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									                  Treatment 2.0:
Utilizing Technology for Enhancement of Services
             and Engagement of Youth

                               Bridget Ruiz, M.Ed.
                               Alison Greene, MA
                                   Elise Lopez
                                 Desiree Bernal

                     Southwest Institute for Research on Women
                             The University of Arizona
                           181 S. Tucson Blvd Suite 101
                                 Tucson, AZ 85716

     Presented at the Strategic Planning for Providers to Improve Business Practices
                                   October 21-23, 2009
                                      Arlington, VA
                   Session Outline
•   Review of media definitions and history
•   Media utilization in health care
•   Web 2.0
•   Description of Assertive Adolescent and Family
    Treatment initiative
•   Enhancing AAFT with media
•   What’s next?
•   Emerging issues, recommendations
•   Acknowledgements/Disclaimer
•   Sources
Media Definitions
   & History

A people without history is like the wind
           on buffalo grass”

             -Lakota saying
                        Media Definition

• Tools used to store and deliver information
  or data(Wikipedia, 2009)

• The means of communication, as radio
  and television, newspapers, and
  magazines, that reach or influence people
  widely(dictionary.com, 2009)
              Brief History of Media

Grunts and Gestures
      Literacy-Greek Alphabet
          Morse Code

     Internet        Convergent Technologies
     Media Utilization in Behavioral Health Care:

• Electronic health records (Knowles, 2009)
• Web-based data collection tools
   – SAIS (Mulvey, Atkinson, Avula, & Lucky, 2005)
   – GAIN (Dennis, M.L., Titus, J.C., White, M.K., Unsicker, J., & Hodgkins, D. 2003)
• Mail and Telephone Continuing Care
  Systems              (Godley, Coleman-Cowger, Titus, Funk, & Orndorff, in press; Kaminer, Burleson, &
  Burker, 2008)
                     Web 2.0

Source: Omniture's
Assertive Adolescent and
Family Treatment (AAFT)
I have found the best way to give advice to your children is to find out
            what they want and then advise them to do it.
                          -Harry S Truman
        SAMHSA-CSAT Adolescent Initiatives
• For more than a decade SAMHSA’s Center
  for Substance Abuse Treatment (CSAT) has
  funded a series of initiatives to replicate
  evidence-based practices and collect
  information on their effectiveness in the
  – CSAT required use of:
    • Evidence based treatment
    • Evidence based assessment (Global Appraisal of
      Individual Needs [GAIN])

    Muck et. al., 2009
           CSAT Adolescent Initiatives
• Since September 2006, the Center for
  Substance Abuse Treatment (CSAT) has
  awarded 32 Assertive Adolescent Family
  Therapy (AAFT) grants
• Purpose of AAFT grants: To provide support
  for the initial training and implementation of
  evidenced based approaches to assessment
  and treatment for adolescents and their
                                 Details of AAFT

• Provide evidence based assessment for
  clinical planning and outcome monitoring
  – Global Appraisal of Individual Needs
• Provide evidence based treatment
  – Adolescent Community Reinforcement
    Approach (ACRA) and Assertive Continuing
    Care (ACC)
     • Social Learning Theory
     • Operant model with social systems approach

     Dennis et. al., 2003; Godley, SH et. al., 2001

• Training and Certification

• Coaching and Supervision

• Peer to Peer Discussions
                           CSAT Full GAIN Data

Source: CSAT 2008 SA Dataset Adolescent Subset (n=16,006)   13
    Change in 6 Month Abstinence Relative to Other
     CSAT Adolescent Treatment Grant Programs

Source: SAIS System (GPRA) 2008 data
Butler et. al., 2009
Enhancing A-CRA/ACC
     with Media
      If I could tell you what it meant,
   there would be no point in dancing it
               -Isadora Duncan
      Enhancing A-CRA for Youth Engagement

• Podcasting
  – iTunes U
  – Eligibility/Agreements
  – MP3 player
  – Therapists

  Ruiz et. al., 2009

Podcast Downloads
Podcast Previews
                   Youth Feedback

You guys must really trust me to lend me this
  iPod—it is a nice one.

