matt claybaugh, ph.d. & a. scott allred, lmft marimed foundation
DESCRIPTION
The 4 th Annual Research and Evaluation of Adventure Programs Symposium Programs, Process, & Progress: The March Towards Evidence-Based Designation. Matt Claybaugh, Ph.D. & A. Scott Allred, LMFT Marimed Foundation. Program. Who we are and what we do. Process. Data in – Data Out - PowerPoint PPT PresentationTRANSCRIPT
The 4The 4thth Annual Research and Evaluation of Annual Research and Evaluation of
Adventure Programs SymposiumAdventure Programs Symposium
Programs, Process, & Programs, Process, & Progress: The March Progress: The March
Towards Evidence-Based Towards Evidence-Based
DesignationDesignation
Matt Claybaugh, Ph.D. & Matt Claybaugh, Ph.D. &
A. Scott Allred, LMFTA. Scott Allred, LMFT
Marimed Foundation Marimed Foundation
ProgramProgram
►Who we are and what we do.Who we are and what we do.
ProcessProcess
►Data in – Data OutData in – Data Out
►Moving towards EBP designationMoving towards EBP designation
ProgressProgress
►Where are we nowWhere are we now►Barriers to success Barriers to success
ProgramsPrograms
►How many of you believe/know you How many of you believe/know you are using an evidence-based model in are using an evidence-based model in your program(s)?your program(s)?
►How many of you are replicating a How many of you are replicating a “best practice,” “evidence-based” or “best practice,” “evidence-based” or “model program?”“model program?”
Marimed’s Residential Marimed’s Residential ProgramsPrograms
KailanaKailana ((Calm Seas) (est.Calm Seas) (est.1993 on O`ahu)1993 on O`ahu) and and
Wahiolanona`opioWahiolanona`opio ((A Healing Place for A Healing Place for Youth) (est. Youth) (est. 2004 on Hawai`i Island) 2004 on Hawai`i Island)
Residential treatment programs for Residential treatment programs for adolescents needing comprehensive adolescents needing comprehensive treatment and education, including mental treatment and education, including mental health and substance abuse services.health and substance abuse services.
Kailana Main Kailana Main CampusCampus
Kailana Voyaging HousesKailana Voyaging Houses
Hale Ho`ohua“House to Bear Fruit”
Hale Kauoha Kākou“House of Our Will”
Wahiolanona`opio Voyaging Wahiolanona`opio Voyaging HousesHouses
Wahiolanona`opio `O Kea`au:Girls House
Wahiolanona`opio `O Kapehu:Boys House
Integrated ServicesIntegrated ServicesExperiential
ClinicalEducational
Marimed’s
Model
Culturally Aligned with Youth Culturally Aligned with Youth PopulationPopulation
Mauka to MakaiMauka to Makai
Lo`i – Kalo, Animal Lo`i – Kalo, Animal Husbandry &FarmingHusbandry &Farming
Culinary ArtsCulinary Arts
Ocean-Based Ocean-Based ProgrammingProgramming
Small Boat SailingSmall Boat Sailing
Outrigger Canoe Outrigger Canoe PaddlingPaddling
Kiakahi Sailing CanoeKiakahi Sailing Canoe
Ho`ailona: Sailing CanoeHo`ailona: Sailing Canoe
S.S.V. Makani OluS.S.V. Makani Olu(gracious wind)(gracious wind)
Five 5sFive 5s
►Organizational ValuesOrganizational Values►Experiential ModelExperiential Model► Interwoven Phase and Level SystemInterwoven Phase and Level System►CPI (Non Violent Crisis Intervention)CPI (Non Violent Crisis Intervention)►Behavioral SupportsBehavioral Supports
