob- American Correctional Association/ lems of Drug Dependence, Inc. Vol- Doweiko, H.E. 1990. Concepts of Chemi- Institute for Behavior and Health, Inc. ume I. NIDA Research Monograph cal Dependency. Pacific Grove, CA: (ACA/IBH). 1991a. Drug Testing in 152. Rockville, MD: U.S. Department Brooks/Cole Publishing Company. Juvenile Detention Centers: Current of Health and Human Services, Na- Elbert, M.J. 1997. The use of creatinine Practice and Future Directions. Litera- tional Institute on Drug Abuse. ture Review, Prototype Drug Testing and specific gravity measurement to Program, and Sample Policies and Brooks, M.K. 1990. Legal Issues for Al- combat urine test dilution. Federal Procedures. Laurel, MD: American cohol and Other Drug-Use Prevention Probation 61(4):3–10. and Treatment Programs Serving High- Correctional Association. Institute of Medicine. 1990. Treating Risk Youth. OSAP Technical Report–2. Drug Problems. Volume I. Washington, American Correctional Association/ Rockville, MD: U.S. Department of DC: National Academy Press. Institute for Behavior and Health, Inc. Health and Human Services, Alcohol, (ACA/IBH). 1991b. Drug Testing of Drug Abuse, and Mental Health Ad- Jackson, K., and Borrowman, S. 1998. Juvenile Detainees. Monograph. ministration, Office for Substance Technology for drug testing. Audio Laurel, MD: American Correctional Abuse Prevention. Teleconference. Lexington, KY: Ameri- Association. can Probation and Parole Association. Clark, R.A. 1993. OSHA Standard on American Correctional Association/ Occupational Exposure to Bloodborne Maloney, D., Romig, D., and Armstrong, Institute for Behavior and Health, Inc. Pathogens. OSHA Standards and T. 1988. Juvenile probation: The bal- (ACA/IBH). 1995. Testing Juvenile De- Compliance Letters. Washington, anced approach. Juvenile and Family tainees for Illegal Drug Use. Final Re- DC: U.S. Department of Labor, Court Journal 39(3). port. Laurel, MD: American Correc- Occupational Safety and Health Mattingly, M. 1998. OJJDP Deputy tional Association. Administration. Administrator John Wilson highlights American Probation and Parole As- Council on Scientific Affairs. 1987. agency positions. Juvenile Justice Update sociation (APPA). 1992. Drug Testing Scientific issues in drug testing. Jour- 4(2):1, 12–15. Guidelines and Practices for Juvenile nal of the American Medical Association Mieczkowski, T. 1995. Hair Analysis Probation and Parole Agencies. Wash- 257(22):3112. ington, DC: U.S. Department of as a Drug Detector. NIJ Research in Justice, Office of Justice Programs, Crowe, A.H. 1998. Drug Identifica- Brief. Washington, DC: U.S. Depart- Office of Juvenile Justice and Delin- tion and Testing in the Juvenile Justice ment of Justice, Office of Justice Pro- quency Prevention. System. Summary. Washington, DC: grams, National Institute of Justice.

