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Adolescent Treatment Effectiveness What we have learned (so far) Michael Dennis, Ph.D. Chestnut Health Systems, Normal, IL Presentation at the Substance.

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Presentation on theme: "Adolescent Treatment Effectiveness What we have learned (so far) Michael Dennis, Ph.D. Chestnut Health Systems, Normal, IL Presentation at the Substance."— Presentation transcript:

1 Adolescent Treatment Effectiveness What we have learned (so far) Michael Dennis, Ph.D. Chestnut Health Systems, Normal, IL Presentation at the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment May 25, 2011, Rockville, MD

2 Goals To take stock of how far we have come as a field, particularly in the last few years To identify reoccurring themes that represent what we have learn (so far) To focus on the road ahead

3 Early Early Adolescent Treatment Work Source: Dennis, M.L., Dawud-Noursi, S., Muck, R., & McDermeit, M. (2003) Worth Street Narcotic Clinic in NY – 743 youth Federal Narcotic Farms in Lexington, KY & Fort Worth, TX 440/yr Riverside Hospital in NYC – 250 youth Teen Addiction Hospital Wards in several cities Drug Abuse Reporting Program (DARP)- 5,405 youth (587 followed) Treatment Outcome Prospective Study (TOPS)-1042 youth (256 followed) Services Research Outcome Study (SROS) youth National Treatment Improvement Evaluation Study (NTIES) youth Drug Abuse Treatment Outcome Study of Adolescents (DATOS-A) - 3,382 youth (1,785 followed)

4 What these early studies taught us Treatment of adolescents with adult models and/or mixed with adults does not work and is actually associated with drop out and increased use Need to modify models to be more developmentally appropriate for youth Need for assess and treat a wider range of problems including victimization, co-occurring mental health and education needs Need to modify materials to be more concrete and use examples relevant to youth

5 Major limits through 1997 Lack of standardized and evidenced based assessment and treatment limited the reliability of what was done Participation, treatment completion, and followup rates were often low limiting the validity of what could be learned The lack of any manualized evidenced based adolescent approaches limited the ability to disseminate and replicate what did work Difficult for clinicians, evaluators and/or researchers to work together or even enter the field

6 6 CSATs 10+ Year Investment in Improving Adolescent Treatment Effectiveness , Cannabis Youth Treatment (CYT) – 600 youth , Adolescent Treatment Models (ATM) youth , CSAT/NIAAA experiments – several hundred youth , Persistent Effects of Treatment Study of Adolescents (PETS-A) youth , CSAT/RWJF Reclaiming Futures, 445 youth , Strengthening Communities for Youth (SCY) – 2,249 youth , Targeted Capacity Expansion (TCE) – 1,417 youth , Adolescent Residential Treatment (ART) – 1,458 youth , Effective Adolescent Treatment (EAT) – 5,854 youth , Co-occurring State Infrastructure Grants (COSIG) -system , Young Offender Re-entry Program (YORP) – 1,597 youth , State Adolescent Coordinator (SAC) -system , Juvenile Treatment Drug Court (JTDC) – 1,678 youth , Adolescent Assertive Family Tx (AAFT)-2,769 youth , Brief Interventions and Referrals to Treatment (BIRT) and other Office of Juvenile Justice and Delinquency Prevention and Robert Woods Johnson Foundation (OJJDP/RWJF)- 315 youth Currently working to extend work in collaboration with CSAP, ED, DOL, HRSA, and OJJDP

7 Big Changes Over 80% participation, use of evidenced based assessment, use of evidenced based intervention, and follow-up Have pooled data from 21,531 adolescents (12-17), 3,153 young adults (18-25) and 1,695 adults (26+) assessed with the Global Appraisal of Individual Needs (GAIN), including 88% with one more follow-up Data made available for program evaluation and secondary analysis, and helped to generate over 200 publications Have supported the creation and evaluation of over 20 adolescent treatment manuals Several System level grants

