Georgetown University Adolescent Health Program

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  • Georgetown University Adolescent Health Program

    1. 1. Georgetown University Adolescent Health Program Michael Mason, Ph.D. Assistant Professor of Psychiatry & Principal Investigator
    2. 2. Project Description <ul><li>Our program is a brief, manualized, evidence-based substance use treatment program for DC area teens. </li></ul><ul><li>Treatment: Motivational Enhancement Therapy/Cognitive Behavioral Therapy-5 (MET/CBT-5) Sampl & Kadden, SAMHSA, CSAT. WWW.SAMHSA.GOV </li></ul>
    3. 3. Treatment Structure <ul><li>Comprehensive evaluation (2 hours) </li></ul><ul><li>Two individual and three group sessions (5.5 hours) </li></ul><ul><li>Parent Support Meeting (2.5 hours) </li></ul><ul><li>Three follow-up meetings over 12 months after treatment (1.5 hours) </li></ul>
    4. 4. MET/CBT-5 Treatment Premise <ul><li>Teens change when the motivation comes from themselves, rather than being imposed by the parent, adult, or therapist . </li></ul><ul><li>Client-centered, directive method for enhancing intrinsic motivation to change by exploring & resolving ambivalence. </li></ul>
    5. 5. Motivational Enhancement Basics <ul><li>Based on a trans-theoretical model: </li></ul><ul><ul><ul><li>1) stages of change theory </li></ul></ul></ul><ul><ul><ul><li>2) client-centered approaches </li></ul></ul></ul><ul><ul><ul><li>3) clinical research </li></ul></ul></ul><ul><li>A strengths-based approach </li></ul><ul><li>Differs from traditional, denial-based approaches </li></ul>
    6. 6. Foundations of MET <ul><li>Therapist style is a powerful determinant of client motivation & change </li></ul><ul><li>Show respect for the client </li></ul><ul><li>Reflective listening is emphasized rather than confrontation </li></ul><ul><li>Ambivalence about change is normal </li></ul>
    7. 7. Cognitive Behavioral Therapy <ul><li>Therapist and client collaborate to understand the client’s behavior in the context of </li></ul><ul><ul><li>situational factors </li></ul></ul><ul><ul><li>thoughts </li></ul></ul><ul><ul><li>feelings </li></ul></ul><ul><ul><li>expected outcomes </li></ul></ul><ul><li>Client learns and applies new coping skills to replace maladaptive behaviors and improve outcomes. </li></ul>
    8. 8. CBT: Social- Learning Approach <ul><li>Focuses on the training of interpersonal and self-management skills </li></ul><ul><li>Primary Goal = Mastery of skills needed to maintain long-term abstinence from substance abuse </li></ul><ul><ul><li>Identify high risk situations, both external circumstances and internal thoughts & feelings </li></ul></ul><ul><ul><li>Develop skills to cope with high risk situations </li></ul></ul><ul><ul><li>Practice, with feedback </li></ul></ul>
    9. 9. Teen Treatment Focus <ul><li>Enhancing intrinsic motivation to change through exploring and resolving ambivalence . </li></ul><ul><li>Providing feedback to encourage personal responsibility for change. </li></ul><ul><li>Developing personal goals. </li></ul><ul><li>Practicing healthful responses to real-life situations . </li></ul><ul><li>  </li></ul>
    10. 10. Evidence-Based Treatment <ul><li>  A randomized national study of 600 adolescents in outpatient substance abuse treatment , the MET/CB T -5 treatment program faired well. </li></ul><ul><ul><ul><li>As reported by Dennis, M. (2003). Cannabis youth treatment (trials: 12 and 30 month main finding. Presentation for SAMHSA Center for Substance Abuse Treatment Grantee Meeting, Baltimore, MD November 2003. </li></ul></ul></ul>
    11. 11. Results: <ul><li>Very positive overall effects as the briefest form of treatment in the study </li></ul><ul><li>Compared with treatments that were more than twice as long, MET/CBT-5 had higher rates of abstinence ce and recovery </li></ul><ul><li>A 50% decrease in problems at 3 months and 25% reduction at 6 months after intake </li></ul><ul><li>Some data to suggest that the positive results last ed for more than 2 years </li></ul>
    12. 12. Benefits Teens May Receive <ul><li>Enhanced levels of motivation </li></ul><ul><li>D evelopment of personal goals </li></ul><ul><li>Increased p roblem solving skills </li></ul><ul><li>Better coping skills </li></ul><ul><li>Effective refusal skills </li></ul><ul><li>Development of plans for drug-free activities </li></ul><ul><li>Increased supportive social network ties </li></ul><ul><li>Improved self- confidence for dealing with high-risk situations </li></ul>
