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									               Intergenerational Substance Abuse &
                     SAMHSA Model Programs

Women Across the Life Span:                  Gale Held
A Conference on Women,
Addiction and Recovery
July 12, 2004
Child Welfare and Substance Abuse
 Face many of the same issues and population
 Need the cooperation of parents, substance
  abuse and mental health providers and the child
  welfare system
 SAMHSA’s National Registry of Effective
  Programs identifies effective, evidence-based
  programs that can help both fields

Model Programs

 Offer some resources to assist child
  welfare professionals in addressing some
  of the critical needs of their parent and
  child clients
 Child welfare professionals can use them
  as part of their repertoire of healing and
  reconciliation for children and between
  children and parents

Model Programs Offer

   Evidence-based opportunities for
     • Parents to learn how to be better parents
     • Children to work on mental health or
       behavioral issues
     • Children to learn strategies to improve their
       functioning with families and peers
     • Families to learn how to reunite and stay
     • Parents to maintain custody of their
       Prevention Framework

 Framework
  Needs Assessment
  Capacity Building
  Program Selection

SAMHSA’s Model Program
National Dissemination System

SAMHSA National Registry of Effective
   Programs & Practices (NREPP)
1) Theory
2) Intervention Fidelity             Score:
3) Process Evaluation
4) Design
                                      1   2   3           4          5
5) Method of assignment

                                                          Effective or Model
                                                          Effective or Model
6) Sample size
7) Attrition
8) Analyses of attrition

9) Methods to correct biases
10) Outcome Measures – substantive
11) Outcome Measures –psychometric
12) Missing Data
13) Treatment of missing data
14) Outcome data collection
15) Analysis
16) Other threats to validity
17) Integrity
18) Utility                                                                    7
          Program Designations

   Scoring:
      Effective programs = 5.0 – 4.0
      Promising programs = 3.99 – 3.33
      Insufficient Current Support = 3.32 – 1.0

   Model Programs have received Effective scores and
    willing and able to go to scale.

   Promising, Effective and Model programs listed:

   Model programs receive SAMHSA promotion
What Makes a Model Program

     Programs Reviewed by NREP

               1051 submitted

                971 reviewed

50 Promising     46 Effective   57 Model
                  NREP Topics
• Substance abuse      •Violence
• Mental health        •Post traumatic stress
• Co-occurring         •Adolescent substance
  disorders            abuse treatment

• Child welfare        •Workplace

• Juvenile justice

        What Kinds of Models are Being

A selection of rigorously evaluated programs with
  strong outcomes for:
 Prevention of alcohol and drug abuse, steroid
  abuse, school drop out, violence, and other high
  risk behaviors
 Beginning to look at related conditions, e.g.,
  PTSD, co-occurring disorders

   What Kinds of Models are Being
      Disseminated? (contd.)
 Diverse ethnic populations

 Community, family, school, workplace,
  child welfare, juvenile justice and faith
 Initially, youth aged 2 to 18 (being
  expanded to other life stages)

Child Welfare and Juvenile Justice

 Foster family care
 Group homes
 Homeless shelters and public housing
 Juvenile court programs
 Residential and alternative schools
 Mental health and family clinics
 Adolescent treatment centers

SAMHSA Model Programs

    How are Model Programs

Awareness & Promotion
Capacity Building

      Awareness and Promotion

 Excellence Awards
 Web site
 Toll-free line
 Printed materials
 Direct promotion activities
 National Partnerships

Model Programs Web Site

           Awareness & Promotion:
          Model Programs Fact Sheets

   Target Population        Implementation
                              Essentials: Training
   Proven Results,           & Materials
                             Program
   Benefits                  Background
   How It Works             Evaluation Design
   Targeted Protective      Program Developer
    & Risk Factors
                             Contact Information

National Partners

   Child Welfare League of America
   National Association of State Alcohol and Drug
    Abuse Directors/National Prevention Network
   National Council of Juvenile and Family Court
   National Center on Substance Abuse and Child
   Others in substance abuse prevention and mental
    health fields, e.g., Community Anti-Drug Coalitions
    of America, National Mental Health Association,
    Phoenix House
Capacity Building

 Support training and technical assistance by
  developers to States and communities
 Interactive Program Implementation CD (IPIC) -
  under development
 National, State and regional training events
 Both implementation and training of trainers
  (TOT) events

   Selecting Model Programs

Program Selection Tools:
 Overview Matrix (web)
 Model Program Fact Sheets (web)
 Search Web site Program Listings (web)
 IPIC—Interactive Program
  Implementation CD

Model Programs to Consider (in order of
most child welfare and juvenile justice settings)

   Parenting Wisely            Project ACHIEVE
   Creating Lasting Family     Trauma-Focused
    Connections                  Cognitive Behavioral
   Positive Action              Therapy
   Strengthening Families      Life-Skills Training
   Second Step                 STARS for Families
   Residential Student
                                Strengthening Families:
    Assistance Program
   Cognitive Behavioral
    Therapy for Child Sexual    Lions-Quest SFA
    Abuse                       Al’s Pals
   Families and Schools
    Together (FAST)                                   23
Mental health programs for children

   Therapeutic intervention and early
    intervention programs primarily delivered in
    therapeutic or mental health settings that
    focus specifically on mental health needs of
    individual children, caused by such events
    and needs as trauma, loss, grief, lack of
    minimally nurturing environment, children of
    alcoholics or substance abusing parents,
    child abuse and neglect, etc.
Mental health programs for children,
 Cognitive Behavioral Therapy for Child
  Sexual Abuse
 Residential Student Assistance Program
 Trauma-Focused Cognitive Behavioral

School-based programs that build
skills and provide support for children

   Support and skill building programs
    primarily delivered in school settings that
    address comprehensive substance abuse
    prevention and early intervention, bullying
    and other types of violence, improving
    academic achievement outcomes, behavioral
    problems, etc.