8 Big Changes - Continued Funded large scale replications of three major evidenced based practices – Motivational Enhancement Therapy/ Cognitive Behavior Therapy (MET/CBT) in the 36 site EAT program and multiple independent grants – Adolescent Community Reinforcement Approach (A-CRA) and Assertive Continuing Care (ACC) in the 78 Site AAFT program and multiple independent grants Also funded multiple state and independent grants to replicate other evidenced based practices including – Family Support Network (FSN) – Motivational Interviewing – Multidimensional Family Therapy (MDFT) – Multi-Systemic Therapy (MST) – Seven Challenges (7C)

9 9 CSAT Sites with adolescent clients and included in the 2009 Summary Analytic GAIN Data Set AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY PR VI JTDC OJJDP ATM TCE AAFT CYT ART EAT OJJDP-BIRT SCY YORP

10 10 Demographic Characteristics *Any Hispanic ethnicity separate from race group CSAT data is diverse with large numbers of females minorities, and younger adolescents Sources: CSAT 2009 SA data set Adolescent Subset (n=19,145).

11 11 Youth are involved in multiple systems placing competing demands on them and potentially in conflict with each other Source: CSAT 2009 SA Data Set Adolescent Subset (n=19,108)

12 12 Multiple Clinical Problems are the NORM! Source: CSAT 2009 Summary Analytic Data Set (n=20,826)

13 13 The Number of Clinical Problems is related to Level of Care Source: CSAT 2009 Summary Analytic Data Set (n=21,332) Significantly more likely to have 5+ problems (OR=5.8)

14 14 The Number of Major Clinical Problems is highly related to Victimization Source: CSAT 2009 Summary Analytic Data Set (n=21,784) Significantly more likely to have 5+ problems (OR=13.9)

15 15 Past 90 day HIV Risk Behaviors are more Related to Sexual Activity than Needle Use *Based on 1+ times had sex while intoxicated, with an injection drug user, with a man who had sex with men, with someone who was HIV positive, or traded sex for goods (n=415) Source: CSAT 2009 SA Data Set Adolescent Subset (n=18,674) Also important to recognize the role of interpersonal violence as a HIV risk factor – particularly for girls

16 Individual Strengths Doing well at close friends Listening, caring or comm. w/ others Sports, exercise, physical activity Doing well at with your family Problem solving and figuring things out Drawing, painting, design or other art Doing well at school or training Working or playing with computers Music, dancing, acting, other perf. art Doing well at work Source: SAMHSA/CSAT 2009 adolescent data set (n=6,681)

17 Sources of Social Support Doing well at close friends Listening, caring or comm. w/ others Sports, exercise, physical activity Doing well at with your family Problem solving and figuring things out Drawing, painting, design or other art Doing well at school or training Working or playing with computers Music, dancing, acting, other perf. art Source: SAMHSA/CSAT 2009 adolescent data set (n=6,681)

18 18 Potential Mentors in the Recovery Environment Home School or Work Social Peers Source: SAMHSA/CSAT 2009 adolescent data set (n=6,681)

19 Major Predictors of Bigger Effects Found in Multiple Meta Analyses (Lipsey, 1997, 2005 ) 1.A strong intervention protocol based on prior evidence 2.Quality assurance to ensure protocol adherence and project implementation 3.Proactive case supervision of individual 4.Triage to focus on the highest severity subgroup

20 Impact of the numbers of these Favorable features on Recidivism in 509 Juvenile Justice Studies in Lipsey Meta Analysis Source: Adapted from Lipsey, 1997, 2005 Average Practice The more features, the lower the recidivism

21 Evidenced Based Treatment (EBT) that Typically do Better than Usual Practice in Reducing Juvenile Use & Recidivism Adolescent Community Reinforcement Approach (A- CRA) Aggression Replacement Training (ART) Assertive Continuing Care (ACC) Cognitive Behavior Therapy (CBT) Functional Family Therapy (FFT) Moral Reconation Therapy (MRT) Thinking for a Change (TFC) Interpersonal Social Problem Solving (ISPS) Motivational Interviewing (MI) Source: Adapted from Lipsey et al 2001, 2010; Waldron et al, 2001, Dennis et al, 2004

