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Strengthening Adolescent Substance Abuse Screening, Referral & Treatment in Central Illinois Susan H. Godley & Mychele Kenney 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) Jo Daviess Carroll Population: 158,006 Burea u Henry Du Page Cook Chicago McDonoug h Fulton Livingsto n Woodfor d Peoria Schuyle r Kankake e Iroquoi s Tazewe ll McLean Mason Adam s Cass Brown De Witt Logan Menar d Ford Champaig n Piatt Macon Scott Morga n Sangamo n ou Calh n Macoupi n St. Clair Monro e Randolp h Cumberlan d Effingha m Fayett e Bond Clay Mario n Clinto n Bloomington/Normal Jaspe r Richlan d Wayne Washingto n Jefferso n Perry Frankli n Jackso n Edgar Coles Shelb y Montgomer y Jersey Madiso n Dougla s Moultri e Christia n Green e Vermilio n Williamso n Union an Alex r k las Pu i Johnso n Hamilto n Saline Pope Massa c White Gallati n Hardin Clark Crawfor d Lawrenc e W ab h as Knox Grund y Edward s Hancoc k Warre n Will La Salle Putna m Marshal l Stark Pike McLean County Kane Lee Merce r Henderso n 4% Hispanic, & 88% White De Kalb Lake Kendal l Rock d Islan Area: 1200 square. miles 6% African American, McHenr y Boone Ogle Whitesid e (118, 564 in Bloomington-Normal) Ethnicity of 12 to 18 year olds: Winnebag o Stephenson de Adolescent Treatment at Time of Grant Adolescent services began in 1985 Use of GAIN-I in agency SAP—but no use of GAIN or EBP in schools Every SAP counselor approached alcohol & drug problems differently Outpatient/IOP programs that had developed over 15+ years No continuing care following OP, but the possibility for stepping-up No regular meetings with Juvenile Justice MIS had very limited clinical usefulness/no usefulness for collaborating agencies GAIN Screening & Evidenced-Based Intervention at Schools Consistency of Screening Assessment Juvenile Justice/JDC/ SAP/Program Coordination with Other Human Service Agencies Strengthening McLean County for Youth (SCY) MIS Development for Continuum and System of Care Evaluating Continuing Care Following OP Evaluating ManualBased Intervention in OP Thanks to all the staff and collaborators After SCY: Consistency in Screening/Assessment In addition to GAINS in the facility & remote locations: GAIN-Q is used across 18 schools 9 Early Intervention staff certified in GAIN-Q GAIN administered at Justice Center GAIN administered at Detention Center 10 adolescent staff certified GAIN administrators and receiving monthly to semi-annual QA reviews During the Life of Project 1,031 GAIN Screenings/Assessments (not including school ones) – 329 GAINS at Justice Center – 229 GAINS at Juvenile Detention Center 1,372 GAIN-Qs administered in schools Pre-Post data used for SAP feedback to schools for 4 years 268 recruited for GPRA; Follow-up rates > 90% for 3,6, 9, & 12 months “We’ve reduced the length of time between the assessment and the final treatment recommendation being provided to the parents/guardians and referral sources and an admission appointment being offered or scheduled. We’ve been much more consistent with following up with adolescents recommended for services and making sure they are either admitted to services or are refusing, not just "slipping through the cracks"; especially those who are required by the criminal justice system to seek evaluation and treatment.” Intake Counselor 3/06 Evidence-Based Practice in Schools Implementation of GAIN-Q and MET/CBT in 18 schools (9 junior and 9 high schools) Tracking system created to monitor – – – – timely completion of screening tool, referrals for evaluations completed evaluations treatment recommendation Coordination improved between SAP and OP staff – – – – follow-up on referrals for GAIN-Is follow-up on referrals for SAP services working with OP therapists during OP treatment continuing to work with students after tx services no longer being provided Lessons Learned Needed to decide which students get the GAINQ both within school year and year to year – 2 or more sessions – At least once a year Needed to address binge drinking in intervention Needed to add check-in session procedures after MET/CBT – Designed content – Checked-in at least monthly Godley, S.H. & White, W.A.(In Press) Student Assistance Programs: A valuable resource for substance-involved adolescents. The Counselor Lessons Learned Need for school district policies to encourage use of services – Reduce suspension if participate in GAIN & if needed, intervention – Require parent meetings at beginning and end SAP students (n=61) differed from OP/IOP adolescents (n-75) on 4 out of 12 variables – – – – More likely female (54% vs. 29%) Younger (41% 11 to 14 vs 15% in OP) Less likely Black (2% vs 8%) Less likely arrested in last year (12% vs. 62%) Substance Use for MET/CBT5: Years 1 - 3 N=61 100% 90% 80% 70% 85% 75% * 66% 62% 60% 49% * 46% 50% Pre 40% Post 30% 15% 20% 7% 10% 0% % 1+ Days Alcohol Use % 1+ Days Heavy % 1+ Days % 1+ Days Other Alcohol Use Marijuana Use Drug Use * Significant difference, p<.05 (McNemar) “SCY has given the program direction and accountability. It