ADOLESCENT TREATMENT MODELS
Funded by the U.S. Substance Abuse and Mental Health Service Administration, Center for Substance Abuse Treatment (CSAT).

Principal Investigator: Patricia Perry, Ph.D.

 PARTICIPATING PROGRAMS:
Dynamic Youth Community, Inc. – Brooklyn, NY
Mountain Manor Treatment Center – Baltimore, MD
La Canada – Tucson, AZ
Phoenix Academy – Los Angeles, CA
Thunder Road – Oakland, CA
Chestnut Health Systems – Bloomington, IL
Epoch Counseling Center – Catonsville, MD
The Village, Inc. – Miami, FL
Teen Substance Abuse Treatment (TSAT) – Phoenix, AZ
Henry Ohlhoff Adolescent Recovery – San Francisco, CA
Four Corners Regional Adolescent Treatment Center – Shiprock, NM

The purpose of the ATM study is to:
1. Conduct an outcome and process evaluation.
2. Create a cost analysis.
3. Generate a treatment manual so the program can be replicated.

The methods used to obtain quantitative and qualitative data included:
1. Interviews with members and the parents.
2. Case studies with members, parents and staff.
3. Focus groups with alumni, parents, staff and Boards of Directors.
4. The research team conducted a Participant Observer Study where two team members “lived” in the residential facility for several days and participated in all treatment activities.

Project Status: The project began in October of 1998. Currently the research team is in the final phase of the project. The Treatment Manual is in the process of its first draft and focus groups are presently being conducted. Their deadline is in the summer of 2001. Unfortunately, there are no findings to date since the project in very much in progress.

Submitted by: Dynamic Youth Community, Inc. – William A. Fusco, Executive Director

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Institute for Professional Development in the Addictions

After two years of planning, evaluating and assessing professional needs in New York State, a 33-member group of addictions professionals from research institutions, education and training organizations, and treatment and prevention agencies joined together to form the newly created Institute for Professional Development in the Addictions.   The formation of the Institute was the culmination of a proposal that Commissioner Jean Somers Miller and Dr. Marc Galanter, of the New York University School of Medicine, presented to the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism to further New York's involvement in research-to-practice efforts through the efforts of an independent, but balanced group of addictions experts dedicated to advancing professionalism in the addiction field.

Through its newly formed Board of Directors, the Institute plans to carry out a three part agenda: (1) furthering the application of scientifically-proven research findings and outcome data to enhance service delivery; (2) promoting and/or providing high quality standardized education and training programs for the full range of professional disciplines in the addiction field; and (3) advocating for and supporting public policies that encourage an environment of continuous learning for New York's addiction professionals.

OASAS has pledged to support the Institute for a limited start-up period, with the expectation that it will become a self-sustaining organization and prime resource for the addiction treatment and prevention community.  Patti Juliana, Board President for the Institute, has indicated that much work still needs to be done before the Institute takes on a life of its own, but given the commitment of its Board and broad-base of support, it is only a matter of time.

Current plans are underway to recruit a full-time Executive Director who will help get the Institute up and running, and to organize a high profile event in the next year that will help to publicize its goals and availability as a critical resource to the addiction field.   

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National Drug Abuse Clinical Trials Network – New York Node

Recent advances in basic and clinical neuroscience, neuroimaging and genetics are providing a rapidly growing body of evidence about pathophysiology and treatment of addictive disorders, and it is now widely accepted that these are chronic relapsing conditions.  New medical and behavioral treatments have been shown to have efficacy, but this work has been carried out primarily in academic treatment research environments, by highly specialized staff, and with patient populations defined by restrictive inclusion and exclusion criteria.  Translating these new treatments to the broader community is an important public health challenge that was highlighted in a 1998 Institute of Medicine Report, Bridging the Gap between Research and Practice, and which is now the focus of the National Drug Abuse Clinical Trials Network launched by the National Institute on Drug Abuse in late 1999.

The missions of the Clinical Trials Network (NIDA CTN) are (1) to conduct effectiveness studies of behavioral and pharmacological interventions across a wide range of community-based treatment settings in diverse clinical populations, (2) to transfer the results of this research to providers and their patients within the community using science as a vehicle, (3) to provide policy advice to ensure the delivery of effective treatment to the broadest possible patient population, and (4) to prepare and provide access to training for providers in the community.   

