SAMHSA’s Strengthening Communities for Youth Initiative

Table of Contents

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Volume 40, Number 1

March 2008

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Editors’ Introduction: SAMHSA’s Strengthening Communities for Youth Initiative — Douglas C. Smith, Ph.D. &  Randolph D. Muck, M.Ed. .

The Strengthening Communities for Youth (SCY) Initiative: A Cluster Analysis of the Services Received, Their Correlates and How They are Associated with Outcomes  — Michael L. Dennis, Ph.D.; Melissa L. Ives, M.S.W.;  Michelle K. White, Ph.D. & Randolph D. Muck, M.Ed.

One-Year Treatment Patterns and Change Trajectories for Adolescents Participating in Outpatient Treatment for the First Time — Susan H. Godley, Rh.D; Lora L. Passetti, M.S.; Rodney R. Funk, B.S.; Bryan R. Garner, Ph.D. & Mark D. Godley, Ph.D.

Adolescent Substance Abuse Treatment Clinicians’ Self-Help Meeting Referral Practices and Adolescent Attendance Rates — Lora L. Passetti, M.S. & Susan H. Godley, Rh.D.

Bringing Adolescents into Substance Abuse Treatment through Community Outreach and Engagement: The Hartford Youth Project — Reginald Simmons, Ph.D.; Jane Ungemack, Dr.P.H.; Jennifer Sussman, M.F.A.; Robyn Anderson, M.A.;  Sandra Adorno; Jose Aguayo, A.A.; Khary Black, B.A; Steven Hodge, B.A; Rachel Tirnady, B.A.      View this article

Predictors of Early Therapeutic Alliance Among Adolescents in Substance Abuse Treatment — Bryan R. Garner, Ph.D.; Susan H. Godley, Rh.D. & Rodney R. Funk, B.S.

Victimization Among African-American Adolescents in Substance Abuse Treatment — Brian E. Perron, Ph.D.; Heather J. Gotham, Ph.D. & Dong Cho, Ph.D.            

Clinical Outcomes of Traumatized Youth in Adolescent Substance Abuse Treatment:  A Longitudinal Multisite Study — Julie K. Williams, Ph.D., L.M.S.W.; Douglas C. Smith, Ph.D., L.M.S.W.; Hyonggin An, Ph.D. & James A. Hall, Ph.D., L.I.S.W.

Understanding Clinical Complexity in Delinquent Youth: Comorbidities, Service Utilization, Cost, and Outcomes  — David L. Hussey, Ph.D.; Allyson M. Drinkard, M.A.; Lynn Falletta, M.P.A., M.A. & Daniel J. Flannery, Ph.D.

An Implementation Story: Moving the GAIN from Pilot Project to Statewide Use — Heather J. Gotham, Ph.D.; Michelle K. White, Ph.D.; Hannah S. Bergethon, B.A.;  Tim Feeney, B.A.; Dong W. Cho, Ph.D. & Barbara Keehn, R.N., B.S.N.

Substance Abuse Treatment with Rural Adolescents: Issues and Outcomes — James A. Hall, Ph.D., L.I.S.W.; Douglas C. Smith, Ph.D., L.M.S.W.;  Scott D. Easton, L.M.S.W.;  Hyonggin An, Ph.D; Julie K. Williams, Ph.D., L.M.S.W.; Susan H. Godley, Rh.D. & Mijin Jang

COVER ART — Epiphyllum Abstract by Deb Casso (www.debcasso.com)

