Hannah K. Knudsen, Ph.D. Center for Research on Behavioral Health and Human Services Delivery

1. 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 Georgia SAPRP Project 053130 The University of Georgia

2. 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 The University of Georgia

3. 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 The University of Georgia

4. Adolescent-Only Levels of Care The University of Georgia

5. Program’s Treatment Model • 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 The University of Georgia

6. Individualized Treatment Plans • 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 The University of Georgia

7. Adoption of Psycho-Social EBPs in Adolescent Treatment The University of Georgia

8. Treatment Fidelity: CBT The University of Georgia

9. Treatment Fidelity: MET/MI The University of Georgia

10. Treatment Fidelity: Brief Strategic Family Therapy The University of Georgia

11. Continuing Care Plans • 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 The University of Georgia

12. 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 The University of Georgia