ERIC ED389987: Toward Excellence in Treatment Services for Adolescents. Submitted by Adolescent Study Group to the Center for Substance Abuse Services, Michigan Department of Public Health.

65 Pages·1993·1.9 MB·English

by  ERIC

DOCUMENT RESUME
CG 026 723
ED 389 987
Toward Excellence in Treatment Services for
TITLE
Adolescents. Submitted by Adolescent Study Group to
the Center for Substance Abuse Services, Michigan
Department of Public Health.
Michigan State Dept. of Public Health, Lansing.
INSTITUTION
Center for Substance Abuse Services.
PUB DATE
93
NOTE
65p.
Reports
Non-Classroom Use (055)
PUB TYPE
Guides
Research/Technical (143)
EDRS PRICE MFOI/PC03 Plus Postage.
*Adolescents; Alcohol Abuse; Clinics; Delinquent
DESCRIPTORS
Rehabilitation; Drug Abuse; Drug Use; Illegal Drug
Use; *Rehabilitation; Reports; Smoking; *State
Programs; Statewide Planning; *Substance Abuse;
Tobacco; Youth Problems
Michigan
IDENTIFIERS
ABSTRACT
An Adolescent Study Group was established by the
Michigan Department of Public Health/Center for Substance Abuse
Services (MCPH/CSAS) to examine the current delivery system of
substance abuse treatment services for adolescents. The primary focus
was on treatment services for alcohol, tobacco and other drug (ATOD)
problems among adolescents in Michigan. The four charges of the group
(1) review CSAS current concept papers and other literature
were to:
(2) recommend how CSAS can assure
and develop a final position paper;
that adolescents have access to and receive quality treatment
(3) review current adolescent residential capacity in
services;
Michigan and make recommendations for improvement; and (4) provide
input to CSAS regarding licensing requirements for adolescent
treatment services. Subcommittees made 31 recommendations for
improvement of service delivery. Some of the highlighted findings
were: special attention to the treatment needs of homeless, runaway
and school dropout adolescents is needed; the adult addiction model
does not zpply to most adolescents and should not be used in a
clinical setting; and, adolescents indicated therapy groups should
not be a mix of adolescents and adults. A glossary and extensive
appendices are also included. Contains 43 references. (JBJ)
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Reproductions supplied by EDRS are the best that can be made
from the original document.
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CENTER for SUBSTANCE ABUSE SERVICES
Michigan Department of Public Health
NIA bicellelice
In Treatment Services
For Adolescents
3
Adolescent Study Group v
contents
Executive Summary
1
Recommendations 2
Introduction and Study Group Process 4
Extent of Adolescent Substance Abuse Problem 6
ACCESS TO SUBSTANCE ABUSE TREATMENT 8
Charge to the Access Subcommittee 8
Survey of. State Programs 8
10
Review of Specific Adolescent Service Needs
12
Planning, Outreach, Screening and Assessment
Resources for Services
14
15
Etiological Models fin- Adolescent Substance Abuse Treatment
Continuum of Care and Ancillary Services
16
Service Coordination.fase Management 17
QUALITY ASSURANCE 18
Charge to the Qualitv Assurance Subcommittee 18
Treatment Models 20
Unique Treatment Programs 23
Treatment Methods 24
Role of the Emily in Treatment of an Adolescent 24
Gender Specific Issues 25
'
EducationiStudent Assistance Programs
Peers 28
Aftercare 29
Juvenile Justice Courts 30
Substance Abuse and Nicotine Use 32
Licensing 33
33
CertificatUm
Glossary 35
Summary of Survey of Adolescent Materials Collected in United States 40
Appendix A:
Michigan Synthetic Estimates 41
Appendix B:
42
Primary Drug by Age Groups for Youth under 21
Appendix C:
Michigan Adolescent Services Summary 44
Appendix D:
Metropolitan Court Judges Committee Report 1987 48
Appendix E:
Organization of the Tobacco-Free Teens Program--American Lung Association 50
Appendix F:
Recommended Additions to Administrative (Licensing) Rules
5 I
Appendix G:
55
References
4
lldu1cscnt Stnd Groq
Karen Schrock, Chief
Chair
Center .for Substance Abuse Services
Michigan Department of Public Health
Co-Chairs
Access
Bruce Haas
Laurence Ziomkowski
Committee
Executive Director
Members
Executive Director
Michigan Network of Runaway,
Project Rehab-North
Homeless and Youth Services
Gail Kleine
Thomas Blume, Director
Family Growth Center
Addiction Studies Institute
Umversity of Detroit Mercy
Yvonne Lewis, Executive Director
Clergy Coalition Against Crack Cocaine
Gene Brown
Michigan Association of Substance Abuse
William Peabody
Coordinators, Inc.
