Vision Session: UK HealthCare - Adolescent Health and Recovery Treatment & Training

2. Catherine Martin,
MD
Ginny Sprang, PhD
Lisa Clark
Miriam Silman, MSW
Jennifer Cole, PhD
Kristin Dawson, MD
Greg Guenthner,
MLIS
Cindy Taylor

3. Goals and Objectives
• Assess and treat adolescent substance
abusers and their families
• Model evidence-based state of the art
treatment and educate providers
• Disseminate model treatment
interventions to communities with the
highest need
• Evaluate and determine the most
effective routes of treatment and
education

4. AHARTT
• KY Kids Recovery
program
• Senate Bill 200
• Mental health and
Substance Abuse Parity
& Affordable Care Act
that require SA
coverage
• Promising Science in
Adolescent Substance
Abuse
• Wonderful scientific and

5. About AHARTT funding:
Kentucky Attorney General Jack Conway's
actions:
• Against Merck, which failed to
disclose to doctors and patients that
taking Vioxx significantly raised the
risk of heart attack. Settled for $25M.
• Against GlaxoSmithKline for allegedly
failing to disclose that patients taking
its diabetes drug, Avandia, were at a
higher risk for cardiovascular
problems. Settled for $15M.

6. • The court orders filed in both
settlements require that the funds be
spent on drug treatment programs.
• 19 substance abuse treatment grant
proposals from across the
Commonwealth
• KY Kids Recovery program of the
Cabinet for Health and Family Services
and the Office of Attorney General Jack
Conway
• Governor’s Substance Abuse
Treatment Advisory Committee
(SATAC) chaired by Attorney General
Jack Conway

7. SB 200 Summary
Attempts to ensure improved
effectiveness and outcomes in
adjudicate youth-
• Focuses the most expensive
resources on more serious
offenders.
• Provides for earlier access to
treatment/supervision and increases
funding for services in local
communities.
• Establishes oversight and

8. FAIR Team
Each judicial district will have a family
accountability, intervention, and
response team that “shall develop
enhanced case management plans and
opportunities for services for children.”

9. AHARTT is the 1st one
funded:
1) Talking
2) Training
3) Tracking
4) Treating

10. AHARTT:
1) Talking
2) Training
3) Tracking
4) Treating

11. Stakeholder Community
Conversation
So far we have had 4 stakeholder
meetings
• Lexington
• Morehead
• Hopkinsville
• Covington
What are we learning??

12. Audience Questions
What barriers have you encountered
delivering or obtaining treatment for
adolescent substance use?
What resources or supports are available
to adolescents in recovery in your
community?
Who are the key players we should be
talking to (other than the ones in this
room today)?

14. Community Conversation:
Access to treatment
• Satellite sites out in communities
• Transportation
• Take the service to the child –
home-based
• Utilize Telehealth more
• Quick response

15. Community Conversation:
Teamwork—Who should be talking
• Legislators
• Parks & Recreation; other
community non-profits
• Businesses (need skilled workers;
clients need jobs and
employment)
• MCO support (care delays and
denials)

16. AHARTT:
1) Talking
2) Training
3) Treating
4) Tracking

17. AHARTT Scholars are working directly in 92
counties from Paducah to Pikeville. Plus 3
programs that draw clients statewide.

18. Training to be the Best:
• Building Capacity through
Learning Community Approach
• Two EBPs Disseminated
1) Functional Family Therapy
2) CBT (ENCOMPASS)
• Continuing Education Modules
• Embedded in learning
communities

19. ENCOMPASS
Integrated
Treatment
for
Adolescents
and Young
Adults

20. Evidence-Based Psychiatric and Substance
Treatments for Adolescents
Substance Use Disorders
• Family-based
• Behavioral (CM,
incentives)
• Cognitive Behavioral
Therapy (CBT)+ MET
Psychiatric Disorders
Conduct Disorder (60-80%)
•Family-Based
•CBT
Depression, Anxiety(30-40%)
•CBT
•Pharmacotherapy
ADHD (30-50%)
•CBT
•Pharmacotherapy