22 Evidenced Based Treatment (EBT) that Typically do Better than Usual Practice in Reducing Juvenile Use & Recidivism Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT) Multi Systemic Therapy (MST) Multidimensional Family Therapy (MDFT) Reasoning & Rehabilitation (RR) Seven Challenges (7C) Source: Adapted from Lipsey et al 2001, 2010; Waldron et al, 2001, Dennis et al, 2004 No evidence of an iatrogenic effect of group treatment Small or no differences in mean effect size between these brand names

23 Other Common Findings Low structure and ad hoc treatment as usual does not do as well as evidenced based practice Wilderness programs have mixed effects Treating adolescents like adults and in boot camp causes harm on average Relapse is still common and there is a need for on- going support, monitoring and when necessary re- intervention

24 Similarity of Clinical Outcomes : Cannabis Youth Treatment (CYT) Source: Dennis et al., Total days abstinent. over 12 months 0% 10% 20% 30% 40% 50% Percent in Recovery. at Month 12 Total Days Abstinent* Percent in Recovery** MET/ CBT5 (n=102) MET/ CBT12 FSN (n=102) MET/ CBT5 (n=99) ACRA (n=100) MDFT (n=99) Trial 1 Trial 2 * n.s.d., effect size f=0.06 ** n.s.d., effect size f=0.12 * n.s.d., effect size f=0.06 ** n.s.d., effect size f=0.16 Not significantly different by condition. But better than the average for OP in ATM (200 days of abstinence)

25 Moderate to large differences in Cost-Effectiveness by Condition Source: Dennis et al., 2004 $0 $4 $8 $12 $16 $20 Cost per day of abstinence over 12 months $0 $4,000 $8,000 $12,000 $16,000 $20,000 Cost per person in recovery at month 12 CPDA* $4.91 $6.15 $15.13 $9.00 $6.62 $10.38 CPPR** $3,958 $7,377 $15,116 $6,611 $4,460 $11,775 MET/ CBT5 MET/ CBT12 FSN MET/ CBT5 ACRA MDFT * p<.05 effect size f=0.48 ** p<.05, effect size f=0.72 Trial 1 Trial 2 * p<.05 effect size f=0.22 ** p<.05, effect size f=0.78 MET/CBT5 and 12 did better than FSN ACRA did better than MET/CBT5, and both did better than MDFT Suggest the need to consider cost-effectiveness of treatment approaches

26 Implementation is Essential (Reduction in Recidivism from.50 Control Group Rate) The effect of a well implemented weak program is as big as a strong program implemented poorly The best is to have a strong program implemented well Thus one should optimally pick the strongest intervention that one can implement well Source: Adapted from Lipsey, 1997, 2005

27 27 Change in Abstinence by level of Quality Assurance: Adolescent Community Reinforcement Approach (A-CRA) Source: CSAT 2008 SA Dataset subset to 6 Month Follow up (n=1,961) Effects associated with Coaching, Certification and Monitoring (OR=7.6)

28 Which general approaches address co- occurring mental health/trauma issues? Nine Treatment Outpatient Approaches Seven Challenges (Schwebel, 2004) (n=114) Chestnut Health Systems (CHS; Godley et al. 2002) Treatment (n=192) Adolescent Community Reinforcement Approach (A-CRA; Godley et al., 2001) -CYT/AAFT (n=2144) and -Other (n=276) Multi-Systemic Therapy (MST; Henggeler et al., 1998) (n=85) Multi-Dimensional Family Therapy (MDFT; Liddle, 2002) (n=258) Motivational Enhancement Therapy-Cognitive Behavior Therapy (METCBT; Sampl & Kadden, 2001)-CYT/EAT (n=5262) and -Other (n=878) Family Support Network (FSN; Hamilton et al., 2001) (n=369) 28

29 Two sets of outcomes Mental Health Emotional Problems Scale Days of Victimization Days of Traumatic Memories Other Outcomes Substance Problems Scale Substance Frequency Scale Illegal Activities Scale HIV Risk Change Index Average Across 29

