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Coordinating Council for Juvenile Justice and Delinquency Prevention. September 12, 2008 Presentation to the Council on the interagency agreement between SAMHSA/CSAT and OJJDP. Past Year Violence & Crime – Youth in CSAT Funded Grant Programs.

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Coordinating council for juvenile justice and delinquency prevention
Coordinating Council for Juvenile Justice and Delinquency Prevention

September 12, 2008

Presentation to the Council on the interagency agreement between SAMHSA/CSAT and OJJDP


Past year violence crime youth in csat funded grant programs
Past Year Violence & Crime – Youth in CSAT Funded Grant Programs

*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)

Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)


Other sources of Referral have grown, but less than expected Programs

Change in Referral Sources: 1993-2003

JJ referrals have doubled, are 53% of 2003 admissions and driving growth

61% growth

Source: Treatment Episode Data Set (TEDS) 1993-2003.


Main elements of the interagency agreement
Main Elements of the Interagency Agreement Programs

  • Partnership Meetings

  • State of the State Summits

  • Tribal Planning Forum on Juvenile Justice and Substance Abuse/Mental Health


Outcomes of the interagency agreement partnership meetings
Outcomes of the Interagency Agreement Partnership Meetings Programs

  • Initial Planning Meeting (OJJDP, NCJCA, CMHS, CSAT, NASADAD, NASMHD)

  • Bi-Weekly calls to discuss progress

  • Ad-hoc Technical Assistance (e.g., Medicaid changes and affect on probation)

  • Changes to structure of grant programs


State of the state summits
State of the State Summits Programs

  • Series of 1 day meetings (researchers, prevention and treatment stakeholders, national associations, consumer groups)

  • Included input from partnership meetings

  • Planning for changes to grant making and grant programs


Outcomes combination of 1 st two elements
Outcomes ProgramsCombination of 1st two Elements

  • Two new joint grant programs

    • OJJDP/CSAT/RWJF MOU to jointly plan, fund and administer juvenile drug court grants

    • OJJDP/CSAT IAA to jointly plan, fund and administer a new grant program: Brief Intervention and Referral to Treatment (BIRT)


Outcomes cont
Outcomes (cont.) Programs

  • Planning (under discussion) for new round of juvenile drug court grants (FY 09)

    • One application

    • One review

    • OJJDP (funds drug court); CSAT (funds treatment services)


Outcomes cont1
Outcomes (cont.) Programs

  • Importance of co-occurring disorders for youth offenders: all CSAT grant announcements require screening/assessment for co-occurring disorders

  • Development of a short screener (20 items) for substance use disorders, co-occurring disorders, and criminal activity (over 98% sensitivity and specificity)

  • Being implemented in city, county and state systems


53 have unfavorable discharges

Despite being widely recommended, only 10% step down after intensive treatment

53% Have Unfavorable Discharges

Source: Data received through August 4, 2004 from 23 States (CA, CO, GA, HI, IA, IL, KS, MA, MD, ME, MI, MN, MO, MT, NE, NJ, OH, OK, RI, SC, TX, UT, WY) as reported in Office of Applied Studies (OAS; 2005). Treatment Episode Data Set (TEDS): 2002. Discharges from Substance Abuse Treatment Services, DASIS Series: S-25, DHHS Publication No. (SMA) 04-3967, Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://wwwdasis.samhsa.gov/teds02/2002_teds_rpt_d.pdf .


Outcomes cont2
Outcomes (cont.) intensive treatment

  • Importance of continuing care for youth identified vs. passive referral to self-help groups

  • Development of mandate in all grant CSAT grant programs (as well as joint CSAT/OJJDP programs) for use of an evidenced-based approach following treatment discharge for continuing care - Assertive Continuing Care (ACC)


Assertive continuing care acc hypotheses

Sustained Abstinence intensive treatment

Early Abstinence

General Continuing Care Adherence

Relative to UCC, ACC will increase General Continuing Care Adherence (GCCA)

GCCA (whether due to UCC or ACC) will be associated with higher rates of early abstinence

Early abstinence will be associated with higher rates of long term abstinence.

Assertive Continuing Care (ACC)Hypotheses

Assertive Continuing Care


Acc improved adherence

UCC intensive treatment

ACC * p<.05

ACC Improved Adherence

100%

20%

30%

10%

40%

50%

60%

70%

80%

90%

0%

Weekly

Tx

Weekly 12 step meetings

Relapse prevention*

Communication skills training*

Problem solving component*

Regular urine tests

Meet with parents 1-2x month*

Weekly telephone contact*

Contact w/probation/school

Referrals to other services*

Follow up on referrals*

Discuss probation/school compliance*

Adherence: Meets 7/12 criteria*

Source: Godley et al 2002, forthcoming


Early 0 3 mon abstinence improved sustained 4 9 mon abstinence

73% intensive treatment

69%

59%

Early (0-3 mon.) Abstainer

* p<.05

Early (0-3 mon.) Abstinence Improved Sustained (4-9 mon.) Abstinence

100%

90%

80%

70%

60%

50%

40%

30%

22%

22%

19%

20%

10%

0%

Any AOD (OR=11.16*)

Alcohol (OR=5.47*)

Marijuana (OR=11.15*)

Early(0-3 mon.) Relapse


Gcca improved early 0 3 mon abstinence

55% intensive treatment

55%

43%

High (7-12/12) GCCA

* p<.05

GCCA Improved Early (0-3 mon.) Abstinence

100%

90%

80%

70%

60%

50%

38%

36%

40%

30%

24%

20%

10%

0%

Any AOD (OR=2.16*)

Alcohol (OR=1.94*)

Marijuana (OR=1.98*)

Low (0-6/12) GCCA


Outcomes cont3
Outcomes (cont.) intensive treatment

  • Importance of the use of cost-effective evidence-based practice for treatment of youth

  • Effective Adolescent Treatment grant program: Motivational Enhancement/Cognitive Behavioral Therapy 5 sessions


Range of effect sizes d for change in days of abstinence intake to 12 months by site

EAT Programs did Better than CYT on average intensive treatment

Range of Effect Sizes (d) for Change in Days of Abstinence (intake to 12 months) by Site

1.40

1.40

6 programs completely above CYT

1.20

1.20

1.00

1.00

0.80

0.80

Cohen’s d

0.60

0.60

0.40

0.40

0.20

0.20

75% above CYT median

0.00

0.00

4 CYT Sites (f=0.39)

(median within site d=0.29)

36 EAT Sites (f=0.21)

(median within site d=0.49)

Source: Dennis, Ives, & Muck, 2008


Tribal planning forum
Tribal Planning Forum intensive treatment

  • Tribal planning forum on Juvenile Justice, Substance Abuse and Mental Health (Nov 2006)

  • SAMHSA hosted first Policy Academy on Co-occurring Substance Use and Mental Disorders for Native Communities (Sep 2007) including tribal youth in Wellness Courts

  • Continuing to work with Tribes to implement their policy changes


Interagency agreement
Interagency Agreement intensive treatment

  • For more information contact:

    Randolph Muck, M.Ed.

    Chief, Targeted Populations Branch

    Center for Substance Abuse Treatment

    240-276-1576

    [email protected]


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