is so helpful to have a standardized intervention to address substance abuse in the schools. Prior to SCY, we did not have any protocol [for] what to do with a student who was using substances but not appropriate for outpatient/ inpatient. It has also helped with coordinating services and referrals for case management and increased communication with other programs… We did become a better, more effective, more functional program with SCY.” SAP Counselor 3/06 Coordination with other Agencies/Child Serving Entities Juvenile Justice – Analyzed the Diversion and Probation Processes Identified time points & types of offenses appropriate for AOD screenings – Added regular meetings with juvenile justice and juvenile detention Review referral and linkage statistics Discuss individual adolescents as needed Discuss how collaboration is going Improved system of referrals and assessments Developed a brochure for families on JJ system Continue to have new avenues for collaboration Performance Indicator Type of JJ Referrals (n=375) AOD-Related 1st Mis. Parental Supervision - 1st Mis. 4% 2% Warn/Min Consequence 11% 1% Informal Sup/Prob - 1st Mis. 25% Parental Supervision - 2nd/Sub. Mis. 1% Informal Sup/Prob - 2nd/Sub. Mis. 2% Prelim Conference 25% 16% 1% Post-Sentencing Hearing 1% Pre-Sentencing/Pre-Trial Condition 3% Post-Placement 1% Felony Offense 7% Left Pos Drug Screen/Admitted Usage Sanction Other Performance Indicator: # Days from Referral to Evaluation (n=362) 4% 18% 0 to 2 3 to 5 6 to 8 9% 38% 9 to 11 >11 Unknown 25% 6% Coordination with other Agencies/Child Serving Entities Interagency steering committee meetings for SCY/ representation continues on several interagency groups after SCY – Representatives from Child Welfare, Homeless, Education, Court Services Provided training on methamphetamines Several events related to the Faith Community— instituted weekly meetings with local group of pastors & ministers re. Youth/Hispanics “The SCY project strengthened the relationship between Chestnut Health Systems and the McLean County Juvenile Court System. CHS has made our job easier by ensuring that adolescents who need treatment actually receive treatment.” Deputy Director, Juvenile Court Services MIS—Electronic Clinical Record and More March 2004: Implemented in intake, outpatient, IOP, and residential December 2004: Trained Juvenile Justice staff—they begin using shortly after April 2005: Test in two SAP schools May 2005: Made available to satellite office in other city (Decatur) September 2005: Make available to all 18 SAP schools MIS Today—over 165 users, many of whom log in daily – – – – – – – Residential (95) OP/IOP (20) Intake (10) SAP (22) Juvenile Justice (12) Research staff (7) Others (Medical staff, records staff, QI Manager, recreation staff) Best news---our IT has taken over maintenance and are still improving the system Used by Juvenile Justice Officers, SAP, Others Referral In Screen Average: 9 referrals a month; 355 hits from JJ staff a week, & Average 9 referrals a month; Weekly 14 different JJ officers average 355 hits Information will be sent to STATE Shows what can & can not be shared Include billing/service data that can be sent to STATE All Diagnosis info Kept in one place GAIN produces report in Word that can be edited and attached. Email the SAP Supervisor requesting review of service plan Add or Remove SAP Life Issues Add objective to Goal (curriculum) Add New Goal (Based off curriculum) Evidenced-Based Practice in Outpatient MET/CBT5 plus two parent sessions Ongoing taping and regular tape review So far, 102 have been randomly assigned to receive MET/CBT7 (106 UOP) Completion rate (all 7 sessions) of 80% MET/CBT Fidelity (n=70) 0% 10% 20% 30% 40% Rapport Building Motivational Interview Personalized Feedback 50% 60% 70% 80% 79% 84% 83% Refusal Skills 84% Enhanced Social Support Coping with EmergencyRelapse Increasing Pleasant Acts 90% 79% 84% 34% Evaluation of Continuing Care Usual Continuing UCC+ Assertive Care (UCC) Continuing Care (ACC) MET/CBT5 + 2 Family Sessions Usual CHS Outpatient MET/CBT7 MET/CBT7 UCC UCC+ACC CHS OP UCC CHS OP UCC+ACC Funding for this study is being provided by National Institute on Drug Abuse, NIH DA18183 Percent of Days out of 180 Outcomes at 6 Months * 100% 90% 80% 70% 61% 76% 66% 78% 60% 50% Days Abstinent* 40% 30% 27% 21% 20% 10% 18% 12% 0% UOP/UCC (n=44) Days Used AOD 5% UOP/ACC (n=38) 13% MET/UCC (n=37) 16% 6% MET/ACC (n=37) Days abstinent minus days in a Controlled Environment. Also, main effect for Continuing Care Type, F(1,155)=7.41, p<.01. Days in Controlled Environment Future—What Will Be Maintained Collection of PI data for screening, assessments, recommendations become part of QI Continue to have screenings/assessments off-site with quick response GAIN-Q and MET/CBT5 training will be written in SAP policies & Procedures/Performance Indicators will continue to part of QI Meetings with JJ will continue MIS (ESSIST) will continue and be improved MET/CBT5 and ACC will continue at least through completion of NIH study