Cannabis Youth Treatment CYT Interventions and Their Implementation with Multicultural Groups

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Cannabis Youth Treatment (CYT) Interventions and
Their Implementation with Multicultural Groups

• Susan Harrington Godley, Rh.D.
• Chestnut Health Systems Lighthouse Institute
• 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)

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Surveyed EATS sites, otherselected sites using
other CYT Interventions, and developers

• EATS goals
• Adopt/Adapt an effective (individual
  outcomes/cost) substance abuse treatment
  intervention for youth (MET/CBT 5)
• Expand the availability of substance abuse
  treatment for youth

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(No Transcript)
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Populations Served(in site descriptors)

• Butler County, Ohio Most are of Appalachian
  descent, few AA and Hispanic
• Culver City, CA 40 to 50 Latino and 40 AA
• DC 42 AA, 33 White, 8 Asia
• Denver 33 White, 23 Hispanic, 2.5 Native
  American, 12.5 Biracial
• Denver TASC Hispanic 51-52
• Houston, TX 45 Hispanic, 45 Caucasian,
  Non-Hispanic, 10 African American spread across
  a large geographic countymuch of it urban

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Populations Served(in site descriptors)

• Lansing, MI 53 AA 21 Hispanic, 5 Asian
  American, 21 Caucasian split between urban and
  rural youth
• Laredo, TX 95 Mexican American and bilingual
  many speak Tex-Mex large percentage of
  counseling sessions are in Spanish half
  urbanhalf rural some live in colonias also
  has satellite offices in rural locations
• Norwalk, CT Urban youth with a number of AA and
  Hispanic referrals
• NYC Primarily Latino and AA, inner-city youth,
  ages 12-17

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Other Sites

• Bloomington, IL Student Assistance Program and
  OP
• Little Rock, AR
• Orlando, FL
• Pinellas Park, FL

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Comments aboutCultural Groups
  We also identified the Teen Culture, Gang
culture, Gender Specific issues, Gay, Lesbian,
and transgender, and the Drug culture as
important issues to be aware of for our clients.
We havent found any major differences between
cultural groups, the issues are general
adolescent issues/behaviors.
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Discussion Points

• Can you be more confrontative with certain
  populations?
• What is the interaction between resistance to
  manual-guided therapy and cultural relevance of
  an approach?
• Commonality among adolescent issues vs. cultural
  issueswhich is greater?
• Culture often interacts with socio-economic
  factorse.g., when planning alternative
  activitiesthis may be a problem due lack of
  fundsnot culture

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No Adaptations(may have added to the
intervention, but did not adapt)

• Arapahoe House Denver, Co.
• Operation Par Pinellas Park, FL
• BEST Adolescent Initiative Orlando, FL
• UAMS Little Rock, AR
• Duke University Durham, NC
• Project TEMPO Norwalk, CT
• Take Five Program Houston, TX
• Butler County, OH
• NY (East Central Harlem), NY -- None yet, but
  plan to adopt the Hip Hop version.
• Prototypes Culver City, CA
• Project BEAT Washington, DC

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Why no adaptations
  I think the intervention is general enough to
allow for normal variances in our approach taken
with individual students.  The biggest
differencesdon't have to do with ethnicity or
socio-economic issues.  Instead, the support
environment and motivation, both internal and
external, appear to be the keys.  For example, a
Caucasian female student with using parents did
not do as well when the intervention was complete
as did an AA male with an extremely supportive
(meaning supporting his goal to remain abstinent)
mother.  As far as internal and external
motivation, the two AA males I had did well in
the intervention.  One did not think using fit
with his self-image and the other was on
probation and being tested.
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Comments About Staff
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Comments aboutStaff
  Our counseling staff is diverse, young, and
energetic. We have not made any
changesbecause we are accustomed to working with
this particular population. A few of our staff
members are fluent in Spanish. Our agency also
coordinated with a local university to provide
Spanish classes to staff members. We have a
staff member that can interpret and is available
to give us insight whenever needed. In our ABT
program, we have an AA primary counselor that
provides direct service and is able to give us
insight as well.
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Staff
  We feel strongly that it is most important to
have clinically sound staff that are Hispanic
acculturated and Non-Hispanic acculturated,
knowledgeable of African American culture, the
differences in the many Anglo cultures as well as
the different Asian populations we see. It is
important that staff are trained in and
culturally competent in order to deal with our
very diverse populationit is importantto state
that just because a counselor is of Hispanic or
AA background does not mean they are culturally
competent to work with that population. Training
is the most important.
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Adaptations

• Lansing, MI
• TASC, Denver

• Provide services in alternative settingsin an
  alternative school, day program do more of the
  CBT individually
• Minor changes in educational materials, Welcome
  uses sculpting to act out what a support group is
  like

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Adaptations

• Bloomington, IL
• SCAN Laredo

• Adapted MET/CBT5 for school setting by changing
  many forms to reflect students and offering CBT
  in individual sessions
• Combine ACRA and ACC for rural area translation
  of some materials in Spanish

