Treatment 2.0: Treatment 2.0: Utilizing Technology for Enhancement of Services Utilizing Technology for Enhancement of Services

and Engagement of Youthand Engagement of Youth

Bridget Ruiz, M.Ed.Bridget Ruiz, M.Ed.Alison Greene, MAAlison Greene, MA

Elise LopezElise LopezDesiree BernalDesiree Bernal

Southwest Institute for Research on WomenSouthwest Institute for Research on WomenThe University of ArizonaThe University of Arizona

181 S. Tucson Blvd Suite 101181 S. Tucson Blvd Suite 101Tucson, AZ 85716Tucson, AZ 85716

bruiz@dakotacom.net

Presented at the Strategic Planning for Providers to Improve Business PracticesPresented at the Strategic Planning for Providers to Improve Business PracticesOctober 21-23, 2009 October 21-23, 2009

Arlington, VAArlington, VA

Session OutlineSession Outline

• 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 DefinitionsMedia Definitions& History& History

A people without history is like the wind on buffalo grass”

-Lakota saying

Media DefinitionMedia Definition

• Tools used to store and deliver information or data (Wikipedia, 2009)

• The means of communication, as radio and television, newspapers, and magazines, that reach or influence people widely (dictionary.com, 2009)

Grunts and Gestures

Hieroglyphics

Literacy-Greek Alphabet

Morse Code

Radio

Television

Internet Convergent Technologies

Brief History of MediaBrief History of Media

Media Utilization in Behavioral Health Care: 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)

Source: Omniture's

Web 2.0Web 2.0

Assertive Adolescent and Assertive Adolescent and Family Treatment (AAFT)Family Treatment (AAFT)

I have found the best way to give advice to your children is to find out 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.what they want and then advise them to do it.

-Harry S Truman-Harry S Truman

SAMHSA-CSAT Adolescent InitiativesSAMHSA-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 InitiativesCSAT 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 AAFTDetails 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/ACCACRA/ACC

• Training and Certification

• Coaching and Supervision

• Peer to Peer Discussions

Source: CSAT 2008 SA Dataset Adolescent Subset (n=16,006) 13

CSAT Full GAIN DataCSAT Full GAIN Data

Source: SAIS System (GPRA) 2008 data

Butler et. al., 2009

Change in 6 Month Abstinence Relative to Other Change in 6 Month Abstinence Relative to Other CSAT Adolescent Treatment Grant ProgramsCSAT Adolescent Treatment Grant Programs

Enhancing A-CRA/ACC Enhancing A-CRA/ACC with Mediawith Media

If I could tell you what it meant, If I could tell you what it meant, there would be no point in dancing itthere would be no point in dancing it

-Isadora Duncan-Isadora Duncan

Enhancing A-CRA for Youth EngagementEnhancing 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 DownloadsPodcast Downloads

Podcast PreviewsPodcast Previews

Youth FeedbackYouth 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 CommentsCaregiver Comments

Maybe I can help you [the youth] download the podcasts.

This is a good way to share information with youth.

Therapist FeedbackTherapist 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 InboxThe Inbox

What’s Next?What’s Next?

"The past is a source of knowledge, and the future is a source of hope.” "The past is a source of knowledge, and the future is a source of hope.”

-Stephen Ambrose-Stephen Ambrose

Recovery Oriented Systems of Care for Youth Recovery Oriented Systems of Care for Youth (ROSC)(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 Las Rosas-ROSC

• Implementing Sanctuary Model (Bloom, 2009)

• Implementing ROSC-Consortium• Examining community perceptions

– 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.”

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

Las Rosas: Services and Supports ModelLas Rosas: Services and Supports Model

Community Survey ResultsCommunity 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 SurveyCommunity 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 adolescents find and receive recovery supports that are How easily can adolescents find and receive recovery supports that are available in our communityavailable in our community

How easily can adolescents find and receive recovery supports that are available in our community?

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%

Degree of ease

Perc

entag

e of

resp

onde

nts Find

Receive

Perceived degrees of sympathy toward and support of adolescents by Perceived degrees of sympathy toward and support of adolescents by typical members of the communitytypical members of the communityPerceived degrees of sympathy toward and support of

adolescents by typical members of the community

0.0%

10.0%20.0%

30.0%40.0%

50.0%60.0%

70.0%

Very Moderately Somewhat Not at all

Degree

Perc

ent o

f res

pond

ents

Sympathetic

Supportive

Perceived extent that the typical member of our community feels that Perceived extent that the typical member of our community feels that adolescents in recovery will be productive in the community or adolescents in recovery will be productive in the community or

successful in lifesuccessful in life

Perceived extent that the typical member of our community feels that adolescents in recovery will be productive in the community

or successful in life

0.0%

20.0%

40.0%

60.0%

80.0%

Very Moderately Somewhat Not at all

Extent

Perc

ent o

f re

spon

dent

s Productive

Successful

Recovery Supports for Adolescents and FamiliesRecovery 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 ServicesRecovery 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, Emerging Issues, RecommendationsRecommendations

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 How Media Can Support Treatment Business PracticesTreatment 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 Changes in Health Care

• Evidence based practice– Specialization

• Outcomes– Production of positive changes

• Cost effectiveness– Best outcomes that are least expensive

RecommendationsRecommendations

• 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 & DisclaimerAcknowledgements & Disclaimer

AcknowledgementsThe 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.