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HomeMy WebLinkAboutMINUTES - 06062000 - C117 u FHS # * + ~� . ." CONTRA ' COSTA TO: BOARD OF SUPERVISORS trf,' COUNTY" �V FROM: Family & Human Services Committee DATE: June 6, 2400 SUBJECT: Status of Youth Alcohol and Drug Treatment Program SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION REC ►�MMENDATIONtSk: ACCEPT the attached report from the Contra Costa Community Substance Abuse Services on implementation of recommendations of the Youth Access and Utilization Study. CKGR NDIREAS►ON S FOR,RECOMMENDATION(SI: On May 22, 2000, the Family and Human Services Committee heard a report on youth alcohol and drug issues from Chuck Deutschman, director, Contra Costa Community Substance Abuse Services (CSAS), Amalia Gonzales-del Valle, CSAS Manager, and Tom Aswad, Chair of the Substance Abuse Advisory Board. Chuck Deutschman stated one of the major difficulties in youth substance abuse services is the lack of funding: 10 years ago the state budgeted $93 million; this year it was $98 million, a net decrease when inflation is taken into account. Over the same ten-year period, his program's General Fund support declined from $4 million to $700,000. The only source of increased revenue has been from the federal government, which imposes numerous restrictions on use of funding. He also stated that public policy is almost exclusively funding treatment in the justice system and that youth needs treatment before they become involved in the justice system. He also expressed concern that the system is "pathologizing" addiction, since it is necessary to have a mental health diagnosis: in order to draw down revenue for treatment. CONTINUED ON ATTACHMENT. _YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR­LRECOMMENDATION OF WARD COMMITTEE APPROVE —OTHER S(CiNAT {s): ONE C�IAMILLA YJ0HNM.G101A CTION CIF ARD ON Ju APPROVED AS RECOMMENDED X--OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A UNANIMOUS{ABSENT – l TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND ENTERED ABSENT: _ABSTAIN: _-_ _ ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact:Sari Hoffman,335-1090 ATTESTED jnnp -61 PHIL.BATCHELOR,CLERK OF TH BOARD OF SUPERVISORS A C NTY ADMINISTRATOR cc: Cly CSAS BY DEPUTY SAAB(via CSAS) Amalia Gonzales-del Valle reviewed the attached report with the committee. She expressed great satisfaction with CSAS's ability to increase the number of youth in treatment, from 99 in FY 96-97 to 313 youth between July 1999 and April 30, 2000. She also stated that the data in some cases undercounts the amount of treatment. For example, mothers under the age of 18 may be given substance abuse treatment through the Born Free Program. She also stated that they are trying to shift their focus to schools without resources to help their students. Ms. Gonzales-del Valle also emphasized the need to standardize screening and assessment across systems to allow all services identify youth who need substance abuse treatment. Tom Aswad, Chair of the Substance Abuse Advisory Board, expressed the satisfaction of his Board with the progress being made by the department. He also stated that he is involved in Partners in Recovery Alliance, which are training recovered addicts as speakers on the need for youth substance abuse treatment and increased public support for funding. Mr. Aswad also invited the committee to visit the Discovery Program in Martinez so they could see for themselves the challenging conditions under which treatment is currently provided. It was agreed the committee would schedule its August 14 meeting at the Discovery Program. Supervisor Gioia noted that Issue Number 9, "Increase the Number of School-Based Prevention Programs," was very important. He felt this was a very essential strategy. Supervisor Canciamilla asked what happened to youth discharged. Ms. Gonzales-del Valle explained that there is supposed to be follow up; however it is difficult due to the mobility of the youth, going from school district to school district and sometimes dropping out of school. Both Supervisors Canciam€lla and Gioia expressed their appreciation for the good work being done not only to increase alcohol and drug treatment programs, but also to provide more opportunities for early intervention and prevention. 2 HtALii,itit i Wil.rt:r,. M. D. CONTRA COSTA rAL ra SF±?yir rS DIRFi EC7� ,.. �, A�9 ,. CJIUCK. DiUISOIMAN ... '*11", - COMMUNITY COMMUNITY o,artt�� _t_w�; ^._� ._ SUBSTANCE CONTRA COSTA ABUSE SERVICES 14 L A L T H S L R N 1 C L S 597 Center Avenue, 320 Martinez, Californialif 9&553 To: Family and Duman Services Committee Ph (925)313-6300Fax (925) 313-6390 From: health Services Community Substance Abuse Services(CSAS) By Amalia Gonzalez del Valle, CSAS Manager Re: Youth Alcohol and Drug Treatment Date: May 18, 2000 The purpose of this report is to update the Committee on the implementation of the recommendations generated by the Youth Access and Utilization Study which are listed below: 1. Increase the number of youth with AOD problems that are identified and referred to AOD treatment. In 1996-1997 only 99 youth (12-18) were admitted to publicly funded AOD treatment programs. The youth study estimated that at least 800 youth in Contra Costa would require publicly funded treatment but at the time only 1 in 8 did. State data shows 133 Contra Costa youth admitted to AOD publicly funded treatment in FY 1997-1998, 166 in FY 98-99 and 58 between July and November of 1999. A preliminary report by CSAS Management Information System covering the period between July 1999 and April 30, 2000 shows 313 youth between the ages 12-19 admitted to CSAS treatment services. 2. Institutionalize a standardized alcohol and drug-screening tool to identify youth with AOD problems. After . examining and testing several screening and assessment instruments recommended by the Center for Substance Abuse Treatment .Improvement Protocol Series, CSAS System of Care providers selected the "Simple Screening Instrument for AOD Abuse" a self-administered form for both youth and parents and the"Comprehensive Adolescent Severity Index Assessment'. In January 1999 the screening form was institutionalized as a requirement for all referrals made to indicated prevention services known as Strengthening Youth or Strengthening Family groups. These groups of no more than 12 participants are conducted once a week for up to 12 weeks. Participants are asked to develop a Behavioral Contract and at the end of the program to evaluate progress on goals stated in their contracts. Contra Costa Community Substance,abuse Services * Contra Costa Emergency Medical Services • Contra Costa Environmental Health • Contra Costa stealth Plan ' "' Contra Costa Hazardous Materials Procrams •Contra Costa Mental;�ealtn • Contra CostaPubl.c Health . Contra Costa flegionaf Medical Center < Contra Costa Health Centers In December 1999 CSAS provided a two-day training on the Comprehensive Adolescent Severity Index Assessment. The training required for all CSAS youth providers was open to mental health, probation and school personnel. In January 2000 the CASI-A was institutionalized as a requirement for youth AOD treatment. In June the CASI-A developer and trainer will be back for a two-day follow up. Early identification and referrals are still very limited even within the CSAS System of Care. One problem is that linkages of prevention participants identified and referred to treatment are not reported if the person has insurance coverage or pays out of pocket. CSAS electronic prevention management information system currently being pilot tested is designed to track linkages, referrals and in the near future performance outcomes. These recommendations require that the screening instrument be incorporated into other youth service systems. The West County Juvenile Drug Court, a collaborative between the courts, public defender, probation, mental health and substance abuse is using the CSAS Simple Screening and the CASI-Assessment. 3. Shift allocation of resources to promote early identification of youth at risk of AOD problems. CSAS staff in collaboration with the Substance Abuse Advisory Board,the Health Services Administration, Probation Department, the County Office of Education, the Safe and Drug Free Schools and Community Drug Alcohol and Tobacco Education (DATE) Coordinators recruited and trained volunteers, arranged logistics, mailed information, made presentations to several venues and obtained donations to defray costs for duplication of the California Healthy Kids Survey. Fifteen school districts conducted the survey including Juvenile Hall and the community schools. One of the barriers to implementation of the survey is the fact that DATE coordinators are overburden with many other responsibilities and get very little support from school administration. Also, volunteers and school personnel assigned to conduct the surveys had little knowledge of the importance of the survey both in terms of prevalence data for planning and funding requirements from the federal government. The return rate of parent permission farms was extremely low. Another concern is that although survey results are public information, there is no plan in place for school districts to make data available. 4. Educate the public on the Youth Study findings and provide cross training for youth providers as a way to promote effective collaboration. CSAS staff`in collaboration with the Substance Abuse Advisory Board and the Community Partnership Forum Alliance developed the purpose, goals and protocol for presentations of the Youth Study to selected venues. Over 55 presentations were conducted by teams comprised of SAAB, Partnership Forum 2 117 members, CSAS staff, Youth and Family providers and local residents. An inventory of local alcohol related and existing ordinances was developed to enable presenters to customize the contents to city councils, police departments, municipal advisory boards, the West County Coordinated Neighborhood Council and the Joint East County MACS, and other meetings attended by line staff serving youth and families. At each presentation packets of information were distributed which contained the Youth Study, the Youth, Family and Community Continuum of Services Guide, the Alcohol Outlet and CSAS Service Maps, the CSAS Resource Guide and SAAB Brochures. 5. Develop effective approaches to link referrals, services and tracking of youth client's through different systems of care. CSAS management information systems for treatment and prevention services are currently being refined to effectively link referral, services and tracking of client's within CSAS System of Care. A new server funded by youth treatment money and shared with mental health will increase the capacity to do statistical analysis and to set up a system to track and measure relational data, performance outcomes, etc. In the future this technology can help CSAS connect with other systems of care. 6. Obtain additional funding to provide AOD treatment to more youth in Contra Costa and increase the intensity of services currently available in outpatient and residential youth AOD treatment. CSAS submitted a project proposal to the State to increase and expand levels of care in youth treatment. The intensive outpatient treatment model for youth and family as well as the increased capacity in residential services was put in place at the end of last year. CSAS Youth, Family and Community contract with Thunder Road provides residential treatment services for 8-10 youth that usually show severe emotional and substance abuse problems. Center Point, is a new community-based agency contracted to provide 6-8 residential treatment placements. Asian Pacific Psychological Services, REACH Project, Discovery Counseling Services of San Ramon 'Halley, Sojourne and Tri-Cities are funded to provide intensive outpatient treatment. New Connections has been allocated youth treatment funds for start up casts of the West County Youth Drug Court, a treatment program primarily funded by Short-Doyle mental health Medical E.P.S.D.T., and during the pilot phase of the program, cover costs for a few non- medical youth. CSAS youth treatment also funds a Care Coordinator, a Drug Court Administrator, a data consultant and an administrative assistant. The County's matching of $300,000 dollars last year is very much needed on an ongoing basis to maintain the level of services that we currently have and to expand capacity to address the Youth Study findings. 7. Educate parents to recognize alcohol and drug use in their children and provide support for parents of youth that are using alcohol and drugs. 3 Youth, Family and Community Alcohol and Drug Abuse Prevention and Treatment Services first and foremost priority is to outreach and serve the children and family members of clients in treatment. With this goal in mind CSAS" shifted service plans that provided universal education that in most cases had no curriculum, no pre and post survey and no results, to the provision of indicated prevention services known as Strengthening Youth and Parents. Last year CSAS submitted a grant proposal to the Center for Substance Abuse Prevention to further develop parent's capacity to learn about best practices and decide which ones are culturally relevant to their experience. Although the proposal was rated very high it was not funded. We are now resubmitting a similar proposal with the intention to raise the number and quality of parent education programs currently funded by CSAS. 8. Make 12 Step meetings and AOD counselors available at local middle and high schools. CSAS strongly encourages youth providers to take their services outside of the clinics and into the schools,group homes and other non-traditional venues. This is a strategy to gain visibility and increase access to other portals of entry into AOD services. CSAS is willing to work with schools to achieve this recommendation but our experience in working with schools is fraught with frustration about the lack of coordination and barriers for collaboration. CSAS Administration under the guidance of Bianca Bloom and Joe Chapoe have developed a new project with the County Community Schools that brings together Probation, New Connections and Sojourne Counseling Center staff at the Golden Gate Community School in Martinez. The Edgar Center, a new transition program for the Boy's Ranch also located at the Golden Gate Community School site, will be also be served by a model similar to work together without "owning" the clients and with a commitment to engage these high risk youth in as many different services as possible. 9. Increase the number of school-based prevention programs. Above example is a model CSAS plans to implement in all County Community Schools. Also, in the last two years youth providers funded by CSAS have moved out of schools that have more resources and services to serve schools that have no resources or by definition serve a more at risk population e.g., alternative and continuation schools. Refer to FY 1999-2000 Prevention and Treatment Service Plans in Resource Guide. See attached allocation of prevention and treatment funding by region and modality. 4 Youth, Family and Community 1999-2000 Funding By Region and By Modality East County Providers Bi-Beat Latino Outreach Big Brother Big Sister New Connections REACH East CounW Funding Universal Prevention $ 84,170 Indicated Intervention $ 152,550 Outpatient Treatment $ 202,043 Total $ 438,763 Central Coun�tLProviders Discovery Counseling of San Ramon New Connections Central County Funding Universal Prevention $ 82,468 Indicated Prevention $ 36,206 Outpatient Treatment $ 163,576 West County Providers Asian Pacific Psychological Services Total $ 282,250 Big Brother Big Sister New Connections Sojoume Tri-Cities I West County Funding Universal Prevention $ 139,153 Indicated Prevention $ 72,282 Countywide Providers Outpatient Treatment $ 592,950 Access Unit Alcohol and Drug Abuse Council Total $ 804,384 Center-Point(Youth Residential) Center for Human Development Community Partnership Thunder Road(Youth Residential) Cou 'de Funding._ Universal Prevention $ 940,130 Indicated Prevention $ 412,348 Youth Residential Treatment $ 216,693 Total $ 1,569,171 TOTAL Funding Universal Prevention $ 1,245,921 Indicated Prevention $ 673,386 Treatment $ 1,175,262 Total $3,094,568 Supes.xis5/21/00 1 Youth, Family and Community FY 1998-1999 Youth Treatment Clients Client Characteristics. Fiscal Year 98-99 f=iscal Year 99-00* Total Total _ Count % Count Count % Male 166 65.9% 58 55.2% 224 62.7% Female 86 34.1% 47 44.8% 133 37.3% RaoeJEthnldty ~White 181 71.8% 64 61.0% 245 68.6% Black 22 8.7% 8 7.6% 30 8.4% Native Amer. 15 6.0% 12 11.4% 27 7.6% API 11 4.4% 7 6.7% 18 5.0% Latino 23 9.1% 14 13.3% 37 10.4% Primaly AQD Probiqm Herein 7 2.8% 1 1.0% 8 2.2% Alcohol 59 23.4% 17 16.2% 76 21.3% Methamphe. 24 9.5% 16 15.2% 40 11.2% Cocaine 3 1.2% 5 4.8% 8 2.2% Marijuana 155 61.5% 64 61.0% 219 61.3% Other 4 1.6% 2 1.9% 6 1.7% Aae sty se Primpry 6 2 0.80k 0 0.0% 2 0.6% 7 1 0.4% 0 0.0% 1 0.3% 8 4 1.6% 0 0.0% 4 1.1% 9 9 3.6% 6 5.8% 15 4.2% 10 12 4.8% 8 7.7% 20 5.6% 11 20 7.9% 7 6.7% 27 7.6010 12 34 13.5% 20 19.2% 54 15.2% 13 58 23.0% 18 17.3% 76 21.3% 14 52 20.6% 12 11.5% 64 18.0% 15 37 14.7% 23 22.1% 60 16.9% 16 21 8.3% 5 4.8% 26 7.3% 17 1 0.4% 4 3.8% 5 1.4% 18 1 0.4% 1 1.0% 2 0.6% �r�Status Completed 54 26.6% 4 30.8% 58 26.9% Early-Satisfactory 32 15.8% 1 7.7% 33 15.3% Early-Unsatlsfact. 9144.8% 7 53.8% 98 45.4010 Referred/Transf. 26 12.8% 1 7.7% 27 12.5% *FY 99-00 from July through November 1999 Supes.xfs5/21/00 2 9 en co 8 10 A 110w8 a8 naysorr` 8 to w wt trf Ln to C1► Ln O to w cMp 00 .=t h ct7 N ��- Ln m cNrs ' dtt+- rr ►v w r» n r r��t N (71 F 01) Ln00 in %0 (n earntoNgMchorn �e N omn to 'c . ., , ., =1 m co fl� C6 E %r r` w .-+ as N w ai as N E rn m � UT > j vii as a %% % W-4M tri m '�` rn w r N-r rn a � u wQ0o D Ln v, 0% w001Ln 10 r4.o LOov,Go Ln Sc► w O 'sef- cn w o h rn ccti rn N rn rn t. rn lw ac co` tti ri rw cw ,-+` V:` ni m rlr cz c c O 0 � � tCJ tfiM -4-a0rr4 GoONhCCMD w O w W to .-a ,-a mt N -4 O M tri (A tri r i in tri N Ln acs Ln to tra 90 0.6 Community Substance Abuse Services Youth, Family & Community System of Care RESOURCE GUIDE v.ii 1. CSAS System of Care Initiative. Development of Children, Youth and .Family Services. Summary: "Study of Youth Access and Utilization of AOD Treatment Services in Contra Costa County". 2. FY 1999-2000 Youth,Family& Community Prevention Service Plan 3. FY 1999-2000 Youth, Family&Community Treatment Service Plan 4. Youth, Family&Community Continuum.of Care 5. CSAS FY 1998-1999 Treatment and Prevention Service Maps b. 1999 Youth Drug and Alcohol Impact index f CONTRA. COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES ADMINISTRATION 597 Center Avenue Suite 320, Martinez, Ca. 94553 Phone (925) 313-6300 Fax (925) 313-6390 TO: CSAS Youth & Family System of Care Executive Directors, Coordinators& Line Staff CC: Chuck Deutschman&s CSAS Management Team Substance Abuse Advisory Board FROM: Amalia Gonzalez del Valle RE: CSAS Youth & Family System of Care DATE: February 12, 20001 The purpose of this binder is to provide you with an overview of CSAS Youth, Family and Community Continuum of Care as well as with its implementation guidelines and procedures. The Youth, Family and Community continuum of services is the result of strategic planning processes established by CSAS System of Care Initiative [April 1997]. The goal of CSAS System of Care initiative is to raise alcohol and drug treatment and prevention services to standards of "best practices" as required by the Substance Abuse and Mental Health Services Administration [SAMHSA] and the Centers for Substance Abuse Treatment [CSAT] and Prevention [CSAP]. I want to take this opportunity to share with you the challenge of implementing a service model that is based on a radical shift from the way the substance abuse field has set up priorities and define practices in the past. It is important to understand that the shift is in synch with CSAP and CSAT national plans to establish scientifically proven best practices to treat addiction to alcohol and other drugs. The concepts of addiction as a disease and prevention as a public health strategy to effectively address alcohol and other drug problems in our society are not new. The radical change is the emphasis on services that are based on research findings, best practices, and performance outcomes. I ask you to review materials included in this binder with a critical frame of mind. The intent is to promote dialogue and to allow differences of opinion as a way to improve quality of services. I invite you to share ideas and concerns with staff, providers, advisory board members, clients and their families. I very much look forward hearing from your discussions, so please fax me your comments (925) 313-6390 or e-mail delvalle@hsd.co.contra-costa.ca.us Gracias! CONTRA COSTA HEALTH SERVICES COMMUMTY SUBSTANCE "USE 8ER'VICES ADMINISTRATION 597 Center Avenue Suite 3201, Martinez, Ca. 94553 Phone (925) 313-6300 Far (926) 313-6390 TO: CSAS Youth & Family System of Care Executive Directors, Coordinators& Line Staff CC: Chuck Deutschman & CSAS Management Team Substance Abuse Advisory Board FROM: Amaha Gonzalez del Valle RE: CSAS Youth& Family Implementation Timelines Guidelines and Procedures DATE: February 12, 2000 ■ As of January 1999 "Strengthening Groups" (indicated prevention education strategy that targets high-risk environments, groups and individuals identified to be more at risk for AOD abuse or addiction than the general population) require following documentation: (1) Screening, (2) Behavioral Contract; (3) Prevention Activities Data System [PADS) for every service; and (4) Participant Satisfaction/Evaluation form for every service session or segment. Please review `blue binder" materials that describe service parameters e.g., number of participants, length of sessions, number of sessions per segment, etc. • As of January 1, 2000 the Comprehensive Adolescent Severity Index Assessment [CAST-A] instrument will be administered to all youth referred to outpatient treatment. To enter residential treatment funded by CSAS -Thunder Road and Center Point - referral source is required to contact Alec Budge, Youth and Family Care Coordinator. • Ideally the counselor that conducts the assessment adds the client to his/her caseload to ensure continuity of care. Another expectation is that case assignment takes into consideration (1) the number of clients carried by each staff and (2) the best clinical "match" between client and counselor. This process should take place during weekly case consultation or staff meetings. ■ As of February 1, 2000 whenever a counselor conducts a CAST-A Assessment s/he writes down issues, barriers and questions about the experience. The list should be faxed to Care Coordinator, without client ID but including demographic characteristics, level of AOD abuse or other pertinent information needed to understand the concerns raised by staff in relationship to a particular client. These lists will help us design training specific to counselor needs. ■ As of February 1, 2000 the first step in conducting CAST assessments includes an orientation session for the youth and family member requesting treatment. Ideally the counselor assigned to do assessment is also responsible for conducting the orientation, a good strategy to engage client and to assess behavioral factors that accompany responses. The orientation session should include. (1) explaining to youth and family member (defined as any responsible adult requesting treatment for a minor, such as foster placement, group home, etc.) what your agency, program and service expectations are; (2) informing youth and family member about norms and policies governing confidentiality, reporting, staff and client role and responsibilities; (3) asking youth and family member if they have questions, concerns or expectations that in any way conflict with issues discussed in (1) and (2). ■ As of January 1, 2000 intake and registration of youth and family requires same CSAS MIS procedures as with adults. I need in writing who does what, when and how to register clients in your program. If youth is the client or IP, services provided to the adult or family member are coded under the client's ID as collateral. If the adult or family member is a client, then you need to open two cases, one for the youth and one for the family member. Whenever family sessions are conducted you need to document service in both charts but code only one service under the youth ID. ■ As of January 1, 2000 all youth treatment client charts require following documentation: (1) registration in CSAS MIS; (2) intake and chart with all required forms signed, etc.; (3) CAST-A assessment, conducted in no more than 2 hours and in no more than 2 one hour sessions; (4) a treatment and after care plan that identifies the problem(s) and goals in behavioral and measurable terms that correspond to the CASIY-A assessment domains; (5) prescribed treatment activities that correspond to each of the treatment goals within CSAS Youth & Family service design; (6) progress notes for each service that once again correspond to treatment plan goals and assessment domains; (7) client and participant satisfaction surveys, for both youth and family member, administered during treatment episodes at intervals of 30 and 60 days, or at the time that client is discharged, terminated or decides not to continue. ■ As of January 1, 2000 youth treatment services should follow design, requirements and protocols depicted in Youth and Family Continuum of Care document distributed April 1999 and revised January 2000 which will be included in the binder to be distributed at the end of this month. ► t17 WII i r Ana B. Wnl M. D. CONTRA COSTA btAl:H SRnt,.s DiRrc?oR CilucK ©lul�ClMAN COMMUNITY DiREcrOR SUBSTANCE CONTRA COSTA ABUSE SERVICES H E A L T H S E RVI C L S 597 Center Avenue, Suite 320 Martinez, California 94553 TO: Family and Duman Services Committee Ph (925) 313-6300 Fax (925) 313-5390 From: Health Services Community Substance Abuse Services(CSAS) By Amalia Gonzalez del Valle, CSAS Manager Re: Youth Alcohol and Drug Treatment Date: May 18, 2000 The purpose of this report is to update the Committee on the implementation of the recommendations generated by the Youth Access and Utilization Study which are listed below: 1. Increase the number of youth with AOD problems that are identified and referred to AOD treatment. In 1996-1997 only 99 youth (12-18) were admitted to publicly funded AOD treatment programs. The youth study estimated that at least 800 youth in Contra Costa would require publicly funded treatment but at the time only 1 in 8 did. State data shows 133 Contra Costa youth admitted to AOD publicly funded treatment in FY 1997-1998, 166 in FY 98-99 and 58 between July and November of 1999. A preliminary report by CSAS Management Information System covering the period between July 1999 and April 30, 2000 shows 313 youth between the ages 12-19 admitted to CSAS treatment services. 2. Institutionalize a standardized alcohol and drug-screening tool to identify youth with AOD problems. After g. examining and testing several screening and assessment instruments recommended by the Center for Substance Abuse Treatment Improvement Protocol Series, CSAS System of Care providers selected the "Simple Screening Instrument for AOD Abuse" a self-administered form for both youth and parents and the"Comprehensive Adolescent Severity Index Assessment". In January 1999 the screening form was institutionalized as a requirement for all referrals made to indicated prevention services known as Strengthening Youth or Strengthening Family groups. These groups of no more than 12 participants are conducted once a weep for up to 12 weeks. Participants are asked to develop a Behavioral Contract and at the end of the program to evaluate progress on goals stated in their contracts. Contra Costa Community Substance Abuse Services + Contra Costa Emergency Medical Services . Contra Costa Environmental Health • Contra Costa Health Plan ''"" Contra Costa Hazardous Materials Programs -Contra Costa Mental Health Contra Cosa Public wealth • Contra Costa Regional Medical Center + Contra Costa Health Centers In December 1999 CSAS provided a two-day training on the Comprehensive Adolescent Severity Index Assessment. The training required for all CSAS youth providers was open to mental health, probation and school personnel. In January 2000 the CASI-A was institutionalized as a requirement for youth AOD treatment. In June the CASI-A developer and trainer will be back for a two-day follow up. Early identification and referrals are still very limited even within the CSAS System of Care. One problem is that linkages of prevention participants identified and referred to treatment are not reported if the person has insurance coverage or pays out of pocket. CSAS electronic prevention management information system currently being pilot tested is designed to track linkages, referrals and in the near future performance outcomes. These recommendations require that the screening instrument be incorporated into other youth service systems. The `test County Juvenile Drug Court, a collaborative between the courts, public defender, probation, mental health and substance abuse is using the CSAS Simple Screening and the CASI-Assessment. 3. Shift allocation of resources to promote early identification of youth at risk of AOD problems. CSAS staff in collaboration with the Substance Abuse Advisory Board,the Health Services Administration, Probation Department, the County Office of Education, the Safe and Drug Free Schools and Community Drug Alcohol and Tobacco Education (DATE) Coordinators recruited and trained volunteers, arranged logistics, mailed information, made presentations to several venues and obtained donations to defray costs for duplication of the California Healthy Kids Survey. Fifteen school districts conducted the survey including Juvenile Hall and the community schools. One of the barriers to implementation of the survey is the fact that DATE coordinators are overburden with many other responsibilities and get very little support from school administration. Also, volunteers and school personnel assigned to conduct the surveys had little knowledge of the importance of the survey both in terms of prevalence data for planning and funding requirements from the federal government. The return rate of parent permission forms was extremely low. Another concern is that although survey results are public information, there is no plan in place for school districts to make data available. 4. Educate the public on the Youth Study findings and provide cross training for youth providers as a way to promote effective collaboration. CSAS staff in collaboration with the Substance Abuse Advisory Board and the Community Partnership Forum Alliance developed the purpose, goals and protocol for presentations of the Youth Study to selected venues. Over 55 presentations were conducted by teams comprised of SAAB, Partnership Forum 2 �5 members, CSAS staff, Youth and Family providers and local residents. An inventory of local alcohol related and existing ordinances was developed to enable presenters to customize the contents to city councils, police departments, municipal advisory boards, the West County Coordinated Neighborhood Council and the Joint East County MACS, and other meetings attended by line staff serving youth and families. At each presentation packets of information were distributed which contained the Youth Study, the Youth, Family and Community Continuum of Services Guide, the Alcohol Nutlet and CSAS Service Maps, the CSAS Resource Guide and SAAB Brochures. 5. Develop effective approaches to link referrals, services and tracking of youth client's through different systems of care. CSAS management information systems for treatment and prevention services are currently being refined to effectively link referral, services and tracking of client's within CSAS System of Care. A new server funded by youth treatment money and shared with mental health will increase the capacity to do statistical analysis and to set up a system to track and measure relational data, performance outcomes, etc. In the future this technology can help CSAS connect with other systems of care. 6. Obtain additional funding to provide AOD treatment to more youth in Contra Costa and increase the intensity of services currently available in outpatient and residential youth AOD treatment. CSAS submitted a project proposal to the State to increase and expand levels of care in youth treatment. The intensive outpatient treatment model for youth and family as well as the increased capacity in residential services was put in place at the end of last year. CSAS Youth, Family and Community contract with Thunder Road provides residential treatment services for 8-10 youth that usually show severe emotional and substance abuse problems. Center Point, is a new community-based agency contracted to provide 6-8 residential treatment placements. Asian Pacific Psychological Services, REACH Project, Discovery Counseling Services of San Ramon Valley, Sojourne and Tri-Cities are funded to provide intensive outpatient treatment. New Connections has been allocated youth treatment funds for start up costs of the West County Youth Drug Court, a treatment program primarily funded by Short-Doyle mental health Medical E.P.S.D.T., and during the pilot phase of the program, cover costs for a few non- medical youth. CSAS youth treatment also funds a Care Coordinator, a Drug Court Administrator, a data consultant and an administrative assistant. The County's matching of $300,000 dollars last year is very much needed on an ongoing basis to maintain the level of services that we currently have and to expand capacity to address the Youth Study findings. 7. .Educate parents to recognize alcohol and drug use in their children and provide support for parents of youth that are using alcohol and drugs. 3 Youth, Family and Community Alcohol and Drug Abuse Prevention and Treatment Services first and foremost priority is to outreach and serve the children and family members of clients in treatment. With this goal in mind CSAS shifted service plans that provided universal education that in most cases had no curriculum, no pre and post survey and no results, to the provision of indicated prevention services known as Strengthening Youth and Parents. bast year CSAS submitted a grant proposal to the Center for Substance Abuse Prevention to further develop parent's capacity to learn about best practices and decide which ones are culturally relevant to their experience. Although the proposal was rated very high it was not funded. We are now resubmitting a similar proposal with the intention to raise the number and quality of parent education programs currently funded by CSAS. 8. Make 12 Step meetings and A©D counselors available at local middle and high schools. CSAS strongly encourages youth providers to take their services outside of the clinics and into the schools, group homes and other non-traditional venues. This is a strategy to gain visibility and increase access to other portals of entry into AOD services. CSAS is willing to work with schools to achieve this recommendation but our experience in working with schools is fraught with frustration about the lack of coordination and barriers for collaboration. CSAS Administration under the guidance of Bianca Bloom and Joe Chapoe have developed a new project with the County Community Schools that brings together Probation, New Connections and Sojourne Counseling Center staff at the Golden Gate Community School in Martinez. The Edgar Center, a new transition program for the Boy's Ranch also located at the Golden Gate Community School site, will be also be served by a model similar to work together without "owning" the clients and with a commitment to engage these high risk youth in as many different services as possible. 9. Increase the number of school-based prevention programs. Above example is a model CSAS plans to implement in all County Community Schools. Also, in the last two years youth providers funded by CSAS have moved out of schools that have more resources and services to serve schools that have no resources or by definition serve a more at risk population e.g., alternative and continuation schools. Refer to FY 1999-2000 Prevention and Treatment Service Plans in Resource Guide. See attached allocation of prevention and treatment funding by region and modality. 4 Youth, Family and Community 1999-2000 Funding By Region and By Modality East County Providers Bi-Bett Latino Outreach --— Big Brother Big Sister New Connections REACH East_Cou!!Iq Funding, Universal Prevention $ 84,170 Indicated Intervention $ 152,550 Outpatient Treatment $ 202,043 Total $ 438,763 Central Counq Providers Discovery Counseling of San Raman New Connections Central County Funding Universal Prevention $ 82,468 Indicated Prevention $ 36,206 Outpatient Treatment $ 163,576 West County Providers Asian Pacific Psychological Services Total $ 282,250 Big Brother Big Sister New Connections Sojourn Tri-Cities West County Funding Universal Prevention $ 139,153 Indicated Prevention $ 72,282 Countywide Providers Outpatient Treatment $ 592,950 Access Unit Alcohol and Drug Abuse Council Total $ 804,384 Center Point(Youth Residential) Center for Human Development Community Partnership Thunder Road(Youth Residential) Count 'de Fundin Universal Prevention $ 940,130 Indicated Prevention $ 412,348 Youth Residential Treatment $ 216,693 Total $ 1,569,171 TOTAL Funding Universal Prevention $ 1,245,921 Indicated Prevention $ 673,386 Treatment $ 1,175,262 Total $3,094,568 Supes.xls5/21/00 1 Youth, Family and Community FY 1998-1999 Youth Treatment Clients Client Characteristics: Fiscal Year 98-99 Fiscal Year 99-00* Total Total Count % Count % Count % .S Male 166 65.9010 58 55.2% 224 62.7% Female 86 34.1% 47 44.8% 133 37.3% Race/EthnidW White 181 71.8% 64 61.0% 245 68.6% Black 22 8.7% 8 7.6% 30 8.4% Native Amer. 15 6.0% 12 11.4% 27 7.6% API 11 4.4% 7 6.7% 18 5.0% Latino 23 9.1% 14 13.3% 37 10.40k Primary ACID Problem Herein 7 2.80k 1 1.0% 8 2.2% Alcohol 59 23.4% 17 16.2% 76 21.3% Methamphet. 24 9.5% 16 15.2% 40 11.2% Cocaine 3 1.2% 5 4.8% 8 2.2% Marijuana 155 61.5% 64 61.0% 219 61.3% Other 4 1.6010 2 1.90/0 6 1.7% Age 1st. Use Primary 6 2 0.8010 0 0.0% 2 0.6% 7 1 0.4% 0 0.0% 1 0.3% 8 4 1.6% 0 0.0% 4 1.1% 9 9 3.6% 6 5.8% 15 4.2% 10 12 4.8% 8 7.7% 20 5.6% 11 20 7.9% 7 6.7% 27 7.6% 12 34 13.5% 20 19.2% 54 15.2% 13 58 23.0% 18 17.3% 76 21.3% 14 52 20.6% 12 11.5% 64 18.0% 15 37 14.7% 23 22.1% 60 16.9% 16 21 8.3% 5 4.8% 26 7.3% 17 1 0.4% 4 3.8% 5 1.4% 18 1 0.4% 1 1.0% 2 0.6% Discharge Satus Completed 54 26.6% 4 30.8% 58 26.9% Early-Satisfactory 32 15.8% 1 7.7% 33 15.3% Early-Urisatisfact. 91 44.8% 7 53.8% 98 45.4% Refierred/T'ransf. 26 12.8% 1 7.7% 27 12.5% *FY 99-00 from July through November 1999 5upes.xis5/21/00 2 h C! ttf Ob V- whyy Cd C3 +� LnC d fV .-� rd K1 N N N N d .-4 ri -4 en rn to ,J y11pp} ��yy � (-4 1�Q t{9�it7 In "�to � cwt) � Ln tG �O � +�-F � rce � tAI OF Q tt� tll wi 4mN � eq fV N N Cl .-t �� C7 w M GI mit) N N 1 n fl% —4 co Ln LU crJ ZqZr- tl�O P� tL? 1�t1 N N if h N rNi tl ��(�ry M m . { + 1r4 N l) C-i M { E MtdJNh! NdN' � NCadm` Ct '-� Cacdt74Mv-4Nto 7p ppryry C�ry �+ N V" v a% N to N tp .� txJ i`� �t' tii' CA 6t? t'�� Or "r M 2c� CCL p dS c cp � 0 tC tt3 rt j isiCN* iT+ MmM � N rrt0stEgliCriA ` cn W Nri N cn �j tD C7 0 !Dn u'1 d' Cdr N cG C� S m t,A Cd � CT+ 'D 0 h C6 go h c to N fn tC1 2n NCS if M Al t�f �t N '� M GO iA C7 f� tY"1 CC} M N t+'� t+f F (r} '�' CO cz Lu M IW ppp ef` tO t e�j- � tt7 � NtO CDcoC MN M!19 Ati ll! !°+1 t71` h. .a tai ay � i11 Al N Lt} CO tJl'Stlt L/5_ N in M N a � Community Substance Abuse Services Youth, Family & Community System of Care RESOURCE GUIDE v.ii 1. CSAS System of Cure Initiative. Development of Children, Youth and Family Services. Summary: "Study of Youth Access and Utilization of AUD Treatment Services in Contra Costa County" 2. FY 1999-2000 Youth,Family &Community Prevention Service Plan 3. FY 1999-2000 Youth,Family &Community Treatment Service Plan 4. Youth, Family&Community Continuum of Care S. CSAS FY 1998-1999 Treatment and Prevention Service Maps 6. 1999 Youth Drug and Alcohol Impact Index CONTRA COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES ADMINISTRATION 597 Center Avenue Suite 320, Martina, Ca. 94553 Rhone (925) 313-6300 Fax (925) 313-6390 TO. CSAS Youth & Family System of Care Executive Directors, Coordinators& Line Staff CC: Chuck Deutschman & CSAS Management Team Substance Abuse Advisory Board. FROM: Amalia Gonzalez del Valle ---q""-<7 RE: CSAS Youth & Family System of Care DATE: February 12, 2000 The purpose of this binder is to provide you with an overview of CSAS Youth, Family and Community Continuum of Care as well as with its implementation guidelines and procedures. The Youth, Family and Community continuum of services is the result of strategic planning processes established by CSAS System of Care Initiative [April 1997]. The goal of CSAS System of Care initiative is to raise alcohol and drug treatment and prevention services to standards of "best practices" as required by the Substance Abuse and Mental Health Services Administration [SAMHSA] and the Centers for Substance Abuse Treatment [CSAT] and Prevention [CSAP]. I want to take this opportunity to share with you the challenge of implementing a service model that is based on a radical shift from the way the substance abuse field has set up priorities and define practices in the past. It is important to understand that the shift is in synch with CSAP and LSAT national plans to establish scientifically proven best practices to treat addiction to alcohol and other drugs. The concepts of addiction as a disease and prevention as a public health strategy to effectively address alcohol and other drug problems in our society are not new. The radical change is the emphasis on services that are based on research findings, best practices, and performance outcomes. I ask you to review materials included in this binder with a critical frame of mind. The intent is to promote dialogue and to allow differences of opinion as a way to improve quality of services. I invite you to share ideas and concerns with staff, providers, advisory board members, clients and their families. I very much look forward hearing from your discussions, so please fax me your comments (925) 313-6390 or e-mail delvalle@hsd.co.contra-costa.ca.us GraCiasl CONTRA COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE 3ERVICFA ADMINISTRATION 897 Center Avenue Suite 320, Martinez, Ca. 94533 Phone (9215) 313-5300 Fax (92 5) 313-6390 TO: CSAS Youth & Family System of Care Executive Directors, Coordinators & Line Staff CC: Chuck Deutschman& CSAS Management Team Substance Abuse Advisory Board FROM: Amalia Gonzalez del Valle. RE: CSAS Youth & Family Implementation Timelines Guidelines and Procedures DATE: February 12, 2000 • As of January 1999 "Strengthening Groups" (indicated prevention education strategy that targets high-risk environments, groups and individuals identified to be more at risk for AOD abuse or addiction than the general population) require following documentation: (1) Screening; (2) Behavioral Contract; (3) Prevention Activities Data System [PADS] for every service; and (4) Participant Satisfaction/Evaluation form for every service session or segment. Please review"blue binder" materials that describe service parameters e.g., number of participants, length of sessions, number of sessions per segment, etc. • As of January 1, 2000 the Comprehensive Adolescent Severity Index Assessment [CASI-A] instrument will be administered to all youth referred to outpatient treatment. To enter residential treatment funded by CSAS -Thunder Road and Center Point - referral source is required to contact Alec Budge, Youth and Family Care Coordinator. • Ideally the counselor that conducts the assessment adds the client to his/her caseload to ensure continuity of care. Another expectation is that case assignment takes into consideration (1) the number of clients carried by each staff and (2) the best clinical "match" between client and counselor. This process should take Place during weekly case consultation or staff meetings. • As of February 1, 2000 whenever a counselor conducts a CASI-A Assessment s/he writes down issues, barriers and questions about the experience. The list should be famd to Care Coordinator, without client ID but including demographic characteristics, level of AOD abuse or other pertinent information needed to understand the concerns raised by staff in relationship to a particular client. These lists will help us design training specific to counselor needs. • As of February 1, 2000 the first step in conducting CAST assessments includes an orientation session for the youth and family member requesting treatment. Ideally the counselor assigned to do assessment is also responsible for conducting the orientation, a good strategy to engage client and to assess behavioral factors that accompany responses. The orientation session should include: (1) explaining to youth and family member (defined as any responsible adult requesting treatment for a minor, such as foster placement, group home, etc.) what your agency, program and service expectations are; (2) informing youth and family member about norms and policies governing confidentiality, reporting, staff and client role and responsibilities; (3) asking youth and family member if they have questions, concerns or expectations that in any way conflict with issues discussed in (1) and (2). ■ As of January 1, 2000 intake and registration of youth and family requires same CSAS MIS procedures as with adults. I need in writing who does what, when and how to register clients in your program. If youth is the client or IP, services provided to the adult or family member are coded under the client's ID as collateral. If the adult or family member is a client, then you need to open two cases, one for the youth and one for the family member. Whenever family sessions are conducted you need to document service in both charts but code only one service under the youth ID. As of January 1, 2000 all youth treatment client charts require following documentation: (1) registration in CSAS MIS; (2) intake and chart with all required forms signed, etc.; (3) CASI-A assessment, conducted in no more than 2 hours and in no more than 2 one hour sessions; (4) a treatment and after care plan that identifies the problem(s) and goals in behavioral and measurable terms that correspond to the CASI-A assessment domains; (S) prescribed treatment activities that correspond to each of the treatment goals within CSAS Youth & Family service design; (6) progress notes for each service that once again correspond to treatment plan goals and assessment domains; (7) client and participant satisfaction surveys, for both youth and family member, administered during treatment episodes at intervals of 30 and 60 days, or at the time that client is discharged, terminated or decides not to continue. ■ As of January 1, 2000 youth treatment services should follow design, requirements and protocols depicted in Youth and Family Continuum of Care document distributed April 1999 and revised January 2000 which will be included in the binder to be distributed at the end of this month. Community Substance Abuse Services Youth, Family & Community System of Care RESOURCE GUIDE v.ii 1. CSAS System of Care Initiative. Development of Children, Youth and Family Services. Summary: "Study of Youth Access and Utilization of AOI) Treatment Services in Contra Costa County" 2. FY 1999-2000 Youth,Family&Community Prevention Service Plan 3. FY 1999-2000 Youth,Family&Community Treatment Service flan 4. Youth, Family&Community Continuum of Care 5. CSAS FY 1998-1999 Treatment and Prevention Service Maps 6. 