I am sharing these podcasts with my friends.

This is pretty cool.

I had a hard time downloading them to the iPod.
             Caregiver Comments

Maybe I can help you [the youth] download
 the podcasts.

This is a good way to share information with
               Therapist Feedback

With one of my clients who has ADHD I was able
 to play the podcast in a session, pause the
 podcast to discuss the procedures and then
 return to listening. For example, with the
 podcast on problem solving I was able to pause
 the recording after each step was reviewed to,
 then, discuss with the client how it applies to his
 real life example. He seemed to focus better
 and understand the material.

I was able to help a client access the site using the
   A-CRA problem solving steps.
The Inbox
                What’s Next?

"The past is a source of knowledge, and the future is a source of hope.”
                         -Stephen Ambrose
   Recovery Oriented Systems of Care for Youth

• Looks very different that adult ROSC.
• Must incorporate representatives from
  various disciplines (e.g., education; juvenile
  justice; child welfare; youth recovery
• Examine our own treatment systems to
  make sure they are healthy.
• Examine issues and implement strategies
  to reduce stigma.
                 Las Rosas-ROSC

• Implementing Sanctuary Model             (Bloom, 2009)

• Implementing ROSC-Consortium
• Examining community perceptions
  – Perceptions of:
    • awareness, availability, access of recovery
      supports for youth
    • Typical adult attitudes/feelings towards youth in
  – 100 electronic surveys distributed to
    ―community leaders.‖
       Las Rosas: Services and Supports Model

Adapted from: Clark, W (2008). The benefits of ROSC for Adolescents and Transitional Aged Youth. Presented at the SAMHSA Consultative
     Session to Develop ROSC for Youth. 11/14/2008 Rockville MD
                     Community Survey Results

• 37 participants: 70% female with an age
  range of 26-76 years old
• Professions represented:
  – Professional, other unspecified (24%)
  – Administrative/management (22%)
  – Consultant/self-employed (14%)
  – Health care (11%)
  – Real estate (8%)
  – Public service, Education, Arts, &
    Retired/Volunteer (5% each)

  Korchmaros, Lopez, & Ruiz (2009)
              Community Survey

• Number of recovery supports available in
  – 36% report 5+ in Tucson
  – 24% report 3 or 4
  – 24% report 1 or 2
  – 16% report 0
          How easily adolescents find and receive recovery supports that
     How easily can can adolescents findand receive recovery supports that are are
                           available in our community
                                 available in our community?
Percentage of










                                                                     't k


                                          Degree of ease
               Perceived degrees of sympathy toward and support of adolescents by
                        Perceived degrees of sympathy toward and support of
                                typical members of the community
                                 adolescents by typical members of the community
Percent of respondents

                         40.0%                                                            Sympathetic
                         30.0%                                                            Supportive
                                 Very       Moderately            Somewhat   Not at all
     Perceived extent that the typical member of our community feels that
         Perceived extent that the will be productive in the community
        adolescents in recovery typical member of our community feels or
                                 successful in life
         that adolescents in recovery will be productive in the community
                                or successful in life

  Percent of

                       Very   Moderately     Somewhat   Not at all
Recovery Supports for Adolescents and Families
• CSAT funded and led by Chestnut Health
• Four Sites:
  – Tucson, Arizona
  – Bloomington, Illinois
  – Seattle, Washington
  – Fitchburg, Massachusetts
          Recovery Support Services

• Recovery support telephone support by trained
• Recovery oriented social networking site
• Family Support using the Community
  Reinforcement and Family Training (CRAFT)
          Emerging Issues,

The world is moved along, not only by the mighty shoves of its heroes,
 but also by the aggregate of the tiny pushes of each honest worker.