Detroit Riverview Hospital
LaClaire Bouknight. Medical Director
Joan Sheard, President
Delinquency Services
Michigan Consortium on Substance Abuse
Michigan Department of Social Services
Education
Eastern Michigan University
M. F. Farrag
ACCESS
Jim Wotring
Division of Children's Services
The Honorable Judge Faye Harrison
Saginaw County Probate Courtiuvenile Div.
Michigan Department of Mental Health
Susana Jackiewicz
CARE Organization
Chair
Quality
Edna Rubin
Assurance
Clinical Program Manager
Committee
.4dolescent Health Center
Members
Harry Bonner. Executive Director
Adolf Armbruster
South Central Michigan Substance Abuse
Department of Social Services Boysville
Prevention Programs
Herb Barton
Minority Program Services. Inc.
Saginaw Chippewa Tribal Police Department
Ernie Boone
(D.A.R.E.)
Delinquency Services
Michigan Department of Social Services
Toward Excellence In Treatment Services For Adolescents
Bradley P. Casemore
Douglas Paterson.
Director
Adolescent Program Administrator
Division of Child & Adolescent Health
Brighton Hospital
Bureau of Child & Family Services
Michigan Department of Public Health
Cheryl Davis
Connie Rau
Substance Abuse Prevention Coordinator
Chelsea Schools
Flint Schools
Richard Deighton
Youth Projects
Henry Ford Health System
Julio Rios
Maplegrove Youth Treatment Center
Child & Family Services of Michigan
Chris Farmer.
Prevention Specialist
Mary Scoblic
Minority Program Services. Inc.
Child & Family Health Unit Chief
South Central Michigan Substance Abuse
Division of Child & Adolescent Health
Prevention Programs
Bureau of Child & Family Services
Thomas Gunnings.
Director
Michigan Department of Public Health
Meridian Psychological Consultants
Ward Thayer
Ivan Harner
Bay Haven Chemical Dependency & Mental
President:CEO
Health Programs
Brighton Hospital
Bay Medical Center
Carlos Marcillo
Pontiac Area Urban League
Mark Monson
Bay Haven Chemical Dependency & Mental
Health Programs
Bay Medical Center
Charlette Brege
Patricia Degnan
CSAS
Juli Fairley
Cheryl Celestin
Project
Kathryn Cieszynski
Jarl Nischan
Staff
Ingrid Davis
Ute von der Heyden
Gerald De Voss
Additional
Derha Donovan,
Photographer
Ackno ledgements
Jeff Fillion.
Creative Director
Public Sector Consultants. inc.
All of the adolescents who appear in the book are models.
vi
Adolescent Study Group
itifiifianj
The Michigan Department of Public Health/Center for Substance
Abuse Services (MDPHICSAS) established an Adolescent Study Group in
the spring of 1992 to examine the current delivery system of substance abuse
treatment services for adolescents. A 32-member study group was selected
from a variety of organizations serving adolescents.
Between May and December 1992, eighteen full group and sub-
committee meetings were held to focus on key issues. The primary focus of
the Adolescent Study Group was on treatment services for alcohol, tobacco
and other drug (ATOD) problems among adolescents in Michigan. The four
major charges of the study group were to: (I) review CSAS current concept
develop a
papers and other literature on adolescent treatment services and
final position paper; (2) recommend how CSAS can assure that adolescents
have access to and receive quality treatment services; (3) review current
adolescent residential treatment capacity in Michigan and make recommen-
dations for improvements in services; and (4) provide input to CSAS re-
garding licensing requirements for adolescent treatment services.
To facilitate discussion and review of materials, the study group
approached the task through subcommittees on Access and Quality Assur-
ance. The Access Subcommittee focused on: (1) financing to improve ac-
in the state.
cess to treatment services and (2) reviewing current capacity
The Access Subcommittee also studied financial barriers to treatment. as-
sessment and treatment models, comprehensive assess-
ment, continuum of care and ancillary services.