1999 Youth Drug and Alcohol Impact Index CONTRA COSTA COUNTY HEALTH SERVICES COtWM,TTY 'SUBSTANCE ABUSE SERVICES Chix�pn; ��� d pixies ""Hot ;oroupO Update &,1+Tdt s On ?coli Prevention adolescents. Studies have demonstrated that adolescent problems have roots in the family's structure and the greater community in which the family exists. • Levels of evidence in program planning should be used to make recommendations for practice, particularly in the arena of community life as the context for families, and families and parent figures raising children between 5 and 18 years of age, should be the .focus of youth interventions. • Prevention is defined in terms of universal (general population that have no known risks but for whom prevention strategies could reduce the possibility of substance abuse) ; selective (subgroups of the population whose risk of developing problems is above average, children of alcohol or drug abusing parents where the children are not using but .have a very high risk for developing substance abuse problems) , and, indicated (applied to individuals found to manifest a risk factor, condition, or abnormality that identifies them as being at high risk for the future development of a problem) which is supported by the capacity to target families with the most serious problems and to design interventions specific to their needs. © In the past CSAS prevention has primarily focused on universal prevention but through the work of the "hot group" there is more emphasis on selective interventions through the use of "high risk" group with youth identified by an adult as exhibiting behaviors that are usually linked to substance abuse. The indicated preventive measures are widely used by Juvenile Justice programs such as Safe Futures, which funds Youth Services Bureau in West County. • Significance of defining antisocial and other problem behaviors as the "problem" as a way of measuring impact of intervention in changing behaviors i.e. , "solution" or outcome. CSAS emphasis is on measurable decrease of AOD behaviors or AOD related behavioral consequences rather than psychological factors that require a very comprehensive, sophisticated tracking and measurement of interrelationship between factors, intervening variables, and long term measurement of change. Also, CSAS priority is AOD rather than other co-occurring disorders, particularly during adolescence, a developmental phase fraught with experimentation and constant fluctuations. • The document articulates the importance of linking theory to a particular approach being as significant as linking the target population to a particular strategy, a mix of service, a particular site where services are delivered and the comprehensive "dosage" or quantity of services needed, • Theory is discussed in terms of "beliefs" that explain individual risk factors such as biology, behavior and personality, family risk mechanisms, peer influence, cultural and social norms and laws, poverty, neighborhood disorganization, failure to achieve in school. Research is cited to show that the strength and association of risk and protective factors differ among groups by gender, ethnicity, culture, and social context. Once again, the importance of local prevention programs to seek local data on which to base prevention designs. Main points of the position paper: 1. There is a trend away from focusing on individual behaviors of children in single domains and toward broad contextual functioning of Created.by Amalia DelValleC:,\Amalia'sDocuments\saab.cyf.doc09l15198 4 CONTRA, COSTA COUNTY HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES Children, Youth and Families "'Hot Croup" Update 6 Nates On AOD `Prevention rational decisions about what interventions to select or design for implementation. 0 Tailor programs for general populations, populations at more than average risk or populations at high risk of developing disorders. Target resources and tailor program efforts at populations with varying degrees of susceptibility to substance abuse. For example, populations at greater risk or further along in the progression of substance abuse are likely to require more intensive, multi-pronged interventions in a wider variety of settings, and with more booster sessions. Main points of the position paper: 1. Substance abuse interventions work well when they focus on clearly defined target populations, selective interventions to address a particular problem outcome for that population, and procedures to measure intervention impact. 2. Research shows compelling evidence of effectiveness of parent, family, and other significant adults involvement in service intervention. 3. Interventions should be universal, selective or indicated, that is, focused on the population as a whole, a subgroup of the population that is at high risk, or a subgroup that is already exhibiting the early signs of drug use. 4. To be effective interventions should occur early and often enough, in key community settings such as homes, schools, workplaces, recreational and other developmental settings, and should cover an extensive range of drug-free, safe and supportive settings in the community. 5. Interventions need to be interactive, use a variety of strategies and a comprehensive approach to address behavior changes. Community-wide policies are very effective to prevent and reduce AOD use and abuse. Anti-drug policies including laws, regulations, are proven to be most effective in changing a community, thus, enhancing the opportunity to support individual and group changes in AOD use and abuse. Preventing Substance Abuse Among Children and Adolescents: Family Centered Approaches Prevention Enhancement Protocol Reference Guide is a document published by the Division of State and Community Systems Development of the Center for Substance Abuse Prevention in SAMHSA. The document stress the significance of substance abuse as the number one preventable health problem in the United States and as a consequence, the psychological and financial burdens on families, family disruption, financial problems, lost productivity, unemployment, and crime or legal problems. A few significant statements of this document/guide: ❑ Statistics that describe the prevalence of substance abuse and its consequences, that is, information on the breadth and extent of substance abuse, including trends among youth, women and other at risk populations is the driving force behind planning service delivery systems. In this County we have excellent AOD service and impact data but no prevalence, no survey data on youth use, etc. * CSAP and substance abuse research shows that family-centered approaches are crucial to problems of substance abuse among Created by Amalia Del valleC:\Amala'sDocuments\saab.cyf.doco9/15/98 3 CONTRA COSTA COUNTY HEALTH SERVICES CCiMMITY SUBSTANCE ABUSE..SERVICES 'Children, Youth and Families "Hot +Group" :Update & Notes On ACED Prevention A Local Perspective on Youth Services: Questions that guide the GYF " Tot Group" Planning Process 1. Are current screening and service modalities friendly to parents, children and youth? 2. What are the barriers that prevent or deter youth and families to seek AOD treatment or join AOD prevention activities? 3. How successful has CSAS System of Care been in raising awareness of available services? Is there a concerted effort to serve CSAS client's children and families? Is recruitment of AOD high-risk youth and/or youth in AOD high-risk environments a priority? 4. What is CSAS youth services utilization and retention rates? 5. Who identifies AOD "at risk" youth and families? Who makes referrals to AOD treatment or prevention services? Is CSAS tracking referrals made by whom to where? 6. What formal linkages and networks currently exist between CSAS providers and Juvenile Probation? Social Services? Courts? Police? Schools? Health Services? Local coalitions, task forces, etc.? Federal Expectations Are Science-Based Substance Abuse Services and A Family Centered Approach to Preventing Substance Abuse .Among children and Adolescents Science-Based Substance Abuse Prevention, a position paper presented at the National Prevention Network's Conference (August 30-September 3, 1998) was crafted by senior officials and scientists from the Department of Health and Human Services, the Department of Education, the Department of Justice, and the Office of National Drug Control Policy. The paper was written in response to the Department of Health and Human Services launching a Youth Substance Abuse Prevention Initiative and a request by Secretary Shalala for definition of acceptable standards for AOD prevention. A few significant statements of this position paper: * A science of substance abuse prevention is emerging from more than twenty years of rigorous research; * Findings focus on systematic and objective study of the efficacy and effectiveness of theory-based and empirically based substance abuse preventive intervention programs and policies. G Prevention science follows a cancer ,research model with modifications specific to alcohol and drug abuse research to document substance abuse prevention principles, practices, and policies that are statistically, clinically, and socially significant in preventing substance abuse. * Outcome data systematically identified, assessed or evaluated must control threats to the validity and scientific integrity of research studies. * Strengthen the science-based design of Federal program and budget proposals by requiring adherence to characteristics address in this paper. 17 Increase the readiness of States and localities to use science-based prevention practices. Program planners and designers should use practices that have been proven by science to work, thus, making more Created by Amal a Del ValleC:\Amalia'sDocuments\saab.cyf.doc09/15/98 2 CONTRA COSTA COUNTY HEALTH SERVICES GONKWITY SUBSTANCE ABUSE SERVICES Children, Youth and Vaml.ies "Hot Group"( Update & 'Notes On-ACID Prevention System of Care Initiative Early 1997, the Board of Supervisors approved CSAS Administration proposal for a System of Care Initiative. In early May, CSAS Administration sponsored a series of training seminars on managed care and learning organization principles. CSAS Administration also set in motion a planning process to develop CSAS System of Care, an integrated continuum of community based alcohol and drug abuse prevention and addiction treatment services. The goals of CSAS System of Care are access to services, culturally appropriate and client focused services, a wide range of modalities and levels of care that are outcome driven, designed around objectives of quality and cost effective standards of care. System of Care Planning Process CSAS System of Care Initiative is implemented through an inclusive planning process that involves CSAS administration, CSAS contract and county operated programs, and Substance Abuse Advisory Board members. The planning process identifies issues that impact access, quality and efficient use of the System of Care service delivery and assigns the "issue" or "task" to a group of CSAS providers and interested SAAB members. This time-limited "hot groups" are based on problem-solving dialogue among %%stakeholders" that results in recommendations. Periodically, CSAS System of Care providers come together to be informed and to respond to recommendations made by the "hot groups". At that point, a final recommendation is presented to CSAS Director for consideration. Children, Youth and Families "Hot Group" The enclosed description of Children, Youth and Families Continuum of Services is a result of recommendations from planning meetings that began February 13, 1997 and are still being held. Although the Children, Youth and Family "hot group" developed principles, defined service priorities and portals of entry for youth and families, and identified existing gaps in services, final recommendations have not been made. The initial focus of "hot group" meetings was primary prevention, which constitutes a large percentage of CSAS funds allocated to serve children and youth. In November 1997, Contra Costa County piloted the California Alcohol and Drug Program (ADP) Prevention Activities Data System (PADS) and in January 1998, ADP instituted the use of PADS to report services funded by the Prevention Set Aside Block Grant and the Safe and Drug Free Schools and Communities. Last May, concurrent with the development of the Youth AOD Services Study, the focus of primary prevention "hot groups" shifted to youth AOD services. The CYE" planning process started with a set of questions from the experience of community-based providers and SAAB members that are local activists. It involved dissemination of information and education on the impact of (a) health care on publicly funded AOD services (service and fiscal accountability, tracking and measurement of outcomes, efficient and effective cost and quality services, consumer driven services) , and (b) science-based substance abuse research and practice findings about what works in AOD services (who, what, when, where, how, and why of services) . Created by Amalia Del valleC:\Amalia'sDocumentsNsaab _cyf.doc09/15/98 1 CONTRA COSTA COUNTY HEALTH SERVICES COMMUNITYSUBSTANCE ABUSE SERVICES Children, Youth and Families "'Hot Groups" Update 6 Notes On AOD Prevention families in multiple domains (address multiple domains rather than just the school, or the family) . 2. There is a trend away from viewing the family as a self-contained and independent unit and toward viewing it as an interdependent unit (families and community networks and systems that affect families' capacities and outcomes) . 3. There is a trend away from intervening in child behavioral problems as isolated events and towards recognizing that children's behaviors are embedded in ongoing developmental and family processes (appropriate age, gender, culture and developmental processes that require earlier and continuous interventions during different developmental stages) . 4. Of the three recommended approaches, at this time CSAS can only provide parent and family skills training to strengthen family life and improve parent/child relationships and some limited family therapy. Family in-home support requires a level of services that would deplete our already limited resources. Results-Based Decision-Making: From Outcomes to Budgeting At the National Prevention Network Conference we attended a presentation by Mark Friedman, senior associate at the Center for the Study of Social Policy in Washington. D.C. The presentation focused on policy and financial technical assistance to states, counties, cities and communities involved in family and children's service system reform. We learned that Friedman is a consultant to Contra Costa County Administration Office and the model for financing human services reform presented at the conference guide the development and implementation of the Children and Family Policy Forum. The model goal is results-based budgeting and accountability. If you want to know more about this topic, we suggest careful reading of the Children's Report Card or asking us to loan you Friedman's publications on the subject (brought back to learn about what is already here and now! ) . Created by Amalia Del Vall'eC:\Amalia'sDocuments\saab.cyf.docO9/15/98 5 fr" CONTRA COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES ADMINISTRATION Study of Youth Access and Utilization of AOD Treatment Services in CCC SUMMARY Purpose: To explore the question "were publicly funded alcohol and drug (AOD) treatment services being under utilized by youth between the ages of 12 and 17 in Contra Costa County?" Method: Key informant interviews, focus groups, and analysis of secondary AOD data were the data collection methods used by the researchers. More than 75 key informant interviews were conducted with individuals representing six primary "systems", the Community Substance Abuse Services and Mental Health Divisions, CSAS Providers Probation/Juvenile Justice, Law Enforcement, Child Welfare and Education/Schools. A series of focus groups were also held-- including three regional focus groups that included parents, clients and Substance Abuse Advisory Board members, and a youth only group. Findings; 1. The study used several different methods to estimate the expected number of youth with serious alcohol and drug problems who require treatment. The data shows that youth (12-18) are under-represented in publicly funded AOD treatment programs. in 1996/97 only 99 youth were admitted to publicly funded substance abuse treatment in the county, compared to an expected estimate of at least 8010 youth, thus, only about 1 in 8 of the youth who need publicly funded AOD treatment are receiving it at present. 2. Youth who need herr and are using alcohol and drugs are not being identified in sufficient numbers. Once identified, youth are not being referred to AOD treatment and if referred, these youth are not entering treatment in adequate numb,.rs. Decent reports suggest that youth use of alcohol and drugs in Contra Costa County is on the increase, yet very few of the young people who are using and abusing alcohol or drugs appear to be receiving the services they need to obtain a drug free lifesAtyle. 3. Data s gge y:. that one of f?urt rnost :c:ious problems is that youth are no receiving i.ntcg_a.te d services. r 4Aaer, each system tends to perceive the nature of yn -if:l1 rbjferaxally. and aasa result, each system tends to AOD prol�tc:n�s among develop and I:up3e.A.tient" Lu, ow!', sc-ii-Lit-io .sv to thesr: problems in isolation. Selected Recommendations: • Increase the number of youth with ACID problems that are identified, referred, and provided with AOD treatment by improving the communication and real collaboration across all of the "systems" that are likely to encounter these young people. • Institutionalize a standardized alcohol and drug-screening tool that would be used to identify youth with AOD problems across systems. • Move away from a strategy that allocates the greatest number of resources to those youth with the greatest number of problems. Instead, find ways to intervene "further up stream", before youth require such intensive services. For example, replicate the "Antioch Youth Diversion Model" to other communities in the county. This youth diversion collaborative model identifies youth earlier in their alcohol or drug using behaviors and intervenes before they penetrate deeper into the juvenile justice system--where it is both more costly and more difficult to address their AOD problems. • Educate the public and provide cross-training opportunities for probation officers and other youth providers to learn about each other's systems and how they might work even more effectively together. • Implement more effective approaches to link referrals and services and to track clients' movement through these systems. • Obtain additional funding to provide treatment to more youth in the county, as well as increasing the intensity or "dosage' of treatment services available to youth. This would mean increasing the amount of high intensity outpatient, and low and high intensity residential services available to youth in Contra Costa County. • Provide education to parents about how to recognize indicators of alcohol and/or drug use in their children, and what to do if they believe their children are using or abusing drugs. • Provide support groups for parents of youth who are currently using alcohol and/or drugs who need to learn ways in which they can stop "enabling" the use of these substances by their children. • Support youth who are in recovery from alcohol and drug use/abuse by making 12- step meetings available at lunch time, on campus at local high schools. Use peer, educators (,youth in AOD recovery) to educate other youth about how to avoid use and promote healthy behaviors. • Increase the number of school-based prevention programs and inake AOD counselors available at least 1 day a week on all middle: and high, schools in the county. t., y Y CONTRA COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES Youth & Family FY 1999-2000 Prevention Services Plan Community Substance Abuse Services Youth and Family !Services FY 1999-2000 Prevention Plan Introduction As CSAS strives to have more cost-effective, research based prevention programs that have measurable alcohol and other drug related outcomes, the consensus is that the need for prevention work in Contra Costa greatly exceeds the current resources. Thus, the significance of establishing priorities and performance outcomes across systems involved in the delivery of prevention, treatment and recovery services. Equally important is the need to establish "best practices" that are culturally relevant and tailored to serve a particular population, community or group. Historically, substance abuse prevention in Contra Costa to a large extent focused almost entirely on individual behavior change through education and alternative strategies until 1989-1990 when CSAS convened several countywide Alcohol and Drug Summits that resulted in a Substance Abuse Action Plan. The Substance Abuse Action Plan was adopted by the Board of Supervisors, taken to the polls and ratified by voters in June 1990. CSAS applied and was funded for a five-year grant from the Center for Substance Abuse Prevention (CSAP) to establish the "Partnership for an Alcohol and Drug Free Contra Costa County". The Contra Costa County Community Partnership "charter" [Appendix 1] emerged from a series of community forums that took place between 1993 and 1995. representatives from law enforcement, substance abuse and prevention providers, schools, churches and grassroots organizations develop the Partnership `charter" and established the Partnership Forum, an alliance of regional Alcohol and Drug Abuse coalitions, task forces and community groups. The intent, to promote collaboration among community "stakeholders" to address substance abuse problems, to implement the County's Substance Abuse Action Plan and to institutionalize the Community Partnership principles within CSAS prevention services. In 1995, the Substance Abuse Advisory Board incorporated the Partnership within two of its standing committees, Public Policy and Public Relations. Last year, SAAB created a Youth and Family Committee and CSAS established a Youth and Family Service track within its System of Care continuum. CSAS Community Partnership is a public health systems model that addresses environmental factors and risk factors within community systems impacted by alcohol and drugs. This approach to prevention takes into consideration the physical and social context in which drinking and other drug using occurs, as well as "the laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior" (Mosher and Jernigan). C:\Amalia!sDocuments\SvePlans\2000pln.doc03J10/99 1 Community Substance Abuse Services Youth and Family Services FY 1999-2000 Prevention Plan CSAS Prevention Plan Practice Principles (1) CSAS Alcohol and Drug Prevention Plan is based on the community approach used to establish the County's Substance Abuse Plan and the Partnership for an Alcohol and Drug Free Contra Costa County (1990); (2) CSAS Alcohol and Drug Abuse Prevention Plan integrates "Principles of Effectiveness" and "Best Practices" required by the Center for Substance Abuse Prevention, the Safe and Drug Free Schools and Community, and the California Alcohol and Drug Programs Prevention Platform; (3) CSAS Alcohol and Drug Abuse Prevention Plan addresses environmental factors, organizes communities and service providers to develop public policy and to promote community norms that are conducive to the lowest level of alcohol and other drug related problems; (4) CSAS Alcohol and Drug Abuse Prevention Plan uses general and indicated prevention strategies designed to serve communities, groups and individuals that are known to have specific risks for substance abuse in order to reduce risks and increase protective factors. Need Assessment and Service Priorities The "Access and Utilization of Youth Treatment Study" spearheaded by the Substance Abuse Advisory Board and funded by the Community Substance Abuse Services Administration questioned why adolescents were so underrepresented among the county's publicly funded substance abuse treatment clients. Data collection required for development of 1998-1999 Service Plans depicted in CSAS Service Maps and interviews with "stakeholders" in Mental Health, Probation, Social Services, Juvenile Court and Schools support some the study's findings and suggest limited collaborative planning within CSAS System of Care providers and between CSAS System of Care providers and other service delivery systems impacted by substance abuse problems in their caseload. For example, + Youth comprised only about 1% of the county's treatment clients but all outpatient providers funded to provide primary and secondary prevention services, mostly in school-based activities and serving C:\Amaha'sDocuments'lSvcPlans\2000plan.docO3/1(?/99 2 <7 Community Substance Abuse Services Youth and Family Services FY 1999-2000 Prevention Flan school-aged children, did not result in early identification or referrals to treatment; • While estimates suggested that a minimum of SO0 youth required publicly funded A+OD treatment, only 99 youth were served in fiscal year 1996/1997. Although other external systems, e.g. schools, probation, mental health, law enforcement and social services reported substance abuse to be a major problem among the youth they served, these systems were not identifying specific youth in need of treatment. In contrast, during the same period CSAS prevention provider's reports show 120,897 persons, primarily children and youth served by primary prevention and 1.,825 children and youth served by secondary prevention services. • Collaboration among the many systems serving youth is poor. External systems seem unaware of the nature of publicly funded substance abuse prevention services in schools but are able to identify providers and programs by name. Also, external systems have limited or no understanding of CSAS prevention providers role in community-based coalitions, a strategy required of all CSAS prevention providers as a way to ensure collaborative planning and advocacy in behalf of substance abuse needs at the local and county- wide levels. * Until recently, CSAS providers were treating youth in individual counseling at the schools but defining the services as secondary prevention, early prevention or intervention. Thus, many youth that were actually receiving CSAS treatment services were being undercounted because. a CARDS was not completed on these youth. Also, youth served by CSAS primary or secondary prevention that were referred to either school funded counseling services, insured or out-of pocket substance abuse treatment services, were not identified within CSAS continuum of care as a measure of the effectiveness of publicly funded prevention strategies that are free of charge to provide early identification and treatment referrals for youth "at risk". Although prevention services are designed to be available to all county residents, the proposed plan concentrates a greater percentage of available resources on youth, schools and communities identified to be "at risk" USE SERVICE AND ALCOHOL RETAIL MAPS TO IDENTIFY SERVICE PRIORITIES, GAPS, DUPLICATION AND POTENTIAL. AREAS OF COLLABORATION WITHIN CSAS SYSTEM OF CARE AND WITH OTHER PROVIDER SYSTEMS. Q\Amalia'sDocuments\SvcPlans\2000plan.docO3/10/99 3 e.117 4 _ .. Community Substance Abuse Services Youth and Family Services FY 1999-2000 Prevention Plan Youth and Family Prevention Service Goals 1. Increase AOD prevention services availability in schools, juvenile probation, child welfare, and mental health systems that serve "high risk" youth, in particular CSAS System of Care programs that are not funded for prevention; 2. Increase AOD prevention services accessibility to CSAS client's children and families, continuation and alternative schools, juvenile detention centers, children in custody of protective services, homeless shelters, and mental health programs that serve "high risk" youth and families that use or abuse alcohol and drugs; 3. Improve AOD prevention services effectiveness and efficiency by establishing and measuring performance standards, service and impact outcomes; 4. Improve AOD prevention services collaborations with service delivery systems and grassroots groups impacted by substance abuse problems in their caseload or communities; 5. Improve the skills and competencies of staff that provide AOD prevention services; 6. Increase awareness, visibility and advocacy of AOD services in local and county-wide planning efforts to obtain and increase funding allocation for treatment and prevention services; 7. Assist communities and schools in their public policy efforts to reduce alcohol and other drug related problems through (a) collection of baseline data about youth access issues; (b) reducing the number of alcohol sales to minors by --%; (c) increasing community support for enforcement of existing youth laves; (d) providing staff support to -- school districts and ---local school efforts to disseminate information and successfully implement the CHECKS Student Survey; 8. Provide staff support and link prevention participants to the Substance Abuse Advisory Board, the Partners in Recovery Alliance, City Councils and Municipal Advisory Boards public policy and environmental initiatives that seek enforcement and local control over availability and density of alcohol outlets, advertisement that targets youth, merchant education, and training about zoning, conditional use permits, etc. IDENTIFY OTHER PREVENTION SERVICE GOALS AND PRIORITIES C:\AmaRaleDQcuments,\SvcPl s\2000plara.doco3J10J99 4 8 'Z X 4 @ .-ftftftw--�, CONTRA COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES Youth & Family FY 1999-2000 Treatment Services Flan Community Substance Abuse Services Youth and Family FY 1999-2000 Treatment Plan Need Assessment and Service Priorities The "Access and Utilization of Youth Treatment Study" spearheaded by the Substance Abuse Advisory Board and funded by the Community Substance Abuse Services Administration questioned why adolescents were so underrepresented among the county's publicly funded substance abuse treatment clients. The study yielded several critical facts: Youth comprised only about 1% of the county's treatment clients. While estimates suggested that a minimum of 800 youth required publicly funded AOD treatment, only 99 youth were served in fiscal year 1996/1997. Although other external systems, e.g. schools, probation, mental health, law enforcement and social services reported substance abuse to be a major problem among the youth they served, these systems were not identifying specific youth in need of treatment. Furthermore, once identified, these youth were not being referred to publicly funded AOD treatment. Collaboration among the many systems serving youth was poor. Many providers were treating youth but calling it intervention, so many youth that were receiving CSAS treatment services were being undercounted because a CARDS was not completed on these youth. Target Population Although youth treatment services are designed to be available to all county youth, the proposed plan concentrates a greater percentage of available resources on the Western and Eastern portions of the county because of the following reasons: 'Test County One of out five children in the county live in West County; + 62.3% of the children living in West County are ethnic minorities; • West County is home to the highest proportion of children living in poverty; Children in West County are at higher environmental risk for AOD use because of the high density of alcohol outlets in the region and the high rate of violations among those outlets; C:\Amalia!sDocuments\System of Care\youth\YouthRx\rxpla.n.doc.. 1 ' 7 Community Substance Abuse Services Youth and Family FY 1999-2000 Treatment Flan • While close to 80% of adult treatment clients reside in West County; youth from the region constitute a relatively low percentage of youth in treatment. East County • One out of four children living in the county lives in Bast County; • The area has experienced extreme growth, and as a consequence school over-crowding; • Children in East County are at higher environmental risk of AOD use because of the high density of alcohol outlets and the high rate of violations among those outlets; • East County is home to a high proportion of children living in poverty; • 28% of children living in East County are ethnic minorities; • Few treatment options exist in East County. Youth and Family Treatment Service Goals 1. Increase the AOD treatment options and capacity available to county youth; 2. Increase the number of youth needing treatment that are identified; 3. Increase the number of youth that once identified, receive treatment; 4. Build a youth specific continuum of care; 5. Provide comprehensive care coordination for adolescents; The goals listed above will be achieved through the addition of a number of new services as well as by expanding our existing services. These services have been developed to respond to the need to increase treatment capacity and options to choose from, reduce existing barriers that prevent youth in need of treatment from being identified, and once identified from receiving the treatment they need. We anticipate that new adolescent treatment funds will provide residential treatment for 15 additional youth, and intensive outpatient treatment services for 56 youth. 'These numbers are in addition to the 100-120 youth currently receiving services. c:\Amalia'sDocuments\System of came\youth\YouthRx\rxP1an.doc Community Substance Abuse Services Youth and Family FY 1999-2000''Treatment Plan New Services Expanded Services • New options for residential • Increase residential capacity treatment • Intensive outpatient services for • Document existing youth youth intervention model • Replicate East County youth • Institute standardized screening intervention model in West for youth and their families in County existing centralized screening unit (ACCESS) • Implement formal linkages • Implement standardized (MOU's) with portals of entry assessment, treatment plan and into System of Care client follow-up • Conduct specialized training in • Implement standardized systems family therapy placement criteria • Provide care coordination to • Standardize treatment "dosage" ensure continuity of care, with of treatment levels emphasis on residential treatment clients • Formalize CSAS internal linkages between prevention, • Implement drug testing treatment and aftercare. A. Treatment Interventions Described below are the interventions to implement in order to achieve the Youth and Family Treatment Plan goals. Goal 1.0: Creation of a youth specific continuum of care; Interventions: Centralize screening, assessment and placement of youth, tracking of youth through the continuum of services rather than through a single episode of treatment; implement intensive outpatient services for youth, increase residential treatment capacity and treatment options, implement standardized placement criteria;provide staff training in family- systems therapy model, institute drug testing. C:\Amalia'sDocuments;\System of Care\youth.\YouthRx\rxplan.doc 3 Community Substance Abuse Services Youth and Family FY 1999-2000 Treatment Plan Goal 2.0: Provision of comprehensive care coordination for adolescents; Interventions: dire adolescent care coordinator; increase formalized linkages (MOU's) with other systems serving youth; standardize treatment "dosage" or levels of care; Goal 3.0: Increase the number of youth needing treatment that are identified: Interventions: Increase outreach to and collaboration with mental health, social services, juvenile justice, schools, police, etc., and replicate East County youth intervention model in West County. Goal 4.0: Increase the number of youth that once identified, receive treatment: Interventions: Replicate East County youth intervention model in West County; increase residential treatment options, increase treatment capacity;provide wrap-around services to address barriers to participation of youth who need treatment and their families. Youth Intervention Program Deferred to above, the Youth Intervention Program was implemented in 1983 by the Antioch Police Department in partnership with the REACH Project and the probation department. The Youth Intervention Program provides intervention services to juveniles arrested for misdemeanor, first offenses. In 1994, based on the success of the combined efforts of participating agencies, the resultant decline in juvenile crime, and the reduced case load on the courts, the model was labeled "the Antioch model' by Superior Court Judge Lois Haight who urged other areas of the county to adopt this very effective program. Youth who receive citations from the Antioch Police Department are required to appear before a youth intervention panel, which takes place at the Antioch Police Department. The panel is staffed by a police officer, probation officer, REACH staff (youth CSAS treatment provider), and a representative from the schools. Youth who appear before the panel are often recommended to receive drug and alcohol treatment and receive a referral to the REACH project, if they do not follow through with the treatment as recommended, they are referred back to the probation department for adjudication and treatment is often made a condition of probation. C.\AmaUia`sDocuments\System of,;Care\youth\Youthlc\rxpian:doc 4 Community Substance Abuse Services YouthandFamily FY 1999-2000 Treatment Plan Expected Outcomes Listed below each of system and client level outcomes are the indicators that will be used to track progress in achieving FY 1999-x2000 Youth and Family Treatment Plan goals: System Level Outcomes Increased adolescent treatment capacity Indicators: 15 youth will receive residential treatment (increase of 100%); • Residential treatment options will be increased to include more than one provider; • 200 youth will receive outpatient treatment, including intensive outpatient services (increase of 50%). Increased utilization of treatment by youth Indicators: • 50% increase in youth that participate in publicly funded treatment. Increased linkages and collaboration among CSAS providers Indicators: • 30% increase in the number of documented collaborations among CSAS youth providers. Increased continuity of care Indicators: • 50% of youth will receive discharge planning across the continuum; • 50% of youth in treatment will be tracked from one level of treatment to another within CSAS System of Care. Increase in % of youth that successfully complete treatment Indicators: • 20% increase in the percentage of youth that complete treatment. C:\Amaha'sDocuments\System of Care\youth\YouthRx\rxplan.doc 5 Community substance Abuse Services Youth and Family FY 1999-2000 Treatment Flan Youth client level outcomes Increase in youth that leave treatment with satisfactory discharge status Indicators: • 40% of youth will receive a satisfactory discharge status; Increase in youth that remain drug free at 3 and 6-month follow-up Indicators: • 50% of youth that complete treatment will remain drug free at follow-up Achievement of treatment plan goals Indicators: • 50% of youth will achieve at least half of their treatment goals Increase in school attendance Indicators: • 50% increase in school attendance Improved school performance Indicators: • 25% of youth will improve their grades Decreased involvement in the juvenile justice system Indicators: • 25% of youth will report decreased involvement with the juvenile justice system C:\Amaha'sDocuments\System of Care\youth\YoutRx\rxplan.doc 6 CONTRA COSTA HEALTH SERVICES Contra Costa county Community Substance Abuse Services FREVENMON EVALUATION Dear Participant: Contra Costa County Community Substance Abuse Prevention Services funds the program, activity, training or event identified in the back of this page. We, along with the Agency conducting the activity want to be sure that our prevention services are the best they can be. That's why we are asking you to tell us what you liked about the activity and to give us suggestions in how to improve it. Your answers to the questions will help us to better serve Contra Costa County residents and communities.Thank you for assisting us. If you have any additional questions or recommendation about prevention services,call our toll free customer service number: 1 877 2710381 If you want information about substance abuse treatment services, call our toll free customer service number: 1 800 846-1652 O STRUC'IZONS: Participant Satisfaction Survey. MSS) is administered at the end of every activity funded by the Community ..Substance Abuse Prevention Services. If the activity is partof a program or training series, the PSS is administered at the end of the`pr or'training series. For example, in a program that serves members of a group that meets weekly for a set number of sessions,the PSS is administered at the end ofprogram or at any-time a member is terminated or referred to another service. If training involves the same participants fora series of activities_aimed to develop skills or _competencies, the PSS is administered at the end of the series. If the activity is a 'one time presentation. or event, the`PSS is administered at the end of the:presentation or,event 1. Activity: 8. Has the activity been helpful? 14. Would you be interested in attending other types of I Yes activities? 2 Somewhat Name of the agency that 3 No. If not,please tell I Yes 2. us why. 2 Not Sure delivered the activity. . 3 No. If not,please tell us why. 9. How satisfied were you with 3. Today's date: - - this activity? 4 Suggestions for other activities: 1 Very Satisfied 4. How did you hear about this 2 Somewhat Satisfied activity? 3 It was OK 4 Somewhat Dissatisfied I Family or Friend 5 Very dissatisfied Please tell us a little about yourself: 2 Probation or Law Enforcement 15. Gender: 3 School 10. Would you recommend this 4 Health Provider program to a friend or family I Male 5 Social Services member? 2 Female 6 TV, Radio, Newspaper,or Flyer I Definitely Yes 16. How old are you? 2 Probably Yes S. Please rate the duality of this 3 Don't Know 1 12- 14 activity. 4 Probably Not 2 15- 18 5 Definitely Not. 3 19-25 1 Excellent 4 26-35 2 Good 5 36-45 3 OK 11. Were you treated with dignity 6 46-55 4 Poor and respect while you were 7 56 or Over 5 Very bad here? 17. Ethnicity 6. Did you get what you 1 Yes expected? 2 Somewhat I Asian 3 No. If not,please tell 2 Pacific Islander I No,Definitely Not us why. 3 Black/African 2 No,Not Really American 3 1 Didn't Know What 4 American Indian to Expect 5 Alaskan Native 4 Yes,In General 6 Hispanic/Latino 5 Yes,Definitely So 7 White/Not Hispanic 12. What,if anything, have we 8 Other: 7. To what extent has this activity done really well? — met your needs? 18. What language do you feel most comfortable speaking? I Almost All of My Needs I English 2 Many of My Needs2 Spanish 3 A Few of My Needs 13. Is there anything we could 3 Vietnamese 4 Almost None of My have done better. 4 Tagalog Needs. Please tell us 5 Hmong why. 6 Other: THANK YOU! 1C. c. K_6 15 k1t Ll CIL COMITY SUBSTANCE ABUSE SERVICES YOUTH AND FAMILY Table of Contents PAGE NO. CSAS System of Care 2 CSAS Youth and Family Continuum of Care 2 Service Priorities 2 Portals of Entry 3 Practice Principles 3 Continuum of Services 4 A. Prevention 4 Universal or General Prevention 6 Community Partnership 6 Partnership Forum Initiatives 7 Selective Prevention 8 Indicated Prevention 8 B. Treatment 9 Assessment 9 Outpatient Drug-Free 10 Residential 10 Appendix 1: Service Continuum and Service Flow Chart Appendix 2: Contra Costa County Community Partnership Appendix 3: Indicated Prevention Screening and Behavioral Contract Appendix 4: Comprehensive Adolescent Severity Inventory Assessment Treatment Levels & Outpatient Intensive Model Design COMMUNITY''SUBSTANCE ABUSE SERVICES YOUTH ANIS FAMILY CSAS System of Care The Community Substance Abuse Services (CSAS) "puts people first". CSAS advocates for alcohol and drug free communities by promoting individual and family responsibility, hope, and self-sufficiency. CSAS operates and contracts for services through a community-based continuum of care that stresses accountability and outcomes, is culturally competent and client driven. All services comply with California State Standards for Substance Abuse Treatment and Prevention Services, and with federal and local laws. CSAS Youth and Family Continuum of Care Youth and Family services are designed to assist communities, families and individuals to reduce and prevent substance abuse; discourage youth access and use of alcohol, tobacco and other drugs; and encourage communities to change conditions that contribute to substance abuse related problems. Service Priorities ■ Children and youth whose parents have alcohol or drug addiction, are in treatment or recovery; ■ Families and significant others that suffer the effects of another person's alcohol or drug addiction, abuse or dependency problems; ■ Populations and groups with special needs such as preschoolers, school dropouts, youth in juvenile detention facilities or juvenile justice system, runaway and homeless children and youth, pregnant and parenting teenagers, children and youth served by social welfare systems; ■ Immigrants, refugees, racial and ethnic minorities, particularly Native Americans, African Americans, Latinos and Asian Pacific Islanders; ■ Residents of public housing, families and individuals living in communities subsidized by local and/or federal government or defined as enterprise zones; ■ School sites with high level of truancy or serving children and youth unable to function in regular settings e.g., continuation, community and alternative schools. C: \amalia's documents\youth family\services.doc 4/1/99 3 COMMUNITY'SUBSTANCE ABUSE SERVICES YOUTH AND FAMILY Portals of Entry CSAS System of Care operates and contracts community-based programs that provide prevention, treatment and after care services for youth and their caregivers or family members (Appendix 1: Service Continuum and Service Flow Chart). These local portals of entry are supported by the Access Unit, a centralized management and information system that provides substance abuse information, problem identification and referrals, screening, placement, registration and care coordination services to Contra Costa County residents. Other portals of entry are Schools, Juvenile Justice System, Children's Protective Services, and Health Services. To address service priorities described above, formal linkages have been established with Mental Health, Public Health, Foster Care, Group Homes, Homeless Shelters, and other Youth Diversion programs i.e., Safe Futures, Juvenile Drug Court, and Independent Living Skills Programs. Practice "Principles": 1. CSAS recognizes that youth experimentation, use, and abuse of alcohol and other drugs is impacted by family and community norms. 2. Given that a large percentage of youth are referred rather than self-referred, the substance abuse problem among youth tends to be ascribed rather than self-defined. 3. Although youth experimentation and use of alcohol and tobacco is illegal, these substances are still accessible and available to young people. Thus, experimentation and use, is to an extent perceived by youth to be "a rite of passage into adulthood". 4. Given different levels of "awareness of the substance abuse problem and readiness to change" among youth, CSAS prevention and treatment services define children of substance abusers and youth that are experimenting or using alcohol and other drugs as "high risk". r. Prevention and treatment services are tailored to a variety of cultural and ethnic populations. 