    13. 13. Social Ecological Approach to Urban Adolescent Substance Abuse <ul><li>Explores the significant connections between teen’s mental health, co-participants of their lives and the everyday settings in which their health behaviors are expressed. </li></ul>Mental Health Social Network Geography of Risk & Protection Urban Teens
    14. 14. Sample Description <ul><li>16 years old </li></ul><ul><li>87% male </li></ul><ul><li>44% African American; 42% White; 11% Hispanic; 2% Asian </li></ul><ul><li>Referrals: Health system, Courts, Schools </li></ul><ul><li>80% Substance Dependence NOS </li></ul><ul><li>76% have had no Tx history </li></ul><ul><li>62% Marijuana primary drug; 33% alcohol primary substance </li></ul><ul><li>40% no MH Dx; Conduct dx, depression, ADHD; 20% have 2 dxs; 20% have 3 dxs </li></ul>
    15. 15. Longitudinal Naturalistic Design With Quantitative & Qualitative Data <ul><li>Outcome measures: </li></ul><ul><ul><li>GAIN: substance use, health, risk behaviors, mental health, environment, legal, vocational/educational </li></ul></ul><ul><ul><li>In-depth Social Network Assessment </li></ul></ul><ul><ul><li>Personalized Environmental/Geographical assessment </li></ul></ul><ul><ul><li>Parent-teen communication assessment </li></ul></ul><ul><ul><li>Case Studies: </li></ul></ul><ul><ul><ul><ul><li>Phenomenology of treatment </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Self-narrative development </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Family topological assessment </li></ul></ul></ul></ul><ul><ul><li>Biological Measure: Urine analysis </li></ul></ul>
    16. 16. Treatment Satisfaction
    17. 17. 3 Month Outcomes
    18. 18. 6 Month Outcomes
    19. 19. 6 Month Outcomes
    20. 20. Ecological Interview Other places Residence Risky Safe Important Free listing Typical Week Locations Details about locations: How When, Who, Length of stay Geographic Information Subjective Rating of Locations
    21. 23. Natasha + + - + - - 1 2 3 4 5 Natasha’s Social Network
    22. 24. Natasha - + 2 Known each other 5 years; Primary domain = Neighborhood & Church; Weekly contact; 1:1 52:0 positive to negative monthly activities Never feels pressured to use; is encouraged not to use daily; perceives her to be very influential on her life 1=19, AA, Hangs out at Natasha’s most Important & Safe locations
    23. 25. Substance Use Stress Depression User Non User Use Pressure Negative Activities Non user Non User User H.S Grad Clinic Connected Alcohol Outlets High Crime Poverty Unemployment Church Connected Drug Use Personal Risk Social Network Risk Environmental Risk Natasha’s Ecological Risk Profile Satisfaction/Desire to Change Library
    24. 26. References & Resources <ul><li>Miller, W.R. and Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change . New York: Guilford Press </li></ul><ul><li>Monti, P., Barnett, N., O’Leary, T. &Colby, S. (2001). Motivational enhancements for alcohol-involved adolescents. In P.M. Monti S. Colby, & T. O’Leary (Eds.) Adolescents, alcohol, and substance abuse: Reaching teens through brief interventions (pp. 145-182). New York: Guilford Press </li></ul><ul><li>Beck, A., Wright, F., Newman, C. & Liese, B. (1993). Cognitive Therapy of Substance Abuse. New York: Guilford Press </li></ul><ul><li>Enhancing Motivation for Change in Substance Abuse by Miller. Treatment Improvement Protocol Series (TIPS) # 35. </li></ul><ul><ul><li>Call 1(800) 729-6686; ask for BKD342 </li></ul></ul>
    25. 27. Conclusions <ul><li>Preliminary data suggests reduction of substance use at 3 & 6 month follow-up </li></ul><ul><li>Monitor mental health outcomes </li></ul><ul><li>Use case study data for implementation </li></ul><ul><li>Compare with other cohort project outcomes </li></ul>
    26. 28. Contact Information <ul><li>Michael Mason, Ph.D., Principal Investigator </li></ul><ul><ul><li>(202) 687-1357 emai l : [email_address] </li></ul></ul><ul><li>Our Web site: http://gumc.georgetown.edu/departments/psychiatry/guadolescenthealth.html </li></ul>

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