Transcript Strengthening Adolescent Substance Abuse Screening

Strengthening Adolescent
Substance Abuse Screening,
Referral & Treatment in Central
Illinois
Susan H. Godley & Mychele Kenney
Funded by:
The Center for Substance Abuse Treatment (CSAT)
Substance Abuse and Mental Health Services Administration
(SAMHSA)
U. S. Department of Health & Human Services (DHHS)
Jo Daviess
Carroll
Population: 158,006
Burea
u
Henry
Du
Page
Cook
Chicago
McDonoug
h
Fulton
Livingsto
n
Woodfor
d
Peoria
Schuyle
r
Kankake
e
Iroquoi
s
Tazewe
ll
McLean
Mason
Adam
s
Cass
Brown
De
Witt
Logan
Menar
d
Ford
Champaig
n
Piatt
Macon
Scott
Morga
n
Sangamo
n
o
Calh
n
Macoupi
n
u
St.
Clair
Monro
e
Randolp
h
Cumberlan
d
Effingha
m
Fayett
e
Bond
Clay
Mario
n
Clinto
n
Bloomington/Normal
Jaspe
r
Richlan
d
Wayne
Washingto
n
Jefferso
n
Perry
Frankli
n
Jackso
n
Edgar
Coles
Shelb
y
Montgomer
y
Jersey
Madiso
n
Dougla
s
Moultri
e
Christia
n
Green
e
Vermilio
n
Williamso
n
Union
ande
Alex
r
k
las
Pu i
Johnso
n
Hamilto
n
Saline
Pope
Massa
c
White
Gallati
n
Hardin
Clark
Crawfor
d
Lawrenc
e
W
ab
h as
Knox
Grund
y
Edward
s
Hancoc
k
Warre
n
Will
La
Salle
Putna
m
Marshal
l
Stark
Pike
McLean County
Kane
Lee
Merce
r
Henderso
n
4% Hispanic, & 88% White
De
Kalb
Lake
Kendal
l
Rock
d
Islan
Area: 1200 square. miles
6% African American,
McHenr
y
Boone
Ogle
Whitesid
e
(118, 564 in
Bloomington-Normal)
Ethnicity of 12 to 18 year
olds:
Winnebag
o
Stephenson
Adolescent Treatment
at Time of Grant
Adolescent services began in 1985
Use of GAIN-I in agency
SAP—but no use of GAIN or EBP in schools
Every SAP counselor approached alcohol & drug
problems differently
Outpatient/IOP programs that had developed over 15+
years
No continuing care following OP, but the possibility for
stepping-up
No regular meetings with Juvenile Justice
MIS had very limited clinical usefulness/no usefulness
for collaborating agencies
GAIN Screening &
Evidenced-Based
Intervention at
Schools
Consistency of
Screening
Assessment
Juvenile
Justice/JDC/
SAP/Program
Coordination
with Other
Human Service
Agencies
Strengthening
McLean County for
Youth (SCY)
MIS
Development
for Continuum
and System
of Care
Evaluating
Continuing
Care Following
OP
Evaluating
ManualBased
Intervention
in OP
Thanks to all the staff and
collaborators
After SCY: Consistency in
Screening/Assessment
In addition to GAINS in the facility & remote
locations:
GAIN-Q is used across 18 schools
9 Early Intervention staff certified in GAIN-Q
GAIN administered at Justice Center
GAIN administered at Detention Center
10 adolescent staff certified GAIN administrators
and receiving monthly to semi-annual QA
reviews
During the Life of Project
1,031 GAIN Screenings/Assessments
(not including school ones)
– 329 GAINS at Justice Center
– 229 GAINS at Juvenile Detention Center
1,372 GAIN-Qs administered in schools
Pre-Post data used for SAP feedback to
schools for 4 years
268 recruited for GPRA; Follow-up rates
> 90% for 3,6, 9, & 12 months
“We’ve reduced the length of time
between the assessment and the final
treatment recommendation being
provided to the parents/guardians and
referral sources and an admission
appointment being offered or
scheduled. We’ve been much more
consistent with following up with
adolescents recommended for services
and making sure they are either
admitted to services or are refusing,
not just "slipping through the cracks";
especially those who are required by
the criminal justice system to seek
evaluation and treatment.”
