Meeting Youth Needs: Working to Create an Adolescent System of Care in CA

1
Meeting Youth Needs Working to Create an
Adolescent System of Care in CA

• Presented by
• Danielle Nava, MAOL
• September 15, 2006

2
Adolescent System of Care

• An overview
• What it means
• What it includes
• Where CA has been on YTS

3
State Level Estimates for AOD Use/Abuse In
California

• Approximately 18 of 12-17 year olds report
  alcohol use in the past month.
• An estimated 9 report binge drinking in the past
  month.
• Overall, 11 report past month use of any illicit
  drug
• Based on DSM-IV criteria, an estimated 8 of
  12-17 year olds report either alcohol, or illicit
  drug, abuse or dependence in the past year.

National Household Survey on Drug Abuse-2002/03
(SAMHSA)
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State Level Estimates for AOD Use/Abuse In
California

• 37 of 11th graders report consuming at least one
  alcoholic drink in the previous 30 days.
• 18 of 11th graders report at least one drink in
  the past three days.
• 23 of 11th graders report binge drinking
  (consumption of 5 or more drinks in a row) within
  the past 30 days.
• The California Student Survey (CSS)-2003/04

5
17,000
Other Includes Outpatient Methodone
Maintenance, Outpatient Detoxification, Residence
Detoxification Hospital Source
Source
Source
Source
Primary AOD Problem FY 19972002
Other Includes Barbiturates, Inhalants,
Non-Prescription Methadone, Other, Other Opiates
/ Synthetics, Other Sedatives / Hypnotics, Other
Tranquilizers, Over the Counter, PCP,
Tranquilizers Methamphetamines Include
Methamphetamines, Other Amphetamines, Other
Stimulants (Source CADDS)
34.4
68.1
655
57.8
Community Agency Includes Employer / Employee
Assistance Program, Other Community
Referral Juvenile and Criminal Justice
Includes Court / Criminal Justice, Court /
Probation, Substance Abuse and Crime Prevention
Act of 2000 (SACPA), SACPA Parole Other
Treatment Includes 12 Step Mutual Aid, Care
Program, Other Health Care Source
26.4
26.2
27.7
27.1
23.4
73.6
73.9
72.3
72.9
76.6
Source
32.6
32.5
31.6
31.7
34.9
67.4
67.5
68.4
68.3
65.1

Source
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Local Need

• Los Angeles Snapshot

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Estimated Adolescent Substance Dependence or
Abuse 2005- LA County
Estimation of Los Angeles Countys total number
of adolescents by gender. Total population ages
12-17 934,614 Males 477,587,
Females457,027 Illicit Drug and Alcohol total
20,562
Sources SAMHSA, OAS, National Survey on Drug Use
and Health, 2005 and The United States Census
Bureau, American Fact Finder 2000.
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Many Youth Struggle with Alcohol Other Drug
(AOD) Problems and Complex Issues in Multiple
Domains
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Co-Occurring Mental Health Problems are Common

• For adolescents who regularly use
• substances various disorders are present
• Anxiety
• Post Traumatic Stress
• Depressive
• Attention Deficit and Hyperactivity
• Attachment
• Eating and Image.

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Risk and Identification of those with AOD Problems

• These histories or events may place an adolescent
  at even greater risk for having future AOD
  problems, especially if they receive little or no
  help.
• The pathways to treatment indicate that youth
  with pre-existing AOD problems often come first
  to attention of justice, welfare, mental health,
  and school officials, rather than to AOD service
  providers.

11
Multiple risk factors among youth entering the
Juvenile Justice system

• Sexual and physical abuse
• Poor emotional and psychological functioning
• Poor educational functioning
• Economically disadvantaged.

12
Adolescent Substance Abuse Needs Services
Planning Report

• Establishing Need

13
Growth and Capacity of Youth Treatment in
California

• A growing number of youth are admitted to
  treatment for AOD problems.
• However, development and growth in capacity are
  seriously hindered by a lack of adequate funding
  for needed services and in the need to address
  limitations in the ability to hire a fully
  qualified workforce.
• Capacity expansion, quality improvement, and
  increased effectiveness will benefit enormously
  from state-level support.

