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: (Total = 11,185) (Total = 12,553) (Total = 14,125) (Total = 20,013) (Total = 16,963) (Total = 10,384) (Ttaol = 11,204) (Total = 11,151) (Total = 12,572) (Total = 12,633) (Total = 14,134) (Total = 20,042) (Total = 17,661) (Total = 16,953) (Total = 15,101) (Total = 10,977) (Total = 12,250) (Total = 13,765) (Total = 16,272) (Total = 19,373) (Total = 16,886) (Total = 19,952) (Total = 11,129) (Total = 12,502) (Total = 14,044) (Total = 16,966) (Total = 14,137) (Total = 20,047) (Total = 11,209) (Total = 12,574) (Total = 16,947) (Total = 10,993) (Total = 12,407) (Total = 9,113) (Total = 19,990) (Total = 11,209) (Total = 12,574) (Total = 14,137) (Total = 16,966) (Total = 20,047) Primary AOD Problem FY 1997–2002 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 Dependenceor Abuse 2005- LA County Estimation of Los Angeles County’s total number of adolescents by gender. Total population ages 12-17= 934,614 Males = 477,587, Females=457,027 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. Families Legal System Education 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. client family community organizations program systems Barriers to Treatment for Youth

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. 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) Residential Facilities with Alcohol & Drug Treatment Certification

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. MAYSI~2 Statewide Screening-California Description of Alcohol/Drug Use & Mental Health Symptoms Among Youth as Identified by the Massachusetts Youth Screening Instrument~2

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 youth’s 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 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.

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@alcoholdrugpolicy.org