School-based programs that build skills and
provide support for children, continued

 Al’s Pals
 LifeSkills Training
 Positive Action
 Project ACHIEVE
   Second Step

Comprehensive family and parent
support programs

   Programs delivered by a variety of community
    based organizations that provide support
    services to families with high risk children and
    youth, serving children and parents together
    or parents on behalf of their families and
    addressing issues of family management,
    parental skill building and training, substance
    abuse prevention, etc.

Comprehensive family and parent
support programs, continued
 Creating Lasting Family Connections
 FAST (Families and Schools Together)
 Lions-Quest Skills for Adolescence
 Parenting Wisely
 STARS for Families
 Strengthening Families
 Strengthening Families 10-14

Some Funding Strategies for Model
   CA counties applied for funds the State received
    from the DHHS Administration of Child Abuse and
    Neglect to prevent delinquency, and implemented
    Families and Schools Together (FAST) .
   A community-based organization in MD provided
    substance abuse prevention services to at-risk
    children within the child welfare system through the
    local school system – funds were matched with the
    Lions Club Foundation to train staff in the model
    program, Lions Quest.

More Funding Strategies for Model
   The Alcohol Council in WI through its SAMHSA
    State Incentive Grant (SIG) subcontracted with a
    local hospital to train staff of the adolescent
    treatment center in Start Taking Alcohol Risks
    Seriously (STARS) for Families.
   A public housing authority in Louisville, KY
    subcontracted with a local nonprofit which
    provided training in Creating Lasting Family
    Connections to residents and their families in a
    local Section 8 housing complex, through county
    drug elimination funds.

Risk Factors Model Programs Address

   Individual
     • Anxiety and depression
     • Lack of Self-control
     • Aggressive or disruptive behavior
   Family
     • Ineffective discipline
     • Family conflict
     • Child abuse and neglect
     • Parental and other family substance abuse

Risk Factors Models Programs Address,
 Peer
   • Association with aggressive youth
   • Pro-drug influences
 School
   • Lack of parental support and involvement in
     school work
   • Tardiness, absence, truancy
   • Academic failure

Other National Dissemination System
Activities: Core Components Analysis
   Reviewed Model programs to isolate
    program elements related to program
    success, such as program content,
    community building, delivery,
    adaptation, parental involvement.

   The CCA provides guidance on what
    elements you want to be cautious
    about changing if you want to adapt
    these programs.

Other National Dissemination System Activities:
Prevention Performance Outcome Monitoring
System (PPOMS):

 Assess the national distribution of
  SAMHSA evidence-based programs,
 Document barriers to and facilitators
  of evidence-based program
 Identify the degree of fidelity to
  original program curricula and

      Where do we go from here?

 Continue to identify new models relevant to child
  welfare agencies and programs and make them
  available to the child welfare community
 Learn more about how model programs have been
  implemented in child welfare; clarify costs
 Identify outcomes specific to child welfare
 Increase the number of national partners, e.g.,

RESULT: Strengthening of the national infrastructure for child
  welfare and substance abuse
Questions For You!
Accessing SAMHSA Model Programs
   What are the top 5 services that children in your
    community need but are currently lacking?
   What are the top 5 services that families in your
    community need but are currently lacking?
   How is your organization currently accessing
    services needed for children and families, and what
    funding strategies are you using?
   What, if any, ways is your organization accessing
    juvenile justice funding streams to serve your child
    welfare clients
More Questions for You!!!

 What are your suggestions for how best to
  showcase relevant Model Programs to the
  child welfare community?
 Do you have programs to submit?
 Can you give us key contacts and programs
  that might be interested in working with us?
 What are financing sources for implementing
  model programs in child welfare?

        SAMHSA Model Programs

 SAMHSA   Model Programs Web address:
 SAMHSA  Model Programs Toll-free line:

    National Registry of Effective
   Send program submissions to:
    • Steven Schinke
      National Registry of Effective Programs
      Intersystems, 30 Wall Street, 4th Floor
      New York, NY 10005
      Toll-free Phone: 866-43NREPP
      Toll-free Fax: 877-413-1150

             Other Resources

 CSAP’s Centers for the Application
 of Prevention Technologies
         Clearinghouse for Alcohol
 National
 and Drug Information (NCADI): or 1-800-729-6686

SAMHSA Model Programs Contacts

   Gale Held - 301-294-5741,
   Ben Smith – 301-294-5714

Suite 400, 1700 Research Blvd.
Rockville, MD 20850


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