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					          Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration

          Adolescent Treatment Models Program


              Grantee Project Descriptions

                      October 2000




                         1
                                            Contents



Program Overview .................................................................................1

Baltimore, Maryland..............................................................................2

Bloomington, Illinois ..............................................................................4

Catonsville, Maryland............................................................................6

Los Angeles, California..........................................................................8

Miami, Florida......................................................................................10

New York, New York...........................................................................12

Oakland, California .............................................................................14

Phoenix, Arizona ..................................................................................16

Shiprock, New Mexico .........................................................................18

Tucson, Arizona....................................................................................20




                                              2
                  Adolescent Treatment Models Program Overview
Project Officers:             Jutta Butler                   Randolph Muck, M.Ed
                              CSAT/SAMHSA                    CSAT/SAMHA
                              301-443-6503                   301-443-6574
                              ebutler@samhsa.gov             rmuck@samhsa.gov

Description
Driven by the need for new theoretical frameworks, basic research, and corresponding
interventions devised specifically for adolescents, CSAT is funding 10 research projects to
evaluate and manualize 10 adolescent treatment programs. At a minimum, programs must
collect client-level data at intake, discharge, and 6 and 12 months post-admission for the purpose
of an outcomes evaluation. The projects also are conducting process and qualitative evaluations
and are working with a contractor to perform a cost analysis for the purpose of producing
treatment program replication manuals. The projects also will submit data to a CSAT contractor
to facilitate cross-site analyses.

Goals and Objectives
Χ      To identify existing adolescent treatment programs that, when evaluated for client
       outcomes and cost under a rigorous study design, demonstrate effectiveness and promise
       for replication

Participants
Χ      Rand Corporation/Phoenix Academy, Los Angeles, CA
Χ      Public Health Institute/Thunder Road, Inc., Oakland, CA
Χ      Johns Hopkins School of Medicine/Mountain Manor Treatment Center, Baltimore, MD
Χ      New York Office of Alcoholism and Substance Abuse Services/Dynamic Youth,
       New York, NY
Χ      University of Arizona/La Cañada, Tucson, AZ
Χ      University of Arizona/Teen Substance Abuse Treatment, Phoenix, AZ
Χ      University of Miami/The Village, Miami, FL
Χ      Chestnut Health Systems (CHS)/CHS Outpatient Treatment Program, Bloomington, IL
Χ      Friends Research Institute, Inc./Epoch Counseling Center, Catonsville, MD
Χ      Shiprock Navaho Behavioral Health Board, Inc./Four Corners Regional Adolescent
       Center, Shiprock, NM

Accomplishments To Date
As of December 2000, the grantees have enrolled over 900 participants into the study. Cost
consultants have conducted a cost analysis at four sites. All grantees are submitting data to a
CSAT contractor to facilitate cross-site analyses. Replication manuals are being developed in
coordination with the CSAT Knowledge Application Program, and an independent panel of
experts will be convened to assess the quality of each program and its potential for replication.
Programs selected for replication will be invited to exhibit at a conference to disseminate their
findings. Preliminary findings will be presented at a cross-site meeting in early 2001.




                                             1
                                    Baltimore, Maryland
Grant #:       TI 11424
Grantee:       Johns Hopkins University
PI:            Marc Fishman, M.D.                                    410-614-3618
               Assistant Professor                                   410-614-5913 (fax)
               Johns Hopkins Univ. School of Medicine                mjfishman@home.com
               Johns Hopkins Hospital, Meyer 4-119
               Baltimore, MD 21287

Model Program:         Mountain Manor Treatment Program


This project aims to document, study, and evaluate the effectiveness of the inpatient adolescent
drug abuse treatment program at Mountain Manor Treatment Center (MMTC) in Baltimore,
Maryland. This program treats a target population of underserved, impoverished, urban
adolescents with very high severities of drug use and functional impairment. The program uses a
centralized linkage model to broaden the scope of more traditional addictions treatment by
incorporating and integrating multiple adjunctive treatment services which address and remediate
some of the core functional deficits among adolescents that act as sustaining factors for
addiction. Considerable consensus in the literature supports centralized linkage as a treatment
approach. At MMTC, these adjunct treatment services are key building blocks of the program
model. These services include psychiatric evaluation and treatment; educational assessment and
full school programming, including special education services; family therapy; behavioral
rehabilitation and remediation of legal issues; recreation therapy; and structuring of free time.
The MMTC program has been identified as exemplary by local and regional experts, community
agencies, and consumers. Pilot outcome data suggest that the program is effective at reducing
drug use and improving psychosocial function.

This project will prospectively track 150 patients from admission through discharge, and at
postadmission followup points of 3, 6, 9, and 12 months. An assessment team will compile
baseline clinical profile data for the target patient population at entry to treatment and will then
document and operationalize the services received during treatment. The role of linked adjunct
treatment services as key program building blocks will be examined through measurements of
proximal outcome variables at completion of inpatient treatment. Distal outcomes of drug use
and psychosocial function at followup assessments will be compared to patients’ baseline data to
estimate treatment effectiveness. We anticipate associations between proximal outcomes related
to the core adjunctive treatment services and distal outcomes related to the corresponding
functional domains (psychiatric status, educational status, family status, legal/behavioral status,
recreation/free time status). Additionally, we anticipate associations between these functional
outcomes, both early and late, and drug use outcome. A CSAT contractor will also perform a
cost-effectiveness audit and further program review. These steps will facilitate the presentation
of the program to a wider audience as well as “packaging” the program for potential replication.




                                             2
                                   Baltimore, Maryland
Treatment Program—Mountain Manor Treatment Program
Χ       Residential: 30 days of residential treatment with up to two 15-day additions granted by
        insurance or managed care.
Χ       Principal Drugs of Use/Abuse: (1) Marijuana, (2) heroin, (3) cocaine, (4) hallucinogens,
        (5) inhalants (especially toluene and spray paint). Alcohol is used widely but is
        considered co-morbid rather than a principal drug of use among program residents.
Χ       Referral Streams: Department of Juvenile Justice (60 to 70%), self-referrals (5 to 10%),
        Department of Social Services (5%), insurance companies or managed care (5%), local
        health departments (5%), State of Delaware’s Youth Rehabilitation Services/Child
        Mental Health Office (5%).