#1: Organizational Values#1: Organizational Values
►CommunityCommunity►HonestyHonesty►AlohaAloha►RespectRespect►TeamworkTeamwork
#2: Experiential Model#2: Experiential Model
►Welcome Aboard / Preparing for SeaWelcome Aboard / Preparing for Sea►Departure / Commitment to the Departure / Commitment to the
VoyageVoyage►Challenge / Windward LegChallenge / Windward Leg►Mastery / WayfindingMastery / Wayfinding►Reflection / StorytellingReflection / Storytelling
#3: Phase and Level System#3: Phase and Level System
► Phases of Treatment:Phases of Treatment:I. Rapport Building: Roles and RulesI. Rapport Building: Roles and Rules
II. Accepting Responsibility and Expressing Needs and IssuesII. Accepting Responsibility and Expressing Needs and Issues
III. Coping SkillsIII. Coping Skills
IV. Dealing with Past Issues that Continue to Impede ProgressIV. Dealing with Past Issues that Continue to Impede Progress
V. Transferring Learning to New Life SettingsV. Transferring Learning to New Life Settings
#4. Crisis Prevention #4. Crisis Prevention Institute Institute
►Non-Violent Crisis InterventionNon-Violent Crisis Intervention
#5. Behavioral Supports#5. Behavioral Supports
►Making it RightMaking it Right►Restorative JusticeRestorative Justice►Cadet CouncilCadet Council►Positive Incident ReportsPositive Incident Reports
I Mua Mau `Ohana: IMOI Mua Mau `Ohana: IMO
►SAMHSA TCE: Targeted Capacity SAMHSA TCE: Targeted Capacity ExpansionExpansion
► Joint Program Enhancement Award: Joint Program Enhancement Award: 2002 Marimed Foundation and Maui 2002 Marimed Foundation and Maui Youth and Family ServicesYouth and Family ServicesVoyaging (For MYFS)Voyaging (For MYFS)12 month Continuing Care (All Islands)12 month Continuing Care (All Islands)
InstrumentInstrument
►Utilized the Global Appraisal of Utilized the Global Appraisal of Individual Needs (GAIN) Core VersionIndividual Needs (GAIN) Core Version
►GAIN also contains GAIN also contains SAMHSASAMHSA Government Performance and Results Government Performance and Results Act (GPRA) InstrumentAct (GPRA) Instrument
Baseline FindingsBaseline Findings
DemographicsDemographics
► Gender: 71% male, 29% female, 1% TGGender: 71% male, 29% female, 1% TG► Average age = 16 years oldAverage age = 16 years old► Ethnicity: 62% Native Hawaiian, 41% Ethnicity: 62% Native Hawaiian, 41%
Caucasian, 37% Asian, 24% other Pacific Caucasian, 37% Asian, 24% other Pacific Islander, and 24% Hispanic (many multi-Islander, and 24% Hispanic (many multi-ethnic)ethnic)
► Past 12 months living with: 71% parent(s) Past 12 months living with: 71% parent(s) ► Treatment prior to intake: Treatment prior to intake:
58% received treatment before; 58% received treatment before; average=1.2 admissionsaverage=1.2 admissions
51% felt they needed treatment51% felt they needed treatment
Criminal Justice InvolvementCriminal Justice Involvement
46% 41%
73%
0%
100%
% Y
ou
th -
Pas
t 90
Day
s
Arrested JuvenileDetention
Any ControlledEnv.
