Better Treatment Outcomes for Teens - Training, Monitoring, and Supervision are the Key

Recently, I visited a community where approximately 30-40 adolescents and their caregivers had shown up just to tell me what they thought of an adolescent substance abuse treatment program funded by the agency I represent, the Center for Substance Abuse Treatment (CSAT). They’d been invited, true, but I was still nervous, since folks tend to show up for town hall meetings and the like only when they have something to complain about.

 
However, to a person -- including the youth -- they had nothing but praise for the program, their therapists, and yes, even the federal government for bringing this intervention to their community. The resounding theme was that the youth and their caregivers now have dramatically improved communication, and they said they were actually getting some real help for the first time. Many spoke of previous multiple failed attempts at treatment for their youth and they had all but given up until this program came to town.
 
I believe these parents and youth were pleased with their care because CSAT has gotten serious about funding adequate training for therapists in evidence-based practices; fidelity of implementation; monitoring; and supervision. The combination may help agencies actually provide the benefits that all too often only get lip-service.
 
The program they were talking about was funded under CSAT’s Assertive Adolescent and Family Treatment (AAFT) grant program, which helped communities implement the Adolescent Community Reinforcement Approach (A-CRA) coupled with Assertive Continuing Care (ACC), both evidence-based substance abuse treatment approaches for adolescents. (The treatment protocols are in the public domain.) We also required grantees to use the Global Appraisal of Individual Needs (GAIN) to assess teens for the program.
 
Over the last several years, CSAT has been requiring that some sites receiving its adolescent treatment grants implement a specified evidence-based practice (in this case, A-CRA and ACC, along with the use of the GAIN). But we’ve taken this a step further: under a contract with Chestnut Health Systems, we also provide training and certification in the GAIN and in the evidence-based treatment practice specified by the grant.
 
A preliminary look at treatment outcomes suggests that this approach seems to be effective. We recently used our Government Performance and Results Act (GPRA) data to look at the relative effectiveness of this approach – requiring an evidence-based practice and funding training and certification -- versus requiring providers to implement the evidence-based practice but leaving it up to them to use their grant funds to get the necessary training. Here’s what we see so far:
 

• At six months post-intake, the abstinence rates for the A-CRA/ACC youth cohorts in the AAFT grant program have improved by 69.3%.
• For youth in other programs we fund that do not require what the AAFT program does (use of the GAIN, mandatory training, supervision and monitoring leading to certification), the increase in abstinence at six months post-intake varies by program from 21% to 40%.

 
Of course, the caveat is that I’m not reporting numbers in each group, level of severity, etc. These will be available at a later date, when the final results are published in a professional journal. However, I have confidence that these differences are significant, and that we are not comparing apples to oranges.
 
The jury is still out on how well the treatment programs in the AAFT program will be able to sustain these treatment approaches, but another reason for mandating their use, training for them, and then monitoring them carefully is that when the grant funds are gone, treatment programs should still have their own staff who can themselves train, supervise and monitor new clinicians in the approaches. Hopefully, they’ll have teens and their caregivers telling them how grateful they are for a long time to come.