Gender/Race Distribution
            Male     Female     Caucasian   African     Latino/    Biracial   Native      Other
                                            American    Hispanic              American
Program       70%       30%        60%          40%

Study         75%       25%        60%          40%


Evaluation—Johns Hopkins University School of Medicine
Χ       Data Collection Waves: Baselines started in June 1999; the final followup wave started
        in June 2000
Χ       Expected Total Enrollment: 150 from model program (no comparison group)
Χ       Age of Adolescents: Ages 11 to 20
Χ       Comparison Group(s): N/A
Χ       Exclusion Criteria: (1) Residence outside of 65-mile catchment area radius, (2) drug use
        for less than 30 of previous 90 days, (3) age less than 11 or more than 20
Χ       Validation of Self-Report Data: 20 percent of all people followed up will receive a
        urine test to validate drug use
Χ       Time of Initial Assessment: within 5 to 7 days of admission
Χ       Followup Data Collection Intervals: 3, 6, 9, and 12 months after intake
Χ       Supplemental Data Collection Forms and Questionnaires: (1) Education subscale
        from the Comprehensive Addiction Severity Index (CASI-A), (2) Family/Household
        subscale from the CASI-A, (3) Beck Depression Inventory, (4) clinician’s assessment
        form for adolescent’s conduct, (5) clinician’s assessment form for adolescent’s family
        situation, (6) clinician’s assessment form for the adolescent’s educational status, (7)
        cohesion and conflict scales from the Family Environment Scale, (8) Reasons for
        Quitting Scale, (9) Discharge Questionnaire (participant version)




                                            3
                                    Bloomington, Illinois
Grant #:       TI11894
Grantee:       Chestnut Health Systems
PI:            Susan Harrington Godley, Ph.D.                       309-829-1058, Ext. 3343
               Senior Research Consultant                           309-829-4661 (fax)
               Chestnut Health Systems                              sgodley@chestnut.org
               Lighthouse Institute
               720 West Chestnut Street
               Bloomington, IL 61701

Model Program:        Chestnut Health Systems Bloomington Outpatient and Intensive
                      Outpatient Program


Chestnut Health System (CHS) is the largest adolescent treatment provider in Illinois. Its
Outpatient Program (CHS-OP) in Bloomington was one of the first exemplary treatment models.
Developed by the State of Illinois in 1985, it has been refined through State and CSAT grants.
The treatment philosophy draws upon four theories of behavioral and emotional change
(Rogerian, behavioral, cognitive, and Reality Therapy) and includes 12-Step concepts and
approaches. A strong emphasis is placed on the early detection of substance use and the
identification of ADHD and conduct disorder. The CHS adolescent program serves clients from
a mix of urban and rural areas and has interagency agreements with more than 100 schools as
well as criminal justice and other community-based agencies. In addition, the staff work in 22
school Early Intervention and Student Assistant Programs. One of the largest research units
operated out of a community-based treatment agency in the United States, the CHS Lighthouse
Institute has conducted almost 50 community-based studies, including a half dozen involving
randomized field experiments of manual-based treatment.

The specific aims of this research project are (1) to document the CHS-OP treatment approach
for replication, (2) to test the relationship of program implementation and intermediate outcomes,
and (3) to examine the effectiveness of CHS-OP compared to alternative approaches and earlier
versions of itself. Critical questions to be answered in this first phase include: (1) Who is being
served? (2) To what extent are resources targeted at the most appropriate/needy people? (3) Is
the treatment approach effective compared to alternatives? (4) How much does the approach
cost compared to the alternatives?

Changes within individuals will be evaluated over time, relative to earlier data on this same OP
program, the five OP programs in the Cannabis Youth Treatment experiments, the residential
programs in this same community, and other model programs funded through this grant initiative
and in collaboration with CSAT.




                                             4
                                        Bloomington, Illinois

Treatment Program—Chestnut Health Systems, Bloomington Outpatient and
Intensive Outpatient Program
Χ           Outpatient Program (OP): 1 to 8 hours of treatment per week
Χ           Intensive Outpatient Program (IOP): 9 to 12 hours per week; 2 to 6 months of OP
            treatment
Χ           Principal Drugs of Use/Abuse: (1) Marijuana, (2) alcohol
Χ           Referral Streams: Parents, self, schools, hospitals, social service agencies, probation
            departments, Department of Corrections, Department of Children and Family Services,
            other treatment facilities

Gender/Race Distribution
        Male Female Caucasian                 African    Latino/       Biracial   Native     Other
                                              American   Hispanic                 American
    Program      72%       28%       77%         8%           4%          9%                    2%

    Study        72%       28%       77%         8%           4%          9%                    2%


Evaluation—Chestnut Health Systems, Lighthouse Institute
Χ           Data Collection Waves: Baselines started in February 2000; final followup wave will
            start in August 2002
Χ           Expected Total Enrollment: 180 from model program (comparison group is archival)
Χ           Age of Adolescents: Ages 12 to 18
Χ           Comparison Group: A sample of 600 adolescents in OP treatment followed up at 3, 6,
            9, and 12 months under the Cannabis Youth Treatment study
Χ           Exclusion Criteria: (1) Adolescent is initially recommended for and transferred to
            residential treatment within 2 months of the OP/IOP admit. (2) The adolescent lacks
            sufficient ability to use English to participate in treatment. (3) Parent lacks sufficient
            ability to use English to complete the measurement tool. (4) Youth has previously
            participated in this study. (5) Youth is currently participating in another followup study.
            (6) Adolescent is a ward of the Illinois Department of Children and Family Services.
Χ           Validation of Self-Report Data: (1) GAIN Collateral Assessment Form, (2) urine tests
            at intake, while in treatment, and at 3- and 6-month followup
Χ           Time of Initial Assessment: Assessments are scheduled as soon as possible after a
            referral is screened on the telephone.
Χ           Followup Data Collection Intervals: 3, 6, 9, and 12 months after intake for adolescents;
            3 and 6 months after intake for collateral assessments
•           Supplemental Data Collection Forms and Questionnaires: (1) GAIN Supplemental
            Assessment Forms (SAF) A through E, including Family Environment Scale; Self-
            Monitoring Scale; Friends Scale; Family, Friends, and Self Scale; Adolescent Relapse
            Coping Questionnaire; and determination of reasons for quitting; (2) Collateral
            Assessment Form items that correspond to GAIN items and the Parenting Practice Scale;
            (3) Discharge Questionnaire–Therapist Version; (4) Working Alliance Inventory; and (5)
            service activity codes and duration data from the agency information system.