The NIDA CTN is based on a model used successfully by other NIH institutes.  It is funded as a cooperative agreement which incorporates substantial NIH scientific and programmatic involvement to accomplish the primary goals in partnership with the grantees.  The Network consists of a National Steering Committee which is the primary governing body and a number of Nodes each of which consists of an academically based Regional Research and Training Center affiliated with five to ten Community-based Treatment Programs (CTPs).  Six Nodes were funded during the CTN’s first year – the Pacific Node funded through the University of California at Los Angeles, the Northwest Node through the Oregon Health Sciences University, the Mid-Atlantic Node through Johns Hopkins University, the Delaware Valley Node through the University of Pennsylvania, the New England Node through Yale University, and the New York Node through New York University.  It is anticipated that another four to eight Nodes will be added within the next year and that when fully implemented the CTN will incorporate between thirty and forty Nodes

The New York Node Regional Research and Training Center includes investigators from New York University, The Rockefeller University, the Nathan S. Kline Institute for Psychiatric Research, and the Mount Sinai School of Medicine.  The Community-based Treatment Programs affiliated with the New York Node include the Addiction Research and Treatment Corporation, the Lower Eastside Service Center, Greenwich House, Bellevue Hospital Medical Center, St. Barnabas Hospital, the Department of Veterans Affairs New York Harbor Health Care System, Mount Sinai Hospital and Gracie Square Hospital.  The New York Node is organized to include an overall Executive Committee, separate Steering Committees to oversee Research and Training activities and Community-based Treatment Program activities, and an Operations Committee

Expertise within the New York Node includes molecular biology and genetics, methadone, LAAM, buprenorphine and other pharmacological approaches, behavioral and psychotherapies, HIV/AIDS and Hepatitis C, public health and public policy, and training and dissemination.  

A first set of CTN protocols has been in development at the national level and is expected to be ready for implementation at CTPs in October or November 2000.  These protocols include (1) a set of inpatient and outpatient buprenorphine/naloxone detoxification and dose-ranging protocols, (2) a motivational enhancement therapy and a motivational interviewing protocol, and (3) motivational incentives protocols to be conducted in abstinence-based and methadone treatment programs.  

In addition a number of new protocol concepts are in review at the local and national level.  Many of these have been initiated as a result of needs identified by the community-based treatment programs.  Protocol concepts submitted from the NY Node that are currently in development or review address smoking cessation, hepatitis C screening, and optimizing treatment options for opiate dependence.  Other developing protocol concepts will address treatment of adolescent opiate dependence, evaluation of baseline characteristics and change in CTN affiliated CTPs, and improved follow-up for patients discharged from residential treatment facilities.  

There are numerous opportunities for interaction between the NIDA CTN New York Node and OASAS projects like the CSAT funded New York State Practice Research Collaborative.  The possibility that a second New York Node will be funded this year will also provide opportunities for additional collaborations. 

For further information on the NIDA CTN New York Node contact:
John Rotrosen, MD
Professor, Department of Psychiatry, NYU School of Medicine
ACOS for MH Research, DVA NY Harbor Health Care System
423 East 23rd St
New York, NY 10010 
e-mail: john.rotrosen@med.va.gov

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New York State Practice/Research Collaborative

Under the current one-year developmental grant, the co-applicants, the NYS Office of Alcoholism and Substance Abuse Services (OASAS), and the Alcoholism and Substance Abuse Providers (ASAP) of NYS, Inc., developed a statewide Practice Research Collaborative (PRC) with 30 members and seven regional Practice Research Networks (PRNs) with a total of 121 members. Members of the PRC and the PRNs operate 376 treatment units and 326 prevention sites, which represent about one-third of all services delivered in NYS and over 80,000 treatment admissions annually.

