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Meeting Youth Needs: Working to Create an Adolescent System of Care in CA

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Title: Meeting Youth Needs: Working to Create an Adolescent System of Care in CA


1
Meeting Youth Needs Working to Create an
Adolescent System of Care in CA
  • Presented by
  • Danielle Nava, MAOL
  • September 15, 2006

2
Adolescent System of Care
  • An overview
  • What it means
  • What it includes
  • Where CA has been on YTS

3
State Level Estimates for AOD Use/Abuse In
California
  • Approximately 18 of 12-17 year olds report
    alcohol use in the past month.
  • An estimated 9 report binge drinking in the past
    month.
  • Overall, 11 report past month use of any illicit
    drug
  • Based on DSM-IV criteria, an estimated 8 of
    12-17 year olds report either alcohol, or illicit
    drug, abuse or dependence in the past year.

National Household Survey on Drug Abuse-2002/03
(SAMHSA)
4
State Level Estimates for AOD Use/Abuse In
California
  • 37 of 11th graders report consuming at least one
    alcoholic drink in the previous 30 days.
  • 18 of 11th graders report at least one drink in
    the past three days.
  • 23 of 11th graders report binge drinking
    (consumption of 5 or more drinks in a row) within
    the past 30 days.
  • The California Student Survey (CSS)-2003/04

5
17,000
Other Includes Outpatient Methodone
Maintenance, Outpatient Detoxification, Residence
Detoxification Hospital Source
Source
Source
Source
Primary AOD Problem FY 19972002
Other Includes Barbiturates, Inhalants,
Non-Prescription Methadone, Other, Other Opiates
/ Synthetics, Other Sedatives / Hypnotics, Other
Tranquilizers, Over the Counter, PCP,
Tranquilizers Methamphetamines Include
Methamphetamines, Other Amphetamines, Other
Stimulants (Source CADDS)
34.4
68.1
655
57.8
Community Agency Includes Employer / Employee
Assistance Program, Other Community
Referral Juvenile and Criminal Justice
Includes Court / Criminal Justice, Court /
Probation, Substance Abuse and Crime Prevention
Act of 2000 (SACPA), SACPA Parole Other
Treatment Includes 12 Step Mutual Aid, Care
Program, Other Health Care Source
26.4
26.2
27.7
27.1
23.4
73.6
73.9
72.3
72.9
76.6
Source
32.6
32.5
31.6
31.7
34.9
67.4
67.5
68.4
68.3
65.1

Source
6
Local Need
  • Los Angeles Snapshot

7
Estimated Adolescent Substance Dependence or
Abuse 2005- LA County
Estimation of Los Angeles Countys total number
of adolescents by gender. Total population ages
12-17 934,614 Males 477,587,
Females457,027 Illicit Drug and Alcohol total
20,562
Sources SAMHSA, OAS, National Survey on Drug Use
and Health, 2005 and The United States Census
Bureau, American Fact Finder 2000.
8
Many Youth Struggle with Alcohol Other Drug
(AOD) Problems and Complex Issues in Multiple
Domains
9
Co-Occurring Mental Health Problems are Common
  • For adolescents who regularly use
  • substances various disorders are present
  • Anxiety
  • Post Traumatic Stress
  • Depressive
  • Attention Deficit and Hyperactivity
  • Attachment
  • Eating and Image.

10
Risk and Identification of those with AOD Problems
  • These histories or events may place an adolescent
    at even greater risk for having future AOD
    problems, especially if they receive little or no
    help.
  • The pathways to treatment indicate that youth
    with pre-existing AOD problems often come first
    to attention of justice, welfare, mental health,
    and school officials, rather than to AOD service
    providers.

11
Multiple risk factors among youth entering the
Juvenile Justice system
  • Sexual and physical abuse
  • Poor emotional and psychological functioning
  • Poor educational functioning
  • Economically disadvantaged.

12
Adolescent Substance Abuse Needs Services
Planning Report
  • Establishing Need

13
Growth and Capacity of Youth Treatment in
California
  • A growing number of youth are admitted to
    treatment for AOD problems.
  • However, development and growth in capacity are
    seriously hindered by a lack of adequate funding
    for needed services and in the need to address
    limitations in the ability to hire a fully
    qualified workforce.
  • Capacity expansion, quality improvement, and
    increased effectiveness will benefit enormously
    from state-level support.