                                                 5
                                   Catonsville, Maryland
Grant #:       TI11874
Grantee:       Friends Research Institute, Inc.
PI:            Robert J. Battjes, D.S.W.                     410-837-3977
               Principal Investigator                        410-752-4218 (fax)
               Director, Social Research Center              rbattjes@friendssocialresearch.org
               Friends Research Institute, Inc.
               1040 Park Avenue, Suite 103
               Baltimore, MD 21201

Model Program:         Epoch Counseling Center

To document effective treatment models for adolescents, this study will evaluate Epoch
Counseling Center’s outpatient adolescent substance abuse treatment program. Epoch has five
treatment facilities located in Baltimore County, Maryland. Epoch’s program has provided
substance abuse treatment services for adolescents, their family members, and adults since 1971.
Epoch has long-standing collaborative relationships with local schools, the Maryland
Department of Juvenile Justice, other treatment facilities, and numerous other agencies.

The Epoch adolescent program is a flexible, semistructured, 20-week program; group therapy is
the primary treatment approach. Additional program components, including individual and
family therapy, parent education, and the overall duration and intensity of the treatment program,
are provided and varied based on client need. Adolescent clients begin treatment by completing a
detailed bio-psycho-social assessment. If outpatient group treatment is appropriate, clients are
admitted to Epoch’s standard course of treatment. The approach is holistic, recognizing that
adolescents’ substance abuse is typically entwined with problems in many areas of their lives.
The approach is based on both social learning theory, which explains substance use initiation,
and conditioning theory, which explains continuation.

In addition to evaluating the Epoch adolescent program, the CSAT-supported evaluation is also
assessing the effect on treatment retention and outcome of adding a brief motivational
intervention at the beginning of treatment. Approximately one-half of the study participants
receive a one-session motivational intervention. This procedure is designed to facilitate
behavioral change by helping clients explore and resolve ambivalence about the need for change.
For comparison purposes, the remaining participants receive a one-session treatment overview
that does not focus on motivation.

Adolescent substance abusers, ages 14 to18, who apply for treatment at any of the five Epoch
locations are recruited to participate in this evaluation study. Adolescents younger than 14 and
those who are age 18 and out of high school are excluded from the study, as they are
inappropriate for inclusion in the group counseling process. Other adolescents who are
determined not to be suitable for group counseling are also excluded. The target study sample
size is 300. Participants are interviewed at treatment entry, at 2 and 6 weeks thereafter to assess
motivation and treatment engagement, and at 6 and 12 months thereafter to assess treatment
outcome.



                                             6
                                   Catonsville, Maryland

Treatment Program—Epoch Counseling Center
Χ       Outpatient Program: One 75-minute group counseling session per week for 20 weeks,
        with a minimum of 3 individual treatment planning/counseling sessions, 4 family therapy
        sessions, and 4 parent group education sessions during the course of treatment. Intensity
        and duration of treatment are flexible, depending on individual client need
Χ       Principal Drugs of Use/Abuse: Primary drug of choice: marijuana (60%), alcohol
        (28%), heroin (2%), none (10%); secondary drug of choice: marijuana (15%), alcohol
        (23%), other (9%), none (53%)
Χ       Referral Streams: Primary sources include Department of Juvenile Justice mandates,
        school guidance counselors, and Maryland Student Assistance Program/Safe and Drug-
        Free Schools. Additional sources include self, family, peer, managed care organizations,
        and assessors representing the Baltimore County Bureau of Substance Abuse

Gender/Race Distribution
            Male     Female   Caucasian   African    Latino/    Biracial   Native     Other
                                          American   Hispanic              American
Progr        60%       40%       85%        13%                                            2%
am
Study        70%       30%       70%        25%                                            5%


Evaluation—Friends Research Institute, Inc.
Χ       Data Collection Waves: Baseline, July 2000 to September 2001; final followup wave,
        July 2001 to September 2002
Χ       Expected Total Enrollment: 300 (150 receiving motivational intervention; 150
        receiving comparison treatment preparation)
Χ       Age of Adolescents: Ages 14 to 18 (14=15%, 15=13%, 16=40%, 17=32%, 18=0%)
Χ       Comparison Group(s): Clients receiving one-session motivational intervention at
        treatment entry will be compared with those receiving general treatment overview
Χ       Exclusion Criteria: Those who are under age 14 or over 18; 18 year olds no longer in
        school; those requiring intensive treatment; and those considered inappropriate for group
        treatment
Χ       Validation of Self-Report Data: (1) Urine testing 1 to 4 times per month, (2) juvenile/
        criminal justice records, (3) school records
Χ       Time of Initial Assessment: At intake, as the person’s first contact with the program,
        unless brought into treatment for an emergency, in which case the GAIN will be done
        within the first week of treatment
Χ       Followup Data Collection Intervals: 2 and 6 weeks, 6 and 12 months after intake
Χ       Supplemental Data Collection Forms and Questionnaires: (1) Problem Oriented
        Screening Instrument for Teenagers (POSIT), (2) Circumstances, Motivation, and
        Readiness Scales, (3) Desire for Help Scale, (4) Social Skills Rating Scale, (5) Drinking-
        Related Locus of Control, (6) Adolescent Relapse Coping Questionnaire, (7) Rosenberg
        Self-Esteem Scale, (8) Working Alliance Inventory (Youth), (9) TCU Client Evaluation
        Scales, and (10) TCU Counselor Rating of Client


                                             7
                                  Los Angeles, California
Grant #:       TI11433
Grantee:       RAND Corporation
PI:            Andrew Morral, Ph.D.                                         310-393-0411
               Associate Behavioral Scientist                               310-451-7063 (fax)
               RAND                                                         morral@rand.org
               1700 Main Street
               PO Box 2138
               Santa Monica, CA 90407

Model Program:        Phoenix Academy

Phoenix Academy at Lake View Terrace (Phoenix Academy) has developed an innovative
adolescent treatment model designed to achieve the extensive social rehabilitation required by
the most recalcitrant youth. Consequently, this academic therapeutic community is now
regularly used by the Los Angeles County Department of Probation as a residential treatment
program for some of the drug-using adolescents it supervises.