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Youth Substance Use and Abuse

• We know
• Substance abuse has decreased in general.
• It has increased in high-risk children.
• Experimentation is occurring at younger ages.
• The drugs available are more potent.

15
Growth in Admissions to Treatment of Adolescents

• There is a growing number of admissions to
  treatment of boys and girls under the age of 18.
• The number of admissions of youth to treatment in
  California in 2001-2002 was approximately 20,000.
  This is nearly double the number of 5 years
  earlier, 1997-1998, when 11,000 were admitted.

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Incidence and Prevalence of AOD Problems in
Special Populations
There is increasing evidence that the rates of
AOD problems and substance use disorders are
considerably higher among specific
sub-populations of youth.

• Those who have been abused or neglected,
  including those removed from their home by child
  welfare officials
• Those arrested, detained, adjudicated, and placed
  out of home by juvenile justice authorities
• Those suffering with or diagnosed with
  psychiatric conditions, such as depression,
  traumatic stress, or conduct disorder
• Those enrolled in special education and those
  assigned to continuation schools by educational
  administrators.

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Estimates for Unmet Treatment Need

• The Treatment Episode Data Set (TEDS) reports on
  annual admissions of youth to treatment
  facilities. According to TEDS, in 2001 an
  estimated 1.1 million youth, ages 12-17 needed
  treatment for an illicit drug problem. Of this
  group treatment was received by only one in 10 of
  all those who needed treatment. (SAMHSA, 2002)

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Estimates for Unmet Treatment Need

• The Center for Substance Abuse Treatment (CSAT,
  SAMHSA) estimates that only one in ten
  adolescents who need substance abuse treatment
  actually receive it. Of those who receive
  treatment, only one in four receive enough
  treatment, of sufficient duration, intensity and
  quality. (CSAT, 2002)

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Estimated 2005 Los Angeles County Adolescent
Treatment Gap
Sources SAMSHA, Office of Applied Studies,
National Survey on Drug Use and Health,
2005 Based on national prevalence rates
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Barriers to Treatment for Youth

• client
• family
• community

• organizations
• program
• systems

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Program Barriers and Issues

• Limited science based treatment programs by age,
  gender, developmental status.
• Incomplete or inadequate assessment tools,
  focused on deficits rather than strengths.
• Workforce - limited experience with low
  compensation.
• Integration of new perspective, philosophy,
  culture.
• Program design core goals, activities,
  interventions.
• Over-regulated with outdated regulations.

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Systemic Barriers and Challenges

• Resources are grossly inadequate.
• Funding available is a patch work of federal,
  Medicaid, out of home placement, juvenile justice
  funds-state set aside.
• Experienced AOD staff are not valued.
• Poor interagency collaboration.
• Limited health or mental health care access.
• Conflicting regulations and practices.

23
Treatment Reality in California

• Treatment is delivered predominantly in
  outpatient settings in most counties where it is
  available.
• Treatment is available in school-based settings
  in some counties, but not all. The school-based
  services are primarily for early intervention.
• Treatment is available in residential settings
  (i.e. through the state Department of Social
  Services foster care/group home licensing) in a
  small number of counties.
• There is no unified treatment system and no
  single source of data on these services.
• Overall, a continuum of care and multi-level
  treatment options are not widely available nor
  are treatment services well distributed
  geographically.

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National Adolescent Substance Abuse Treatment
Referrals
Source Dennis, ML, Dawud-Noursi, S, Much, R, and
McDermeit, M. The Need for Developing and
Evaluating Adolescent Treatment Models. In
Stevens, SJ and Morral, AR (eds.) Adolescent
Substance Abuse Treatment in the United States
Exemplary Models from a National Evaluation
Study. Binghampton, NY Haworth Press. 2002
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Characterization of Youth Admitted to Treatment
in California

• Primary drug used is marijuana or alcohol.
• Referral to treatment is most frequently through
  juvenile justice. Schools are next in frequency.
  Family or self-referral are far less common.
• As many as one in four have had a prior treatment
  experience.
• Approximately half leave treatment without
  satisfactory progress.
• These characteristics are comparable to those
  among youth entering treatment nationwide.

