Thomas M. Brady, Ph.D. Division of Epidemiology, Services and Prevention Research

1. Continuing Care for Adolescents with Substance Use Disorders: Opportunities for Health Services Research Thomas M. Brady, Ph.D. Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse Department of Health and Human Services AcademyHealth Annual Research Meeting Washington, D.C., June 9, 2008

2. NIDA National Institute on Drug Abuse • Cynthia Campbell, Kaiser Permanente Division • of Research • “Continuing Care & Three-Year Outcomes in Adolescents Who Entered Chemical Dependency Treatment” • Susan Godley, Chestnut Health Systems • “Preliminary Findings from a Randomized Clinical Trial Examining Assertive Continuing Care with Two Types of Outpatient Treatment for Adolescents with Substance Use Disorders” • D. Paul Moberg, University of Wisconsin • “Recovery High Schools as Continuing Care for Adolescents with Substance Use Disorders”

3. Session Objectives • Outline examples of continuing care models serving adolescents at risk for substance use disorders • Highlight some analytic approaches to study continuing care models • Discuss possible health services research questions for further study

4. Learning Objectives • Describe at least two continuing care models serving adolescents at risk for substance use disorders • Discuss at least one approach to study continuing care • Develop possible health services research questions for further study

5. Introduction • Evidence suggests that treatment programs routinely engaging patients in continuing care are likely to have better outcomes than programs that do not offer these services. • Although findings of the effectiveness of continuing care approaches with adult populations continues to grow, • Much less is known about the effects of continuing care with adolescents, and very few outcome studies with this population exist.

6. Continuing Care • A lower intensity phase of treatment that follows an initial high-intensity form of treatment • Often delivered after an outpatient service after an initial residential treatment episode • More recently, an outpatient treatment episode of lower intensity which follows intensive outpatient treatment French, McKay (2008)

7. How Do We Define Continuing Care? • When does treatment end and continuing care begin? • What are the active ingredients of continuing care? • How long do we provide treatment and with what resources? M. Godley & Kaminer (2008)

8. Continuing care Assertive continuing care Aftercare Disease management Step-down care Stepped care Extended interventions Range of Definitions McKay (2008)

9. Continuing Care Models for Adolescents: Great Deal of Programmatic Diversity Services and treatment approaches range from • primary care • mental health • chemical dependency services • community reinforcement approach • case management • home visitation • motivational interviewing • cognitive behavioral therapy • educational counseling

10. Study key dimensions of continuing care in adolescent addiction treatment Such as access, cost-effectiveness, quality and cultural competency At the conclusion of the panel presentations We hope to have a discussion on future approaches and questions for health services research Additional Health Services Research is Needed…

11. Multidisciplinary field of scientific inquiry that: Defining Health Services Research Examines how: Affect: Social Factors Access & Utilization Financing Quality of Care Organization Cost of Care Management Technologies Personal & public health & well being Individual Factors For individuals, families, organizations & institutions, and communities & populations