Abstracts

The Strengthening Communities for Youth (SCY) Initiative: A Cluster Analysis of the Services Received, Their Correlates and How They are Associated with Outcomes — Michael L. Dennis, Ph.D.; Melissa L. Ives, M.S.W.;  Michelle K. White, Ph.D. & Randolph D. Muck, M.Ed.
Abstract —This article describes the Strengthening Communities for Youth (SCY) initiative using data from 1,297 adolescents in eight U.S. cities (Oakland, CA; Tucson, AZ; Iowa City, IA; Bloomington, IL; St. Louis, MO; Cleveland, OH; Louisville, KY, New York, NY) to better understand the pattern of services they received, how these services varied by need, and how services were associated with initial treatment outcomes. Data include adolescent reports collected with the Global Assessment of Individual Needs (GAIN) at treatment intake and 90 days post-intake, information on early therapeutic alliance using a modified Working Alliance Inventory (WAI), and staff reports from service logs. Cluster analysis identified four patterns of treatment received: (1) substance abuse and mental health treatment, (2) primarily residential treatment, (3) interrupted treatment, and (4) primarily outpatient treatment. Outcomes examined included changes in substance use, substance abuse/dependence problems, recovery environment risk, as well as risk from social peers, illegal activity and emotional problems. Overall and for most groups, treatment was associated with reduced or unchanged problems in each of these areas. The exception was for cluster 1, for whom emotional problems actually increased. Implications for placement, treatment planning and future research are discussed.
Keywords—adolescent, substance abuse treatment patterns, cluster analysis, need for treatment, outcomes, Strengthening Communities for Youth (SCY)

Adolescent Substance Abuse Treatment Clinicians’ Self-Help Meeting Referral Practices and Adolescent Attendance Rates — Lora L. Passetti, M.S. & Susan H. Godley, Rh.D.
Abstract—Clinicians in adolescent substance abuse treatment programs often recommend attendance at 12-Step meetings; however, there has been no systematic study of their referral practices or possible influence on attendance rates. Quantitative and qualitative data were used to examine: (a) the self-help referral practices of clinicians employed in adolescent substance abuse treatment programs; and (b) the potential relationship between practices and self-help attendance. Data were analyzed from open-ended interviews with 28 clinicians at eight CSAT-funded SCY sites and from follow-up interviews with over 1,600 adolescents. Results indicated that clinicians referred adolescents almost exclusively to 12-Step groups. Various factors were considered when recommending attendance, including substance use severity and ability to grasp 12-Step concepts. Meeting age composition and availability were common influences when suggesting specific meetings. Clinicians who described their treatment programs as “12-Step based” and actively linked adolescents to groups tended to be employed at sites that had the highest overall rates of self-help attendance. Findings suggest that if clinicians want to facilitate self-help attendance, they might assess the “fit” between individual adolescents and particular meetings. Additionally, programs may want to develop and train staff in standardized referral procedures. Further research is needed to empirically test referral strategies with adolescents.
Keywords—adolescent, referral, self-help, substance use treatment

Bringing Adolescents into Substance Abuse Treatment through Community Outreach and Engagement: The Hartford Youth Project — Reginald Simmons, Ph.D.; Jane Ungemack, Dr.P.H.; Jennifer Sussman, M.F.A.; Robyn Anderson, M.A.;  Sandra Adorno; Jose Aguayo, A.A.; Khary Black, B.A; Steven Hodge, B.A; Rachel Tirnady, B.A.
Abstract—While outreach and case management services have been shown to improve retention of at-risk youth in behavioral health treatment, these important support services are challenging to implement. The Hartford Youth Project (HYP), established by the Connecticut Department of Children and Families as a pilot for the state adolescent substance abuse treatment system, made outreach and engagement integral to its system of care. HYP brought together a network of stakeholders: referral sources (juvenile justice, schools, community agencies, child welfare, and families); community-based outreach agencies; treatment providers; and an administrative service organization responsible for project coordination. Culturally competent Engagement Specialists located in community agencies were responsible for: cultivation of referral sources; community outreach; screening and assessment; engagement of youth and families in treatment; case management; service planning; recovery support; and advocacy. This article describes HYP’s approach to identifying and engaging youth in treatment, as well as its challenges. Use of family-based treatment models, expectations of referral sources, limited service capacity, youth and family problems, and staff turnover were all factors that affected the outreach and engagement process. Process, baseline assessment and case study data are used to describe the needs and issues specific to Hartford’s substance-abusing Latino and African-American youth.
Keywords—adolescent, outreach, substance abuse treatment