► 87% had lifetime arrests87% had lifetime arrests
Education & EmploymentEducation & Employment
► 89% of youth were enrolled in school or 89% of youth were enrolled in school or trainingtraining
► Only 5% reported engaging in some Only 5% reported engaging in some type of “non-full-time work”type of “non-full-time work”
Substance Use at IntakeSubstance Use at Intake
58.8%65.0%
28.8%
0%
100%
% U
sed
in
Pas
t 90
Day
s
Alcohol Marijuana Ice/Stimulants
Mental Health at IntakeMental Health at Intake
33.3%
58.2%
40.1%
22.0%
42.4%
0%
100%
% S
cori
ng
"H
igh
"
ConductDisorder
ADHD Depression Anxiety TraumaticStress
General Crime at IntakeGeneral Crime at Intake
62.7%
48.6%
22.0%28.8%
0%
100%
% S
co
rin
g "
Hig
h"
on
In
dic
es
GeneralCrime
PropertyCrime
Interpers.Crime
Drug Crime
Outcome FindingsOutcome Findings
Arrests – Past 90 DaysArrests – Past 90 Days
34.9%
14.0%20.9%
11.6%
0%
100%
% A
rres
ted
in P
ast
90 D
ays
Intake 3 month 6 month 12 month
Days in Juvenile Detention – Days in Juvenile Detention – Past 90 DaysPast 90 Days
7.655.184.99
18.48
0
5
10
15
20
Intake 3 month 6 month 12 month
Mea
n D
ays
in J
Din
Pas
t 90
Day
s
EducationEducation
83.3%90.7%
72.1%
39.5%
0%
100%
% E
nro
lled
in
Sch
oo
lo
r Jo
b T
rain
ing
Intake 3 month 6 month 12 month
EmploymentEmployment
9.60%2.30%
11.60%
41.8%
0%
100%
% E
ng
aged
in
or
Lo
oki
ng
F
or
Wo
rk
Intake 3 month 6 month 12 month
Substance UseSubstance Use
0
5
10
15
20
25
30
35
Intake 3 Months 6 Months 12 Months
Mea
n D
ays
Use
d
in P
ast
90 D
ays
Alcohol Marijuana Crack Hallucinogens Ice
Substance Problem ScalesSubstance Problem Scales
00.5
11.5
22.5
33.5
4
Intake 3 Months 6 Months 12 Months
Mea
n S
core
s
SUBSTANCE PROBLEMS Substance Issues
Substance Abuse Substance Dependence
Emotional Problem ScaleEmotional Problem Scale
0
0.05
0.1
0.15
0.2
0.25
0.3
Intake 3 Months 6 Months 12 Months
Mea
n S
core
s
Emotional Problem Scale
SummarySummary
► Youth mostly Native Hawaiian and other Youth mostly Native Hawaiian and other Pacific IslanderPacific Islander
► Youth at intake showed high levels of Youth at intake showed high levels of criminal justice involvement, criminal justice involvement, substancesubstance use, and both internal and external use, and both internal and external behavior problems.behavior problems.
► Significant rSignificant reduction in arrests and days in eduction in arrests and days in juvenile detentionjuvenile detention
► Significant rSignificant reductions in substance use and eductions in substance use and related substance problemsrelated substance problems
► Significant rSignificant reduction in emotional problemseduction in emotional problems
Wahiolanona`opioWahiolanona`opio►Received SAMHSA TCE Earmark for Received SAMHSA TCE Earmark for
Methamphetamine Treatment 2004Methamphetamine Treatment 2004
InstrumentsInstruments►Wahiolanona`opio Survey Wahiolanona`opio Survey
GAIN-QGAIN-Q Family Management, Family Bonding, Self-Family Management, Family Bonding, Self-
Efficacy, Cultural Pride, & School BondingEfficacy, Cultural Pride, & School Bonding
►Government Performance and Results Act Government Performance and Results Act (GPRA) Instrument(GPRA) Instrument
Data CollectionData Collection► From July 1, 2004 to September 30, 2006From July 1, 2004 to September 30, 2006► 58 total admissions58 total admissions► Baseline assessmentsBaseline assessments
52 GPRA 52 GPRA 46 Wahiolanona’opio surveys46 Wahiolanona’opio surveys
► Three-month assessmentsThree-month assessments 39 GPRA39 GPRA 34 Wahiolanona’opio surveys34 Wahiolanona’opio surveys
► Six-month assessmentsSix-month assessments 32 GPRA32 GPRA 27 Wahiolanona’opio surveys27 Wahiolanona’opio surveys
► 12-month assessments12-month assessments 16 GPRA16 GPRA 11 Wahiolanona’opio surveys11 Wahiolanona’opio surveys
DemographicsDemographics► Gender: 69% male; 31% femaleGender: 69% male; 31% female► Age: range=13-18, avg.=15.7 years oldAge: range=13-18, avg.=15.7 years old► Education: range=6th-11th grade, Education: range=6th-11th grade,
avg.=9.2 yearsavg.=9.2 years
EthnicityEthnicity
2.4%
2.4%
7.3%
19.5%
19.5%
78.0%
0% 20% 40% 60% 80% 100%
Black/African American
American Indian
Asian
White
Hispanic
Hawaiian or Pacific Isl.