This study compares the outcomes of drug-using adolescent probationers who receive
rehabilitation services at Phoenix Academy or at other group homes in Los Angeles. RAND,
working in collaboration with the Los Angeles Department of Probation, identified a pool of 450
juvenile offenders who were placed at Phoenix Academy (200 participants) or at one of six
comparison group homes selected by the Probation Department as most comparable to Phoenix
Academy (200 participants). Adolescents were assessed immediately before entering these
residential programs and again 3, 6, and 12 months later to determine rates of improvement on
measures of drug use, criminal behavior, psychosocial functioning, and productive activity.

This research design offers: (1) a comparison of the outcomes associated with the Phoenix
Academy treatment model versus alternative residential treatments and (2) one of the few
followup evaluations of adolescent residential treatment, which is the second most widely used
treatment modality for adolescents in the country. Adolescent probationers represent the
subgroup of young substance users who suffer from the most advanced forms of behavioral,
psychiatric, family, and substance abuse problems. As such, they are in grave need of exemplary
treatment services. Court-referred youth are also the largest population of adolescents receiving
substance abuse treatment. Better understanding of their treatment needs and outcomes therefore
represents a critical public health research effort. In addition, the study will permit examination
of (1) the characteristics of adolescents for whom therapeutic community treatments like Phoenix
Academy are most helpful and (2) whether specific program services increase the likelihood of
successful rehabilitation. Evaluating these issues creates the opportunity for improvements in
adolescent treatment programs and in the efficient matching of adolescents to the services that
will most benefit them.

Now in the last year of the grant, the project ended recruitment in April 2000. A total of 449
clients are actively enrolled in the study, and followup interviews are still being conducted. No
preliminary findings are available.



                                             8
                                  Los Angeles, California

Treatment Program—Phoenix Academy
Χ       Residential (12 months) and Aftercare
Χ       Principal Drugs of Use/Abuse: (1) Alcohol, (2) marijuana, (3) methamphetamine or
        crack (more rarely reported: PCP, inhalants, and heroin)
Χ       Referral Streams: Los Angeles County Department of Probation (90%); Department of
        Children and Family Services (5%); local hospitals, schools, and agencies in Los Angeles
        County, and self-referrals (5%)
Χ       Exclusion Criteria: (1) Younger than age 13, older than 17; (2) unable to speak English
        fluently; (3) history of fire starting; (4) severe mental illness; (5) history of violent
        offenses against authorities; (6) perceived to pose a threat of violence to members of the
        therapeutic community

Gender/Race Distribution
            Male     Female   Caucasian   African    Latino/      Biracial   Native     Other
                                          American   Hispanic                American
Program      80%       20%       20%         9%          60%                    3%         8%

Study        87%       13%       20%         9%          60%                    3%         8%


Evaluation—RAND Corporation
Χ       Data Collection Waves: Baselines started in March 1999; final followup wave started in
        March 2000
Χ       Actual Total Enrollment: 449 (breakdown not available)
Χ       Age of Adolescents: Ages 13 to 17
Χ       Comparison Group(s): Six group homes recognized as suitable placements by the Los
        Angeles County Department of Probation
Χ       Validation of Self-Report Data: (1) Probation records will be used to confirm arrest and
        conviction data, (2) urinalysis may be used to confirm drug use (urine tests are not done
        on a consistent basis), (3) school records may be used to confirm academic performance
        if access can be negotiated easily
Χ       Time of Initial Assessment: Prior to admission to treatment, usually within 1 to 3 days,
        but never later than 7 days after admission
Χ       Followup Data Collection Intervals: 3, 6, and 12 months after intake
Χ       Supplemental Data Collection Forms and Questionnaires: (1) Group Home
        Characteristics Form (for information about comparison group programs), (2) Zero
        Incarceration Placement Officer Rating Form (probation officers’ perceptions of
        progress), (3) Trauma Experience and PTSD Symptoms Assessment, (4) process form to
        assess perceptions of safety, helpfulness of program components, professionalism of
        counselors, (5) questionnaire to assess how such drug information is lost with traditional
        question formats, (6) handgun use and experiences inventory




                                             9
                                       Miami, Florida
Grant #:       TI11871
Grantee:       University of Miami
PI:            Howard Liddle, Ed.D.                                 305-243-6434
               Professor of Psychiatry and Psychology               305-243-5577 (fax)
               Director, Center for Treatment Research on           hliddle@med.miami.edu
                 Adolescent Drug Abuse
               University of Miami School of Medicine
               1400 Northwest 10th Avenue, 11th Floor
               Miami, FL 33136

Model Program:        Multidimensional Family Therapy at The Village, Inc.


This research project is a randomized field-effectiveness trial of a developmentally appropriate,
manualized, family-based treatment—Multidimensional Family Therapy (MDFT). MDFT has
been shown to be more effective than alternative treatments in reducing drug use, as well as
externalizing and internalizing symptoms, in two randomized clinical trials with inner city,
minority adolescents (mean age=16 years). MDFT has not been tested (1) with an exclusively
early adolescent sample, or (2) with a sample having an equal mix of females and males, or (3) in
a rigorous field experiment in a real world clinical setting.

This study has several aims: (1) to investigate the comparative effectiveness of MDFT versus a
manualized, peer-based, psycho-educational group intervention with a sample of drug-using
early adolescents; (2) to investigate the therapeutic mechanisms of action in both treatments to
explain how each intervention achieves its effects; and (3) to explore gender-related issues in
adolescent treatment for substance abuse. This project presents a unique collaboration with an
established community treatment center, The Village, Inc., which currently provides MDFT to
drug-abusing adolescents in several ongoing programs.

In this study, 144 adolescents, ages 12 to 15, who are referred to an existing outpatient drug
abuse treatment program at The Village, will be randomly assigned to either MDFT or the
comparison group therapy treatment. Adolescents and their parent(s) will be assessed at intake,
at 6 weeks after intake, at discharge, and at 6 and 12 months after intake on a range of measures,
including drug use, delinquency, internalizing and externalizing disorders, family relationships,
and social skills.