The Quality Assurance Subcommittee focused
on: (1) reviewing current guidelines issued by the fed-
eral government, MDPH/CSAS and those of other states
on adolescent treatment services and (2) providing in-
put regarding licensing, credentialing and contract re-
quirements for providers of adolescent treatment ser-
vices programming. The Quality Assurance Subcommittee addressed the
basic need for special programming for adolescents. gender specific consid-
erations and family involvement in the treatment process. Discussion and
of
surveys also focused on the emotional and physical developmental stages
the adolescent that are a major consideration in the appropriate treatment of
position paper pro-
an adolescent's substance abuse problem. The resulting
findings and recom-
\ ides detailed information, by subcommittee, on their
mendations for action.
Toward Excellence In Treatment Servica For Adolescents
1
The recommendations are di-
to screen and refer youth who exhibit high risk
rected at improving the quality
behaviors (i.e., truancy, juvenile delinquency)
Treatment services must be ap-
of treatment services for adoles-
that may be linked to substance abuse.
propriate for age, developmen-
cents and their families in Michi-
tal level, ethnicity, race and ge-
gan and reducing access barrieF
ography.
to existing services. The folic A-
There should be regional outreach programs to
ing recommendations are de-
..1,141,11~Ate
'14Klawn,,
make adolescents and their families aware of
signed as an action strategy for
services.
A state level ad hoc committee
the Center for Substance Abuse
consisting of officials from
Services during the coming
MDPH/CSAS, probate courts.
years.
State/federal dollars should be allocated based
DSS and provider(s) should be
on adolescent treatment service plans that dem-
established to address legal and
onstrate a collaborative working relationship
other issues specific to delivery
among human services agencies, courts and
of services to adolescents.
Ilecomundatiolls
schools.
rtm*:"T1440fR-PrtjoPr
.
ACCESS
Treatment providers should as-
SUBCOMMITTEE
Medicaid reimbursement should be made avail-
sure that case management ser-
able for all levels of treatment services based
vices are provided to adoles-
on a comprehensive assessment.
cents.
A plan should be developed by
each regional coordinating
QUALITY
ASSURANCE
agency for the provision of ado-
An ad hoc committee consisting of officials from
SUBCOMMITTEE
lescent substance abuse treat-
service providers, the insurance commission and
ment services.
health insurance companies should be estab-
tratrilr!.
,--"tomPuNcr.".ir
lished to address reimbursement of substance
abuse services for adolescents.
The comprehensive adolescent
Every adolescent and his/her
treatment model recommended
family should have access to a
by the Quality Assurance Sub-
screening for substance abuse
Title XX funding for substance abuse services
committee should be adopted
services.
should be restored to assist in payment for non-
statewide and regionally.
Medicaid eligible children.
14.00****WC41,-
risimmlikallUkten
Based on the screening and/or
Adolescents identified with
assessment, adolescents should
sexually transmitted diseases
Diagnostic criteria, screening and assessment
have access to comprehensive
should be offered HI WAIDS
instruments used should be based on adolescent
treatment services regardless of
models of chemical dependency.
testing.
ability to pay.
Irreripumpor
Treatment services should be community-based
Adolescent treatment programs
_ _
-;7.,t!'74"L_
_
Each school should have a
should adopt at stinence from
to the extent possible, including the provision
teacher, counselor or other pro-
of "in-home" and "family centered" care when-
alcohol, tobacco and other drugs
e er possible.
fessional identified and trained
as a treatment goal.
8
2
Adolescent Study Group
should coordinate treatment ser-
Recommemiation #18
Recommendation #23
Innovative program models
vices with a tobacco cessation
Adolescent treatment programs should be gen-
der sensitive and address the special needs of
program such as the American
should be developed for adoles-
Lung Association's "Tobacco-
cent care that build on the rec-
homosexual adolescents.
ommended treatment compo-
Free Teens" program (See Ap-
Recommendation #24
pendix F).
nents.
MDPH/CSAS should work with the Department
of Education to implement the Michigan Stu-
Recommodadon #19
Recommendation #31
Adolescent specific and associ-
dent Assistance Program standards.