Predictors of Early Therapeutic Alliance Among Adolescents in Substance Abuse Treatment — Bryan R. Garner, Ph.D.; Susan H. Godley, Rh.D. & Rodney R. Funk, B.S.
Abstract—Given the importance of the therapeutic alliance in achieving positive treatment outcomes, research is needed to illuminate the factors that contribute to the development of this important relationship. The aim of the current study was to expand upon the existing literature by examining predictors of the early therapeutic alliance among adolescents treated in two outpatient programs. Use of multilevel modeling techniques revealed that the majority of the variance in adolescents’ ratings of the therapeutic alliance was due to adolescent factors (91%), while the variance in therapist ratings of alliance were nearly equally divided between adolescent and therapist factors (52% vs. 48%). Participant age was found to be the only significant predictor of therapist-rated alliance, with therapists reporting higher alliances with older adolescents. Adolescents reporting higher levels of social support, greater problem recognition, and more reasons for quitting also reported higher therapeutic alliance ratings. Future research is needed to examine if early identification of adolescents with low social support and problem recognition combined with brief treatment readiness interventions can be a promising approach to help improve therapeutic engagement and post-treatment substance use outcomes.
Keywords—adolescent, substance abuse, therapeutic relationship, working alliance

Victimization Among African-American Adolescents in Substance Abuse Treatment — Brian E. Perron, Ph.D.; Heather J. Gotham, Ph.D. & Dong Cho, Ph.D.
Abstract—Given the importance of the therapeutic alliance in achieving positive treatment outcomes, research is needed to illuminate the factors that contribute to the development of this important relationship. The aim of the current study was to expand upon the existing literature by examining predictors of the early therapeutic alliance among adolescents treated in two outpatient programs. Use of multilevel modeling techniques revealed that the majority of the variance in adolescents’ ratings of the therapeutic alliance was due to adolescent factors (91%), while the variance in therapist ratings of alliance were nearly equally divided between adolescent and therapist factors (52% vs. 48%). Participant age was found to be the only significant predictor of therapist-rated alliance, with therapists reporting higher alliances with older adolescents. Adolescents reporting higher levels of social support, greater problem recognition, and more reasons for quitting also reported higher therapeutic alliance ratings. Future research is needed to examine if early identification of adolescents with low social support and problem recognition combined with brief treatment readiness interventions can be a promising approach to help improve therapeutic engagement and post-treatment substance use outcomes.
Keywords—adolescent, substance abuse, therapeutic relationship, working alliance

Clinical Outcomes of Traumatized Youth in Adolescent Substance Abuse Treatment:  A Longitudinal Multisite Study — Julie K. Williams, Ph.D., L.M.S.W.; Douglas C. Smith, Ph.D., L.M.S.W.; Hyonggin An, Ph.D. & James A. Hall, Ph.D., L.I.S.W.
Abstract—The purpose of this study was to evaluate the effectiveness of outpatient substance abuse treatment for youth with high traumatic stress compared to youth without high traumatic stress in substance abuse treatment centers across the United States. The data for this study were gathered using a longitudinal survey design with purposive sampling from nine drug treatment delivery systems across the United States participating in the cooperative grant Strengthening Communities for Youth (SCY) awarded by SAMHSA’s Center for Substance Abuse Treatment (CSAT) between September 2002 and June 2006. Follow-up assessments were conducted with the youth at three, six, and 12 months following intake. Traumatized youth responded to outpatient treatment in a similar pattern when compared to nontraumatized youth, although the traumatized youth had consistently higher scores on substance use frequency and substance problems scales than nontraumatized youth throughout the study. Current empirically validated treatments for adolescent substance abuse do not prepare the practitioner for trauma-informed practice or specifically address trauma-informed recovery. Based on our results, we advocate for the development and integration of trauma-informed practice within substance abuse treatment for adolescents to help them recover from trauma and substance abuse issues.
Keywords—adolescent, drug abuse, substance abuse treatment, trauma