                                            10
                                           Miami, Florida

Treatment Program—The Village, Inc.
•       Intensive Outpatient: 12 weeks
•       Principal Drugs of Use/Abuse: (1) Marijuana, (2) alcohol
•       Referral Streams: Dade County Public Schools Trust Counselors, Juvenile Justice
        Probation Officers, Public Defenders Office, Juvenile Assessment Center, Community
        Mental Health Centers, Department of Children and Families, and other community-
        based organizations

Gender/Race Distribution
            Male     Female    Caucasian    African       Latino/    Biracial   Native     Other
                                            American or   Hispanic              American
                                            Caribbean
Program      53%      47%        7%            68%          25%

Study        50%      50%                      40%          50%                              10%


Evaluation—University of Miami School of Medicine
•       Data Collection Waves: Baselines from March 2000 to August 2001; final followup
        wave from March 2001 to July 2002
•       Expected Total Enrollment: 144 (72 from model program)
•       Age of Adolescents: Ages 12 to 15
•       Comparison Group: This randomized clinical trial compares Multidimensional Family
        Therapy (MDFT) with a peer-based, psycho-educational group therapy intervention
•       Exclusion Criteria: (1) Presence of mental retardation, eating disorders, pervasive
        developmental disorder, or schizophrenia, (2) presence of suicidal ideation, (3) chronic or
        severe psychiatric disorders requiring intensive mental health treatment, (4) substance
        abuse disorder warranting inpatient treatment, (5) five or more arrests, (6) aggressive
        behavior that is ongoing or severe in nature, (5) adolescents who are currently in foster
        care or in the custody of the Department of Children and Families
•       Validation of Self-Report Data: (1) Urine analysis, (2) Dade County Juvenile Justice
        records, (3) Dade County Public School records
•       Time of Initial Assessment: Within 1 week of treatment intake
•       Followup Data Collection Intervals: 6 weeks, time of discharge, 6 months postintake,
        and 12 months postintake
•       Supplemental Data Collection Forms and Questionnaires: (1) Adolescent Intake and
        Followup Interviews; (2) Parent Intake and Followup Interviews; (3) Child Behavior
        Checklist, internalizing and externalizing scales; (4) Youth Self-Report, internalizing and
        externalizing scales; (5) Timeline Follow Back Interview; (6), National Youth Survey,
        delinquency and peer delinquency; (7) Circumstances, Motivation, Readiness Scales; (8)
        Family Environment Scale; (9) Working Alliance Inventory; (10) Parent Daily Interview;
        (11) Adolescent Daily Interview; (12) Social Skills Rating System; (13) weekly therapy
        process form; (14) treatment contact logs; (15) family therapist self-rating form (MDFT);
        (16) group leader self-rating form (group)



                                              11
                                    New York, New York
Grant #:       TI11423
Grantee:       New York Office of Alcoholism and
                  Substance Abuse Services
PI:            Patricia Perry, Ph.D.                         (518) 485-1136
               Research Scientist IV                         (518) 485-0261 (fax)
               New York Office of Alcoholism and             patriciaperry@OASAS.state.ny.us
                  Substance Abuse Services
               1450 Western Avenue
               Albany, NY 12203

Model Program:         Dynamic Youth Community, Inc.


Dynamic Youth Community (DYC) Inc. is a multiphase adolescent therapeutic community that
serves youth from New York City. It has three major treatment modalities: a residential
program located outside New York City in Fallsburg, New York, an intensive outpatient
program in Brooklyn, and ambulatory services also located in Brooklyn. The course of treatment
consists of residential services for 9 to 12 months, followed by intensive outpatient services for 8
to12 months, and terminating with ambulatory services two times per week in the evening for 8
to 12 months. During the residential and intensive outpatient phases, clients attend treatment and
school at the DYC treatment facilities. DYC requires that families participate in parent groups
while their son/daughter is in treatment.

DYC has been in existence for 30 years and has adapted to meet the needs of the community.
While the majority of the young men and women enrolled at DYC are Caucasian, DYC also
serves African American and Latino youth. Currently, the community has a substantial number
of Russian immigrant families who are served by the program.

To determine the effectiveness of the program, this research project is investigating (1) client-
level outcomes (e.g., self-concept, depression, anxiety, trauma, academic achievement, criminal
justice involvement, employment, and substance use), and (2) program-level outcomes compared
to other adolescent treatment programs in New York City (e.g., length of stay, reason for
discharge, drug use status).

Descriptive information about the program will be obtained by qualitative research methods
consisting of (1) a participant observer study, (2) focus groups with parents and alumni, and (3)
ethnographic interviews with clients, parents, alumni, and staff.

Data obtained from these multiple sources will contribute to the development of a treatment
manual so that the program can be replicated in other settings.


.




                                             12
                                   New York, New York

Treatment Program—Dynamic Youth Community, Inc.
Χ       Residential (1 year), then Intensive Outpatient (8 to12 months), then Standard
        Outpatient (8 to 12 months)
Χ       Principal Drugs of Use/Abuse: (1) Crack and cocaine, (2) PCP and hallucinogens, (3)
        barbituates and heroin, (4) marijuana and alcohol. These drug combinations are the same
        reporting categories used by Dynamic Youth.
Χ       Referral Streams: Self-referrals, including those from friends and family members
        (43%); other drug treatment providers (26%); criminal justice authorities (24%); Child
        Protective Services, social service providers, mental health providers, and health care
        providers (7%)
Χ       Exclusion Criteria: (1) Younger than age 12, (2) manifesting severe psychiatric
        problems, (3) lacking a family sponsor, (4) responsible for serious criminal activities
        (rape, murder, arson, etc.)

Gender/Race Distribution
             Male    Female    Caucasian     African    Latino/    Biracial    Native     Other
                                            American    Hispanic              American
Program      79%      21%         64%            13%      23%

Study        74%      26%         64%            8%       15%                   1%         12%


Evaluation—New York Office of Alcoholism and Substance Abuse Services
Χ       Data Collection Waves: Baseline started in April 1999; final followup wave started in
        April 2000
Χ       Expected Total Enrollment: 130 from model program (comparison group is archival)
Χ       Age of Adolescents: Ages 12 to 20 for cross-site, may be older than 20 for local study
Χ       Comparison Group(s): Admission and discharge records for youth receiving treatment
        in New York State and reporting data to State of New York
Χ       Validation of Self-Report Data: Questionnaire will be administered to collateral
        respondent(s)
Χ       Time of Initial Assessment: Within 7 to 14 days of admission
Χ       Followup Data Collection Intervals: 3, 6, 9, and 12 months after intake, for both
        adolescents and collateral interviews
Χ       Supplemental Data Collection Forms and Questionnaires: (1) GAIN Collateral
        Assessment Form–Initial, (2) GAIN Collateral Assessment Form–Followup, (3)
        qualitative data from a participant observer study, focus groups with parents and alumni,
        and an ethnographic study which consists of interviews with clients, parents, alumni, and
        staff.




