Girls and Opioids: Vulnerabilities & Opportunities

by Reclaiming Futures Staff

In two separate blog posts in 2016, we discussed opioid use rates and substance use issues among adolescent girls involved with juvenile justice. In July 2017, the United States Department of Health and Human Services, Office on Women’s Health (OWH) released a report on opioid use, misuse, and overdose in women. The report provides information on the gender-specific issues and gaps in knowledge regarding females with substance use concerns/disorders.

The report discusses the differences among females and males regarding the progression of substance use, the biological, social, and cultural issues (e.g., pain; relationships; family/parenting; trauma, determinants of health), effective treatments and barriers to implementation, and areas for further research. As it relates to adolescent girls (ages 12-17 years old), the report indicates they are more likely to use and become dependent on non-medical uses of prescription drugs as compared to adolescent boys. Access to prescription drugs can come from a home medicine cabinet and may help relieve mental health or physical pain symptoms and/or be part of their peer culture.

Other National Efforts

Testimony from leaders during the President’s Commission on Combating Drug Addiction and Opioid Crisis meeting in June communicated important recommendations relevant to the opioid problems given that death rates have quadrupled since 1999 and other serious consequences (e.g., family; long term health issues; loss of productivity). The Commission emphasized:

  • Delaying the onset of any type of substance use is critical to preventing the long-term consequence of addiction. Studies find the younger a person is when they first initiate substance use; the more likely they are to develop a substance use disorder over time. To achieve this, collaborate with communities, schools, and justice to implement evidence-based prevention including screening, brief intervention, and referral to treatment, develop or improve policies and practices for a continuum of services and supports, and eliminate stigma associated with substance use and help seeking.
  • Improving the implementation of evidence based prevention and treatment through workforce development, financing, and accountability. Repeatedly, the Commission said the science is solid, yet implementation is low. In other words, there studies and experts that have demonstrated and communicated, “What works,” but providers and communities don’t actually implement these strategies, services and supports, or treatments. Translating science into practice requires leadership, resources, training and technical support.
  • Using strategies such as systematic screening, assessment, and access to evidence based care to reduce the number of people with substance use concerns in the justice system.

The Commission is recommending rapid responses with scalable solutions to address this epidemic in communities across the country. What was missing from the discussion was the importance of being mindful of culture in any type of response. We know strategies to engage and respond to girls are different from boys as well as those for diverse racial and ethnic backgrounds, gender identity and sexual orientation, and where one lives (e.g., urban; rural). Considering cultural context is imperative to the successful implementation and adoption of any types of services and supports.

Medication Assisted, Counseling, and Behavioral Treatments

Medication-Assisted Treatment (MAT) combines medications to help people reduce the physiological cravings of alcohol, tobacco, and other drugs and behavioral therapies address the thoughts, behaviors, and other factors associated with substance use disorders (e.g., mental health symptoms and trauma; disparities).

Medications found effective for treating opioid addiction are methadone, naltrexone, and buprenorphine. Methadone is approved for use for people 18 years or older. Few studies have examined the effectiveness of naltrexone for adolescents, but experts suggest it is promising. Buprenorphine has been approved by the Food and Drug Administration for use with young people 16 years and older and has research to support its efficacy when combined with behavioral treatments for adolescents.

We must not forget the seminal report by the former United States Surgeon General on alcohol, drug use, and health. It provides background and recommendations for prevention, treatment, recovery support, and health care.  A primary theme of this report highlights treating substance use concerns/disorders as a chronic health condition rather than moral failing. Research shows medications, counseling, and behavioral therapies effectively treat substance use disorders whereas punitive approaches such as incarceration do not. 

Applications for Reclaiming Futures

The Reclaiming Futures approach has been shown effective for getting young people the services and supports they need. As such, Reclaiming Futures sites are leaders in the identifying and connecting young people to resources in their communities. So, continue what you are doing and constantly find ways to improve quality and use the latest research to guide decision-making.

Here are some other ways sites can respond specifically for girls of diverse racial and ethnic backgrounds:

  • Identify gender-specific and culturally responsive approaches used to screen, assess, and coordinate services in your communities. If there are gaps, consider ways to improve the community directed response for adolescent girls. Key considerations include mental health services including trauma, family supports, sexual health, positive human development opportunities and activities (e.g., family engagement; education; civic involvement and leadership; recreation; recovery support).
  • Check out your local resources for MAT. What are the requirements? How do families pay for services? Are there age limitations? Where are they located and how accessible are they? Are services gender-specific and culturally responsive for the community for which they serve?
  • Meet with local leaders to determine what, if any, policies or procedures are being implemented to address the opioid crisis and what is missing? What is explicitly inclusive for adolescent girls?