30 Change (post-pre) Effect Size for Emotional Problems by Type of Treatment Four best on mental health outcomes include 7 challenges, CHS, A-CRA, & MST

31 Change (post-pre) Effect Size for Core Treatment Outcomes by Type of Treatment Four best on treatment outcomes include A-CRA, MST, MDFT, & FSN

32 Findings All programs reduced mental health / trauma problems with 4 doing particularly well: 7 challenges, CHS, A-CRA, & MST All programs reduced general outcomes on average, with 4 doing particularly well: A-CRA, MST, MDFT, FSN – All more assertive/family/systemic programs – All have formal training, quality assurance, monitoring & technical assistance Where we could break in two (A-CRA & MET/CBT), programs with more training, quality assurance, monitoring and technical assistance did better than those with less A-CRA with a mix of BA/MA did as well as MST which targets MA level therapists and family therapists that are often in short supply While it is not as effective, the shortest & least expensive (MET/CBT5) still has positive effects CSAT Funding large scale dissemination of A-CRA and MET/CBT 32

33 Adolescents Have Complex Pathways to Recovery In the Community Using (60% stable) In Treatment (45% stable) In Recovery (61% stable) Incarcerated (41% stable) Source: 2009 CSAT AT data set; unique n = 11,710 Avg of 48% change status each quarter 18% 16% 22% 17% 27% 14% 17% 24% 21% 9 % 4%4% 4%4% Treatment is the most likely path to recovery What predicts who enters and maintains recovery? Change occurs in ever possible direction

34 Risk and Protective Factors Associated with Transitioning to/Remaining in Recovery Risk Factors – Older – Male – Caucasian – Substance Problems – Substance Frequency – Repeated Treatment – Mental Health Problems – Illegal Activity – Employment Protective Factors – Younger – Female – Racial Minority – Recent Treatment – Number of Drug Screens – Attend 12 Step Meetings – Positive Social Peers – Positive Recovery Environment – School Attendance/ Conduct Source: 2009 CSAT Adolescent Treatment Dataset

35 Recovery* by Level of Care Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. Percentages in parentheses are the treatment outcome (intake to 12 month change) and the stability of the outcomes (3months to 12 month change) Source: CSAT Adolescent Treatment Outcome Data Set (n-9,276) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pre-IntakeMon 1-3Mon 4-6Mon 7-9Mon Percent in Past Month Recovery* Outpatient (+79%, -1%) Residential(+143%, +17%) Post Corr/Res (+220%, +18%) OP & Resid Similar CC better

36 Time to Enter Continuing Care and Relapse after Residential Treatment (Age 12-17) Source: Godley et al., 2004 for relapse and 2000 Statewide Illinois DARTS data for CC admissions 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Days after Residential (capped at 90) Percent of Clients Cont. Care Admis. Relapse

37 Assertive Continuing Care (ACC) can Improved General Aftercare Adherence Source: Godley et al 2002, % 10% 20% 30% 40%50%60%70%80% WeeklyTx Weekly 12 step meetings Regular urine tests Contact w/probation/school Follow up on referrals* ACC * p<.05 90% 100% Relapse prevention* Communication skills training* Problem solving component* Meet with parents 1-2x month* Weekly telephone contact* Referrals to other services* Discuss probation/school compliance* Adherence: Meets 7/12 criteria* UCC

38 High GCCA Improves Early (0-3 mon.) Abstinence Source: Godley et al 2002, % 36% 38% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Any AOD (OR=2.16*)Alcohol (OR=1.94*) Marijuana (OR=1.98*) Low (0-6/12) GCCA 43% 55% High (7-12/12) GCCA * p<.05

39 Percent of Days Abstinent from AOD in Offender Re-entry Programs by Age Source: CSAT 2010 SA Horizontal, YORP and ORP studies only (N = 2,966) Limit of current GPRA, starts measurement at release and does not control for or even measure time in a controlled environment

