Treatment 2.0: Utilizing Technology for Enhancement of Services and Engagement of Youth

1. Treatment 2.0: Utilizing Technology for Enhancement of Services and Engagement of Youth Bridget Ruiz, M.Ed. Alison Greene, MA Elise Lopez Desiree Bernal Southwest Institute for Research on Women The University of Arizona 181 S. Tucson Blvd Suite 101 Tucson, AZ 85716 bruiz@dakotacom.net Presented at the Strategic Planning for Providers to Improve Business Practices October 21-23, 2009 Arlington, VA

2. Session Outline • Review of media definitions and history • Media utilization in health care • Web 2.0 • Description of Assertive Adolescent and Family Treatment initiative • Enhancing AAFT with media • What’s next? • Emerging issues, recommendations • Acknowledgements/Disclaimer • Sources

3. Media Definitions& HistoryA people without history is like the wind on buffalo grass”-Lakota saying

4. Media Definition • Tools used to store and deliver information or data (Wikipedia, 2009) • The means of communication, as radio and television, newspapers, and magazines, that reach or influence people widely (dictionary.com, 2009)

5. Brief History of Media Grunts and Gestures Hieroglyphics Literacy-Greek Alphabet Morse Code Radio Television Internet Convergent Technologies

6. Media Utilization in Behavioral Health Care: • Electronic health records (Knowles, 2009) • Web-based data collection tools • SAIS (Mulvey, Atkinson, Avula, & Lucky, 2005) • GAIN (Dennis, M.L., Titus, J.C., White, M.K., Unsicker, J., & Hodgkins, D. 2003) • Mail and Telephone Continuing Care Systems (Godley, Coleman-Cowger, Titus, Funk, & Orndorff, in press; Kaminer, Burleson, & Burker, 2008)

7. Web 2.0 Source: Omniture's

8. Assertive Adolescent and Family Treatment (AAFT)I have found the best way to give advice to your children is to find out what they want and then advise them to do it.-Harry S Truman

9. SAMHSA-CSAT Adolescent Initiatives • For more than a decade SAMHSA’s Center for Substance Abuse Treatment (CSAT) has funded a series of initiatives to replicate evidence-based practices and collect information on their effectiveness in the community • CSAT required use of: • Evidence based treatment • Evidence based assessment (Global Appraisal of Individual Needs [GAIN]) Muck et. al., 2009

10. CSAT Adolescent Initiatives • Since September 2006, the Center for Substance Abuse Treatment (CSAT) has awarded 32 Assertive Adolescent Family Therapy (AAFT) grants • Purpose of AAFT grants: To provide support for the initial training and implementation of evidenced based approaches to assessment and treatment for adolescents and their families

11. Details of AAFT • Provide evidence based assessment for clinical planning and outcome monitoring • Global Appraisal of Individual Needs • Provide evidence based treatment • Adolescent Community Reinforcement Approach (ACRA) and Assertive Continuing Care (ACC) • Social Learning Theory • Operant model with social systems approach Dennis et. al., 2003; Godley, SH et. al., 2001

12. ACRA/ACC • Training and Certification • Coaching and Supervision • Peer to Peer Discussions

13. CSAT Full GAIN Data Source: CSAT 2008 SA Dataset Adolescent Subset (n=16,006) 13

14. Change in 6 Month Abstinence Relative to Other CSAT Adolescent Treatment Grant Programs Source: SAIS System (GPRA) 2008 data Butler et. al., 2009

15. Enhancing A-CRA/ACC with MediaIf I could tell you what it meant, there would be no point in dancing it-Isadora Duncan

16. Enhancing A-CRA for Youth Engagement • Podcasting • iTunes U • Eligibility/Agreements • MP3 player • Therapists Ruiz et. al., 2009

17. TAKE A LISTEN! SIROW PRESENTS: A-CRA PODCAST

18. Podcast Downloads

19. Podcast Previews

20. Youth Feedback You guys must really trust me to lend me this iPod—it is a nice one. I am sharing these podcasts with my friends. This is pretty cool. I had a hard time downloading them to the iPod.

21. Caregiver Comments Maybe I can help you [the youth] download the podcasts. This is a good way to share information with youth.

22. Therapist Feedback With one of my clients who has ADHD I was able to play the podcast in a session, pause the podcast to discuss the procedures and then return to listening. For example, with the podcast on problem solving I was able to pause the recording after each step was reviewed to, then, discuss with the client how it applies to his real life example. He seemed to focus better and understand the material. I was able to help a client access the site using the A-CRA problem solving steps.

23. SIROW “My Space” HOMEPAGE

24. The Inbox

25. What’s Next?"The past is a source of knowledge, and the future is a source of hope.” -Stephen Ambrose

26. Recovery Oriented Systems of Care for Youth (ROSC) • Looks very different that adult ROSC. • Must incorporate representatives from various disciplines (e.g., education; juvenile justice; child welfare; youth recovery community). • Examine our own treatment systems to make sure they are healthy. • Examine issues and implement strategies to reduce stigma.

27. Las Rosas-ROSC • Implementing Sanctuary Model (Bloom, 2009) • Implementing ROSC-Consortium • Examining community perceptions • Perceptions of: • awareness, availability, access of recovery supports for youth • Typical adult attitudes/feelings towards youth in recovery • 100 electronic surveys distributed to “community leaders.”