All future substance abuse ma-
ated licensing rules as shown in
terials written by MDPH/CSAS
used in adolescent substance
Appendix G should be adopted.
Recommendation #25
Peers should be involved, as appropriate, in
abuse treatment, including the
treatment of adolescent substance abusers.
"Know Your Rights" brochure
Recommendation #32
Agencies that provide adoles-
and treatment consent forms,
cent substance abuse services
Recommendation #26
should be written so that adoles-
should employ one full-time
cents can easily comprehend
Adolescent substance abuse treatment programs
clinical staff person possessing
should assure that clients receive comprehen-
their content.
a specialty certification for (a)
sive aftercare.
every 40 outpatient clients, (b)
Reammendation #20
every 6 residential clients. and
Recommendation #27
The Center for Substance Abuse
Aftercare programs should be provided in
(c) every 12 clients in intensive
Services should develop a video
that outlines and explains the
schools for returning adolescents to reduce re-
outpatient treatment.
rights of an adolescent in sub-
lapse.
Recommendation #33
stance abuse treatment.
Recommendation #28
An adolescent addiction special-
ist certification should be estab-
The court system should consider sending an
Recommendation #21
lished to recognize profession-
adolescent to substance abuse treatment prior
Adolescent treatment programs
als who possess degrees or
to placement in a correctional facility. All staff
should be family centered. Be-
graduate certificates from ac-
in residential programs serving juvenile offend-
cause the family is recognized as
credited universities or colleges
ers should receive training in early identifica-
a source of power to produce and
tion of possible substance abuse problems and
with core courses that have been
sustain change, concerted efforts
make appropriate referrals for assessments.
should be made to get involve-
identified as necessary in an ado-
lescent substance abuse treat-
ment of family members in the
ment component.
Recommendation #29
treatment of adolescents.
All licensed substance abuse treatment programs
should have a comprehensive Drug-Free Work-
Recommendation #22
place program in place.
All third-party payors should re-
imburse for related family treat-
ment and reimbursement rates
Recommendation #30
All substance abuse treatment programs serv-
for these services should be ad-
ing adolescents should be tobacco free and
equate to cover costs.
3
Toward Excellence In Treatment Services For Adolescents
AVAILABLE
BEST COPY
9
Introduction RI* group PrOCHS
Adolescents are a priority target population with the Michigan De-
partment of Public Health:Center for Substance Abuse Services (MDPH
CSAS). One of the goals of MDPH/CSAS is to make substance abuse treat-
ment services accessible for undersernd populations. including adolescents
CSAS began to address this issue in 1983 when a concept paper was devel-
oped on the status of alcohol and other drug use among adolescents. In 1989
the plan was reviewed and updated in a staff briefing paper.
A decision was made in late 1991 to evaluate alcohol and other
drug use among adolescents in Michigan and to assess the treatment ser-
vices available to them. The Center for Substance Abuse Services deter-
mined that development of a statewide study group would be helpful in the
analysis. Two subcommittees were formed to address the issues of access to
treatment and quality of treatment. Prevention was not a focus of this study
group because the Governor's Task Force on Drug-Exposed Infants \\:as
addressing substance abuse prevention among adolescents in its final report
and recommendations.
The Center for Substance Abuse Services charged the Adolescent
Study Group with making recommendations in the following areas: (Access
Subcommittee) access. capacity. organization. distribution and financing of
sen ices: and (Quality Assurance Subcommittee) clinical requirements for
quality service delivery, program standards. credentialing. contract and
licensure standards.
.11Ria
Susan Becker. director of the Division for State
Assistance, Office for Treatment Improvement. Wash-
ington. D.C.. was invited to the first Adolescent 2,tud.v
Group meeting to address adolescent substance abuse.
1.
She emphasized that there are high risk adolescents ( run-
ays. homeless, institutionalized people) who are
missed by the national sun eys. thus creating a picture
that can understate actual use patterns. She explained hok categorical pro-
grams are funded. with funding decisions ()lien based on "mainstream
She said that local data should be included and
America- research only.
used in compiling more accurate needs assessments and that coordination of
the ju\ enile justice. social services, mental health and substance abusc sys-
tems is an issue that needs more attention.
Se \ eral other guest speakers addressed the Adolescent St ud ( iroup.
Adolescents who had been in treatment also shared their ideas on important
4
Adolescent Study Group
1 0