All across the country, families and communities are losing loved ones and becoming activists to prevent other families from experiencing this pain and suffering. Prevention is collaborating to activate coordinated community responses. Law enforcement, medical first responders, and juvenile justice are working to implement interventions. Behavioral health is working in creative ways to offer MAT, counseling, and other treatment. Responding to substance use and misuse for young people requires increased collaboration, coordination, and messaging about its tragedies, victories, and everything in between.

——

Authors Note: Discussion of gender in this blog post assumes biological sex at birth since the documents reviewed did not specify. For consistency, this was maintained throughout the blog post. Reclaiming Futures is cognizant of and respectful that gender is not a dichotomous construct, but a continuum of identities.

 

Reclaiming Futures SBIRT Implementation: Progress & Plans

by Bridget Murphy

Before sharing our accomplishments and expansion efforts, let’s take a moment to acknowledge numerous people and organizations that we have had the privilege of working with over the past few years to implement Reclaiming Futures’ version of Screening, Brief Intervention, and Referral to Treatment (RF-SBIRT).

First, we must acknowledge the youth and families who have agreed to participate and engage in a process of considering how substance use and mental health concerns might be affecting their goals. This may not have been easy and we appreciate their willingness.

Second, the SBIRT coordinators, project directors and other project staff have collaborated to provide us with critical feedback, offered in the kindest way, on aspects that needed improvement. Project staff also shared examples of how RF-SBIRT is empowering young people and their families to decide to work towards their goals keeping health and wellness in mind. Repeatedly, we hear the strength-based screening helps engage youth and families. The screening combines a series of strength-based questions and the Global Appraisal of Individual Needs Short Screener. It screens for a young person’s self-identified strengths and symptoms related to mental health and substance use. The information is used to start a conversation with a young person to affirm their strengths and determine if they would benefit from the brief intervention and/or referral to other services and supports.

Third, the Conrad N. Hilton Foundation (Foundation) has provided leadership, expertise, resources, and support to expand the use of SBIRT with adolescent populations across the country. The Foundation’s goals for SBIRT are:

  1. Ensure health care and other youth providers have the knowledge and skills for screening and early intervention services
  2. Improve funding for, access to, and implementation of screening and early intervention services
  3. Conduct research and advance learning to improve screening and early intervention practices

The Foundation has funded projects in a variety of areas including local and state-level advocacy and education, implementation of SBIRT in school-based health and wellness centers, medical and juvenile justice settings, employee training programs, and so much more. It is impressive to see the goals operationalized in such diverse yet related ways.

Fourth, we acknowledge Abt Associates and its partnering organizations for leading the evaluation, training and technical assistance efforts for the Foundation’s SBIRT funded sites, and Impact Justice for evaluating our own implementation. Understanding strengths and areas for improvement ensures we are offering quality services and supports to youth and families.

Fifth, four sites representing six counties in Ohio have invested in RF-SBIRT, participated in training, begun implementation, and contributed to its refinement. We appreciate their commitment to youth and families in Ohio.

These acknowledgements are relevant for numerous reasons, but in particular, because in 2016 the former United States Surgeon General released a report on alcohol, drugs, and health. The report indicated that alcohol and drug misuse is a critical public health concern, and it affects millions of youth and families across the country. It was a call to action for prevention, treatment, recovery, and health care to work together to address and respond to the public health crisis of substance misuse and related disorders. It is important to involve health care systems and other systems such as schools, juvenile justice, and child welfare. Young people and families who are affected by alcohol and drug use may present in a variety of settings. As such, we must be able to respond effectively regardless of where they may present.

 Our Accomplishments

Since our last update, we are pleased to share our cumulative accomplishments in the areas of youth and family involvement, training and technical assistance, and evaluation that are aligned with the Foundation’s goals. Table 1 displays the number of project activities completed between February 2015 and March 2017 followed by a brief discussion of additional accomplishments.

