Stigma, SocialNCT05152342
Reducing Stigma Among Individuals With Addiction and Staff in the Criminal Justice System
A study testing Stigma Awareness Training for Legal System Staff and Acceptance and Commitment Therapy for self-stigma in people with Stigma, Social and Behavior, run by East Tennessee State University at 1 site in United States.
Trial summary
Stigma is one of the most pervasive barriers to addiction care in the U.S. criminal justice (CJ) system. However, there have been no stigma reduction interventions developed for this context. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Stigma, Social, Behavior
- What is being tested?
- Stigma Awareness Training for Legal System Staff and Acceptance and Commitment Therapy for self-stigma
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 110 participants
- Where
- 1 siteUnited States
- Study dates
- 30 Sep 2021to 30 Dec 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Any legal system staff (e.g., judges, attorneys, probation officers, treatment staff, support staff) who work with the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS) program in Sullivan, Jefferson, Grainger, Sevier, Monroe, and McMinn counties are eligible to participate in the staff training.
- Clients who have been accepted into the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS) program in Sullivan, Jefferson, Grainger, Sevier, Monroe, and McMinn counties are eligible to participate in the staff training.
Who cannot join
- Staff who have not had contact with TN-ROCS clients in the past 90 days are not eligible.
- Clients who are not accepted into the TN-ROCS program, or who become re-incarcerated are not eligible to participate.
Trial locations and contacts
1 site in 1 country.
United States1 site
East Tennessee State University
Johnson City, Tennessee, 37614
About this study
Official title: Reducing Stigma Among Individuals With Addiction and Staff in the Criminal Justice System: A Pilot Feasibility Trial
Stigma is one of the most pervasive barriers to addiction care in the U.S. criminal justice (CJ) system. However, there have been no stigma reduction interventions developed for this context. This project addresses this gap with a new multi-level stigma intervention, Combatting Stigma to Aid Reentry and Recovery (CSTARR), for justice-involved people with addiction and criminal justice staff. This intervention will be implemented in 6 (mostly rural) counties in TN for clients and staff in the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS) program, which coordinates multiple CJ sectors (i.e., courts, corrections, probation, treatment) to divert and treat people with addiction. This project aims to 1) examine the feasibility, acceptability, and implementation considerations of integrating CSTARR in the TN-ROCS program, and 2) determine whether CSTARR impacts individual, staff, and program-level outcomes. We aim to recruit 25 stakeholders, 80 clients, and 75 staff over the course of this 18-month project to participate in our intervention and evaluation efforts. Staff and clients will be asked to complete online surveys before and after the intervention, as well as 1- and 3-month follow ups, for which they will receive gift-cards. The overall goal of this project is to examine the feasibility and utility of stigma reduction efforts in the criminal justice system to determine whether they can help facilitate engagement with evidence-based addiction care and improve client and staff outcomes.
Read the detailed description
Stigma is one of the most pervasive barriers to addiction care in the U.S. criminal justice (CJ) system. Stigmatizing attitudes about addiction, its intersecting conditions (i.e., criminal involvement), and its treatment (i.e., medications for opioid use disorder [MOUD]) are widespread throughout court, corrections, probation, and treatment sectors. These attitudes impact treatment decisions as well as how staff interact with clients. CJ-involved individuals with addiction are aware of this stigma, perceiving negative stereotypes, expecting to be judged, and often feeling ashamed and worthless as a result (i.e., self-stigma). Self-stigma is a robust predictor of treatment avoidance, non-compliance, and dropout in many stigmatized groups, including people with addiction and CJ involvement, making this a critical treatment barrier. Despite the negative consequences of stigma in the CJ system, there are virtually no stigma reduction interventions in this context. Given that the CJ system provides a substantial portion of addiction treatment, and untreated addiction increases risk for relapse, re-arrest, overdose, and other negative outcomes, it is essential to address stigma-related barriers to addiction care.
We drew from existing evidence-based interventions to develop a multi-level stigma intervention, Combatting Stigma to Aid Re-entry and Recovery (CSTARR), that simultaneously targets CJ staff attitudes as well as CJ-involved individuals' ability to cope with stigma in separate client and staff interventions. The staff intervention involves a half-day Stigma Awareness Training, and the client intervention involves a three-session Acceptance and Commitment Therapy for self-stigma group that was adapted to address criminal involvement in addition to addiction stigma. We will deliver both interventions virtually in 6 (primarily rural) Tennessee counties that contain infrastructure called the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS). TN-ROCS coordinates multiple CJ sectors (i.e., courts, corrections, probation, treatment) to divert and treat people with addiction, thus presenting a unique unified system to intervene with stigma at both client and staff levels. Also, select TN-ROCS counties are integrating MOUD services, providing an opportunity to reduce stigma that may ultimately impact MOUD engagement. This project aims to 1) examine the feasibility, acceptability, and implementation considerations of integrating CSTARR in the TN-ROCS program, and 2) determine whether CSTARR impacts individual, staff, and program-level outcomes.
