MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS
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MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW PowerPoint PPT Presentation


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MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW. MINEOLA COMMUNITY TREATMENT CENTER ADDICTION TREATMENT SERVICES ZUCKER HILLSIDE HOSPITAL NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM. Outpatient Substance Abuse Treatment

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MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW

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Matrix intensive outpatient treatment with adolescents martin moskowitz lcsw casac seamus mcentee lmsw

MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTSMartin Moskowitz, LCSW, CASACSeamus McEntee, LMSW


Matrix intensive outpatient treatment with adolescents martin moskowitz lcsw casac seamus mcentee lmsw

MINEOLA COMMUNITY TREATMENT CENTERADDICTION TREATMENT SERVICES ZUCKER HILLSIDE HOSPITAL NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM

  • Outpatient Substance Abuse Treatment

  • Serves Adolescents and Adults

  • Medication Mgmt, Groups, Family Tx

  • STAFF: Social Workers, Counselor, Psychiatrists, Teachers, Interns

  • Medically supervised

  • OASAS Licensed


Intensive outpatient program description

INTENSIVE OUTPATIENT PROGRAM DESCRIPTION

Treatment for Teenagers ages 13 – 18 with Substance Abuse, Mental Health and behavioral problems

Clients attend 5 days / week, Monday – Friday, 9:00 AM – 3:00 PM

Treatment for abuse of any Substance

Psychiatric: ADHD, ODD, Conduct Disorder, Bipolar, LD, H/O SI, Self-Cutting and Inpt, Trauma Hx

Behavioral: Truancy, Failing School, Defiance, Legal Involvement,

Parents required to attend weekly groups


Exploration stage why now

EXPLORATION STAGE WHY NOW

Program was experiencing low completion rate – Concerns that current program was not working

Below census and underutilized

Desire to move from Punitive, Consequence-oriented (TC) to Supportive

Program’s high hurdles – lengthy, at-home client supervision – deterred many families

Greater Awareness of Evidenced-Based Practices


Why matrix

WHY MATRIX

  • As reported by NIDA, studies by Rawson, et al, Matrix was an approach that demonstrated effectiveness

  • Current program and Matrix model shared some similarities: Didactic, Workbooks, Structured, Tx provided through Groups, Self Help

  • Training materials for clinicians, treatment materials for clients, manuals for both make Matrix user-friendly


Matrix components

MATRIX COMPONENTS

Family Sessions

Early Recovery Skills Groups and Relapse Prevention Groups in Intensive Outpatient Level

Social Support Groups following IOP

Urinalysis Screens

Positive Client/Therapist Relationship

Substance Abuse Education for Client & Family

Self-Help Involvement

Manuals, Workbooks, Handouts, Assignments

Time-Limited


Adapting the matrix model

ADAPTING THE MATRIX MODEL

  • Developed for Cocaine and other stimulant abusers

  • Focus on adult populations

  • MCTC implementing for general substance abuse

  • MCTC using for adolescent population


Programmatic differences

PROGRAMMATIC DIFFERENCES

PRE MATRIX

  • Duration of Tx = 8-12 Mon

  • More and longer restrictions

  • Harsher consequences

  • 3-6 mon parental at-home supervision

  • More focus on confronting defenses

  • Lingering TC model

  • Greater potential for fostering dependence

POST MATRIX

  • Tx Duration = 4-6 Mon

  • Fewer and shorter restrictions

  • Supportive and E-B practices: MI, CM, RP

  • 1-2 mon parental supervision

  • More focus on abstinence skills (“The Why” of CD and “The How” of Recovery)

  • Better adapted to treat Co-occurring disorders


Installation stage

INSTALLATION STAGE

Multiple sessions with staff reviewing Matrix material

Re-structuring current IOP

Changed program guidelines, and expectations, rules, privileges, consequences, rewards and length of Tx


Implementation stage

IMPLEMENTATION STAGE

Fidelity Addressed

Consistent at the beginning through supervision and staff meetings

Fidelity Challenges

As supervision focusing on Matrix Maintenance decreased, fidelity also decreased


Staff experience

STAFF EXPERIENCE

PROS:

Group Modality

Measurable interventions

Material is organized and focused on relapse prevention

Offered direction and support

CONS:

Clients complained of repetitive information

Minimal focus on insight

Concerns that lack of consequences will lead to disruptive behavior and compromise safety

Less insight into individual and family dynamics


Staff acceptance

STAFF ACCEPTANCE

Tended to alternate between resistance and acceptance

Initial trepidation followed by acceptance, then commitment  disappointment  perhaps trending to realistic expectations and hope

Overall staff level of Matrix acceptance =

6-7 (0=No Tx Value; 10=Best Tx)


Supervision

Supervision

Much time devoted initially in team meetings as well as individual supervision

Once program was installed, less follow up in meetings or supervision

Focus became group, family and individual psychodynamics


Supervision and fidelity graph

SUPERVISION AND FIDELITY GRAPH


Summary of data 1 year pre 1 year post matrix implementation date 7 09

SUMMARY OF DATA: 1 YEAR PRE & 1 YEAR POST MATRIX IMPLEMENTATION DATE 7/09


Matrix intensive outpatient treatment with adolescents martin moskowitz lcsw casac seamus mcentee lmsw

TOTAL CLIENTS 1 MONTH COMPLETED STARTING PROG. RETENTION PROGRAM


Percent relapse rates pre post matrix

PERCENT RELAPSE RATES: PRE & POST MATRIX


Lessons learned

Lessons Learned

Include consistent Matrix Model review in individual and group supervision sessions

Develop tool to measure Matrix fidelity

Design survey for follow up with clients post treatment

Continue to collect and analyze data on rates of abstinence, retention, completion, improved grades, decreased psychiatric sx’s, decrease in family conflicts

Insight-oriented therapy also needs to be provided as it relates to psychological obstacles to tx and recovery


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