14
Youth Substance Use and Abuse
  • We know
  • Substance abuse has decreased in general.
  • It has increased in high-risk children.
  • Experimentation is occurring at younger ages.
  • The drugs available are more potent.

15
Growth in Admissions to Treatment of Adolescents
  • There is a growing number of admissions to
    treatment of boys and girls under the age of 18.
  • The number of admissions of youth to treatment in
    California in 2001-2002 was approximately 20,000.
    This is nearly double the number of 5 years
    earlier, 1997-1998, when 11,000 were admitted.

16
Incidence and Prevalence of AOD Problems in
Special Populations
There is increasing evidence that the rates of
AOD problems and substance use disorders are
considerably higher among specific
sub-populations of youth.
  • Those who have been abused or neglected,
    including those removed from their home by child
    welfare officials
  • Those arrested, detained, adjudicated, and placed
    out of home by juvenile justice authorities
  • Those suffering with or diagnosed with
    psychiatric conditions, such as depression,
    traumatic stress, or conduct disorder
  • Those enrolled in special education and those
    assigned to continuation schools by educational
    administrators.

17
Estimates for Unmet Treatment Need
  • The Treatment Episode Data Set (TEDS) reports on
    annual admissions of youth to treatment
    facilities. According to TEDS, in 2001 an
    estimated 1.1 million youth, ages 12-17 needed
    treatment for an illicit drug problem. Of this
    group treatment was received by only one in 10 of
    all those who needed treatment. (SAMHSA, 2002)

18
Estimates for Unmet Treatment Need
  • The Center for Substance Abuse Treatment (CSAT,
    SAMHSA) estimates that only one in ten
    adolescents who need substance abuse treatment
    actually receive it. Of those who receive
    treatment, only one in four receive enough
    treatment, of sufficient duration, intensity and
    quality. (CSAT, 2002)

19
Estimated 2005 Los Angeles County Adolescent
Treatment Gap
Sources SAMSHA, Office of Applied Studies,
National Survey on Drug Use and Health,
2005 Based on national prevalence rates
20
Barriers to Treatment for Youth
  • client
  • family
  • community
  • organizations
  • program
  • systems

21
Program Barriers and Issues
  • Limited science based treatment programs by age,
    gender, developmental status.
  • Incomplete or inadequate assessment tools,
    focused on deficits rather than strengths.
  • Workforce - limited experience with low
    compensation.
  • Integration of new perspective, philosophy,
    culture.
  • Program design core goals, activities,
    interventions.
  • Over-regulated with outdated regulations.

22
Systemic Barriers and Challenges
  • Resources are grossly inadequate.
  • Funding available is a patch work of federal,
    Medicaid, out of home placement, juvenile justice
    funds-state set aside.
  • Experienced AOD staff are not valued.
  • Poor interagency collaboration.
  • Limited health or mental health care access.
  • Conflicting regulations and practices.

23
Treatment Reality in California
  • Treatment is delivered predominantly in
    outpatient settings in most counties where it is
    available.
  • Treatment is available in school-based settings
    in some counties, but not all. The school-based
    services are primarily for early intervention.
  • Treatment is available in residential settings
    (i.e. through the state Department of Social
    Services foster care/group home licensing) in a
    small number of counties.
  • There is no unified treatment system and no
    single source of data on these services.
  • Overall, a continuum of care and multi-level
    treatment options are not widely available nor
    are treatment services well distributed
    geographically.

24
National Adolescent Substance Abuse Treatment
Referrals
Source Dennis, ML, Dawud-Noursi, S, Much, R, and
McDermeit, M. The Need for Developing and
Evaluating Adolescent Treatment Models. In
Stevens, SJ and Morral, AR (eds.) Adolescent
Substance Abuse Treatment in the United States
Exemplary Models from a National Evaluation
Study. Binghampton, NY Haworth Press. 2002
25
Characterization of Youth Admitted to Treatment
in California
  • Primary drug used is marijuana or alcohol.
  • Referral to treatment is most frequently through
    juvenile justice. Schools are next in frequency.
    Family or self-referral are far less common.
  • As many as one in four have had a prior treatment
    experience.
  • Approximately half leave treatment without
    satisfactory progress.
  • These characteristics are comparable to those
    among youth entering treatment nationwide.

