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MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW.

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Presentation on theme: "MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW."— Presentation transcript:

1 MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW

2 MINEOLA COMMUNITY TREATMENT CENTER ADDICTION TREATMENT SERVICES ZUCKER HILLSIDE HOSPITAL NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM Outpatient Substance Abuse Treatment Outpatient Substance Abuse Treatment Serves Adolescents and Adults Serves Adolescents and Adults Medication Mgmt, Groups, Family Tx Medication Mgmt, Groups, Family Tx STAFF: Social Workers, Counselor, Psychiatrists, Teachers, Interns STAFF: Social Workers, Counselor, Psychiatrists, Teachers, Interns Medically supervised Medically supervised OASAS Licensed OASAS Licensed

3 INTENSIVE OUTPATIENT PROGRAM DESCRIPTION Treatment for Teenagers ages 13 – 18 with Substance Abuse, Mental Health and behavioral problems Treatment for Teenagers ages 13 – 18 with Substance Abuse, Mental Health and behavioral problems Clients attend 5 days / week, Monday – Friday, 9:00 AM – 3:00 PM Clients attend 5 days / week, Monday – Friday, 9:00 AM – 3:00 PM Treatment for abuse of any Substance Treatment for abuse of any Substance Psychiatric: ADHD, ODD, Conduct Disorder, Bipolar, LD, H/O SI, Self-Cutting and Inpt, Trauma Hx Psychiatric: ADHD, ODD, Conduct Disorder, Bipolar, LD, H/O SI, Self-Cutting and Inpt, Trauma Hx Behavioral: Truancy, Failing School, Defiance, Legal Involvement, Behavioral: Truancy, Failing School, Defiance, Legal Involvement, Parents required to attend weekly groups Parents required to attend weekly groups

4 EXPLORATION STAGE WHY NOW Program was experiencing low completion rate – Concerns that current program was not working Program was experiencing low completion rate – Concerns that current program was not working Below census and underutilized Below census and underutilized Desire to move from Punitive, Consequence-oriented (TC) to Supportive Desire to move from Punitive, Consequence-oriented (TC) to Supportive Program’s high hurdles – lengthy, at-home client supervision – deterred many families Program’s high hurdles – lengthy, at-home client supervision – deterred many families Greater Awareness of Evidenced-Based Practices Greater Awareness of Evidenced-Based Practices

5 WHY MATRIX As reported by NIDA, studies by Rawson, et al, Matrix was an approach that demonstrated effectiveness As reported by NIDA, studies by Rawson, et al, Matrix was an approach that demonstrated effectiveness Current program and Matrix model shared some similarities: Didactic, Workbooks, Structured, Tx provided through Groups, Self Help Current program and Matrix model shared some similarities: Didactic, Workbooks, Structured, Tx provided through Groups, Self Help Training materials for clinicians, treatment materials for clients, manuals for both make Matrix user-friendly Training materials for clinicians, treatment materials for clients, manuals for both make Matrix user-friendly

6 MATRIX COMPONENTS Family Sessions Family Sessions Early Recovery Skills Groups and Relapse Prevention Groups in Intensive Outpatient Level Early Recovery Skills Groups and Relapse Prevention Groups in Intensive Outpatient Level Social Support Groups following IOP Social Support Groups following IOP Urinalysis Screens Urinalysis Screens Positive Client/Therapist Relationship Positive Client/Therapist Relationship Substance Abuse Education for Client & Family Substance Abuse Education for Client & Family Self-Help Involvement Self-Help Involvement Manuals, Workbooks, Handouts, Assignments Manuals, Workbooks, Handouts, Assignments Time-Limited Time-Limited

7 ADAPTING THE MATRIX MODEL Developed for Cocaine and other stimulant abusers Developed for Cocaine and other stimulant abusers Focus on adult populations Focus on adult populations MCTC implementing for general substance abuse MCTC implementing for general substance abuse MCTC using for adolescent population MCTC using for adolescent population