 

 

 

 

 

 

 

 

 

 

Youth and Family Involvement

  • We have engaged 242 youth and families in RF-SBIRT. While we are still working to meet our goal of 500 youth included in the evaluation, we have gathered plenty of implementation data, which will contribute to our learning about RF-SBIRT.
  • We aim to ensure our materials and approaches respond to the needs of culturally diverse groups. For example, we use images and case studies that reflect diverse racial, ethnic, gender, physical and learning abilities, and sexual orientations. We have Spanish versions of all the evaluation, screening, and brief intervention materials. We use gender-neutral language in our trainings and materials. We improve access for those with visual impairments by using recommended font types, color contrasts, and alternative text on images, graphics, and tables. These are substantial and modest ways we demonstrate our commitment for creating an inclusive RF-SBIRT environment. Yet, we know that cultural responsivity means consistently demonstrating respectful and authentic interactions with youth and families, project staff, collaborators, and funders, and always keeping in mind the wide-ranging worldviews.

Training and Technical Assistance

  • The 2017 RF-SBIRT training plan has been implemented and we continue to expand and diversify our training modalities (e.g., online short webinars; training video development)
  • Related to training and technical assistance, two project staff offered these reflections about implementation
  • The training from local expertise has helped to enhance my Motivational Interviewing techniques, specifically focusing on utilizing the skills of reflective discussion and open-ended questions to facilitate an open dialogue with clients and parents. This training has helped me to work with clients in identifying how their current usage/behavior could impact their future goals and what steps they can take to achieve their goals moving forward.  – Katie Marshall, Chittenden County Court Diversion

  • We found, with implementation of the model, a willingness to be flexible went a long way. When we first began the implementation process and laid everything out on paper, it looked great. After we started doing the work, we realized some changes needed to be made in where we had situated the intervention. An openness to flexibility with our implementation plan while maintaining the fidelity of the model was one way we found success in providing this intervention at our site.” – Katherine Wiley, Washington County SBIRT Coordinator

Evaluation

  • We have a Portland State University; Institutional Review Board approved research protocol. Additionally, we have a National Institutes of Health Certificate of Confidentiality to add extra protections for youth participants and their data.
  • We continue to collect data at intake (screening) and 3- and 6-months post intake. We continue to work on improving the quantity and quality of data collection efforts.
  • We are collecting data on demographics (e.g., race/ethnicity; age; sexual identity and orientation), substance use and mental health symptoms, age of first use and frequency of alcohol and marijuana use, school difficulties, legal involvement, placements (e.g., group homes; foster care), beliefs about alcohol and drug use, and perception of and satisfaction with the SBIRT process. These data will help us answer these four evaluation questions:
    • Does RF-SBIRT allow program staff to provide accurate mental health and substance use referrals?
    • Does RF-SBIRT lead to positive behavior health, youth development, and juvenile justice outcomes for youth?
    • Does RF-SBIRT shift program staff views of behavior health problems among youth?
    • Is SBIRT an effective screening, intervention and triage tool for youth in juvenile justice diversion meetings?

Expanding RF-SBIRT

King County, Washington

RF-SBIRT is expanding in King County, Washington. Under the Best Starts for Kids initiative, King County has established a license agreement with Portland State University, Reclaiming Futures to implement RF-SBIRT in more than 100 middle schools. The aim is to identify and intervene with young people who may have substance use and mental health concerns. As indicated, we will use our manualized brief intervention to work with young people and their caregivers and, if necessary, provide referrals for assessment, services, or supports.

It is important to recognize that the evidence that supports SBIRTs efficacy and effectiveness for adolescents is limited. Yet, we have designed RF-SBIRT based on the most rigorous evidence available, which shows the importance of multiple sessions that are longer in duration as compared to typical brief interventions, and includes caregivers. We also anticipate that RF-SBIRT will offer schools a greater understanding of substance use and the related issues and provide alternatives for disciplinary actions to keep young people in school, families involved, and additional services and supports.

King County has taken a strategic approach for expanding RF-SBIRT by first engaging with schools to seek their interest and then requesting information. Subsequently, schools will be engaged in planning and implementation workshops resulting in actual implementation. As we have learned, implementing RF-SBIRT in settings such as schools and juvenile justice requires deliberate planning and coordination to work through many of the initial issues that arise with implementation. Questions that arise vary from policy and practice to logistical issues. For example, questions such as: Do we screen all youth or a sub-set of youth?  How do we know if they would benefit from a brief intervention? How do we engage families?  What room/office do we use to conduct the brief intervention? How do we comply with privacy and confidentiality laws? How do we make a referral and to what organizations? These types of questions are important to work through, prior to implementation, and we look forward to collaborating with King County and the participating schools.