24 Mieczkowski, T. 1997. Hair Assays and Substance Abuse and Mental Health Mieczkowski, T. 1997. Hair Assays and Urinalysis Results for Juvenile Drug Of- Services Administration. Urinalysis Results for Juvenile Drug Of- fenders. Research Preview. Washington, fenders. Research Preview. Washing- Update: Universal precautions for pre- DC: U.S. Department of Justice, Office ton, DC: U.S. Department of Justice, vention of transmission of human im- of Justice Programs, National Institute Office of Justice Programs, National munodeficiency virus, hepatitis b virus, of Justice. Institute of Justice. and other bloodborne pathogens in Mieczkowski, T., and Lersch, K. 1997. health care settings. 1988 (June 24). Pretrial Services Resource Center. 1998. Drug testing in criminal justice: Evolv- Morbidity and Mortality Weekly Report Pretrial Drug Testing: Overview of Issues ing uses, emerging technologies. Na- 37(24):377–382, 387–388. and Practices. Washington, DC: Pretrial tional Institute of Justice Journal 234:9–15. Services Resource Center. Visher, C., and McFadden, K. 1991. A Milgram, G.G. 1990. The Facts About Comparison of Urinalysis Technologies Robinson, J.J., and Cargain, M.J. 1998. Drinking. New York, NY: Consumers for Drug Testing in Criminal Justice. Re- Criminal justice drug testing: Burgeon- Union. search in Action. Washington, DC: U.S. ing technology in applications for the Department of Justice, Office of Justice future. Journal of Offender Monitoring Office of National Drug Control Policy. Programs, National Institute of Justice. 11(4):21–23. 1990. Understanding Drug Treatment. White Paper. Washington, DC: Office of National Drug Control Policy. For Further Information Substance Abuse Treatment The Center for Substance Abuse Treat- Pretrial Services Resource Center. Suggested Readings ment publishes numerous protocols 1989. Estimating the Costs of Drug Test- and technical assistance materials on ing for a Pretrial Services Program. Drug Testing substance abuse treatment. All are free Washington, DC: U.S. Department The following publications offer addi- of charge and available from: of Justice, Office of Justice Programs, tional information on drug testing Bureau of Justice Assistance. National Clearinghouse for Alcohol strategies and procedures. and Drug Information (NCADI) Pretrial Services Resource Center. 1998. P.O. Box 2345 Pretrial Drug Testing: Overview of Issues American Probation and Parole As- sociation. 1992. Drug Testing Guide- Rockville, MD 20857–2345 and Practices. Washington, DC: Pretrial lines and Practices for Juvenile Proba- 800–729–6686 Services Resource Center. tion and Parole Agencies. Washington, The following publications may be or- Robinson, J.J., and Cargain, M.J. 1998. DC: U.S. Department of Justice, Of- dered from NCADI by title and number: Criminal justice drug testing: Burgeon- fice of Justice Programs, Office of ing technology in applications for the Juvenile Justice and Delinquency Assessment and Treatment of Patients future. Journal of Offender Monitoring Prevention. with Coexisting Mental Illness and Alco- 11(4):21–23. hol and Other Drug Abuse (BKD134) Crowe, A.H. 1998. Drug Identification Substance Abuse and Mental Health and Testing in the Juvenile Justice System Combining Alcohol and Other Drug Services Administration (SAMHSA). Summary. Washington, DC: U.S. De- Abuse Treatment with Diversion for Ju- 1998a. Mandatory Guidelines for Fed- partment of Justice, Office of Justice veniles in the Justice System (BKD169) eral Workplace Drug Testing Programs. Programs, Office of Juvenile Justice Comprehensive Case Management for Washington, DC: U.S. Department of and Delinquency Prevention. Substance Abuse Treatment (BKD251) Health and Human Services, Office Crowe, A.H., and Schaefer, P. J. 1992. of Applied Studies, Substance Detoxification from Alcohol and Other Identifying and Intervening with Drug- Abuse and Mental Health Services Drugs (BKD172) Involved Youth. Lexington, KY: Ameri- Administration. can Probation and Parole Association. Juvenile Justice Treatment Planning Substance Abuse and Mental Health Chart (PHD 598) Del Carmen, R.V., and Sorensen, J.R. Services Administration (SAMHSA). 1988. Legal issues in drug testing Guidelines for the Treatment of Alcohol 1998b. Preliminary Results From the Federal and Other Drug Abusing Adolescents 1997 National Household Survey on probationers and parolees. Probation 52:19–27. (BKD109) Drug Abuse. Rockville, MD: U.S. De- partment of Health and Human Principles of Drug Addiction Treatment: Services, Office of Applied Studies, A Research-Based Guide (BKD347)

