Case Management with Individual Adolescents as Drug Treatment

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Case Management with Individual Adolescents as
Drug Treatment

• Pamela E. Noel, MSW, Ph.D.
• The University of Iowa,
• School of Social Work

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Intervention Model

• Individual, Therapeutic Case Management
• Case Management Functions
• Assessment
• Service Planning and Delivery
• Identification of and Linking to Resources
• Coordination
• Advocacy

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Intervention Model

• Individual, Therapeutic Case Management
• Other Components of the Intervention
• Crisis Intervention
• Transportation
• Administration
• Supervision

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Intervention Model

• Individual, Therapeutic Case Management
• Cognitive Behavioral Orientation
• Raise awareness of negative, destructive
  cognition
• Replace negative cognition with positive,
  constructive cognition.
• Change quality of interaction with the
  environment.

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Intervention Model

• Individual, Therapeutic Case Management
• Dimensional Characteristics
• Individual Face-to-Face Contact
• At Least 1 Hour , Once Per Week for 16 Weeks
• Small Caseload (lt10)
• Broad, Inclusive Services

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Intervention Model

• Individual, Therapeutic Case Management
• Dimensional Characteristics
• Office Hours (900 am - 500 pm M-F)
• Professionally Directed
• No Administrative Authority
• Individual CM Caseload

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Intervention Model

• Individual, Therapeutic Case Management
• Context
• Financial Base
• Free Services
• Target Population
• Teen Women ages 14-19 years
• Pregnant or at-risk for pregnancy
• Using substances or at-risk for use based on
  POSIT score

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Intervention Model

• Individual, Therapeutic Case Management
• Context
• Gatekeeping
• Fidelity
• Setting
• In-house
• Supportive Service System

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Intervention Model

• Individual, Therapeutic Case Management
• Case Managers
• Masters Level Social Workers
• 1 years Prior Work Experience
• Intensive Training on the Model
• Regular Supervision
• Regular In-Service Training

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Intervention Model

• Main Goals
• To decrease the frequency/amount of substance use
  by the teen, ultimately leading to sobriety.
• To remove barriers to substance use treatment
  that can interfere with the treatment and healing
  process.

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Intervention Model

• Integrity
• Defined as the difference between intention and
  what actually occurred.
• How close did case managers adhere to program
  protocol?

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Intervention Model

• Integrity
• Measuring Integrity
• Determine criteria
• Specify referent
• standard population
• standard practice (case management model)
• Phase of substance abuse treatment

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Intervention Model

• Integrity
• Procedures
• Chart Reviews
• Quality Inventory
• Results
• Overall integrity good
• Highest Scores for administrative task
• Lowest scores for case management functions

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Study Methods

• Specific Aims
• to examine the impact of case management on four
  functional areas known to be associated with
  problematic substance use behavior.
• Mental Health
• Family Relations
• Peer Relations
• Aggressive Behavior/Delinquency

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Study Methods

• Research Design
• Random Assignment to either
• Case management n 141
• No case management n 158

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Study Methods

• Assessment Procedures
• Assessed at five points (pre, mid, post, 3mo,
  12mo)
• Standardized Assessment Instruments
• Childrens Manifest Anxiety (Reynolds, 1978)
• Childrens Depression Inventory (Kovacs, 1980/81)
• Novaco Anger Scale (Novaco, 1990)

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Study Methods

• Assessment Procedures
• Standardized Assessment Instruments
• Family Cohesion Adaptability (Olson, 1985)
• Issues Checklist (Prinz, 1977)
• Missouri Peer Relations Inventory (Borduin, 1989)
• Youth Self-Report (Achenbach, 1991)

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Study Results

• Participants assigned to the case management
  condition reported greater improvements in
  depression, self-esteem, and aggressive
  behavior/delinquency than participants not
  assigned to case management.

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Study Conclusions

• Teens with increased susceptibility to multiple
  health, social, emotional, and developmental
  problems have a higher risk for problems with
  substance use than their peers without increased
  susceptibility.

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Study Conclusions

• Teens with increased susceptibility are not
  likely to be deterred by broad-based intervention
  efforts.
• Individualized, comprehensive interventions may
  be essential to preventing/reducing substance use
  problems in this population.

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Future Research

• Re-Analyze Data
• Positive Youth Development