Collaborating with Tribal Communities

Through a partnership with the Center for Court Innovation, we are working to develop and expand a tribal version of RF-SBIRT. We started by working with the Yurok Tribe and have the opportunity to work with several more tribes.

We are proud of our accomplishments, energized for continual improvement, curious to see the evaluation results, and encouraged by the expansion process. Stay tuned for more RF-SBIRT news.

 

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

Juvenile Drug Treatment Court Guidelines

by Bridget Murphy

As many of you know, in 2016 the Office of Juvenile Justice and Delinquency Prevention (OJJDP) released the Juvenile Drug Treatment Court Guidelines (JDTC). The purpose for developing the Guidelines was to organize the most effective JDTC implementation components based on the best available research. Building on the 2003 Juvenile Drug Courts: Strategies in Practice (JDC: SIP), this systematic and thorough review developed seven objectives, each with corresponding guidelines statements, and supporting information.

Before going forward, it’s appropriate to look back. Reclaiming Futures and JDC: SIP have co-existed in many juvenile justice jurisdictions. OJJDP funded a number of grants to implement both Reclaiming Futures and JDC: SIP. Subsequently, they funded a cross-site evaluation that examined the implementation process, youth changes over time, and costs of Reclaiming Futures and the combined Reclaiming Futures and JDC: SIP approach. Findings from this study were used to support the empirical basis for some of the JDTC objectives.

Of relevance, Greene and colleagues (2016) developed a logic model blending Reclaiming Futures and JDC: SIP. The authors indicated the two approaches are complimentary and aim to achieve the same goals: reduce/eliminate substance use and future crime.  They indicated Reclaiming Futures and JDCs both emphasize (1) developing team collaboration (2) expanding the network of services through community partnerships, (3) focusing on youth strengths, (4) involving and engaging the family, and (5) monitoring and evaluation. Greene and colleagues also noted some differences. As compared to JDCs, Reclaiming Futures is a broader approach, recommends a greater number of individuals involved in collaboration process, works towards system change rather than implementing programmatic activities, and places a greater emphasis on community directed engagement following  services and supports.

The authors’ delineated 16 key activity areas that Reclaiming Futures and JDC: SIP overlap including:

  • Community engagement and collaborative partnerships
  • Judicial leadership aligned with JDC and RF concepts
  • Collaborative leadership and structured team work
  • Defined eligibility criteria
  • Balance confidentiality procedures and collaboration
  • Comprehensive screening and ongoing assessment
  • Strength-based and care coordination
  • Individualized evidence-based treatment services
  • Services appropriate to youths’ gender, culture, and development
  • Engage family in all program components
  • Regular, random drug testing
  • Strength based incentives and sanctions
  • Program monitoring and evaluation
  • Educational linkages
  • Successful initiation, engagement, and completion of treatment
  • Implementation community transition plan

Many of the commonalities and differences between Reclaiming Futures and the JDTC Guidelines remain the same.  Both have expanded and enhanced their approaches and models using research. Both have focused on the importance of culture and language – Reclaiming Futures through its decision-making approach to reduce racial and ethnic disparities in behavioral health decisions and JDTCs through explicit guidelines that address culture and language. JDTCs increased its emphasis on case management and continuing care and Reclaiming Futures has added a brief intervention for youth who do not need higher level of care. JDTCs continue to focus on the individual treatment needs such as trauma and co-occurring issues and Reclaiming Futures focuses on system issues to improve the identification, screening, assessment and coordination of these individualized services.

Both the development of the JDTC Guidelines and Reclaiming Futures cross-site evaluation has highlighted the need for rigorous research and evaluation to help the field better understand the effectiveness of interventions designed for youth and families involved in juvenile justice. We are entering this next phase of implementation and research of JDTCs with the release of OJJDPs notice that it is seeking applications for funding specifically for JDTCs.

This is an important time for us to use the knowledge gained, continually improve systems, services, and supports, and let research guide development. Implementation and research of the seven JDTC objectives will advance our understanding of JDTCs effectiveness for youth and families with substance use disorders. Based on the Reclaiming Futures cross-site evaluation study, juvenile justice jurisdictions may achieve extra value in terms of youth and family outcomes and cost savings by blending Reclaiming Futures and JDTC Guidelines. Determining the best approaches to meet the needs of youth and families within different contexts requires deliberate and thoughtful considerations of a multitude of issues for which Reclaiming Futures sites are very experienced.

