Cannabis Youth Treatment (CYT) Interventions and Their Implementation with Multicultural Groups

1. Cannabis Youth Treatment (CYT) Interventions and Their Implementation with Multicultural Groups Susan Harrington Godley, Rh.D. Chestnut Health Systems’ Lighthouse Institute 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. Surveyed EATS sites, otherselected sites using other CYT Interventions, and developers • EATS goals • Adopt/Adapt an effective (individual outcomes/cost) substance abuse treatment intervention for youth (MET/CBT 5) • Expand the availability of substance abuse treatment for youth

4. Populations Served(in site descriptors) • Butler County, Ohio: Most are of Appalachian descent, few AA and Hispanic** • Culver City, CA: 40 to 50% Latino and 40% AA • DC: 42% AA, 33% White, 8% Asia • Denver: 33% White, 23% Hispanic, 2.5% Native American, 12.5% Biracial • Denver TASC: Hispanic 51-52% • Houston, TX: 45% Hispanic, 45% Caucasian, Non-Hispanic, 10% African American spread across a large geographic county—much of it urban

5. Populations Served(in site descriptors) • Lansing, MI: 53% AA; 21% Hispanic, 5% Asian American, 21% Caucasian; split between urban and rural youth • Laredo, TX: 95% Mexican –American and bilingual; many speak Tex-Mex; large percentage of counseling sessions are in Spanish; half urban—half rural; some live in “colonias”; also has satellite offices in rural locations** • Norwalk, CT: Urban youth with a number of AA and Hispanic referrals • NYC: Primarily Latino and AA, inner-city youth, ages 12-17

6. Other Sites • Bloomington, IL Student Assistance Program and OP • Little Rock, AR • Orlando, FL • Pinellas Park, FL

7. Comments aboutCultural Groups “We also identified the Teen Culture, Gang culture, Gender Specific issues, Gay, Lesbian, and transgender, and the Drug culture as important issues to be aware of for our clients.” “We haven’t found any major differences between cultural groups, the issues are general adolescent issues/behaviors.”

8. Discussion Points • Can you be more confrontative with certain populations? • What is the interaction between resistance to manual-guided therapy and cultural relevance of an approach? • Commonality among adolescent issues vs. cultural issues—which is greater? • Culture often interacts with socio-economic factors—e.g., when planning alternative activities—this may be a problem due lack of funds—not culture

9. No Adaptations(may have added to the intervention, but did not adapt) • Arapahoe House; Denver, Co. • Operation Par; Pinellas Park, FL • BEST Adolescent Initiative; Orlando, FL • UAMS; Little Rock, AR • Duke University; Durham, NC • Project TEMPO; Norwalk, CT • Take Five Program; Houston, TX • Butler County, OH • NY (East & Central Harlem), NY -- None yet, but plan to adopt the Hip Hop version. • Prototypes; Culver City, CA • Project BEAT; Washington, DC

10. Why no adaptations “I think the intervention is general enough to allow for normal variances in our approach taken with individual students.  The biggest differences…don't have to do with ethnicity or socio-economic issues.  Instead, the support environment and motivation, both internal and external, appear to be the keys.  For example, a Caucasian female student with using parents did not do as well when the intervention was complete as did an AA male with an extremely supportive (meaning supporting his goal to remain abstinent) mother.  As far as internal and external motivation, the two AA males I had did well in the intervention.  One did not think using fit with his self-image and the other was on probation and being tested.”

11. Comments About Staff

12. Comments aboutStaff “Our counseling staff is diverse, young, and energetic.” “We have not made any changes…because we are accustomed to working with this particular population.” “A few of our staff members are fluent in Spanish. Our agency also coordinated with a local university to provide Spanish classes to staff members. We have a staff member that can interpret and is available to give us insight whenever needed. In our ABT program, we have an AA primary counselor that provides direct service and is able to give us insight as well.”

13. Staff “We feel strongly that it is most important to have clinically sound staff that are Hispanic acculturated and Non-Hispanic acculturated, knowledgeable of African American culture, the differences in the many Anglo cultures as well as the different Asian populations we see. It is important that staff are trained in and culturally competent in order to deal with our very diverse population…it is important…to state that just because a counselor is of Hispanic or AA background does not mean they are culturally competent to work with that population. Training is the most important.”

