Assertive Adolescent Family Treatment (AAFT) Cross-Site Progress Report

1
Assertive Adolescent Family Treatment (AAFT)
Cross-SiteProgress Report

• Jutta Butler Randolph D. Muck,
• SAMHSA, CSAT
• Michael L. Dennis, Susan H. Godley, Mark D.
  Godley
• The Chestnut Health Systems Team
• Webinar Presentation for AAFT grantees on
  February 25th

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Goals

1. Describe the background for the AAFT initiative
2. Summarize GAIN and A-CRA/ACC training/certificatio
   n progress
3. Report overall recruitment and follow-up
   performance
4. Describe the adolescents seen in the initiative
   based on a number of demographic and clinical
   characteristics
5. Present outcome data summarized across sites and
   compared to other CSAT initiatives

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CSAT Adolescent Treatment Grant Program

• 1997-2000 4- Cannabis Youth Treatment (CYT)
  experiments
• 1998-2003 10- Adolescent Treatment Models (ATM)
• 2000-2003 7- Persistent Effects of Treatment
  Study (PETS-A)
• 2002-2007 12- Strengthening Communities for Youth
  (SCY)
• 2002-2007 10- Reclaiming Futures (RF) diversion
  projects
• 2002-2008 12 Targeted Capacity Expansion TCE/HIV
  
• 2003-2006 17 Adolescent Residential Treatment
  (ART)
• 2003-2007 38 Effective Adolescent Treatment (EAT)
  
• 2004-2009 22 Young Offender Re-entry Programs
  (YORP)
• 2005-2008 20 Juvenile Family Drug Treatment
  Court (TDC)
• 2005-2008 16 State Adolescent Coordinator (SAC)
  grants
• 2006-2010 33 Adolescent Assertive Family
  Treatment
• 2007-2010 4 OJJDP RWJF Replication grants
• 2008-2009 3 OJJDP-CSAT Brief Intervention and
  Referral to Treatment (BIRT)

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Overview of Program

• Purpose To provide support for the initial
  training and implementation of evidenced based
  approaches to assessment and treatment for
  adolescents and their families/primary caregivers
• Key Components
• Formal training and technical assistance
  implementing the Global Appraisal of Individual
  Needs (GAIN) to improve intake assessment,
  clinical interpretation, monitoring, and data
  management
• Formal training and technical assistance
  implementing the Adolescent Community
  Reinforcement Approach (A-CRA) and Assertive
  Continuing Care (ACC) to support clinical
  intervention and supervision
• Average of 328,000/yr x 3 years grant award to
  help with initial implementation
• Other technical assistance to facilitate
  implementation

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Assertive Adolescent Family Treatment (AAFT)
Grant Sites by Funding Cohort
WA
NH
VT
ME
MT
ND
OR
MN
Manchester
ID
NY
SD
WI
Syracuse
MI
Boston
CA
WY
Oakland
Cambridge
IO
San Francisco
PA
Fitchburg
CT
RI
Reno
NE
OH
San Jose
Thornton
IL
Columbus
NJ
IN
NV
UT
WV
Fresno
Aurora
CO
MO
DE
Huntington
KS
VA
Los Angeles
KY
MD
Columbia
Downey
D.C
NC
AZ
Tarzana
Oak Ridge
TN
.
Nashville
AR
Phoenix
OK
NM
SC
Little Rock
Tucson
AAFT Cohort 1 (2006-2009)
GA
MS
AL
TX
Ft Worth
LA
AAFT Cohort 2 (2007-2010)
Huntsville
FL
Orlando
Houston
AK
San Antonio
Pinellas Park
Laredo
PR
HI
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Unique Components of this initiative

• GAIN clinical certification
• ABS software
• Clinical supervisor certification process
• Web-based tool for clinical and supervisory
  certification based on digital technology
• Implementation calls paired with monthly
  implementation progress reports
• Cultural responsiveness committee

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Clients Served and Costs

• The grantees are 2-3 years into their 3 year
  awards
• They have served 2,160 of the prorated 2,582
  target to date (84) and 4,233 target over the
  whole program (51)
• They have an average raw cost of 9,729.6 per
  family served vs. an expected cost of 7,962.7
  per family served (122)
• They have an average adjusted cost (cutting off
  20 for overhead/evaluation) of 7,783.70 per
  family served vs. an expected adjusted cost of
  6,370 per family served (122)