 

 

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

Surgeon General’s Report on Alcohol, Drugs, and Health

by Bridget Murphy

There are so many noteworthy aspects to the “first ever” Surgeon General’s Report on Alcohol, Drugs, and Health. For example, it is grounded in the best evidence available to date and it examines issues of neurobiology, prevention, treatment, recovery, and health care systems. It also has educational and promotional materials such as fact sheets and social media ideas and resources. If you have not reviewed it – now is the time. It’s my understanding that additional fact sheets are forthcoming including one on criminal/juvenile justice populations. As such, keep visiting the website for updates and let’s keep talking about this report and its importance to individuals, families, and communities impacted by substance misuse and/or disorders.

I want to take a moment to discuss the chapter on prevention. The efforts we make each day with youth and families to provide education; supports, Asian Girl 600 x 190 SGR Digital Ad (a)and services are likely preventing further consequences of substance use and involvement with juvenile/criminal justice systems. The Surgeon General’s report indicates that the “vast majority of people who misuse substances in the United States do not have a substance use disorder” (p. 3-4). This suggests that prevention efforts to educate and intervene about the potential harmful effects of substance misuse while offering healthy behavioral options might be sufficient for the majority of people. This is not to suggest that treatment options should be ignored; but rather, taking the time to respond to a young person’s needs using a continuum of services and supports is likely to be most effective.

The Surgeon General’s report discusses three prevention interventions – universal, selective, and indicated. I would like to suggest that these prevention interventions are directly aligned with Reclaiming Futures 6-step model.

  • Universal prevention strategies are designed for the entire population. Step 1.0 in the Reclaiming Futures model is screening. The goal of screening is to screen all youth involved with juvenile justice to help identify young people who may have substance use concern(s).
  • Selective prevention strategies are aimed at those who may have substance use and/or mental health concerns. The goal of step 1.5 (Reclaiming Futures’ brief intervention) and 2.0 (initial assessment) are to intervene and assess young people who show substance use concerns based on the screening results.
  • Indicated prevention strategies are for those involved with substance use at levels that suggest treatment is necessary. Using results from the screening, brief intervention, assessment and interaction with the young person, the goals of steps 3.0 – 6.0 are to coordinate services and work to assist the young person in initiating, engaging in, and transitioning from services.

Reclaiming Futures 6-step model is based on population and public health approaches and best practices in the prevention and treatment domains for both substance use and mental health concerns among young people involved in juvenile justice.

The Surgeon General’s prevention chapter discusses types of prevention, developmentally appropriate interventions, and cost benefits. Moreover, we must not forget the National Research Council’s (2013) publication Reforming Juvenile Justice A Developmental Approach and the entire chapter focused on prevention. Taken together, these two seminal reports communicate the importance of intervening at the appropriate time with the appropriate intervention, using evidence-supported tools and interventions while adhering to implementation fidelity. These reports detail the evidence that shows using these approaches improves health and wellness of young people, decrease crime/delinquency, and offer costs benefits.

Authors Note: Reclaiming Futures will be releasing an update to its 6-step model that adds step 1.5 for our brief intervention. Stay tuned for more information.

 

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

H.R.6 – 21st Century Cures Act

by Bridget Murphy

Acknowledged as the final signed legislation for President Obama’s Administration, the 21st CeBridgetntury Cures Act is important for behavioral health and juvenile justice. The key components of this Act include provisions for:

In addition to the jurisdiction and community level supports, the Act provides structural changes to the way the government oversees and funds behavioral health. The 21st Century Cures Act includes developing a committee for federal agencies such as the Substance Abuse and Mental Health Services Administration, Department of Justice to work together on behavioral health issues; it designates a new position – Assistance Secretary for Mental Health and Substance Use, and designates an advisory board for analyzing treatments and services.

I am optimistic this Act will help coordinate funding and improve behavioral health policy, improve practice to identify individuals in need of services, increase equitable access to evidence-based services and supports, reduce stigma associated with accessing services by celebrating those in recovery, and expand the availability of community-based treatment throughout the United States.