40 Comparison of Treatment Outcomes: Adolescent Outpatient (AOP) vs. Juvenile Treatment Drug Court (JTDC) Source: Ives et al., in press *p<.05 change greater for JTDC vs AOP (d=-0.24) Substance Use* ( d=-0.45, -0.57) Emotional Problems (d=-0.32, -0.22) Trouble w/ Family (d= -0.23, -0.18) In Controlled Environment (d=-0.02, -0.08) Illegal Activity (d=-0.11, -0.02) Post- Pre d (AOP, JTDC) JTDC Reduced Use More than AOP (d between= -0.24) Others Outcomes Not Significantly Different

41 Outcome Data has also been used to make comparison groups for GPRA, NOMS and other outcomes by gender, race, age, level of care, type of evidenced based practice, and program CYT interventions vs. regular outpatient treatment Post residential treatment recovery support services vs. aftercare as usual Opioid Users vs. Alcohol/Marijuana Users Transitional Age Youth vs. adolescents & adults Impact of experience and certification on GAIN quality Deaf and hard of hearing vs. hearing Gender, Race and Ethnicity differences in the response to A-CRA

42 Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 Cost of Substance Abuse Treatment Episode $22,000 / year to incarcerate an adult $30,000/ child-year in foster care $70,000/year to keep a child in detention $750 per night in Detox $1,115 per night in hospital $13,000 per week in intensive care for premature baby $27,000 per robbery $67,000 per assault Many SBIRT, School, Workplace and other early intervention programs focus on brief intervention

43 Quarterly Costs to Society* associated with higher intensity of justice system involvement Source: SAMHSA/CSAT 2009 adolescent data set (n=17,335) in 2009 dollars

44 Investing in Treatment has a Positive Annual Return on Investment (ROI) Substance abuse treatment has been shown to have a ROI of between $1.28 to $7.26 per dollar invested Treatment drug courts have an average ROI of $2.14 to $2.71 per dollar invested Source: Bhati et al., (2008); Ettner et al., (2006) This also means that for every dollar treatment is cut, we lose more money than we saved.

45 SAMHSA/CSATs Adolescent Clients Data were pooled on clients from 148 local evaluations, recruited between 1997 to 2009 and followed quarterly for 6 to 12 months (over 80% completion). In 2009 dollars, the 16,915 adolescents averaged $3,908 in costs to taxpayers in the 90 days before intake ($15,633 in the year before intake). This would be $3.9 Million per 1,000 adolescents served. Within 12 months, the cost of treatment provided by CSAT grantees was offset by reductions in other costs producing a net benefit to taxpayers of $4,592 per adolescent.

46 Economic Benefit to Society of SAMHSA/CSAT Funded Treatment by Level of Care Adolescent Level of Care Year before intake Year after Intake a One Year Savings b Outpatient $10,993 $10,433 $560 Intensive Outpatient $20,745 $15,064 $5,682 Outpatient Continuing Care $34,323 $17,000 $17,323 Long Term Residential $27,489 $26,656 $833 Short Term Residential $25,255 $21,900 $3,355 Total $15,633 $13,642 $1,992 \a Includes the cost of treatment \b Year after intake (including treatment) - year before treatment

47 In practice we need a Continuum of Measurement (Common Measures) Screening to Identify Who Needs to be Assessed (5-10 min) – Focus on brevity, simplicity for administration & scoring – Needs to be adequate for triage and referral – GAIN Short Screener for SUD, MH & Crime – ASSIST, AUDIT, CAGE, CRAFT, DAST, MAST for SUD – SCL, HSCL, BSI, CANS for Mental Health – LSI, MAYSI, YLS for Crime Quick Assessment for Targeted Referral (20-30 min) – Assessment of who needs a feedback, brief intervention or referral for more specialized assessment or treatment – Needs to be adequate for brief intervention – GAIN Quick – ADI, ASI, SASSI, T-ASI, MINI Comprehensive Biopsychosocial (1-2 hours) – Used to identify common problems and how they are interrelated – Needs to be adequate for diagnosis, treatment planning and placement of common problems – GAIN Initial (Clinical Core and Full) – CASI, A-CASI, MATE Specialized Assessment (additional time per area) – Additional assessment by a specialist (e.g., psychiatrist, MD, nurse, spec ed) may be needed to rule out a diagnosis or develop a treatment plan or individual education plan – CIDI, DISC, KSADS, PDI, SCAN Screener Quick Comprehensive Special More Extensive / Longer/ Expensive