Under the three year cooperative agreement for the PRC Implementation Program, the co-applicants are requesting funds to improve the quality of alcoholism and substance abuse service delivery by supporting the infrastructure for practice research collaboration which has been developed and carrying out the knowledge development and application agenda developed by the PRC. The goals of the proposed project are to:

1. Maintain and further develop a flexible, open infrastructure that supports practice/research collaboration at the local and state level;

2. Evaluate and implement methods for technology transfer and the adoption of innovative practices within addiction services settings;

3.         Create policies and principles that promote collaboration and adoption of more responsive research and clinical practices that are mutually endorsed by policy makers, practitioners, researchers, and consumers.

1. Maintain and further develop a flexible, open infrastructure that supports practice/research collaboration at the local and state level;

2. Evaluate and implement methods for technology transfer and the adoption of innovative practices within addiction services settings;

3. Create policies and principles that promote collaboration and adoption of more responsive research and clinical practices that are mutually endorsed by policy makers, practitioners, researchers, and consumers.

Activities to be supported include core program services, network enhancement, pilot studies and knowledge application evaluations, and an evaluation of the PRC Implementation Program as executed in NYS. Knowledge application evaluations and pilot studies will involve new clinical and information technologies including identification of dual disorders (i.e., mental health conditions), interventions in health care settings, motivational enhancement, and Web-based learning.

Under the cooperative agreement, OASAS and ASAP will collaborate with CSAT, the Coordinating Center, and other PRC implementation sites, especially regarding the PRC process evaluation and the development of pilot studies and knowledge application evaluations.

For further information please contact:
Susan Brandau, Project Director   (518) 457-6129                                                       SusanBrandau@OASAS.state.ny.us 

John Coppola, Associate Director, ASAP  (518) 426-3122                                        mballester@asanysp.org

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New York University - Department of Health Studies

"GRAsP: Guide to Rehabilitation Assessment and Planning":
This project was funded by the NYS ATTC part of their faculty/practitioner fellowship. GRAsP was created to assist in rehabilitation planning for individuals in substance abuse treatment. It is designed to supplement existing, more detailed and specific psycho/social history and assessment instruments. The content allows the counselor and the client, individually and together, to examine feelings related to essential life domains and their impact positive treatment outcomes.

The instrument examines the domains of drug/alcohol use, emotional/spiritual well-being, work life, social and family interactions. These domains emerged from the synthesis of a much larger set of domains. Each domain is segmented according to past, present and future time frames. The past inquires as to perception of success in relation to the questions asked; the present allows the person to identify how frequently he/she experiences certain feelings or situation; the future allows the client to identify how much change is needed for success in certain situations. After administration a score is derived which is then transferred to guidelines for treatment planning. Application of GRAsP has produced excellent responses from counselors and clients. It has been used in individual and group sessions. Clients have reported that it has opened their thinking to a more expanded dimension and has allowed them to consider factors that have inhibited their progress from a new perspective. Counselors have expressed that this instrument has helped them attain new understanding of their clients.

Substance Abuse on-line Library: Focus on Clinical Supervision:
This project was funded by NYS OASAS to an interdisciplinary consortium on substance abuse at New York University. The consortium, ICSA, is an organization comprised of faculty from six schools and nine programs within the University. The on-line library (SATOL) is an assemblage of the most current research on clinical supervision with each reference abstracted and critiqued with guidelines for application. Full texts of 20 articles were on-line and the remainder appeared in abstract only (this was either based on lack of permission from the publisher or time constraints) The articles were categorized based upon ICRC guidelines on clinical supervision. Twelve supervisors were chosen from a random sample. These supervisors were oriented to the site and then directed to select an article each week for 8 weeks. Articles were to be selected based on relevance to their work. After reading the article the supervisor submitted a log including reference to the article selected, its application to their work. Five supervisors from the initial sample completed the course in addition to four work-study supervisors. Those who did not participate cited time constraints, change of job, other demands as reasons for non-participation.Evaluations of the impact reveal excellent results and recommendations for expansion. The supervisors found the articles extremely relevant. The ability to access the resource any time facilitated the learning process. The site was evaluated as excellent to navigate.

Eileen Wolkstein, Ph.D.
New York University - Department of Health Studies
35 West 4th Street, Suite 1200
New York, NY  10012
email:ew10@is2.nyu.edu

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NIAAA Researcher-in-Residence

Stutzman Addiction Treatment Center, Steven Schwartz, Director
Alan Zweben, Ph.D., Researcher

ISSUE:   What evidence-based best clinical practice can improve the retention rate of patients in an inpatient addiction treatment center?