Intake Counselor 3/06
Evidence-Based Practice in
Schools
Implementation of GAIN-Q and MET/CBT in 18 schools
(9 junior and 9 high schools)
Tracking system created to monitor
–
–
–
–
timely completion of screening tool,
referrals for evaluations
completed evaluations
treatment recommendation
Coordination improved between SAP and OP staff
–
–
–
–
follow-up on referrals for GAIN-Is
follow-up on referrals for SAP services
working with OP therapists during OP treatment
continuing to work with students after tx services no longer being
provided
Lessons Learned
Needed to decide which students get the GAINQ both within school year and year to year
– 2 or more sessions
– At least once a year
Needed to address binge drinking in intervention
Needed to add check-in session procedures
after MET/CBT
– Designed content
– Checked-in at least monthly
Godley, S.H. & White, W.A.(In Press) Student Assistance Programs: A valuable
resource for substance-involved adolescents. The Counselor
Lessons Learned
Need for school district policies to encourage
use of services
– Reduce suspension if participate in GAIN & if needed,
intervention
– Require parent meetings at beginning and end
SAP students (n=61) differed from OP/IOP
adolescents (n-75) on 4 out of 12 variables
–
–
–
–
More likely female (54% vs. 29%)
Younger (41% 11 to 14 vs 15% in OP)
Less likely Black (2% vs 8%)
Less likely arrested in last year (12% vs. 62%)
Substance Use for MET/CBT5: Years 1 - 3
N=61
100%
90%
80%
70%
85%
75%
*
66%
62%
60%
49%
*
46%
50%
Pre
40%
Post
30%
15%
20%
7%
10%
0%
% 1+ Days Alcohol
Use
% 1+ Days Heavy % 1+ Days
% 1+ Days Other
Alcohol Use
Marijuana Use
Drug Use
* Significant difference, p<.05 (McNemar)
“SCY has given the program direction
and accountability. It is so helpful to
have a standardized intervention to
address substance abuse in the
schools. Prior to SCY, we did not have
any protocol [for] what to do with a
student who was using substances but
not appropriate for outpatient/
inpatient. It has also helped with
coordinating services and referrals for
case management and increased
communication with other
programs… We did become a better,
more effective, more functional
program with SCY.” SAP Counselor
3/06
Coordination with other
Agencies/Child Serving Entities
Juvenile Justice
– Analyzed the Diversion and Probation Processes
Identified time points & types of offenses appropriate for AOD
screenings
– Added regular meetings with juvenile justice and
juvenile detention
Review referral and linkage statistics
Discuss individual adolescents as needed
Discuss how collaboration is going
Improved system of referrals and assessments
Developed a brochure for families on JJ system
Continue to have new avenues for collaboration
Performance Indicator
Type of JJ Referrals (n=375)
AOD-Related 1st Mis.
Parental Supervision - 1st Mis.
4%
2%
Warn/Min Consequence
11%
1%
Informal Sup/Prob - 1st Mis.
25%
Parental Supervision - 2nd/Sub. Mis.
1%
Informal Sup/Prob - 2nd/Sub. Mis.
2%
Prelim Conference
25%
16%
1%
Post-Sentencing Hearing
1%
Pre-Sentencing/Pre-Trial Condition
3%
Post-Placement
1%
Felony Offense
7%
Left Pos Drug Screen/Admitted Usage
Sanction
Other
Performance Indicator:
# Days from
Referral to Evaluation (n=362)
4%
18%
0 to 2
3 to 5
6 to 8
9%
38%
9 to 11
>11
Unknown
25%
6%
Coordination with other
Agencies/Child Serving Entities
Interagency steering committee meetings for
SCY/ representation continues on several
interagency groups after SCY
– Representatives from Child Welfare, Homeless,
Education, Court Services
Provided training on methamphetamines
Several events related to the Faith Community—
instituted weekly meetings with local group of
pastors & ministers re. Youth/Hispanics
“The SCY project
strengthened the relationship
between Chestnut Health
Systems and the McLean
County Juvenile Court System.
