Transcript GPAC High Rate Underage Users Workgroup

An Intervention Model
for the High Rate User
-SAPsPresentation to the
California County Coordinators
January 20, 2005
Presented by:
Joël L. Phillips
Community Prevention Institute (CPI)
(CARS, Inc.)
What we have learned… about underage
AOD use/users.
AOD use/Binge Drinking
Despite emphasis on AOD prevention, percentage of students
who report high rate use has been relatively constant over past
decades.
 A substantial percentage of California secondary school
students report they are high rate users (30% for EAUs, 20%
for HRUs)
 Excessive alcohol use is more prevalent than high risk drug
use
 Approximately a quarter of 11th graders binge once a month,
12% binge 3 or more times per month. For 9th graders, 11.5%
binge once a month, 7.2% binge 3 or more times per month.
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Consequences of Binge Drinking
 Social Harm
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Binge drinkers are more likely involved in
gangs and potential violence than students
who do not binge
One third of binge drinkers have reported
being in a drink/drive situation three or more
times (nearly triple the rate of the total sample)
Binge drinkers are more likely to be involved in
relationship violence than non-binge drinkers
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Consequences of Binge Drinking
(continued)
 School Related Harm
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Binge drinkers are more likely to use substances at
(23.6%), or before school (30.4%)
Some are more likely to engage in violent or
destructive behavior at school
Much more likely to skip school or cut class (one
estimate is 3.7 million missed days for California high
rate users)
Tend to have lower connectedness to school
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High Risk Drug Users (HRU)
Profile – 11th Grade
 One quarter:
Used marijuana and alcohol at school, past 20 days
 Drunk/high at school 7+ times
 One third:
 3 or more dependency indicators
 2 or more use-related problems
 Drinking/driving 3+times
 One half or more:
 Regularly (c. weekly) binge drink (5+ drinks/row)
 Weekly marijuana use
 High on drugs 7+ times
 Sold drugs

*Source: West Ed 12/2/2004
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New Analysis (West Ed)
•Document clear association between a number of student AOD
risk factors and overall school performance.
FINDING
Higher rates of AOD use
resulted in
lower levels of academic
performance
measured by changes in SAT 9
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Summary of HRU
Characteristics
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Endemic and resistant heavy alcohol and drug use
Poorer school attendance and performance
Multiple risk factors in lives, including early onset
High correlation with violence on and off school
Less positive response to prevention
Open to cessation but little follow through and low
perception of help from school
*Source: West Ed 12/2/2004
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Program Implications
 Efforts to raise test scores and improve schools – as
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well as create safe and drug free campuses – need
to address needs of heavy substance users
Different approaches from standard prevention
Early intervention addressing multiple risk factors
Need to address wide range of substance use
behaviors and other problems
Need to identify, support cessation, and provide
referral to services – Student Assistance
* Source: West Ed 12/2/2004
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Estimating Need for Services
HRU Plus: (HRU +2 or more consequences (WestEd )
4.5% 9th
8.6% 11th
Binge Drinkers Plus (BDP): (Binge Drinking Plus 2 or
more problems)
4.4 % 9th (2.3% binged 3+ times)
10.7% 11th (6.4% binged 3+ times)
Overlap: HRU Plus, Binge Drinkers Plus
75% 9th (BDP) were also HRU Plus
60% 11th (BDP) were also HRU Plus
Result: We estimate 6.1% of 9th graders and 13.1% of 11th graders
ARE IN PARTICULAR NEED OF INTERVENTION
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Summary of the Estimates
 High School Binge Drinkers:
356,000
 High School Problematic Use:
(2 or more problems/issues)
 Serious Alcohol Use (GW)
 16-17 yrs
 Dependent/Abuse

114,700
83,750
(National Household Survey Extrapolations)
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Alcohol Dependency 12-17 yrs
Alcohol Dependency/Abuse 12-17 yrs
Alcohol or Illicit Dependence/Abuse
12-17 yrs
50,000
138,000
221,000
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Issues
 Who do we target?
 How do we screen?
 What intervention services can we use?
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SAP’s, others
 How can we structure service delivery?
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Who do we Target? -Points of Intervention
Individual Needs and Levels of Service:
Exhibit 1
Needs
None
Mild
Moderate
Substantial
Severe
Specialized Treatment
Services
Brief Intervention
Primary Prevention
IOM Model
Universal – everyone
Selected – sub-groups
Indicated – Individuals with risks/problem behaviors
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Points of Intervention (cont)
Implications:
 IOM categorization at selected/indicated requires
screening and identification
Question: What are we doing in our schools to screen students
before they participate in one of our Model Programs designated
“selective” or “indicated”?
 Based on our estimates there are thousands of
youths in need of intervention services
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Promising Interventions
 Project Brief Interventions – K. Winters
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2-3 sessions
Strong Points
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For adolescents
Can be used by paraprofessionals
Good evaluation results
 Student Assistance programs (SAPs)
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Project SUCCESS
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A SAP program, but has some solid evidence, experience
 Recovery High Schools
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More intensive option
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The SAP Model
What is a Student Assistance Program?
 SAPs are a school-based approach to providing
focused services to students needing interventions for
substance abuse or other problems.
 SAPs are a process (not a curriculum or treatment
center) that connects education, programs, and
services within and across systems to aid students and
their families.
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What do SAPs do?
 SAPs…
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Identify troubled students
Assess students’ needs
Provide support and referral to school, family, and
community resources to address these needs
 The overarching goal of SAPs is to remove barriers
to education so that a student may achieve
academically.
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What does a SAP look like?
There are several possibilities…..