48 Longer assessments identify more areas to address in treatment planning Source: Reclaiming Futures Portland, OR and Santa Cruz, CA sites (n=192) Most substance users have multiple problems 5 min. 20 min 30 min 1-2 hr

49 Source: 2008 CSAT AAFT Summary Analytic Dataset 553/771=72% unmet need 218/224=97% to targeted 771/982=79% in need Importance of Targeting on Performance Measures Size of the Problem Extent to which services are currently being targeted Extent to which services are not reaching those in most need Treatment Received in the first 3 months Mental Health Need at Intake No/LowMod/HighTotal Any Treatment No Treatment Total

50 Mental Health Problem (at intake) vs. Any MH Treatment by 3 months Source: 2008 CSAT AAFT Summary Analytic Dataset

51 Why Do We Care About Unmet Need? If we subset to those in need, getting mental health services predicts reduced mental health problems Both psychosocial and medication interventions are associated with reduced problems If we subset to those NOT in need, getting mental health services does NOT predict change in mental health problems Conversely, we also care about services being poorly targeted to those in need.

52 Residential Treatment need (at intake) vs. 7+ Residential days at 3 months Opportunity to redirect existing funds through better targeting Source: 2008 CSAT AAFT Summary Analytic Dataset

53 AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY CSAT 2010 SAMHSA/CSAT Grantee Data Set (185 sites) 23 Programs 185 Sites 26,390 clients PR VI

54 AK AL AR AZ CA CO DC FL GA HI IA ID IL IN KS KY LA ME MI MN MO MS MT NC ND NE NH NM NV NY OH OK OR PA SC SD TN TX UT VA VT WA WI WV WY CSATOther 2011 Expanded Data Set (2010 CSAT Other Sites) 50 Programs 305 Sites 58,934 clients PR VI CT DE MA MD NJ RI

55 2011 Expanded Data Set Age (N=34,627) (N=8,746) 26+ (N=14,805) Total (N=58,934) Female28%38%45%34% Minority58%44%45%52% Prior Treatment29%49%66%42% First use under 1582%59%46%69% Ever Homeless10%28%44%21% Any Victimization52%63%68%6% Veteran0%1%6%2%

56 More in BZ, CA, CN, JP, MX ID IL MO ND VI ME OK PR SD AR KS MS MT NM WV IN AL AK IA MN NJ NV RI SC UT HI LA DE NE TN PA VT VA DC MI CO KY GA OH OR MD AZ TX NY NH WI CA NC CT FL MA WA WY No. of GAIN Sites None (Yet) 1 to to to 165 All GAIN Collaborators in the U.S (1700 agencies in 48 states, 6 Canadian provinces and 6 other contries) State or Regional System GAIN Short Screener GAIN Quick GAIN Full 3/10 56

57 Recent Initiatives 2 page GAIN short screener already implemented in a dozen states, translated into 19 languages and spreading fast Using web-based GAIN & ACRA training modules to reduced the duration of off-site training, to provide support for local trainers to train new staff, and to be used in college course to prepare the work force coming out Computer based support for clinical decision making related to diagnosis, treatment planning, and placement using narrative and graphical reports Up grading site profiles to more closely reflect the individual reports so that clinicians and evaluators are speaking the same language GAIN evaluation manual and training to help local evaluators and others interested in secondary analysis use the data at the program or group level Linkage to multiple HIT systems

58 Recent Initiatives (Continued) Monitoring assessment and treatment sessions to measure and improve fidelity Randomized trial of therapist performance incentives to improve implementation/fidelity and client outcomes Expansion of A-CRA/ACC modules targeting trauma and HIV risk behaviors Addition of A-CRA/ACC supervisor training Analysis of health disparities by gender, race, age, pregnancy, and disabilities Multi-cultural training on how to adapt training and assessment to better serve clientele Revisions to GAIN Quick (25-30 min) to better support screening, brief intervention, and referral to treatment in behavioral health settings (e.g., SAP, EAP,DCF, Justice) where there are health, stress, mental health, substance use and crime/violence issues