Baseline ATOD UseBaseline ATOD UsePast 30 Days – % YouthPast 30 Days – % Youth
31.7%
92.7%
92.7%
61.0%
70.7%
0% 20% 40% 60% 80% 100%
% Youth Used
Ice
Marijuana
Other Illegal Drugs
Alcohol to Intox.
Alcohol
Qualitative Findings IQualitative Findings I► Sample of participants from the residential and day Sample of participants from the residential and day
treatment programs were interviewedtreatment programs were interviewed► Most participants felt they had changed positively, Most participants felt they had changed positively,
including increased acceptance of responsibility, including increased acceptance of responsibility, honesty, problem solving, anger management, self-honesty, problem solving, anger management, self-esteem, patience, positive attitudes, pro-social esteem, patience, positive attitudes, pro-social behaviors, academic performance, and remaining behaviors, academic performance, and remaining drug freedrug free
► Some participants also felt their families and their Some participants also felt their families and their relationships with their families changed for the betterrelationships with their families changed for the better
Qualitative Findings IIQualitative Findings II►Participants felt staff gave them support, Participants felt staff gave them support,
hope, and skills to deal with their problemshope, and skills to deal with their problems►Participants enjoyed the learning and Participants enjoyed the learning and
experiences they acquiredexperiences they acquired►When asked what was difficult about When asked what was difficult about
working with staff, participants mentioned working with staff, participants mentioned lack of consistency and organizationlack of consistency and organization
►Other concerns related to theOther concerns related to the location and location and living conditions of the homeliving conditions of the home
Limitations of FindingsLimitations of Findings►Small sample sizeSmall sample size►““Selection bias” due to follow-up survey Selection bias” due to follow-up survey
completion ratecompletion rate►Cultural sensitivity of required measuresCultural sensitivity of required measures►Social desirabilitySocial desirability
Summary ISummary I► Substantial decreases in AOD use at all follow-ups Substantial decreases in AOD use at all follow-ups
and reduced impact of AOD use at both 6- and 12-and reduced impact of AOD use at both 6- and 12-month follow-ups.month follow-ups.
► Increasing improvements in high-risk behaviors at Increasing improvements in high-risk behaviors at each follow-up.each follow-up.
► Although decreases in enrollment in school, there Although decreases in enrollment in school, there was increased school functioning for youth still in was increased school functioning for youth still in school and increased engagement in work for other school and increased engagement in work for other youth. Qualitative data also suggests some youth. Qualitative data also suggests some improvement in academics.improvement in academics.
Summary IISummary II► While some increases in psychological/emotional While some increases in psychological/emotional
problems revealed, decreases in external behavior problems revealed, decreases in external behavior problems also revealed. By 12 months, problems also revealed. By 12 months, improvements shown in both internal and external improvements shown in both internal and external behavior.behavior.
► Increases in self-efficacy and cultural pride Increases in self-efficacy and cultural pride also shown at all follow-ups.also shown at all follow-ups.
►Although family functioning scales showed Although family functioning scales showed only slight improvements, qualitative data only slight improvements, qualitative data suggests some improvements.suggests some improvements.
► Improvements in living conditions and Improvements in living conditions and number of youth receiving various types of number of youth receiving various types of treatment.treatment.
Where Are We Now?Where Are We Now?►Next StepsNext Steps►BarriersBarriers
T. S. EliotT. S. Eliot
“We shall not cease from explorationAnd the end of all our exploringWill be to arrive where we startedAnd know the place for the first time.”
T.S. Eliot
Thank YouThank You
Senator Daniel Inouye
Mayor Harry Kim (Hawai`i County)
Billy Kenoi
Char Shigemura
All Hawai`i Treatment Providers and Educators
Richard Kim, Ph.D., The Catalyst Group, LLC
Mahalo Mahalo
The endThe end