                                            13
                                    Oakland, California
Grant #:       TI11432
Grantee:       Public Health Institute
PI:            Patricia Shane, Ph.D., M.P.H.                                (510) 549-3430
               Senior Research Scientist                                    (510) 649-7894 (fax)
               Public Health Institute                                      pshane@phi.org
               2168 Shattuck Avenue
               Berkeley, CA 94704

Model Program:        Thunder Road, Inc.

This project evaluates the effectiveness and replicability of Thunder Road, a 50-bed therapeutic
community with a comprehensive, multimodality treatment regimen for teens, ages 13 to 19.
Dually licensed by the California Department of Health Services and Department of Social
Services, Thunder Road operates with two treatment tracks that uniquely allow treatment access
to both public and private sector clients. Clients admitted to treatment through the Chemical
Dependency Recovery Hospital track, with residential stays of up to 45 days, are contrasted with
those admitted to treatment through the Group Home track, which is largely publicly funded,
with residential stays lasting up to 12 months, although stays cluster around 120 days. Clients
participate in 16 different group processes, including therapeutic community concepts, co-
dependency, gender, psychosocial issues and values, anger management, proactive confrontation,
resolution, grief, health, diversity, relapse prevention, 12-Step concepts, education, family and
multifamily therapy, sexual abuse survivors’ support, and reunification issues. Treatment plans
incorporate an aftercare phase and the gradual transition to a stepdown of formal services.

The project will compare 200 clients at Thunder Road with 100 clients enrolled in two 12-week
outpatient treatment modalities implemented by the Child Guidance Center (CGC) in
Philadelphia as part of the Cannabis Youth Treatment program. The two treatment conditions at
CGC include Adolescent Community Reinforcement Approach, consisting of 10 individual
sessions with the adolescent and 4 sessions with caregivers, and Multidimensional Family
Therapy, consisting of 12 to 15 individual family-focused sessions plus additional phone and
case management contacts.

Comparisons between the two programs will be based primarily on data from the GAIN. The
research design involves a longitudinal two-way design with repeated measures within subject.
Four treatment groups within two treatment programs will be compared. The four tracks will be
tested for clinically significant differences, using multiple regression analyses with seven
covariates: gender, race-ethnicity, number of different substances used during and following
treatment, primary drug of abuse, health, co-occurring mental diagnoses, and the percentage of
services received relative to the level set for that type of service. Repeated measures will be
obtained baseline (intake), and at 3, 6, 9, and 12 months postadmission. Chart audits will
contribute data on adolescent functioning, assessment of competencies, family integrity and
dynamics, patterns of alcohol and other drug use, co-occurring problems/needs, treatment
processes, level of client engagement with services, correlates of treatment tenure, and length of
time in treatment (residential and aftercare).



                                            14
                                    Oakland, California

Treatment Program—Thunder Road, Inc.
•   Residential and Aftercare: Residential and aftercare are combined for a total of 12 months
    of treatment. Hospital Track is 30 to 45 days of residential treatment, followed by up to 11
    months of aftercare; Group Home Track is 3 to 12 months of residential treatment, followed
    by aftercare as needed to complete a total of 12 months of treatment.
•   Principal Drugs of Use/Abuse: (1) Marijuana, (2) alcohol, (3) methamphetamine
    (approximately 85% are polydrug users)
•   Referral Streams: Drug treatment programs and health care providers (25%); self-referrals,
    including those from family members and friends (19%); insurance companies (16%);
    private physicians and private therapists (16%); juvenile justice referrals (10%); managed
    care organizations (6%); schools or other Department of Education sources (5%)

Gender/Race Distribution
            Male     Female   Caucasian   African    Latino/       Biracial   Native     Other
                                          American   Hispanic                 American
Program      60%      40%        60%         7%          14%         19%

Study        61%      39%        60%         8%          11%         18%         2%         1%


Evaluation—Public Health Institute
•   Data Collection Waves: Baselines started in April 1999; the final followup wave started in
    April 2000
•   Expected Total Enrollment: 200 from model program (comparison group is archival)
•   Age of Adolescents: Ages 13 to 19
•   Comparison Group(s): Child Guidance Center (located in Philadelphia, PA; the Center is a
    participant site in the Cannabis Youth Treatment Program)
•   Exclusion Criteria: (1) Younger than age 13, older than 19; (2) being actively suicidal at
    intake; (3) being violent or threatening others; (4) manifesting acute psychiatric problems at
    intake
•   Validation of Self-Report Data: (1) Urinalysis during residential treatment to confirm drug
    use, (2) chart audits to confirm some self-report data
•   Time of Initial Assessment: Usually 12 to 36 hours after admission to treatment, but never
    later than 7 days after admission
•   Followup Data Collection Intervals: 3, 6, 9, and 12 months after intake
•   Supplemental Data Collection Forms and Questionnaires: (1) Response Evaluation
    Measure for Youth (measuring coping skills), (2) Things I Have Seen and Heard (measuring
    exposure to extreme violence), (3) Rochester Longitudinal Study Adolescent Life Events
    Form (stress experienced as a result of major life events), (4) School Success Profile
    (measuring neighborhood safety, school performance, friendships, family, and well-being)




                                            15
                                      Phoenix, Arizona
Grant #:       TI11892
Grantee:       EMPACT–Suicide Prevention Centers, Inc.
PI:            Sally Stevens, Ph.D.                                 (520) 434-0334
               Research Associate Professor                         (520) 434-0336 (fax)
               Southwest Institute for Research on                  sstevens@dakotacom.net
                  Women
               University of Arizona
               3910 South Sixth Avenue
               Tucson, AZ 85714

Model Program:        Teen Substance Abuse Treatment Program


The Teen Substance Abuse Treatment (TSAT) Program Evaluation is a joint effort between
EMPACT–Suicide Prevention Centers (SPC), Inc., and the University of Arizona–Southwest
Institute for Research on Women (U of A–SIROW) to assess the differential effectiveness of two
programs for adolescent substance abusers. The TSAT program is an exemplary 3-month,
family-driven, abstinence-based program for adolescents. This outpatient program provides
assessment, home-based family therapy (6 hours per week tapering to 2 hours per week),
multifamily group therapy (1 time per month), and partial care services (3 hours of group, 3
times per week). Treatment outcomes for the TSAT program will be compared with a less
intensive Arizona Department of Juvenile Corrections (ADJC) program. The ADJC program
provides assessment, 8 weeks of substance abuse groups (1 hour per week), and family therapy
(starting with 1 hour per week and tapering to 1 hour per 2 weeks over an average of 4.5
months).