26
Residential Facilities with Alcohol Drug
Treatment Certification
  • Tahoe Turning Point (4)
  • Right Roads (1)
  • Phoenix House (3)
  • Sunny Hills Childrens Services (1)
  • Our Family (3)
  • Social Model Recovery Systems (1)
  • McAlister Institute (4)
  • Walden House (1)
  • Baker Place (3)
  • Life Steps (1)
  • Daytop Village (2)
  • Center Point (1)
  • Advent Group Ministries (6)
  • CRC Recovery (1)
  • Wilderness Recovery Centers (1)

27
Statewide Residential SA Adolescents Admissions

Source Department of Drugs and Alcohol
28
Levels of Care in Treatment of Adolescents
Daily, approximately 100,000 youth participate in
public substance abuse treatment programs
nationally.
29
Fragmented and conflicting mission and goals
between referral, funding and oversight agencies
30
Medi-Cal Youth Substance Abuse Treatment
Cedillo Bill- SB 1288
31
MAYSI2 Statewide Screening-California
  • Description of Alcohol/Drug Use Mental Health
    Symptoms Among Youth as Identified by the
    Massachusetts Youth Screening Instrument2

32
Treatment System Design
  • Adopt shared, broadly endorsed protocols for
    screening and referring youth across service
    settings and across service sectors.
  • Reduce the stigma for youth entering AOD
    treatment.
  • Deliver treatment in the least restrictive
    community-based setting possible, while ensuring
    physical and emotional safety.
  • Make treatment geographically and culturally
    accessible to youth and their families in each
    region of the state.
  • Develop treatment options that are appropriate
    for youth with special service needs, including
    those not living at home and those with emotional
    disorders.
  • Disseminate information to families, other
    providers, and professionals about treatment, its
    availability, and its effectiveness.

33
System Design Improving Access to Treatment
  • Broaden Access to Care
  • Implement NO WRONG DOOR
  • Develop Mechanisms for Early Identification of
    Alcohol and Other Drug Problems Among Youth
  • Create Linkages to Treatment
  • Site Services and Screening/Referral Services
    Where Youth Are Usually Seen.
  • Schools, Juvenile Justice, Child Welfare, Mental
    Health, Health Care

34
System Design Improve Treatment Effectiveness
  • Assess the Needs of Each Youth Entering Treatment
    in Multiple Domains
  • Education
  • Family Relationships
  • Mental Health
  • Behavioral Patterns
  • Life and Vocational Skills
  • Physical Health and Safety

35
System Design -Continuum of Care
  • Create a Horizontal Continuum of Care to Ensure
    these Needs are Addressed, As a Response to the
    Assessment.
  • Create a Vertical Continuum of Care to Move the
    Youth through Stepped Up (Intensified) or
    Stepped Down (Less Intensive) Levels of Care,
    As Indicated Through Assessment.

36
System Design Linking Assessment to Placement
  • Place the youth in the most clinically
    appropriate level and setting of care, based
    upon the assessment.
  • Periodically re-assess the youths progress and
    issues.
  • Provide extended continuing care and support for
    recovery, including family support.

37
System Design Enhancing Treatment Models and
Treatment Plans
  • Individualized - Tailored to match the complexity
    of each individuals needs.
  • Developmentally Appropriate - Designed for
    adolescents at various stages of physical,
    behavioral and emotional maturation.
  • Gender-specific Developed to meet the needs of
    males and females.
  • Culturally Appropriate Inclusive of diverse
    backgrounds and cultures.
  • Trust-Based Built around the Therapeutic
    Alliance to engage and retain clients.
  • Outcome-Oriented Based on measurable outcomes
    and benchmarks of progress.

38
System Design Expanding Capacity Improving
Quality
  • Staff Development Training, proficiency
    standards and clinical supervision to improve
    treatment delivery to adolescents.
  • Program Standards Accountability and continuous
    quality improvement through adoption of
    standards.
  • Performance Monitoring System-wide effort to
    support functional improvement through data
    collection, monitoring and periodic review.

39
System Design Information to Improve Treatment
Effectiveness
  • Systematically gathered, maintained, and archived
    information should include a minimum data set.
  • Measures should be developed out of consensus in
    the field.
  • Data should incorporate assessed client needs,
    services delivered, and client outcomes.
  • Monitoring should have the capacity to measure
    overall program performance.
  • Archived database should provide informational
    support for planning and resource allocation
    decisions at the client, program and systems
    levels.

40
  • THANK YOU!
  • Visit us at
  • www.alcoholdrugpolicy.org
  • or contact us at
  • 714.505.3525
  • dnava_at_alcoholdrugpolicy.org
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