Assertive Adolescent Family Treatment (AAFT) Cross-Site Progress Report Jutta Butler & Randolph D. Muck, SAMHSA, CSAT Michael L. Dennis, Susan H. Godley, Mark D. Godley & The Chestnut Health Systems Team Webinar Presentation for AAFT grantees on February 25 th

2 Goals 1.Describe the background for the AAFT initiative 2.Summarize GAIN and A-CRA/ACC training/certification progress 3.Report overall recruitment and follow-up performance 4.Describe the adolescents seen in the initiative based on a number of demographic and clinical characteristics 5.Present outcome data summarized across sites and compared to other CSAT initiatives

3 CSAT Adolescent Treatment Grant Program Cannabis Youth Treatment (CYT) experiments Adolescent Treatment Models (ATM) Persistent Effects of Treatment Study (PETS-A) Strengthening Communities for Youth (SCY) Reclaiming Futures (RF) diversion projects Targeted Capacity Expansion TCE/HIV Adolescent Residential Treatment (ART) Effective Adolescent Treatment (EAT) Young Offender Re-entry Programs (YORP) Juvenile & Family Drug Treatment Court (TDC) State Adolescent Coordinator (SAC) grants Adolescent Assertive Family Treatment OJJDP RWJF Replication grants OJJDP-CSAT Brief Intervention and Referral to Treatment (BIRT) Grant Programs that Are Completely ( ) or Partially ( ) using a common evidenced based assessment, the Global Appraisal of Individual Needs (GAIN), and pooling their data to support immediate clinical decision making, local program evaluation/development, and secondary analysis for policy/research

4 Overview of Program Purpose: To provide support for the initial training and implementation of evidenced based approaches to assessment and treatment for adolescents and their families/primary caregivers Key Components – Formal training and technical assistance implementing the Global Appraisal of Individual Needs (GAIN) to improve intake assessment, clinical interpretation, monitoring, and data management – Formal training and technical assistance implementing the Adolescent Community Reinforcement Approach (A-CRA) and Assertive Continuing Care (ACC) to support clinical intervention and supervision – Average of $328,000/yr x 3 years grant award to help with initial implementation – Other technical assistance to facilitate implementation

5 Assertive Adolescent Family Treatment (AAFT) Grant Sites by Funding Cohort Aurora Boston Cambridge Columbia Columbus Downey Fitchburg Fresno Ft Worth Houston Huntington Huntsville Laredo Little Rock Los Angeles Manchester Nashville Oak Ridge Oakland Orlando Phoenix Pinellas Park Reno San Antonio San Francisco Syracuse Tarzana Thornton Tucson AAFT Cohort 1 ( ) AAFT Cohort 2 ( ) WA OR CA NV ID UT WY MT CO AZ NM TX ND SD NE KS OK MN IO MO AR LA WI IL IN KY TN MS AL GA FL SC NC VA WV OH PA NY ME. CT VT NH NJ DE MD D.C RI MI AK HI PR San Jose

6 Unique Components of this initiative GAIN clinical certification ABS software Clinical supervisor certification process Web-based tool for clinical and supervisory certification based on digital technology Implementation calls paired with monthly implementation progress reports Cultural responsiveness committee

7 Clients Served and Costs The grantees are 2-3 years into their 3 year awards They have served 2,160 of the prorated 2,582 target to date (84%) and 4,233 target over the whole program (51%) They have an average raw cost of $9,729.6 per family served vs. an expected cost of $7,962.7 per family served (122%) They have an average adjusted cost (cutting off 20% for overhead/evaluation) of $7, per family served vs. an expected adjusted cost of $6,370 per family served (122%)

8 GAIN Certification Progress

9 Demographic Profile Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544) *Any Hispanic ethnicity separate from race group.

10 Pattern of Weekly Use (13+/90 days) : Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544)

11 Substance Use Problems Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544)

12 Past 90 day HIV Risk Behaviors Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544)

13 Co-Occurring Psychiatric Problems Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544)

14 Past Year Violence & Crime Notes: \a Dealing, manufacturing, prostitution, gambling (does not include simple possession or use); \b 14 or more days on probation/parole with urine monitoring Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544)

15 Count of Major Clinical Problems at Intake\a Note: \a Based on count of self reporting criteria to suggest Alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544) Median = 4 Problems

16 No. of Problems\a by Severity of Victimization Severity of Victimization Source: CSAT August 2008 AAFT GAIN Data Set (n=1,544) Note: \a Based on count of self reporting criteria to suggest Alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity. OR=Odds Ratio relative to Low

17 Performance (goal): Recruitment and Monitoring 100% 10%20%30%40%50%60%70%80%90%100% Notes: \a based on done divided by due minus expected, plus same percent expected of those still pending in window 91% 84% 85% 79% 71% 0% Sites with 2+ Staff GAIN Certified or In process Within Window (100% of Sites) Recruitment Rate (80%+) Session 2 Alliance (80%+)\q 3 Month follow-up (80%+)\a 6 Month follow-up (80%+)\a 12 Month follow-up (80%+)\a Site Data Submission Ok to Good (80%+) Source: CSAT October 2008 AAFT Management Report (n=1,602)

18 A-CRA/ACC Certification Progress

19 Performance (goal): Treatment Received Source: CSAT October 2008 AAFT Management Report (n=1,602) Targeted Improvement over general practice

20 Performance (goal): Early Treatment Outcomes Source: CSAT August 2008 AAFT GAIN Data set with 1+ Follow-up (n=1,045)

21 Performance: Change Over Time in Selected Outcomes Source: CSAT August 2008 AAFT GAIN Data set with 1+ Follow-up (n=1,045)

22 Intake to 6 Month GPRA Outcomes Relative to Other CSAT Adolescent Treatment Programs Source: SAIS System (GPRA) 2008 data

23 Performance: Outcome Status at Last Wave Source: CSAT August 2008 AAFT GAIN Data set with 1+ Follow-up (n=1,045)

24 Performance: Count of Positive Outcomes Source: CSAT August 2008 AAFT GAIN Data set with 1+ Follow-up (n=1,045)

25 Count of Positive Outcomes by Continuing Care at 90 days Source: CSAT August 2008 AAFT GAIN Data set with 1+ Follow-up (n=1,045)

26 Change in 6 Month Abstinence Relative to Other CSAT Adolescent Treatment Grant Programs Notes: \a GAIN Required, \b A-CRA/ACC required, \c MET/CBT5 required, \d Juvenile justice grant encouraging use of GAIN, ACRA/ACC and/or MET/CBT5 but without as much training/oversight Source: SAIS System (GPRA) 2008 data

27 Characteristics and Outcomes Site Profiles Report Site Profile report is created quarterly for each project. Included are charts that depict:  Client demographics, violence, crime, SES, etc at intake  Client use patterns at intake  Preliminary outcome measures based on scale scores using GAIN M90 compared to GAIN I scores  Treatment Satisfaction average results  Comparison charts with the option to compare to other sites in the project cohort Where to get access: – Reports are ed to the PI and Data Manager each quarter – Reports are also archived on the APSS website ( under the “GAIN Multi-Site Collaboration Materials” Report bullet. – Contact for more information or assistance in accessing and using

28 Summary The CSAT Adolescent Treatment program has demonstrated the ability to replicate A-CRA and ACC approaches in community based settings Both the GAIN and the A-CRA/ACC training and certification processes appear to be working well in AAFT based on numbers of staff achieving certification Adolescents appear to like the intervention Outcomes to date compare favorably to previous CSAT replication efforts and other CSAT funded initiatives

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