Core Team Model, which is founded on a central group of school personnel,
including:
 Student Assistance Coordinator
 Vice Principal
 School Counselors
 School Social Workers and Psychologists
 Classroom and Special Ed Teachers
 Student Services Staff
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The Core Team works collaboratively to identify and assist students.
Counselor Model, which is founded on an outside contracted body serving as
the source for SAP services.
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It requires a certified, experienced counselor to serve as program coordinator.
It effectively removes the SAP from the hands of school personnel.
SAP’s can be:
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School-based model, where each school has an independent SAP
District-based model, where a centralized SAP serves schools throughout
the district
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Identification of Services
How are students identified for SAP services?
 Referral of students comes from classroom teachers, school counselors, through
school disciplinary processes, by parents, and occasionally by students
themselves. (Ideal: Behavioral checklist)
 Students then proceed through the SAP process in a typical manner.
Who delivers SAP services?
 Services are delivered by a core group of individuals, typically a combination of
school personnel (administrators, nurses, counselors, teachers) and external
service providers (community-based organizations, community health providers).
What services are provided?
 Services provided include educational support groups, referral to outside
agencies, tutoring, after-school activities, peer mediation and conflict resolution,
and career services an family conferences, which are the heart of some SAP’s.
What issues are addressed?
 Issues addressed by many SAPs are:
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prevention (AOD, tobacco, drop-out, pregnancy, & STDs),
violence/bullying,
academics/attendance, and/or
behavior and mental health (grief, anger management, relationships, self-harm).
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What have we learned…
about SAPs in California?
Survey/Site Visit Results:
1. Not sure about numbers – identified 100 plus schools with SAPs – 40
High Schools offering SAP type services (CDE estimates: 353/1298
LEA’s had a SAP in 2003-2004)
2. Multiple Names
3. Problems (Top 3 co-equal) at 92%
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4.
AOD
Mental Health
Academic
20 plus other issues addressed by 1 or more schools
Services Offered
Support Peer Groups 97%
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AOD Problem Identified 94%
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School Counselor Consults 86%
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Prevention Education (classrooms) 83%
11 plus additional services
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What have we learned…
about SAPs in California? (cont)
5.
6.
SAPs (80%) work with community agencies
Students are referred through 4 ways:
Use
Teachers
Self Referral
Counselor
Parent
7.
100% of schools
89% of schools
97% of schools
97% of schools
Account for
41% of referrals
32% of referrals
24% of referrals
7% of referrals
Service size varied greatly (from small numbers 6-32 youth to
district size
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What have we learned…
about SAPs in California? (cont)
Participation:
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Most reported engagement (42%) 4-12 weeks
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12% - all school year, 12% 1-4 weeks
9.
Problems:
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Funding – low, piecemeal
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Staffing – burdened teacher staff
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Program awareness/buy-in
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Minimal evaluations – most process oriented
10. Need:
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Better statewide sharing of information between SAP
providers
8.
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Evaluations of SAP’s
1.
2.
We found only one rigorous study of a SAP.
We did find three statewide studies of SAPs.
Vermont (comparative study)
- Having a SAP counselor:
A reduction in violence, including:
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13 times fewer physical assaults
7 times fewer threats to staff by students
Half the physical threats to students by
other students
 Fewer fights and weapon carrying
A reduction in school infractions, including:
 Less than half the disciplinary actions
 Less vandalism
A reduction in incidences of substance use, including:
 Almost half the suspensions for drug use and drug sales by students
 Four times more student self-referrals for drug use
 Less drinking
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What did we learn about
evaluation? (continued)
Pennsylvania (3 year retrospective)
83-90 % referred were linked to a service
 73-90 % assessments completed
 60 % of referred students had no further disciplinary
suspension
 63-68 % of SAP students either were promoted or graduated
from high school

Washington State
 Increased protective factors (i.e., self-esteem, self-control,
assertiveness, cooperation and bonding)
 Reductions in 7 anti-social behaviors – including truancy, fighting,
and vandalism
 Reductions in use of 7 substances
- 33 % reduction in marijuana use
- 40 % reduction in amphetamine use
 Positive school behavior and academic “dramatic long-term improvements in
attendance and grades”
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What did we learn about
evaluation? (continued)
Project SUCCESS (continued)
• One SAP model rigorously evaluated – Project SUCCESS (control
study).
37 % decrease in substance use
23 % of those using, stop
Second Year Project SUCCESS
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33 % no longer used alcohol
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45% no longer used marijuana
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23 % no longer used tobacco
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Other Evaluation Results - Vermont evaluators cited the following:
Schools with SAPs experience:
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Reductions in overall substance use (Washington)
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Reductions in alcohol and marijuana use (New York, Wisconsin)
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Increases in school attendance (New York, Wisconsin, California)
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Decreases in drop-outs (California, Pennsylvania)
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Decreases in disciplinary actions (Wisconsin and Pennsylvania) and
vandalism (Wisconsin)
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What did we learn about
evaluation? (continued)
Conclusions:
Evaluations used varying methodology (some
better) but a consistent picture of positive
outcomes emerge for youth participating in a
SAP type program.
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Issues
Do we know enough to feel comfortable with
recommending SAPs?
How can we support more rigorous studies?
More technical – do SAPs work better with
certain problems/populations? Other issues?
What are the key service components of a
SAP?
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Summary Points
 Serious problems with high rate AOD users in
our High Schools
 A population in need of intervention services.
 Intervention services requires individual
screening
 Two promising program models
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Brief Intervention Services (K. Winters)
SAP’s
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