Clients in both programs will be assessed at baseline, during treatment, and at 3, 6, 9, and 12
months after baseline using a battery of instruments (GAIN-I, GAIN-M90, Participant Progress
Scale [counselor and client rated], Acculturation Scale for Hispanics [ASH], the Environmental
Stress Inventory, HIV Knowledge and Risk Assessment, the Adolescent Relapse and Coping
Questionnaire, and Reasons for Quitting). An ethnographic case study will help illuminate
issues surrounding drug-involved adolescents. During treatment, progress and process data will
be collected, and a cost analysis of the TSAT program will be conducted.

Baseline data will be compared with data collected at 3, 6, 9, and 12 months after baseline to
assess changes in the areas of substance abuse, criminal behavior, family and school functioning,
peer relationships, mental health, and life skills. The differential effectiveness of the two
programs for the clients enrolled, including effectiveness for various subgroups of clients (i.e.,
Hispanics, females, gang-involved youth) will be examined.

The project is also conducting process and qualitative evaluations, producing a replication
manual, participating in a cross-site collaboration, and working with a contractor to perform the
cost analysis.




                                            16
                                       Phoenix, Arizona

Treatment Program—Teen Substance Abuse Treatment Program
•     Intensive Outpatient: 3 months
•     Principal Drugs of Use/Abuse: (1) Marijuana, (2) alcohol, (3) cocaine, (4)
      methamphetamine, (5) LSD
•     Referral Streams: Regional Behavioral Health Authority (ValueOptions), Juvenile
      Probation Department

Gender/Race Distribution
              Male    Female   Caucasian   African    Latino/     Biracial   Native     Other
                                           American   Hispanic               American
    Program    59%     41%       55%         2%          26%                              17%

    Study      80%     20%       60%         6%          29%                   2%         2%


Evaluation—University of Arizona
•     Data Collection Waves: Baselines from February 2000 to April 2002; final followup wave
      from February 2001 to June 2002
•     Expected Total Enrollment: 540 (270 from model program; 270 from comparison group)
•     Age of Adolescents: Ages 13 to 17
•     Comparison Group(s): (1) EMPACT–SPC Teen Substance Abuse Treatment (TSAT), (2)
      EMPACT–SPC Arizona Department of Juvenile Corrections (ADJC)
•     Exclusion Criteria: (1) History of extreme violence, (2) younger adolescents who have been
      assessed as too socially and cognitively immature to benefit from the TSAT program, (3)
      cognitive level below 70
•     Validation of Self-Report Data: Weekly urine screening for both TSAT and ADJC
      programs
•     Time of Initial Assessment: First contact, 2-hour home visit (Intake)
•     Followup Data Collection Intervals: 3, 6, 9, and 12 months after baseline
•     Supplemental Data Collection Forms And Questionnaires: (1) Acculturation Scale for
      Hispanics (2) HIV/AIDS Knowledge and Risk Assessment, (3) Counselor-Rated Progress
      Scale, (4) Client-Rated Satisfaction Scale, (5) Environmental Stress Inventory, (6)
      Adolescent Relapse Coping Questionnaire




                                             17
                                  Shiprock, New Mexico
Grant #:       TI11888
Grantee:       Shiprock Navaho Behavioral Health Board, Inc.
PI:            Candice Stewart Sabin, Ph.D.                                (505) 368-4712
               Chief Clinical Officer                                      (505) 368-5457 (fax)
               Four Corners Regional Adolescent Treatment Center           fctop@cyberport.com
               PO Box 3529
               Shiprock, NM 87420

Evaluator:     Mark Chaffin, Ph.D.
               University of Oklahoma

Model Program:        Four Corners Regional Adolescent Treatment Center


Four Corners Regional Adolescent Treatment Center (FCRATC), a nonprofit organization on the
Navaho Nation Reservation in Shiprock, New Mexico, has been in existence since 1989. This
24-bed residential facility treats male and female adolescents, ages 12 to 19, utilizing a bio-
psycho-social model. Over the past 2 years, FCRATC has evolved from using an AA-based
treatment model to a culturally sensitive, dual diagnosis 60-day treatment model for Native
American adolescents. This bicultural treatment approach integrates aspects of Western therapy
with culturally relevant Navajo practices and traditional activities.

This research project will evaluate several of the core tenets of the new model, determine model-
related factors associated with success or failure, determine the comparative success of this
specialized treatment approach, and manualize the treatment approach for future replication.

This project plans to enroll 200 male and 100 female Native American adolescents, ages 12 to
19. Currently, 120 youth are referred to the program annually, with similar numbers of each
gender. Approximately 80 percent of the adolescents enrolled in the study will be from the
Navajo Nation reservation that encompasses New Mexico, Arizona, and Utah. The others will
come from other Tribes across the country.