                            -Helen Keller
           How Media Can Support
         Treatment Business Practices

• Data and communication infrastructures
• Shift from informing to creating value
• Design virtual spaces to connect recovery
• Transactional and relational
            Changes in Health Care

• Evidence based practice
  – Specialization
• Outcomes
  – Production of positive changes
• Cost effectiveness
  – Best outcomes that are least expensive

• Internet and mobile technology media is
  here to stay! Given this, we need to
  continue to find innovative ways it can be
  useful to and complimentary of services.
• There is little documented in the literature
  about the effectiveness of technology uses
  in the addiction field.
• It is thought that utilization of technology is
  cost efficient yet we need more studies that
  examine these costs.
          Acknowledgements & Disclaimer

The authors wishes to thank Jutta Butler, Monica Davis, Stuart Glogoff, Mark
   Godley, Susan H. Godley, Kristin Hedges, Sasha Keyes, Jo Korchmaros,
   Vicki Lilligard, Randy Muck, Raquel Ramirez, Andrea Verdin, project staff
   who have helped in the development of this presentation. Moreover the
   author wishes to acknowledge all the youth/families who have participated
   in treatment and engaged in the recovery process.

The development of this presentation was funded, in part, by a grant from the
   Substance Abuse and Mental Health Services Administration Center for
   Substance Abuse Treatment – TI-17604 & TI-020138. The views expressed
   here are the authors and do not necessarily represent the official policies of
   the Department of Health and Human Services; nor does mention of trade
   names, commercial practices, or organizations imply endorsement by the
   U.S. Government.

Bloom, S. (2009) The Sanctuary Model: Implementation Training. Yonkers, NY January 26-30, 2009

Butler, J., Muck, R., Dennis, M.L., Godley, S.H., & Godley, M.D. (2009) Assertive Adolescent Family Treatment (AAFT) Cross-Site Progress
      Report. Webinar Presentation for AAFT grantees on February 25, 2009.

Dennis, M.L., Titus, J.C., White, M.K., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN): Administration guide
     for the GAIN and related measures. Bloomington, IL: Chestnut Health Systems. Retrieved from http://www.chestnut.org/li/gain

Godley, M. Coleman-Cowger, VH., Titus, J., Funk, R., Orndorff, MG (in press). A randomized control trial of telephone continuing care. Journal
     of Substance Abuse Treatment.

Godley, S.H., Meyers, R.J., Smith, J.E., Karvinen, T., Titus, J., Godley, M., Dent, G., Passetti, L., & Kelberg, P (2001) . The adolescent
     Community Reinforcement Approach for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 4, DHHS Pub.
     No. 01- 3489. Rockville, MD Center for Substance Abuse Treatment, Substance Abuse and Mental Health Service Administration.

Kaminer, Y., Burleson, JA & Burke, RH (2008). Efficacy of outpatient aftercare for adolescent with alcohol use disorders: A randomized control
     study. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1405-1412

Knowles, P (2009). Collaborative communication between psychologist and primary care providers. Journal of Clinical Psychology Medical
     Settings, 16 72-76. DOI 10.1007/s10880-009-9151-1.

Korchmaros, J., Lopez, E. & Ruiz, B. (2009). Perceptions of Community Feelings and Attitudes about Adolescents in Recovery: Summary
     Report. University of Arizona’s – Southwest Institute for Research on Women: Unpublished Reports. Tucson, Arizona.

Mulvey, K., Atkinson, DD., Avula, D. Luck, JW (2005). Using the Internet to Measure Program Performance. American Journal of Evaluation,
     26, 587-597. DOI 10.1177/1098214005281320.

Muck, R. Dennis, M., Godley, SH & Godley, MD (2009). A National Model for Funder-Researcher-Provider EBP Implementation. Presented at
     the 2nd Annual NIH Conference on the Science of Dissemination and Implementation. Bethesda, MD January 29, 2009.

Ruiz, B., Greene, A., Lopez, E. & Bernal, D. (2009). Enhancing the Adolescent Community Reinforcement Approach (A-CRA) with Podcasts:
      Interim Report. University of Arizona’s - Southwest Institute for Research on Women: Unpublished reports. Tucson, Arizona.

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