INTERVENTION:  Motivational Enhancement Training for Clinical Staff

GOAL:  To improve retention in treatment by utilization of motivational enhancement techniques by individual staff and by the agency.

PROCESS:  Dr. Zweben visited the Stutzman ATC February, 2000 for three days of training and consultation of all available clinical staff and some nursing staff.  He used Enhancing Motivation for Change in Substance Abuse Treatment, TIP 35, SAMHSA/ CSAT, 1999 and additional handouts.
          Staff began to apply MET techniques with individual clients.
          Agency policies and practices were reviewed and changed to be more consistent with this approach (less confrontational and more motivational).
          Discussion of MET was included in staff meetings, conferences and daily rounds.

PRELIMINARY RESULTS:
          Retention improved somewhat during the six-month period, but this may have been due to another intervention---the use of Daily Rounds.
          Staff reported the timing of the training, a few days after a triennial JCAHO survey, was more stressful than beneficial.  Staffing shortages in the late spring and summer months, due to planned vacations and unplanned medical leaves and resignations, made it difficult to focus on innovation rather than working “the same old way.”
          The Researcher-in-Residence will be requested to visit the facility in the fall for a booster session.

CONCLUSIONS:
1.     Timing of orientation and training on new evidence-based interventions is very important.  It was seen as more of a burden than an honor.
2.     Clinical settings are not controlled settings.  Lots of things are happening all at once.
3.     It takes time to measure the impact of any new innovation.

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 Northeastern States Addiction Technology Transfer Center (NSATTC)

The NSATTC is a CSAT-funded, regional, collaborative project, covering New York, New Jersey, and Pennsylvania.  It’s one of 13 ATTC’s that provide, among other things,  research-to-practice activities in 39 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.    

Research to Practice Activity Being Conducted in NYS

·        Participation in Institute for Professional Development in the Addictions-NSATTC staff serve as a Board member, member of Executive Committee, and Chair of the Education/Training Committee-NSATTC will support evolving IPDA research to practice initiatives.

·        One of key partners in Practice Research Collaborative (PRC).  NSATTC staff serve on PRC Advisory Consortium and have worked with Project Management Team to offer ATTC resources as 7 statewide Practice Research Networks evolved.

·        Support for NSATTC satellite office at SUNY Buffalo’s School of Social Work and Research Institute on Addictions (RIA).  Among other projects in Western NY, the satellite office is developing: a product called “Research & Practice Dialogue”-offering lay versions of current evidence-based research; a CD-ROM based on the work of a previously funded ATTC Faculty/Provider Fellowship focused on Motivational Interviewing; a website offering research to practice information. 

·        Support for an additional training team from NYS Department of Correctional Services to attend TTT program, “Therapeutic Communities Experiential Training,” sponsored by NSATTC, and offered by the national ATTC network.

·        Collaboration with Binghamton University in support of the conference “Treating Women’s Addictions: Research Confronts Reality,” to be held in Oswego, NY October 2-3, 2000. 

·        Collaboration with Dr. Carlton Erickson in bringing his one-day, NIDA-funded Science Education Drug Abuse Partnership program to New York State, on June 6, 2001, in Syracuse, NY.  (see Save the Date Postcard) 

·        Development/maintenance of NSATTC home-office website, with numerous links to state/national sites of interest to treatment/prevention practitioners, faculty, and others interested in the SA field, and in technology transfer/research to practice.

·        Collaboration with Puerto Rico/U.S. Virgin Islands ATTC to disseminate certain Spanish-language materials, and promote a potential conference in late May 2001- “The Hispanic/Latino Family in the New Millennium: Strategies to Prevent and Treat Substance Abuse among Hispanic/Latino Children and Adolescents.”

·        Targeted distribution of two national ATTC publications, “The Change Book,” and “Untangling the Web.”  Both provide users with useful/practical information on successful technology transfer, and use of the Internet by SA Treatment Programs.

·        Collaboration with Dean Katharine Briar-Lawson of SUNY Albany’s School of Social Welfare, on potential research to practice initiatives she and OASAS are currently discussing.