14. Lansing, MI TASC, Denver Provide services in alternative settings—in an alternative school, day program; do more of the CBT individually Minor changes in educational materials, Welcome; uses sculpting to act out what a support group is like Adaptations

15. Bloomington, IL SCAN; Laredo Adapted MET/CBT5 for school setting by changing many forms to reflect students and offering CBT in individual sessions Combine ACRA and ACC for rural area; translation of some materials in Spanish Adaptations

16. Arapahoe House, Denver TASC, Denver, CO Little Rock, AR Durham, NC Norwalk, CT Houston, TX Bloomington, IL Butler County, OH Laredo, TX Culver City, CA Didn’t necessarily adapt, but added to the intervention

17. Additions—Family Sessions (9 sites) • Family sessions when needed, involve family, family psychotherapy (2) • Add FSN sessions (2) • Family sessions at the beginning and end of treatment to orient to the treatment and review progress • Two parent education sessions, done in a group that meets twice per month, education about the treatment, about monitoring adolescent substance use and consequences for use, and about parent-adolescent communication

18. Additions—Family Sessions (9 sites) • Added a family component, which runs concurrently with the first two CBT sections. It is a support/education group for parents of program participants. • After MET/CBT 5—case manager has 2 family appointments—preferably in the home, clients come back for one more booster session, and then one last family/case management session.

19. Other Additions • CBT7 sessions (2) • CM which starts with their first MET session either • case management every week for 2 months and 2 X the third month + phone CM • 2 in-home sessions and then phone for the rest of the year—depending on assessment

20. Hip Hop MET/CBT5

21. Hip Hop MET/CBT5 • Used old school hip hop music to start sessions—chosen to fit the themes—very positive • Change words to fit urban slang, e.g., • Drug refusal, AKA ‘How to represent’ • Problem solving, AKA ‘Breaking it Down’ • Social Support, AKA ‘My Peeps’ • Anger Management, AKA ‘Chilling’ • Participant folders were customized—colorful—with graffiti from the city and a rapper guy

22. Contact for Hip Hop Information John Callas CT Juvenile Training School Wk No. 860-638-2722

23. MDFT(information courtesy of Dr. Cindy Rowe) • Developed and first tested in San Francisco with a largely Caucasian sample • “Temple University” study: 75% African-American • University of Miami Center for Treatment Research on Adolescent Drug Abuse

24. FAMILY THERAPY WITH AFRICAN AMERICAN YOUTH Jackson-Gilfort, Liddle, Dakof, & Tejeda (in press): • Does inclusion of culturally relevant themes facilitate engagement of African-American male adolescents in family therapy? • Trust/Mistrust Anger/rage • Alienation Respect/disrespect • Spirituality Boyhood to manhood • Racial identity Racism • Hopelessness

25. LINKING CULTURAL THEME EXPLORATION AND OUTCOMES Results: • Journey from Boyhood to Manhood: improved quality of therapeutic relationship; increased participation in therapy, and facilitated deeper exploration of issues generally • Anger/rage: increased engagement in therapy and facilitated deeper exploration of issues • Alienation: increased participation and engagement in therapy • Racial Identity: increased participation • General Issues of Racism: increased participation in therapy

26. LINKING CULTURAL THEME EXPLORATION AND OUTCOMES Results: • Exploration of cultural themes was associated with increased participation and decreased negativity of youth in the next treatment session • Conclusion: Exploring culturally meaningful themes is directly linked to investment in treatment for African-American youth

27. ACRA/ACC in Laredo

28. Used for primary OP and stepping down (there is no IOP) • Use home-based model • Spanish translation of certain tools—especially important for parents who may be first generation • Added FSN family night in conjunction and for those on waiting list—important for a sense of community and belonging—snacks are provided and all family members are welcome

29. Spanish Publications • From SAMHSA’s National Clearinghouse for Alcohol and Drug Information: • La marihuana: Información para los adolescentes (Marijuana: Facts for Teens) - Order pamphlet free of charge at: http://store.health.org/catalog/ProductDetails.aspx?ProductID=14609 • Marijuana: lo que los padres deben saber (Marijuana: Facts Parents Should Know) - Order pamphlet free of charge at: http://store.health.org/catalog/ProductDetails.aspx?ProductID=14606 • From Chestnut Health Systems: • Folleto de Información General (General FAQ designed for parents with questions about adolescent substance use in general or for those participating in an initial substance use assessment): http://www.chestnut.org/Adolescent/Folleto_Uno.pdf • Folleto de Tratamiento (Residential treatment FAQ designed for parents whose adolescent is entering residential treatment): http://www.chestnut.org/Adolescent/Folleto_Dos.pdf

30. Susan H. Godley, Rh.D. Chestnut Health Systems 720 W. Chestnut St. Bloomington, IL 61704 309.829.3543 ext.83343 sgodley@chestnut.org Contact Information