59 New Initiatives Testing the GAIN Q in school and justice settings Testing ability to recruit, train and certify staff on GAIN & A- CRA with incentives but without SAMHSA/CSAT grants to demonstrate the feasibility of transferring the technology to state and local governments Doing reviews of school based behavioral health intervention research in the literature and in SAMHSA/CSAT demonstrations to understand how they are similar/different from community based adolescent treatment Created a CSAT + non-CSAT analytic file that can be used to better understand the needs of smaller groups (e.g. Emerging adults, Mixed Race, Vets, GLBTQ) Demonstrate the feasibility of using the web-based training modules as part of College Courses to better prepare the work force

60 Potential AOD Screening & Intervention Sites for Adolescents Age 12 to 17 Source: SAMHSA National Survey On Drug Use And Health, 2006 [Computer file] Key potential of School Based Health Clinics being expand under health care reform

61 Why Schools Care Source: SAMHSA National Survey On Drug Use And Health, 2006 [Computer file] Substance use severity is related to family, school and emotional problems

62 Why Society Cares if we fail to help in School Source: SAMHSA National Survey On Drug Use And Health, 2006 [Computer file] Substance use severity is related to crime and violence

63 Evidenced Based Practices You Can Use Now General approaches to adolescent substance abuse treatment at or Guidance for ambulatory/outpatient detoxification at Trauma informed therapy and sucide prevention at and Externalizing disorders medication & practices Tobacco cessation protocols for youth _cessation/index.htm _cessation/index.htm HIV prevention with more focus on sexual risk and interpersonal victimization at or For individual level strengths see For improving customer services

64 Acknowledgement and Contact Information Borrowed slides from earlier presentations by myself, Randy Muck & Doreen Cavanaugh This presentation was supported by analytic runs provided by Chestnut Health Systems for the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) under Contracts , , and C using data provided by the following 152 grantees: TI11317 TI11321 TI11323 TI11324 TI11422 TI11423 TI11424 TI11432 TI11433 TI11871 TI11874 TI11888 TI11892 TI11894 TI13190TI13305 TI13308 TI13313 TI13322 TI13323 TI13344 TI13345 TI13354 TI13356 TI13601 TI14090 TI14188 TI14189 TI14196 TI14252 TI14261 TI14267 TI14271 TI14272 TI14283 TI14311 TI14315 TI14376 TI15413 TI15415 TI15421 TI15433 TI15438 TI15446 TI15447 TI15458 TI15461 TI15466 TI15467 TI15469 TI15475 TI15478 TI15479 TI15481 TI15483 TI15485 TI15486 TI15489 TI15511 TI15514 TI15524 TI15524 TI15527 TI15545 TI15562 TI15577 TI15584 TI15586 TI15670 TI15671 TI15672 TI15674 TI15677 TI15678 TI15682 TI15686 TI16386 TI16400 TI16414 TI16904 TI16928 TI16939 TI16961 TI16984 TI16992 TI17046 TI17070 TI17071 TI17334 TI17433 TI17434 TI17446 TI17475 TI17476 TI17484 TI17486 TI17490 TI17517 TI17523 TI17535 TI17547 TI17589 TI17604 TI17605 TI17638 TI17646 TI17648 TI17673 TI17702 TI17719 TI17724 TI17728 TI17742 TI17744 TI17751 TI17755 TI17761 TI17763 TI17765 TI17769 TI17775 TI17779 TI17786 TI17788 TI17812 TI17817 TI17825 TI17830 TI17831 TI17864 TI18406 TI18587 TI18671 TI18723 TI19313 TI19323 TI Any opinions about this data are those of the authors and do not reflect official positions of the government or individual grantees. Comments or questions can be addressed to Michael Dennis, Chestnut Health Systems, 448 Wylie Drive, Normal, IL Phone ; More information on the GAIN is at or by ing


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