Transcript Five Strategies of MET

Cannabis Youth
Treatment (CYT)
Interventions and
Their Implementation
with Multicultural
Groups
Susan Harrington Godley, Rh.D.
Chestnut Health Systems’ Lighthouse Institute
Funded by: The Center for Substance Abuse Treatment (CSAT)
Substance Abuse and Mental Health Services Administration (SAMHSA)
U.S. Department of Health & Human Services (DHHS)
Surveyed EATS sites, other
selected sites using other CYT
Interventions, and developers
EATS goals


Adopt/Adapt an effective (individual
outcomes/cost) substance abuse treatment
intervention for youth (MET/CBT 5)
Expand the availability of substance abuse
treatment for youth
Providers Responding to E-Mail Inquiries
Sponsored by: Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services
Administration (SAMHSA), U.S. Department of Health and Human Services
Populations Served
(in site descriptors)
Butler County, Ohio: Most are of Appalachian
descent, few AA and Hispanic**
Culver City, CA: 40 to 50% Latino and 40% AA
DC: 42% AA, 33% White, 8% Asia
Denver: 33% White, 23% Hispanic, 2.5% Native
American, 12.5% Biracial
Denver TASC: Hispanic 51-52%
Houston, TX: 45% Hispanic, 45% Caucasian,
Non-Hispanic, 10% African American spread
across a large geographic county—much of it
urban
Populations Served
(in site descriptors)
Lansing, MI: 53% AA; 21% Hispanic, 5% Asian
American, 21% Caucasian; split between urban
and rural youth
Laredo, TX: 95% Mexican –American and
bilingual; many speak Tex-Mex; large percentage
of counseling sessions are in Spanish; half
urban—half rural; some live in “colonias”; also has
satellite offices in rural locations**
Norwalk, CT: Urban youth with a number of AA
and Hispanic referrals
NYC: Primarily Latino and AA, inner-city youth,
ages 12-17
Other Sites
Bloomington, IL Student Assistance
Program and OP
Little Rock, AR
Orlando, FL
Pinellas Park, FL
Comments about
Cultural Groups
“We also identified the Teen Culture, Gang
culture, Gender Specific issues, Gay, Lesbian,
and transgender, and the Drug culture as
important issues to be aware of for our
clients.”
“We haven’t found any major differences
between cultural groups, the issues are general
adolescent issues/behaviors.”
Discussion Points
Can you be more confrontative with certain
populations?
What is the interaction between resistance to
manual-guided therapy and cultural relevance
of an approach?
Commonality among adolescent issues vs.
cultural issues—which is greater?
Culture often interacts with socio-economic
factors—e.g., when planning alternative
activities—this may be a problem due lack of
funds—not culture
No Adaptations
(may have added to the intervention, but did not adapt)
Arapahoe House; Denver, Co.
Operation Par; Pinellas Park, FL
BEST Adolescent Initiative; Orlando, FL
UAMS; Little Rock, AR
Duke University; Durham, NC
Project TEMPO; Norwalk, CT
Take Five Program; Houston, TX
Butler County, OH
NY (East & Central Harlem), NY -- None yet,
but plan to adopt the Hip Hop version.
Prototypes; Culver City, CA
Project BEAT; Washington, DC
Why no adaptations
“I think the intervention is general enough to allow for normal
variances in our approach taken with individual students. The
biggest differences…don't have to do with ethnicity or socioeconomic issues. Instead, the support environment and
motivation, both internal and external, appear to be the
keys. For example, a Caucasian female student with using
parents did not do as well when the intervention was complete
as did an AA male with an extremely supportive (meaning
supporting his goal to remain abstinent) mother. As far as
internal and external motivation, the two AA males I had did well
in the intervention. One did not think using fit with his selfimage and the other was on probation and being tested.”
Comments About Staff
Comments about
Staff
“Our counseling staff is diverse, young, and energetic.”
“We have not made any changes…because we are
accustomed to working with this particular population.”
“A few of our staff members are fluent in Spanish. Our
agency also coordinated with a local university to provide
Spanish classes to staff members. We have a staff
member that can interpret and is available to give us
insight whenever needed. In our ABT program, we have
an AA primary counselor that provides direct service and
is able to give us insight as well.”
Staff
“We feel strongly that it is most important to have
clinically sound staff that are Hispanic acculturated and
Non-Hispanic acculturated, knowledgeable of African
American culture, the differences in the many Anglo
cultures as well as the different Asian populations we
see. It is important that staff are trained in and culturally
competent in order to deal with our very diverse
population…it is important…to state that just because a
counselor is of Hispanic or AA background does not
mean they are culturally competent to work with that
population. Training is the most important.”
Adaptations
Lansing, MI
Provide services in alternative
settings—in an alternative
school, day program; do more
of the CBT individually
TASC, Denver
Minor changes in educational
materials, Welcome; uses
sculpting to act out what a
support group is like
Adaptations
Bloomington,
IL
Adapted MET/CBT5 for school
setting by changing many
forms to reflect students and
offering CBT in individual
sessions
SCAN; Laredo
Combine ACRA and ACC for
rural area; translation of some
materials in Spanish
Didn’t necessarily adapt,
but added to the
intervention
Arapahoe House,
Denver
TASC, Denver, CO
Little Rock, AR
Durham, NC
Norwalk, CT
Houston, TX
Bloomington, IL
Butler County, OH
Laredo, TX
Culver City, CA
Additions—Family
Sessions (9 sites)
Family sessions when needed, involve family,
family psychotherapy (2)
Add FSN sessions (2)
Family sessions at the beginning and end of
treatment to orient to the treatment and review
progress
Two parent education sessions, done in a group
that meets twice per month, education about the
treatment, about monitoring adolescent
substance use and consequences for use, and
about parent-adolescent communication
Additions—Family
Sessions (9 sites)
Added a family component, which runs
concurrently with the first two CBT
sections. It is a support/education group
for parents of program participants.
After MET/CBT 5—case manager has 2
family appointments—preferably in the
home, clients come back for one more
booster session, and then one last
family/case management session.
Other Additions
CBT7 sessions (2)
CM which starts with their first MET
session either
case management every week for 2
months and 2 X the third month + phone
CM
 2 in-home sessions and then phone for the
rest of the year—depending on
assessment

