1. The 4 th Annual Research and Evaluation of Adventure Programs Symposium Programs, Process, & Progress: The March Towards Evidence-Based Designation The 4 th Annual Research and Evaluation of Adventure Programs Symposium Programs, Process, & Progress: The March Towards Evidence-Based Designation Matt Claybaugh, Ph.D. & A. Scott Allred, LMFT Marimed Foundation

2. Program ► Who we are and what we do.

3. Process ► Data in – Data Out ► Moving towards EBP designation

4. Progress ► Where are we now ► Barriers to success

5. Programs ► How many of you believe/know you are using an evidence-based model in your program(s)? ► How many of you are replicating a “best practice,” “evidence-based” or “model program?”

6. Marimed’s Residential Programs  Kailana (Calm Seas) (est.1993 on O`ahu) and and  Wahiolanona`opio (A Healing Place for Youth) (est. 2004 on Hawai`i Island) Residential treatment programs for adolescents needing comprehensive treatment and education, including mental health and substance abuse services. Residential treatment programs for adolescents needing comprehensive treatment and education, including mental health and substance abuse services.

7. Kailana Main Campus

8. Kailana Voyaging Houses Hale Ho`ohua “House to Bear Fruit” Hale Kauoha Kākou “House of Our Will”

9. Wahiolanona`opio Voyaging Houses Wahiolanona`opio `O Kea`au: Girls House Wahiolanona`opio `O Kapehu: Boys House

10. Integrated Services Experiential ClinicalEducational Marimed’s Model

11. Culturally Aligned with Youth Population

12. Mauka to Makai

13. Lo`i – Kalo, Animal Husbandry &Farming

14. Culinary Arts

15. Ocean-Based Programming

16. Small Boat Sailing

17. Outrigger Canoe Paddling

18. Kiakahi Sailing Canoe

19. Ho`ailona: Sailing Canoe

20. S.S.V. Makani Olu (gracious wind)

21. Five 5s ► Organizational Values ► Experiential Model ► Interwoven Phase and Level System ► CPI (Non Violent Crisis Intervention) ► Behavioral Supports

22. #1: Organizational Values ► Community ► Honesty ► Aloha ► Respect ► Teamwork

23. #2: Experiential Model ►W►W►W►Welcome Aboard / Preparing for Sea ►D►D►D►Departure / Commitment to the Voyage ►C►C►C►Challenge / Windward Leg ►M►M►M►Mastery / Wayfinding ►R►R►R►Reflection / Storytelling

24. #3: Phase and Level System ► Phases of Treatment: I. Rapport Building: Roles and Rules II. Accepting Responsibility and Expressing Needs and Issues III. Coping Skills IV. Dealing with Past Issues that Continue to Impede Progress V. Transferring Learning to New Life Settings

25. #4. Crisis Prevention Institute ► Non-Violent Crisis Intervention

26. #5. Behavioral Supports ► Making it Right ► Restorative Justice ► Cadet Council ► Positive Incident Reports

28. I Mua Mau `Ohana: IMO ► SAMHSA TCE: Targeted Capacity Expansion ► Joint Program Enhancement Award: 2002 Marimed Foundation and Maui Youth and Family Services  Voyaging (For MYFS)  12 month Continuing Care (All Islands)

29. Instrument ► Utilized the Global Appraisal of Individual Needs (GAIN) Core Version ► GAIN also contains SAMHSA Government Performance and Results Act (GPRA) Instrument

30. Baseline Findings

31. Demographics ► Gender: 71% male, 29% female, 1% TG ► Average age = 16 years old ► Ethnicity: 62% Native Hawaiian, 41% Caucasian, 37% Asian, 24% other Pacific Islander, and 24% Hispanic (many multi-ethnic) ► Past 12 months living with: 71% parent(s) ► Treatment prior to intake:  58% received treatment before; average=1.2 admissions  51% felt they needed treatment

32. Criminal Justice Involvement ► 87% had lifetime arrests

33. Education & Employment ► 89% of youth were enrolled in school or training ► Only 5% reported engaging in some type of “non-full-time work”

34. Substance Use at Intake

35. Mental Health at Intake

36. General Crime at Intake

37. Outcome Findings

38. Arrests – Past 90 Days

39. Days in Juvenile Detention – Past 90 Days

40. Education

41. Employment

42. Substance Use

43. Substance Problem Scales

44. Emotional Problem Scale

45. Summary ► Youth mostly Native Hawaiian and other Pacific Islander ► Youth at intake showed high levels of criminal justice involvement, substance use, and both internal and external behavior problems. ► Significant reduction in arrests and days in juvenile detention ► Significant reductions in substance use and related substance problems ► Significant reduction in emotional problems

46. Wahiolanona`opio ► Received SAMHSA TCE Earmark for Methamphetamine Treatment 2004

47. Instruments ► Wahiolanona`opio Survey  GAIN-Q  Family Management, Family Bonding, Self- Efficacy, Cultural Pride, & School Bonding ► Government Performance and Results Act (GPRA) Instrument

48. Data Collection ► From July 1, 2004 to September 30, 2006 ► 58 total admissions ► Baseline assessments  52 GPRA  46 Wahiolanona’opio surveys ► Three-month assessments  39 GPRA  34 Wahiolanona’opio surveys ► Six-month assessments  32 GPRA  27 Wahiolanona’opio surveys ► 12-month assessments  16 GPRA  11 Wahiolanona’opio surveys

49. Demographics ► Gender: 69% male; 31% female ► Age: range=13-18, avg.=15.7 years old ► Education: range=6th-11th grade, avg.=9.2 years

50. Ethnicity

51. Baseline ATOD Use Past 30 Days – % Youth

52. Qualitative Findings I ► Sample of participants from the residential and day treatment programs were interviewed ► Most participants felt they had changed positively, including increased acceptance of responsibility, honesty, problem solving, anger management, self- esteem, patience, positive attitudes, pro-social behaviors, academic performance, and remaining drug free ► Some participants also felt their families and their relationships with their families changed for the better

53. Qualitative Findings II ► Participants felt staff gave them support, hope, and skills to deal with their problems ► Participants enjoyed the learning and experiences they acquired ► When asked what was difficult about working with staff, participants mentioned lack of consistency and organization ► Other concerns related to the location and living conditions of the home

54. Limitations of Findings ► Small sample size ► “Selection bias” due to follow-up survey completion rate ► Cultural sensitivity of required measures ► Social desirability

55. Summary I ► Substantial decreases in AOD use at all follow-ups and reduced impact of AOD use at both 6- and 12- month follow-ups. ► Increasing improvements in high-risk behaviors at each follow-up. ► Although decreases in enrollment in school, there was increased school functioning for youth still in school and increased engagement in work for other youth. Qualitative data also suggests some improvement in academics.

56. Summary II ► While some increases in psychological/emotional problems revealed, decreases in external behavior problems also revealed. By 12 months, improvements shown in both internal and external behavior. ► Increases in self-efficacy and cultural pride also shown at all follow-ups. ► Although family functioning scales showed only slight improvements, qualitative data suggests some improvements. ► Improvements in living conditions and number of youth receiving various types of treatment.

57. Where Are We Now? ► Next Steps ► Barriers

58. T. S. Eliot “We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time.” T.S. Eliot

59. Thank You Senator Daniel Inouye Mayor Harry Kim (Hawai`i County) Billy Kenoi Char Shigemura All Hawai`i Treatment Providers and Educators Richard Kim, Ph.D., The Catalyst Group, LLC

60. Mahalo The end