CHS has made our job easier
by ensuring that adolescents
who need treatment actually
receive treatment.”
Deputy Director, Juvenile
Court Services
MIS—Electronic Clinical
Record and More
March 2004: Implemented in intake,
outpatient, IOP, and residential
December 2004: Trained Juvenile Justice
staff—they begin using shortly after
April 2005: Test in two SAP schools
May 2005: Made available to satellite
office in other city (Decatur)
September 2005: Make available to all 18
SAP schools
MIS
Today—over 165 users, many of whom log in
daily
–
–
–
–
–
–
–
Residential (95)
OP/IOP (20)
Intake (10)
SAP (22)
Juvenile Justice (12)
Research staff (7)
Others (Medical staff, records staff, QI Manager,
recreation staff)
Best news---our IT has taken over maintenance
and are still improving the system
Used by Juvenile Justice
Officers, SAP, Others
Referral In Screen
Average: 9 referrals a month; 355 hits from JJ staff
a week, &
Average 9 referrals a month; Weekly 14 different JJ officers
average 355 hits
Information
will be sent to
STATE
Shows what
can & can not
be shared
Include
billing/service
data that can
be sent to
STATE
All Diagnosis
info Kept in
one place
GAIN produces
report in Word
that can be
edited and
attached.
Email the SAP Supervisor requesting review
of service plan
Add or Remove SAP Life Issues
Add objective to
Goal (curriculum)
Add New Goal
(Based off curriculum)
Evidenced-Based Practice
in Outpatient
MET/CBT5 plus two parent sessions
Ongoing taping and regular tape review
So far, 102 have been randomly assigned
to receive MET/CBT7 (106 UOP)
Completion rate (all 7 sessions) of 80%
MET/CBT Fidelity (n=70)
0%
10%
20%
30%
40%
Rapport
Building
Motivational
Interview
Personalized
Feedback
50%
60%
70%
80%
79%
84%
83%
Refusal Skills
84%
Enhanced
Social Support
Coping with
EmergencyRelapse
Increasing
Pleasant Acts
90%
79%
84%
34%
Evaluation of Continuing Care
Usual Continuing
UCC+ Assertive
Care (UCC)
Continuing Care (ACC)
MET/CBT5
+ 2 Family
Sessions
Usual CHS
Outpatient
MET/CBT7
MET/CBT7
UCC
UCC+ACC
CHS OP
UCC
CHS OP
UCC+ACC
Funding for this study is being provided by National Institute on Drug Abuse,
NIH DA18183
Percent of Days out of 180
Outcomes at 6 Months
*
100%
90%
80%
70%
61%
76%
66%
78%
60%
50%
Days Abstinent*
40%
30%
27%
21%
20%
10%
18%
12%
0%
UOP/UCC
(n=44)
Days Used
AOD
5%
UOP/ACC
(n=38)
13%
MET/UCC
(n=37)
16%
6%
MET/ACC
(n=37)
Days abstinent minus days in a Controlled Environment.
Also, main effect for Continuing Care Type, F(1,155)=7.41, p<.01.
Days in Controlled
Environment
Future—What Will Be
Maintained
Collection of PI data for screening, assessments,
recommendations become part of QI
Continue to have screenings/assessments off-site with
quick response
GAIN-Q and MET/CBT5 training will be written in SAP
policies & Procedures/Performance Indicators will
continue to part of QI
Meetings with JJ will continue
MIS (ESSIST) will continue and be improved
MET/CBT5 and ACC will continue at least through
completion of NIH study