Hip Hop MET/CBT5
Hip Hop MET/CBT5
Used old school hip hop music to start
sessions—chosen to fit the themes—very
positive
Change words to fit urban slang, e.g.,
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Drug refusal, AKA ‘How to represent’
Problem solving, AKA ‘Breaking it Down’
Social Support, AKA ‘My Peeps’
Anger Management, AKA ‘Chilling’
Participant folders were customized—
colorful—with graffiti from the city and a
rapper guy
Contact for Hip Hop
Information
John Callas
CT Juvenile Training School
Wk No. 860-638-2722
MDFT
(information courtesy of Dr.
Cindy Rowe)
Developed and first tested in San Francisco
with a largely Caucasian sample
“Temple University” study: 75% AfricanAmerican
University of Miami Center for Treatment
Research on Adolescent Drug Abuse
FAMILY THERAPY WITH
AFRICAN AMERICAN YOUTH
Jackson-Gilfort, Liddle, Dakof, & Tejeda (in press):
Does inclusion of culturally relevant themes
facilitate engagement of African-American male
adolescents in family therapy?
Trust/Mistrust
Alienation
Spirituality
Racial identity
Hopelessness
Anger/rage
Respect/disrespect
Boyhood to manhood
Racism
LINKING CULTURAL THEME
EXPLORATION AND OUTCOMES
Results:
 Journey from Boyhood to Manhood: improved
quality of therapeutic relationship; increased
participation in therapy, and facilitated deeper
exploration of issues generally
 Anger/rage: increased engagement in therapy and
facilitated deeper exploration of issues
 Alienation: increased participation and engagement
in therapy
 Racial Identity: increased participation
 General Issues of Racism: increased participation
in therapy
LINKING CULTURAL THEME
EXPLORATION AND OUTCOMES
Results:
 Exploration of cultural themes was associated with
increased participation and decreased negativity of
youth in the next treatment session
 Conclusion: Exploring culturally meaningful themes
is directly linked to investment in treatment for
African-American youth
ACRA/ACC
in Laredo
Used for primary OP and stepping down
(there is no IOP)
Use home-based model
Spanish translation of certain tools—
especially important for parents who may be
first generation
Added FSN family night in conjunction and for
those on waiting list—important for a sense of
community and belonging—snacks are
provided and all family members are
welcome
Spanish Publications
From SAMHSA’s National Clearinghouse for Alcohol and Drug
Information:
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
La marihuana: Información para los adolescentes (Marijuana: Facts
for Teens) - Order pamphlet free of charge at:
http://store.health.org/catalog/ProductDetails.aspx?ProductID=14
609
Marijuana: lo que los padres deben saber (Marijuana: Facts Parents
Should Know) - Order pamphlet free of charge at:
http://store.health.org/catalog/ProductDetails.aspx?ProductID=14
606
From Chestnut Health Systems:
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Folleto de Información General (General FAQ designed for parents
with questions about adolescent substance use in general or for
those participating in an initial substance use assessment):
http://www.chestnut.org/Adolescent/Folleto_Uno.pdf
Folleto de Tratamiento (Residential treatment FAQ designed for
parents whose adolescent is entering residential treatment):
http://www.chestnut.org/Adolescent/Folleto_Dos.pdf
Contact Information
Susan H. Godley, Rh.D.
Chestnut Health Systems
720 W. Chestnut St.
Bloomington, IL 61704
309.829.3543 ext.83343
[email protected]