6. Services engage (1) youth, (2) parent or caregiver, and (3) the environment in which the youth substance abuse problem is identified e.g., the family, group or foster home, child welfare, school, criminal justice system, etc. but are not contingent on parental participation. C:\amalia's documents\youth family\services.doc 4/1/99 4 COMMUNITY SUBSTANCE AI USE'SERVICES YOUTH ANDFAMILY Continuum of Services A. Prevention The goals of prevention services are (1) to reduce alcohol and drug use and availability of those substances in the community; (2) to reduce alcohol and drug use among school-aged youth; and (3) to increase the use of prevention activities that are research-based and outcome driven. CSAS Community Partnership prevention approach (Appendix 2: Contra Costa County Community Partnership) is a public health systems model that addresses environmental factors and risk factors within communities impacted by alcohol and drugs. The approach takes into consideration the physical and social context in which drinking and other drug use occurs, as well as "the laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior" (Mosher and Jernigan). CSAS's prevention services are funded by the California Alcohol and Drug Programs Title IV "Safe and Drug Free Schools and Communities" (SFDS) Grant Program, and Title 45 of the United States Code of Federal regulations (C.F.r. 96.125) which governs the Substance Abuse Prevention and Treatment (SAPT) Block Grant Primary Prevention Set-Aside required strategies listed below: INFORMATION DISSEMINATION [CODE 12]: Involves dissemination of information to raise knowledge and awareness of the nature and extent of alcohol, tobacco and drug use, abuse, and addiction and their effects on individuals, families and communities. It also provides knowledge and awareness of available prevention programs and treatment services. Information dissemination is characterized by one- way communication from the source to the audience with limited contact between the two. EDUCATION [CODE 13]: Involves two-way communication and is distinguished from the Information Dissemination strategy by the fact that interaction between the educator/facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g., of media messages), and systematic judgement abilities. C:\amalia`s documents\youth family\services.doc 411!99 5 COMMUNITY SUBSTANCE ABUSE SERVICES YOUTH AND FAMILY ALTERNATIVES [CODE 14]: Involves the participation of target populations in activities that exclude alcohol, tobacco and other drug use. The assumption is that constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by alcohol, tobacco and other drug and would, therefore, minimize or obviate resort to the latter. PROBLEM IDENTIFICATION AND REFERRAL [CODE 15]: This strategy aims to identify those who have indulged in illegal/age inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person is in need of treatment. COMMUNITY-BASED PROCESS [CODE 16]: This strategy aims to enhance the ability of the community to more effectively provide prevention and treatment services for alcohol, tobacco and drug abuse disorders. Activities in this strategy include organizing, planning, and enhancing efficiency and effectiveness of service implementation, interagency collaboration, coalition building, and networking. ENVIRONMENTAL [CODE 17]: This strategy establishes or changes written and unwritten community standards, codes and attitudes, thereby influencing incidence and prevalence of the abuse of alcohol, tobacco, and other drugs used in the general population. This strategy is divided into two sub-categories to permit distinction between activities which center on legal and regulatory initiatives and those, which relate to the service and action-oriented initiatives. As CSAS strives to have more cost-effective, research based prevention programs that can measure alcohol and other drug related outcomes, determining priorities and performance outcomes across systems involved in the delivery of ACID services has become a significant factor. Equally important is the need to establish "best practices" to ensure compliance with principles of effectiveness required as of July 1, 1999 by the Center for Substance Abuse Prevention and the California Alcohol and Drug Programs. For this purpose, CSAS prevention include universal prevention strategies to serve general populations as well as selective and indicated strategies that target communities, groups and individuals that are known to have specific risks for substance abuse. C: \amalia's documents\youth family\services.doc 4/1/99 6 COMMUNITY SUBSTANCE ABUSE SERVICES YOUT11 ANDFAMILY Universal or General Prevention' - The purpose of general prevention services is to provide low intensity and high volume AOD information to children, youth, parents and the community at large. The intent is change in knowledge and attitude, increased awareness of risks, resiliency factors and available resources. A significant aspect of these services is the facilitation and support of strategies that promote development of partnerships among schools, churches, local groups and service organizations concerned with substance abuse problems impact on the health and well being of local communities. Services include AOD education curriculum provided in a regular classroom or community setting. This service requires approved curriculum, measurement of knowledge and attitude change using pre-post surveys, and administration of participant satisfaction evaluations. Another service strategy, AOD alternatives, aims to build leadership skills among a core group of individuals involved in planing alcohol and drug free events and activities for others. The intent is to increase AOD awareness and to develop leadership skills among "core" group members. A skills inventory is required to measure changes in AOD knowledge and increased capacity among "core" members, as well as administration of evaluation questionnaires to rate satisfaction among those that attend alcohol and drug free activities and events. Community Partnership - CSAS Community Partnership services provide technical assistance, training, and resources to regional alcohol and drug abuse prevention coalitions and grassroots organizations. The Community Partnership uses coalition building, collaboration, and environmental strategies to promote "A Drug and Alcohol Free Contra Costa County". The Community Partnership initiatives engage those most affected by the substance abuse problem in the planning, implementation, and evaluation of proposed solutions through the following activities: • Mini-grants are offered to grassroots groups through a proposal process, which is both a vehicle for skill development and an effort to recruit community members to join substance abuse coalitions. ■ Citizen development focused on building leadership capacity in the community. The strategy is to recruit and bring out new and emerging leaders to define the local prevention agendas in their communities. ' "...universal measures are directed to general population groups that have not been identified on the basis of risk factors related to substance abuse."in Preventing Substance Abuse Among Children and Adolescents: Family- Centered Approaches Reference Guide,DHHS Publication No.{SMA}3223-FY98,"Introduction"page xxii C:\amalia's documents\youth family\services.doc 9/1/99 7 COMMUNITY SUBSTANCE ABUSE'SERVICES YOUTH AND FAMILY ■ Pro-active community outreach to constituencies that are not represented in the substance abuse coalitions. The strategy is to use culture specific outreach that is appropriate to the yet-to-be-reached citizens. ■ Organizing the community to identify issues, target solutions and pursue goals. The strategy is to encourage collaboration, facilitate problem solving, acknowledge power differentials and build alliances. Partnership Forum - CSAS Administration staffs an alliance of local prevention groups that work with the Substance Abuse Advisory Board (SAAB) to implement the Contra Costa County's Substance Abuse Action Plan. In 1995 SAAB formally included the Partnership Forum in two of its standing committees, the Public Policy and Public Relations Committees. The goal, to encourage community residents and appointed members of the Substance Abuse Advisory Board, in particular youth and persons in recovery, to articulate and evaluate initiatives, recommend policies and advocate for AOD services. Some of the current Partnership Forum supported initiatives are listed below: 1. CSAS System of Care - A process to develop, implement and evaluate publicly funded substance abuse services which involves CSAS administration, CSAS county operated and contract providers, and the Substance Abuse Advisory Board; 2. Los Medanos and Pegasus Mentor Projects - A project to increase representation of minority and low income people in health care professions and to provide opportunities for high school students to interact informally with adult role models in the employment arena. Los Medanos serves youth residents from a Housing Project in Bay Point and Pegasus serves Richmond High School students. 3. Las Casitas - A collaborative process to provide technical assistance and training to Housing Project Resident Councils in Contra Costa County. 4. Partners In Recovery Alliance [PIRA] - A three year project funded by the Center for Substance Abuse Treatment brings together recovery community to (a) advocate for improved ACID treatment services; (b) promote local, regional, and statewide recovery groups; (c) promote empowerment, education, recovery, rehabilitation, and socialization of all persons in recovery. 5. Alcohol/Drug Sensitive Information Planning System/Geographic Information System [ASIPS/GIS] - A community-based process to collect C:\amalia's documents\youth family\services.doc 4/1/99 8 COMMUNITY SUBSTANCE ABUSE SERVICES YOUTH'AND''FAMILY alcohol/drug problem information from local sources, including public agencies and community groups involved in the prevention and reduction of local alcohol and drug problems. The intent is to educate, organize and mobilize communities to pursue strategies aimed to reduce or eliminate high-risk environments of alcohol and drug use and availability. 6. Access and Utilization of Youth AOD Treatment - An attempt to explore why publicly funded AOD treatment services in Contra Costa County are underutilized by youth between the ages of 12 and 17. Concurrent with this study CSAS System of Care planning process proposed a family- centered Youth and Families continuum of care, shifting emphasis on early identification, standardized measurements and linkages between prevention, treatment and after care services e.g., recruiting youth that successfully completed treatment to join youth prevention programs that support recovery. 7. Mapping of Alcohol Retail Outlets and Violations in Contra Costa County - An educational and organizational tool to mobilize elected officials, community residents and merchants to establish responsible retail practices, in particular, sales to minors and compliance with the California Alcohol and Beverage Control regulations. Selective Prevention2 - The purpose of selective prevention is to ensure that CSAS client's children and family as well as clients from other systems that serve clients that abuse or are addicted to alcohol and drugs are identified and referred to CSAS System of Care. Outreach efforts are directed to CSAS outpatient, residential and detox treatment clients, their children and families, under served communities, Probation, Mental Health and Social Service clients. Services include presentations, dissemination of information and educational materials, AOD education and support to '"high risk" individuals, families and groups. Indicated Prevention3 - The purpose of indicated prevention is to provide high intensity and low volume AOD services to groups of persons identified as "high risk" for substance use, abuse or addiction. The intent is behavior change by increasing resiliency and decreasing risk behaviors. Services involve an adult referral or a youth self-referral to an educational group for the purpose of z"... selective measures are directed to families with children who do not yet abuse substances but who,as a subgroup,have an above average risk for developing substance abuse problems." in Preventing Substance Abuse Among Children and Adolescents:Family-Centered Avvroaches Reference Guide,DHHS Publication No.{SMA} 3223-FY98,"Introduction"page xxiii s"...indicated measures are directed to specific families whose children are not abusing substances but who have known,identified risk factors for doing so."in Preventing Substance Abuse Among Children and Adolescents: Family-Centered Ayyroaches Reference Guide,DHHS Publication No.(SMA)3223-FY98,"Introduction"page xxiii C:\amalia's documents\youth family\services.doc 9/1/99 9 COMMUNITY SUBSTANCE ABUSE SERVICES "YOUTH AND FAMILY modifying or changing a problem behavior. For example, a youth is a member of an identified peer or family group within which other individuals abuse alcohol or drugs or, has a current history of behavioral problems at home, school, or community that are directly related to the use of alcohol and drugs. This prevention strategy accommodates youth that are using alcohol or drugs but do not believe this is a problem for them as well as youth that have tested positive or have been found to use alcohol or drugs and are required to attend a program. Services apply to adults as well. Indicated prevention requires a standardized screening4 (Appendix 31 to establish the "problem" in terms of expected behavioral changes. Screening results are used to develop a contractual agreement specific to each youth or adult, which includes a plan to change or reduce the problem behavior. Services are structured in terms of (a) a set number of hours of group sessions; (b) discussion and strategies for behavior change; (c) evaluation of behavior change; and (d) referrals to a higher or lower level of services e.g., assessment and treatment, or general prevention activities. B. Treatment The goals of treatment services are (1) to provide a continuum of care that is family centered, culturally competent and youth specific; (2) to increase the number of youth needing treatment that are identified and once identified, to increase the number that receive treatment; and (3) to provide comprehensive care coordination for youth to ensure increased length of stay in a continuum of services that supports recovery and promotes resiliency. A fully accredited multi- disciplinary staff of Licensed Social Workers (LCSW), Marriage, Family, Child Counselors (MFCC), and Substance Abuse Counselors provide assessment for addiction severity and dual diagnosis, individual and group counseling, and an array of other services for family and youth who are directly or indirectly affected by substance use or abuse. Assessment - A youth referred to a treatment program for assessment fits the same criteria than a youth referred to an indicated prevention "high risk" group described above, but the severity of use and behavioral problems have resulted in more serious consequences. A standardized assessment is required to establish the severity of addiction, emotional, psychological, or environmental conditions that contribute to the AOI) problem Appendix 4: Comprehensive Adolescent Severity Inventory Assessment. Findings determine treatment °Screening and Assessment of Alcohol and Other Drug Abusing Adolescents. Treatment Imt)rovement Protocol (TIP)Series No.3,pages 9 through 16--Substance Abuse and Mental Health Services Administration,Center for Substance Abuse Treatment,DHHS Publication No.(SMA)94-2094.Printed 1994. C: \amalia's documents\youth family\services.doc 4/1199 10 COMMUNITY SUBSTANCE ABUSE?SERVICES YOUTH AND FAMILY placement level of care or appropriate referral to mental health, children protective services, etc. as well as development and evaluation of individualized treatment plans and client outcomes. Outpatient Drug-Free --- CSAS non-residential drug-free youth treatment services are structured in terms of a family centered social model treatment philosophy which includes a set number of required (a) individual, group, family and multi-family treatment sessions; (b) educational and twelve step groups; (c) drug-testing; (d) relapse prevention and after care services; and (e) care coordination to ensure continuity of care between treatment levels and among service modalities. CSAS non-residential drug-free youth treatment consists of three levels of care, one non-intensive and two intensive levels (Amoendix 5: Treatment Levels and Performance Measures). Level I Non-Intensive treatment dosage ranges from one to six hours per week for youth and one to three hours for adult caregiver or parent for a period of eight weeks, a total of forty four treatment hours per segment. Level II Intensive treatment dosage requires ten hours of treatment per week for youth and four hours per week for adult caregiver or parent for a period of ten weeks, a total of ninety five treatment hours per segment. Level III Intensive treatment dosage requires twelve hours of treatment per week for youth and four hours per week for adult caregiver or parent for a period of twelve weeks, a total of one hundred and thirty five treatment hours per segment. Care coordination services includes monitoring progress within the different treatment levels and between modalities to ensure continuity of care and support for recovery. Parent or caregiver participation is highly recommended but is not a requirement for services. Residential - Residential programs are 24 hour per day, seven day per week social model environments that require a minimum of 40 hours per week of counseling and/or structured therapeutic activities such as consciousness raising, twelve steps, stress management, poly-drug education, relapse prevention and planning groups. Treatment includes assessment, development and monitoring of individualized treatment and discharge plans, education and required attendance to AA and NA groups. Modality includes after care and relapse prevention. residential treatment dosage is twenty-four hours per day for forty five days, another forty-five days of Level II or III intensive outpatient at the residential facility with comprehensive care coordination services to link client to a community-based outpatient drug-free treatment program at discharge time. The intent is to provide continuity of care from residential to outpatient treatment levels and then to prevention services to support recovery and to build resiliency. C:\amalia's documents\youth family\services.doc 9/1/99 II Appendix #1 MSAs Youth and Farni/y n Trea"h �e�le�t��ortinuum of Cah �, Q Prevent Assess Protect Change Promote Support Al+�oho( & Drug Recovering Free Individuals Communities and and Their Families FamifiQs � e r E*k,lx 'i {J.},c�,•"\`buv f}.n.it+..�hpc�,•,�,�}c,�:Jjy4}G,��i�.„} � :' .>,../�y�L,," •`},'?'.'y}n Jij.'.�:v1:,'{,'v:;.J,:X-%o!{...y. .0}�vr:Sf? <9{'`::':u::. :'rf rC.q, .). ,Yf fA.., "(�Y^'�s�S,:�•L:.' ;"'i v�kti;,•' �:`g,'i'f:;�'='.ti2a;{:?i'kf�Gk'.',,v�,.^'.•:?Cr'>`.>"k<'`h°.r :)•i"'%�i3:: i%<��> f? T:•':y:}-.ai`>s ri.:;yc:3.:,i:,3zr`i�•':'i-'?: �`�:::"'t`.^f{; l � .:�!��j;�}f4Tr Tr!L�:•:l i},)'E�d ti��� :i::•hr�j4i:: :moi;:; [✓: '�;:�:;3r:%t :).L? �i`jiii S.:,h,+';`r^;C's:';!.y,;)••:r'`%%)?2ia:lf+5',) :3:� `^.<'':of^.- :•i'i ''':`:i+;,•:ii;•'yt'f}},k_/:"%�^` Y:ji%y.;ti'}:):��%iji'l.±?`�Y:^'Q'T:ri�'x::' hyi-i:,%i::f t�k2�ikhh<':ti •}i i.)e`}:ry1�`{.�,,'?�'!'�!�<h� .^:';{n.SvT[y:*'Y."; .,,}.� ..wf`:'`}r:' .JYn .f:J:¢::'•S.' �N/ls<{•`iYf !/f l� / { Ly d-r3 L 4 T'•}i i}'�. � w ✓;.yi::C�r:y:3-? `�)T z}25+a�f?>� ::t;S:y%� 'i 3: ):<•C;f:,iS.}•.:4::+.:4'. ��"fkk;krfy'�/•:��f j:>,•S'.T R:}n�l:'y};!.,}:l.'' :i("f��!:�i �: i%:i•..t{Lyw n.:;2>:��=,::;i' >"t fif,.-.4;f:.5.<2?:^ iek,`.:;•s;�'^i 'yt�.`<:�?�R 4 • # i +Y• �s �.v IIS I III I li ISI II �� 4 C L 4_O �yS .�.=rte=••:'.�.,._ x,� .. x ti? 0 d' z t ............ --------- ---------- --- M571 i-M iT i ........ ......... ............ Appendix #2 WILLIAM B. WALKER, M. D. CONTRA COSTAHEALTH SERVICES DIRECTOR s " CHUCK DEUTSCHMAIV COMMUNITY DIRECTOR `- SUBSTANCE CONTRA COSTA ABUSE SERVICES 597 Center Avenue, Cults a HEALTH SERVICES Martinez, Californian 94553 Ph (925)313-6300 Fax(925)313-6390 The Community Substance Abuse Services (CSAS) prevention services or Community Partnership provide comprehensive strategies designed to assist communities, families and individuals to reduce and prevent substance abuse; to discourage youth access and use of alcohol, tobacco and other drugs; and to encourage communities to change conditions that contribute to substance abuse related problems. The goals of the Community Partnership are (1) to reduce alcohol and drug use and availability of those substances in the community; (2) to reduce alcohol and drug use among school-aged youth; and (3) to increase the use of prevention activities that are research-based and outcome driven. To promote equitable distribution of prevention resources, to ensure accountability and performance outcomes, and to promote culturally relevant services that are specific to community needs CSAS has instituted three initiatives inclusive of community-based providers, volunteers, local residents appointed by the Board of Supervisors to the Substance Abuse Advisory Board and members of the recovery community: CSAS System of Care, Community Partnership and Partners in Recovery Alliance. The System of Care, a continuum of treatment, prevention and after care community-based services, operates through an infrastructure of accountability based on cost, quality and measurement of performance outcomes. The Access Unit, its centralized management and information system, provides information and referrals, screening for substance abuse placement, registration, and waiting list management. The Community Partnership provides technical assistance, training and access to resources through an alliance of community- based substance abuse prevention coalitions, task forces and grassroots groups known as the Partnership Forum. The Partnership environmental and community-based strategies promote volunteer participation, collaborative efforts, in-kind matching of resources and strategic community-wide planning and evaluation among "partners" working towards a Drug and Alcohol Free Contra Costa County. The Partners in Recovery Alliance brings together recovery community in Contra Costa County to advocate for improved substance abuse treatment and prevention services; to promote local, regional and statewide recovery groups; and to promote empowerment, education, recovery, rehabilitation and socialization of all person in recovery. The Alliance operates through a Management Team composed of persons in recovery in partnership with representatives from CSAS Administration and the Substance Abuse Advisory Board. • Contra Costa Community Substance Abuse Services • Contra Costa Emergency Medical Services • Contra Costa Environmental Health • Contra Costa Health Plan + + Contra Costa Hazardous Materials Programs •Contra Costa Mental Health • Contra Costa Public Health • Contra Costa Regional Medical Center • Contra Costa Health Centers hi�P fob n+d 0�#�S Approach and # rug Abuse Prevention mcLusiom POLICY LaTnTes > A forum to network and exchange substance abuse prevention information. ➢ A catalyst for the creation of a community culture that "de-normalizes" the use and abuse of illegal drugs, alcohol, tobacco, and the violence related to AOD use and abuse. ➢ An alliance of "partners" that comes together to collaborate with various public and private sectors in the community. ➢ A commitment to work with citizens to build a locally crafted, shared vision of the changes necessary to create a healthy community. ➢ An agreement to broker, mediate, and negotiate the implementation of social policies, programs, and practices the community needs to use to increase protective factors and decrease risk factors in the community. CAAMALIA`SDOCUMENTS\PARTNERSHIMPARTNERSHIP.D©CJune 23. 1999 . yt1at ,:1tblxe Cesttitt-COOCtnist m Community Partnerships working towards a drug and alcohol free Contra Costa County Each and every member of the Contra Costa County community will work towards a safer and healthier environment by the reduction of Alcohol, Tobacco, and Other Drugs (ATODA) use and abuse and their related problems. The Partnership is based on a bottom up approach to prevention. This principle is practiced through the following actions: +► Doing with the community rather than doing for them. Creating capacity building opportunities for residents and volunteers. • Promoting shared leadership. The Partnership values diversity and respects differences. These principles are practiced through the following actions: • Ensuring inclusion of all ethnic, cultural, and socio-economic groups in the community. Creating opportunities for dialogue, reflection, and collective action. • Implementing a multi-sector community-wide prevention strategy that is representative of the community. • Promoting strategic alliances and collaborative efforts between different community "stakeholders". • Developing "partnerships" that are willing to share risks, resources, responsibilities, and rewards. The Partnership is intentional in its commitment to community empowerment. This principle is practiced through the following actions: • Acknowledging differential power status between groups and populations. • Developing democratic structures to ensure group representation and relationships that are predicated on responsibility, experience, and skills. • Ensuring equal access to resources, opportunities, and choices. • Creating a communication system that is open and inclusive. • Implementing policies that encourage conflict resolution and problem solving. CA AMALIRSDOCUMENTM PARTNERSHIP\PARTNERSHIP.DOCJune 23. 1999 :r► GENERAL PREVENTION Information Dissemination: Service Information, Educational and Promotional Materials Problem Identification and Referrals: Screening, Registration and Placement, Residential Wait List Management, Outreach to Spanish Speaking and Asian Pacific Groups AOD Education: Presentations to General Public, Students, Health Providers, Civic Groups, etc. AOD Free ,Activities and Events: Friday Night and Club Live, Youth Educator, Mentor Programs, :Summer Camps, Community Celebrations AOD Safe Schools and Communities: - Environmental strategies to promote community norms, conditions and policies that aim to reduce AOD access to youth, over concentration of alcohol outlets and merchant practices that violate state and local policies and regulations. - Community processes to promote collaborative efforts that aim to reduce AOD problems by increasing early identification and referral of people that use or abuse alcohol and drugs, and support for recovering individuals and their families. Appendix #3 SELECTIVE AND INDICATED PREVENTION Problem Identification and Referrals: Screening and Referral to AOD Educational Support Group or Referral to Treatment Provider for Assessment and Placement. Care coordination and outreach to ensure linkages between program modalities, agencies and other provider systems. ACID indicated Education: Educational support groups for individuals and settings identified to be at risk for AOD use or abuse, to decrease risk behaviors and increase resiliency. Alcohol and Drug Free schools and Communities: - Environmental strategies implemented in communities and settings where A00 has been identified to be a public health issue. - Community processes to promote collaborative efforts that aim to reduce AOD problems identified to be a public health issue. Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families SALE SCREENING INSTRUMENT FOR AOD ABUSE The Screening Process.' Screening is a broad term that may be defined as a range of evaluation procedures and techniques. The screening process, however, is distinguishable from comprehensive assessment procedures in several ways. It is important to understand this distinction so that the limitations of the screening instruments are recognized, thereby increasing the likelihood that they will be used appropriately and effectively. A screening instrument does not enable a clinical diagnosis to be made, but rather merely indicates whether there is a probability that the condition looked for is present. Screening is a preliminary assessment or evaluation that attempts to measure whether key or critical features of the target problem area are present in an individual. A comprehensive assessment, on the other hand, is a thorough evaluation whose purpose is to establish definitively the presence or absence of a diagnosable disorder or disease. Accomplishing this goal entails evaluating other problems that may be related to the individual's disorder. A screening procedure typically involves a single event. A comprehensive assessment, in contrast, necessarily encompasses multiple procedures and sources of information. In addition to ascertaining the presence of AOD abuse or infectious disease, a comprehensive assessment is also aimed at identifying problems that may be related to the condition being !den tified...infoxmation is used to develop a treatment plan and to determine person's need for additional services. The options arising from the results of screening should be limited to the fallowing: 1. The individual is likely to benefit from a referral for a comprehensive assessment to determine the provision of treatment or referral for treatment and for other specialized assessments, 2. Findings suggest that the individual is engaging in "high risk" AOD behaviors {youth is experimenting or using, behavior problems indicate potential use or abuse, care givers are substance abusers, etc.} and is likely to benefit from participation in education groups tailored to change identified problem behaviors. FOR DETAILED INFORMATION REFER TO ENCLOSED DOCUMENTS LISTED BELOW: "Chapter 2-Development of the Simple Screening Instrument for AOD Abuse and "Chapter 2-Preliminary Screening of Adolescents"3 1 "Introduction" in Treatment Improvement Protocol (r]P) Series No.11, Pelle 3 - Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment,DHHS Publication No. (SMA) 95®3058. Printed 1994. 2 ibid,pages 9 through 18 and Assessmentf,Alcohol amf C+thar Drug Ab&= Adolescents. TMM=t Improvement Protocol (TTP)P) Series No.3, pages 9 through 16- Substance Abuse and Meatal Health Services Administration, Center for Substance Abuse Treatment,DHHS Publication No.(SMA)94-2094.Printed 1994. Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families AOD EDUCATION FOR HIGH RISK GROUPS Target Population Youth referred to an educational group for the purpose of modifying or changing a problem behavior are identified to be "at risk" for substance abuse addiction because: (a) they are members of an identified peer or family group within which other individuals abuse alcohol or drugs or, (b) have a current history of behavioral problems at home, school, or community that are directly related to use of alcohol and drugs. Service Strategy Alcohol and Other Drug Education for "at risk" groups is a prevention strategy for youth that are using alcohol or drugs but do not believe this is a problem for them as well as youth that have tested positive or have been found to use alcohol or drugs. The service consists of 8 to 12, one to two hours, weekly or bi-weekly group sessions. The educational process is experiential, it follows guided discussions of AOD topics and strategies to change participants' identified "problem" behaviors. Service Requirements Providers accepting referrals to CSAS Alcohol and Other Drug Education "high risk" groups are expected (a) to gather information about the referral source including their perception of what the problem behavior is; (b) to use a standardized screening instrument to establish the "problem" in terms of expected behavioral changes and severity of AOD problem; (c) to develop a standardized contractual agreement specific to each individual including a plan to change or reduce the problem behavior; (d) to document and evaluate behavioral change progress; (e) to document linkages and referrals to AOD assessment, treatment or prevention activities; (f) to document linkages and referrals to other services such as health care, mental health, social services, probation or school counseling programs. Service Data Tracking participants' progress and referrals includes the use of CSAS System of Care as well as other private pay or publicly funded service resources such as Safe and Drug Free Schools and Communities, Safe Futures, Healthy Start, etc. Service documentation requirements include the following: 1. Maintaining group files that document attendance and process notes that describe topics, highlights of discussion, etc. 2. Keeping confidential files with screening, behavioral contract, evaluation of individual progress, linkage and referral data. 3. Submitting monthly Prevention Activities Data Systems reports. 4. Administering Participant Satisfaction Survey when participants complete the program (8-12 sessions) , are terminated or referred. rv.�...,r.. .y..»...,....�.......t. f r c Iran Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families SIMPLE SCREENING INSTRUMENT FOR AOD ABUSE SELF—ADMINISTERED FORM Directions: The questions that follow are about your use of alcohol and other drugs. Your answers will be kept private. Mark the response that best fits for you. Answer the questions in terms of your experiences in the past 6 months. During the last 6 months... 1. Have you used alcohol or other drugs? (Such as wine, beer, hard liquor, pot, coke, heroin or other opiates, uppers, downers, hallucinogens, or inhalants) ? YES NO 2. Have you felt that you use too much alcohol and other drugs? YES NO 3. Have you tried to cut down or quit drinking or using alcohol or other drugs? YES NO 4. Have you gone to anyone for help because of your drinking or drug use? (Such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, counselors, or a treatment program)? YES NO 5. Have you had any health problems? For example, have you Had blackouts or other periods of memory loss? Injured your head after drinking or using drugs? _­w—Had convulsions, delirium tremens (DT's) ? Had hepatitis or other liver problems? Felt sick, shaky, or depressed when you stopped? Felt "coke bugs" or a crawling feeling under the skin after you stopped using drugs? Been injured after drinking or using? Used needles to shoot drugs? 6. Has drinking or other drug use caused problems between you and your family or friends? YES NO 7. Has your drinking or other drug use caused problems at school or at work? YES NO 8. Have you been arrested or had other legal problems? (Such as bouncing bad checks, driving while intoxicated, theft, or drug possession) YES NO 9. Have you lost your temper or gotten into arguments of fights while drinking or using other drugs? YES NO PLEASE TURN PACE TO CONT IMM C:\Amalia'sDocuments\System of Carelyouth\assessment\cyfscreening.docO2118f99 c. Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families SIMPLE SCREENING INSTRUMENT FOR AOD ABUSE 10. Are you needing to drink or use drugs more and more to get the effect you want? YES NO 11. Do you spend a lot of time thinking about or trying to get alcohol or other drugs? YES NO 12. When drinking or using drugs, are you more likely to do something you wouldn't normally do, such as break rules, break the law, sell things that are important to you, or have unprotected sex with someone? YES NO The next questions are about your lifetime experiences. 13. Have you ever had a drinking or other drug problem? YES NO 14 . Have any of your family members ever had a drinking or drug problem? YES NO 15. Do you feel that you have a drinking or drug problem now? YES NO Thanks for filling out this questionnaire. Scoring for the AOD Abuse Screening Instrument Name/ID No: Date: Provider Name: Place/Location: Items 1 and 15 are not scored. The following items are scored as 1 (yes) or 0 (no): 2 7 12 3 6 13 4 9 14 5 (any items listed) 10 16 6 11 Total Score:ffrm Score Range: 0 - 14 Preliminary interpretation of responses: Score Degree of Risk for AOD Abuse 0-1 None to low 2-3 Minimal >4 Moderate to high: possible need for assessment ABOVE RESPONSES ARE PRIVATE AND CONFIDENTIAL. PROVIDER IS REQUIRED TO INFORM RESPONDENT OF THEIR RIGHTS FOR CONFIDENTIALITY, SITUATIONS WHEN PROVIDER RESPONSIBILITY TO DISCLOSE INFORMATION SUPERCEDES CONFIDENTIALITY, CONSENT TO SHARE INFORMATION OR SECURE PARENTAL CONSENT AS NEEDED. C:\Amalia'sDocuments\System of Care\youth\assessment\cyfscreening.doc02/18/99 Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families SIMPLE SCREENING INSTRUMENT FOR AOD ABUSE SELF—ADMINISTERED FORM Directions: The questions that follow are about your use of alcohol and other drugs. Your answers will be kept private. Mark the response that best fits for you. Answer the questions in terms of your experiences in the past 6 months. During the last 6 mouths... 1. Have you used alcohol or other drugs? (Such as wine, beer, hard liquor, pot, coke, heroin or other opiates, uppers, downers, hallucinogens, or inhalants) ? YES NO 2. Have you felt that you use too much alcohol and other drugs? YES NO 3. Have you tried to cut down or quit drinking or using alcohol or other drugs? YES NO 4. Have you gone to anyone for help because of your drinking or drug use? (Such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, counselors, or a treatment program) ? YES NO 5. Have you had any health problems? For example, have you Had blackouts or other periods of memory loss? Injured your head after drinking or using drugs? Had convulsions, delirium tremens (DT's)? Had hepatitis or other liver problems? Felt sick, shaky, or depressed when you stopped? Felt "coke bugs" or a crawling feeling under the skin after you stopped using drugs? Been injured after drinking or using? Used needles to shoot drugs? 6. Has drinking or other drug use caused problems between you and your family or friends? YES NO 7. Has your drinking or other drug use caused problems at school or at work? YES NO 8. Have you been arrested or had other legal problems? (Such as bouncing bad checks, driving while intoxicated, theft, or drug possession) YES NO� 9. Have you lost your temper or gotten into arguments of fights while drinking or using other drugs? YES NO PLEwSE TURN PAM TO CONTINUE C:\Amalia'sDocuments\System of Carelyouth\assessment\cyfscreening.doc02/18/99 Contra Costa County Health Services Community Substance Abuse Services Children, Youth and Families SIMPLE SCREENING INSTRUMENT FOR AOD ABUSE 10. Are you needing to drink or use drugs more and more to get the effect you want? YES NO 11. Do you spend a lot of time thinking about or trying to get alcohol or other drugs? YES NO 12. When drinking or using drugs, are you more likely to do something you wouldn't normally do, such as break rules, break the law, sell things that are important to you, or have unprotected sex with someone? YES NO The next questions are about your lifetime experiences. 13. Have you ever had a drinking or other drug problem? YES NO 14. Have any of your family members ever had a drinking or drug problem? YES NO 15. Do you feel that you have a drinking or drug problem now? YES NO Thanks for filling out this questionnaire. Scoring for the AOD Abuse Screening Instrument Name/ID No: Date: Provider Name: Place/Location: Items 1 and 15 are not scored. The following items are scored as 1 (yes) or 0 (no) : 2 7 12 3 8 13 4 9 14 5 (any items listed) 10 16 6 11 Total Score:RMScore Range: 0 - 14 Preliminary interpretation of responses: Score Degree of Risk for AOD Abuse 0-1 None to low 2-3 Minimal >4 Moderate to high: possible need for assessment ABOVE RESPONSES ARE PRIVATE AND CONFIDENTIAL. PROVIDER IS REQUIRED TO INFORM RESPONDENT OF THEIR RIGHTS FOR CONFIDENTIALITY, SITUATIONS WHEN PROVIDER RESPONSIBILITY TO DISCLOSE INFORMATION SUPERCEDES CONFIDENTIALITY, CONSENT TO SHARE INFORMATION OR SECURE PARENTAL CONSENT AS NEEDED. C.1Amalia'sDocuments\System of Care\youth\assessment\cyfscreening.doc02/18/99 l! E Contra Costa County Health Services w� Community Substance Abuse Services Children,Youth and.Families BEHAVIOR CONTRACT Directions: Cover Form filled by Provider/Group Facilitator 1. Who referred youth to "high risk" group? (a) Name Date: { ) Position Program: (c) Site/Location 2. How did referral source define the behavioral problem for which s/he made the referral? (a) (b) (c) 3. Participant Information: Name: Age: Sex Race/Ethnicity: School: Grade: GPA: CPS: Probation: 4. Screening protocol score: Screening date: 5. Describe how problem identified by screening protocol corresponds to (a) referral source and (b) youth's perception of problem? 6. Disposition Requires Counselor and Youth (or Adult Participant) description of rationale for any of the choices outlined below: (1) Satisfactory Completion (2) Unsatisfactory (3) Termination (4) Request for more sessions (5) Referred to AOD assessment (6) Referred to Mental Health (7) Referred to Social Services (8) Referred to Probation (9) Referred to Other Services *Requires approval from CSAS Prevention Manager 7. Evaluation: C.tAmalia'sDocumants\System of Caretyouthlassessmenticyf iehavcontract.doc 12/29/98 Contra Costa County health Services Community Substance Abuse Services Children, Youth and Families BEHAVIOR CONTRACT Directions: Youth and Provider/Facilitator review referral information and screening to jointly develop the contract. As a member of the group sponsored by , I agree to the following points as part of my participation in the group. 1. I will not attend group while under the influence - EVALUATION + of any illegal substances. 1 2 3 4 5 2. I will be present each week, be on time, and will remain throughout the entire meeting. If unable to attend, I will let my counselor know beforehand. 1 2 3 4 5 3. I will put feelings into words, not actions. 1 2 3 4 5 4. I will treat all group members with respect. 1 2 3 4 5 5. I will not discuss group meetings with anyone outside the group. 1 2 3 4 5 6. I will remain in the group until the issues that brought me to group have been resolved, or until the group ends. 1 2 3 4 5 I agree to work on changing the following behaviors: {1) 1 2 3 4 5 (2) 1 2 3 4 5 (3) 1 2 3 4 5 In order to achieve my goal to change above behaviors and to develop a more positive support system, I need the support of the following people: (1) 1 2 3 4 5 (2) 1 2 3 4 5 (3) 1 2 3 4 5 I feel that I have accomplished my goal by changing the behaviors that resulted in my referral to the group. I believe that I deserve the following rating: Participant Signature and Date Counselor Signature and Date C:\Amalia'sDocuments\System of Carelyouth\assessment\cyfbehavcontract.docl2/29/98 Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families SIMPLE SCREENING INSTRUMENT FOR AOD ABUSE (PARENT VERSION) SELF"--ADMINISTERED FORM (PARENT VERSION) Directions: The questions that follow are about your child's use of alcohol and other drugs. Your answers will be cross checked with responses that your child provided on a similar instrument. Please mark the response that you feel is the best description of your child's behavior during the past 6 months. During the last 6 months... 1. Has your child used alcohol or other drugs? (Such as wine, beer, hard liquor, pot, coke, heroin or other opiates, uppers, downers, hallucinogens, or inhalants)? YES NO 2. Do you feel that your child uses too much alcohol and other drugs? YES NO 3. Has your child tried to cut down or quit drinking or using alcohol or other drugs? YES NO 4. Has your child gone to anyone for help because of their drinking or drug use? (Such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, counselors, or a treatment program)? YES NO 5. Has your child had any health problems? For example, have they Had blackouts or other periods of memory loss? Injured their head after drinking or using drugs? Had convulsions, delirium tremens (DT's)"? Had hepatitis or other liver problems? Felt sick, shaky, or depressed when they stopped? Felt "coke bugs" or a crawling feeling under the skin after they stopped using drugs? Been injured after drinking or using? Used needles to shoot drugs? 6. Has drinking or other drug use caused problems between your child and your family or their friends? YES NO 7. Has your child's drinking or other drug use caused problems at their school or work? YES-NO 8. Has your child been arrested or had other legal problems? (Such as bouncing bad checks, driving while intoxicated, theft, drug possession, or suspension or expulsion from school) YES NO 9. Has your child lost their temper or gotten into arguments or fights while drinking or using other drugs? YESNO PLZA8Z Tunq PAM TO CsDMI21 M Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families SIMPLE SCREENING INSTRUMENT FOR ACID ABUSE (PARENT VERSION) 10. Does your child need to drink or use drugs more and more to get the effect they want? YES NO 11. Does your child spend a lot of time thinking about or trying to get alcohol or other drugs? YES NO 12. When your child is drinking or using drugs, are they more likely to do something they wouldn't normally do, such as break rules, break the law, sell things that are important to them, or have unprotected sex with someone? YES NO The next questions are about yourchild's lifetime experiences. 13. Has your child ever had a drinking or other drug problem? YES NO 14. Has any other family member ever had a drinking or drug problem? YES NO 15. Do you feel that your child has a drinking or drug problem now? YES NO Thanks for filling out this questionnaire. Scoring for the AM Abuse Screening Instrument Name/1D No: Date: Provider Name: Place/Location: Items l and 13 are not scored. The following* item* are *cored as l (yes) or 0 (no): 2 ? 12 3 8 13 4 9 14 5 (any items listed) 10 16 6 11 Total Score - Score Range: 0 - 14 Preliminary interpretation of responses: Score Degree of Risk for AOD Abuse 0-1 None to low 2-3 Minimal >4 Moderate to high: possible need for assessment ABOVE RESPONSES ARE PRIVATE AND CO1=DENTIAL. PROVIDER IS REQUIRED TO INrORM RESPONDENT OF THEIR RIGHTS FOR CONFIDENTIALITY, SITUATIONS WHEN PROVIDER RESPONSIBILITY TO DISCLOSE IN1"0RMATION SUPERCEDES CONFIDENTIALITY, CONSENT TO SNAKE INFORMATION OR SECURE PARENTAL CONSENT AS NEEDED. Contra Costa County Health Services Community Substance Abuse Services Children,Youth and Families BEHAVIOR CONTRACT Directions: Client and Provider/Facilitator review referral information and screening to jointly develop the contract. As a member of the group sponsored by , I agree to the following points as part of my participation in the group: 1. I will not attend group while under the influence - EVALUATION + of any illegal substances. 1 2 3 4 5 2. I will be present each week, be on time, and will remain throughout the entire meeting. If unable to attend, I will let my counselor know beforehand. 1 2 3 4 5 3. I will put feelings into words, not actions. 1 2 3 4 5 4. I will treat all group members with respect. 1 2 3 4 5 5. I will not discuss group meetings with anyone outside the group. 1 2 3 4 5 6. I will remain in the group until the issues that brought me to group have been resolved, or until the group ends. 1 2 3 4 5 I agree to work on changing the following behaviors: (1) 1 2 3 4 5 (2) 1 2 3 4 5 (3) 1 2 3 4 5 In order to achieve my goal to ahangs above behaviors and to develop a more positive support system, I need the support of the following people: (1) 1 2 3 4 5 (2) 1 2 3 4 5 (3) 1 2 3 4 5 I feel that I have acsconplishsd my goal by changing the behaviors that resulted in my referral to the _ group. I believe that I deserve the following rating: -----r___ -- Participant Signature and Date Counselor Signature and hate r..�..».yx.w. .t. ....,«a......tA--^IMCIM d Appendix #4 Treatment Youth Assessment - C-ASI-A is administered to establish severity of use, behaviors and conditions that contribute to the AOD problem. Family Assessment - The FES is administered to identify problems, promote change and strengthen the family unit. Outpatient Treatment - Three levels of family centered social model include individual, group, family► and multi-family sessions, educational and 12 step groups, drug testing and relapse prevention. See Charts 1 & 2 Residential Treatment - Forty five, 24 hours a day, T days per week social model environment that requires a minimum of 40 hours per week of counseling and/or structured therapeutic activities. Another 4 days emphasis on relapse prevention and linkages to outpatient services. Client ID # SELECT THE MODULES YOU'CISH TO ADMINISTER Confidential: Cannot be reproduced or distributed without written permission of• Kathleen Meyers University of Pennsylvania/ Treatment Research Institute One Commerce Square 2005 Market Street, Ste. 1170 Philadelphia, PA 19103 -7220 (215) 665 -2880/(215) 665 -2864 (FAX) Copyright 0 1996,by K.Meyers Version 1.1 1999 JUVEN11LE DRUG AND ALCOHOL IMPACT INDEX Prepared by. M. K. Associates For Contra Costa County Community Substance Abuse Services And Contra Costa County Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Table of Contents Pg. No. Introduction Anatomy of a Per Capita Comparison Chart Anatomy of a 111.00 Percent"Bar Chart Indicator 1: Taxable Sales at Off-sale Retail Alcohol Outlets Indicator 2: Retail Alcohol Licenses Indicator 3: Sales-to-Minors Violations Indicator 4: Juvenile Drug Arrests Indicator 5: Juvenile Alcohol Arrests Indicator 6: Juvenile DUI Arrests Indicator 7: Teen Drivers in Alcohol Involved Collisions Indicator 8: Victims of Teenage Drunk Drivers Indicator 9: Teen Victims of Alcohol Involved Collisions Indicator 10: Drug-Related Hospital Discharges Indicator 11: Alcohol-Related Hospital Discharges Indicator 12: AOD-Involved Coroner Investigated Youth Deaths Indicator 13: Juvenile AOD-Deaths Indicator 14: AOD Use Among High School Students Indicator 15: Juveniles in Substance Abuse Treatment Age at Admission Age of First Drug Use Gender Sources of Referral to Treatment Legal Status at Admission Treatment Completion Status at Discharge Produced by Costa Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendices Tables for Indicators 1-15 Sources for facts contained in re port Produced by Costa Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Anatomy of a Per Capita Comparison Chart Anatomy of a Per Capita Comparison chart This is a sample of a "per capita comparison" chart. The chart shows the indicator (e.g.,juvenile drug arrests) by population (usually per 10,000 people of some age range). By portraying the data In per capita terms Is It possible to compare the numbers of any subject in one population with those in another population of different size. So In order to compare, say,juvenile drug arrests for Contra Costa County and the State of California as a whole, or to compare one year to another, the number of drug arrests in each population are calculated using a common population denomenator, such as 10,000 persons aged 10-17 years. Description of the data being:plotted, Juvenile DUI Arrests including the Contra Costa County vs.State of California,19934997 common population Per 10,000 Persons Aged 10-17 Yrs. denominator. The denominator for the s 1000 charts in this-report 9.00 is usually 10;000 < 900 persons of whatever This is the age range,is ''00 ;'chart's key. relevant to the data. 8 e.00 It identifies 5� -.-State which line County represents the `� 3.00 State's data a 3.00 and which This is the chart's a 2.00represents the scale. It shows the ,00 County's data values that are e being plotted (e.g., z 0.00 the number of drug 1993 1994 1995 1998 1997 arrests per10,000 The source(s)of the data for this chart are listed here. persons aged 10-17 Data sources. yrs.). There are a number of things to look for or keep in mind when viewing the per-capita charts in this report. Look at the relative positions of the different data lines - this will give you a general impression of which population has a higher or lower number of, in this case,juvenile drug arrests per 10,000 persons aged 10-17 years. ♦ For each of the populations, look to see if the data line generally trends upwards or downwards or stays fairly level across the range of years. In the above chart, the number of juvenile DUI arrests decreased during the period 1993 to 1997, from a level 60% higher than the rate for the State to a rate that is fairly consistent with the average for the State as a whole. The per-capita comparison charts can be used to directly compare the rates, in this sample case, of arrests for juvenile drug offenses for the County with those of the State. Rates can also be compared within a population (County or State) for one year with those of another year. Pay attention to the scale of the data. The scale will allow you to approximate the value of each datapoint being plotted (refer to the accompanying data tables to see the actual data for each chart). In the sample chart shown above, the difference from one gridline to another is 10 drug arrests. Even when you have payed attention to the scale, you must still decide, based on an understanding of the indicator in question, how much of a difference between the State and the County or between one year and another is really meaningful. Regardless of how much higher on the chart one datapoint is than another, is a difference of 4 arrests per 10,000 meaningful, or does the difference have to be 10 or more to be important. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board . is 1 4 y ti'• .." '� ¢� 1999 Juvenile Alcohol and Drug Impact Index Anatomy of a "100-Percent" Oar Chart Anatomy of a "100-Percent" Bar chart This is a sample of a "100-Percent" bar chart. Each bar represents the data for one year, and each segment of a bar represents the data for one region of the county for that year. The height of each segment Is determined by the proportion of the total number of, say,juvenile DUI arrests for the year that happened In that region. For Instance, If a region had 50 percent of the total number of Juvenile drug arrests for the whole county that year, the height of that region's segment would be half the height of the whole bar. The number given in each segment is the actual value for the Indicator, and the values for all of the segments in a bar sum to the total value for that year. By portraying the data in "100-percent" terms, is it possible to compare the relative proportion of arrests from one region to another in the same year and to observe the change in the relative proportion of arrests in a region from one year to another. Descr;ption of what; the height of each Juvenile DUI Arrests segment represents. Contra Costa County.1993-1997 This is the Each segment - chart's key. represents the ,00x It Identifies which pattern number of arrests-as Sox represents a percentage of the w -� total number of ,, 80% w each region's arrests for the year. ,axa ,2 data. . ■West a so% ®Acalanes South This is the chart's 40%-_ 0Central e 30%-- 10 ®East scale. It allows one A aural' to determine the d 20x 20 ,a - n 23 percentage of arrests represented w... by each segment7The ox 1993 1994 1995 1996 1997 (see the attached tables for the actualrces)of the data in this chart are listed here. percentages). Data sources. __f Here's what to look for when viewing the "100-percent" charts in this report. Look at the relative sizes of the different bar segments, either in the same year or across different years. The biggest segment for a given year represents the region with the highest proportion for that year and the smallest segment shows the region with the lowest proportion for that year. If a region has the same proportion from year to year, then the size of the region's segment will be the same from year to year regardless of the actual number of, say, arrests in each year. In the chart above, for Instance, the relative proportion of juvenile DUI arrests in the unincorporated areas of Contra Costa County (which had the highest proportion of arrests In each year) declined somewhat over the five-year period from 1993 to 1997, and fell off significantly in 1996. Keep in mind that because there Is a difference in meaning between the number of arrests and the relative proportion of those arrests for a given year, a situation can occur where the number of arrests have increased in a region from one year to the next, but the proportion of arrests for that region relative to the other regions has actually decreased. Such a situation occurs for the unincorporated area: In 1995, the number of arrests was only 17- compared with 23 for 1997. However, the proportion of arrests in the unincorporated area compared to the other regions actually decreased from roughly 37% to roughly 31% (see the 100-percent scale at the left edge of the chart. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory ward 1999 Juvenile Alcohol and Drug Impact Index Indicator 1:Taxable Sales at Off-Sale Retail Outlets Indicator 1: Taxable Sales.at Retail Alcohol Outlets This chart compares the average amount of money spent on alcohol at off- sale retail alcohol outlets (outlets that sell alcohol for consumption off- r'T imirnoreallysure way to premises) In Contra Costa County with the average amount spent on alcohol know if we are drh2ldng more at retail alcohol outlets in the State of California as a whole, during the years as society,but when the fact 1993 to 1997. that alcohol consumpbou increased m the County is coupled with the fact that Average Taxable Sales Per Off-Sale Retail Alcohol Outlet DUTshavealso risen, Contra Costa County vs.State of California,19931997 something is going on." 600.00 550.00 v 500.00- 0 450.00 FACT: A more accurate d 400.00 measure of alcohol consumption in the county .9 350.00 S -�-County could be determined by a __ '00'0" state random sanple,behavioral S 250.00 phone survey of county y 200.00 residents a + ,50.00 ,00.00 50.00 0.00 1993 1994 1995 1996 1997 THINGS YOU CAN DO: Taxable sales data from the California Board of Equalization. + Red Ribbon Week provides an opportunity for county residents to This chart shows the average amount of sales generated by off-sale retail limit or reduce their alcohol outlets in Contra Costa County during the period from 1993 to 1997. alcohol consumption in The relative amount of sales can be compared from region to region and recognition of the more year to year. than—people who died in alcohol related accidents in 1997. Average Taxable Sales Per Off-Sale Retail Alcohol Outlet Contra Costa County,1993-1997 TECHNICAL NOTES: In the bottom chart, Because t the sales figures are averages, �- adding the segments of a column together does not 3 yield a meaningful number. o However, the segments of a each column accurately C4e6. ■west represent the relative amount t te. taAcalanes of sales from one region/year o tscwh to the next and can be used to ... oCentrdl provide a visual understanding 576:: w :::3 ' -:-525,:= of differences region-to-region maser and year-to-year. e 304 322 9 241 304 Taxable safes data are not collected for sales of alcohol 1993 1994 1995 1996 1997 per se, but Instead represents the gross sales of businesses Taxable sales data from the California Board of Equalization. with a tax business class code of 22 (package liquor stores). The category of"package (cont.on next page) Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 1:Taxable galeal ar Retail Alcohol Outlets Indicator is Taxable Sales.at Retail Alcohol Outlets This chart shows the average amount of money spent each year per person of legal drinking age at off-sale retail alcohol outlets during the period from Iv announced nonced the Toe Cellars has 1993 to 1997 In Contra Costa County and the State of California. Per capita uesholiday debut of Santa Reserve Merlot spending amounts can be compared state to county and year to year. e Ho!Hol The label features Santa Claus,wine glass in hand,toasting Rudolph,as he Taxable Sales at Off-Sale Retail Alcohol Outlets by Year prepares to step down a Contra Costa County vs.State of California chimney. Per Capita Comparison Is Santa drinking on the job? 100 Driving under the influence? A poem printed on the back label 65 makes everything clear: ® as eo 71lfas the night before io Christmas and finally it's time, 05 For Santa tosavor W His Avorite red wine. a 50 � The gifts are delivered I" 45 -------------_--___.,___�._.�..__ _.__._.______ __._....____._._. _..__._ To children so sweet bA0 ............______..___...._........._.------.. ._____. _._.......__._.............__...-..-___._.._._._.__.__......__..___�. 35 .-. _____._.._...._...-..................................._._...._.._ St Nick can enjoy a30 ..____..__._._._........................._..._..._.._.... ..__..._._....._..__.__. ._._...---..._..........___........_.....--.--.....___. His Avoritetreat! c 25 ..... Chocolate and berries 15 ....... _. .... -. ..-.... ......__. . .. ........ ..._.......-.. ......... In every sip, 10 .____.____.r....._..._.__...__-.._....___-.__.._._.......___........._..._.__.._._..___.___._...................._..___ The perfect reward y5 __......_ ... _...__...._._.___.. _ ._.. _ _ Y__...____.. ..__...._...._._._......_.___._._.v 4 For Santa s long trip! 1993 1994 1995 1996 1997 Selected from the wine cellar At the home ofKris kringle, Taxable sales data from the California Board of Equalization. Perfect for your family and Populatlon data from the California Department of Finance. Friends to enjoy as you mingle! TECHNICAL NOTES (cont.) liquor stores" includes a) package liquor stores with Alcohol Beverage Control license types 20 and 21,and b) food stores whose predominant sales are package liquor. License type 20 Is for off-sale (for consumption off-premises) beer and wine sales, and license type 21 is for off-sale general alcohol sales. Sales from non-alcoholic items In these stores are not separated from sales of alcoholic Items. The most significant segment of the off-sale market that is excluded from this data are supermarkets that sell alcohol. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Indere Indicator 2: Retail Alcohol Outlets Indicator 2: Retail Alcohol Licenses This chart compares the number of currently active "off-sale" alcohol licenses "Every time you turn around (which allow the sale of alcohol for off-premise consumption) to the number there of currently active "on-sale" licenses (which allow the sale of alcohol for on- alcohasanotshso ce Rhes alcohol.I wish some ofthese premise consumption) in Contra Costa County, as of October, 1998. places would sell vegetables or fruit instead. There are a lot of kids in this neighborhood." Active Retail Alcohol Licenses as of October,1998 Contra Costa County by Region 300 250 260- 240- 220, ®o240 220 FACT: South County had the s zoo highest percentage of on-sale tea licenses(74%)in 1997. West ci teo County had the highest too �,, r,a sale percentage of ofd sale licenses E120, ®Orrsale (49%). 221 z' too so i14G 15e ':itee 60 X144 :t15 40 �.91 i :•100 20 _12— s 0 West Acalanes south central east unlncorp. THING'S YOU CAN DCI: Retali outlet license data from the California Alcoholic Beverage Control. • Call 925-555-1234 to find out how you can become involved in your local MAPP to control the number of alcohol outlets in your neighborhood. TECHNICAL NOTES: Currently active licenses Include licenses whose status is "active," "surrendered not In use;" "revocation pending due to non-payment,"and on "social services hold". The status of 96 percent of the licenses is"active". The number of currently active licenses is not to be confused with the number of currently active outlets, as some outlets have two licences and a few have three. Unlike the taxable sales data In Indicator 1, which Included only 20- and 21-type licenses, all license types(except for special events)are included in this data. Produced by Contra Costa Co.Community Substance Abuse Services Diuision and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 3s males-to-Minor Violations Indicator 3: Sales-=to-Minor Violations This chart shoves the number of sales-to-minor violations for retail alcohol "Im not21 butr1wow3or4 outlets in Contra Costa County during the period from 1995 to 1998. The places I can get a clerk Xknow relative proportions of violations can be compared from region to region, and to sellme some beer. Ijust year to year. gine him an extra five bucks. Sates to Minor Violations for Retail Alcohol Outlets Contra Costa County,1995-1958 10ox Sox Fact: The number of sales-to- ::: minor violations has risen from lox 25 in 1995 to 66 in 1998. Fast ■west County has typically had the asoxi, .a.. ail o 1 9Acalanes most,with 25 in 1998 A pax ®South 30%--- �{ ' � G7central 20% 17 25 MEW a 9 10% 0% 1995 199a 1997 t995 THINGS YOU CAN DO: Sales-to-minors violations data from the California Alcoholic Beverage Control. Find out Which alcohol • outlets in your neighborhood illegally sell alcohol to minors and educate them on how they can be more responsible members of the community by limiting youth access to alcohol. TECHNICAL NOTES: Sales-to-minor violations Include the following subcategories: Sales-to- minor, sales-to-minor (decoy), and sale to and consumption by minor. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 4:Juvenile Drug Arrests Indicator 4: Juvenile Drug Arrests This chart compares the number of juvenile arrests for drug offenses per 10,000 persons aged 10-17 years in Contra Costa County with the number of "I thought smokingpotwas juvenile drug arrests in the State of Caiifomia during the period from 1993 to cool-and didnrhurt anyone, 1997. That was untV rgot caught smoking at a school dance and now they want to kick me out ofschool." Juvenile Drug Arrests Contra Costa County vs.state of California,1993-1997 -Student at a Contra Costa Per 10,000 Persons Aged 10-17 Yrs. . County High School. 80.00 75.00 d 70.00 IM 65.00— FACT: Studies show that `0 8400 treatment for substance abuse CL 55.00 can significantly CL so.o0 g Y decrease g 45.00 crime rates. Most criminal d 40.00 -+-Stateactivities declined between 23- t 35•001-0-County38 percent following drug ° 30.0o treatment. H 25.00- 20.00- M00 5.0020.00ts.00 10.00 " 5.00 z 0.00 1993 1994 1995 1996 1997 THINGS YOU CAN DO: Juvenile drug arrest data from the California Department of justice,Criminal Justice Statistics Center. + If there is a juvenile court Contra Costa County and State of California population data from the California Department of Finance. in your county or region, give it your support. If This chart shows the number of juvenile arrests for drug offenses for each there isn't one,talk to local region of Contra Costa County during the period from 1993 to 1997 (the lawmakers about starting number labelling each bar segment). The chart allows a comparison of the one. relative proportion of arrests from one region and year to another. Juvenile Drug Arrests Contra Costa County,1993-1997 TECHNICAL NOTES: yooX Arrests for the following r 90% t01 + drug offenses are included in 1$ 8% this indicator: Felony J2 77 narcotics, felony marijuana, 70% felony dangerous drugs, 80X felony other drug violations, ' 4i ez; ■west misdemeanor marijuana, o sox +.. : tzr: aAcaianes misdemeanor other drugs, :: Mouth ? r 7a'' dCentrai and misdemeanor glue 40% o meant sniffing. m 30% 1C 20% 148 tab ❑Unincorp. C t 18 140 6 10% 54 2< OX , 1993 1994 1995 1998 1997 Juvenile drug arrest data from the California Department of Justice,Criminal Justice Statistics Center. Produced by Contra Costa Co. Community Substance Abuse Services.Division and Substance Abuse Advisory Board 1.999 Juvenile Alcohol and Drug Impact Index Indicator S:Juvenile Alcohol Arrests Indicator 5 Juvenile Alcohol Arrests This chart compares the number of juvenile arrests for alcohol offenses per 10,000 persons aged 10-17 years in Contra Costa County with the number of "Tootxranypeoplethinkthat Juvenile alcohol arrests In the State of California during the period from 1993 it's nobrgdeal ifteenalge& to 1997. drink. They don t see all of the damage and ruined lives that result." Juvenile Alcohol Arrests Thomas Gilfether, Contra Costal County vs.State of California,1993-1997 Alcohol and Drug Counselor Per 10,000 Persons Aged 10-17 We. 40.00- 37.50- 35.00, 0.0037.5035.04 < 35•50FACT: Youth who drink are 2 30,00- 0 27.50 7.5 times as likely to,use any o. 25.00 illicit drug and 50 times more 22 s0 likely to use cocaine than �' 1! 20.00 4>-smote young people who never drink v r 17.50 -0-Countyalcohol. � 15.00 X12.50- 10.00. 0 7.50 y 5.00 E 2.50 0.00 1997 1994 1995 1998 1997 THINGS YOU CAN DO: Juvenilealcohol arrest data from the California Department of Justice,Criminal Justice Statistics Center. `Volunteer to help at,or Contra Costa County and State of California population data from the California Department of Finance. even start,a sober graduation night program This chart shows the number of juvenile arrests for alcohol offenses for each at your local high school. region of Contra Costa County during the period from 1993 to 1997 (the number labelling each bar segment). The chart allows a comparison of the relative proportion of arrests from one region and year to another. Juvenile Alcohol Arrests Contra Costa County,1993-1997 TECHNICAL NOTES: 100% 1 Arrests for the following alcohol offenses are Included e0% w 7 In this indicator. Misdemeanor drunkeness, $ 70% 7 misdemeanor liquor laws, s �; NW" civil drunkeness. usox BAcelanes a 13s01,a, `0 30%--- MEast ClUni corp. L 20% 52 a 0 10% 9L 4 0% 1997 1994 1995 1998 1997 Juvenile alcohol arrest data from the California Department of Justice,Criminal Justice Statistics Center. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 6: Juvenile DLIII Arrests Indicator 6: Juvenile DUI Arrests This chart compares the number of juvenile arrests for DUI offenses per 10,000 persons aged 10-17 years in Contra Costa County with the number of "Irealize now that 1could Juvenile DUI arrests In the State of California during the period from 1993 to have wrappedmyselfarounda 1997. telephone pole or even killed someone else driving drunk Personally,I'm glad Igot caught. Juvenile DUI Arrests Contra Costa County vs.State of California,1993-1997 17yr old DUI offender. Per 10,000 Persons Aged 10-17 Yrs. 0 10.00 9.00 FACT: A DUI conviction Ce.0o means a fine of more than r TOO $1000,and three years of IL 8.� probation. In addition,first- 0 -+-stave time offenders have to take a r 5.00 -0•,Cou weekly class that costs$445. CL 0.00 And ofcourse,ifyour 3.00 insurance company doesn't t drop you your rates will 0 z.0o 0 double. 1.00 E z 0.00 1993 1994 1995 lose 1997 THINGS YOU CAN DO: Juvenile DUI arrest data from the California Department of Justice,Criminal Justice Statistics Center. • Never drink and drive. Contra Costa County and State of California population data from the California Department of Finance. 'volunteer to be the designated driver for your This chart shows the number of juvenile arrests for DUI offenses for each group and stay sober. region of Contra Costa County during the period from 1993 to 1997 (the number labelling each bar segment). The chart allows a comparison of the relative proportion of arrests from one region and year to another. Juvenile DUI Arrests Contra Costa County,1993-1997 TECHNICAL NOTES: 1o0% Arrests for the following DUI offenses are included in this 80% indicator. Felony driving 70% 1z under the influence and ::`. ...:• 1 misdemeanor driving under a 80% ?::: ::::5;::: the influence. ■west ea1e`' E7Acalanes 50% 6 5 ......h ®South 40% ...... [7 Central IM30% 10 M East J1 I A nincorp. C 20% 20 18 17 23 10% 15 0% ., .,,.,.,,... .. 1993 1994 1995 1998 1997 Juvenile DUI arrest data from the California Department of Justice,Criminal Justice Statistics Center. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 7:Teen Drivers in Alcohol Involved Collisions Indicator 7: Veen [givers in Alcohol Involved Collisions This chart shows the number of collisions in which at least one of the parties to involved was under the age of 18 and had been drinking as a percentage of 'ink It hadthat was e. all collisions involving any drivers under the age of 18. Percentages for But the way home, ome, lie. Contra Costa County during the period 1993-1997 are compared with intoBut on the deyhome,Igor percentages for the same period In the State of California as a whole. hurt, an accident. No one was hurt,but I had my license suspended and now 1 can't Alcohol involved Motor Vehicle Collisions drive until am 21." Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County vs.State of California,1993-1997 17yearold high school Number of Collisions As a Percentage of All Collisions involving student Drivers Under 18 Yrs of Age V eta 5.04 FACT: The figures on teens 0 4 la 440 who drink show that about three-quarters of high school 3.sa seniors drink alcohol,and half C a 3.001 have gotten drunk. And when ° z.50 1-4-State the party"s over;they get s 40 o-cou behind the wheel of a car and _w try to drive home. a 1.so e, 1.04 0.54 d 0.00 a 1993 1994 1995 lose 1997 THINGS YOU CAN DO: Collision data from the California Highway Patrol. Arrange to have teenage victims and perpetrators of alcohol involved accidents This chart shows the number of collisions in which at least one of the parties come to speak at your involved was under the age of 18 and had been drinking as a percentage of child's school about how all collisions involving any drivers under the age of 18. Percentages are drinking and driving has shown for each region of Contra Costa County during the period 1993-1997, impacted their lives. This chart allows a comparison of the percentages from one region and year to another. Alcohol Involved Motor Vehicle Collisions Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County by Region,19934997 TECHNICAL NOTES: Number of Collisions As a Percentage of All Collisions Involving Drivers Under 18 Yrs of Age A driver is designated "Had been drinking" based on the judgement of the attending 144 law enforcement officer. sox 1 There are four levels: Had W% not been drinking, had been : y rax •1.o drink(HBD)- impairment 3 atiye5t unknown, HBD- not under `< y :;1.5::: :z.a•: ®Acalanes influence, and HBD- under C 50% .7 influence. A collision in e +u •••4.7r. C95outh c 40 .:.y, :: s 4. which an2. y driver is judged to Deentral 30%-- .2 ®East be any level of HBD Is 7• classified as an "alcohol lox 52 4.7 0.4 ClUnlncarp lox 2.6 2.2 Involved collision. o% 1993 1994 1995 1998 1997 Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory.Hoard 1999 Juvenile Alcohol and Drug Impact Index Indicator 8:Victims of Teenage Drunk Drivers Indicator 8: Victims of Teenage Drunk Drivers This chart shows the per capita number of persons of all ages who were killed or Injured in collisions where any of the drivers involved was under the "There is no excuse for driving age of 18 and had been drinking. The rates of deaths and Injuries in Contra while under the influence, Costa County during the period 1993-1997 are compared with the rates for none at all-especially when the same period In the State of California as a whole. you axe under age. It breaks my heart every time I come to the scene ofa fatal DUI Alcohol Involved Motor Vehicle Collisions accident. 91hata homble Involving Had Been Drinking Drivers Under 18 Yrs of Age waste oflYe." Contra Costa County vs.State of California,1993-1997 Number of Persons of All Ages Killed or Injured Per 100,000 Persons CHP 011icer O 7.00 6.50 0 6.00 5.50 q FACT: During the period r 6.00 1993-1997,while the rate of a.so death and injury due to under- 4.00 nder- 4 00 18 drunk drivers has decreased �g -#-State a 3.50 across the State as a whole,for 93.00- -0-Conn Contra Costa County,the rate 2.s0 has increased by nearly 37% 2.00 t 1.50 1.00 iv a 0.50 E 0.00THINGS YOU CAN DO: z 1993 1994 1995 1996 1997 • Draft a"contract for life" Collision data from the California Highway Patrol. with your teenager, Population data from the California Department of Finance. agreeing that he or she needs to act responsibly, and that you will be there This chart shows the number of persons of all ages who were killed or day or night to provide a injured in collisions where any of the drivers involved was under the age of ride home if otherwise it 18 and had been drinking. Numbers are shown for each region of Contra would mean he or she Costa County during the period 1993-1997. This chart allows a comparison would drive drunk or be in of the relative proportion of people killed or injured from one region and year a car driven by someone to another. who is drunk. Alcohol involved Motor Vehicle Collisions Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County by Region,1993-1997 TECHNICAL NOTES: Number of Persons Killed or Injured There are four levels of 100% "injury": Complaint of pain, „ other visible Injury, severe 90% 1! 90% and death. There F. 60% 1 were only 2 persons killed lox :::::i::::: during the period 1993-1997 V :3>::' in Contra Costa County in Y 60x .. West alcohol involved collisions « •:•:2•:•:• 6 :: ;; :Acalanes sox :::4 : where any had-tseen- C eox ®south drinking driver was under Q. 1° OCentral the age of 18. g 30% a MEast 20%--- 10 17 t7Unincorp E 70 13 z 10% 6 01s 1993 1994 1995 1996 1997 Collision data from the California Highway Patrol. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 9:Teen Victims!of Alcohol Involved Collisions Indicator 9: Teen Victims of Alcohol Involved Collisions This chart shows the per capita number of persons under the age of 18 who were killed or injured In collisions where any of the drivers involved had been '71newmyboyhiendhad drinking. The rates of deaths and injuries in Contra Costa County during the drunldng and when he and period 1993-1997 are compared with the rates for the same period in the three other&endsgot inhis State of California as a whole. car to go to anotherparty,I said no. Less than five miles from the house,they got into Alcohol Involved Motor Vehicle Collisions an accident.thatkilled"one of Contra Costa County vs.State of California,1993-1997 them and paralyzed another. Number of Persons Under 18 Killed or Injured Think about it before you get Per 10,000 Persons Under 18 in a.car with someone who 91 has been drinking,I am glad I 15.00 did.» 12 13.75 a 12.50 19 year oldgirl C. 11.25 10.00 CL t! 8.75 PACT: In 1997, 16,189 t 7.50 •-coun Americans were killed in n 5.25 alcohol-related crashes, 0 5 accounting for nearly half of all traffic fatalities. That's 3.75 2.50 another person killed every 32 125 minutes. E 0.00 1993 1994 1995 1998 1997 THINGS YOU CAN DO: Collision data from the California Highway Patrol. Population data from the California Department of Finance. + Visit the website library.advanced.org/ This chart shows the number of persons under 18 years of age who were 23713/&amesetlitml for a killed or injured in collisions where any of the drivers involved had been very informative and well- produced interactive drinking. Numbers are shown for each region of Contra Costa County during presentation of many the period 1993-1997. This chart allows a comparison of the relative aspects of drinking and proportion of people killed or Injured from one region and year to another. driving. Alcohol Involved Motor Vehicle Collisions Contra Costa County by Region,19934997 Number of Persons Under 18 Killed or Injured 100% 90% 1 e0% 1 v sox 1 :� ■west 50% :;: ;.;: X'41-:•: MAcalanes om south aox ocentral CL Sox MEast 83 ClUnincorrp E ZO% d5 82 79 73 10% z 0% 1993 1994 1995 1996 1997 Collision data from the California Highway Patrol. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 10: Drug-Related Hospital Discharges Indicator 10: Drug-Related Hospital Discharges This chart compares the number of drug-related hospital discharges per 10,000 persons aged 5 to 24 years In Contra Costa County with the number "I nearly died last year from of drug-related hospital discharge In the State of California during the period an overdose. Iwas alone in a from 1994 to 1997. room at a pansy and when my friends found me r was unconscious. The whole thing really scared all ofus. Iguess Drug-Related Hospitalizations onegoodthrngaboutitisnow Contra Costa County vs.State of California,1994-1997 my friends dont do drugs by Year,for Persons Aged 5-24 Yrs. anymore either." 25.00 18 yr.old high school student. a 22.50 S20.00 FACT: The American t! 17.50 Medical Assn.estimates that, nationally,at least 25%of g 15.00 hospital inpatients and 20%of ® +state 12.50 Coca primary care patients have hidden problems with drugs $Y0'°0 and alcohol,yet only 5%of all 7.50 hospital admissions are a 5,00 recognized as drug or alcohol related. 2.50- Z 0.00- 1994 1995 1998 1997 THINGS YOU CAN DO: Hospital discharge data from the California Office of Statewide Health planning and Development,through the • If you believe you California Department of Alcohol and Drug programs. Contra Costa County and State of California population data from the California Department of Finance. teenager is endangering his or her health through drug This chart shows the number of hospital discharges among persons aged 5- use,don't deny it. Get 24 years for which drug usage was indicated in the patient's diagnoses. medical help before it is Numbers for each region during the period from 1994 to 1997 are provided too late. (the number labelling each bar segment). The chart allows a comparison of the relative proportion of drug-related hospital discharges from one region and year to another. Drug-Related Hospitalizations Contra Costa County,1994-1997 by Region and Year,for Persons Aged 5-24 Yrs. TECHNICAL NOTES: 100% This indicator includes all hospital discharges where 90% any of the first eight sox diagnoses on record are r related to drug use. The 70 rs ICD-9 codes used to define 3 sox awest "drug-related"are the w oSox ®Aeaianes following: Drug psychoses ;: :; : ::-sa::::: 0south (code 292 Inca. all a0x ....... acentrai subcategories),drug sox meast dependence(code 304 Incl. aunincorp all subcategories),and non- e zox r dependent use of drugs 10% (code 305.1 to 305.9). Data 0% for the year 1993 is not 1994 1995 1996 1997 available, Hospital discharge data from the California Office of Statewide Health planning and Development,through the California Department of Alcohol and Drug Programs. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board ice + r; , 1999 Juvenile Alcohol and Drug Impact Index Indicator 11:Alcohol-Related Hospital Discharges Indicator 11. Alcohol-Related Hospital Discharges This chart compares the number of alcohol-related hospital discharges per 10,000 persons aged 5 to 24 years In Contra Costa County with the number "Kids need to be better educated of alcohol-related discharges In the State of California during the period from about what can happen rfyou 1994 to 1997. drink. laratkidstnthe hospital that ha ve come to within an inch oftheir He by poisoning themselver with Alcohol-Related Hospitalizations alcohol and nevereven knew Contra Costa County vs.State of California,19944997 drinkirng could be dangerous." by Year,for Persons Aged 5-24 Yrs. Ken Messmer,PR Physician. 5.00 4.50 4.00 FACT: Most binge drinking begins in high school and is 3.5o continued through college and s.00 is correlated with other risk ® -*-State taking behavior and social 2' -0-Countyl activity. 2.00- 1.50 1.00 0.50 0.00. 1994 1995 1996 1997 THINGS YOU CAN DO: Hospital discharge data from the California Office of Statewide Health Planning and Development,through the Educate yourself and California Department of Alcohol and Drug Programs. your Child. You Should Contra Costa County and State of California population data from the California Department of Finance. y know the signs of teenage This chart shows the number of hospital discharges for persons aged 5-24 alcoholism,and your years for which alcohol use was Indicated In the patient's diagnoses, teenager should know that Numbers for each region during the period from 1994 to 1997 are provided drinking at all is illegal (the number labelling each bar segment). The chart allows a comparison of and that drinking too the relative proportion of alcohol-related discharges from one region and much at one time can kill year to another. you. Alcohol-Related Hospitalizations Contra Costa County,1994-1997 by Region and Year,for Persons Aged 5-24 Yrs. TECHNICAL NOTES: 100% This Indicator Includes all hospital discharges where 90% 1 any of the first eight 80% 1 diagnoses on record are related to alcohol use. The cox ICD-9 codes used to define 60% , ■west "alcohol-related"are the ►- 15Acatanes following: Alcoholic % ?` south psychoses (code 291 Incl. all a ::::::i::.:.: Emcentrai subcategories), alcoholic 30% :;a:::a;;:::: o:::ia;:a:; MEast dependence syndrome(code a 20% 1 rlUnincorp 303 Incl. all subcategories), 6 non-dependent use of 10% 6 alcohol (code 305.0), and 0% excessive alcohol In blood 1994 1995 1996 1997 (code 790.3). Data for the year 1993 is not available. Hospital discharge data from the California Office of Statewide Health Planning and Development,through the California Department of Alcohol and Drug Programs. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 12:AOD-Involved Coroner-Investigated Deaths Indicator 12: AOD-Involved Coroner-Investigated Deaths This table lists all the coroner-investigated deaths in Contra Costa County from 1993-1997 of children under the age of 18 where drugs and/or alcohol "Alcohol and drugs have were found In the body. destroyed three genemdons of men in myfamily. lam the only male over 40 who has not been the victim ofdrugs, violence,or both." List of AOD-Involved Coroner-Reported Deaths Among Youths Between 11 and 17 Years of Age Contra Costa County During the Period 1993 to 1997 by Region. Year Age Gender Ethnicity Cause of Death AOD Found FACT: Of the 21 AOD West County involved coroner investigated 1993 17 male black gunshot alcohol deaths among youths I I to 17 1993 17 male black gunshot methamphetamine years of age in Contra Costa 1993 15 male hispanic stabbed alcohol County during the period 1993 1994 16 male black gunshot alcohol to 1997,more than half were 1994 15 male black gunshot alcohol caused by gun violence. 1994 17 male asian gunshot alcohol 1994 16 male black gunshot alcohol 1994 15 female white stabbed alcohol THINGS YOU CAN DO: 1995 16 male black gunshot alcohol 1995 15 female white gunshot benzoylecgonine Support local,state,and Lamorinda federal policies designed to 1994 11 male white dru / olson-acc. trichloroethylene keep alcohol and firearms 1995 16 male white asphyxia methamphetamine out of the hands of youth. 1995 14 male white gunshot-acc. alcohol 1996 15 male white gunshot-ace. alcohol South County 1994 16 male black gunshot alcohol 1994 17 male white ash is-suic. alcohol CO 1997 16 male hispanic gunshot-acc. alcohol Central County 1996 17 female white drug/poison-suic. fluoxetine 1996 17 female white drug/poison-suic. alcohol,fluoxetine East County TECHNICAL NOTES: 1994 17 male black my solo-acc. alcohol 1994 17 male white drowning-acc. methamphetamine Coroner-reported deaths are Contra Costa County Coroner's Office,Forensic Services division. typically those that happened "acc."-acddental,"suic."-suicide,"Co"-Carbon Monoxide,"mv-motor vehicle. under suspicious circum- stances or occurred while the deceased was not under the care of a physician. One of the drawbacks of the coroner- reported death data is that the reports do not differentiate between drugs taken by the deceased and drugs administered by a hospital. In this data, all drugs commonly known to be physician- administered have been removed. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board ...._... _ ........._........_............. 1999 Juvenile Alcohol and Drug Impact Index Indicator 13:Juvenile AOD-Related Deaths Indicator 13: Juvenile AOD-Related Deaths If the data were available, this chart would compare the proportions of all "Legal drugs kill a lot of deaths of persons under the age of 18 that Involve drug and/or alcohol in people in the United States Contra Costa County during the period from 19931997 with the same everyyear,•400,000from proportions of such deaths in the State of California. tobacco use,and 125,000 from the use ofalcohol. Fipy percent of emergency room Juvenile Alcohol and Drug Involved Deaths admissions and 70%ofaff Contra Costa County vs.State of Califamtk 1993-1557 drug-related deaths involve Percentage of Deaths Involving Alcohol or drugs by Year prescription drugs. to 50.00 c 45.00 40.00 .. . FACT: The United States has 35')0 the world's highest incarceration 30.00 rate;the majority are imprisoned � 00County for drug crimes. t-state i z0.0a 0 15.00 1000 THINGS YOU CAN DO: 5'00 • Citizens and community a 0.00 groups have joined with 1993 1904 1095 1996 1997 police to eliminate drug There Is currently no acceptable source for AOD-related deaths data. markets. For example,lack of adequate lighting contributes to the presence of drug markets. In many communities,the police If the data were available, this chart would show the number of deaths and residents have among juveniles for which alcohol and/or drug use was a contributing factor. recurred the assistance of Numbers would be provided for each region for each year during the period local utilities to improve from 1993 to 1997. Comparisons could be made of the relative proportion of lighting and make needed such deaths from one region and year to another. repairs on existing lighting. Juvenile Alcohol and Drug Involved Deaths Contra Costa County TECHNICAL NOTES: 1993-1997 by Year Currently there are only two + sources for AOD-related W% death data. One Is the coroner's office--which so% reports only In cases of colt suspicious deaths or deaths which occurr while not under a aou ■west the care of a physician. asole ®Acalanes Furthermore,the coroner 40" t6sauth may or may not report on the presence of drugs or 6 '051 E3 Central alcohol if they were not the .4 2ft mEast primary cause of death. The a second is data gathered by t01` the state from death certificates. This data is 1993 1994 1995 1006 1997 similarly incomplete because the presence of drugs or There Is currently no acceptable source for A00-related deaths data. alcohol is not always reported If it was not the direct cause of death. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 14:AOD Use Among high School Students Indicator 14: AOD Use Among High Schaal Students If the data.were available, this chart would compare the proportions of all high school students who say they used alcohol and/or drugs In Contra Costa V used to come to school County during the period from 1993-1997 with the same proportions of stoned a#thetrme. Td even alcohol and/or drug users in the State of California. AN asleep lndin,but the teachers neverknew l'was high." Alcohol and Drug Use Among High School Students Contra Costa County vs.State of California,1993-1997 Percentage of Students who Are AOD Users by Year 50.00 C „ 45.00 0 40.00FACT: In 1996,among 10th graders in the United States, a 35'°0 marijuana use in the past year 30.0 was more than 6 times as high e 25.00 -+-County as it was in 1992(it increased d -n-state from 5%to 34%). B 20.00 N 0 15.00 -Monitoring the Future g C 10.00 C 0 L 5.o0 m a 0.00 1993 1994 1995 loges 1997 THINGS YOU CAN DO: Currently,there Is no comprehensive and consistent source for data about drug and alcohol use among + Work with the Office of high school students. Education and the Substance Abuse Advisory There is no data presently available for this indicator. If there were data, Board representative in this chart would show the number of high school students who say they use your region to see that a alcohol and/or drugs. Numbers would be provided for each region for each student drug use survey is year during the period from 1993 to 1997. Comparisons could be made of implemented in your local the relative proportion of alcohol/drug users from one region and year to schor and senior high another. schools. Drug and Alcohol Use Among High School Students Contra Costa County 1993-1997 by Year 100% L W% 70% L" N W% ■west o W% 13Acalanes `o 40% Clsouth Y 1 30%!1 CICentral 20X, m East d a imc 0% 1993 1994 1995 1998 1997 Currently,there is no comprehensive and consistent source for data about drug and alcohol use among high school students. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1993 Juvenile Alcohol and Drug Impact Index Indicator 16:Juveniles In Substance Abuse Treatment Indicator 15: Juveniles in Substance Abuse Treatment This chart shows the number of juveniles aged 10 to 17 years in treatment "Authoritiesshouldn'the per 10,000 juveniles aged 10 to 17 In Contra Costa County and the State of agoutdiugs. Theyshouldn't California. Comparisons can be made between the county and the state for sayitsnotfun,because most the five-year period from 1993 to 1997. kids that dodrugsthh2kitis fun. Ifyou tell them it isn't, they won't believe anything Juveniles in Substance Abuse Treatment Programs by Year else you tell them—like how Contra Costa County vs.State of California,1993-1997 doing drugs can wreck your Per 10,000 Persons Aged 10-17 Yrs. life,addict you,etc." C40•00Substance Abuse Counselor. 37.50 0 35.00 n 32.80 30,E FACT: Publicly funded AOD 27.50 services for youth are being v 25.00 under-utilized in Contra Costa 20.80 +county County 20.00 -0-state +-v 17.50 moo ----- 12,50- 10.00. ., 7.80 S 5.00 2.50 E o.00 Z 1993 1994 1995 19% 1997 THINGS YOU CAN ISO: Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data derived from the state CADDS(California Alcohol and Drug Data System)forms. Set a goad example. Contra Costa County and State of California population data from the California Department of Finance. Though you may not realize it,younger kids look to older kids for guidance. If you use drugs to cope with problems,to make you feel like part of What to look for in your teenager's behavior that could indicate the group,etc.,they may problems with drug abuse: too. • Sudden, unexplained changes in mood and behavior. • Loss of interest in regular activities, such as hobbies and TECHNICAL NOTES: sports. • Significant drop in grades. Data for the Thunder Road • Withdrawal from family. Alam� which i Alameda County treadn treats m Contra Costa • Sudden sloppiness in appearance. county, is veniles fmss ng for 1997. • Overreaction to criticism. Otherwise, this indicator Includes data reported to the • Sudden weight loss. State Department of Alcohol and Drug Programs for all. • Unusual secretiveness. Contra Costa County Juveniles who received • Decreased energyand drive.. substance abuse treatment • Slurred speed, unclear thinking, poor short-term memory. either in Contra Costa County or at Thunder Road. For juveniles who have received treatment more than once, data is included only for their most recent episode. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Indere Indicator 15;Juveniles In Substance Abuse Treatment Indicator 15: Juveniles in Substance Abuse Treatment Age at Admission "Idrankmy&st beer when I This chart shows the age at admission for juvenile clients of treatment was 9,smoked mytustjoint programs in Contra Costa County during the period from 1993 to 1997. when rwas u. Ihnowno The proportion of clients at each age range can be compared from region other way to ha ve a good time to region and year to year. than by using&-ugs" Juveniles In Substance Abuse Treatment Programs by Year Contra Costa County,1993-1997 Age at Admission 100% Y Sox FACT: In 1997,youth made 13 up only about 1 percent of 70%--- X Contra Costa's total treatment 60%-- ...... ::: clients. Although the v 50x — .',Si::. ..... ■<id yrs percentage has risen slightly, Y 48 .•39.:: _.. '••?g•'• ©14 yrs Contra Costa County still has anx a 15 yrs the lowest percentage of youths 30%-- ©1e yrs in treatment when compared to 0 20%--- a g1 37 31 27 U 17 yrs other large California counties. 10% a 0% 1993 1994 1995 loge 1997 THINGS YOU CAN DO: Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data • Tfou know someone who derived from the state CADDS(California Alcohol and Drug Data System)forms. y is having a problem with alcohol and/or drugs,call 925-555-1379 to get them Age of First Drug Use , help. This chart shows the age of first drug use for juvenile clients of treatment programs in Contra Costa County during the period from 1993 to 1997. The proportion of clients at each level of first-drug-use age can be compared from region to region and year to year. Juveniles In Substance Abuse Treatment Programs by Year Contra Costa County,1993-1997 Age of First Use i 00% 90% 7 80% � 70 _ 'I t ......�..•� tia5, , S a0% 132 7 - 1 50% 2 ■<12 yrs 40% M 12-13 yrs -a 30% 5 7 014-15 yrs `0 20% a 1318-17 yrs 1� 10% Ox 1993 1994 1995 1998 1997 Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data derived from the state CADDS(California Alcohol and Drug Data System)forms. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Indicator 15:Juveniles In Substance Abuse Treatment Indicator 15: Juveniles in Substance Abuse Treatment fender "Kids use drugs fora lot of This chart shows the gender distribution of juvenile clients of treatment reasons; Saesr,boredom, programs In Contra Costa County for the period from 1993 to 1997. The trying tonin,to lose weight, proportion of males and females In treatment can be compared from region tofeel cool,to not feel, to region and year to year. wanting to die." Juveniles In Substance Abuse Treatment Programs by Year Substance Abuse Counselor. Contra Costa County,1993-1997 Gender 100% Sox FACT": Four out of five youth 8°x in treatment in Contra Costa 70x , , County reported using their .9 aox ' drug of choice at 14 years of 11 « age or younger.. C Sax ■Male 40% 3 Sox }° r 0 z0x •�i�7'^ �i1`s.'^ `g THINGS YOU CAN I7O ;, 10x �` to help a friend who's using 0. p drugs: 1993 1994 1995 1998 1997 a Share what you know. Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data Your friend may not have derived from the state CARDS(California Alcohol and Drug Data System)forms. accurate information about drugs and the consequences of drug use. Be a good Sources of Referral to Treatment express feeelill listener. your friend ngs and tell you about problems. Urge your This chart shows the sources of referral to treatment for juvenile clients of friend to get help. treatment programs in Contra Costa County during the period from 1993 to Encourage your friend to 1997. The proportion of clients at referred by each source can be compared discuss problems with his from region to region and year to year. or her parent. Juveniles In Substance Abuse Treatment Programs by Year Contra Costa County,1993-1997 Referral Source 100% 1: Sox a0% w lox Sox ■9alf Sox _ MCOurts 82 P �� ®School 14 Mono wnity aax VHeatth Care :::23:�: 00ihar 10%d :{1•:•: :•.17. .'.. is 4 0x 1993 1994 1995 1998 1997 Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data derived from the state CADDS(California Alcohol and Drug Data System)forms. Produced by Contra Costa Co. Community Substance Abuse Services Division and Substance Abuse Advisory Board • Department of Education Division of Public Health Policy 600 Independence Avenue, S.W. 200 Independence Avenue, S.W. Portals Building Hubert H. Humphrey Building, Washington, DC 20202-6123 Room 442E (800) 872-5327 Washington, DC 20201 (202) 401-2000 (202) 690-6870 http://www.ed.gov Department of Labor • Office of Elementary and 200 Constitution Avenue, N.W., Secondary Education Doom S•-1032 Safe and Drug Free Schools Washington, DC 20210-0002 600 Independence Avenue, S.W. (202) 219-8211 Portals Building http://wwvv.dol.gov Washington, DC 20202-6123 • Womens Bureau Clearinghouse (202) 260-3954 200 Constitution Avenue, N.W.., • Even Start Family Literacy Room S3306 Program Washington, DC 20210-0002 600 Independence Avenue, S.W. (800) 827-5335 Portals Building Work and Family Clearinghouse Washington, DC 20202 200 Constitution Avenue, N.W., (202) 260-2777 Room.3317 • Department of Health and Human Washington, DC 20210-0002 Services (202) 219-4486 Office of the Assistant Secretary for Housing and Urban Development Planning and Evaluation 200 Independence Avenue, S.W. 451 7th Street, S.W. Washington, DC 20410 Hubert H. Humphrey Building, Room 415E {202} 708-1420 Washington, DC 20201 http://www.hud.gov (202) 690-7858 Community Connections http://www.hhs.gov Information Center • Division of Children and Youth Office of Community Planning and Policy Development 200 Independence Avenue, S.W. PO. Box 7189 Hubert H. Humphrey Building, Gaithersburg, MD 20898-7189 Room 450G (800) 998-9999 Washington, DC 20201 (202) 690-6461 Preventing Substance Abuse Among Children and Adolescents 65 _eo , • University Partnership Juvenile Justice Clearinghouse Clearinghouse PO. Box 6000 HUD USER Rockville, MD 20850 P.9. Box 6091 (800) 638-8736 Rockville, MD 20849 http://ncjrs.aspensys.corn (800) 245-2691 Indian Health Service Nongovernmental Organizations • Division of Clinical/Preventive American Association for Marriage Services and Family'Therapy 5600 Fishers Lane, Room 6A-55 Research and Education Foundation Rockville, MD 20857 1133 15th Street, N.W., Suite 300 (301) 443-4644 Washington, DC 20005 http://www.ihs.gov (202) 452-0109 http://www.aamft.org • Maternal and Chile!Health Bureau Health Resources and Services American Public Welfare Association Administration 810 First Street, N.E., Suite 500 5600 Fishers Lane, Room 18-20 Washington, DC 200024267 Rockville, MD 20857 (202) 682-0100 (301) 443-0205 http://www.hrsa.dhhs.gov Center for Family Life in Sunset Park 345 43rd Street • Division of Healthy Start Brooklyn, NY 11232 5600 Fishers Lane, Room 11A-13 (718) 788-3500 Rockville, MD 20857 (301) 443-0509 Children's Defense Fund 25 E Street, N.Wil. • Division of Services for Children Washington, DC 20001 With Special Health Needs (202) 628-8330 5600 Fishers Lane, Room 18A-27 (202) 628-8787 Rockville, MD 20857 http://www.childrensdefense.org (301) 443-2350 The Children's ,Foundation • Division of Maternal, infant, Child and Adolescent Health 725 15th Street, N.W., Suite 505 5600 Fishers Lane, Room 18A-30 Washington, DC 20005 (202) 347-3300 Rockville, MD 20857 (301) 443-2250 Child Welfare League of America 440 First Street, N.W., Suite 310 Washington, DC 20001-2085 (202) 638-2952 http://www.cwla.org ed A Practitioner's Guide Family Resource Coalition National Center for the Early 200 South Michigan Avenue, 16th Childhood Work Force Floor 733 15th Street, N.W., Suite'800 Chicago, IL 60604 Washington, DC 20005 (312) 341-0900 (202) 737-7700 The C. Henry Kempe National National Child Care Information Center for the Prevention and Center Treatment of Child Abuse and 301 Maple Avenue West, Suite 602 Neglect Vienna,VA 22180 1205 Oneida Street ($00) 616-2242 Denver, CO 80220 Fax 1 (800) 716-2242 (303) 321-3963 htrp://ericps.ed.uiuc.edu/nccic httpr//wwwkempecenter. org National Head Start Association National Association of Child Care 1651 Prince Street Resource and Referral Agencies 1319 F Street, N.W., Suite 810 Alexandria, VA 22314 Washington, DC 20004-1106 (703) 739-0875 (202) 393-5501 http://www.nhsa.org National Black Child Development National Indian Child Care Institute Association 1023 Fifteenth Street, N.W., 279 East 137th Street Suite 600 Glenpool, OK 74033 Washington, DC 20005 (918) 756-2112 (202) 387-1281 National Indian Child Welfare http;//www.nbcdi.org Association National Center for Children in 3611 SW Hood St., Suite 201 Poverty Portland, OR 97201 Columbia University School of Public (503) 222-4044 Health Columbia University National Information Center for 154 Haven Avenue Children,and Youth with Disabilities New York, NY 10032 PO. Box 1492 (212) 927-8793 Washington, DC 20013-1492 (212) 304-7100 (800) .695-0285 http://cpmcnet.columbia.edu/deptl http://www.nichcy.org nccp Preventing Substance Abuse Among Children and Adolescents 67 .................................. National Information Clearinghouse Zero To Three: National Center for for Infants With Disabilities and Infants, Toddlers, and Families Life-Threatening Conditions 734 15th Street, N.W., Tenth Floor University of South Carolina Washington, DC 20005-2101 Benson Building, First Floor (202) 638-1144 Columbia, SC 29208 (800) 899-4301 (publications) (800) 922-9234 htrp://www.zerotothree.org (803) 777-4435 Foundations National Maternal and Child Health Clearinghouse The following are illustrative of private 8201 Greensboro Drive, Suite 600 foundations that provide grants for set- McLean, VA 22102-3843 vices and research regarding family- (703) 821-8955 centered interventions. Grantmaker or- ganizations such as The Foundation National Parent Information Network Center can provide information on the ERIC Clearinghouse on Elementary wide array of private foundations, and Early Childhood Education corporate grantmakers, grantmaking University of Illinois at public charities, and community foun- Urbana-Champaign dations. Children's Research Center 51 Gerry Drive The Carnegie Corporation of New Champaign, IL 61820-7469 York (217) 333-1386 437 Madison Avenue New York, NY 10022 http:/lwww.uiuc.edu (212) 371-3200 National Resource Center on Child hrtp://www.carnegic.org Abuse and Neglect 63 Inverness Drive East The Annie E. Casey Foundation Englewood, CO 80112-5117 701 St. Paul Street (800) 227-5242 Baltimore, MD 21202 (410) 546-6600 National Youth Center Network http://www.aecf.org 254 College Street, Suite 501 The Foundation Center New Haven, CT 06510 (203) 773-0770 79 Fifth Avenue/16th Street hrtp://www.nycn.org New York, NY 10003-3076 (2 12) 620-4230 http://fdncenter.org 68 A Practitioner's Guide The Ford Foundation The David.and Lucile Packard 320 East 43rd Street Foundation New York, NY 10017 300 Second Street, Suite 200 (212) 573-5000 Los Altos, CA 94022 http://www.fordfound.org (415) 948-7658 http://www.packfound.org The William Randolph Hearst Foundations The Pew Charitable Trusts 888 Seventh Avenue, 2005 Market Street, Suite 1700 45th Floor Philadelphia, PA 19103 New York, NY 10106-0057 (215) 575-9050 (212) 584-5404 http://ww`v.pcwtrusts.com The Robert Wood Johnson Foundation Route 1 and College Road East RO. Box 2316 Princeton, NJ 08543-2316 (609) 452-8701 http://www.rwjf.org The Henry J. Kaiser Family Foundation 2400 Sand Hill Road Menlo Park, CA 94025 (415) 854-9400 http://www kff.org The WX Kellogg Foundation One Michigan Avenue East Battle Creek, MI 490174058 (616) 968-1611 http://www.wkkforg The John D. and Catherine T MacArthur Foundation 140 S. Dearborn Street, Suite 1100 Chicago, IL 60603-5285 (312) 727-8000 http://www. macfdn.org Preventing Substance Abuse Among Children and Adolescents 69 ....._. ......... ......... ......... ......... ............ _ _....._ ......... ......... ......... ......... ......... ....._... ._._....... .._....._.. ..........._............ .... .. .. .... .... .... ..._..._. _... CONTRA COSTA HEALTH SERVICES COMMUNITY SUBSTANCE ABUSE SERVICES Fiscal Year 1998-1999 Treatment and Prevention Service Maps April 1999 Cx S11b r Service"� Purpose The Community Substance Abuse Service Maps depict Fiscal Year 1998- 1999 community, school and clinic based prevention and treatment services displayed within each Supervisorial District. Two other documents are included with the service maps (1) a description of the Community Substance Abuse Services Youth and Family Continuum of Care and (2) the California Department of Alcohol and Drug Programs County Proffle of AOD Risk and Need Indicators for Contra Costa County. Distribution of these materials is intended to raise awareness about publicly funded alcohol and drug abuse services in Contra Costa as well as to promote collaborative planning and establishment of "best practices" among systems and community "stakeholders" impacted or concerned about alcohol and drug abuse problems. Goal 1: Promote Collaboration Across Systems Serving Youth Findings from "Study of Youth Access and Utilization of Alcohol and Drug Treatment Services in Contra Costa County"', a joint project of the Contra Costa County Substance Abuse Advisory Board (SAAB) and the Community Substance Abuse Services (CSAS) Administration, show that youth that are using or abusing alcohol and other drugs (AOD) are not being identified in sufficient numbers, that once identified, youth are not referred to ACID treatment in adequate numbers, and once referred, youth are not entering AOD treatment in adequate numbers. The study interviews with Probation, School, Social Service, Mental Health, Law Enforcement and AOD Providers suggest that one of the most serious barriers to youth access and utilization nation of AOD treatment services is that each system involved with youth tends to perceive the nature of AOD problems differently, and as a result, each system tends to develop and implement its own solutions to these problems in isolation. Thus, the need for collaboration to ensure standardized tools for early identification, appropriate referrals and measurement of outcomes across systems involved in serving youth that use or abuse alcohol and other drugs. Goal 2: Promote "Principles of Effectiveness" and "Best Practices" Among Systems Serving Youth Identified as Using or Abusing Alcohol and Other Drugs. The "Study of Youth Access and Utilization of Alcohol and Drug Treatment Services in Contra Costa County" findings and recommendations go hand 1 Copies of the study available per request. C:\Amalia'sDocuments\Amalia\maps\svcmaps.doc 1 in hand with Federal and State funding requirements articulated in terms of "Principles of Effectiveness" and "Best Practices". These guidelines emphasize cost-effective, research-based treatment and prevention programs, establishment of performance standards, and outcome evaluations. Compliance requires the following: (1) programs based on need/risk assessment about drug and alcohol problems in the communities intended to be served; (2) assistance of local and regional advisory groups, to prioritize results of the assessments to ensure that the identified needs are culturally sensitive of the community intended to be served; (3) establishment of a set of measurable goals and objectives for each program, as well as a design of the activities proposed by the program to meet goals and objectives that are based on needs identified in the assessment process; (4) program design and implementation based on research or evaluation that provides evidence to support the strategies used to prevent or reduce alcohol and drug use in a culturally relevant manner; (5) ongoing program evaluation to assess program progress toward achieving its goals and objectives as well as use of evaluation findings to refine, improve and strengthen services. CSAS FY 98-99 Service Maps Information is organized into three sets of maps: [1] Treatment and Prevention Providers, [2] School-Based and [3] Community-Based Prevention. Each set of maps is overlayed on census data that shows (a) Percentage of Children in the Population, (b) Percentage of Children Living At or Below the Poverty Level, and (c) Median Household Income by Region. The colored areas of the maps show variations in areas of the county by percentage of children living in the area, percentage of children living in poverty and median household income. It is useful to compare maps depicting where percentage of children in the population is high (lavender areas] with maps that show areas of the county where highest percentage of children in the population live at or below the poverty level [once again lavender areas]. The comparison suggests a greater need for prevention services in areas where the number of children in the population is higher as well as well the need for a more comprehensive approach to indicated prevention services where high concentration of children live at or below the poverty line. The areas with lower median household incomes are colored pink and the areas with high household incomes are colored lavender, once again suggesting the need for approaches to AOD services that are C:\Amalia'sDocuments\Amalia\maps\svcmaps.doo 2 a /V appropriate to populations with higher or lower levels of income, where corresponding levels of education, percentage of population unemployed and underemployed, percentage of families that have health care insurance coverage, etc. are good indicators of the different need/risk factors in each area of the county. [1] Treatment and Prevention Providers CSAS county-operated and contract providers are identified by name, address, and service area. Data shows the type of service (modality) offered by each program and the type of persons served (special populations). Red circles show prevention services that serve youth and blue circles, treatment services that serge youth. Red triangles indicate prevention services that serve adults and blue triangles, treatment services that serve adults. A red square is used to show prevention services that target both adults and youth and yellow squares are used to show programs that provide both prevention and treatment services that serve adults and youth. [2] School-Based Prevention CSAS school-based prevention, publicly funded substance abuse services which are free of charge for all Contra Costa County residents, depict FY 98-99 service projections by school and by either (1) West and Central or (2) Central and Bast areas of the county. The spread of services as well as the gaps depicted in these maps suggest (a) the need for collaborative planning between CSAS System of Care youth providers and school districts that are federally funded by Safe and Drug Free Schools and Communities Block Grant to provide alcohol, tobacco and other drug prevention services, and (b) the lack of or limited objective processes used to identify need/risk assessment about drug and alcohol problems in the schools intended to be served that have taken into consideration assistance of local and regional advisory groups, to prioritize needs that can ensure culturally competent services appropriately matched to schools that serve Contra Costa County's diverse socioeconomic and multiethnic student populations. Red circles are used to show 132 schools that have no CSAS prevention services. Blue triangles are used to show (52) schools where one CSAS provider delivers General or Universale prevention services. Blue squares are used to show (1 d) schools where one CSAS provider delivers High Risk or Indicated 3prevention services. In the same fashion, yellow triangles Z General or Universal Prevention in CSAS Youth and Family Continuum, page 6. April 1999 3 High Risk or Indicated Prevention ibid. page 8 Ca\Amalia'sDocuments\Amalia\maps\svcmaps.doc 3 w show (9) schools where two CSAS providers deliver General/Universal prevention services and yellow squares show (1) school where two CSAS providers deliver High Risk/Indicated prevention services. The yellow pentagons show (6) schools where two CSAS providers deliver both types of service, General/Universal and High Risk/Indicated prevention. The green pentagons show (12) schools where three or more CSAS providers deliver both types of service, General/Universal and High Risk/Indicated prevention. School-based prevention maps include tables of Contra Costa County (18) school districts with each school identified by naive and address, type of school e.g., elementary, middle, junior, high, continuation, and total number of students enrolled in each school as per Contra Costa County Office of Education 1997 Public Schools Directory. Another table shows the number of students in each school projected to be served by a CSAS provider during FY 98-99. The data is displayed by provider name, type of prevention service, number of students projected to be served in each school, and the percentage of students from each school total student population projected to be served by CSAS providers. For explanation of abbreviations used in tables, see bottom of page 16. The table also shows the number of students in each district projected to be served by a CSAS provider, the percentage of the student population in each district projected to be served by a CSAS provider, and the number and percentage of total student population projected to be served by CSAS providers. Table totals also show the number of students projected to be served in each district and the percentage of the total student population in the district that corresponds to the projection of students served by CSAS school-based prevention services. [3] Community-Based Prevention The maps show community sites that correspond to the list of coalitions/task forces/initiatives projected to be served by CSAS providers during FY 98-99. The list shows coalition names, service area, provider name, organization that sponsors or staffs the coalition, and organization address. In some locations, multiple agencies offer services from within the same building, thus, overlapping community site markers have been moved to mare them visible. The community sites are displayed in county maps that show [1) Percentage of Children in the Population, [2] Percentage of Children Diving At or Below the Poverty Dine, and [3) Median Household Income by City Overlay. For the last two years, in an effort to promote collaboration between systems that serve youth that use or abuse alcohol and drugs as well as "stakeholders" impacted or concerned with substance abuse problems in C:\Amalia'sDocuments\Amalia\maps\svcmaps.doc 4 their communities, CSAS has required prevention providers to allocate a percentage of their budget to community-based strategies4, in particular those that provide school-based services. CSAS expected results were: (a) to increase awareness of the ACID problem and resources among coalitions where CSAS prevention providers are members; (b) to increase the number of collaborative initiatives among systems that serve youth that use or abuse alcohol and drugs where CSAS providers are involved; [c] to increase system-wide strategic planning processes to ensure compliance with Principles of an s equitable allocation of resources that is based on need/risk assess" and performance outcomes; (d) to increase support for community driven sity of efforts to curb youth access to alcohol,outlets licensings regulations,alcohol promoteincrease compliance of alcohol responsible retail practices among alcohol merchantsS. Expected results so far, are extremely limited in spite of the fact that CSAS providers projected community-based services for FY 98-99 included allocation of prevention funding to almost 60 staff persons and staff participation in 85 different community and school coalitions, task forces, and advisory boards. At the same time, CSAS systems approach to map youth services is the first step of a results-based planning and evaluation process for FY 1999-2000. Ideally, othr you strat�es tosystems servouth that use or to be able to develop a comprehensiv abuse alcohol and drugs. Abww k `SaWIM COMMIliln 597. �x ;ilna�c,'C X553 . ►iae: 19,25)"3; " 3t )"313=639t} .: • clelvallhsd co contra-costa.ca.us 4 community-Based Process Strategy in CSAS Youth and Family continuum of Care page 5 April 1995 Mail Alcohol outlets Maps Presentations available upon request. C:\Amalia'soocuments\Amalia\maps\svcmaps.doc 5 CO w w ., U w co in0) W CO co CL o LL ' • k t F}: :•i«•,v+.M>::moi:. 0 a. 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UlIAr U Cr y a C C U ar b a) N !moi if {.7UUI'aJ CO O�r.� CA � �'Q �i>I5 ; a iw Ir.+,C 'C','C b CA ar N >1 S 0 000 0 d .t0 c�c tTS V t' 2' 00 � � tyr �;CL w tQaarro � 'i- , Cn ti CJOm > `,� `.rUUtc �. c I E E b b b ar nr Co v E f'C' co: CL! ! i) G CL CL'',to,Z) aI p� 0 0 O° j dr a) a);a)Q b O C�11� Ise '. ar a a I ar d (L D Id-) 14 1 4,) U) 65 ' i I a) b a)) j 1S Sim N E E E C H V V V 0 J, a) ar N 0` Z i CIC C b tL 1 t coo EI Ic E ar dd ca,ca ca ft;a a, zoU) 5:» i� ci'c� 0 ell 9 1999 Juvenile Alcohol and Drug Impact Index Indicator 15:Juveniles In Substance Abuse'Treatment Indicator 15: Juveniles in Substance Abuse Treatment Legal Status at Admission "Somebody should tell parents This chart shows the legal status at admission for juvenile clients of about the kinds ofhelp treatment programs in Contra Costa County during the period from 1993 to available to them iftheirldds 1997. The proportion of clients at each status can be compared from region are using drugs andlor to region and year to year. alcohol—even ifthey dont have money." Juveniles in Substance Abuse Treatment Programs by Year Parent of teen in treatment. Contra Costa County,1993-1997 Legal Status 100% 90 41 %$°K FACT: Marijuana,alcohol and € 1 i 131 methamphetamines were the 70% 1 three drugs reported as the s 60% "drug of choice"among youth >ti� 50% ■NtA in treatment in the county. 40K ��.'� ®Probation 30% x ®Incarcerated 20% 5�;,; .100" ©Other Id 10% CL • •..11.•. 14:•: :.. :.a;.•: OK 1993 1994 1995 1996 1997 THINGS YOU CAN DO: Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data . Encourage your teenagers derived from the state CADDS(California Alcohol and Drug Data System)forms. to participate in the "Friday Nite Life"or "Club Life"activities at Treatment Completion Status at Discharge school. This chart shows the discharge status for juvenile clients of treatment programs in Contra Costa County during the period from 1993 to 1997. The proportion of clients at each status can be compared from region to region and year to year. Juveniles in Substance Abuse Treatment Programs by Year Contra Costa County,1993-1997 Discharge Status 100% c 9oK 90% 70% C 60% — ~ m 50K — ■ICompieted oy 40 �,j w ° ®Satisfactory ro x '�f2f- -74. F 30K 117,; ta} ®unsatisfactory 20%-- n DReferral 1oK ;t x CL :•22:•: .•.18.. '•15:•: •:12}: oK 1993 1994 1995 1996 1997 Substance abuse treatment program data from the California Department of Alcohol and Drug Programs(data derived from the state CADDS(California Alcohol and Drug Data System)forms. Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board APPENDICES 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Fables for Indicator Charts Indicator 1: Taxable Sales at Off-Sale Retail Alcohol Outlets; First Page, Top Chart Average Taxable Sales Per Retail Alcohol Outlet Contra Costa County vs. State of California, 1993-1997 County State 1993 433.05 327.90 1994 415.67 318.96 1995 459.45 327.47 1996 504.01 341.42 1997 551.85 357.26 Figures represent average sales in Dollars per outlet. Data Source(s): Taxable sales data from the California Board of Equalization Indicator 1: Taxable Sales at Off-Sale Retail Alcohol Outlets; First Page, Bottom Chart Average Taxable Sales Per Retail Alcohol Outlet Contra Costa County, 1993-1997 West Acalanes South Central East 1993 368 288 516 398 304 1994 312 305 516 379 322 1995 322 322 330 469 293 1996 336 333 558 525 241 1997 310 343 486 576 300 Figures represent average sales in Dollars per outlet by year. Data Source(s): Taxable sales data from the California Board of Equalization Indicator 1: Taxable Sales at Off-Sale Retail Alcohol Outlets; Second Page Taxable Sales for Retail Alcohol Outlets by Year Contra Costa County vs. State of California Per Capita Comparison County State 1993 67.71 81.97 1994 62.96 78.44 1995 65.34 78.64 , 1996 70.86 79.57 1997 70.84 79.94 Figures represent average sales in Dollars per individual 21 or older. Data Source(s): Taxable sales data from the California Board of Equalization Population data from the California Department of Finance Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts r Indicator 2: Retail Alcohol Outlets Retail Alcohol Outlets as of October, 1998 On-Sale Off-Sale Total West 158 149 307 Acalanes 168 91 259 South 290 100 390 Central 221 115 336 East 180 144 324 Unincorp. 12 3 15 Figures represent number of retail alcohol outlets by sales type. Data Source(s): Retail outlet license data from the California Alcoholic Beverage Control Indicator 3: Sales-to-Minor Violations Sales to Minor Violations for Retail Alcohol Outlets Contra Costa County, 1995-1998 West Acalanes South Central East Total 1995 2 0 0 9 14 25 1996 16 0 3 6 9 34 1997 13 8 2 8 17 48 1998 18 9 10 4 25 66 Figures represent the percentage of total sales-to-minor violations by year. Data Source(s): Sales-to-minor violations data from the California Alcoholic Beverage Control Indicator 4: Juvenile Drug Arrests; Top Chart Juvenile Drug Arrests Contra Costa County vs. State of California, 1993-1997 Per 10,000 Persons Aged 10-17 Yrs. State County 1993 53.55 43.08 1994 67.65 56.94 1995 68.88 54.76 1996 69.83 46.40 1997 72.58 57.28 Figures represent the number of arrests per 10,000 persons aged 10-17 yrs. Data Source(s): Juvenile drug arrest data from the California Department of Justice, CJSC Population data from the California Department of Finance Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board .............. 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 4: 3uvenile Drug Arrests; Bottom Chart Juvenile Drug Arrests Contra Costa County, 1993-1997 West Acalanes South Central East Unineorp. Total 1993 101 45 47 78 109 9 389 1994 122 72 62 94 162 15 527 1995 95 48 91 130 140 13 517 1996 82 44 50 103 146 24 449 1997 92 77 60 121 166 54 570 Figures represent the percentage of total drug arrests by year. Data Source(s): Juvenile drug arrest data from the California Department of Justice, CJSC Indicator 5: Juvenile Alcohol Arrests; Top Chart Juvenile Alcohol Arrests Contra Costa County vs. State of California, 1993-1997 Per 10,000 Persons Aged 10-17 Yrs. State County 1993 22.77 20.16 1994 23.13 28.20 1995 27.47 38.66 1996 33.54 35.45 1997 29.52 32.16 Figures represent the number of arrests per 10,000 persons aged 10-17 yrs. Data Source(s): Juvenile alcohol arrest data from the California Department of Justice, CJSC Population data from the California Department of Finance Indicator 5: Juvenile Alcohol Arrests; Bottom Chart Juvenile Alcohol Arrests Contra Costa County, 1993-1997 West. Acalanes South Central East Unincorp. Total 1993 10 37 43 37 52 3 182 1994 9 70 52 61 63 6 261 1995 12 138 68 62 78 7 365 1996 24 74 80 98 66 1 343 1997 32 67 27 122 58 14 320 Figures represent the percentage of total alcohol arrests by year. Data Source(s): Juvenile alcohol arrest data from the California Department of Justice, CISC Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board AV 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 6: 3uvenile DUI Arrests; Top Chart Juvenile DUI Arrests Contra Costa County vs. State of California, 1993-1997 Per 10,000 Persons Aged 10-17 Yrs. State County 1993 5.05 7.64 1994 5.20 7.24 1995 4.76 4.66 1996 5.10 4.44 1997 4.67 4.82 Figures represent the number of arrests per 10,000 persons aged 10-17 yrs. Data Source(s): Juvenile DUI arrest data from the California Department of Justice, CJSC Population data from the California Department of Finance Indicator 6: Juvenile DUI Arrests; Bottom Chart Juvenile DUI Arrests Contra Costa County, 1993-1997 West Acalanes South Central East Unincorp. Total 1993 6 5 4 7 6 20 48 1994 4 . 5 6 5 5 18 43 1995 5 6 2 5 9 17 44 1996 4 13 13 12 10 15 67 1997 5 8 12 14 7 23 69 Figures represent the percentage of total DUI arrests by year. Data Source(s): Juvenile DUI arrest data from the California Department of Justice, CJSC Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A. Data Tables for Indicator Charts Indicator 7: Teen Drivers in Alcohol Involved Collisions; Top Chart Alcohol Involved Motor Vehicle Collisions Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County vs. State of California, 1993-1997 Number of Collisions As a Percentage of All Collisions Involving Drivers Under 18 Yrs of Age State County_ 1993 2.90 2.70 1994 2.80 2.10 ].995 2.70 2.80 1996 2.30 2.90 1997 2.50 3.70 Figures represent the Percentage of All Collisions Involving Drivers < 18 Yrs of Age Data Source(s): Collision data from the California Highway Patrol Indicator 7: Teen Drinkers in Alcohol Involved Collisions; Bottom Chart Alcohol Involved Motor Vehicle Collisions Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County by Region, 1993-1997 Number of Collisions As a Percentage of All Collisions Involving Drivers Under 18 Yrs of Age West Acalanes South Central East Unincorp. 1993 4.94 3.18 1.73 1.91 2.80 2.64 1994 3.49 1.01 2.63 0.74 3.23 2.21 1995 5.14 2.90 0.46 1.31 2.34 5.24 1996 2.37 2.22 2.15 1.48 4.55 4.75 1997 2.34 5.37 2.35 2.02 4.92 6.44 Figures represent the Percentage of All Collisions Involving Drivers < 18 Yrs of Age Data Source(s): Collision data from the California Highway Patrol Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A:Data Tables for Indicator Charts Indicator 8: Victims of Teenage Drunk Drivers; Top Chart Alcohol Involved Motor Vehicle Collisions Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County vs. State of California, 1993-1997 Number of Persons Killed or Injured Per 100,000 Persons State County 1993 5.46 3.76 1994 5.07 3.72 1995 4.98 2.77 1996 5.22 4.33 1997 4.72 5.13 Figures represent the Number of Killed or Injured Per 100,000 Persons Data Source(s): Collision data from the California Highway Patrol Population data from the California Department of Finance Indicator 8: Victims of Teenage Drunk Drivers; Bottom Chart Alcohol Involved Motor Vehicle Collisions Involving Had Been Drinking Drivers Under 18 Yrs of Age Contra Costa County by Region, 1993-1997 Number of Persons Killed or Injured West Acaianes South Central Fast Unincorp. Total 1993 7 4 3 4 8 6 32 1994 6 3 5 2 6 10 32 1995 4 0 1 4 5 10 24 1996 3 0 9 3 6 17 38 1997 8 6 5 5 10 12 46 Figures represent the Number of Persons Killed or Injured Data Source(s): Collision data from the California Highway Patrol Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 9: Teen Victims of Alcohol Involved Collisions; Top Chart Alcohol Involved Motor Vehicle Collisions Contra Costa County vs. State of California, 1993-1997 Number of Persons Under 18 Killed or Injured Per 10,000 Persons Under 18 State County 1993 5.71 11.20 1994 S:04 9.05 1995 4.85 11.18 1996 4.62 12.80 1997 3.80 10.35 Figures represent the Number of Killed or Injured Per 10,000 Persons Under 18 Data Source(s): .Collision data from the California Highway Patrol Population data from the California Department of Finance Indicator 9: Teen Victims of Alcohol Involved Collisions; Bottom Chart Alcohol Involved Motor Vehicle Collisions Contra Costa County by Region, 1993-1997 Number of Persons Under 18 Killed or Injured West Acalanes South Central East Unincorp. Total 1993 63 14 21 28 34 85 245 1994 33 17 14 22 32 83 201 1995 51 9 33 40 36 82 251 1996 64 24 33 52 39 79 291 1997 43 24 30 41 29 73 240 Figures represent the Number of Persons Under 18 Killed or Injured Data Source(s): Collision data from the California Highway Patrol Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board f fD 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts I Indicator 10: Drug-Related Hospital Discharges; Top Chart Drug-Related Hospitalizations Contra Costa County vs. State of California, 1994-1997 by Year, for Persons Aged 5-24 Yrs. State County 1994 21.63 16.31 1995 21.05 19.08 1996 18.91 18.33 1997 20.42 18.94 Figures represent the number of discharges per 10,000 persons, aged 5-24 yrs. Data Source(s): Hospital discharge data from the CA Office of Statewide Health Planning and Dev. Population data from the California Department of Finance Indicator 10: Drug-Related Hospital Discharges; Bottom Chart Drug-Related Hospitalizations Contra Costa County, 1994-1997 by Region and Year, for Persons Aged 5-24 Yrs. West Acalanes South Central East Unincorp Total 1994 68 56 56 87 105 3 375 1995 45 63 85 98 147 6 444 1996 64 58 76 72 160 4 434 1997 78 64 68 93 158 1 462 Figures represent the percentage of total drug-related hospital discharges by year. Data Source(s): Hospital discharge data from the CA Office of Statewide Health Planning and Dev. Indicator 11: Alcohol-Related Hospital Discharges; Top Chart Alcohol-Related Hospitalizations Contra Costa County vs. State of California, 1994-1997 by Year, for Persons Aged 5-24 Yrs. State County 1994 1.7951 1.4350 1995 1.7662 1.9772 1996 1.8330 1.6053 1997 1.6383 1.3121 Figures represent the number of alcohol-related discharges per 10,000 persons, aged 5-24 yrs. Data Source(s): Hospital discharge data from the CA Office of Statewide Health Planning and Dev. Population data from the California Department of Finance Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 11: Alcohol-Related Hospital Discharges; Bottom Chart Alcohol-Related Hospitalizations Contra Costa County, 1994-1997 by Region and Year, for Persons Aged 5-24 Yrs. West Acaianes South Central East Unincorp Total 1994 11 7 3 6 6 0 33 1995 13 0 8 7 16 2 46 1996 5 3 15 10 5 0 38 1997 4 6 7 7 8 0 32 Figures represent the percentage of total alcohol-related discharges by year. Data Source(s): Hospital discharge data from the CA Office of Statewide Health Planning and Dev. Indicator 13: Juvenile AOD-Related Deaths; Top Chart Alcohol and Drug Involved Deaths Contra Costa County vs. State of California, 1993-1997 Percentage of Deaths Involving Alcohol or Drugs by Year County State 1993 0.00 0.00 1994 0.00 0.00 1995 0.00 0.00 1996 0.00 0.00 1997 0.00 0.00 Figures represent the number of deaths involving alcohol or drugs per 10,000 persons aged 10-17 yrs. Data Source(s): There is currently no source for AOD-related deaths data Indicator 13: Juvenile AOD-Related Deaths; Bottom Chart Alcohol and Drug Involved Deaths Contra Costa County 1993-1997 by Year West Acalanes • South Central East Total 1993 0 0 0 0 0 0 1994 0 0 0 0 0 0 1995 0 0 0 0 0 0 1996 0 0 0 0 0 0 1997 0 0 0 0 0 0 Figures represent the percentage of total AOD-related deaths by year. Data Source(s): There is currently no source for AOD-related deaths data Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 14: AOD Use Among High School Students; Top Chart Alcohol and Drug Use Among High School Students Contra Costa County vs. State of California, 1993-1997 Percentage of Students Who Are AOD Users by Year County State 1993 0.00 0.00 1994 0.00 0.00 1995 0.00 0.00 1996 0.00 0.00 1997 0.00 0.00 Figure represent the number of students who are AOD users per 1,000 high school students. Data Source(s): There is no adequate source of data for AOD usage among high school students Indicator 14: AOD Use Among High School Students; Bottom Chart Drug and Alcohol Use Among High School Students Contra Costa County 1993-1997 by Year West Acalanes South Central East Total 1993 0 0 0 0 0 0 1994 0 0 0 0 0 0 1995 0 0 0 0 0 0 1996 0 0 0 0 0 0 1997 0 0 0 0 0 0 Figures represent the percentage of total AOD users by year. Data Source(s): There is no adequate source of data for AOD usage among high school students Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board x-x la7 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 15: Juveniles in Substance Abuse Treatment, Page 1, Top Chart Juveniles in Substance Abuse Treatment Programs by Year Contra Costa County vs. State of California, 1993-1997 Per 10,000 Persons Aged 10-17 Yrs. County State 1993 34.33 19.22 1994 35.66 22.01 1995 25.84 23.88 1996 17.36 23.81 1997 12.56 22.58 Figures represent the number of juveniles in treatment per 10,000 persons aged 10-17 yrs. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and drug Programs 'Population data from the California Department of Finance Indicator IS: Juveniles in Substance Abuse Treatment Juveniles in Substance Abuse Treatment Programs by Year Contra Costa County, 1993-1997 Age at Admission <14 yrs 14 yrs 15 yrs 16 yrs 17 yrs Total 1993 12 24 28 48 48 160 1994 8 20 31 51 61 171 1995 5 19 28 38 37 127 1996 7 13 16 29 31 96 1997 2 8 13 16 27 66 Figures represent the percentage of total juveniles In treatment by year. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and Drug Programs a Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A:Data Tables for Indicator Charts Indicator 15: Juveniles in Substance Abuse Treatment; Age of First Use Chart Juveniles In Substance Abuse Treatment Programs by Year Contra Costa County, 1993-1997 Age of First Use c12 yrs 12-13 yrs 14-15 yrs 16-17 yrs Total 1993 79 127 75 21 302 1994 58 132 118 17 325 1995 50 87 87 16 240 1996 35 71 54 6 166 1997 23 45 45 12 125 Figures represent the percentage of total juveniles in treatment by year. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and Drug Programs Indicator IS: Juveniles in Substance Abuse Treatment, Gender Chart Juveniles in Substance Abuse Treatment Programs by Year Contra Costa County, 1993-1997 Gender Male Female Total 1993 203 107 310 1994 217 113 330 1995 165 79 244 1996 122 46 168 1997 67 58 125 Figures represent the percentage of total juveniles in treatment by year. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and Drug Programs Produced by Contra Costa Co.Community Substance Abuse services Division and Substance Abuse Advisory Board 1999 Juvenile Alcohol and Drug Impact Index Appendix A: Data Tables for Indicator Charts Indicator 15: Juveniles lin Substance Abuse Treatment; Source of Referral Chart Juveniles In Substance Abuse Treatment Programs by Year Contra Costa County, 1998-1997 Referral Source Self Courts School Commnty. Hlth Care Other Total 1993 72 75 62 77 12 8 806 1994 65 39 88 115 17 2 326 1995 65 77 26 52 18 6 244 1996 27 66 29 24 16 6 168 1997 46 26 14 23 14 2 125 Figures represent the percentage of total juveniles in treatment by year. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and Drug Programs Indicator IS: Juveniles in Substance Abuse Treatment; Legal Status Chart Juveniles in Substance Abuse Treatment Programs by Year Contra Costa County, 1993-1997 Legal Status N/A Probation Incarc. Other Total 1993 165 60 75 8 308 1994 164 54 100 10 328 1995 131 84 16 11 242 1996 98 56 0 14 168 1997 85 28 0 8 121 Figures represent the percentage of total juveniles in treatment by year. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and Drug Programs Indicator 15: Juveniles in Substance Abuse Treatment; Discharge Status Chart Juveniles in Substance Abuse Treatment Programs by Year Contra Costa County, 1998-1997 Discharge Status Completed Satin.- Unsatis. Referral Total 1993 58 96 117 22 293 1994 56 122 118 18 314 1995 52 41 121 15 229 1996 38 18 74 12 142 1997 29 18 66 4 117 Figures represent the percentage of total juveniles in treatment by year. Data Source(s): Substance abuse treatment data from the CA Dept. of Alcohol and Drug Programs Produced by Contra Costa Co.Community Substance Abuse Services Division and Substance Abuse Advisory Board Youth, Family and Community 19992000 Funding By Region and By Modality East County 19% 46%41 i 35% 113 Universal Prevention i Indicated Intervention ®Outpatient Treatment Central County 29. 5B°lo 13°r6 ©Universal Prevention ■Indicated Prevention ®Outpatient Treatment fhhsnumbers.xis5/22/00 1 Youth, Family and Community 1999-2000 Funding B Region and By Modality E West County i I 17% s 9% i t E 074% universal Prevention ■Indicated Prevention ®Outpatient Treatment CountyWide 14% 26%1jjjjjjjjjjj!!!!!!!!! g0°i6 C7 universai Prevention ■Indicated Prevention ®Youth Residential Treatment Funding By Service Type 51,175,262 $1,245,921 ill M;i $673,386 OUniversal Prevention M indicated Prevention ®Treatment fhhsnumbers.xls5/22/00 1 1141 Youth, Family and Community FY 1998-1999 Treatm nt Clients Hander Racefflthnlcfty 2 Aar i Neale Amer. 1 Nick VWft 0 50 100 150 200 i s ■Female 0 50 w 100 155'0 200 ■Male Primary AOD Problem Discharge Status oxer � � ` �� Maq— n t ct` Cocul a amity t ' met-row ENts'- Slactory AJcrotwl d� �� COnlarbted Herrin K A y$ 0 50 i00 150 200 0 20 40 60 80 100 j Age of First Use i � t L t Yet l h. t 4 , 6 7 8 9 10 11 12 13 14 15 16 17 16 fhhsnumbers.xls5/22/00 2 RJ cm C6 Y...: U) 04 T «D T 04 T T T T NQS •C M N c 'd O ' Z LIM ce iJ N O o ti Y7 N LC L 1 C tE t PREVENTING SUBSTANCE ABUSE AMONG CHIL,DR.EN AND ADOLESCENTS . FAMILY-CENTERED APPROACHES Practitioner' s Guide Publication No. (ADP) 98-4718 Resource Center (800) 879-2772 (California Only) State of California (916) 327-3728 Alcohol and Drug Programs FAX: (916) 323-1270 1700 R Street TTY: (916) 445-1942 First Floor Internet: http://www.adp.state.ca.us Sacramento, CA 95814 E-Mail: ResourceCenter@adp.state.ca.us Prevention Enhancement Protocols System (PEPS) PREVENTING SUBSTANCE ABUSE AMONG CHILDREN AND ADOLESCENTS: FAMILY-CENTERED APPROACHES Practitioner's Guide Second in a Series Prakash L. Grover, Ph.D., Executive Editor Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention Division of State and Community Systems Development The Prevention Enhancement Protocols System (PEPS) Series was initiated by the Center for Substance Abuse Prevention in the Substance Abuse and Mental Health Services Administration (CSAP/SAMHSA) to systematically evaluate both research and practice evidence on substance abuse prevention and make recommendations for the field. In doing so, PEPS strives to maximize the prevention efforts of State substance abuse prevention agencies, practitioners, and local communities. Prakash L. Grover, Ph.D., M.P.H., is the program director of PEPS and the Execu- tive Editor of the Guideline series for the Center for Substance Abuse Prevention (CSAP). Mary Davis, Dr.P.H., succeeded by Robert Bozzo, served as team leader for the PEPS staff during the development process for this series of publications. With assistance from the Expert Panel, the PEPS staff, primarily Mim Landry, Susan Weber, and Deborah Shuman, wrote and edited the main guideline through several iterations. Karol Kumpfer, Ph.D., panel chair, was also a major contributor. Donna Dean wrote the Practitioner's Guide and the Community Guide based on the evidence summarized in the main guideline. Exhaustive review of the documents was conducted by Robert W Denniston, Mark Weber, and Tom Vischi. Clarese Holden served as the Government project officer of the Prevention Technical Assistance to States (PTATS) project under which this publication was produced. The presentations herein are those of the Expert Panel and do not necessarily reflect the opinions, official policy, or position of CSAP, SAMHSA, or the U.S. Department of Health and Human Services. This publication was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), CSAP by Birch & Davis Associates, Inc. (Con- tract No. 277-92-1011). DHHS Publication No. (SMA) 3224-FY98. PANEL OF EXPERTS LEADING THE DEVELOPMENT OF THE GUIDELINE PREVENTING SUBSTANCE ABUSE AMONG CHILDREN AND ADOLESCENTS: FAMILY-CENTERED APPROACHES Karol L. Kumpfer, Ph.D., Chair Jose Szapocznik, Ph.D., Co-chair Richard Catalano, Ph.D. Richard R. Clayton, Ph.D. Howard A. Liddle, Ed.D. Robert McMahon, Ph.D. Joyce Millman Maria Elena V brrego, M.A. Nila Rinehart Iris Smith Richard Spoth, Ph.D. Marilyn Steele, Ph.D. i v : Foreword he Center for Substance Abuse Prevention in the Substance Abuse and Mental Health Services Administration (CSAP/SAMHSA) is committed to enhanc- ing prevention activities as planned and implemented by federally funded State agencies and community-based organizations across the country. Through a participatory process involving policymakers, researchers, program managers, and practitioners, the Prevention Enhancement Protocols System (PEPS) is generating products that can substantially improve planning and management of prevention programs, consolidate and focus prevention interventions, and potentially serve as the foundation for prevention studies. CSAP selected the topic of family-centered prevention approaches because problems of substance abuse among adolescents are pervasive, serious, and usually embedded in multiple issues of adolescent antisocial behavior relating to mental health, delin- quency, violence, poverty, and parental and family incapacities. Additionally, etio- logical and intervention research is increasingly demonstrating how adolescent problems of antisocial behavior have roots in the family's structure and the greater community in which the family exists. On both the national and local levels, govern- ment, communities, and organizations are interested in finding ways to support fami- lies more effectively in their efforts to meet the needs of their children. This guideline is designed for broad use. Its intended audiences include not only State substance abuse agencies but also national, State, and local organizations that address issues relating to children and families, such as substance abuse, delinquency, child health and welfare, and family support. It is a practical, detailed guide for con- sidering the advantages and disadvantages of specific interventions and for planning prevention initiatives in the community. The most important aspect of PEPS is the use of systematic protocols to prepare guidelines such as this one. Ultimately, the overarching methodological accomplish- ments of PEPS may have far greater influence than any single guideline, for they will have given birth to a tradition of development and dissemination of science-based recommendations for the substance abuse prevention field. Nelba Chavez, Ph.D. Karol Kumpfer, Ph.D. Administrator Director SAMESA Center for Substance Abuse Prevention, SAMHSA iii Acknowledgments n extensive review of the evidentiary research and practice literature on a subject such as the one represented by this guideline is a collaborative ven- ture requiring dedicated participation and the skills of many people. One can only attempt to adequately thank these individuals in a forum such as this. On behalf of CSAP, I would like to express-our deep gratitude to Dr. Karol Kurnpfer and Dr. Josh Szapocznik, ccs-chairs, and members of the Expert Panel for their hard work and dedication in systematizing and synthesizing the evidence on the role of family in substance abuse prevention.The panel's vision in adding sections on emerging strategies and collateral research will be particularly useful to both practitioners and researchers. Of course, throughout this process, the leadership and guidance of the PEPS Planning Group has been invaluable. Both the Planning Group and the Expert Panel reviewed several drafts of the guideline, and their efforts are reflected in the final version. We would also like to acknowledge the contributions of the Federal Resource Panel in sharpening the focus of the guideline and for its assistance in accessing fugitive literature. Many researchers and practitioners in the field reviewed the guideline and provided valuable comments. We believe that their incorporation has substantially improved the final product. Thanks are also due to staff in various CSAP divisions who re- viewed successive versions. Special thanks are due to Tom Vischi, Mark Weber, and Bob Denniston for their extensive review and comments. I would be`seriously remiss if I did not acknowledge the ongoing support of Dr. Ruth Sanchez-Way, director, Division of State and Community Prevention Systems. Last but not least, I want to express my deep appreciation to the staff at Birch & Davis Associates, Inc., who drafted the guideline documents and tirelessly reworked them as they passed through various stages of review.The contribution of EEI Com- munications in final copyediting, production, and quality control is also sincerely appreciated. Executive Editor v Contents Foreword..................................................................................................................iii Acknowledgments ..................................................................................................v AboutThis Guideline..............................................................................................ix PREVENTING SUBSTANCE ABUSE AMONG CHILDREN AND ADOLESCENTS: FAMILY-CENTERED APPROACHES..................................1 Why Use Family-Centered Approaches? Aren't Our School and Community Efforts Sufficient?........................................................................2 How Big a Problem Is Substance Abuse Among Youth? .................................3 Eighth-Grade Students ...................................................................................4 Tenth-Grade Students......................................................................................4 HighSchool Seniors........................................................................................5 Alcohol Use Remains High ............................................................................5 What Puts Children and Adolescents at Risk for Substance Abuse?............5 Family-Centered Approaches to Prevention of Substance Abuse— WhatWorks.......................................................................................................6 Prevention Approach 1: parent and Family Skills Training ......................9 Prevention Approach 2: Family In-Home Support................................... 15 Prevention Approach 3: Family Therapy ................................................... 16 General Recommendations on Family-Centered Approaches......................20 Program Development and Delivery of Family-Centered Approaches........22 Specific Tasks and Activities of Program Development ........................22 Special Planning Issues...............................................................................26 Conclusion..............................................................................................................32 An Afterword: Emerging Areas of Research and Practice............................32 vii The Construct of Resilience ........................................................................32 The Construct of Family Support ................................................................33 Final Thoughts About Resilience and Family Support ............................34 References ............................................................................................ .....34 Research Studies and Practice Cases..............................................................36 Parent and Family Skills Training................................................................36 FamilyIn-Home Support...............................................................................40 FamilyTherapy...............................................................................................41 Appendixes A. Criteria for Establishing Levels of Evidence of Effectiveness ..................43 B. Abbreviations and Glossary of Terms Used in Family-Centered Approaches to Substance Abuse Prevention .............................................45 C. Resource Guide.................................................................................................59 Viii About This Guideline he Prevention Enhancement Protocols System (PEPS) is a systematic and analytical process that synthesizes a body of knowledge on specific preven- tion topics. It was created by the Division of State and Community Systems Development of CSAP/S.AMHSA primarily to support and strengthen the efforts of State and territorial agencies responsible for substance abuse prevention activities. The PEPS program is CSAPs response to the field's need to know"what works" and is an acceptance of the responsibility to lead the field with current information sup- ported by the best scientific knowledge available. This second guideline in the PEPS series summarizes state-of-the-art approaches and interventions designed to strengthen the role of families in substance abuse preven- tion.This topic was chosen in response to the field's expressed need for direction and in recognition of the important role of the family as the first line of defense against the dangerous, insidious, and addictive consequences of substance abuse. THE PEPS DEVELOPMENT PROCESS The development of a PEPS guideline begins with the deliberations of a Planning Croup composed of nationally known researchers and practitioners in the field of substance abuse prevention. With input from their colleagues in the field, these•ex- pens identify a topic arca that meets preestablished. criteria for developing a guide- line. A Federal Resource Panel (FRP) with representatives from appropriate Federal agencies then convenes to discuss the proposed content of the guideline. The FRP, taking into consideration recommendations from CSAP and the PEPS Planning. Croup, identifies those experts in the field best suited to serve on an Expert Panel for the chosen topic. Once formulated, the Expert Panel meets to determine the scope of the problem to he addressed in the guideline. The PEPS staff conducts exhaustive searches for rel- evant research and practice information,guided by the knowledge of the Expert Panel and its Chair. The studies and practice cases found are extensively analyzed and their findings compiled and presented in draft form according to the similarity of the prevention approaches used. ix A subpanel of selected Expert Patiel members then meets to apply the PEPS Mules of Evidence (described later in this section) to formulate summary judgments on the qual- ity of the research and practice evidence, by approach, and to develop recommenda- tions for the prevention field. This draft is reviewed by the full Panel. A revised version of the guideline, including the revisions of the Expert Panel, is distributed for an exten- sive review by the field.The critique and analysis received are used to further refine and increase the accuracy, readability, and presentation of the guideline. PEPS SERFS GOALS The primary goal of PEPS is to develop a systematic and consistent process for im- provement of substance abuse prevention practice and research. Its objectives are to, • Synthesize research and practice evidence on selected topics • Present recommendations for effective substance abuse prevention strategies in versions suitable for several target audiences • Ensure that PEPS products receive optimal dissemination among target audiences • Monitor the usefulness and relevance of PEPS products • Identify areas in which additional research is needed Although lessons from available science are distilled and specific recommendations are made, this guideline is not a "how-to" handbook, nor is it a prescriptive preven- tion planning guide. Audiences for PEPS products include State prevention agencies, other Federal and State authorities, and community-based organizations addressing the problems of substance abuse or serving high-risk populations. Therefore, tar- geted users of the PEPS guidelines include policy analysts and decisionmakers, who need sound data to justify funding for prevention planning, State agency and com- munity-based administrators and managers,who will find the series useful in allocat- ing resources and planning programs; researchers, who will receive guidance on the need for future studies, and practitioners, who will find recommendations for pro- gramming options that are most appropriate for the populations they serve. THE SCOPE OF THIS GUIOELINE Preventing Substance Abuse Among Children and Adolescents: Family-Centered Ap- proaches focuses on research and practice evidence for a select number of approaches to the prevention of family-related problems.The criteria used for inclusion of stud- ies in this guideline excluded some research and practice evidence. Although other X conceptual or practice approaches do exist, sufficient documentation of their use is nor yet available. The guideline describes the following three prevention approaches: 1. Parent and Family Skills Training 2. Family In-Home Support 3. Family Therapy This practitioner's guide summarizes much of the information in the guideline and highlights practical information that is most useful to those directly involved in plan- ning and implementing prevention programs. A brochure-length parent and com- munity guide was also developed to provide a brief overview of substance abuse problems and courses of action for concerned citizens, and to offer tips for becoming involved in family-centered prevention. LEVELS OF EVIDENCE At the heart of the guideline development process are several concepts concerning the weight of the evidence that makes research or practice information strong enough to serve as the basis for recommendations. As these concepts are basic to an under- standing of the rigorous process used in developing this guideline, they are explained in detail in this introductory section. The term research evidence refers to the research-based body of knowledge existing for a specific prevention approach. This information is gained from scientific inves- tigations that range in design rigor from experimental to quasi-experimental to nonexperimental. The term practice evidence describes information gained from pre- vention practice cases, which is generally presented in the form of well-designed and -executed case studies that include process evaluation information on program imple- mentation and procedures. Each of the prevention approaches described in this guide includes at least one shaded box that presents information on leveLk of evidence. These boxes highlight the con- sensus of the Expert Panel on conclusions that can reasonably be drawn from an analysis of the research and/or practice evidence for each approach. They also indi- cate the strength of the level of cumulative evidence supporting the conclusions.The criteria for assigning levels of evidence are shown in the following boxes. The first three categories for level of evidence indicate the extent of research and practice evi- dence for rating the varying degrees of confirmation of positive effect. The fourth X1 Strong Level of Evidence a. Consistent positive results of strong or medium effect from a series of studies, including: • At least three well-executed studies of experimental or quasi-experimental design OR • Two well-executed studies of experimental or quasi-experimental design AND • Consistent results from at least three case studies b. The use of at least two different methodologies c. Unambiguous time ordering of intervention and results d. A plausible conceptual model ruling out or controlling for alternative causal paths or explanations Application.This level of evidence means that practitioners can use a prevention approach, with the most assurance that the approach can produce the particular effect specified in the evidence statement. Medium Level of Evidence a. Consistent positive results from a series of studies, including: • At least two well-executed studies with experimental or quasi-experimental designs OR • At least one well-executed study and three prevention case studies showing statistically significant or qualitatively clear effects b. The use of at least two different methodologies c. Unambiguous time ordering of intervention and results when so measured d. A plausible conceptual model,whether or not competing explanations have been ruled out Application.This level of evidence means that although the number or rigor of the studies reviewed is limited at this time,there is still substantial support for a prevention approach's ability to produce the particular effect specified in the evidence statement. Practitioners can proceed, but should exercise discretion in application and in assessment of process and outcomes. xii Suggestive but Insufficient Evidence This category is used to describe research and/or practice evidence that (1) is based on a plausible conceptual model or on previous research and (2) is being demonstrated in rigor- ous evaluation studies or appropriate intervention programs currently in process. One of two conditions typically causes evidence to be described as suggestive but insufficient: a. In the first condition,the evidence, although limited,appears to support a conclu- sion, but additional research is needed to fully support the conclusion.This con- dition often applies to areas in which there has been little study, such as those that are not easily researched or new areas of study. b. A second condition involves equivocal results. In this condition, a specific conclu- sion is supported in some studies but is not supported in others. Application.This level of evidence means that the prevention approach has shown prom- ise for the particular effect specified, but should be regarded as not well documented. Prac- titioners should be cautious about undertaking approaches with this level of evidence. However,depending on local circumstances,should the approach fit the situation and merit adoption, special attention should be given to its systematic testing and documentation. Substantial Evidence of Ineffectiveness This category describes research and practice evidence demonstrating that a prevention approach is not effective.The criterion for inclusion in this category is the absence of a statistically significant effect or the observation of a statistically significant negative effect in a majority of well-executed studies,including at least two quantitative studies with sample sizes sufficient to test for the significance of the effect Application.This level of evidence means that the approach has not demonstrated the in- tended results or has shown negative findings for the particular effect specified. Practitio- ners should avoid these approaches because they offer no promise of success at this time. category applies to research and practice evidence indicating that a prevention approach is ineffective. Using Levels of Evidence in Program Planning Because prevention activities vary in their emphasis, scope, and content, no two re- search studies or practice cases are the same. As they differ in the subjects of evalua- tion and in the methods used, it is difficult to reach a single conclusion about a particular approach. Additionally, there may be varying levels of evidence for differ- ent desired results of a prevention approach, as shown by similar findings from more than one study. Therefore, more than one evidence statement may be made to iden- tifv and rate conclusions that can be drawn from evidence available on a single ap- xiii proach. For instance, studies may show that a prevention approach has strong evi- dence for attaining a desired effect in the short term, but suggestive but insufficient evidence for sustaining that effect over time. The prevention approaches presented in this guide should be considered in light of local circumstances; it may not be feasible to implement only those approaches with a strong level of evidence. Local needs, interests, resources, and abilities—as well as the level of evidence--must all be considered when planners and practitioners make program development choices. RECOMMENDATIONS FOR PRACTICE Following the evidence-based analysis of each approach is a special section outlining recommendations for practice. This section presents the PEPS Expert Panel mem- bers' recommendations, suggestions, observations, and interpretations regarding the prevention approach evaluated in the preceding text. General recommendations and suggestions that are applicable to more than one prevention approach appear later in the chapter. Types of Recommendations The recommendations for practice vary considerably in nature and intent. Some are practical suggestions for optimal implementation of a particular intervention, while others suggest techniques and cautions to avoid problems. A few are practical obser- vations about what to expect during certain prevention activities. Others interpret research findings or illustrate the practical context of prevention efforts. Some rec- ommendations reflect expert opinions of the panel members, such as assumptions and hypotheses that drive certain prevention activities. Many represent "best prac- tices" among prevention experts, while some recommendations relate to the imple- mentation of specific prevention interventions. Basis of Recommendations These recommendations are based on the research and practice evidence reviewed in the Analysis of Evidence section, additional evidence not described in the section, and the professional experience and opinions of Expert Panel members. Many rec- ommendations are derived from the experiences of Expert Panel members involved with research or practice activities that are not explicitly described in the chapter. AV 34 /50 These recommendations represent the transfer of practical information from preven- tion research and practice experts to prevention decisionmakers, such as State and local prevention authorities, other prevention practitioners and researchers, and mem- bets of community prevention organizations. A REQUEST TO READERS Based on comments received from users of the first guideline, .Deducing Tobacco Use Among Youth. Community-Based Approaches, several significant changes have been made in the structure and presentation of this publication. CSAP actively seeks a continuing dialogue with its constituents on the extent to which they find this series useful and the ways in which future guidelines may be improved. Therefore, com- ments are actively solicited for inclusion in revisions of this guideline or in produc- tion of future guidelines.They should be referred to PEPS Program Director,Division of State and Community Systems Development, Center for Substance Abuse Preven- tion, SAMHSA, 5600 Fishers Lane, Rockwall II, Rockville, MD 20857. xv Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches he Center for Substance Abuse Prevention (CSAP) created the Pre- vention Enhancement Protocols System (PEPS) to systematically identify current knowledge on prevention programs and-to de- velop recommendations to guide and strengthen State prevention efforts. Under the PEPS program, panels of prevention experts have, for the first time, organized research and practice evidence on effective prevention pro- grams into a set of guidelines and recommendations that meet the needs-of practitioners. To date, one other PEPS guideline has been developed: Re- ducing Tobacco Use Among Youth: Community-Based Approaches. All of the PEPS documents will be accessible through CSAP's World Wide Web site at http://www.health.org. Each guideline topic is presented in a set of three documents: 1. A comprehensive reference guide that describes in fuli the substance abuse topic to be evaluated, reviews research and practice information on the prevention approaches used to address the problem, analyzes the effec- tiveness of these approaches, discusses lessons learned, suggests a pro- gram design and method of implementation, and gives recommendations of the Expert Panel on developing effective prevention programs and de- signing research 2. A practitioner's guide that distills the guideline into an implementation-directed summary 3. A community guide, in brochure form, that practitioners may use to illus- trate the rationale for their proposed prevention plans and to solicit com- munity involvement and support Preventing Substance Abuse Among Children and Adolescents 1 The practitioner's guide is a unique planning cool. It allows practitioners to: 1. Choose from among proven strategies and approaches to develop their own pre- vention programs 2. Learn to use a risk factor/protective factor approach to identify problems, collect data, and develop, carry out, and evaluate programs 3. Strengthen program effectiveness by using the "Developing and Delivering Family-Centered Approaches" section 4. Benefit from the evidence-based "Lessons Learned" drawn from the review and analysis of prevention research and practice evidence 5. Benefit from the "Recommendations for Practice" based on the expertise of the PEPS Expert Panel as well as the review of the research and practice evidence WHY USE FAMILY-CENTERED APPROACHES? AREN'T OUR SCHOOL AND COMMUNITY EFFORTS SUFFICIENT? Most Americans agree that the family is primarily responsible for ensuring the safety of children and for providing the nurturing and guidance children need. Skillful parenting helps children to become competent, caring adults who can live together peacefully and productively. In the past few decades, however, dramatic changes have taken place in American society and in the character of American family life (espe- cially the role of women). Many of these changes can stress the family's ability to nurture healthy children and increase the likelihood that our youth, even at a very early age, will turn to substance abuse.just listing some of these stress factors makes the challenge obvious: 1. Economic deprivation For many economically deprived youth, drug trafficking and substance abuse have become the only perceived options for breaking the cycle of poverty and getting the goods and advantages their parents cannot afford to give them (Hawkins, Catalano, and Miller 1992). 2. Homelessness--Drug use by homeless and runaway youth in shelters was reported in one study in the southeastern United States to be two to seven times higher than in comparison school samples (Fars and Rojek 1991). 3. Mothers in the workforce--Working mothers have less time than nonworking moth- ers to spend with and monitor their children. Less maternal involvement is associ- ated with anincreased risk for behavior problems, conduct disorders, and sub- stance abuse as the child approaches adolescence (Kandel and Andrews 1987). 4. Single parent families—Children living in single-parent families are more likely than others to have emotional problems and academic difficulties, which in turn are risk factors for substance abuse (Emery 1988; McLanahan 1988; McLanahan and Sandefur 1994). 2 A Practitioner's Guide 5. Child abuse and neglect—Abour 90 percent of the perpetrators of child maltreat- ment are parents and other relatives of the victims. In recent years, substance abuse by parents has come to be seen as a major cause of child abuse and neglect (Na- tional Center on Child Abuse and Neglect 1994). 6. Teenaged motbers----Teenaged mothers, many of whom lack adequate social sup- port, are less capable than adult mothers of parenting and managing crises and may be more likely to turn to substance abuse to cope with stress (Department of Health and Human Services 1993). The case for family-centered approaches is strong.While school-and community-based substance abuse prevention programs are essential, they are not sufficient. Frequently, schools do not begin addressing the substance abuse problem until adolescence, al- though the data indicate that the problem often begins in preadolescence. If families are to be successful in preventing substance abuse during the early years of a child's development, both parents and children need to develop the behaviors and skills that will enable them to manage themselves and their families in ways that support healthy growth. This training and support is all the more important today as a variety of stressors push and pull the family from every side. Some families require only occasional support as specific problems arise. Others have greater difficulty and need ongoing support, and a small percentage of families who have a great need for resources and support have only a marginal capacity to find and use them. These families may need active assistance to protect the children and to help the parents impart the values and skills that will enable their children to succeed as adults. HOW BIG A PROBLEM IS SUBSTANCE ABUSE AMONG YOUTH? What do we know about our kids and substance abuse? Data on substance abuse among young children have not been systematically collected. However, the Moni- toring the Future Study (University of Michigan Institute for Social Research 1997) shows that the use of illicit drugs by adolescents increased significantly between 1991 and 1996, representing a reversal of previous downward trends. by 1997, the re- surgence showed signs of leveling off, especially among eighth-grade students. Preventing Substance Abuse Among Children and Adolescents 3 Eighth-Grade Students The percentage of eighth-grade students reporting any marijuana use in the past month increased from 3 percent in 1091 to 10 percent in 1097, down from 1 1 per- cent in 1996.The percentage reporting any cigarette use in the past month rose from 14 percent in 1991 to 19 percent in 1997, down from 21 percent in 1996. The percentage reporting any heroin use within the past month, although quite low, more than doubled from 0.3 percent in 1991 to 0.7 percent in 1996 before easing to 0.6 percent in 1997. Similarly, the percentage reporting any hallucinogen use rose from 0.8 percent in 1991 to 1.8 percent in 1997, also slightly lower than the year before. (University of Michigan Institute for Social Research 1997). Box 1 illustrates the substance use experience of eighth-grade students as noted in the 1997 Monitoring the Future Study. All of these figures are slightly lower than the 1996 results. BOX 1: Lifetime Substance Use by Eighth-Grade Students in 1997 In 1997,the percentages of eighth-grade students reporting the use of a substance of abuse at least once in their lifetime were reported as follows: 1. Alcoho"4 percent 2. Cigarettes-47 percent 3. Marijuana-23 percent 4. Inhalants-21 percent 5. Smokeless tobacco--17 percent 6. Stimulants-12 percent 7. Hallucinogens--5 percent 8. Cocaine--4 percent S. Heroin--2 percent (University of Michigan Institute for Social Research 1997) Tenth-Grade Students Of students in the tenth grade, the percentage reporting any marijuana use in the past month increased from 8 percent in 1992 to 21 percent in 1997. The percentage reporting any cigarette use in the past month rose from 21 percent in 1991 to 30 percent in 1997. The percentage reporting any heroin use within the past month is quite small but tripled from 0.2 percent in 1991 to 0.6 percent in 1997. Similarly, the percentage reporting any hallucinogen use doubled from 1.6 percent in 1991 to 3.3 percent in 1997 (University of Michigan Institute for Social Research 1997). 4 A Practitioner's Guide eel 7 Z High School Seniors The percentage of high school seniors reporting any illicit drug use in the past month was nearly 40 percent in 1979; it decreased to a low of 14 percent in 1992 but in- creased to 26 percent in 1997. Perhaps the most troubling increase involved mari- juana. The percentage of high school seniors reporting marijuana use in the past month was 37 percent in 1979; it dropped to 12 percent in 1992 but rose to 24 percent in 1997. Similarly, the past-month use of cigarettes declined from a high of 38 percent in 1977 to a low of 28 percent in 1992. However, by 1997, the rate had increased to 37 percent (National Institute on Drug Abuse 1997; University of Michi- gan Institute for Social Research 1997). High school seniors' reports of using a hallucinogen during the past month have fluctuated between 2 percent and 4 percent from 1975 through 1997. However, their rate of lifetime use of hallucinogens has risen from about 10 percent during the early 1990s to 15 percent in 1997, signaling an increase in experimentation (University of Michigan Institute for Social Research 1997). The use of heroin by high school seniors has always been low, generally about 0.2 to 0.3 percent from the late 1970s through the early 1990s. 'However, though still less than 1 percent, the rate increased somewhat to 0.5 percent in 1997 (University of Michigan Institute for Social Research 1997).. Alcohol Use Remains High In general, alcohol use among high school students has remained fairly stable in the past several years, although the rates are unacceptably high. Slightly more than half of high school seniors report drinking in the past month, a fairly consistent pattern in the 1990s. This rate is down from about 70 percent in the late 1970s and early 1980s. Even among eighth-grade students, more than half have tried alcohol, and a quarter report having had alcohol within the past month (University of Michigan Institute for Social Research 1997). WHAT PUTS CHILDREN AND ADOLESCENTS AT RISK FOR SUBSTANCE ABUSE? Researchers believe that to maximize the prevention of adolescent substance abuse, it is important both to reduce risks and to enhance protective factors. Certain conditions--risk and protective factors—in the lives of some children and adolescents make it more or less likely that they will use alcohol, tobacco, or illicit drugs. Interaction of risk and protective factors within and among the three domains discussed below can affect the likelihood of adolescent substance abuse. For example, Preventing Substance Abuse Among Children and Adolescents 5 a recent study concluded that, despite similar exposures to violence in their neigh- borhoods, children showed varying degrees of successful adaptation and behavioral problems. The impact of the risk factors in the community was lessened by the pro- tective factors of family warmth, cohesion, and strong parenting (Richters and Martinez 1993). Similarly, high population density, overcrowding, and poor housing appear to contribute to antisocial behavior and delinquency—which, in turn, are known risk factors for substance abuse. In general, risk and protective factors can be seen as operating in three areas of influ- ence, or domains: 1. .Individual child factors of biology, behavior, and personality 2. Family,factors 3. Environmental factors Risk and protective factors within each domain are listed below. While there are fewer identified protective factors than risk factors, their interaction with risk factors means that practitioners should always try to enhance them as they strive to reduce risk factors. However, doing so can be challenging because risk and protective factors are complex. In addition to the difficulties that may be posed by their number, inten- sity, and duration, risk and protective factors work within a dynamic and interactive system. FAMILY-CENTERED APPROACHES TO PREVENTION OF SUBSTANCE ABUSE—WHAT WORKS As PEPS evaluated research studies and practice cases, it grouped the evidence into three prevention approaches. 1. Parent and family skills training 2. Family in-home support 3. Family therapy These approaches focus on the dynamics within the family as a whole and within a community—not merely the individual child within the family. Furthermore, these prevention approaches do not directly address substance abuse among youth. Rather, they address known risk and protective factors that increase or decrease the likeli- hood that children will begin—or continue—to abuse substances. It is also impor- tant to note that many approaches to preventing substance abuse in children and youth, including the three presented, in this practitioner's guide, are based on the four developmental models(developmental pathways, social development, social ecol- ogy, and contextualism) defined in appendix B, which identify the ways risk and protective factors interact to shape children's lives. 6 A Practitioner's Guide The basic logic for reducing substance abuse is as depicted below: Family-Centered Reduce Risk Factors Decrease Likelihood Prevention and Increase of Substance Abuse Approaches Protective Factors Among Youth Each approach is presented below in terms of its underlying concept, the activities of the studies reviewed, the strength of the evidence supporting the approach, lessons learned from the evidence, and recommendations for practice based on the evidence, as well as the insight of the Expert Panel: General recommendations for practice follow presentation of the three approaches. Risk and Protective Fetors for Children and Adolescents Individual Child Factors of Biology,Behavior,and Personality Risk Factors Protective Factors 1. Antisocial and other problem behaviors 1. Positive temperament such as stealing,vandalism,conduct 2. Social coping skills disorder,attention-deficit hyperactivity 3. Belief in one's own ability to exert control disorder(ADHA),rebelliousness,and over what happens(self-efficacy)and in one's aggressiveness—particularly in boys ability to adapt to changing circumstances 2. Alienation 4. Positive social orientation 3. High tolerance for deviance and strong need for independence 4. Psychopathology 5. Attitudes favorable to drug use 6. High-risk personality factors such as sensation seeking, low harm avoidance, and poor impulse control Preventing Substance Abuse Among Children and Adolescents 7 Family Factors Risk Factors Protective.Factors 1. Family behavior concerning substance 1. Cohesion, warmth, and attachment or abuse: bonding between parents and children a. Parental substance use and drug use during childhood modeling 2. Parental supervision b. Perceived parental permissiveness of 3. Interaction and communication between youth's substance use and among parents, parents and children, 2. Siblings' drug use, particularly that of and siblings older brothers 3. Poor family management and parenting practices: a. Overinvolvement of one parent and distancing by the other b. Low parental aspirations for children's educational achievement c. Unclear or unrealistic parental expectations for children's behavior, especially as they relate to the child's developmental level d. Poor disciplinary techniques, such as lack of or inconsistent discipline and extremely harsh punishment 4. Poor maternal-child relationships: a. Lack of maternal involvement in children's activities b. Cold, unresponsive, underprotective mother c. Low maternal attachment d. Maternal use of guilt to control children's behavior 5. Family conflict (a strong predictor of delinquency and antisocial behavior, including substance abuse) 6. Physical abuse (the earlier the age of experience, the greater its negative effects) g A Practitioner's Guide Environmental Factors Risk Factors Protective Factors 1. Peer influence--rejection or low accep- 1. Sources of positive emotional support tance, particularly in early school years outside the family,such as close friends(one I Deficient cultural and social norms and or several), neighbors,extended family, laws, such as poor enforcement of minimum peers, and elders purchase age for alcohol and tobacco I Formal and informal supports and resources products, social norms condoning use, available to the family and proliferation of tobacco and alcohol 3. Community and school norms, beliefs,and product advertisements behavioral standards against substance 3. Extreme poverty,for children with behavior abuse problems and other risk factors 4. Successful school performance and strong 4. Neighborhood disorganization that commitment to school reduces the sense of community, increases experiences with crime,and creates high mobility and transience 5. Failure to achieve in school,especially in the late elementary grades, regardless of whether it is due to behavior problems, truancy, learning disabilities, poor school environment,or other causes Box 2 lists principles practitioners should follow in addressing the risk and protective factors on which the following prevention approaches are based. Prevention Approach 7. Parent and Family Skills Training Family functioning, structure, and values have a significant impact on children's ca- pacity to develop prosocial skills and cope with life's challenges. Parent and family skills training; can provide parents and family members with new skills. These skills enable families to better nurture and protect their children, help children develop prosocial behaviors, and train families to deal with particularly challenging children. This prevention approach addresses two clusters based on the risk levels of the target populations: I. Families with children who are not known to have risk factors and families with children who are exposed to risk factors and are therefore at above-average risk., Common risks might include being in a single-parent family, a family in economic distress, or a family of divorce. Preventing Substance Abuse Among Children and Adolescents g 2. Families with children who etre at high risk because they are exposed to multiple risk factors or have a high level of exposure to a single risk tactor. Examples might be children identified as having serious behavior problems, as being delinquent, as having substance-abusing parents, or as being victims of child abuse. The risks faced by families in the first cluster call for universal or selective prevention measures, as defined in the Institute of Medicine's (IOM's) classification system. In- dicated prevention measures are appropriate for the second cluster (Gordon 1983, 1987; Institute of Medicine 1994). Because the activities and levels of evidence are unique to each cluster, they are pre- sented separately below. The lessons learned and recommendations for practice that follow apply to both clusters. BOX 2 How Can Practitioners Have the Greatest Impact? In addressing the various risk and protective factors around which family-centetre+ approaches are built,practitioners should keep in mind the following principles: 1. Select prevention approaches according to the risk level of the targeted,families. Differentiate among: a. Families not yet known to have any risk factors, b. Families with children who belong to subgroups that have risk factors for stance abuse but do not yet use substances,and 4' C' Families with children who already are known to have such factosuch rias` antisocial behavior and conduct disorder. Respectively,risk levels a,b,and c represent the population groups to which three ries of prevention activitles(universal,selective,or indicated)should be direcied.(tordars `. 1983, 1987;institute of Medicine 1594). 2. Focus on families with young,school-aged,children(before hegs#cve behavioral' and family problems become entrenched). 3. Reduce exposure to risks. a 4. Enhance protective factors. tiR, S. Choose strategies that are developmentally and gender appropriate, x+, 6. Develop interventions in multiple contexts and settings (e.g.,schools, c:uitural life, religious institutions, neighborhoods,and communities). 5 7. Address multiple risk factors simultaneously(e.g.,working to reduce domestic ` conflict and children's antisocial behavior while improving parenting skills and school performance). 8. Build on families'strengths,preserve their integrity(including their language and culture), and encourage their leadership in the growth process. " 10 A Practitioner's Guide Expected Changes and Key Activities for Approach i Ouster 1. This cluster, as noted above, includes families with children who have no known risk factors. As noted earlier, according to the IOM's classification system, universal preventive measures are appropriate for these families. duster 1 also in- cludes families with children who are exposed to risk factors and are therefore at above-average risk. Selective preventive measures are appropriate for these families. The parent and family training activities or interventions in this cluster include some training sessions that involve the child and other,family members and others that are parent oriented. All of the activities focus on changes in. 1. Parents—Acquiring or improving parenting skills, child management abilities, psychological helping skills, relationship development, and empathy 2. Families.—Improving family cohesion, organization, relationships, and conflict resolution 3. Youth--Improving general child behavior, psychological adjustments, attachment to family, and commitment to school Activities include: 1. Didactic presentations, both live and videotaped, followed by discussions 2. Role-playing and skills practice sessions 3. Curriculum-based training to recognize and modify risk and protective factors 4. Modeling sessions on interaction, communication, and crisis handling 5. Cognitive-behavioral workshops and multisession training programs (See box 3 for the levels of evidence for this cluster.) Preventing Substance Abuse Among Children and Adolescents 11 BOX 3: Levels of Evidence—Approach 1 Cluster 1 For families with children who are not known to have risk factors and for families with children who are exposed to risk factors,the research and practice evidence reviewed indicates that it is possible to implement parent and family skills training interventions: • There is strong evidence that these interventions can stabilize or improve the conditions that decrease risk factors for substance abuse,such as poor parent-child communication,child problem behavior, inadequate parenting skills, poor family relationships,parental substance use,family conflict,and family disorganization. • There is suggestive but insufficient evidence that,when specifically directed,these interventions can improve children's social skills and prosocial behavior. • There is suggestive but insuffident evidence that,when specifically directed,these interventions can reduce parental stress and depression, improve children's self-esteem,and promote improvements related to differences in social assimila- tion between parents and children. • There is suggestive but insufficient evidence that using a combination of parent training,children's social skills training, and family relationship training leads to greater improvements overall in parent-child relationships than would any of these interventions alone. Cluster 2 For families with children who arc at high risk for substance abuse because they either aro exposed to multiple risk factors or have a high-level exposure to a single risk factor,such ars conduct disorder,the research and practice evidence indicates that it is possible to imple- ment parent and family skills training interventions: • There is strong evidence that these interventions can decrease risk factors such as child problem behavior and poor parenting skills and increase.protective fac- tors such as.healthy family communication, bonding,and conflict resolution. • There is suggestive but insufficient evidence that these interventions reduce par- ents'stress, depression,and substance use; improve children's self-esteem, and promote improvements related to differences in social assimilation between par- ents and children. • There is strong evidence that these interventions have a positive and lasting ef- feet in improving parenting skills and behaviors as well as reducing diagnosed problem behaviors in children. MUTE:The criteria used to rate the strength of evidence for each prevention approach are shown in appendix A. 12 A Practitioners Guide Cluster 2. As noted above, this cluster includes families with children at high risk for substance abuse because they are exposed to multiple risks or have a high level of exposure to a single factor, such as conduct disorder. Indicated preventive measures are appropriate for these families (Institute of Medicine 1994). The parent and family training activities or interventions examined in this cluster include parent training without child involvement, parent training with separate child training, family skills training, and parent training plus family skills training. All of the activities focus on changes in: 1. Parents—Improving parents' attitudes toward their children, aquiring or improv- ing parenting skills, child management abilities, problem-solving skills, communi- cation skills, and crisis management abilities 2. Youth--Improving general behavior, acquiring or improving self-control and com- pliance, reducing antisocial and other problem behaviors, and reducing arrest rates Activities include: 1. Videotaped modeling sessions, with and without counseling and practice 2. Manual-based training, with and without discussions 3. Didactic, role-playing, and skill practice sessions 4. Cognitive-behavioral and problem-solving skills training 5. Behavioral parent training 6. Parent and teacher training 7. Structural family therapy and family effectiveness training 8. Parent counseling 9. Individual and group therapy for parents, both with and without children (See box 3 for the levels of evidence for this cluster.) Lessons Learned for Approach 1 1. Research demonstrates that parent and family skills training can greatly benefit parents, the family, and children: a. Parents increased their knowledge, parenting skills, problem-solving skills, child management skills, and coping skills and improved their attitudes, in- cluding acceptance of their children. b. Parent-child relations showed increased family cohesion and decreased fam- ily problem behaviors, .family conflicts, and substance abuse. c. Children showed increased prosocial behaviors and decreased hyperactivity, social withdrawal, aggression, and delinquency. Preventing Substance Abuse Among Children and Adolescents 13 2. Research suggests that increased parental effectiveness is associated with their de- creased use of substances. The causal direction of this relationship, however, is unknown: a. Some positive effects may be due to children's exerting pressure on parents to stop substance use. b. It is also likely that some changes are due to improved communication skills and an increased parental awareness of the effects of their drug use on family dynamics. 3. Research suggests that parent and family training may have an impact on parents being treated for substance abuse that is above and beyond the treatment effect: a. This may be particularly true for women who increase their ability to com- municate and manage their families effectively. b. Adding parent and family training to addiction treatment may also reduce the likelihood of relapse. 4. Research suggests that the more competent the trainer (e.g., having good group process skills) and the better he or she is able to relate to parents and family mem- bers, the more likely it is that parents will enter the programs and master higher functioning skills. 5. Research suggests that videotaped training and modeling, when combined with group discussion and a therapist's consultation, can be an effective and economical way to teach new behaviors and skills. Recommendations for Practice for Approach 1 The PEPS Expert Panel also made recommendations regarding parent and family skills training based on members' experience and their interpretation of the research and practice evidence. The panel's recommendations focused on the benefits of com- bining parent training and children's skills training with family therapy, cultural con- tent, environmental context, multicomponent programs, and efforts to retain participants: 1. Combining parent training and children's skills training with family therapy ad- dresses a broader array of family risk and protective factors for substance abuse and helps prevent "family sabotage effects" that emerge when only the individual child or parent is treated. 2. Parent and family skills training is easier to implement than family skills therapy because it is highly structured and requires fewer skills. It is also easier tri adapt to meet ethnic, cultural, regional, and child developmental stages. 3. Parent and family skills training programs should incorporate cultural content. Specifically, culture can serve as the core around which changes in family dynamics and roles can be initiated through parent and family skills training interventions. 14 A Practitioners Guide Training programs should identih•, build on, and measure the intervention's abil- ity to maximize the family's cultural strengths. 4. When parents do not succeed in parent and family skills training, it is important to consider more than the training class itself. Other serious problems in the family and environment might be affecting the parents' ability to learn. Consider factors such as home violence, unsafe neighborhood, and poverty-related stresses. 5. For greater success, address multiple family and community contexts, such as re- ducing social isolation, building peer support networks, increasing awareness of community resources, and coping with depression and parenting stress. When possible, use an integrated family-school strategy. 6. Research demonstrates that parents of children with conduct problems, even those with multiple problems, are often successfully retained in parent training. This is in contrast to an opinion frequently expressed by prevention specialists that such retention is nearly impossible. It may be that parent training promotes participant retention because parents view it as a helpful and acceptable form of intervention, or it may be that it increases the parents' hope and sense of competence. 7. Parent training interventions for children with conduct problems are more effec- tive with younger children than with older children. Prevention programs should incorporate the concept that early intervention is best. (General recommendations are listed on pages 20-22 immediately following the presentation of approaches.) Prevention Approach 2. Family In-Homo Support This prevention approach targets families who are at high risk because they face multiple risk factors or have a high level of exposure to one risk factor. According to the Institute of Medicine's framework, indicated preventive measures are appropriate for these families. These families are more likely than others to fall apart and have children placed outside the home. In-home support addresses these risks simultaneously and tailors its interventions to the family's unique situation. Intensive and comprehensive ser- vices provided for several months to a year can help stabilize the family and enhance the parents' ability to nurture and protect their children. Among the most common goals of family in-home support is decreasing the likelihood of domestic violence, child abuse, or neglect and preventing placement of children in foster homes or insti- tutions for juvenile delinquents (Kinney et al. 1990). Preventing Substance Abuse Among Children and Adolescents 15 Expected Changes and Key Activities for Approach 2 The primary objective of in-home prevention interventions is to preserve; Families so they can nurture, protect, and teach their children to become capable, competent, and caring adults. All activities focus on changes in: 1. Parents –Acquiring or improving parenting skills related to discipline, Family rela- tions, communication,and anger management and for decreasing the likelihood of child abuse and/or neglect 2 Youth---Training in communication skills and anger management, increasing com- pliance with curfew and school attendance, and diminishing the rates of arrests and criminal activities among juvenile offenders 3. Families—Preventing children from being removed from the family, and reuniting previously removed children with their families Activities include: 1. Direct services--Transportation, cash assistance, clothing, food, help with home repairs, etc. 2. Sacral services—Individual and family counseling, crisis intervention, behavior management training, substance abuse referrals for treatment, case management services, and reuniting children with their families after outside placement BW(4:Levels of Evidence—Approach 2 The research evidence reviewed conceritnites on in-home support services as indicated preventive measures--comprehensive, intensive, multipurpose services provided in the home and designed to a nage of family problems,typically involving all family members. The research and practice evidence reviewed indicates that it is possible to implement in-home support serves as lixicaftill pmventive measures: • There is mecl mr evidence that multisystemic therapy, provided in the home,is effective in reducing l Nenile crit hal activity and rearrest. • There is me&=evidence that multisystemic therapy,provided in the home, is effective in improving family characteristics associated with juvenile antisocial behavior,such as family cohesion and symptomatology: • There is medium evidence that home-based family preservation services are effective in avokfing out-of-home placement and reducing the number of days of placement NOTE:The criteria used to rate the strength of evidence for each prevention approach are shown in appendix A. 16 A Practitioner's Guide Lessons Learned for Approach 2 i. The level of evidence is not strong. Practitioners need to be aware that although use of the in-home support services prevention approach is currently in favor, there is a dearth of controlled studies. One reason is the ethical issue of assigning families with identified needs and problems to a nontreatment control group. 2. The use of comparison treatment conditions as a control group is underutilized. 3. Only very broad conclusions can be reached regarding the provision of services and the effect of an intervention on families.This is due to a number of reasons,among them the scarcity of experimental studies having a common focus and the difficulty of designing research that: a. Teases out the differing effects of particular elements, such as different facers of an intervention b. Examines whether there is a priority of needs , c. Measures the interrelationships of specific elements of the intervention and specific outcomes Recommendations for Practice for Approach 2 The PEPS Expert Panel's recommendations for in-home support services were based on members' experience and interpretation of the research .findings. The panel fo- cused on family-centered assessments, strength-based assessments, fragmentation of services, use of neighborhood-based family workers, and a variety of family preserva- tion efforts: 1. Families should be encouraged to become partners in any assessment of family needs in the community. Assessments should include the family's perspectives on both the nature of the problems and the ways these problems should be solved. .Assessments should reflect the family's perceptions of its needs, problems, goals, objectives, and timelines. Including the family in this process is in itself an inter- vention that increases its ability to manage and make decisions. 2. Include family contacts and informal supports, such as involvement of members of the extended family and churches, in ends and services plans. 3. Experience suggests that assessments and services plans are more useful when they focus not only on problems but also on the competencies, and capabili- ties that help the family survive.When a family's strengths are enhanced and weak- nesses reduced, its capacity to thrive grows. The evaluation of family strengths should include the familys readiness to change and the parents' ability to invest in learning parenting skills. Preventing Substance Abuse Among Children and Adolescents 17 4. Families in crisis may need numerous health and social services at times when they are least able to find and gain acce.