Asian Youth Community Reinforcement Project

1. Asian Youth Community Reinforcement Project Joint Meeting on Adolescent Treatment Effectiveness Daniel Toleran, MS AOD Coordinator/ SAMHSA Project Director December 16, 2010

2. Workshop Agenda • Presenter Introductions • Agency Overview • ACRA/ACC • Clinical Supervision • Notes from the field • Project outcomes • Q & A

3. Session Objectives • Be familiar with Adolescent Community Reinforcement Approach and Assertive Continuing Care (ACRA/ACC) an evidence based intervention (EBI) approach used with inner city urban youth who have substance use and abuse history. • Be able to discuss cultural and linguistic strategies to meet the needs of substance using Asians and other ethnic minority inner city urban youth. • Be able to identify key adaptations made to an EBI to serve diverse inner city urban youth.

4. Asian Community Mental Health Services MISSION Asian Community Mental Health Services (ACMHS) provides and advocates for multicultural, multilingual services that empower the most vulnerable members of our community to lead healthy, contributing, and self-sufficient lives.

5. Asian Community Mental Health Services ACMHS has a total of 120 full and part time staff: • Licensed Clinical Social Workers • Marriage & Family Therapists • Psychiatrists • Clinical Psychologists • Mental Health Specialist • Case Managers • Registered AOD Counselors

6. Cambodian Cantonese English Japanese Khmuu Korean Burmese and Karen Laotian Mandarin Mien Tagalog Toisan Vietnamese Current Language Capacity ACMHS staff provide services in 13 languages:

7. Asians and Pacific Islanders • California Department of Mental Health indicate that rates of psychopathology among A&PI have been underestimated. • Research has consistently shown that A&PI and other communities of color tend to delay seeking mental health services, and as a result suffer from more severe mental health conditions. (Rita Chi-Ying Chung, Keh-Ming Lin, 2004) • A&PI have longer hospitalizations than other ethnic groups. (Steven Tötösy de Zepetnek and Jennifer W. Jay, 1997)

8. Asians and Pacific Islanders Among logistic, systemic and cultural obstacles cited for underutilization of Behavioral Health Services: • Limited English Proficiency (LEP) • Economic/financial limitations • Transportation difficulties • Post-traumatic stress disorder • Multiple and interrelated health and mental health problems • Lack of understanding of U.S. social service and health care systems • Stigma related to seeking psychological/counseling support or treatment.

9. Youth AOD Services • Referral • Case Disposition • Engagement and Screening • Intake • Treatment • Alternative/Pro-social Actvities

10. Youth AOD Clients FY 2010 • Other: Self referred, family member, and none identified.

11. Jane Yi, MA, PhD. InternACRA/ACC Clinical Supervisor ACRA/ACC Supervision Success, Challenges and Adaptations

12. Asian Youth Community Reinforcement (ACRA/ACC) Clients • as of 9/10 73 clients/ Grant Target 102 Age: (14%) under 15yo, (61%) 15-17yo, (25%) 18+ Ethnicity: (36%) African American, (23%) Asian, (12%) Hispanic, (23%) Mixed School and clinic based treatment service (40/60) (Located at: Oakland High School and ACMHS Clinic)

13. ACRA/ACC Model Description • Procedures (Manual-ized Treatment: 9 core, 10 additional procedures) • Certification Requirements • Clinician • Supervision • GAIN local trainer • Digital Session Recording/Fidelity Test • Coaching calls • Upload to centralized multi-site data storage • Chestnut Health Systems

14. Implementation • Referral, follow up, registration, engagement • Course of Treatment • Home/Community/School Environment • Transition/Discharge Planning • 3, 6 and 12 month follow up

15. Project and Clinical Supervision • Procedures • Successes • Challenges • Adaptation

16. Notes from the field:ACRA/ACC in the community Diana Truong, MS. ACRA/ACC ClinicianMary Kay Chin, MA. ACRA/ACC Clinician

17. Notes from the field:ACRA/ACC in the community Diana Truong, MS. ACRA/ACC ClinicianMary Kay Chin, MA. ACRA/ACC Clinician

18. Oakland Quick Facts

19. Oakland –City and High School

20. “Life Hassles” faced by clients • Developmental • Environmental • Societal • Family Life • Systemic Issues • Force migration • Violence

21. Challenges for providers • Cultural • Lack of resources • Grief and trauma • Legal involvement • Family structure • Alternative approaches (example: client volunteering drug use vs. random testing)

22. Procedures • Case example(s):using a procedure • Challenges faced in working with clients

23. Engagement and Retention Strategies encouraging continued participation: • Snacks and food • Incentives • Frequent client contact • Use of agency resources • Meeting clients where they are • Group pro-social activities

24. Retention Data

25. Retention and Follow Up Kristin Johnson, BA Outreach and Retention Specialist

26. Follow up: Data Collection • Tracking down clients at 3, 6 and 12 months • Meeting clients where ever they are • Challenges: communication, contact information, • Support: family members, school personnel, P.O., friends • Challenges of Data Collection Instrument – GAIN “your killing me slowly” • Internal Evaluation: Client Satisfaction Survey (individual interviews)

27. Pro-social Activities • Why ? • Retention • Healthy Alternatives • Development of “community” • What it takes: Planning and Coordination • Client participation and involvement • Unique challenges • Cross cultural/ethnic relationships between participants and venues/sites

28. Outcomes: How we measured it • Retention rate • Navigating school • Number of contacts • Follow up information • Client satisfaction survey • Keep them “at home” • Completion of probation • Decrease in drug use • Shift in relationship with drug use

29. Outcomes: client perspectivesPreliminary Findings Internal evaluation use of individual interview N= 30: 37% (11) African American/Black; 33% (10) Asian; 13% (4) Latino; 13% (4) Multi-racial; 3%(1) Caucasian/White. Sex: 90% (27) male; 10% (3) female Age: 15-20 yo, average 17.5 (SD=1.5 years) Ave. # of sessions: 10.7

30. Outcomes: clients perspectivesPreliminary Findings Relationships with Counselors: • “She was hella cool. We could talk about anything.” • “They were very nice, professional, understanding, had a polite aura. They were good at keeping people in a calm state.” • “She talks to me nicely and respects what I say. She’s like a friend I can trust.” Drug Usage: - “I stopped smoking marijuana for 4 months…” - “It helped me to slow down on my marijuana use each day, step by step. Sessions helped show me how to use less drugs step by step.”

31. Outcomes: clients perspectivesPreliminary Findings

32. Outcomes: clients perspectivesPreliminary Findings

33. Lessons learned: from clients • Building rapport with youth (ethnicity and gender do not match with provider) • Trust building • Non-monetary incentives • Monetary incentives • Food and nourishment • Age or grade level performance • Bi-national/out of country or out of county parents

34. Lessons learned:organizational • Youth service integration into Adult Clinic • AOD services in an adult Mental Health OP Clinic • Diversity of youth clients • Under staffed youth service and coordination across youth projects • Challenges of underfunded schools and its impact on the safety net • Perceptions of AYCR clients by clinic staff and community/neighborhood

35. CLOSING • Q and A • Thank You • Contact Info • Daniel Toleran,M.S. AOD Coordinator/SAMHSA Project Director danielt@acmhs.org 510.869.6095