2017 is guaranteed to bring many changes. I hope this Act will offer the field the leadership, coordination, funding, and research that will help us continue to improve the work we do in partnership with youth, families, and communities.

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

News from the National Executive Director, November 2016

by Evan Elkin

Reclaiming Futures National Executive Director Evan ElkinIn this month’s Reclaiming Futures newsletter, we draw your attention to a new report issued by US Surgeon General Vivek Murthy on November 17, 2016.  The report is significant because it marks the first time a United States Surgeon General has taken such a clear and strong position that substance use and addiction should be viewed first and foremost as a public health issue.  This is a position many advocates and organizations, like Reclaiming Futures, have taken for many years because we know firsthand the collateral consequences of continuing to view substance use and addiction as a moral failing and as a matter for the criminal justice system, and not the public health system and/or through a racially biased lens.

We know from our own work and national evaluation results that partnering with juvenile justice systems across the country to adopt a public health lens and replacing punitive responses with science-based, humanistic, and community-driven treatment alternatives, attending to issues of equity in access to care and justice, not only leads to better health outcomes for youth, but reduces recidivism and saves significant taxpayer dollars that could be reinvested in community-based treatment alternatives.

The Surgeon General’s report is encouraging and the potential policy and national public health implications of the Surgeon General’s position are enormous, but only if there continues to be high level government support and investment in continued reforms to the way we view and respond to substance use and mental health treatment needs in this country.

Evan Elkin

About

Evan Elkin is the executive director of Reclaiming Futures.

 

News from the National Executive Director, August 2016

by Evan Elkin

Reclaiming Futures National Executive Director Evan ElkinIn the current Reclaiming Futures newsletter we focus our attention on Screening Brief Intervention and Referral to Treatment (SBIRT). SBIRT is a public health-oriented framework revolutionizing the way we think about behavioral health and substance use screening and prevention. Buoyed by strong evidence from the adult research literature, there has been a surge in national interest in translating the successes of the adult SBIRT model for youth populations.

The process of developing an SBIRT framework for youth is in its very early stages and the interest in the approach is currently outpacing the presence of either a body of research evidence and a set of best practices to guide the field. However, with a significant strategic investment by the Conrad N. Hilton Foundation (CNHF), the field is making strides. Among other elements of a multi-pronged strategy, CNHF is supporting the field to develop and pilot innovative approaches to youth SBIRT, to look at workforce training, and to explore appropriate settings for implementation. The result has been to challenge a number of youth-serving systems like schools and juvenile justice systems to view their work with youth through a public health lens.

Reclaiming Futures is a grantee of CNHF and has been tasked with developing a new adaptation of SBIRT for juvenile justice system involved youth populations. See a recent blog post by Reclaiming Futures Program and Policy Analyst Bridget Murphy for an update on our SBIRT pilot. Reclaiming Futures has also just embarked on a project to collaborate with a number of tribal communities, beginning with the Yurok Tribal Community of Northern California, to develop a cultural adaptation of our SBIRT approach for tribal youth. We look forward to reporting on the progress of that work in an upcoming newsletter.

Evan Elkin

About

Evan Elkin is the executive director of Reclaiming Futures.

 

Year 2 Update! Reclaiming Futures’ Version of Screening, Brief Intervention, and Referral to Treatment (SBIRT)

by Bridget Murphy

As many of you know, Reclaiming Futures was awarded a Conrad N. Hilton Foundation grant in September 2014. The purpose of this grant is to develop, pilot test, evaluate, and disseminate a new version of SBIRT for youth at risk for deeper involvement with the juvenile justice system. As a first step, Reclaiming Futures issued a request for proposals and awarded five sites to help us in the endeavor. The sites selected, through a competitive process, were:

  • Chittenden County, Vermont
  • King County, Washington
  • Mecklenburg County, North Carolina
  • Nassau County, New York
  • Washington County, OregonMap of Reclaiming Futures sites, now including NW Ohio

Subsequently, in April 2016, using local resources, four sites in Ohio joined our SBIRT initiative. These sites include:

  • Hocking County
  • Lucas County
  • Montgomery County
  • Northwest Ohio – Three County Collaboration (Williams, Henry, and Defiance Counties)

We are wrapping up the second year of the Hilton funding and have some exciting updates. Before I share our collective accomplishments and upcoming directions, let me provide a little information about SBIRT and Reclaiming Futures’ version of SBIRT.

