Funded by : The Center for Substance Abuse Treatment (CSAT)

1. Strengthening Adolescent Substance Abuse Screening, Referral & Treatment in Central IllinoisSusan 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)

2. Population: 158,006 (118, 564 in Bloomington-Normal) Area: 1200 square. miles Ethnicity of 12 to 18 year olds: 6% African American, 4% Hispanic, & 88% White

3. Adolescent Treatmentat 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

4. GAIN Screening & Evidenced-Based Intervention at Schools Consistency of Screening Assessment Juvenile Justice/JDC/ SAP/Program Strengthening McLean County for Youth (SCY) Evaluating Continuing Care Following OP Evaluating Manual-Based Intervention in OP MIS Development for Continuum and System of Care Coordination with Other Human Service Agencies

5. Thanks to all the staff and collaborators

6. After SCY: Consistency in Screening/Assessment In addition to GAINS in the facility & remote locations: • GAIN-Q is used across 18schools • 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

7. 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

8. “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

9. Evidence-Based Practice inSchools • 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

10. Lessons Learned • Needed to decide which students get the GAIN-Q 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

11. 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%)

12. Substance Use for MET/CBT5: Years 1 - 3 N=61 100% 85% 90% 75% * 80% 66% 62% 70% * 60% 49% 46% 50% Pre 40% Post 30% 15% 20% 7% 10% 0% % 1+ Days Heavy % 1+ Days % 1+ Days Other % 1+ Days Alcohol Alcohol Use Marijuana Use Drug Use Use * Significant difference, p<.05 (McNemar)

13. “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

14. 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

15. Performance Indicator Type of JJ Referrals (n=375)

16. Performance Indicator: # Days from Referral to Evaluation (n=362)

17. 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

18. “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

19. 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

20. 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

21. 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

22. Information will be sent to STATE Shows what can & can not be shared Include billing/service data that can be sent to STATE GAIN produces report in Word that can be edited and attached. All Diagnosis info Kept in one place

23. 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)

24. 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%

25. MET/CBT Fidelity (n=70) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Rapport Building 79% Motivational Interview 84% Personalized Feedback 83% Refusal Skills 84% Enhanced Social Support 79% Coping with Emergency- Relapse 84% Increasing Pleasant Acts 34%

26. Evaluation of Continuing Care Usual Continuing Care (UCC) UCC+ Assertive Continuing Care (ACC) MET/CBT5 + 2 Family Sessions Usual CHS Outpatient MET/CBT7 UCC MET/CBT7 UCC+ACC CHS OP UCC CHS OP UCC+ACC Funding for this study is being provided by National Institute on Drug Abuse, NIH DA18183

27. Outcomes at 6 Months 100% 90% 80% 70% 61% 76% 66% 78% 60% 50% Percent of Days out of 180 Days Abstinent* 40% Days Used AOD 30% 27% 21% 20% Days in Controlled Environment 18% 16% 10% 12% 13% 5% 6% 0% UOP/ACC (n=38) MET/UCC (n=37) MET/ACC (n=37) UOP/UCC (n=44) * Days abstinent minus days in a Controlled Environment. Also, main effect for Continuing Care Type, F(1,155)=7.41, p<.01.

28. 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