&5 to them. Often the services they need are fragmented and compartmentalized. Families must work with several provider rep- resentatives and 611 out duplicative agency-specific paperwork. Luring crisis, fami- lies need integrated and comprehensive resources. Any effort to simplify the pro- cess should have a significant impact on the ability of families in crisis to obtain the help they need. 5. Neighborhood-based family workers should be recruited to form a bridge between agencies and families. Such workers help both families and agencies integrate and manage the services received. They help care providers form alliances with formal and informal support networks in the community that can in turn strengthen family functioning. Such workers also provide ongoing emotional support and a consistent flow of accurate information. (General recommendations are listed immediately following the presentation of approaches.) Prevention Approach 3: Family Therapy Like the second prevention approach, "in-home services," this prevention approach targets families at high risk because they face multiple risk factors or have a high level of exposure to a particular risk factor. The interventions in this approach are de- signed to improve family functioning and reduce juvenile delinquency, recidivism, child abuse, and other strong antisocial behaviors. Family therapy helps family members develop interpersonal skills and improve com- munication, family dynamics, and interpersonal behavior. It can be used to help family members improve their perceptions about one another, decrease negative be- havior, and create skills for healthy family interaction. It can also be used to enhance parenting skills and reduce inappropriate parental control over children. Expected Changes and Key Activities for Approach 3 The expected changes in this prevention approach all focus on improving family functioning and reducing children's recidivism and other problem behaviors. All activities focus on changes in: 1. Families—Increasing mutual positive reinforcement and decreasing maladaptive interaction patterns; improving family dynamics in families with juvenile offend- ers or adolescents with strong antisocial behaviors, acquiring skills, improving com- munication, learning effective discipline methods, and learning self-managemenr skills 18 A Practitioner's Guide ✓✓V 2. Youth—Reducing behavioral and emotional problems and repeat offender rates, improving the functioning of juvenile offenders, and preventing the initiation of substance abuse Activities include various types of family-centered therapies used with diverse groups of clients. The following illustrate some of the therapies and groups treated: 1. Functional family therapy, used by paraprofessional therapists and foster care case- workers for families with seriously delinquent youth (Alexander and Parsons 1982) 2. Structural family therapy, used for Hispanic families with boys diagnosed as hav- ing opposition disorder, conduct disorder, adjustment disorder, or anxiety disorder (Santisteban et al. 1995) 3. Multisystemic family-ecological therapy for families with juvenile offenders (Henggeler et al. 1986; Henggeler, Melton, and Smith 1992) (See box 5 for levels of evidence for this approach.) BOX 5: Levels of Evidence—Approach 3 The research and practice evidence reviewed indicates that it is possible to implement family therapy for families with children who are at high risk of substance abuse: • There is medium evidence that family therapy results in enhanced parenting skills, improved family'oommunication, increased parental knowledge about how to reduce antisocial child behavior, improved perceptions and attitudes of parents and adolescents about each other,and reduced inappropriate control of parents over adolescents. • There is strong evidence that family therapy reduces recidivism in.delinquent teenagers. NOTE.The criteria used to rate the strength of evidence for each prevention approach are shown in appendix A Lessons Learned for Approach 3 1. Research demonstrates that family therapy is an effective resource for improving family functioning, increasing parenting skills, and decreasing the recidivism of juvenile offenders. 2. Most empirical investigations of family therapy have focused on families with ado- lescents, many of whom are juvenile offenders. These youth are often much more difficult to influence and have moderate to severe disorders. The impact of family therapy in families with younger children and less severe behavior problems needs to be thoroughly investigated. Preventing Substance Abuse Among Children and Adolescents 19 3. RLsearch and practice demonstrate that family therapy can be part of a multicom- ponent prevention effort. For instance, family therapy can be a component in pre- vention efforts that include in-home family support and school-based problem-solving counseling. Recommendations for Practice for Approach 3 The PET'S Expert Panel members made recommendations regarding family therapy based on their experience and their interpretation of the research and practice evi- dence. The panel focused on interagency collaboration, participant recruitment and retention, cultural context, and interventions appropriate to the developmental level of young children: 1. Because families in crisis are likely to receive services from multiple agencies, fam- ily therapy providers should be linked with social and other services agencies. In- teragency collaboration and coordination and integrated case management are es- sential. Formal and informal agreements, including memorandums of understand- ing,case management meetings,and regular multidisciplinary interagency trainings, are helpful. A special contract or some other mechanism is necessary to spell out roles and services such as joint referral, intake, and assessment procedures. 2. Family therapy is still viewed very negatively among people from some regions of the country and among certain ethnic and socioeconomic groups. This makes re- cruitment and retention in family therapy difficult.The intervention design needs to address educating the target population to increase their positive regard for fam- ily therapy. Neighborhood volunteers and community outreach workers can be trained to give lectures on depression, anxiety, substance abuse, and child problem behaviors to help demystify family therapy. These activities, offered in collabora- tion with churches, schools, and community centers, can serve as a way to recruit families into therapy. 3. Practitioners should understand the cultural values, beliefs, and traditions of the families they serve.They should also be familiar with the resources available in the community where the family lives. 4. Family therapy that requires a participant's understanding of complex family and interpersonal dynamics may not be appropriate for young children:When children are to be participants, interventions should be chosen that are appropriate to their developmental level (e.g., family play therapy for families with young children). GENERAL RECOMMENDATIONS ON FAMILY-CENTERED APPROACHES 1. Family-centered prevention services are not likely to be successful for families with significant unmet needs related to food, shelter, employment, literacy, and physical and mental health. Prevention practitioners need to either supply the necessary 20 A Practitioner's Guide - - w services or help Families get them. Basic needs must be met during and after inter- vention if the prevention program is to be successful. 2. It is unrealistic to expect that a short-term (e.g., 10 to 14 sessions) intervention involving parent training, family skills training, or family therapy will provide a "single-shot cure."This is especially true for children with severe or chronic behav- ioral problems in difficult family and community contexts. It is more realistic to use repeated "booster" interventions tailored to the major stages of a child's devel- opment. It is advisable to consider using other types of interventions before, dur- ing, and after or in place of the family-centered intervention. Student counseling, psychiatric interventions, self-help programs, and other educational services help sustain the behavior change process over time. 3. Whenever possible, prevention interventions should be conducted in settings and locations that are comfortable, natural, and easily accessible to parents and chil- dren. It is ideal to bring the intervention to the target population, using their schools, workplaces, homes, churches, and community centers. 4. Family-centered approaches are highly compatible with and can be easily inte- grated into most substance abuse prevention programs. For example, school-based interventions could include a parent and family skills training component or even family therapy interventions. Doing so would strengthen both programs. 5. Family-centered interventions can be made more attractive and accessible by pro- viding vital services that remove barriers to participation, such as transportation, child care, and meals. G. When community support is sought, family-centered interventions can be more easily integrated into the community. This might involve community outreach to educate relevant community leaders, such as ministers, physicians, and educators, and conducting focus groups and other community education efforts. y. There is a tremendous need to build and sustain active partnerships between pre- vention practitioners and researchers. Both groups have skills, knowledge, and ex- pertise to share. Good practice programs are based on the latest research. If ad- vances in knowledge are to be made, researchers need the help of practitioners in designing and implementing studies that capitalize not only on their valuable in- put, but also on that of local community experts, residents, and parents. Research- ers, in turn, continue to seek answers to the many questions that plague the prac- titioner in designing and implementing prevention programs. 8. Especially when involved in community education, prevention experts should not present themselves as authorities who identify problems in others and then provide the answers "from above." They need to assume the role of information provider and resource expert by: a. Providing information on a variety of health and mental health issues b. Teaching families to recognize when a problem requires professional attention Preventing Substance Abuse Among Children and Adolescents 21 c. Providing information on options and resources in the community d. Teaching families how to gain access to resources Understanding the effectiveness of each prevention approach requires a thorough comprehension of the rating system used. For help in understanding the level-of-evidence statements used to assess the particular effects of each prevention approach, practitioners should refer to box 6. PROGRAM DEVELOPMENT AND DELIVERY OF FAMILY-CENTERED APPROACHES The reference guide from which this document is derived, Preventing Substance Abuse Among Children and Adolescents. Family-Centered Approaches, has a detailed and ex- tremely helpful presentation on program development, delivery, and evaluation. Prac- titioners are encouraged to examine that section of the full guideline very carefully. The material presented in this section contains: 1. A detailed planning table entitled "Specific Tasks and Activities of Program Devel- opment." The table lists the basic activities and tasks for the four steps of program development: a. Assessment b. Planning c. Delivery d. Evaluation 2. Special planning issues for family-centered approaches include: a. A discussion on ways to relate demographic information to risk and protec- tive factors and to table 2, Community and Family Data Organized by Risk and Protective Factors, with suggestions for doing so b. Ideas and suggestions for creating a partnership with potential program par- ticipants and the target community to keep them involved in every step of prevention intervention development and delivery c. A brief discussion on identifying community resources d. Ways to define the problem using a risk and protective factor approach At this point, readers would do well to review box 2, "How Can Practitioners Have the Greatest Impact?" presented earlier in this guide. Those observations were pre- sented to provide an overview or sense of the "big picture." Reviewing them at this point will set the framework for the following material. Specific Tasks and Activities of Program Development Table 1, Specific Tasks and Activities of Program Development, lists the four pri- mary steps essential to the development of any prevention program: assessment, plan- 22 A Practitioner's Guide BOX 6: Using Levels of Evidence To Guide Your Program Planning The PEPS Expert Panel, as it reviewed the research and practice evidence, used a set of preestablished criteria to rate the relative strength of evidence based on the rigor of the studies and the number of studies with similar findings.These levet-of-evidence statements should help practitioners confidently select approaches and specific interventions accord- ing to the demonstrated effectiveness of each strategy. Because prevention activities vary in their emphasis, scope, and content, no two research studies or practice cases are the same.They differ in what they evaluate and the methods used.This can make it difficult to reach a single conclusion about any particular approach. Therefore, several evidence statements may be created to identify and rate the specific conclusions that can be drawn about a prevention approach,as shown by similar findings from more than one study. For instance,studies may show that a prevention approach has strong evidence for attaining a desired effect in the short term but suggestive but insuffi- cient evidence for sustaining that effect over time. Strong evidence means that given the current state of the art, practitioners can use a pre- vention approach with the most assurance that the approach can produce the particular effect specified in the evidence statement. ` Medium evidence means-that although the number of the studies reviewed is limited,there is stili substantial support for a prevention approach's ability to produce the particular ef- fect specified in the evidence statement. Practitioners may still use it but should have so- cial,logistic, economic, political,or other reasons to choose this approach. Suggestive but insufficient evidence means that the prevention approach has shown promise for the particular effect specified but should still be regarded as not well demonstrated. . Practitioners should be cautious about undertaking approaches with this level of evidence.::`. However,depending on circumstances,the approach might fit the local situation but would ` clearly merit further substantial documentation and evaluation of effects. If contradictory results are reported by the studies reviewed, caution should be used in selecting intervendon(s) within an approach. Substantial evidence of ineffectiveness means that the approach has not demonstrated the intended results or has shown negative findings for the particular effect specified. Practit)o-'` ners should avoid these approaches,as they offer no promise of success at present. All of the prevention approaches failing within the strong evidence category in this guide should be considered.in certain circumstances,approaches with a strong level of evidence. for the particular effect sought by practitioners may not be feasible. Local needs, interests, resources,and abilities--as well as the level of evidence—must all be considered as,practi- tioners make their program development choices. Preventing Substance Abuse Among Children and Adolescents 23 ning, delivery, and evaluation. Both the tasks and the activities involved in accom- plishing each step are specifically tailored to the challenge of planning and imple- menting a family-centered prevention intervention. Table 1 can serve as a checklist for good planning. An expanded treatment of each item is provided in the full guideline. TABLE 1: Specific Tasks and Activities of Program Development Step in Program Development Tasks Activities Step 1:Assessment Develop a family and community Gather information on demographics profile of risk and protective factors and other social indicators Gather descriptive information (surveys, interviews, meetings) Include formal and informal sources Define the problem Compare assessment information with risk and protective factors specified on pages 7-9 Choose target families and Determine where problem has the prevention approaches greatest impact on families Assess interests, needs,concerns, and issues of families and their acceptance of potential approach(es) Assess extent of support and resources from community partners Assess characteristics of target Understand and respond to family families that will affect their cultures and values participation Understand and respond to parental attitudes and beliefs Establish a process for involving (See above activities) families and community partners Step 2: Planning Plan partnerships with parents and Identify barriers to recruitment of community collaborators families Identify barriers to their participation 1. lack of awareness of benefits 2. Cultural barriers 3. Support for basic needs 4. Negative views of approaches 5. Work site barriers 6. Characteristics and settings Address the needs of the Pit intervention to age,gender,and targeted children developmental stage of children from participating target families 24 A Practitioner's Guide Step in Program Development Tasks Activities Step I Delivery Wire and support staff Develop staff hiring criteria (e.g., expertise,training,interpersonal skills) Develop hiring criteria specifically for facilitators and therapists Train facilitators Provide staff support(e.g.,team building,facilitator meetings) Deliver the intervention in a Involve parents in the delivery of the partner relationship with parents intervention Encourage dialogue between parents and facilitators Use parent"graduates"of the program in leadership roles Develop strategies to monitor and Establish and publicize incentives for retain participants participation Monitor participant response and reasons for not participating Maintain referral network for basic support Step 4: Evaluation Consult with evaluation experts Consider options and choose the most appropriate and feasible evaluation Involve participants,staff,and Offer opportunities to participate in other community stakeholders in the evaluation design the evaluation process Consider a variety of methods and Choose evaluation methods and measures to evaluate process measures that accommodate the and outcomes activities of the intervention and the budget Identify data sources and develop Develop unambiguous definitions of procedures for collecting data what is to be measured and explain to staff Identify such sources as assessments, client attendance,and feedback Ensure similar recording of data among different facilitators/therapists Consider cost factors Determine scope of evaluation design needed to accomplish purpose and achieve outcomes of evaluation Document significant improvements in outcomes Outline cost of activities to determine barriers to recruitment and participation Determine length of evaluation Preventing Substance Abuse Among Children and Adolescents 25 Special Planning Issues Collecting and Organizing Data by Risk and Protective Factors To select the most appropriate family-centered approach for a given community, it is vital to identify the specific problems and community needs that,increase the risk of adolescent substance abuse as well as the assets or strengths that protect against or reduce these risks. By creating a community profile that organizes data around risk and pro- tective factors, program developers can highlight community and family characteris- tics that seem to have the greatest correlation with substance abuse. (See table 2, Community and Family Data Organized by Risk and Protective Factors.) Members of the target population and community---especially parents, children, and adolescents—should be enlisted to help gather and analyze community and family information. Whatever methods are chosen to gather the data for a community profile, it is essential to involve families who are likely to participate in the family-centered interventions. Seek the opinions and ideas of a wide variety of people who live in the community. Use telephone interviews, focus groups, written surveys, community meetings, and personal.interviews. Include community members of various socioeconomic levels, cultures, languages, and neighborhoods in gathering and analyzing information. TABLE 2: Community and Family Data Organized by Risk and Protective Factors Community and Family Indicators Social Conditions Risks Protective Factors Economic status Rate of families living in poverty Rate of families living in poverty who of families have successfully raised their children to be productiveadults Rate of parents who have achieved economic self-sufficiency Availability of community programs to assist parents with achieving economic self-sufficiency Neighborhood Violence and crime rates,including Number of programs in high-risk organization rates of juvenile delinquency communities that work with children and homicide among youth and adolescents Rate of suicide among children Counseling resources available for and adolescents children and adolescents Number of neighborhoods that have banded together to make improvements Availability of child care resources Presence of housing opportunities for low-income families 26 A Practitioner's Guide Community and Family Indicators Social Conditions Risks Protective Factors Social behavior Rate of children and adolescents Availability of therapy resources for of children and with diagnosed conduct and other children and families adolescents problem behaviors Violence and crime rates,including Availability of juvenile juvenile delinquency court rehabilitation resources Rate of children living in poverty Availability of alternative school programs and meaningful vocational education opportunities Rate of unemployment Rate of low-income children enrolled among young adults in programs for high achievers, gifted/talented programs Family management Rate of teenaged parents Parent and family skills training and parenting programs available to all families and practices to high-risk families Number of home visitation programs and other resources for new or young parents Presence of parent self-help groups Family behavior Rate of adult alcohol and Availability of substance abuse concerning drug abusers prevention programs for families substance abuse Rate of adolescent substance Availability of treatment programs for .abusers(alcohol,tobacco, parents and children illicit drugs) Community laws and norms regarding adolescents'access to and abuse of substances Physical treatment Rates of child abuse and out-of- Availability and adequacy of family of child home placement preservation programs Percentage of children available for adoption who are adopted Presence of child abuse prevention programs in the community Failure to achieve Rate of school dropouts Availability of special education in school services,tutoring,counseling,etc., for children and adolescents Rate of students who fall required Availability of alternative education achievement tests or grades opportunities Rate of runaway and homeless Availability of shelters and services for youth runaway and homeless youth Parental Rate of working mothers Availability of after-school care for monitoring children of all working parents Rate of parents who do not Flexibility of hours in school and participate in school events for other community programs parents,including conferences Rate of children who are not in Adequacy and safety of public supervised after-school programs transportation systems for adolescents Rate of children who are at home alone after school,by age Preventing Substance Abuse Among Children and Adolescents 27 TABLE 2(continued):Community and Family Data Organized by Risk and Protective Factors Community and Family Indicators Socia! Conditions Risks Protective Factors Parental Physical and mental health status monitoring of children,including those with (continued) developmental delay,learning disabilities,and emotional or behavioral problems Family bonding Low-cost opportunities in communities for various family activities Availability of family support programs for all families and for high-risk families NOTE: Wherever possible, information on these indicators should be gathered according to culture and ethnicity as well as geographic or neighborhood distribution Establishing a Process for Involving Families and Communities as Partners The key to success in family-centered approaches is building in, at each stage of develop- ment, strategies that involve the participants in planning and decisionmaking. When this is done,_the design and implementation of the intervention will be more likely to match the needs, strengths, and expectations of those it serves. In other words, and to reemphasize, involve participants and community leaders in each of these activities. 1. Assessment a. Information gathering, problem definition, and target population selection b. Analysis of the cultural values and parental attitudes and beliefs that relate to the substance abuse problem and their capacity to affect that problem 2. Planning a. Building opportunities for parent participation in planning b. Ensuring that practitioners really listen to parents' goals and expectations c. Designing programs that reflect the cultures of and diversity in the target families d. Designing interventions that integrate the families' natural helping networks e. Developing a core of community organizations that collaborate to provide a "safety net" of services to meet the basic needs of participating families £ Idenrifying barriers to recruitment and participation from the community's perspective g. Developing strategies to overcome these barriers so that the community is aware of the benefits of the program, feels the program is sensitive to differ- ing cultures, and offers training that will help community members deal more effectively with their family problems 28 A Practitioner's Guide 3. Delivery a. Serving as support staff and paraprofessional trainers b. Helping with logistics and food serving c. Serving as language or cultural translators d. Encouraging dialogue between parents and facilitators e. Using "graduate parents" in leadership roles to motivate others to partici- pate, contact dropouts, and serve as consultants in the replanning and deliv- ery of the intervention f. Developing strategies to monitor and retain participants g. Establishing and publicizing incentives for participation, such as free trans- portation and child care, snacks or meals during intervention activities, free coupons for food or video rentals, "graduatiod° gifts, parties or family out- ings, access to clothing and food banks, and referral services for legal, medi- cal, housing, and financial aid h. Maintaining a referral network for basic family support and monitoring it to identify breakdowns in collaboration and coordination that reduce the family's ability to participate in the intervention 4. Evaluation a. Designing a"stakeholders" evaluation specific to the community being served b. Working with the project evaluator to hold focus group meetings with po- tential participants to overcome their reluctance to be involved in programs that include evaluations c. Involving participants in the collection of participation rate data for a pro- gram to increase their willingness to evaluate it Program developers, trainers, social workers, and psychologists have conducted con- duct assessments and implemented solutions based on what they think is best for the family. With this approach, families rarely have an opportunity to express their ideas about their own needs or to collaborate in the development of a program. It stands to reason that a program designed by "outsiders" will not have the same "fit," participa- tion rate, or effect as one designed with the collaboration and input of the target population. The more involved members of the target community become in the planning and delivery of a program, the more likely they are to use it to their benefit. Defining the Problem Using a Risk-and-Protective-Factor Approach Once the assessment of the community's risk and protective factors is completed, practitioners can work with community partners to analyze the collected informa- tion.They will need to identify the most prominent substance abuse problems among children and adolescents in the community and the risk and protective factors that are most clearly associated with those problems. Preventing Substance Abuse Among Children and Adolescents 29 17 Substance abuse problems are often hidden or silent. Even statistical data and anec- dotal information may not make the problem visible to the community or give a clear outline of its extent. Risk and protective factors can function like clues, pointing out problems that increase the likelihood of substance abuse and factors that help to prevent it. The risk and protective factors outlined earlier are valuable in determin- ing when there is a need to intervene. Most likely, practitioners will identify several key problems during the assessment. But how can priorities be set so that a plan can be developed? Sometimes the serious- ness of the problem and the resources available determine what needs to be done first. One of the most important resources is members of the community who are willing and available to work with practitioners on the problem. Program developers may want to start with an easy problem to build community sup- port around a successful undertaking. To others, it may seem best to plan a complex, multiproblem strategy that will take full advantage of the resources the community already has in place. Practitioners should know that it is vital to involve community members in identifying the problem so they will develop ownership in the solution. Community mapping is an important tool for analyzing the scope of community problems: • In a neighborhood needs map, identify areas with negative community factors, such as unemployment, gangs, and child abuse. Fill in demographic and de- scriptive information pertaining to these areas. • In a community assets map, identify community strengths, such as parks, cul- rural groups, businesses, and religious institutions. Provide demographic and descriptive information pertaining to these areas. Community planners often forget about neighborhood assets and how they can provide support for chil- dren and families. (For more information on community mapping, see the reference guide.) Defining the problem includes selecting a target population. Questions to ask at this time are: • Does the problem have its greatest impact on all families in the community or only a certain group of families who are at above-average risk for adolescent substance abuse? • What was learned during the assessment that might help in selecting the target population? .Ask these questions: 1. Would participation be increased by offering intervention to all families instead of singling out families? 2. How would high-risk families respond to the availability of extra support? 30 A Practitioner's Guide 3. Which families at risk bring other special strengths and therefore might be more successful? The more help practitioners have from the community in identifying target families, designing the intervention, providing collateral support services, and funding the intervention, the more likely they are to succeed. Identifying Community Resources Include any and all resources that might support the target families and the commu- nity that the prevention approach will serve. Contact such resources and learn how the prevention approach can be coordinated with the support they provide. In many cases, community resources that support families are outside the obvious formal and traditional sources, such as schools, child welfare agencies, or mainline service organizations with a "substance abuse prevention" or"family" label. Examples include the following: 1. Neighborhood leaders and informal networks 2. Community businesses 3. Neighborhood drop-in programs 4. Community centers 5. .Religious organizations, such as churches, temples, and mosques 6. Centers for various cultural groups 7. Child care and Head Start programs 8. Literacy programs It is also important to identify more formal resources that offer family-centered pro- grams-including parent training, in-home support services, and family therapy. Such resources include, but are not limited to, the following: 1. School-based programs that offer parent training or education about substance abuse prevention 2. Child welfare agencies providing in-home support services to prevent separation of families or specialized foster.parent training programs for children with special needs 3. Juvenile court programs that offer parent training or family therapy 4. Universities, community colleges, and hospitals or health clinics that provide spe- cial therapeutic services, parent training programs, or special demonstration or research programs Family therapy interventions should be linked with the social and support services available in the target community. It is not enough to merely identify existing community resources. Practitioners need to establish ways their program can col- laborate, coordinate, and perhaps share case management with these other support Preventing Substance Abuse Among Children and Adolescents 31 ''%Y v� ..sj�► 'C..c services. Formal and informal agreements, including memorandums of understand- ing, case management meetings, and regular multidisciplinary interagency trainings, are helpful. A contract or some other mechanism is necessary to spell out roles and services, such as joint referral, intake, and assessment procedures. Based on these, practitioners need to develop detailed guidance for families on how to best use the other community resources. CONCLUSION This practitioner's guide is intended to be brief and simple. For much greater detail concerning the analysis of the three prevention approaches, recommendations for practice, guides for program development and delivery, and emerging areas of re- search and practice, see the reference guide. Practitioners face many challenges im their efforts to intervene with families to pre- vent substance abuse in their children. Despite the complexity of the challenges, a growing body of research and practice literature has documented successful strategies for family-centered interventions. For the first time, information on these strategies and interventions has been brought together in a systematic analysis of their effective- ness. The resulting guidelines are designed to be clear, realistic, and easy to use. It is hoped that they will help develop markedly more effective family-centered approaches to prevent substance abuse among children and adolescents. AN AFTERWORD: EMERGING AREAS OF RESEARCH AND PRACTICE Two issues of interest to practitioners have not been included in this guide's review of research and practice. These issues are the constructs of resilience and family sup- port.Many may wonder why two prevention approaches and strategies that are widely discussed and often funded are not included in the reference guide or this practitioner's guide. The reason is that these approaches did not meet the rigorous criteria used to select approaches: an ample body of research and/or practice evidence sufficient to permit a thorough analysis. For both of these strategies, the research evidence is in the early stages. The Construct of Resilience For the purposes of this guide, resilience is defined as either of the following capaci- ties of children (Herrenkohl, Herrenkohl, and Egolf 1994; Luthar 1991; Luthar and Cushing, in press; Turner, Norman, and Zunz 1993): • The capacity to recover from traumatic life events and restore or improve fam- ily functioning. Traumatic life events include the death of a parent, divorce, sexual abuse, and homelessness. 32 A Practitioner's Guide * The capacity to withstand chronic stress and yet sustain competent functioning. Examples of chronic stress are extreme poverty, alcoholic parents, chronic illness, and ongoing domestic or neighborhood violence. Most resilience researchers agree that resilience involves an interaction among char- acteristics of the child, the family, and community environments and exposure to adverse circumstances, especially at an early age. However, intervention-based stud- ies are distinctly lacking, so little is known about how these elements interact. Vital questions remains • To what extent does resilience rely on and build on biological traits as opposed to learned patterns of behavior? • Can everyone learn to be resilient, or must certain conditions be present? The Construct of Family Support The driving force behind the family support construct is the conviction that it is the responsibility of family-helping programs and resources to go beyond preventing problems to supporting the optimum development of the capacities that are inherent in all families. This approach is often called "empowerment." Vital assumptions are that the primary responsibility for the development and well-being of children lies within the family, that family services should be rooted in community support sys- tems, and that the role of help-giving agencies is to become partners with families in problem solving (Family Resource Coalition 1996). Researchers and practitioners who evaluate family support interventions believe that the traditional evaluation approaches are insufficient. They contend that family sup- port research should involve participants in research design and implementation and employ methods that make them stakeholders in evaluation goals and results. Recent and ongoing research efforts include the following: * Identifying the importance of using informal resources to help families * Determining how a family's style of functioning affects its capacity to cope and promote positive growth • Describing the effects that various modes of helping might have on an individual's ability to become more independent . A general problem in the development of a body of knowledge about family support has been the lack of data sources and information about family and community strengths and assets. Most of the data about families describe either neutral or deficit information, problems, and needs. Until more data are collected and analyzed, it will be difficult to identify which strengths and assets are most useful for helping families achieve optimum results. Preventing Substance Abuse Among Children and Adolescents 33 Final Thoughts About Resilience and Family Support Interventions based on resilience and family support offer program options that might be more effective and less expensive than traditional treatment or deficit-focused strategies. As practitioners experiment with, interventions that make intuitive sense and address the problems they see each day, the challenge for research is to keep pace with practice by: • Further defining these constructs • Developing accurate measures • Incorporating evaluation processes that include participants • Assembling the findings into an integrated body of evidence This points to many opportunities for researchers and practitioners to work together to determine what works and subsequently increase the impact of interventions us- ing these constructs. REFERENCES Alexander, J., & Parsons, B. V. Functional family therapy (1982)..Monterey, CA: Brooks/Cole Publishing Company. Department of Health and Human Services. (1993). Measuring the health behavior of adolescents: The youth risk behavior surveillance system and recent reports on high-risk adolescents. Public.Health Reports, 108 (Suppl. 1), 25-36. Emery, R. F. (1988). Marriage, divorce, and children`s adjustment. Newbury Park, CA: Sage. Fors, S. W., & Rojek, D. G. (1991). A comparison of drug involvement between runaways and school youth. journal of Drug Education, 21, 13-25. Gordon, R. (1993). An operational classification of disease prevention. Public Health Reports, 98, 147-109. Gordon, R. (1987). An operational classification of disease prevention. In J. A. Steinberg and M. M. Silverman (Eds.). Preventing mental disorders (pp. 20- 26). (DHHS Pub. No. ADM 87-1492). Rockville, MD: Department of Health and Human Services. Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112 (1), 64-145. Herrenkohl, E. C., Herrenkohl, R. C., & Egolf, B. (1994). Resilient early school- age children from maltreating homes: Outcomes in late adolescence. American Journal of Orthopsychiatry, 64 (2), 301-309. gq A Practitioner's Guide Henggeler, S. W, Rodick, J. D., Borduin, C. M., Hanson, C. 1.., Watson, S. tii., & Urey, J. R. (1986). Multisystemic treatment of juvenile offenders: Effects on adolescent behavior and family interaction. Developmental Psychology, 22 (1), 132-141. Henggeler, S. W, Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60 (6), 965961. Kandel, D. B., & Andrews, K. (1987). Processes of adolescent socialization by parents & peers. International Journal of the Addictions, 22, 31-342. Kinney, J., Haapala, D., Booth, C., & Leavitt, S. (1990). The homebuilders model. In J. L. Whittaker, J. Kinney, E. M. Tracy, and C. Booth (Eds.), Reaching high- risk families. Intensive family preservation in human services. pp. 3164. New York: Aldine de Gruyter. Luthar, S. S. (1991). Vulnerability and resilience: A study of high-risk adolescents. Child Development, 62, 600-616. Luthar, S. S., & Cushing G. (in press). Measurement issues in the empirical study of resilience: An overview. In M. Glantz, Z. Sloboda, & L. C. Huffman (Eds.). Resiliency and development: Positive lifeadaptations. Ntvv York: Plenum Press. McLanahan, S. (1988). The consequences of single parenthood for subsequent generations. Focus, 2 (3), 16-21. McLanahan, S., & Sandefur, G. (1994). Growing up with a single parent.- What hurts, what helps. Cambridge, MA: Harvard University Press. National Center on Child Abuse and Neglect. (1994). Child maltreatment 1993. Reports from the States to the National Center on Child Abuse and Neglect Hyattsville, MD: National Center for Health. Statistics. National Institute on Drug Abuse. (1997). Monitoring the future study. (NIDA Capsules). Rockville, MD: National Institute on Drug Abuse. Richters, J. E., & Martinez, P. E. (1993). Violent communities, family choices, and children's chances: An algorithm for improving the odds. Development and Psychopathology, 3, 609--627. Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., .Mitran, V., Jean-Gilles, M., & Szapocznik, J. (1995). Brief structuraUstrategic family therapy with African American and Hispanic high-risk youth. Unpublished manuscript, Miami, Center for Family Studies, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine. Preventing Substance Abuse Among Children and Adolescents 35 x Turner, S., Norman E., & Zunz, S. (1993). From risk to resilienr}� a paradigm shift. A literature review and annotated bibliography Unpublished manuscript, Fordham University Graduate School of Social Service, New York. University of Michigan Institute for Social Research. (1997). Monitoring the Future StueO- 1 X97 Arin Arbor, MI: Author. RESEARCH STUDIES AND PRACTICE CASES The following references are the research studies and practice eases that were ana- lyzed to determine the level of effectiveness of the three prevention approaches.They have been grouped according to prevention approach. Parent and Family Skills Training Research Evidence Aktan, G. B., Kumpfer, K L., &Turner, C. W (in press).The Safe Haven Program: Effectiveness of a family skills training program for substance use prevention with inner city African-American families. International journal of the Addictions. Anastopoulos, A. D., Shelton, T. L., DePaul, G.J., & Guevremont, D. C. (1993). Parent training for attention-deficit hyperactivity disorder. Its impact on parent functioning. journal of Abnormal Child Psychology, 21, 581-596. Arnold,J. E., Levine, A. G., & Patterson, G. K (1975). Changes in sibling behavior following family intervention. journal of Consulting and Clinical Aychology, 4.3 (5), 683-688. Bank, L., Marlowe, H., Reid,J. B., Patterson, G. R., &Weinrott, M. R (1991). A comparative evaluation of parent-training interventions for families of chronic delinquents. journal of Abnormal Child Psychology, 19 (1), 115-133. Baum, C. G., & Forehand, R. (1981). Long term follow-up assessment of parent training by use of multiple outcome measures. Behavior Therapy, 12, 643-652. Bernal, M. E., Minnert, M. D., & Schultz, L. A. (1980). Outcome evaluation of behavioral parent training and client-centered parent counseling for children with conduct problems. journal of Applied Behavior Analysis, 13, 677-691. Catalano, R E, Haggerty, K P., Gainey, R. R., Hoppe, M. J., & the Social Development Research Group. (1995). Reducing parental risk factors for children's substance abuse: Preliminary outcomes with opiate-addic d parents. Unpublished manuscript, Seattle, WA. The University of Washington, Seattle. Dishion, T. J., & Andrews, D. W. Preventing escalation in problem behaviors with high-risk young adolescents. Immediate and 1-year outcomes. journal of Consulting and Clinical Psychology, 63, 538-548. 36 A Practitioners Guide > 7 Dubey, D. R., O'Leary, S. G., & Kaufman, K. F. (1983). Training parents of hyperactive children in child management: A comparative outcome study. Journal of Abnormal Child Psychology, 11 (2), 229-246. Dumas,J. E. (1984). Interactional correlates of treatment outcome in behavioral parent training. Journal of Consulting and Clinical Psychology, 52 (6), 946- 954. Family Resource Coalition. (1996). Guidelines for family support practice. Chicago: Author. Feiner, R. D., Brand, S., Erwin Mulhall, K, Counter, B., .Millman,J. B., & ,Fried, J. (1994). The parenting partnership: The evaluation of a human service/ corporate workplace collaboration for the prevention of substance abuse and mental health problems and the promotion of family and work adjustment. Journal of Primary Prevention, 15 (2), 123-146. Fleischman, M.J. (1981). A replication of Pattersons "Intervention for boys with conduct problems."journal of Consulting and Clinical Psychology, 49 (3), 342-351. Forehand, R., & Long, N. (1988). Outpatient treatment of the acting out child: Procedures, long term follow-up data, and clinical problems. Advances in Behaviour Research and Therapy, 10, 129--177. Guerney, L. (1977). A description and evaluation of a skills training program for foster parents. American journal of Community Psychology, 5 (3), 361-371. Guerney, I.. E, &Wolfgang, G. (1981). Long-range evaluation of effects on foster parents of a foster parent skills training program.Journal of Clinical Child Psychology, 10(1), 33-37. Horn, W. E, Ialongo, N. S., Pascoe,J. M., Greenberg, G., Packard, T., Lopez, M., Wagner, A., & Puttler, L. (1991). Addictive effects of psychostimulants, parent training, and self-control therapy with ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry, 30 (22), 233-240. Hughes, R. C., & Wilson, P. H. (1988). Behavioral parent training: Contingency management versus communication skills training with or without the participation of the child. Child and Family Behavior Therapy, 10 (4), 11-23. Ialongo, N. S., Horn, W E, Pascoe, J. M., Greenberg, G., Packard, T., Lopez, M., Wagner, A., & Puttler, L. (1993). The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: A 9-month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 32 (1), 182-189. Institute of Medicine. (1994). Reducing risks for mental disorders. Frontiers for preventive intervention research. Washington, DC: National Academy Press. Preventing Substance Abuse Among Children and Adolescents 37 w v. Kazdin, A. E., Siegel, T: C.. & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60 (5), 733--747. Knapp, P. A., & Deluty, R. H. (1989). Relative effectiveness of two behavioral parent training programs. journal of Consulting and Clinical Psychology, 18, 314-322. Kosterman, R., Hawkins, J. D., Spoth, R., Haggerty, K. P., & Zhu, K. (1995). Preparing for the Drug--Free Years: Effects on videotaped family interactions." Unpublished manuscript, Seattle, WA: The Social Development Research Group, University of Washington, Seattle. Kumpfer, K. L., & DeMarsh, J. P. (1987). Prevention services for children of substance-abusing parents. Unpublished manuscript, Social Research Institute, Graduate School of Social Work, University of Utah. Kumpfer, K. L., Turner, C. W., & Palmer, S. (1991). YCOSA Black Parenting Project.• Third and fourth year evaluation report Unpublished manuscript, Department of Health Education, University of Utah. Long, R, Forehand, R., Wierson, M., & Morgan, A. (1994). Does parent training with young noncompliant children have long-term effects? Behaviour Research and Therapy, 3.2, 101-107. McMahon, R J., Forehand, R., & Griest, D. L. (1981). Effects of knowledge of social learning principles on enhancing treatment outcome and generalization in a parent training program. Journal of Consulting and Clinical Psychology, 49 (4), 526--532. Myers, H. F., Alvy, K T., Richardson, M., Arrington, A., Marigna, M., Huff, R., Main, M., & Newcomb, M. (1990). The Effective Black Parenting Program:A control research study with inner-city black families. Unpublished manuscript, Studio City, California, Center for Improvement of Child Caring. Patterson, G. R. (1974). Retraining of aggressive boys by their parents..Review of the literature and follow-up evaluation. Canadian Psychiatric Association Journax 19, 142-161. Patterson, G. R. (1975). Multiple evaluations of a parent-training program. In T. Thompson, T. (Ed.). Applications of behavior modification (pp. 299322). New York: Academic Press. Rogers, T. R., Forehand, R, Griest, D. L., Wells, K. C., & McMahon, R. J. (1981). Socioeconomic status: Effects on parent and child behaviors and treatment outcome of parent training.Journal of Clinical Child Psychology, 10(2), 98-101. 