We aim to recruit 25 stakeholders, 80 clients, and 75 staff over the course of this 18-month project to participate in our intervention and evaluation efforts. Staff and clients will be asked to complete online surveys before and after the intervention, as well as 1- and 3-month follow ups, for which they will receive gift-cards. The overall goal of this project is to examine the feasibility and utility of stigma reduction efforts in the criminal justice system to determine whether they can help facilitate engagement with evidence-based addiction care and improve client and staff outcomes.
- Conditions
- Stigma, Social, Behavior
- Being tested
- Stigma Awareness Training for Legal System Staff, Acceptance and Commitment Therapy for self-stigma
- Keywords
- stigma reduction, substance use disorder, criminal involvement
- Medical subject headings
- Social Stigma, Behavior, Substance-Related Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Stigma Awareness Training for Legal System StaffBehavioural
Multilevel intervention package addressing stigma associated with substance use and criminal involvement for staff and justice-involved clients enrolled in a diversion treatment program.
Acceptance and Commitment Therapy for self-stigmaBehavioural
Multilevel intervention package addressing stigma associated with substance use and criminal involvement for staff and justice-involved clients enrolled in a diversion treatment program.
| Study group | Role | What they receive |
|---|---|---|
| Staff intervention | Experimental | Half day virtual training for staff focusing on stigma reduction strategies. Receives: Behavioral: Stigma Awareness Training for Legal System Staff |
| Client intervention | Experimental | Three session virtual therapy group for clients focusing on behavioral strategies to cope with stigma. Receives: Behavioral: Acceptance and Commitment Therapy for self-stigma |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Perspectives on Stigma Reduction from Baseline to 3 month follow-up (staff)
24-item internally developed measure that assesses perspectives on stigma and use of stigma reduction strategies among staff, total score ranges from 24 to 216 with higher scores indicating more positive views
Measured: Baseline, 1-day, 1-month, 3-months
Change in Social Distance Scale from Baseline to 3 month follow-up (staff)
5-item adapted measure that assesses desired social distance from people with a criminal and addiction history, total score ranges from 5-25 with higher scores indicating less desired social distance
Measured: Baseline, 1-day, 1-month, 3-months
Change in Difference and Disdain Scale from Baseline to 3 month follow-up (staff)
9-item adapted measure that assesses how staff view people who have substance use problems and criminal involvement, total score ranges from 9-81 with higher scores indicating more differences/disdain
Measured: Baseline, 1-day, 1-month, 3-months
Change in Substance Use Self-Stigma Scale from Baseline to 3 month follow-up (client)
41-item measure that assess how clients view themselves because of their criminal involvement and substance use problems, total score ranges from 41 to 205 with higher scores indicating more self-stigma
Measured: Baseline, 1-day, 1-month, 3-months
Change in Internalized Shame Scale from Baseline to 3 month follow-up (client)
24-item measures that assesses internalized shame, total score ranges from 40-120, with higher scores indicating more internalized shame
Measured: Baseline, 1-day, 1-month, 3-months
Change in Self-efficacy from Baseline to 3 month follow-up (client)
4-item measure that assesses clients' self-efficacy for navigating stigma stressors, total score ranges from 4-40 with higher scores indicating more self-efficacy
Measured: Baseline, 1-day, 1-month, 3-months
Secondary outcomes (4)
Change in Attitudes Toward Prisoners Scale from Baseline to 3 month follow-up (staff)
36-item measure that assesses attitudes, beliefs, and negative stereotypes about people with criminal involvement, total score ranges from 36 to 180 with high scores indicating more stigmatizing attitudes
Measured: Baseline, 1-day, 1-month, 3-months
Change in Dual-Relationship Inventory from Baseline to 3 month follow-up (staff)
9-item measure that assesses how staff view and treat the justice-involved people they oversee, total scores range from 9 to 63 with higher scores indicating better relationships
Measured: Baseline, 1-day, 1-month, 3-months
Change in Treatment Experiences Scale from Baseline to 3 month follow-up (client) from Baseline to 3 month follow-up (client)
13-item adapted measure that assesses how clients feel about their ability to complete treatment, total scores range from 13 to 130 with higher scores indicating more confidence in treatment
Measured: Baseline, 1-day, 1-month, 3-months
Change in Dual-Relationship Inventory from Baseline to 3 month follow-up (client)
9-item adapted measure that assesses how justice-involved clients feel staff view and treat them, total scores range from 9 to 63 with higher scores indicating better relationships
Measured: Baseline, 1-day, 1-month, 3-months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Dec 2021
- Study start30 Sep 2021
- Primary completion30 Dec 2023
- Study completion30 Dec 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Stigma, SocialStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 110 participants (actual)
Sponsor and investigators
- Lead sponsor
- East Tennessee State University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Kelly E. Moore (Schirr), East Tennessee State University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05152342
- Sponsor's protocol ID
- 0721.5sd
- Status last verified
- May 2024
- First submitted
- 5 Nov 2021
- Last updated
- 16 May 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Moore KE, Johnson JE, Luoma JB, Taxman F, Pack R, Corrigan P, Hart J, Slone JD. A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol. Health Justice. 2023 May 15;11(1):24. doi: 10.1186/s40352-023-00224-x.