Understanding Clinical Complexity in Delinquent Youth: Comorbidities, Service Utilization, Cost, and Outcomes  — David L. Hussey, Ph.D.; Allyson M. Drinkard, M.A.; Lynn Falletta, M.P.A., M.A. & Daniel J. Flannery, Ph.D.
Abstract—This study describes the extent and severity of multiple comorbidities in a juvenile detention center population, and explores how these numerous problems impact the utilization of treatment services, costs, and outcomes including those for substance abuse, mental illness, and criminal activity. Cluster analyses of the outcome scales at intake yielded two groups: youth high (42%) and youth lower (58%) on all factors. Girls experienced the most significant impairments across emotional problems, behavior complexity, internal mental distress, and victimization domains, utilized significantly more units of residential treatment, individual counseling and case management, and had the highest treatment costs. The total cost of services ($1,171,290, N = 114) was significantly related to substance problems in the past year (r = .219, p < .05), emotional problems (r = .237, p < .05), behavior complexity (r = .318, p < .05), internal mental distress (r = .263, p < .05), environmental risk (r = .205, p < .05), and conflict tactics (r = .240, p < .05). Despite initial differences in measures of baseline severity, high and low cluster youth, and boys and girls in general, achieved similar results on the key outcome variables 12 months later. Study implications include a need for co-occurring, integrated treatment efforts that address family, emotional, and mental health problems of delinquent youth (especially females) in order to improve their ability to successfully attend to substance abuse problems and interpersonal conflicts.
Keywords—adolescent, comorbidity, delinquent, substance abuse treatment

An Implementation Story: Moving the GAIN from Pilot Project to Statewide Use — Heather J. Gotham, Ph.D.; Michelle K. White, Ph.D.; Hannah S. Bergethon, B.A.;  Tim Feeney, B.A.; Dong W. Cho, Ph.D. & Barbara Keehn, R.N., B.S.N.
Abstract—Similar to implementing an evidence-based practice (EPB), implementing an evidence-based assessment (EBA) is a long, complex process that can take several years to complete. Between 2002 and 2007, the state of Missouri first piloted the Global Appraisal of Individual Needs-Initial (GAIN-I; Dennis et al. 2006) assessment at one state-contracted adolescent substance abuse treatment program and then implemented the GAIN statewide. This case study documents the implementation process through Fixsen and colleagues’ (2005) six stages of implementation, from exploration and adoption through sustainability, and outlines challenges and solutions encountered at the external, organizational, and individual staff level. Strengths of this project included recognition that implementation is an ongoing multistep process, strong support by state-level staff, contracting with an external purveyor for ongoing technical assistance at the agency level as well as training of front-line clinicians, and an implementation team comprised of stakeholders at multiple levels.
Keywords—adolescent substance abuse treatment research, evidence-based assessment, implementation

Substance Abuse Treatment with Rural Adolescents: Issues and Outcomes — James A. Hall, Ph.D., L.I.S.W.; Douglas C. Smith, Ph.D., L.M.S.W.; Scott D. Easton, L.M.S.W.;  Hyonggin An, Ph.D; Julie K. Williams, Ph.D., L.M.S.W.; Susan H. Godley, Rh.D. & Mijin Jang
Abstract—This study compared the characteristics and treatment outcomes of rural adolescents with urban adolescents in substance abuse treatment programs in CSAT’s Strengthening Communities for Youth (SCY) initiative. Using data from ten SCY programs nationally, the authors classified adolescents as rural or urban using Rural-Urban Commuting Area (RUCA) codes. We then evaluated changes in substance use frequency and substance-related problems at three, six, and 12 months after baseline assessments for the two sites that treated rural (n = 59) and urban (n = 345) youth in outpatient settings. Data were analyzed using a two-part mixed effects model for zero-saturated dependent variables. At treatment intake, rural youth exhibited greater problem severity on a number of substance abuse and mental health indices. From intake to the 12-month follow-up point, the percentages of both urban and rural youth who reported abstinence increased significantly. Both rural and urban youth also reported fewer problems due to substance use over time, but differences between groups were not consistent. Overall, treatment appears equally effective for both rural and urban adolescents. As few rural youth obtained treatment, we encourage funding agencies and treatment providers to consider innovative ways for providing services in rural areas and addressing gaps in primary prevention, early identification, and continuing care.
Keywords—adolescent, drug abuse, rural studies, substance abuse treatment