the university of georgia evidence-based treatment practices in adolescent substance abuse treatment...
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The University of Georgia
Evidence-Based Treatment Practices in Adolescent Substance Abuse
Treatment Programs:Data from the Public and Private Sectors
Hannah K. Knudsen, Ph.D.Center for Research on Behavioral Health and Human Services Delivery
The University of GeorgiaSAPRP Project 053130
The University of Georgia
Project Significance
• Adolescent substance abuse is a significant public health problem– Treatment can improve outcomes
• Historically, adolescents were integrated into adult programs, which ignored the unique needs of youths– CSAT now advocates the separation of adolescent and adult
services– “Adolescent-only” care is a necessary, but not sufficient,
condition of evidence-based treatment
• There are few data on the adoption and implementation of evidence-based treatment practices (EBPs) within adolescent-only programs
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Research Design
• Builds on NIDA-funded research of nationally representative samples of publicly funded & privately funded SATx centers
• Use of telephone screening to identify eligible programs– Must admit clients 18 years or younger– Must offer at least one treatment program that is “adolescent-only”– Programs can be outpatient, inpatient and/or residential
– A high percentage of centers either do not admit or do not have an adolescent-only level of care (~60%)
• Primary data collection via telephone interviews with adolescent program managers
• Current sample size is 128 centers
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Adolescent-Only Levels of Care
16%20%
13%
52%
68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
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Program’s Treatment Model
47.7%39.8%
7.0%5.5%
12-Step CBT
Eclectic Other
• The most common treatment model was described as “eclectic/mixed”– These programs
drew on elements from multiple models
• Few centers relied only on a 12-step model
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Individualized Treatment Plans
4.84.5
3.83.84.1
0
1
2
3
4
5
Sev
erity
of S
A
Co-
Occ
urri
ng
Age
/Mat
urity
Cul
tura
l Bac
kgro
und
Gen
der
• Individualized treatment plans have been nearly universally adopted
• Program managers were asked about the extent (0 = none, 5 = a great deal) that the plan is tailored to take into into account the characteristics of the client
• Although plans were highly likely to take into account SA and MH needs, treatment plans were less likely to take into account demographic characteristics
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Adoption of Psycho-Social EBPs in Adolescent Treatment
26.0%
95.3%
67.2%71.9%
38.1%31.5%
0%
20%
40%
60%
80%
100%
12-StepMeetings Held
CBT MotivationalEnhancement
Therapy
MotivationalInterviewing
Brief StrategicFamily Therapy
MotivationalIncentives
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Treatment Fidelity: CBT“Thinking about how CBT is used at this center, to what extent does the delivery emphasize the following…”
Mean
0 = not at all emphasized
5 = heavily emphasized
The use of functional analysis to identify clients’ thoughts and feelings before and after substance use.
3.84
The identification of triggers of substance use 3.75
Routine discussions of encounters with “high risk” situations for substance use and the coping skills used in those situations
4.73
The use of role-playing to learn new skills 3.55
The assigning of homework to practice new skills 3.61
The development of concrete strategies for coping with craving 4.26
Learning drug refusal skills 4.41
Creating an “all purpose coping plan” of emergency contacts, safe places, and reliable distracters
4.29
Developing problem-solving skills 4.54
Scale properties: One-factor solution with = .81 4.22 (SD=.54)
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Treatment Fidelity: MET/MI“Thinking about how Motivational Enhancement Therapy/Motivational Interviewing is used at this center, to what extent does the delivery emphasize the following…”
(0 = not at all emphasized to 5 = heavily emphasized)
Mean
(MET-Concordant
Factor)
Mean
(MET-Discordant
Factor)
Assessing clients with regard to the five stages of change 3.89
Confronting clients about their substance-related problems 4.06
Encouraging clients to evaluated how their behaviors are different from their goals and ideals
4.37
Allowing clients to compare the costs and benefits of continuing or stopping their substance abuse
4.30
Exploring the areas in the which clients want to achieve change 4.41
Avoiding the use of argumentation with clients 4.24
Expressing support for the client’s ability to succeed 4.68
The use of reflexive listening 4.24
Encouraging clients to develop their own “change plan” with goals and plans for dealing with barriers to those goals
4.23
Confronting clients about resistance 3.79
Scale Properties: Two-factor solution with
MET-Concordant = .84 and MET-Discordant = .69
4.27 (SD=.68) 3.92 (SD=.98)
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Treatment Fidelity: Brief Strategic Family Therapy
“Thinking about how Brief Strategic Family Therapy is used at this center, to what extent does the delivery emphasize the following…”
Mean
0 = not at all emphasized
5 = heavily emphasized
Building therapeutic alliances with the adolescent as well as family members
4.26
Gaining the trust of the family members as a foundation for the change process
4.32
Including the entire family in the treatment process 3.94
Assessing patterns of family communication and interaction that contribute to the adolescent’s drug use
4.34
The use of behavioral contracting to set clear ground rules for family interactions
3.74
Having family members speak directly to each other rather than recounting events to the therapist
4.11
Developing appropriate boundaries between family members that avoid enmeshment and reduce disengagement
4.21
Empowering parents to be the leaders of the family 4.36
Reframing negativity expressed by the client and/or family members 4.32
Scale properties: One-factor solution with = .90 4.18 (SD=.74)
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Continuing Care Plans
40.9%
14.2%
0%
25%
50%
75%
100%
Telephone Counseling
Home-Based Counseling
• Nearly all centers (92.0%) report that a continuing care plan is developed for all of their adolescent clients
• Those plans sometimes include contact via telephone counseling, but rarely include home-based counseling
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Summary• Adolescent treatment programs largely deliver outpatient care
using either an eclectic or CBT-based model
• Several psycho-social EBPs have been widely adopted, including CBT, motivational interviewing, and motivational enhancement therapy– Motivational incentives (contingency management) and Brief
Strategic Family Therapy are less common, but have been adopted by about one-third of programs
• Among adopters, CBT and BFST appear to be largely implemented with fidelity– However, MET/MI-adopting centers continue to use confrontational
approaches, which are not consistent with MET/MI
• Treatment plans and continuing care plans have been adopted– There is variability in 1) the extent to which treatment plans are
tailored and 2) the use of telephone & home-based counseling as part of continuing care