PubMed 37184615
Study at a glance
From the registry record, last updated by the sponsor on 16 May 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Reducing Stigma Among Individuals With Addiction and Staff in the Criminal Justice System: A Pilot Feasibility Trial
- ClinicalTrials.gov ID
- NCT05152342
- Acronym / sponsor ID
- 0721.5sd
- Conditions
- Stigma, Social, Behavior
- Keywords
- stigma reduction, substance use disorder, criminal involvement
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 110 participants (actual)
- Lead sponsor
- East Tennessee State UniversityUniversity, hospital or other
- Study start
- 30 Sep 2021 (actual)
- Primary completion
- 30 Dec 2023 (actual)
- Study completion
- 30 Dec 2023 (actual)
- First posted
- 9 Dec 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Stigma is one of the most pervasive barriers to addiction care in the U.S. criminal justice (CJ) system. However, there have been no stigma reduction interventions developed for this context. This project addresses this gap with a new multi-level stigma intervention, Combatting Stigma to Aid Reentry and Recovery (CSTARR), for justice-involved people with addiction and criminal justice staff. This intervention will be implemented in 6 (mostly rural) counties in TN for clients and staff in the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS) program, which coordinates multiple CJ sectors (i.e., courts, corrections, probation, treatment) to divert and treat people with addiction. This project aims to 1) examine the feasibility, acceptability, and implementation considerations of integrating CSTARR in the TN-ROCS program, and 2) determine whether CSTARR impacts individual, staff, and program-level outcomes. We aim to recruit 25 stakeholders, 80 clients, and 75 staff over the course of this 18-month project to participate in our intervention and evaluation efforts. Staff and clients will be asked to complete online surveys before and after the intervention, as well as 1- and 3-month follow ups, for which they will receive gift-cards. The overall goal of this project is to examine the feasibility and utility of stigma reduction efforts in the criminal justice system to determine whether they can help facilitate engagement with evidence-based addiction care and improve client and staff outcomes.
Detailed description
Stigma is one of the most pervasive barriers to addiction care in the U.S. criminal justice (CJ) system. Stigmatizing attitudes about addiction, its intersecting conditions (i.e., criminal involvement), and its treatment (i.e., medications for opioid use disorder [MOUD]) are widespread throughout court, corrections, probation, and treatment sectors. These attitudes impact treatment decisions as well as how staff interact with clients. CJ-involved individuals with addiction are aware of this stigma, perceiving negative stereotypes, expecting to be judged, and often feeling ashamed and worthless as a result (i.e., self-stigma). Self-stigma is a robust predictor of treatment avoidance, non-compliance, and dropout in many stigmatized groups, including people with addiction and CJ involvement, making this a critical treatment barrier. Despite the negative consequences of stigma in the CJ system, there are virtually no stigma reduction interventions in this context. Given that the CJ system provides a substantial portion of addiction treatment, and untreated addiction increases risk for relapse, re-arrest, overdose, and other negative outcomes, it is essential to address stigma-related barriers to addiction care.
We drew from existing evidence-based interventions to develop a multi-level stigma intervention, Combatting Stigma to Aid Re-entry and Recovery (CSTARR), that simultaneously targets CJ staff attitudes as well as CJ-involved individuals' ability to cope with stigma in separate client and staff interventions. The staff intervention involves a half-day Stigma Awareness Training, and the client intervention involves a three-session Acceptance and Commitment Therapy for self-stigma group that was adapted to address criminal involvement in addition to addiction stigma. We will deliver both interventions virtually in 6 (primarily rural) Tennessee counties that contain infrastructure called the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS). TN-ROCS coordinates multiple CJ sectors (i.e., courts, corrections, probation, treatment) to divert and treat people with addiction, thus presenting a unique unified system to intervene with stigma at both client and staff levels. Also, select TN-ROCS counties are integrating MOUD services, providing an opportunity to reduce stigma that may ultimately impact MOUD engagement. This project aims to 1) examine the feasibility, acceptability, and implementation considerations of integrating CSTARR in the TN-ROCS program, and 2) determine whether CSTARR impacts individual, staff, and program-level outcomes.