As you may know, SBIRT is a population health approach designed to offer universal screening to help identify individuals in need of behavioral health supports, services, and/or treatment (substance use or mental health). Historically, SBIRT has been implemented in primary care settings and is used to detect unhealthy alcohol or other drug use and to intervene in order to prevent further problems or severity. Our project is unique as we are working in juvenile justice settings. The goal is to combine public health and justice approaches to identify, intervene, and refer youth who are in the pre-adjudication phase to prevent further penetration in the justice system. There is another Hilton funded project working in juvenile justice being led by the National Center on Mental Health and Juvenile Justice (NCMHJJ). Together, Reclaiming Futures and NCMHJJ will be able to offer important implementation considerations about SBIRT in juvenile justice settings.

Reclaiming Futures executive director Evan Elkin and his colleagues developed our four-session brief intervention. It is strength-based and uses Motivational Interviewing as a way to engage youth and families. The intervention allows the youth to examine how behavioral health concerns might be influencing their goals. It also encourages parents/caregivers to create empathetic environments by remembering their own experiences as a youth and learning about adolescent development. In addition, it reminds project staff to take time to gain insight about the context of a family’s situation prior to making justice, treatment, or community decisions. While we are still early in implementation, we are optimistic about the promising benefits to families – as the SBIRT coordinator at one of the pilot sites said:

“I can’t fully express the beauty and joy that are these sessions. The rapport that is built through the activities in the parent session that dovetails so gracefully into the parent/youth session is profound. Every time I have a session I benefit from the experience of a deeper and sometimes in that moment unearthed, if only for a short time, bond between a parent and their teen. It is an honor every time to witness parents with their children in those moments. The activities allow me to be a trusted bystander while the family interacts. It is seriously awesome.”

–Katherine Wiley, Washington County, Oregon

We have some other notable accomplishments since beginning implementation:

  • Through a competitive process, we hired an external evaluator to conduct a cross-site process and outcome study – Impact Justice is leading it. This included designing research protocols, training project staff on participant protections, and obtaining Portland State University Institutional Review Board and National Institutes of Health, Certificate of Confidentiality approvals
  • Developed and implemented a screening tool and feedback report that combines strength-based questions with the Global Appraisal of Individual Needs – Short Screener
  • Engaged sites to provided us with invaluable feedback for refining the intervention and implementation process
  • As of the end of June, 2016, we have:
    • Enrolled 36 youth into the evaluation and they are in some phase of the project (intervention; follow up)
    • Trained 165 providers. Providers are defined as individuals who are implementing or supervising the implementation of SBIRT
    • Distributed SBIRT related materials to 403 people (PowerPoint slide deck; manual)
    • Completed 44 monthly implementation calls
    • Hosted SBIRT-specific monthly Learning Collaborative calls. Rates of staff attendance vary by site, but, on average, staff have participated in 89% of the calls
    • Disseminated Reclaiming Futures version of SBIRT through formal activities (e.g., presentation); we have reached approximately 435 people

Futures Directions:

We recently held a Training of Trainers (ToT) event to increase our capacity for training with current sites and for sustainability purposes. We continue to expand by seeking other partners in schools and juvenile justice settings. For example, recently in collaboration with the Center for Court Innovation, we have begun working on a Tribal version of SBIRT. The evaluators will be conducting on-site visits with the Hilton funded grants to examine the process of implementation.

If you would like more information, please feel free to contact us.

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

“Read All About It” – Research Findings Published!

by Bridget Murphy

BridgetReasons why I am proud to write this blog post…

Reason 1: My former colleagues (and friends) at The University of Arizona, Southwest Institute for Research on Women (UA SIROW) (UA SIROW) have been leading the efforts on the national evaluation of Juvenile Drug Courts and Juvenile Drug Courts blended with Reclaiming Futures (JDC/RF).  UA SIROW collaborated with Chestnut Health Systems and Carnevale Associates, LLC to implement a comprehensive evaluation that included data from Juvenile Drug Courts, Juvenile Drugs Courts blended with Reclaiming Futures, and non-justice related intensive adolescent outpatient programs. The purpose was to examine processes, outcomes, and costs.

Reason 2: A collection of five research reports and two commentaries are published in a guest issue of the Drug Court Review – a project of the National Drug Court Institute.