28. Las Rosas: Services and Supports Model Adapted from: Clark, W (2008). The benefits of ROSC for Adolescents and Transitional Aged Youth. Presented at the SAMHSA Consultative Session to Develop ROSC for Youth. 11/14/2008 Rockville MD

29. Community Survey Results • 37 participants: 70% female with an age range of 26-76 years old • Professions represented: • Professional, other unspecified (24%) • Administrative/management (22%) • Consultant/self-employed (14%) • Health care (11%) • Real estate (8%) • Public service, Education, Arts, & Retired/Volunteer (5% each) Korchmaros, Lopez, & Ruiz (2009)

30. Community Survey • Number of recovery supports available in Tucson: • 36% report 5+ in Tucson • 24% report 3 or 4 • 24% report 1 or 2 • 16% report 0

31. How easily can adolescents find and receive recovery supports that are available in our community

32. Perceived degrees of sympathy toward and support of adolescents by typical members of the community

33. Perceived extent that the typical member of our community feels that adolescents in recovery will be productive in the community or successful in life

34. Recovery Supports for Adolescents and Families • CSAT funded and led by Chestnut Health Systems • Four Sites: • Tucson, Arizona • Bloomington, Illinois • Seattle, Washington • Fitchburg, Massachusetts

35. Recovery Support Services • Recovery support telephone support by trained volunteers • Recovery oriented social networking site • Family Support using the Community Reinforcement and Family Training (CRAFT)

36. Emerging Issues, RecommendationsThe world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker.-Helen Keller

37. How Media Can Support Treatment Business Practices • Data and communication infrastructures • Shift from informing to creating value • Design virtual spaces to connect recovery communities • Transactional and relational

38. Changes in Health Care • Evidence based practice • Specialization • Outcomes • Production of positive changes • Cost effectiveness • Best outcomes that are least expensive

39. Recommendations • Internet and mobile technology media is here to stay! Given this, we need to continue to find innovative ways it can be useful to and complimentary of services. • There is little documented in the literature about the effectiveness of technology uses in the addiction field. • It is thought that utilization of technology is cost efficient yet we need more studies that examine these costs.

40. Acknowledgements & Disclaimer Acknowledgements The authors wishes to thank Jutta Butler, Monica Davis, Stuart Glogoff, Mark Godley, Susan H. Godley, Kristin Hedges, Sasha Keyes, Jo Korchmaros, Vicki Lilligard, Randy Muck, Raquel Ramirez, Andrea Verdin, project staff who have helped in the development of this presentation. Moreover the author wishes to acknowledge all the youth/families who have participated in treatment and engaged in the recovery process. Disclaimer: The development of this presentation was funded, in part, by a grant from the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment – TI-17604 & TI-020138. The views expressed here are the authors and do not necessarily represent the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

41. Sources: Bloom, S. (2009) The Sanctuary Model: Implementation Training. Yonkers, NY January 26-30, 2009 Butler, J., Muck, R., Dennis, M.L., Godley, S.H., & Godley, M.D. (2009) Assertive Adolescent Family Treatment (AAFT) Cross-Site Progress Report. Webinar Presentation for AAFT grantees on February 25, 2009. Dennis, M.L., Titus, J.C., White, M.K., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN): Administration guide for the GAIN and related measures. Bloomington, IL: Chestnut Health Systems. Retrieved from http://www.chestnut.org/li/gain Godley, M. Coleman-Cowger, VH., Titus, J., Funk, R., Orndorff, MG (in press). A randomized control trial of telephone continuing care. Journal of Substance Abuse Treatment. Godley, S.H., Meyers, R.J., Smith, J.E., Karvinen, T., Titus, J., Godley, M., Dent, G., Passetti, L., & Kelberg, P (2001) . The adolescent Community Reinforcement Approach for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 4, DHHS Pub. No. 01- 3489. Rockville, MD Center for Substance Abuse Treatment, Substance Abuse and Mental Health Service Administration. Kaminer, Y., Burleson, JA & Burke, RH (2008). Efficacy of outpatient aftercare for adolescent with alcohol use disorders: A randomized control study. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1405-1412 Knowles, P (2009). Collaborative communication between psychologist and primary care providers. Journal of Clinical Psychology Medical Settings, 16 72-76. DOI 10.1007/s10880-009-9151-1. Korchmaros, J., Lopez, E. & Ruiz, B. (2009). Perceptions of Community Feelings and Attitudes about Adolescents in Recovery: Summary Report. University of Arizona’s – Southwest Institute for Research on Women: Unpublished Reports. Tucson, Arizona. Mulvey, K., Atkinson, DD., Avula, D. Luck, JW (2005). Using the Internet to Measure Program Performance. American Journal of Evaluation, 26, 587-597. DOI 10.1177/1098214005281320. Muck, R. Dennis, M., Godley, SH & Godley, MD (2009). A National Model for Funder-Researcher-Provider EBP Implementation. Presented at the 2nd Annual NIH Conference on the Science of Dissemination and Implementation. Bethesda, MD January 29, 2009. Ruiz, B., Greene, A., Lopez, E. & Bernal, D. (2009). Enhancing the Adolescent Community Reinforcement Approach (A-CRA) with Podcasts: Interim Report. Universityof Arizona’s - Southwest Institute for Research on Women: Unpublished reports. Tucson, Arizona.