·        Partner in national ATTC concept paper entitled, “Substance Abuse and Child Welfare Training in Context: Training and Nurturing Effective Staff for Effective Programs.”  The draft proposal will be submitted to CSAT, in hopes of funding a New York pilot program that “supports state and local efforts….to enhance the capacities of child welfare and TANF systems..,” as well as address needs of the substance abuse treatment/prevention staff working with these systems. The impetus for the project came from the April 1999 HHS report, “Blending Perspectives and Building Common Ground/A Report to Congress on Substance Abuse and Child Protection.”  The report was called for by Congress as part of the implementation of the Adoption and Safe Families Act-P.L. 105-89 (ASFA).

·        Participation with OASAS, the Office of Temporary and Disability Assistance, and the Department of Labor, on providing a comprehensive approach in New York to the successful identification of TANF-eligible families for appropriate referral to substance abuse treatment and other services, as they are assessed for employment readiness, and possible temporary assistance benefits (using pre-release TAP “Identifying Substance Abuse Among TANF-Eligible Families”)

·        Dissemination of numerous state, regional, and national substance abuse curricula and other supportive materials to our region, other states, and to a limited number of other countries, and if requested, providing technical assistance regarding their use.

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OASAS
Treatment Research/Evaluation Bulletin

 This is a periodic publication to be distributed to selected OASAS staff and the clinical directors at all OASAS-licensed treatment programs. It will provide updates on the status of Evaluation Unit projects and summarizes the findings of current research articles that are relevant to IPMES/Workscope issues and that address the effectiveness of various treatment approaches.

The first draft of the first issue is nearing completion.  After internal review it will be shared with the Executive Committee for release approval.

Best Practices Studies

This is a series of studies that seek to identify the factors that contribute to effective AOD treatment.  The first study is examining medically supervised drug free outpatient programs in the Long Island Region.  OASAS Field Office staff ranked and then filled out a questionnaire on the functioning of each program.  Program performance data were then used to identify the high and low performers.  Those programs consistently identified as high or low by the three measures were then selected for study participation.  Program visits are conducted in which staff and clients are interviewed, client records examined, and program operations observed.  Our objective is to identify those factors that contribute to high performing programs.

Once the initial factors are identified, a second group of programs elsewhere in the State will be selected for Best Practice validation visits.  Once these are completed, the final set of “best practice” factors will be identified.  OASAS will then develop an RFA seeking programs that are willing to adopt the identified “best practices.”  A field test would then be implemented to determine if adopting the “best practices” actually leads to improved client and program performance.  If the findings are positive, the best practices will be issued by OASAS as practice guidelines.

Best Practice visits are currently being conducted.   

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Outreach Project
Current Initiatives

Researcher-In-Residence
In cooperation with NIAAA & CSAT, we are one of six NYS programs participating in this initiative which seeks to encourage the adoption of research-based advances into clinical practice.

Nationally-recognized researchers briefly consult with the treatment program towards integrating a practice which has shown efficacy in research studies into clinical practice.

Specifically, our initiative sought to utilize assessment tools as a means of motivating and informing treatment planning with outpatient adolescents who are primarily alcohol or polysubstance abusers. While some of this protocol was developed during the course of NIAAA's Project MATCH, significant adaptations had to be developed to accommodate the clients' reading level, age, substance use profile, and needs of the clinicians. Our results, so far, are mixed. Operationalizing this intervention has been challenging due to staff shortages, "buy in" by direct care staff, and integration into a tight program format. Still, there is interest by staff that have used the tools, and by other units in our Agency who see the potential utility with their populations.

TOPPS II Study
We are one of twenty four (24) NYS programs participating in this CSAT-sponsored study of outcomes in a variety of modalities. Clients from our adult outpatient alcohol abuse clinic are the target population. They are administered a version of the Addiction Severity Index (ASI) at admission, and data regarding services received during their course of treatment is gathered and put in the OASAS Client Data System. Clients will be contacted six months post-discharge and administered the ASI again. It is our hope that we will not only get general feedback on our client outcomes, but what factors are correlated with particular outcomes.