Reason 3: A logic model was developed for the blended juvenile drug courts and Reclaiming Futures, which includes problem statement(s), sub-problems, goals, objectives, key activities, and output measures (Greene, et. al., p. 31). With proper credit to the authors, this could be adapted and used in other jurisdictions implementing Juvenile Drug Courts and Reclaiming Futures.

Reason 4: The collection of research articles highlights some key points:

  • A historical look at the implementation and evaluations of Juvenile Drug Courts and Reclaiming Futures (Dennis, et. al., p. 6)
  • Youth enrolled in JDC/RF are younger, male, and nonwhite, in comparison to the general population of youth who met criteria for JDC (Baumer et. al., p. 60)
  • Reductions in substance use and delinquency/crime were evidenced over time.
  • Seven program characteristics were found to positively impact substance use and crime/delinquency changes over time including (Korchmaros, et. al. p. 80):
    • Having a defined target population and eligibility criteria
    • Imposing sanctions to modify non compliance
    • Conducting random and observed drug testing
    • Coordinating with the school system
    • Providing gender-appropriate treatment
    • Employing policies and procedures responsive to cultural differences
    • Training personnel to be culturally competent
  • Eight feasible recommendations for engaging the community to improve health and well-being of youth and families are discussed (Greene, et. al, p. 150)

Reason 5: While Reclaiming Futures has had previously published peer reviewed journal articles and reports (RF_Bibliography 07.06.16), this is the first to examine youth characteristics, effective program characteristics, and youth changes over time as it relates to the blended approach of Juvenile Drug Courts and Reclaiming Futures. As Tyson (2016, p. 163) indicates these studies do not conclusively support this approach as the only way to work with youth involved in the juvenile justice system, but they offer the important information about the “why, who, and how” for supporting and improving the practice of juvenile justice services and supports.

Reason 6: Policy recommendations are summarized about the research findings (Kagan & Ostlie, 2016, p. 155). The authors recommend targeting youth with high substance use severity and delinquency/crime as these youth seem most responsive to this approach and model. It is recommended to identify youth through universal screening and assessments. Furthermore, it is recommended that juvenile justice jurisdictions ensure that the implementation of the seven program characteristics found to reduce substance use and crime/delinquency.

For these reasons, I am thrilled to help disseminate this work. Of course, maintaining a critical eye on any type of research is important. All studies have limitations, but scholars that discuss these limitations and leave the reader with additional questions to consider helps build the foundation for improved policy, practice, and subsequent studies. We encourage the Reclaiming Futures community to read and share these articles and discuss how policy and practice improvements might be made based on the research findings.

 

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

Talking About Addiction

by Kate Knappett

On June 1, 2016, our Reclaiming Futures national executive director Evan Elkin spoke at Red Emma’s in Baltimore for Open Society Institute-Baltimore’s second event in their “Talking About Addiction” series. Elkin was accompanied on the panel by Dr. Hoover Adger from Johns Hopkins Children’s Center and by Carin Callan Miller, who founded Save Our Children Peer Family Support. The conversation was moderated by Scott Nolen, director of OSI-Baltimore’s Drug Addiction Treatment Program. A full room of community members joined them for the evening, including families affected by adolescent addiction.

Youth, Addiction and the Juvenile Justice System

Whereas the first “Talking About Addiction” event explored alternative law enforcement approaches to addiction, this event focused on youth, addiction, and the juvenile justice system. Despite public acknowledgment of the failures of the “War on Drugs,” and an increased understanding of addiction as a public health issue rather than a criminal justice issue, OSI-Baltimore recognizes that research and policy around adolescent addiction are slow to reach the mainstream. Indeed, during the discussion, some attendees expressed frustration with how long addiction treatment reform is taking; OSI moderator Nolen suggested reassurance that the addiction paradigm is finally shifting.

The conversation was reported on by the Juvenile Justice Information Exchange and OSI-Baltimore and includes these takeaways:

  • Inequitable healthcare makes for inadequate healthcare infrastructures
  • Race plays a significant role in adolescent substance use treatment
  • The stigma surrounding addiction is an obstacle for treatment
  • Teens need access to substance use treatment in their communities, rather than the system
  • Youth treatment should consider the whole family and not take a punitive approach

If you missed the discussion, but would like to know more, you can listen to this WEAA Marc Steiner Show podcast which includes an hour-long talk with Elkin and Nolen recorded on the morning of the event.

Kate Knappett

About Kate Knappett

Kate Knappett is a member of the Reclaiming Futures National Program Office.