We aim to recruit 25 stakeholders, 80 clients, and 75 staff over the course of this 18-month project to participate in our intervention and evaluation efforts. Staff and clients will be asked to complete online surveys before and after the intervention, as well as 1- and 3-month follow ups, for which they will receive gift-cards. The overall goal of this project is to examine the feasibility and utility of stigma reduction efforts in the criminal justice system to determine whether they can help facilitate engagement with evidence-based addiction care and improve client and staff outcomes.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Staff intervention | Experimental | Behavioral: Stigma Awareness Training for Legal System StaffHalf day virtual training for staff focusing on stigma reduction strategies. |
| Client intervention | Experimental | Behavioral: Acceptance and Commitment Therapy for self-stigmaThree session virtual therapy group for clients focusing on behavioral strategies to cope with stigma. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Any legal system staff (e.g., judges, attorneys, probation officers, treatment staff, support staff) who work with the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS) program in Sullivan, Jefferson, Grainger, Sevier, Monroe, and McMinn counties are eligible to participate in the staff training.
- Clients who have been accepted into the Tennessee Recovery Oriented Compliance Strategy (TN-ROCS) program in Sullivan, Jefferson, Grainger, Sevier, Monroe, and McMinn counties are eligible to participate in the staff training.
Key exclusion criteria (2 listed)
- Staff who have not had contact with TN-ROCS clients in the past 90 days are not eligible.
- Clients who are not accepted into the TN-ROCS program, or who become re-incarcerated are not eligible to participate.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Stigma Awareness Training for Legal System StaffMultilevel intervention package addressing stigma associated with substance use and criminal involvement for staff and justice-involved clients enrolled in a diversion treatment program. | Behavioural | Staff intervention |
| Acceptance and Commitment Therapy for self-stigmaMultilevel intervention package addressing stigma associated with substance use and criminal involvement for staff and justice-involved clients enrolled in a diversion treatment program. | Behavioural | Client intervention |
Primary outcome
Change in Perspectives on Stigma Reduction from Baseline to 3 month follow-up (staff)
Time frame: Baseline, 1-day, 1-month, 3-months
24-item internally developed measure that assesses perspectives on stigma and use of stigma reduction strategies among staff, total score ranges from 24 to 216 with higher scores indicating more positive views
Change in Social Distance Scale from Baseline to 3 month follow-up (staff)
Time frame: Baseline, 1-day, 1-month, 3-months
5-item adapted measure that assesses desired social distance from people with a criminal and addiction history, total score ranges from 5-25 with higher scores indicating less desired social distance
Change in Difference and Disdain Scale from Baseline to 3 month follow-up (staff)
Time frame: Baseline, 1-day, 1-month, 3-months
9-item adapted measure that assesses how staff view people who have substance use problems and criminal involvement, total score ranges from 9-81 with higher scores indicating more differences/disdain
Change in Substance Use Self-Stigma Scale from Baseline to 3 month follow-up (client)
Time frame: Baseline, 1-day, 1-month, 3-months
41-item measure that assess how clients view themselves because of their criminal involvement and substance use problems, total score ranges from 41 to 205 with higher scores indicating more self-stigma
Change in Internalized Shame Scale from Baseline to 3 month follow-up (client)
Time frame: Baseline, 1-day, 1-month, 3-months
24-item measures that assesses internalized shame, total score ranges from 40-120, with higher scores indicating more internalized shame
Change in Self-efficacy from Baseline to 3 month follow-up (client)
Time frame: Baseline, 1-day, 1-month, 3-months
4-item measure that assesses clients' self-efficacy for navigating stigma stressors, total score ranges from 4-40 with higher scores indicating more self-efficacy
4 secondary outcomes
Change in Attitudes Toward Prisoners Scale from Baseline to 3 month follow-up (staff)
Time frame: Baseline, 1-day, 1-month, 3-months
Change in Dual-Relationship Inventory from Baseline to 3 month follow-up (staff)
Time frame: Baseline, 1-day, 1-month, 3-months
Change in Treatment Experiences Scale from Baseline to 3 month follow-up (client) from Baseline to 3 month follow-up (client)
Time frame: Baseline, 1-day, 1-month, 3-months
Change in Dual-Relationship Inventory from Baseline to 3 month follow-up (client)
Time frame: Baseline, 1-day, 1-month, 3-months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 May 2024.
- Derived from this study: PubMed 37184615Moore KE, Johnson JE, Luoma JB, Taxman F, Pack R, Corrigan P, Hart J, Slone JD. A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol. Health Justice. 2023 May 15;11(1):24. doi: 10.1186/s40352-023-00224-x.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Stigma Awareness Training for Legal System Staff and Acceptance and Commitment Therapy for self-stigma in people with Stigma, Social and Behavior, run by East Tennessee State University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 16 May 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Perspectives on Stigma Reduction from Baseline to 3 month follow-up (staff) (time frame: Baseline, 1-day, 1-month, 3-months). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05152342, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 May 2024.