                                           18
                                   Shiprock, New Mexico

Treatment Program—Four Corners Regional Adolescent Treatment Center
Χ       Residential: 60 days of residential treatment, evaluated every 2 weeks to determine level
        of care; 55 days is the average length of stay
Χ       Principal Drugs of Use/Abuse: (1) Marijuana, (2) alcohol, (3) inhalants
Χ       Referral Streams: Department of Juvenile Justice (35%), Navajo Department of
        Behavioral Health (12%), Department of Social Services (30%), Indian Health Services
        (18%), schools (3%), other Tribes (1%), self-referrals (1%)

Gender/Race Distribution
            Male       Female    Caucasian   African    Latino/    Biracial   Native     Other
                                             American   Hispanic              American

Program       67%        33%                                                   100%

Study         67%        33%                                                   100%


Evaluation—University of Oklahoma
Χ       Data Collection Waves: Baselines started in March 2000; final followup wave will be in
        January 2001 to February 2002
Χ       Expected Total Enrollment: 300 from model program (no comparison group)
Χ       Age of Adolescents: Ages 12 to 19
Χ       Comparison Group(s): None
Χ       Exclusion Criteria: (1) Younger than age 12, (2) no certificate of Indian blood, (3)
        severe psychiatric problems, (4) actively suicidal/homicidal at intake, (5) medical issues
        that prevent active participation in program, (6) mental retardation affecting ability to
        participate in program, (7) child refuses to sign consent to treatment at intake, (8)
        pregnancy past the first trimester
Χ       Validation of Self-Report Data: Clinical files (court/probation records, family intake,
        school records, Addiction Severity Index pre/posttest); GAIN Collateral Assessment
        Form
Χ       Time of Initial Assessment: Within 24 to 72 hours after admission
Χ       Followup Data Collection Intervals: 3, 6, 9, and 12 months after discharge
Χ       Supplemental Data Collection Forms and Questionnaires: (1) Addiction Severity
        Index pre/posttest, Native American version; (2) Million Adolescent Clinical Inventory,
        pretest only; (3) Goals 2000 level test−criterion reference achievement test, pre/posttest
        and followup at 6 and 12 months; (4) Lisrey social support and stress; (5) Cultural
        Assessment; (6) client s daily treatment diary; (7) post-traumatic stress and
        environmental violence; (8) determining the three levels of care and efficacy of lowering
        target behaviors; (9) K-snap for inhalant users, traumatic brain injured, fetal alcohol
        syndrome, and other indicated clients




                                             19
                                        Tucson, Arizona
Grant #:       TI11422
Grantee:       CODAC Behavioral Health Services
                  of Prima County, Inc.
PI:            Sally Stevens, Ph.D.                                   (520) 434-0334
               Research Associate Professor                           (520) 434-0336 (fax)
               Southwest Institute for Research on Women              sstevens@dakotacom.net
               University of Arizona
               3910 South Sixth Avenue
               Tucson, AZ 85714

Model Program:         La Cañada Adolescent Treatment Program

The La Cañada Treatment Program Evaluation is a joint effort between CODAC Behavioral
Health Services, Arizona's Children Association, and the University of Arizona–Southwest
Institute for Research on Women. The project will assess the differential effectiveness of two
programs for adolescent substance abusers. A 5-month abstinence-based program (La Cañada)
will be compared with a 2-month harm reduction program (Seven Challenges) and with a 9-
month outpatient Drug Court program.

The La Cañada program is a three-phase program. Phase I provides residential care (1 month);
Phase II provides intensive outpatient services (2 months); and Phase III provides non-intensive
outpatient services (2 months). The Seven Challenges program provides intensive outpatient
services (2 months). Both programs include family, group, and individual counseling. The La
Cañada program also includes a Growth Activities and Self-Help (GASH) component, which is a
personal model that the youth uses to re-enter the community, replacing harmful activities with
constructive, meaningful, and enjoyable involvement with peers and community groups.

Clients in both programs are assessed at baseline and at 3, 6, 9 and 12 months after admission to
the program. A battery of instruments is used, including: the GAIN-I and GAIN-M90, the
Participant Progress Scale (counselor and client rated), the HIV/AIDS Knowledge and Risk
Assessment, the Progress Scale (to measure communication skills, self-esteem, social skills,
conflict resolution, social adjustment, and primary caregivers’ parental skills), the Satisfaction
Scale (to measure which aspects of program have been helpful), the Environmental Stress
Inventory, the Adolescent Relapse Coping Questionnaire, and the Acculturation Scale for
Hispanics.

Baseline data will be compared with followup data to assess changes in the areas of substance
abuse, criminal behavior, family and school functioning, peer relationships, mental health, and
life skills. The differential effectiveness of the two programs for the clients enrolled, including
various subgroups of clients (i.e., Hispanics, females), will be examined.

The project also is conducting process and qualitative evaluations, producing a replication
manual, participating in a cross-site collaboration, and working with a contractor to perform a
cost analysis.



                                             20
                                         Tucson, Arizona

Treatment Program—La Cañada
•     Residential: 30 days, then mandatory aftercare (120 days total)
•     Principal Drugs of Use/Abuse: (1) Marijuana, (2) alcohol, (3) cocaine
•     Referral Streams: Pima or Cochise County courts (90-95%), self-referrals (<5%),
      Children’s Managed Care (1%), Child Protective Services (1%), aftercare programs (<1%),
      mental health services programs (<1%)

Gender/Race Distribution
              Male       Female    Caucasian   African    Latino/    Biracial   Native     Other
                                               American   Hispanic              American
    Program     69%        31%        46%                   34%        14%                    6%

    Study       70%        30%        48%           2%      37%        12%         1%


Evaluation—University of Arizona
•     Data Collection Waves: Baselines started in January 1999; the final followup wave started
      in January 2000
•     Expected Total Enrollment: 360 (180 from model program; 180 from comparison group)
•     Age of Adolescents: Ages 12 to 17
•     Comparison Groups: (1) Drug Court, (2) Seven Challenges (both programs are located in
      Tucson, Arizona)
•     Exclusion Criteria: Cognitively impaired at the time of intake
•     Validation of Self-Report Data: (1) Urinalysis to confirm drug use, (2) clinical files to
      confirm some self-reported data, (3) county court data to confirm GAIN information about
      criminal justice involvement
•     Time of Initial Assessment: Within 7 days of admission
•     Followup Data Collection Intervals: 3, 6, 9, and 12 months after intake
•     Supplemental Data Collection Forms and Questionnaires: (1) Acculturation Scale for
      Hispanics, (2) HIV/AIDS Knowledge and Risk Assessment, (3) Progress Scale (to measure
      communication skills, self-esteem, social skills, conflict resolution, social adjustment, and
      primary care givers’ parental skills), (4) Satisfaction Scale (to measure which aspects of
      program have been helpful), (5) Environmental Stress Inventory, (6) Adolescent Relapse
      Coping Questionnaire, and (7) Reasons for Quitting.




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