Coordinating Council for Juvenile Justice and Delinquency Prevention

1. Coordinating Council for Juvenile Justice and Delinquency Prevention September 12, 2008 Presentation to the Council on the interagency agreement between SAMHSA/CSAT and OJJDP

2. Past Year Violence & Crime – Youth in CSAT Funded Grant Programs *Dealing, manufacturing, prostitution, gambling (does not include simple possession or use) Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)

3. Other sources of Referral have grown, but less than expected Change in Referral Sources: 1993-2003 JJ referrals have doubled, are 53% of 2003 admissions and driving growth 61% growth Source: Treatment Episode Data Set (TEDS) 1993-2003.

4. Main Elements of the Interagency Agreement • Partnership Meetings • State of the State Summits • Tribal Planning Forum on Juvenile Justice and Substance Abuse/Mental Health

5. Outcomes of the Interagency Agreement Partnership Meetings • Initial Planning Meeting (OJJDP, NCJCA, CMHS, CSAT, NASADAD, NASMHD) • Bi-Weekly calls to discuss progress • Ad-hoc Technical Assistance (e.g., Medicaid changes and affect on probation) • Changes to structure of grant programs

6. State of the State Summits • Series of 1 day meetings (researchers, prevention and treatment stakeholders, national associations, consumer groups) • Included input from partnership meetings • Planning for changes to grant making and grant programs

7. Outcomes Combination of 1st two Elements • Two new joint grant programs • OJJDP/CSAT/RWJF MOU to jointly plan, fund and administer juvenile drug court grants • OJJDP/CSAT IAA to jointly plan, fund and administer a new grant program: Brief Intervention and Referral to Treatment (BIRT)

8. Outcomes (cont.) • Planning (under discussion) for new round of juvenile drug court grants (FY 09) • One application • One review • OJJDP (funds drug court); CSAT (funds treatment services)

9. Outcomes (cont.) • Importance of co-occurring disorders for youth offenders: all CSAT grant announcements require screening/assessment for co-occurring disorders • Development of a short screener (20 items) for substance use disorders, co-occurring disorders, and criminal activity (over 98% sensitivity and specificity) • Being implemented in city, county and state systems

10. Despite being widely recommended, only 10% step down after intensive treatment 53% Have Unfavorable Discharges Source: Data received through August 4, 2004 from 23 States (CA, CO, GA, HI, IA, IL, KS, MA, MD, ME, MI, MN, MO, MT, NE, NJ, OH, OK, RI, SC, TX, UT, WY) as reported in Office of Applied Studies (OAS; 2005). Treatment Episode Data Set (TEDS): 2002. Discharges from Substance Abuse Treatment Services, DASIS Series: S-25, DHHS Publication No. (SMA) 04-3967, Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://wwwdasis.samhsa.gov/teds02/2002_teds_rpt_d.pdf .

11. Outcomes (cont.) • Importance of continuing care for youth identified vs. passive referral to self-help groups • Development of mandate in all grant CSAT grant programs (as well as joint CSAT/OJJDP programs) for use of an evidenced-based approach following treatment discharge for continuing care - Assertive Continuing Care (ACC)

12. Sustained Abstinence Early Abstinence General Continuing Care Adherence Relative to UCC, ACC will increase General Continuing Care Adherence (GCCA) GCCA (whether due to UCC or ACC) will be associated with higher rates of early abstinence Early abstinence will be associated with higher rates of long term abstinence. Assertive Continuing Care (ACC)Hypotheses Assertive Continuing Care

13. UCC ACC * p<.05 ACC Improved Adherence 100% 20% 30% 10% 40% 50% 60% 70% 80% 90% 0% Weekly Tx Weekly 12 step meetings Relapse prevention* Communication skills training* Problem solving component* Regular urine tests Meet with parents 1-2x month* Weekly telephone contact* Contact w/probation/school Referrals to other services* Follow up on referrals* Discuss probation/school compliance* Adherence: Meets 7/12 criteria* Source: Godley et al 2002, forthcoming

14. 73% 69% 59% Early (0-3 mon.) Abstainer * p<.05 Early (0-3 mon.) Abstinence Improved Sustained (4-9 mon.) Abstinence 100% 90% 80% 70% 60% 50% 40% 30% 22% 22% 19% 20% 10% 0% Any AOD (OR=11.16*) Alcohol (OR=5.47*) Marijuana (OR=11.15*) Early(0-3 mon.) Relapse

15. 55% 55% 43% High (7-12/12) GCCA * p<.05 GCCA Improved Early (0-3 mon.) Abstinence 100% 90% 80% 70% 60% 50% 38% 36% 40% 30% 24% 20% 10% 0% Any AOD (OR=2.16*) Alcohol (OR=1.94*) Marijuana (OR=1.98*) Low (0-6/12) GCCA

16. Outcomes (cont.) • Importance of the use of cost-effective evidence-based practice for treatment of youth • Effective Adolescent Treatment grant program: Motivational Enhancement/Cognitive Behavioral Therapy 5 sessions

17. EAT Programs did Better than CYT on average Range of Effect Sizes (d) for Change in Days of Abstinence (intake to 12 months) by Site 1.40 1.40 6 programs completely above CYT 1.20 1.20 1.00 1.00 0.80 0.80 Cohen’s d 0.60 0.60 0.40 0.40 0.20 0.20 75% above CYT median 0.00 0.00 4 CYT Sites (f=0.39) (median within site d=0.29) 36 EAT Sites (f=0.21) (median within site d=0.49) Source: Dennis, Ives, & Muck, 2008

18. Tribal Planning Forum • Tribal planning forum on Juvenile Justice, Substance Abuse and Mental Health (Nov 2006) • SAMHSA hosted first Policy Academy on Co-occurring Substance Use and Mental Disorders for Native Communities (Sep 2007) including tribal youth in Wellness Courts • Continuing to work with Tribes to implement their policy changes

19. Interagency Agreement • For more information contact: Randolph Muck, M.Ed. Chief, Targeted Populations Branch Center for Substance Abuse Treatment 240-276-1576 Randy.muck@samhsa.hhs.gov