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Meeting Youth Needs: Working to Create an Adolescent System of Care in CA. Presented by Danielle Nava, MAOL September 15, 2006. Adolescent System of Care. An overview: What it means What it includes Where CA has been on YTS. State Level Estimates for AOD Use/Abuse In California. - PowerPoint PPT Presentation
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Meeting Youth Needs: Working to Create an Adolescent System
of Care in CA
Meeting Youth Needs: Working to Create an Adolescent System
of Care in CA
Presented by
Danielle Nava, MAOL
September 15, 2006
Adolescent System of Care
An overview:What it meansWhat it includes Where CA has been on YTS
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 National Household Survey on Drug Abuse-2002/03 (SAMHSA)(SAMHSA)
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
74
89
109
94
96
121
149
219
244
368
216
279
315
397
365
6,3
01
7,6
87
8,7
35
12,4
9610,7
24
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1997-1998 1998-1999 1999-2000 2000-2001 2001-2002
Hallucinogens Other* Cocaine / Crack Heroin Methamphetamines** Alcohol Marijuana / Hashish
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)
Primary AOD Problem FY 1997–2002
Primary AOD Problem FY 1997–2002
Local Need
Los Angeles Snapshot
Estimated Adolescent Substance Dependence or Abuse 2005- LA County
Illicit Drug Alcohol
Illicit Drug or Alcohol
Total 43,491 51,779 75,186
Females 20,566 27,422 37,933
Males 22,925 24,357 37,253
Sources: SAMHSA, OAS, National Survey on Drug Use and Health, 2005 and The United States Census Bureau, American Fact Finder 2000.
Estimation of Los Angeles County’s total number of adolescents by gender. Total population ages 12-17= 934,614
Males = 477,587, Females=457,027Illicit Drug and Alcohol total 20,562
Many Youth Struggle with Alcohol & Other Drug (AOD) Problems and Complex Issues in Multiple Domains
Legal System Educatio
n
Families
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.
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.
Multiple risk factors among youth entering the
Juvenile Justice system
Sexual and physical abuse;Poor emotional and
psychological functioning;Poor educational functioning;Economically disadvantaged.
Adolescent Substance Abuse: Needs & Services Planning Report
Establishing Need
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.
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.
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.
Incidence and Prevalence of AOD Problems in Special Populations
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.
There is increasing evidence that the rates of AOD There is increasing evidence that the rates of AOD problems and substance use disorders are problems and substance use disorders are
considerably higher among specific sub-populations considerably higher among specific sub-populations of youth.of youth.
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)
Estimates for Unmet Treatment NeedEstimates for Unmet Treatment Need
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)
Estimated 2005 Los Angeles County Adolescent Treatment Gap
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Illicit Drug Alcohol Illicit Drugor Alcohol
Dependence orAbuseLA CountyTreatment
Sources: SAMSHA, Office of Applied Studies, National Survey on Drug Use and Health, 2005*Based on national prevalence rates
Barriers to Treatment for Youth
client
family
community
organizations
program
systems
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.
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.
Treatment Reality in CaliforniaTreatment 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.
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
National Adolescent Substance Abuse Treatment Referrals
National Adolescent Substance Abuse Treatment Referrals
16%
20%
5%
5% 15%
39%
Criminal Justice System
Other
Other Health Care Provider
Other Substance AbuseTreatment Agency
Self/Family
School/Community Agency
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.
Residential Facilities with Alcohol & Drug Treatment Certification
Tahoe Turning Point (4)
Right Roads (1) Phoenix House (3) Sunny Hills Children’s
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)
Statewide Residential SA Adolescents Admissions
1000
1100
1200
1300
1400
1500
1600
96-97 97-98 98-99 99-00 00-01 '01-02 '02-03
13-17years
Source: Department of Drugs and Alcohol
Levels of Care in Treatment of Adolescents
8%
5%
12%
8%
67%
Short TermResidentialOther Detoxificationor other HospitalIntensive Outpatient
Long-termResidentialOutpatient
Daily, approximately 100,000 youth participate in public substance abuse treatment programs nationally.
Fragmented and conflicting mission and goals between referral, funding and oversight agencies
Medi-Cal Youth Substance Abuse Treatment
Cedillo Bill- SB 1288
MAYSI~2 Statewide Screening-California
Description of Alcohol/Drug Use & Mental Health Symptoms Among Youth as Identified by the Massachusetts Youth Screening Instrument~2
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.
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
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
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.
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 youth’s progress and issues.
Provide extended continuing care and support for recovery, including family support.
System Design – Enhancing Treatment Models and Treatment Plans
Individualized - Tailored to match the complexity of each individual’s 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.
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.
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.
