Transcript Treatment 2.0: Utilizing Technology for Enhancement of

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
[email protected]
Presented at the Strategic Planning for Providers to Improve Business Practices
October 21-23, 2009
Arlington, VA
Session Outline
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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
• The means of communication, as radio
and television, newspapers, and
magazines, that reach or influence people
widely
(Wikipedia, 2009)
(dictionary.com, 2009)
Brief History of Media
Grunts and Gestures
Hieroglyphics
Literacy-Greek Alphabet
Morse Code
Radio
Television
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
community
– 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
families
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
ACRA/ACC
• 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
TAKE A LISTEN!
SIROW PRESENTS:
A-CRA PODCAST
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
youth.
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.
SIROW “My Space” HOMEPAGE
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
(ROSC)
• Looks very different that adult ROSC.
• Must incorporate representatives from
various disciplines (e.g., education; juvenile
justice; child welfare; youth recovery
community).
• 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
• Implementing ROSC-Consortium
• Examining community perceptions
(Bloom, 2009)
– Perceptions of:
• awareness, availability, access of recovery
supports for youth
• Typical adult attitudes/feelings towards youth in
recovery
– 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
Tucson:
– 36% report 5+ in Tucson
– 24% report 3 or 4
– 24% report 1 or 2
– 16% report 0
How easily
can can
adolescents
receiverecovery
recovery
supports
that are
How easily
adolescentsfind
findand
and receive
supports
that are
available in our community
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Find
w
no
't k
on
ve
ry
Id
Degree of ease
6
5
y
mo
d
era
tel
3
2
ta
ll
Receive
No
ta
Percentage of
respondents
available in our community?
Perceived degrees of sympathy toward and support of adolescents by
Perceivedtypical
degrees
of sympathy
toward
and support of
members
of the
community
Percent of respondents
adolescents by typical members of the community
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Sympathetic
Supportive
Very
Moderately
Somewhat
Degree
Not at all
Perceived extent that the typical member of our community feels that
Perceived extent
that the typical
of ourincommunity
feels or
adolescents
in recovery
will bemember
productive
the community
successful
in life
that adolescents in recovery
will be productive
in the community
or successful in life
Percent of
respondents
80.0%
60.0%
Productive
40.0%
Successful
20.0%
0.0%
Very
Moderately
Somewhat
Extent
Not at all
Recovery Supports for Adolescents and Families
• CSAT funded and led by Chestnut Health
Systems
• Four Sites:
– Tucson, Arizona
– Bloomington, Illinois
– Seattle, Washington
– Fitchburg, Massachusetts
Recovery Support Services
• Recovery support telephone support by trained
volunteers
• Recovery oriented social networking site
• Family Support using the Community
Reinforcement and Family Training (CRAFT)
Emerging Issues,
Recommendations
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
communities
• Transactional and relational
Changes in Health Care
• Evidence based practice
– Specialization
• Outcomes
– Production of positive changes
• Cost effectiveness
– Best outcomes that are least expensive
Recommendations
• 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
Acknowledgements
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.
Disclaimer:
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.
Sources:
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.