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GAIN Certification Progress
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Demographic Profile
Any Hispanic ethnicity separate from race group.
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Pattern of Weekly Use (13/90 days)
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Substance Use Problems
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Past 90 day HIV Risk Behaviors
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Co-Occurring Psychiatric Problems
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Past Year Violence Crime
Notes \a Dealing, manufacturing, prostitution,
gambling (does not include simple possession or
use) \b 14 or more days on probation/parole
with urine monitoring
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Count of Major Clinical Problems at Intake\a
Median 4 Problems
Note \a Based on count of self reporting
criteria to suggest Alcohol, cannabis, or other
drug disorder, depression, anxiety, trauma,
suicide, ADHD, CD, victimization, violence/
illegal activity
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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No. of Problems\a by Severity of Victimization
Severity of Victimization
Note \a Based on count of self reporting
criteria to suggest Alcohol, cannabis, or other
drug disorder, depression, anxiety, trauma,
suicide, ADHD, CD, victimization, violence/
illegal activity. OROdds Ratio relative to Low
Source CSAT August 2008 AAFT GAIN Data Set
(n1,544)
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Performance (goal) Recruitment and Monitoring
100
10
20
30
40
50
60
70
80
90
100
100
Notes \a based on done divided by due minus
expected, plus same percent expected of those
still pending in window
Source CSAT October 2008 AAFT Management Report
(n1,602)
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A-CRA/ACC Certification Progress
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Performance (goal) Treatment Received
Targeted Improvement over general practice
Source CSAT October 2008 AAFT Management Report
(n1,602)
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Performance (goal) Early Treatment Outcomes
Source CSAT August 2008 AAFT GAIN Data set with
1 Follow-up (n1,045)
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Performance Change Over Time in Selected Outcomes
Source CSAT August 2008 AAFT GAIN Data set with
1 Follow-up (n1,045)
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Intake to 6 Month GPRA Outcomes Relative to Other
CSAT Adolescent Treatment Programs
Source SAIS System (GPRA) 2008 data
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Performance Outcome Status at Last Wave
Source CSAT August 2008 AAFT GAIN Data set with
1 Follow-up (n1,045)
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Performance Count of Positive Outcomes
Source CSAT August 2008 AAFT GAIN Data set with
1 Follow-up (n1,045)
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Count of Positive Outcomes by Continuing Care at
90 days
Source CSAT August 2008 AAFT GAIN Data set with
1 Follow-up (n1,045)
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Change in 6 Month Abstinence Relative to Other
CSAT Adolescent Treatment Grant Programs
Notes \a GAIN Required, \b A-CRA/ACC required,
\c MET/CBT5 required, \d Juvenile justice grant
encouraging use of GAIN, ACRA/ACC and/or MET/CBT5
but without as much training/oversight Source
SAIS System (GPRA) 2008 data
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Characteristics and Outcomes Site Profiles Report

• Site Profile report is created quarterly for each
  project. Included are charts that depict
• Client demographics, violence, crime, SES, etc at
  intake
• Client use patterns at intake
• Preliminary outcome measures based on scale
  scores using GAIN M90 compared to GAIN I scores
• Treatment Satisfaction average results
• Comparison charts with the option to compare to
  other sites in the project cohort
• Where to get access
• Reports are emailed to the PI and Data Manager
  each quarter
• Reports are also archived on the APSS website
  (http//www.chestnut.org/li/APSS/) under the
  GAIN Multi-Site Collaboration Materials Report
  bullet.
• Contact data_submit_at_chestnut.org for more
  information or assistance in accessing and using
  reports.

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Summary

• The CSAT Adolescent Treatment program has
  demonstrated the ability to replicate A-CRA and
  ACC approaches in community based settings
• Both the GAIN and the A-CRA/ACC training and
  certification processes appear to be working well
  in AAFT based on numbers of staff achieving
  certification
• Adolescents appear to like the intervention
• Outcomes to date compare favorably to previous
  CSAT replication efforts and other CSAT funded
  initiatives

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Questions?
For more information or a copy of this
presentation please contactgaininfo_at_chestnut.or
g