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Residential Facilities with Alcohol Drug
Treatment Certification

• Tahoe Turning Point (4)
• Right Roads (1)
• Phoenix House (3)
• Sunny Hills Childrens Services (1)
• Our Family (3)
• Social Model Recovery Systems (1)
• McAlister Institute (4)

• Walden House (1)
• Baker Place (3)
• Life Steps (1)
• Daytop Village (2)
• Center Point (1)
• Advent Group Ministries (6)
• CRC Recovery (1)
• Wilderness Recovery Centers (1)

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Statewide Residential SA Adolescents Admissions

Source Department of Drugs and Alcohol
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Levels of Care in Treatment of Adolescents
Daily, approximately 100,000 youth participate in
public substance abuse treatment programs
nationally.
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Fragmented and conflicting mission and goals
between referral, funding and oversight agencies
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Medi-Cal Youth Substance Abuse Treatment
Cedillo Bill- SB 1288
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MAYSI2 Statewide Screening-California

• Description of Alcohol/Drug Use Mental Health
  Symptoms Among Youth as Identified by the
  Massachusetts Youth Screening Instrument2

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Treatment System Design

• Adopt shared, broadly endorsed protocols for
  screening and referring youth across service
  settings and across service sectors.
• Reduce the stigma for youth entering AOD
  treatment.
• Deliver treatment in the least restrictive
  community-based setting possible, while ensuring
  physical and emotional safety.
• Make treatment geographically and culturally
  accessible to youth and their families in each
  region of the state.
• Develop treatment options that are appropriate
  for youth with special service needs, including
  those not living at home and those with emotional
  disorders.
• Disseminate information to families, other
  providers, and professionals about treatment, its
  availability, and its effectiveness.

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System Design Improving Access to Treatment

• Broaden Access to Care
• Implement NO WRONG DOOR
• Develop Mechanisms for Early Identification of
  Alcohol and Other Drug Problems Among Youth
• Create Linkages to Treatment
• Site Services and Screening/Referral Services
  Where Youth Are Usually Seen.
• Schools, Juvenile Justice, Child Welfare, Mental
  Health, Health Care

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System Design Improve Treatment Effectiveness

• Assess the Needs of Each Youth Entering Treatment
  in Multiple Domains
• Education
• Family Relationships
• Mental Health
• Behavioral Patterns
• Life and Vocational Skills
• Physical Health and Safety

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System Design -Continuum of Care

• Create a Horizontal Continuum of Care to Ensure
  these Needs are Addressed, As a Response to the
  Assessment.
• Create a Vertical Continuum of Care to Move the
  Youth through Stepped Up (Intensified) or
  Stepped Down (Less Intensive) Levels of Care,
  As Indicated Through Assessment.

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System Design Linking Assessment to Placement

• Place the youth in the most clinically
  appropriate level and setting of care, based
  upon the assessment.
• Periodically re-assess the youths progress and
  issues.
• Provide extended continuing care and support for
  recovery, including family support.

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System Design Enhancing Treatment Models and
Treatment Plans

• Individualized - Tailored to match the complexity
  of each individuals needs.
• Developmentally Appropriate - Designed for
  adolescents at various stages of physical,
  behavioral and emotional maturation.
• Gender-specific Developed to meet the needs of
  males and females.
• Culturally Appropriate Inclusive of diverse
  backgrounds and cultures.
• Trust-Based Built around the Therapeutic
  Alliance to engage and retain clients.
• Outcome-Oriented Based on measurable outcomes
  and benchmarks of progress.

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System Design Expanding Capacity Improving
Quality

• Staff Development Training, proficiency
  standards and clinical supervision to improve
  treatment delivery to adolescents.
• Program Standards Accountability and continuous
  quality improvement through adoption of
  standards.
• Performance Monitoring System-wide effort to
  support functional improvement through data
  collection, monitoring and periodic review.

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System Design Information to Improve Treatment
Effectiveness

• Systematically gathered, maintained, and archived
  information should include a minimum data set.
• Measures should be developed out of consensus in
  the field.
• Data should incorporate assessed client needs,
  services delivered, and client outcomes.
• Monitoring should have the capacity to measure
  overall program performance.
• Archived database should provide informational
  support for planning and resource allocation
  decisions at the client, program and systems
  levels.

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• THANK YOU!
• Visit us at
• www.alcoholdrugpolicy.org
• or contact us at
• 714.505.3525
• dnava_at_alcoholdrugpolicy.org