25 The Role and Current Status of Patient Drug Information Hotline National Institute on Drug Abuse Placement Criteria in the Treatment 800–662–4357 National Institutes of Health of Substance Use Disorders (BKD161) 6001 Executive Boulevard, Juvenile Justice Clearinghouse Room 5213 Screening and Assessment of Alcohol 800–638–8736 Bethesda, MD 20892 and Other Drug Abusing Adolescents Legal Action Center 301–443–1124 (BKD108) 153 Waverly Place, Eighth Floor National Juvenile Detention Simple Screening Instruments for Out- New York, NY 10014 Association reach for Alcohol and Other Drug Abuse 212–243–1313 Eastern Kentucky University and Infectious Diseases (BKD143) National Association of Drug 217 Perkins Building Substance Abuse Treatment Planning Court Professionals Richmond, KY 40475–3127 Guide and Checklist for Treatment-Based 901 North Pitt Street, Suite 300 606–622–6264 Drug Courts (SMA 97–3136) Alexandria, VA 22314 National Treatment Accountability 703–706–0576 for Safer Communities 703–706–0565 (fax) Organizations 1911 North Fort Meyer Drive, American Correctional Association National Association of Suite 900 4380 Forbes Boulevard State Alcohol and Drug Arlington, VA 22209 Lanham, MD 20706–4322 Abuse Directors 703–522–7212 301–918–1800 444 North Capitol Street NW. 703–741–7698 (fax) 301–918–1900 (fax) Suite 642 Office of Justice Programs Washington, DC 20001 American Probation and Parole Drug Court Clearinghouse 202–783–6868 Association and Technical Assistance Project Juvenile Drug Testing Project National Center for American University P.O. Box 11910 Juvenile Justice Brandywine 660 Lexington, KY 40578–1910 701 Forbes Avenue 4400 Massachusetts Avenue NW. 606–244–8192 Pittsburgh, PA 15219–3000 Washington, DC 20016–8159 606–244–8001 (fax) 412–227–6950 202–885–2875 412–227–6955 (fax) 202–885–2885 (fax) Center for Substance Abuse Treatment National Center on Office of Juvenile Justice and Substance Abuse and Mental Health Addiction and Substance Abuse Delinquency Prevention Services Administration 152 West 57th Street U.S. Department of Justice 5600 Fishers Lane, Rockwall II New York, NY 10019 Office of Justice Programs Rockville, MD 20857 212–841–5200 810 Seventh Street NW. 301–443–2467 212–956–8020 (fax) Washington, DC 20531 301–443–3543 (fax) 202–307–5911 National Clearinghouse for Alcohol Centers for Disease Control and Drug Information Pretrial Services Agency and Prevention P.O. Box 2345 District of Columbia U.S. Department of Health Rockville, MD 20847–2345 Superior Court and Human Services 800–729–6686 400 F Street NW., 1600 Clifton Road NE. 301–468–6433 (fax) Suite 310 Atlanta, GA 30333 Washington, DC 20001 National Institute on Alcohol Abuse 770–488–5292 202–727–2911 and Alcoholism 202–727–9852 (fax) Drug Courts Program Office 6000 Executive Boulevard, Wilco U.S. Department of Justice Building Office of Justice Programs Bethesda, MD 20892–7003 810 Seventh Street NW. 301–443–3860 Washington, DC 20531 202–616–5001 202–514–6452 (fax)

26 Points of view or opinions expressed in this document are those of the authors and do Share With Your Colleagues not necessarily represent the official position or policies of OJJDP or the U.S. Department Unless otherwise noted, OJJDP publications are not copyright protected. of Justice. We encourage you to reproduce this document, share it with your col- leagues, and reprint it in your newsletter or journal. However, if you reprint, The Office of Juvenile Justice and Delin- please cite OJJDP and the authors of this Bulletin. We are also interested in quency Prevention is a component of the Of- your feedback, such as how you received a copy, how you intend to use the fice of Justice Programs, which also includes information, and how OJJDP materials meet your individual or agency the Bureau of Justice Assistance, the Bureau of Justice Statistics, the National Institute of needs. Please direct your comments and questions to: Justice, and the Office for Victims of Crime. Juvenile Justice Clearinghouse Publication Reprint/Feedback Acknowledgments P.O. Box 6000 Rockville, MD 20849–6000 Ann H. Crowe and Linda Sydney 800–638–8736 are Research Associates at the 301–519–5600 (fax) American Probation and Parole E-Mail: [email protected] Association.

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