Susan H. Godley, Brooke Hunter, & Rodney R. Funk Chestnut Health Systems Bloomington, IL

1. Equivalence of Adolescent Community Reinforcement Approach Treatment Process and Outcomes in Community and School Based SettingsJMATE April 2012 Susan H. Godley, Brooke Hunter, & Rodney R. Funk Chestnut Health Systems Bloomington, IL

2. Determining School-Based Delivery • AAFT 1, 2, & 3 and TCE grantee sites (n = 36) • First, sites that reported they were providing all services in schools (3 sites) were included • Next, for those sites (4) that reported they were providing some services in schools, participants were included if they had at least 2 of their GAINs collected in a school setting • The comparison group was composed of all other non-TAY sites (n=29); any participants with 2+ interviews in school were dropped from the comparison group

3. Sample • 7 school based A-CRA sites (492 adolescents) • 29 center based A-CRA sites (2,276) • Adolescents had to have attended school within the past year and been 18 or younger

4. Community Size

5. Demographics *P < .05

6. Mental Health

7. Illegal Activity *p < .05

8. Substance Use *p < .05

9. Creation of Equal Groups • Propensity score weights created from 70 intake variables were used to control for intake differences and to create an equal sized comparison group (n=492) • Prior to PSW, 22 intake characteristics were significantly different between the 2 samples • After propensity weighting, there were no statistically significant baseline differences

10. Implementation Measures

11. Initiation & Engagement = is statistically equivalent * is significantly different

12. Sessions & A-CRA Exposure Scale = is statistically equivalent * is significantly different

13. 6 Month Outcomes

14. Overall Change in 6 Month Outcomes Emotional Problem Scale*

15. Days of Substance Use = is statistically equivalent * is significantly different

16. Emotional Problems Scale = is statistically equivalent * is significantly different

17. Days of Illegal Activity & Being in a Controlled Environment = is statistically equivalent * is significantly different

18. Days of Trouble with Family & Trouble at School = is statistically equivalent * is significantly different

19. Savings in Cumulative Costs to Society

20. Summary of Findings • School-based services when compared to ‘center’ based services included: • more females and youth with less involvement in the justice system, • youth with similar mental health problems, similar numbers of youth using before age 15 and for 3+ years • Implementation: • Center participants had higher rates of engagement • School participants had equivalent initiation rates, number of sessions & A-CRA Exposure

21. Summary of Findings • 6 Month Outcomes • Overall, participants reported significant improvement from intake to follow-up for days of substance use, illegal activity, trouble with family, trouble with school, and a decrease in emotional problems (EPS) • At 6-months follow-up, School & Center participants reported statistically equivalent days of substance use, emotional problems, illegal activity, and of trouble at school • Center treated participants reported higher number of days in a controlled environment and of trouble with family • Relative to the year before intake, youth treated with A-CRA in schools had reductions in their total health care costs by an average of $2,508 per youth in the year after intake.

22. Next Steps • Implement A-CRA and other EBTs in School Based Health Clinics so that substance use treatment is more available and integrated into primary care per the Affordable Care Act • Assess the need for adapting A-CRA further for school-based delivery and evaluate adaptations • Include options for briefer interventions for lower level problems • Continue to include family involvement when possible • Increase emphasis on using CRA treatment procedures for co-occurring problems • Build in continuing care based on standard ‘check-ins’ because it naturally fits in school based settings