38 A Practitioner's Guide Santisteban, D. A., Szapocznik, J., Perez-Vidal, A., Kurtines, W. M., Murray, E. J., & LaPerriere, A. (in press). Efficacy of interventions for engaging youth/ Families into treatment and some factors that may contribute to differential effectiveness. Journal of Family Psychology. Spoth, R., & Redmond, C. (1995). "A theory-based model of protective parenting processes incorporating intervention attendance effects. Unpublished manuscript, Social and Behavioral Research Center for Rural.Health, Iowa State University, Ames, Iowa. Spoth, R., Redmond, C., Haggerty, K., & Ward, T. (1995). A controlled parenting skills outcome study examining individual difference and attendance effects. Journal of Marriage and the Family, 57, 449-464. Szapocznik, J., Santisteban, D., Rio, A., Perez-Vidal, A., Kurtines, W M., & Hervis, D.E. (1986). Bicultural effectiveness training: An intervention modality for families experiencing intergenerational/intercultural conflict. Hispanic journal of Behavioral Sciences, 8, 303-330. Szapocznik, J., Santisteban, D., Rio, A., Perez-Vidal, A., Santisteban, D., & Kurtines, W M. (1989). Family effectiveness training. An intervention to prevent drug abuse and problem behaviors in Hispanic adolescents. Hispanic Journal of Behavioral Sciences, 11 (1), 4-•-27. Thompson, R. W, Grow, C. R., Ruma, P. R., Daly, D. L., & Burke, R. V. (1993). Parent education: Evaluation of a practical parenting program with middle- and low-income families. Family Relations, 42 (1), 21--25. Tremblay, R E., McCord, J., Boileau, H., Charlebois, P., Gagnon, C., Le Blanc, M., & Larivee, S. (1991). Can disruptive boys be helped to become competent? Psychiatry, 54, 148-161. Wahler, R. G., Cantor, P G., Fleischman, J., & Lambert, W. (1993). The impact of synthesis reaching and parent training with mothers of conduct-disordered children. journal of Abnormal Child Psycholog 21 (4), 425-440. Webster-Stratton, C. (1984). Randomized trial of two parent-training programs for families with conduct-disordered children. Journal of Consulting and Clinical Psychology, 52 (4), 666-678. Webster-Stratton, C. (1990a). Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children. journal of Abnormal Child Psychology, 18 (5), 479-492. Webster-Stratton, C. (1990b). Long-term follow-up of families with young conduct-problem children: From preschool to grade school. Journal of Clinical Child Psychology, 1.9 (2), 144-149. Preventing Substance Abuse Among Children and Adolescents 39 Webster-Stratton, C., Kolpacoff', M., & Hollinsworth, T (1988). Self-administered videotape therapy for families with conduct-problem children: Comparison with two cost-effective treatments and a control group.journal of Consulting and Clinical Psychology, 56(4), 558-566. Webster-Stratton, C., Kolpacoff, M., & Hollinsworth, T. (1989). The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children. journal of Consulting and Clinical Psychology, 57(4), 550-553. Wolchik, S. A., Fest, S. G., Westover, S., Sandler, I. N., Martin, A., Lustig,J., Tein, J. Y., & Fisher, J. (1993). The children of divorce parenting intervention: Outcome evaluation of an empirically based program. American journal of Community Psychology, 21 (3), 293--330. Practice Evidence The Communication and Parenting Skills program. Milwaukee, Wisconsin. The Creating Lasting Impressions program of the Council on Prevention and Education. Substances. Louisville, Kentucky. The Families in Focus program of Cottage Program International. Salt Lake City, Utah. The Families and Schools Together program of Family Service. Madison, Wisconsin. The I{ansas Family Initiative of the Kansas Department of Social and Rehabilitation Services. Topeka, Kansas. The Nurturing Program for Parents and Children. Eau Claire, Wisconsin. The Parenting fir.Prevention program of the King County Department of Alcohol and Substance Abuse Services. Seattle, Washington. Family In-Home Support Research Evidence Berry, M. (1992). An evaluation of family preservation services. Fitting agency services to family needs. Social Work, 37(4), 314-321. Borduin, C. M., Mann, B. J., Cone, L. T., Henggeler, S. W, Fucci, B. R., Blaske, D. M., & Williams, R. A. (1995). Multisystemic treatment of serious juvenile, offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63, 569-578. Haapala, D. A., & Kinney, J. M. (1988). Avoiding out-of-home placement of high-risk status offenders through the use of intensive home-based family preservation services. Criminal justice and Behavior, 15 (3), 334--348. 40 A Practitioner's Guide Henggeler, S. W, Melton, G. B., & Smith, L. A. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology 60(6), 965-961. Henggeler, S. W, Melton, G. B.; Smith, L. A., Schoenwald, S. K., & Hanley, J. H. (1993). Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders.,journal of Child' and Family Studies, 2 (4), 283-293. Lutzker, J. R., & Rice, J. M. (1987). Using recidivism data to evaluate Project 12-gays: An ecobehavioral approach to the treatment and prevention of child abuse and neglect. Journal of Family Violence, 2 (4), 283--290. Lutzker,J. R., Wesch, D., & Rice,J. M. (1984). A review of Project 12-Ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect. Advances in Behaviour Research and Therapy, G, 63--73. Walton, E., Fraser, M. W:, Lewis, R. E., Pecora, P. J., &Walton, W. K (1993). In-home family-focused reunification: An experimental study. Child Welfare, ,72(5), 473-487. Pfactice Evidence The In-Home Care Demonstration Projects of the Office of Child Abuse Prevention, Department of Social Services, State of California. Sacramento, California. The Intensive Family Preservation Services of the State of Connecticut. Hartford, Connecticut. Family Therapy Research Evidence Alexander, J. E, & Parsons, B. V. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81 (3), 219-225. Barton, C., Alexander, J. E, Waldron, H., Turner, C. W, &Warburton, J. (1985). Generalizing treatment effects of functional family therapy: Three replications. American Journal ofFamily Therapy, 13 (3), 16-26. Gordon, D. A., Arbuthnot, J., Gustafson, K E., & McGreen, P. (1988). Home-based behavioral-system family therapy with disadvantaged juvenile delinquents. American,journal of Family Therapy, 16(3), 243-255. Henggeler, S. W., Rodick,J. D., Borduin, C. M., Hanson, C. L., Watson, S. M., & Urey, J. R. (1986). Multisystemic treatment of juvenile offenders. Effects on adolescent behavior and family interaction. Developmental Psychology, 22 (1), 132-141. Preventing Substance Abuse Among Children and Adolescents 41 ��JJ r-a,•'S Klein, N. C., Alexander, J. F., & Parsons, B. V. (1977). Impact of Gamily systems intervention on recidivism and sibling delinquency: A model of primary prevention and program evaluation. Journal of Consulting and Clinical Psychology, 45 (3), 469-474. Mann, B.J., Borduin, C. M., Henggeler, S. W., & Blaske, D. M. (1990). An investigation of systemic conceptualizations of parent-child coalitions and symptom change. Journal of Consulting and Clinical Psychology, 58 (3), 336-344. McPherson, S .J., McDonald, L. E, & Ryer, C. W. (1983). Intensive counseling with families of juvenile offenders. Juvenile tr Family Court Journa4 34, 27--33. Sandsteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Mitrani, V., Jean-Gilles, M., & Szapocznik, J. (1995). Brief structuraUstrategic family therapy with African American and Hispanic high-risk youth. Unpublished manuscript, Miami, Center for Family Studies, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine. Springer,J. E, Phillips, J. L., Phillips, L., Cannady, L. P., & Kerst-Harris, E. (1992). CODA: A creative therapy program for children in families affected by abuse of alcohol or other drugs. OSAP special issue. Journal of Community Psychology, 55-74. Szapocznik,J., Murray, E., Scopetta, M., Hervis, O., Rio, A., Cohen, R., Rivas-Vazquez, A., Posada, V., & Kurtines, W (1989). Structural family versus psychodynamic child therapy for problematic Hispanic boys. Journal of Consulting and Clinical Psychology, 57(5), 571-578. 42 A Practitioner's Guide Appendix A: criteria for Establishing Levels of Evidence of Effectiveness he following descriptions are intentionally brief For a more rigorous defini- tion of the criteria, refer to the reference guide, STRONG LEVEL. OF EVIDENCE Consistent results of strong or medium effect from: • At least three studies with experimental or quasi-experimental designs and • The use of at least two different methodologies OR • Two studies with experimental or quasi-experimental designs and • At least three case studies MEDIUM LEVEL OF EVIDENCE Consistent positive results from; • At least two studies with experimental or quasi-experimental designs and • The use of at least two different methodologies OR Preventing Substance Abuse Among Children and Adolescents 43 • One study with experimental or quasi-experimental design and • At least three case studies SUGGESTIVE BUT INSUFFICIENT EVIDENCE Research or practice evidence that: • Is based on a plausible rationale or on previous research and • Is being demonstrated in well-designed studies or programs currently in process • Minimally demonstrates that the intervention being tested is linked to a positive effect SUBSTANTIAL EVIDENCE OF INEFFECTIVENESS Research and practice evidence demonstrating that a prevention approach is not ef- fective. The criterion for inclusion in this category is a statistically significant nega- tive effect in a majority of competently done studies, including at least two quantitative studies with sample sizes sufficient to rest for the significance of the effect. r 44 A Practitioner's Guide Appendix B: Abbreviations and Glossary of Terms Used in Family-Centered Approaches to SubstanceAbuse Prevention ABBREVIATIONS AGOG American College of Obstetricians and Gynecologists ADHD Attention-Deficit Hyperactivity Disorder AFDC Aid to Families with Dependent Children AHCPR Agency for Health Care Policy and Research AIDS Acquired Immunodeficiency Syndrome AODs Alcohol and Other Drugs ATP Adolescent Transitions Program BET Bicultural Effectiveness Training CAPS Communication and Parenting Skills CDC Centers for Disease Control and Prevention COSSMHO National Coalition for Hispanic Health and Human Services CSAP Center for Substance Abuse Prevention LSAT Center for Substance Abuse Treatment DHHS U.S. Department of Health and Human Services FAST Families and Schools Together FET Family Effectiveness Training FF'T' Functional Family Therapy FRP Federal Resource Panel Preventing Substance Abuse Among Children and Adolescents 45 GDVM Group Discussion-oriented Basic Parent Skills Training Program HTV Human Immunodeficiency Virus HPV Human Papillomavirus IOM Institute of Medicine IVM Individually Self-administered Videotaped Modeling (Treatment) IVMC IVM Treatment plus Therapist Consultation LSD Lysergic Acid Diethylamide MDMA 3-4-Methylenedioxymethamphetamine MST Multisystemic Therapy NCHS National Center for Health Statistics NHIS National Health Interview Survey NHSDA National Household Survey on Drug Abuse NIAA National Institute on Alcohol Abuse and Alcoholism NIDA National Institute on Drug Abuse NPHS National Pregnancy and Health Survey NPN National Prevention Network ONDCP Office of National Drug Control Policy OSAP Office for Substance Abuse Prevention (now CSAP) PCP Phencyclidine PDFY Preparing for the Drug-Free Years (Program) PEPS Prevention Enhancement Protocols System PHS Public Health Service PSST Problem-Solving Skills Training SAMHSA Substance Abuse and Mental Health Services Administration SFT Structural Family Therapy SSA Single State Agency (State Substance Abuse agency) STD Sexually Transmitted Disease TIP Treatment Improvement Protocol TOT Training of Trainers YRBSS Youth Risk Behavior Surveillance System 46 A Practitioner's Guide GLOSSARY Adjustment Disorder—a behavior-related disorder in which a person exhibits clini- cally significant emotional or behavioral symptoms in response to a psychosocial stressor. Includes distress in excess of expectations or significant impairment in social .or academic, functioning. See attention-deficit hyperactivity disorder, conduct disor- der, and oppositional defiant disorder. Antisocial and Other Problem Behaviors—can describe behavior-related problems (e.g., poor conduct and impulsiveness), behavior-related disorders (e.g., attention-deficit hyperactivity disorder), or both. Assignment—the process by which researchers place study subjects in an interven- tion, control, or comparison group. Experimental design studies randomly assign study subjects to both intervention and control conditions.Quasi-experimental studies nonrandomly assign study subjects to intervention and comparison conditions. Ran- dom assignment increases the likelihood that the intervention and control groups`are equal or comparable and have similar characteristics. Attention-Deficit Hyperactivity Disorder--a behavior-related disorder in which there is a persistent pattern of inattention and/or hyperactivity and impulsivity. See adjust- ment disorder, conduct disorder, and oppositional defiant disorder. Attrition—an unplanned reduction in the size of the study sample caused by partici pants dropping out of the evaluation, such as due to relocation. Behavioral Factor---a certain pattern of conduct that may be associated with sub- stance abuse-related attitudes or behavior. Most prominent in substance abuse pre- vention efforts are behavioral factors that lead to the perception of substance use or related conditions as functional or appropriate. See environmental factor, personal factor, and sociodemographic factor. Behavior-Related Disorder--a specific behavioral problem that occurs in persistent patterns and characteristic clusters and causes clinically significant impairment. See behavior-related problem. Behavior-Related Problem—a behavioral problem that is isolated or intermittent and is not part of a persistent behavior pattern and that varies in severity and serious- ness of its consequences. See behavior-related disorder. Bias---the extent to which a measurement, sampling, or analytic method systemad- cally underestimates or overestimates the true value of an attribute. In general, biases are sources of systematic errors that arise from faulty designs, poor data collection procedures, or inadequate analyses. These errors diminish the likelihood that ob- served outcomes are attributable to the intervention. Preventing Substance Abuse Among Children and Adolescents 47 Case Study—a method for learning about a complex instance, based on a compre- hensive understanding of that instance, obtained by extensive description and analy- sis of the instance, taken as a whole and in its context. Conduct Disorder—a behavior-related disorder in which there is a repetitive and persistent pattern of violating the basic rights of others or major age-appropriate societal norms or rules. It can include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules. Sea adjustment dis- order, attention-deficit hyperactivity disorder, and oppositional defiant disorder. Community---a group of individuals who share cultural and social experiences within a common geographic or political jurisdiction. Community-Based Approach a prevention approach that focuses on the problems or needs of an entire community, including large cities,small towns, schools,worksites, and public places. See individual-centered approach. Community Readiness--the degree of support for or resistance to identifying sub- stance use and abuse as significant social problems in the community. Stages of com- munity readiness for prevention provide an appropriate framework for understanding prevention readiness at the community or State level. See community tolerance, con- firmation/expansion, denial, initiation, institutionalization, preparation, preplanning, professionalization, and vague awareness. Community Tolerance—a condition in which community norms actively encourage problematic behavior, which is viewed as socially acceptable. See community readi- ness. Comparison Group--in quasi-experimental evaluation design, a group of evalua- tion participants that is not exposed to the intervention. This term usually implies that participants are not randomly assigned, but have characteristics similar to the intervention group. See control group. Conceptual Framework--in this guideline, the philosophical basis for a prevention approach. Specifically, the assumed reasons or hypotheses that explain why the inter- ventions in a specific prevention approach should work. Confirmation/Expansion---the stage in which existing prevention programs are viewed as effective and authorities support expansion or improvement of the efforts. Data are routinely collected at this stage, and there is a clear understanding of the local problem and the risk factors for the problem. New programs are being planned to reach other community members at this stage. See community readiness. Construct--an attribute, usually unobservable, such as educational attainment or socioeconomic status, that is represented by an observable measure. 48 A Practitioner's Guide nt :tualism--a theory that all behavior must be understood within the content of its occurrence. Context is broadly defined to include not only transactions between an individual and his or her immediate environment, but also between and among the individual and the domains of family, school, peers, community, and the larger societal or global environment. See developmental pathways model, social develop- ment model, and social ecology model. Control Group—in experimental evaluation design, a group of participants that is essentially similar to the intervention group but is not exposed to the intervention. Participants are designated to be part of either a control or intervention group through random assignment. See comparison group. Conventional Primary Prevention-substance abuse prevention approaches that fo- cus on deterring initial use. See conventional secondary prevention. Conventional Secondary Prevention—psychology-based substance abuse preven- tion approaches that encourage people to stop. See conventional primary prevention. Correlational lysis---a form of relational analysis that assesses the strength and direction of association between variables. Cross-Sectional Design—a research design that involves the collection of data on a sample of the population at a single point in time. When exposure and health status data are collected, measures of associations between them are easily computed. How- ever, lowever, because health status and exposure are measured simultaneously, inferences cannot be made that the exposure muses the health status. Data—information collected according to a methodology using specific research methods and instruments. Data Analysis---=the process of examining systematically collected information. Denial--rhe stage in which the behavior is not usually approved of according to community norms. At this stage, people are aware that the behavior is a problem but believe that nothing needs to or can be done about the behavior at a local level. See community readiness. Design---often referred to as research or study design. An outline or plan of the procedures to be followed in scientific experimentation in order to reach valid con- clusions. See experimental design, nonexperimental design, quasi-experimental de- sign, and pre-post test. Designer Drug a substance that is a synthetic analogue of a controlled substance, manufactured illegally for the specific purpose of abuse. Created by making minor changes in the molecular structure of substances such as amphetamines. Preventing Substance Abuse Among Children and Adolescents 49 Developmental Pathways Model—a model that argues that the presence of certain risk factors in a child's life, whether individual, Familial, or social in nature, can pre- dispose him or her to engage in negative behaviors, which in turn may lead to addi- tional adverse events and circumstances and further counterproductive and disadvantageous interactions. See contextualism, social development model, and so- cial ecology model. Dual Diagnosis—a term used to describe the phenomenon of coexisting psychiatric and substance abuse disorders. Effect a result, impact, or outcome. In evaluation research, attributing an effect to a program or intervention requires establishing, through comparison, a logical rela- tionship between conditions with and without the program or intervention. . Effectiveness—the degree to which a prevention approach or intervention achieves specified objectives or outcomes. See effectiveness evaluation and efficacy evaluation. Effectiveness Evaluation—an evaluation that assesses an intervention under practice conditions.—typically, the implementation of an intervention in the field. See effec- tiveness and efficacy evaluation. Efficacy Evaluation---an evaluation used when an intervention is assessed under optimal program conditions--usually a well-funded project conducted by research- ers. See effectiveness and effectiveness evaluation. Environmental Factor a factor that is external or is perceived to be external to an individual but that may nonetheless affect his or her behavior. A number of these factors are related to the individual's family of origin, while others have to do with social norms and expectations. See behavioral factors, personal factor, and sociodemographic factor. Experimental Design—a research design that includes random selection of study subjects, an intervention and a control group, random assignment to the groups, and measurements of both groups. Measurements are typically conducted before and al- ways after the intervention. The results obtained from these studies typically yield the most interpretable, definitive, and defensible evidence of effectiveness. See de- sign, nonexperimental design, pre-post test, and quasi-experimental design. External Validity—the extent to which outcomes and findings apply (or can be gen- eralized) to persons, objects, settings, or times other than those that were the subject of the study. See validity. Family—parents (or persons serving as parents) and children who are related either through biology or through assignment of guardianship, whether formally (by law) so A Practitioner's Guide or informally, and who are actively involved together in family life—sharing a social network, material and emotional resources, and sources of support. Family In-Hoare Support—a prevention approach that addresses risk and protective Factors by focusing on preserving families through intervention in their home envi- ronments. See family therapy and parent and family skills training. Family Support—a proactive construct that views parenting as a developmentally learned task for all families and affirms that strategies for delivering family services should be rooted in a community support system. See resilience. Family Therapyl­a prevention approach that provides professionally led counseling services to a family for the purpose of decreasing maladaptive family functioning and negative behaviors and increasing skills for healthy family interaction. See family in-home support and parent and family skills training. Focus Group--a qualitative research method consisting of a structured discussion among a small group of people with shared characteristics. Focus groups are designed to identify perceptions and opinions about a specific issue.They can be used to elicit feedback from target group subjects about prevention strategies. Formative Evaluation—a process that is concerned with helping the developer of programs or products through the use of empirical research methodology.Also called feedback evaluation. Fugitive Literature--articles or materials of a scientific or academic nature that are typically unpublished, informally published, or not readily available to the scientific community, such as internal reports and unpublished manuscripts. In this guideline, some practice cases are considered fugitive literature. Gatevmy Hypothesis---a hypothesis which states that the use of alcohol and tobacco at an early age is associated with progression to illicit drug use and greater involve- ment with drugs at older ages. Heavy Drinker—a person who consumes 2 or more alcoholic beverages per day or 14 or more alcoholic beverages per week. Incidence---the number of nese cases of a disease or occurrences of an event in a par- ticular period of rime, usually expressed as a rate with the number of cases as the nu- merator and the population at risk as the denominator. Incidence rates are often presented in standard terms, such as the number of new cases per 100,000 population. Indicated preventive Measure--a preventive measure that is directed to specific in- dividuals with known, identified risk factors. See preventive measure, selective pre- ventive measure, and universal preventive measure. Preventing Substance Abuse Among Children and Adolescents 51 Individual-Centered Approach—a prevention approach that focuses on the prob- lems and needs of the individual. See community-based approach. Initiation—the stage in which a prevention program is under way but is still "on trial." Community members often have great enthusiasm for the effort at this stage because obstacles have not yet been encountered. See community readiness. Institutionalization—occurs when several programs are supported by local or State governments with established (but not permanent) funding. Although the program is accepted as a routine and valuable practice at this stage, there is little perceived need for change or expansion of the effort. See community readiness. Instrument—a device that assists evaluators in collecting data in an organized fash- ion, such as a standardized survey or interview protocol. See methodology. Intermediate Outcome--an intervention outeorttc, such as changes in knowledge, attitudes, or beliefs, that occurs prior to and is assumed to be necessary for changes in an ultimate or long-term outcome, such as prevention of or decreases in substance use and substance-related problems. Internal Validity—the ability to make inferences about whether the relationship be- tween variables is causal in nature and, if it is, the direction of causality. Intervention--a manipulation applied to a group in order to change behavior. In substance abuse prevention, interventions at the individual or environmental level may be used to prevent or lower the rate of substance abuse or substance abuse-related problems. Intended Measurable Outcome--in this guideline, the overall expected consequences and results of the interventions within each prevention approach. Lesson Learned---in this guideline, a conclusion that can be reached about a specific prevention approach that is based on the research and practice evidence reviewed to evaluate that prevention approach. Longitudinal Data---observations collected over a period of time; the sample may or may not be the same each time (sometimes called time series dara). Maturation Effect—a change in outcome that is attributable to participants} grow- ing wiser, stronger, more experienced, and the like, solely through the passage of time. Mean=the arithmetic average of a set of numeric values. Methodology a procedure for collecting data. See instrument. 52 A Practitioner's Guide ..,.,:,,•......:. . :..:N::: Multicomponent Program--a prevention approach that simultaneously uses mul- tiple interventions that target one or more substance abuse problems. Programs that involve coordinated multiple interventions are likely to be more effective in achiev- ing the desired goals than single-component programs and programs that involve multiple but uncoordinated interventions. See single-component program.. Multivariate---an experimental design or correlational analysis consisting of many dependent variables. See variable. Nonexperimental Design--a type of research design that does not include random assignment or a control group. With such research designs, several factors prevent the attribution of an observed effect to the intervention. See design, experimental design, pre-post test, and quasi-experimental design. Oppositional Defiant Disorder-a behavior-related disorder showing a recurrent pattern of negative, defiant, disobedient, and hostile behavior toward authority fig- ures. Includes some features of conduct disorder, but does not include the persistent pattern of violating the rights of others or major societal norms or rules. See adjust- ment disorder, attention-deficit hyperactivity disorder, and conduct disorder. Outcome Evaluation or Summative Evaluation—analysis that focuses research ques- tions on assessing the effects of interventions on intended outcomes. See process evaluation and program evaluation. Parent and.Family Skills Training a prevention approach in which parents are trained to develop new parenting skills and children are trained to develop prosocial skills. See family in-home support and family therapy. Personal Factor---a cognitive process, value, personality construct, and sense of psy- chological well-being inherent to an individual and through which societal and envi- ronmental influences are filtered. See behavioral factor, environmental factor, and sociodemographic.factor. Practice Evidence—information obtained from prevention practice cases, which are generally compiled in the form of case studies and often include information about evaluating program implementation and procedures. See research evidence. Pre-Post 'Fest—in research design, the collection of measurements before and after an intervention to assess its effects. See design, experimental design, nonexperimental design, and quasi-experimental design. Preparation—the stage in which plans are being made to prevent the problem, lead- ership is active, funding is being solicited, and program pilot testing may be occur- ring. See community readiness. Preventing Substance Abuse Among Children and Adolescents 53 Preplanning—the stage in which there is a clear recognition that a problem with the behavior exists locally and that something should be done about it. At this stage, general information on the problem is available and local leaders needed to advance change are identifiable, but no real planning has occurred. See community readiness. Prevalence—the number of all new and old cases of a disease or occurrences of an event during a particular period of time, usually expressed as a rate with the number of cases or events as the numerator and the population at risk as the denominator. Prevalence rates are often presented in standard terms, such as the number of cases per 100,000 population. Prevention Approach--a group of prevention activities that broadly share common methods, strategies, assumptions (theories or hypotheses), and outcomes. Preventive Measure--a cluster of interventions that share similarities with regard to the population groups among which they are optimally used. See indicated preven- tive measure, selective preventive measure, and universal preventive measure. Primary Prevention—efforts that seek to decrease the number of new cases of a disorder. See secondary prevention and tertiary prevention. Probability Sampling—a method for drawing a sample from a population such that all possible samples have a known and specified probability of being drawn. Proem .Evaluation—an assessment designed to document and explain the dynamics of a new or continuing prevention program. Broadly, a process evaluation describes what happened as a program was started, implemented, and completed. A process evaluation is by definition descriptive and ongoing. It may be used to the degree to which prevention program procedures were conducted according to a written pro- gram plan. See outcome evaluation or summative evaluation and program evalua- tion. Professionalization—the stage in which detailed information has been gathered about the prevalence, risk factors, and etiology of the local problem. At this point, various programs designed to reach general and specific target audiences are under way. Highly trained staff run the program, and community support and involvement are strong. Also at this stage, effective evaluation is conducted to assess and modify programs. See community readiness. Program Evaluation---the application of scientific research methods to assess pro- gram concepts, implementation, and effectiveness. See outcome evaluation or summative evaluation and process evaluation. 54 A Practitioner's Guide Promotion Model—a method of enhancing and making the most of people's posi- tive functioning through the development and improvement of competence and ca- pabiliries that strengthen people's functioning and their capacity to adapt. Protective Factor---an influence that inhibits, reduces, or buffers the probability of drug use, abuse, or a transition to a higher level of involvement with drugs. See risk factor. Qualitative Data—contextual information in evaluation studies that usually describes participants and interventions. Often presented as text, the strength of qualitative data is their ability to illuminate evaluation findings derived from quantitative meth- ods. See quantitative data. Quantitative Data—in evaluation studies, measures that capture changes in targeted outcomes (e.g., substance use) and intervening variables.(e.g., attitudes toward use). The strength of quantitative data is their use in testing hypotheses and determining the strength and direction of effects. See qualitative data. Quasi-Experimental Design—a research design that includes intervention and com- parison groups and measurements of both groups, but in which. assignment to the intervention and comparison conditions is not done on a random basis. With such research designs, attribution of an observed effect to the intervention is less certain than with experimental designs. See design, experimental design, nonexperimental design, and pre-post test. Questionnaire—research instrument that consists of written questions, each with a limited set of possible responses. Random Assignment--the process through which members of a pool of eligible study participants are assigned to either the intervention group or a control group on a random basis, such as through the use of a table of random numbers. Reliability-the extent to which a measurement process produces similar results on repeated observations of the same condition or event. Reliable Measure—a measure that will produce the same result (score) when applied two or more times. See valid measure. Representative Sample•----a segment of a larger body or population that mirrors in composition the characteristics of the larger body or population. Research—the systematic effort to discover or confirm facts by scientific methods of observation and experimentation. Preventing Substance Abuse Among Children and Adolescents 55 Research Evidence—information obtained from research studies conducted to evaluate the effectiveness of an intervention and published in peer-reviewed journals. See prac- tice evidence. Resilience---either the capacity to recover from traumatically adverse life events (e.g., the death of a parent, divorce, sexual abuse, homelessness, or a catastrophic event) and other types of adversity so as to achieve eventual restoration or improvement of competent functioning; or the capability to withstand chronic stress (e.g., extreme poverty, alcoholic parents, chronic illness, or ongoing domestic or neighborhood vio- lence) and to sustain competent functioning despite ongoing stressful and adverse life conditions. See family support. Risk Factor—a condition that increases the likelihood of substance abuse. See pro- tective factor. Secondary Prevention---efforts that seek to lower the rate of established cases. See primary prevention and tertiary prevention. Selective Preventive Measure—a preventive measure that is directed to subgroups of the populations that have a higher than average risk for developing a problem or disorder. See indicated preventive measure, preventive measure, and universal pre- ventive measure. Simple Random Sample--in experimental research designs, a sample derived from indiscriminate selection from a pool of eligible participants, such that each member of the population has an equal chance of being selected for the sample. See stratified' random sample. Single-Component Program--a prevention approach using a single intervention or strategy to target one or more problems. See multicomponent program. Social Development Model—a model that seeks to explain behaviors that are them- selves risk factors for substance abuse by specifying the socialization processes (the interaction of developmental mechanisms carried out through relationships with fam- ily, school, and peers) that predict such behaviors. See contextualism, developmental pathways model, and social ecology model. Social Ecology Model—a model that posits that an adolescent's interactions with social, school, and family environments ultimately influence substance abuse and other antisocial behaviors. It also emphasizes the importance of increasing opportu- nities within the social environment for youth to develop social competencies and self-efficacy. See contextualism, developmental pathways model, and social develop- ment model. 56 A Practitioner's Guide Sociodemographic Factor---a social trend, influence, or population characteristic that affects substance abuse-related risks, attitudes or behaviors. Such factors have an indirect but powerful influence because of.rhe limitations of the political, social, economic, and educational systems of society. See behavioral factor, environmental factor, and personal factor. Statistical Significance---the strength of a particular relationship between variables. A relationship is said to be statistically significant when it occurs so frequently in the data that the relationship's existence is probably not attributable to chance. Stratified :Random Sample—in experimental research designs, a sample group de- rived from indiscriminate selection from different subsegments of a pool of eligible participants (e.g., men and women). See simple random sample. Substance .Abuse---the consumption of psychoactive drugs in such a way that it sig- nificantly impairs an individual's functioning in terms of physical, psychological, or emotional health; interpersonal interactions; or functioning in work, school, or so- cial settings. The use of psychoactive drugs by minors is considered substance abuse. Tertiary Prevention---efforts that seek to decrease the amount of incapacity associ- ated with an existing condition. See primary prevention and secondary prevention. Threats to Internal Validity----the factors other than the intervention that evaluators must consider when a program evaluation is conducted, regardless of the rigor of the evaluation design, that might account for or influence the outcome. They diminish the likelihood that an observed outcome is attributable to the intervention. Time-Series Design—a research design that involves an intervention group evalu- ated at least once before the intervention and retested more than once after the inter- vention. A time-series analysis involves the examination of fluctuations in the rates of a condition over a long period in relation to the rise and fall of a possible causative agent. Universal Preventive Measure®-a preventive measure that is directed to a general population or a general subsection of the population that has not been identified on the basis of risk factors, but for which the prevention activity could reduce the likeli- hood of problems developing. See indicated preventive measure, preventive measure, and selective preventive measure. Vague Awareness--the stage in which there is a general feeling that a behavior is a local problem that requires attention. However, knowledge about the extent of the problem is sparse, there is little motivation to take action to prevent it, and there is a lack of leadership to address it. See community readiness. Preventing Substance Abuse Among Children and Adolescents 57 ....................... Valid Measure---an accurate assessment of what the evaluator wants to measure. See reliable measure. Validity—the ability of an instrument to measure what it purports to measure. See external validity. Variable--a factor or characteristic of the intervention, participant, and/or the con- text that may influence or be related to the possibility of achieving intermediate and long-term outcomes. See multivariate. NOTE: This glossary is based partially on work performed by Westover Consultants, Silver Spring, Maryland, and the Pacific Institute for Research and Evaluation, Bethesda, Maryland, under other contracts with the Center for Substance Abuse Prevention. 58 A Practitioner's Guide „ < Appendix Q Resource Guido his Resource Guide provides suggestions for family-centered resources. The first section lists names and addresses of researchers and practitioners whose work was considered as evidence in evaluating the various intervention pro- grams. Names and addresses reflect information that was current at the time these individuals were last involved with PEPS. Because detailed descriptions of their pro- gram planning and content are beyond the scope of this guideline (and often are not fully described in their published works), CSAP thought that those interested in implementing specific strategies might want to obtain more detailed information directly from these researchers and practitioners. The second section of this appen- dix lists the various Federal Government agencies and nongovernment organizations that provide information, resources, and guidance regarding f=iilyr related interven- tions and programs. Some of these organizations have information clearinghouses. It also lists examples of foundations that provide support for family-centered interven- tions or research. Some of the foundations also provide educational materials for practitioners or the lay public. Preventing Substance Abuse Among Children and Adolescents 58 RESEARCHERS AND PRACTITIONERS Researchers Georgia Aktan, Ph.D. Marianne Berry, Ph.D. Needs Assessment Studies School of Social Work Michigan Department of Public University of Texas at Arlington Health Arlington, TX 76019 Center for Substance Abuse Services 3423 Martin Luther King, Jr. Charles Borduin, Ph.D. Boulevard Department of Psychology P.O. Box 30195 University of Missouri, Columbia Lansing, MI 48909 21 McAlester Hall Columbia, MO 65211 James Alexander, Ph.D. Department of Psychology Richard Catalano, Ph.D. University of Utah Social. Development Research Group Salt Lake City, UT 84112 School of Social Work University of Washington Arthur Anastopoulos, Ph.D. 146 North Canal Street Department of Psychiatry Suite 211, XD-50 University of Massachusetts Medical Seattle, WA 98103 Center 55 Lake Avenue North Thomas Dishion, Ph.D. Worcester, MA 01655 Oregon Social Learning Center Lew Bank, Ph.D. 207 East Fifth Avenue, Suite 202 Oregon Social Learning Center Eugene, OR 97401 207 East Fifth Avenue, Suite 202 Robert Felner, Ph.D. Eugene, OR 97401 National Center on Public Education and Social Polity Cole Barton, Ph.D. University of Rhode Island Psychology Department Shephard Building, Room 300 Davidson College 80 Washington Street Davidson, NC 28036 Providence, RI 02903 Martha Bernal, Ph.D. Matthew Fleischman, Ph.D. Department of Psychology Family Research Associates Arizona State University 81 East 14th Street Box 871104 Eugene, OR 97401 Tempe, AZ 85287-1104 60 A Practitioner's Guide t.r Rex Forehand, Ph.D. Alan Kazdin, Ph.D. Institute for Behavioral Research Department of Psychology Psychology Department 'Yale University Barrow Hall, Room 111 P.U. Box I IA University of Georgia Yale Station Athens, GA 30602 New Haven, CT 06520-7447 Donald Gordon, Ph.D. Michael Klein, Ph.D. Department of Psychology Department of Educational Ohio University Psychology Athens, OH 45701-2979 University of Wisconsin—Milwaukee P.O. Box 413 Louise Guerney, Ph.D. Milwaukee, WI 53201 Individual and Family Consultation Center Patricia Knapp, Ph.D. The Pennsylvania State University Department of Psychology University Park, PA 16802 University of Maryland Baltimore County David Hawkins, Ph.D. 1000 Hilltop Circle Social Development Research Group Baltimore, MD 21250 School of Social Work University of Washington Rick Kosterman, Ph.D. 146 North Canal Street Social Development Research Group Suite 211, SC-50 School of Social Work Seattle, WA 98195 University of Washington 9725 3rd Avenue, N.E., Suite 401 Scott Henggeler, Ph.D. Seattle, WA 98115 Department of Psychiatry and Behavioral Sciences Karol Kumpf9er, Ph.D. Medical University of South Carolina Department of Health Education 171 Ashley Avenue PIPER N-215 (Annex 2007) Charleston, SC 29425 University of Utah Salt Lake City, UT 84112 Nicholas Ialongo, Ph.D. School of Hygiene and Public Health Patricia bong, Ph.D. Department of Mental Hygiene Department of Psychology Johns Hopkins University Oklahoma State University 624 North Broadway 215 North Murray Baltimore, MD 21205 Stillwater, OK 74078 Preventing Substance Abuse Among Children and Adolescents 61 . ............................... Barton Mann, Ph.D. Fred Springer, Ph.D. Department of Psychology EMT Associates, Inc. University of Missouri—Columbia 771 Oak Avenue Parkway, Suite 2 210 McAlester Folsom, CA 95630 Columbia, MI 65211 Jose Szapocznik, Ph.D. Hector Myers, Ph.D. Department of Psychiatry Center for the Improvement of Child University of Miami School of Caring Medicine 11331 Ventura Boulevard, Suite 103 University of Miami Studio City, CA 91604 1425 NW 10th Avenue Miami, FL 33136 Gerald Patterson, Ph.D. Oregon Social Learning Center Ronald Thompson, Ph.D. 207 East Fifth Avenue, Suite 202 Program Planning, Research, and Eugene, OR 97401 Evaluation Common Sense Parenting Program John Reid, Ph.D. Father Flanagan's Boys Home Oregon Social Learning Center Boys Town, NE 68010 207 East Fifth Avenue, Suite 202 Eugene, OR 97401 Richard Tremblay, Ph.D. Research Unit on Children's Daniel Santisteban, Ph.D. PsychoSocial Maladjustment Center for Family Studies University of Montreal. Department of Psychiatry and 750 Gouin Boulevard East Behavioral Sciences Montreal, Q.u6bec, Canada H2C IA6 University of Miami School of Medicine Robert Wahler, Ph.D. 1425 NW 10th Avenue Department of Psychology Miami, FL 33136 227 Austin Peay Building University of Tennessee Richard Spoth, Ph.D. Knoxville, TN 37996 Social and Behavioral Research Center for Rural Health Elaine Walton, Ph.D. Center for Family Research in Rural College of Social Work Mental Health Ohio State University Iowa State University 1947 College Road ISU Research Park Columbus, OH 43210 Building 2, Suite 500 2625 North Loop Drive Ames, IA 50010 62 A Practitioner's Guide Carolyn Webster-Stratton, Ph.D. Eileen Carroll Parenting Clinic In-Home Care School of Nursing California Department of Social Box 354801 Services 1107 N.E. 45th Street, Suite 305 Office of Child Abuse Prevention University of Washington 744 P Street, Mail Slot 19-82 Seattle, WA 98105-4631 Sacramento, CA 95814 Peter Wilson, Ph.D. Mary Heckenliable Department of Psychology Intensive Family Preservation Program University of Sydney Hall,Neighborhood House, Inc. Sydney, N.S.W. 2006, Australia 361 Bird Street Bridgeport, CT 06605 Sharlene Wolchik, Ph.D. Department of Psychology Pat Mouton, M.S.W. Arizona State University Parenting for Prevention Program PCS. Box 871104. King County Division of Alcohol and Tempe, AZ 85287-1108 Substance Abuse Services 999 3rd Avenue, Suite 900 Practitioners Seattle, WA 98104 Stephen Bavolek, Ph.D. Ted Strader The Nurturing Program for Parents Creating Lasting Connections and Children Council on Prevention and Education: Family Development Resources Substances 27 Dunnwoody Court 1228 East Breckenridge Street Arden, NC 28704-9588 Louisville, KY 40204 Bernell Boswell Linda Wheeler Families in Focus Program Families and Schools Together The Cottage Program International Program 57 West South Temple, Suite 420 Family Service America Salt Lake City, UT 84101-1511 11700 West Lake Park Drive Herbert Callison Milwaukee, WI 53224-3099 Kansas Family Initiative Kansas Department of Social and Rehabilitation Services PO. Box 47054 . Topeka, KS 66647 Preventing Substance Abuse Among Children and Adolescents 63 ..................... AGENCIES, ORGANIZATIONS, AND FOUNDATIONS Government Agencies Administration for Children and National Child Care Information Families Center 301 Maple Avenue West, Suite 602 • Administration on Children, Vienna, VA 22180 Youth, and Families 330'C Street, S.W., Room 2026 (800) 616-2242 Washington, DC 20201 http://www.ericps.ed.uiuc.edu/nccic (202) 205-8347 • National Clearinghouse on Child Internet: http://www.acf.dhhs.gov Abuse and Neglect Information I'.O. Box 1182 • Children's Bureau Washington, DC 20013-1182 330 C Street, S.W., Room 2070 Washington, DC 20201 (800) FYI-3366 (703) 385-7565 (202) 205-8618 http://www.calib.com/nccanch • Child Care Bureau National Clearinghouse on Families 200 Independence Avenue, S.W and Youth Room 320F P.O. Box 13505 Washington, DC 20201 Silver Spring, MD 20911-3505 (202) 401-6947 (301) 608-8098 • Child Welfare Bureau Office on Child Abuse and Neglect 330 C Street, S.W., Room 2068 330 C Street, S.W, Room 2026 Washington, DC 20201 Washington, DC 20201 (202) 205-8618 (202) 205-8586 • Family and Youth Services Bureau Center for Substance Abuse 330 C Street, S.W, Room 2046 Prevention Washington, DC 20201 National Clearinghouse for Alcohol (202) 205-8102 and Drug Information RO. Box 2345 • Head Start Bureau Rockville, MD 20847-2345 330 C Street, S.W., Room 2058 (800) 729-6686 Washington, DC 20201 http://www.samhsa.gov/csap (202) 205-8573 64 A Practitioner's Guide