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Didnt necessarily adapt, but added to the
intervention

• Arapahoe House, Denver
• TASC, Denver, CO
• Little Rock, AR
• Durham, NC
• Norwalk, CT

• Houston, TX
• Bloomington, IL
• Butler County, OH
• Laredo, TX
• Culver City, CA

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AdditionsFamily Sessions (9 sites)

• Family sessions when needed, involve family,
  family psychotherapy (2)
• Add FSN sessions (2)
• Family sessions at the beginning and end of
  treatment to orient to the treatment and review
  progress
• Two parent education sessions, done in a group
  that meets twice per month, education about the
  treatment, about monitoring adolescent substance
  use and consequences for use, and about
  parent-adolescent communication

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AdditionsFamily Sessions (9 sites)

• Added a family component, which runs concurrently
  with the first two CBT sections. It is a
  support/education group for parents of program
  participants.
• After MET/CBT 5case manager has 2 family
  appointmentspreferably in the home, clients come
  back for one more booster session, and then one
  last family/case management session.

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Other Additions

• CBT7 sessions (2)
• CM which starts with their first MET session
  either
• case management every week for 2 months and 2 X
  the third month phone CM
• 2 in-home sessions and then phone for the rest of
  the yeardepending on assessment

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Hip Hop MET/CBT5
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Hip Hop MET/CBT5

• Used old school hip hop music to start
  sessionschosen to fit the themesvery positive
• Change words to fit urban slang, e.g.,
• Drug refusal, AKA How to represent
• Problem solving, AKA Breaking it Down
• Social Support, AKA My Peeps
• Anger Management, AKA Chilling
• Participant folders were customizedcolorfulwith
  graffiti from the city and a rapper guy

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Contact for Hip Hop Information

• John Callas
• CT Juvenile Training School
• Wk No. 860-638-2722

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MDFT(information courtesy of Dr. Cindy Rowe)

• Developed and first tested in San Francisco with
  a largely Caucasian sample
• Temple University study 75 African-American
• University of Miami Center for Treatment Research
  on Adolescent Drug Abuse

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FAMILY THERAPY WITH AFRICAN AMERICAN YOUTH

• Jackson-Gilfort, Liddle, Dakof, Tejeda (in
  press)
• Does inclusion of culturally relevant themes
  facilitate engagement of African-American male
  adolescents in family therapy?
• Trust/Mistrust Anger/rage
• Alienation Respect/disrespect
• Spirituality Boyhood to manhood
• Racial identity Racism
• Hopelessness
•  

 
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LINKING CULTURAL THEME EXPLORATION AND OUTCOMES

• Results
• Journey from Boyhood to Manhood improved quality
  of therapeutic relationship increased
  participation in therapy, and facilitated deeper
  exploration of issues generally
• Anger/rage increased engagement in therapy and
  facilitated deeper exploration of issues
• Alienation increased participation and
  engagement in therapy
• Racial Identity increased participation
• General Issues of Racism increased participation
  in therapy

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LINKING CULTURAL THEME EXPLORATION AND OUTCOMES

• Results
• Exploration of cultural themes was associated
  with increased participation and decreased
  negativity of youth in the next treatment session
• Conclusion Exploring culturally meaningful
  themes is directly linked to investment in
  treatment for African-American youth

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ACRA/ACC in Laredo
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• Used for primary OP and stepping down (there is
  no IOP)
• Use home-based model
• Spanish translation of certain toolsespecially
  important for parents who may be first generation
• Added FSN family night in conjunction and for
  those on waiting listimportant for a sense of
  community and belongingsnacks are provided and
  all family members are welcome

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Spanish Publications

• From SAMHSAs National Clearinghouse for Alcohol
  and Drug Information
• La marihuana Información para los adolescentes
  (Marijuana Facts for Teens) - Order pamphlet
  free of charge at http//store.health.org/catalog
  /ProductDetails.aspx?ProductID14609
• Marijuana lo que los padres deben saber
  (Marijuana Facts Parents Should Know) - Order
  pamphlet free of charge at http//store.health.or
  g/catalog/ProductDetails.aspx?ProductID14606

• From Chestnut Health Systems
• Folleto de Información General (General FAQ
  designed for parents with questions about
  adolescent substance use in general or for those
  participating in an initial substance use
  assessment) http//www.chestnut.org/Adolescent/Fo
  lleto_Uno.pdf
• Folleto de Tratamiento (Residential treatment FAQ
  designed for parents whose adolescent is entering
  residential treatment) http//www.chestnut.org/Ad
  olescent/Folleto_Dos.pdf

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Contact Information

• Susan H. Godley, Rh.D.
• Chestnut Health Systems
• 720 W. Chestnut St.
• Bloomington, IL 61704
• 309.829.3543 ext.83343
• sgodley_at_chestnut.org