Treatment Environmental Risk Index (TERI) Study
The TERI, developed by Nancy Jainchill, Ph.D. of the Center for Therapeutic Community Research, seeks to refine a tool which identifies the aspects of adolescent residential treatment environments which might be associated with client dropout. We participated in the original study to develop the tool which will now, in this study, seek to refine, reduce and replicate the tool, perhaps even for future use in adult settings. The work will involve interviewing clients and staff regarding various aspects of the treatment environment.

Outreach
As we are strategically interested in cultivating research-based clinical practice and/or evaluation activities which will enhance the quality of our services, we have met with research groups and individual researchers to discuss possible collaborations now, or in the future. This involves sharing Agency values in working with researchers, identifying Agency and researcher areas of interest, and resource capacity (data gathering, technology, staffing, funding, etc.).

Outreach Project
117-11 Myrtle Avenue
Richmond Hill, N.Y. 11418
Phone: (718) 847-9233
Fax: (718) 849-1093
E-Mail: nodrugs@erols.com
Contact: Kevin Wadalavage, Vice President

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TREATMENT OUTCOME STUDY (TOS)

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) has implemented a statewide Treatment Outcome Study (TOS).  The primary goals of the TOS are:

·        to examine the relationship between types and intensity of services received and positive client outcome;

·        to examine the effectiveness of different types of programs in producing positive outcomes in clients with similar presenting problems;

·        to examine the cost-benefit of the New York drug and alcohol treatment system; and

·        to determine the effectiveness of individual OASAS-licensed drug and alcohol treatment programs in producing positive client outcomes.

The TOS utilizes a random sample of 116 treatment programs based on program type, size and geographic location. Within each program, 85 adult clients will be selected to participate on a voluntary basis resulting in a subject pool of approximately 10,000 clients.  For a client to be included in a program=s TOS sample, he/she must have used alcohol or drugs in the past 30 days unless they are referred from the criminal justice system.

Upon a client's admission to the study, direct-care staff will record every service provided to the client, the duration of the service, the date the service was provided, and whether it was provided on-site or not. These data allow OASAS to examine the relationship between the type, frequency and intensity of services received and client change while in treatment and after leaving treatment.

The Addiction Severity Index (ASI) will be used to assess clients' level of functioning in seven areas: medical status, employment status, drug and alcohol use, family history, family and social relationships, legal status, and psychiatric status.  In addition, the client's motivation and readiness for treatment is assessed.  For every three months that the client remains in treatment, the program will administer a shortened version of the ASI.  These data will permit OASAS to examine the progress clients make while in treatment.

Six months following the client=s termination from the program, a contractor will contact him/her by telephone and administer a follow-up ASI and collect information concerning his/her current status and activities, and satisfaction with the treatment received.  The contractor will utilize a Computer Assisted Telephone Interviewing (CATI) system to administer this follow-up.

OASAS will issue annual reports that describe the status of the project and the results of the analyses relating to the impact of client services on outcomes and the relative effectiveness of treatment types.  As soon as this and the program-specific data become available, they will be used to direct the provision of technical assistance and to inform OASAS funding and planning decisions. 

 Treatment Outcome Performance Pilot Study Enhancement (TOPPS II)

There are twenty-four programs participating in TOPPS II that will collect data on 75 clients resulting in a sample of approximately 1800 clients. The goals of TOPPS II is to continue development of an Outcomes Monitoring System (OMS) that is sustainable, affordable and that allows continual tracking and reporting on the effectiveness of the State’s substance abuse treatment providers. To accomplish this goal, the predictive validity of a set of performance indicators that are currently included in New York’s MIS will be assessed.  If the performance indicators are valid predictors of outcomes, the State will move toward using data currently provided by the MIS to predict outcomes rather than relying on expensive and time consuming long-term outcome evaluation. 

Secondly, the State will evaluate whether the assessment instrument that is currently mandated statewide is sufficiently comprehensive and sensitive to support case mix adjustment or whether an alternative instrument necessary to increase the predictive power of the performance indicators.  The ASI Lite will be pilot tested and the cost-effectiveness of using it in the OMS will be evaluated by determining how much the improved precision in predicting outcomes costs in terms of the additional expense to the State for training and additional time to provider staff to administer at intake.

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