Adolescent Treatment Models: Program and Client Descriptions

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Adolescent Treatment Models Program and Client
Descriptions

• Sally J. Stevens, Ph.D.,
• Research Professor
• University of Arizona
• Southwest Institute for Research on Women
• Services Research Office
• 3912 S. 6th Avenue
• Tucson, AZ 85714
• [phone]
• Workshop presentation for SAMHSA-CSAT Adolescent
  Grantee Meeting Washington, DC.
• February 23-25, 2004

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Overview of Workshop

• I)  815 to 825 Introductions and workshop
  agenda - Andrew/Sally
• II)  825 to 900 Goals of the ATM program and
  program models - Sally
• III) 900 to 945 Outcomes unadjusted case mix
  differences case mix adjusted outcomes -
  Andrew
•  BREAK (945 to 1000)
• III) 1000 to 1045 Outcomes unadjusted case
  mix differences case mix adjusted outcomes -
  Andrew
• IV) 1045 to 1115 Gender issues and drug slang
  game - Sally
• V)  1115 to 1145 Cultural issues in program
  implimentation - Candice
• VI) 1145 to 1215 Selecting programs for
  specific populations and places - Andrew led
  discussion group        
• VII) 1215 to 1230 Wrap up - All

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Presentation Objectives

• Provide an overview of CSATs Adolescent Treatment
  Models (ATM) initiative
• Provide information on the treatment programs
• Provide information on client characteristics

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Adolescent Treatment Models Overview
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Grant Project Overview

• Sponsor CSAT Adolescent Treatment Models (ATM)
  Program
• Years 1998 to2002/2003
• Goals
• Evaluate promising adolescent treatment program
  with regard to 1) who they serve, 2) services
  provided, 3) costs of services, and 4) treatment
  effectiveness.
• Develop replication manuals which describe the
  treatment program (i.e., treatment setting,
  administration, curriculum, staffing pattern)

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1998 Five ATM Programs Funded

• Therapeutic Communities
• Los Angeles Phoenix Academy. Evaluation by
  RAND, Inc.
• Oakland, CA Thunder Road. Evaluation by Public
  Health Institute.
• New York Dynamic Youth. Evaluation by New York
  Office of Alcoholism and Substance Abuse Service.
• Short Term Residential
• Tucson La Cañada. Evaluation by University of
  Arizona.
• Baltimore Mountain Manor. Evaluation by John
  Hopkins School of Medicine.

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1999 Five ATM Programs Funded

• Short Term Residential
• Shiprock, NM Four Corners Regional Adolescent
  Center. Evaluation by University of Oklahoma.
• Outpatient
• Miami The Village. Evaluation by the
  University of Miami.
• Catonsville, MD Epoc Counseling Center.
  Evaluation by Friends Research Institute.
• Bloomington, IL Chestnut Health Systems.
  Evaluation by Chestnut Lighthouse Institute.
• Phoenix, AZ Teen Substance Abuse Treatment.
  Evaluation by the University of Arizona.

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Therapeutic Communities - TCs (Phoenix House,
Thunder Road and Dynamic Youth)

• Treatment Model
• Client Characteristics

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TCs Phases of Treatment

• Phase I Orientation and Stabilization
• Phase II Primary Treatment
• Phase III Transition and Re-entry

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Characteristics of the TC

• Public vs. Private
• Personal Authority from Experience vs. Granted
  Authority
• Whole Person Change vs. Changes in Symptoms
• Jobs vs. Roles

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Adapting Adult TCs for Adolescents

• Emphasis on formal education vs. operations of
  the community
• Emphasis on assessment (psychological disorders,
  learning disabilities, ADHD)
• Emphasis on family
• Longer length of stays
• Additional staff involvement in treatment
• Less confrontation

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TCs Client Characteristics
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TCs Client Characteristics (continued)
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TCs Client Characteristics (continued)
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TCs Client Characteristics (continued)
Primary Substance
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Short-Term Residential La Cañada, Mountain
Manor, Four Corners Regional Adolescent Center
(FCRAC)

• Treatment Model
• Client Characteristics

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La Cañada Treatment Model and Characteristics

• Residential Step-down Model
• 30-days residential
• 2-month intensive outpatient
• 2-month non-intensive outpatient
• Treatment Characteristics
• Based on systems theory and utilizes an milieu
  approach
• Housing for girls is at a separate facility
• Specialized groups (i.e., identity, family)
• Focus on positive community involvement

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Mountain Manor Treatment Model and
Characteristics

• Medically Based Model
• Detoxification (if needed)
• 2-month residential
• Centralized linkage to aftercare outpatient
  services
• Treatment Characteristics
• Based on a medical model with blending of the TC
  approach
• Availability of detoxification
• Medication management and psychiatric care
• Incorporation of 12-step approach
• Separate track for young adults

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Four Corners Regional Adolescent Center (FCRAC)
Treatment Model and Characteristics

• Culturally Based Model
• 3-month residential
• Treatment Characteristics
• Combines cognitive behavioral and
  bio-psychosocial approaches
• Three treatment tracks based on need (Air, Water,
  Earth)
• Incorporation of traditional cultural-spirited
  program
• Emphasis on skill building

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Short-Term Residential - Client Characteristics
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Short-Term Residential - Client Characteristics
(continued)
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Short-Term Residential - Client Characteristics
(continued)
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Short-Term Residential - Client Characteristics
(continued) - Primary Substance
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Outpatient Programs(Epoch Counseling Center, The
Village, Chestnut Health Systems, Teen Substance
Abuse Treatment)

• Treatment Model
• Client Characteristics

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Epoc Counseling Center

• Group-Based Model
• Semi-structured 20 week program
• Treatment Characteristics
• Based on social learning theory and conditioning
  theory
• Treatment induction sessions Motivational and
  Counseling
• Two phases Drug Education Skills Training
• Parental educational support groups

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The Village

• Family-based treatment
• Treatment Characteristics
• Based on multidimensional family therapy
• Four domains
• Adolescent and parent modules

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Chestnut Health Systems (CHS)

• Community-based model
• Outpatient and Intensive Outpatient
• Continuum of care
• Small urban, rural and semi-rural areas
• Treatment Characteristics
• Based on behavioral emotional change theories and
  12-step
• Three treatment tracks
• Family Nights
• System of care

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TSAT

• Home and Group-Based
• 90-days
• Treatment Characteristics
• Based on cognitive behavioral therapy and family
  systems approach
• Transportation
• In-home and multi-group family counseling
• Teen groups

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Outpatient - Client Characteristics
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Outpatient - Client Characteristics (continued)
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Outpatient- Client Characteristics (continued)
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Outpatient- Client Characteristics (continued) -
Primary Substance
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Conclusions

• Client characteristics are mostly male and
  involved with the criminal justice system
• Adolescent present to treatment with multiple
  problems (family, peer, victimization, mental
  distress)
• Substance abuse treatment needs to address
  substance abuse PLUS provide treatment for
  related issues
• Treatment programs should consider the needs of
  special populations (i.e., gender)