8 PROGRAMMATIC DIFFERENCES PRE MATRIX Duration of Tx = 8-12 Mon Duration of Tx = 8-12 Mon More and longer restrictions More and longer restrictions Harsher consequences Harsher consequences 3-6 mon parental at-home supervision 3-6 mon parental at-home supervision More focus on confronting defenses More focus on confronting defenses Lingering TC model Lingering TC model Greater potential for fostering dependence Greater potential for fostering dependence POST MATRIX Tx Duration = 4-6 Mon Fewer and shorter restrictions Supportive and E-B practices: MI, CM, RP 1-2 mon parental supervision More focus on abstinence skills (“The Why” of CD and “The How” of Recovery) Better adapted to treat Co- occurring disorders

9 INSTALLATION STAGE Multiple sessions with staff reviewing Matrix material Multiple sessions with staff reviewing Matrix material Re-structuring current IOP Re-structuring current IOP Changed program guidelines, and expectations, rules, privileges, consequences, rewards and length of Tx Changed program guidelines, and expectations, rules, privileges, consequences, rewards and length of Tx

10 IMPLEMENTATION STAGE Fidelity Addressed Fidelity Addressed Consistent at the beginning through supervision and staff meetings Consistent at the beginning through supervision and staff meetings Fidelity Challenges Fidelity Challenges As supervision focusing on Matrix Maintenance decreased, fidelity also decreased As supervision focusing on Matrix Maintenance decreased, fidelity also decreased

11 STAFF EXPERIENCE PROS: PROS: Group Modality Group Modality Measurable interventions Measurable interventions Material is organized and focused on relapse prevention Material is organized and focused on relapse prevention Offered direction and support Offered direction and support CONS: CONS: Clients complained of repetitive information Clients complained of repetitive information Minimal focus on insight Minimal focus on insight Concerns that lack of consequences will lead to disruptive behavior and compromise safety Concerns that lack of consequences will lead to disruptive behavior and compromise safety Less insight into individual and family dynamics Less insight into individual and family dynamics

12 STAFF ACCEPTANCE Tended to alternate between resistance and acceptance Tended to alternate between resistance and acceptance Initial trepidation followed by acceptance, then commitment  disappointment  perhaps trending to realistic expectations and hope Initial trepidation followed by acceptance, then commitment  disappointment  perhaps trending to realistic expectations and hope Overall staff level of Matrix acceptance = Overall staff level of Matrix acceptance = 6-7 (0=No Tx Value; 10=Best Tx)

13 Supervision Much time devoted initially in team meetings as well as individual supervision Much time devoted initially in team meetings as well as individual supervision Once program was installed, less follow up in meetings or supervision Once program was installed, less follow up in meetings or supervision Focus became group, family and individual psychodynamics Focus became group, family and individual psychodynamics

14 SUPERVISION AND FIDELITY GRAPH

15 SUMMARY OF DATA: 1 YEAR PRE & 1 YEAR POST MATRIX IMPLEMENTATION DATE 7/09 PRE MATRIX 7/08-7/09 POST MATRIX 7/09-7/10 % & DIRECTION CHANGE SCREENINGS304550% STARTED IOP % % STARTING IOP 43%51%19% 1 MONTH RETENTION % % RETAINED 1 MONTH 85%65%34% % RELAPSED 36%17%48% # CLIENTS COMPLETED % % COMPLETED 18%48%267%

16 TOTAL CLIENTS 1 MONTH COMPLETED STARTING PROG. RETENTION PROGRAM TOTAL CLIENTS 1 MONTH COMPLETED STARTING PROG. RETENTION PROGRAM

17 PERCENT RELAPSE RATES: PRE & POST MATRIX

18 Lessons Learned Include consistent Matrix Model review in individual and group supervision sessions Include consistent Matrix Model review in individual and group supervision sessions Develop tool to measure Matrix fidelity Develop tool to measure Matrix fidelity Design survey for follow up with clients post treatment Design survey for follow up with clients post treatment Continue to collect and analyze data on rates of abstinence, retention, completion, improved grades, decreased psychiatric sx’s, decrease in family conflicts Continue to collect and analyze data on rates of abstinence, retention, completion, improved grades, decreased psychiatric sx’s, decrease in family conflicts Insight-oriented therapy also needs to be provided as it relates to psychological obstacles to tx and recovery Insight-oriented therapy also needs to be provided as it relates to psychological obstacles to tx and recovery


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