21. Individual CBT is consistently
associated with greater sustained
or increasing decrease in substance
abuse than other evidence-based
substance treatment interventions
for adolescents (Tripodi et al 2010;
Waldron et al., 2008).
Strengths of ENCOMPASS CBT

22. 22
These procedures include:
• 3-day face-to-face training followed
by weekly clinical supervision and
fidelity/adherence monitoring.
• Randomly selected audio-recorded
sessions from each therapist are
reviewed, rated for fidelity/adherence
and provided written and oral
feedback by the Encompass MET/CBT
supervisor
Strengths of ENCOMPASS CBT

23. • Encompass MET/CBT can be
individually tailored for patients by
selecting the modules (from a menu of
modules) that are most clinically
relevant for individual patients.
• Depression: negative mood states
often trigger substance use. Focus on
mood regulation skills.
• ADHD: focus on organizational skills,
impulse control, anticipation and
planning ahead for high risk
situations.
Strengths of ENCOMPASS CBT

24. Thomas L. Sexton, Ph.D., ABPP and Astrid van Dam

25. Functional Family Therapy
• Comprehensive, family-focused,
evidence-based model addressing
co-occurring disorders
• Flexible & adaptive to fit clients
across range of cultural contexts,
clinic or in-home delivery,
voluntary & court-ordered families
• Uses data to drive decisions &
improve fidelity

26. FFT Core Principles
• Problems are embedded in multisystemic,
relational risk and protective factors.
• Families are the primary focus of treatment
and assessment.
• Obtainable Change Goals are family based.
• Alliance Based Motivation creates positive
engagement and lasting change.
• Evidence based clinical decision making
results in better community based
outcomes.

27. Stages
Delivered weekly sessions in each
treatment phase occur in a successful
treatment episode
Engagement Motivation
Behavior Change
Generalization

28. • Fidelity is tracked with
both of these models
with individual and
group review of cases
and tapes of sessions
and self monitoring and
patient monitoring of
progress.
• Also training the trainer
for CBT.

29. Continuing Education Modules

30. AHARTT:
1) Teamwork
2) Training
3) Tracking
4) Treating

31. Adolescent Kentucky Treatment
Outcome Study (AKTOS)
• Severity of use, withdrawal
• Physical health problems
• Mental health problems
• Clinicians complete intake survey
using a secure, online system
• Narrative report is generated
• Research team at UK CDAR
completes follow-up at 12 months

32. Model Clinic
• Assessment and Treatment
• Goal is to manualize and to have
onsite clinical experiences

33. Timeline Followback

35. • How do we
track e-cigs,
smokeless
tobacco?
• What if TLFB
shows use but
UDS and CO
are negative?

36. How can we track
alcohol
use…beyond
Timeline
Followback?

37. Assessment (cont)
• Child Behavior Checklist
• Achenbach Youth
• School Records

38. AHARTT:
1) Teamwork
2) Training
3) Tracking
4) Treating

39. Treatment
Functional Family
Therapy
Encompass
Cognitive
Behavioral
Therapy
Contingency
Management
Pharmacotherapy

40. Dispel
Myths
You do NOT have
to be CLEAN to
start medication
for a co-morbid
disorder

41. Comorbidity, Medication,
Psychiatric Disorders & Substance
Use
Co-
Morbidity
Medicatio
n
Psychiatric Sx
Substance
Use
Bipolar Lithium Stabilized Mania SU
ADHD Stimulants
 Impulsivity
 Attention
 Smoking
in the lab
No change
SU
ADHD +
Depression
Bupropion
 Depression
 Attention
 Smoking
Depression sertraline  Depression
No change in
SA

42. Naloxone NS: You Can Be Saved By A
Nose!!!
Daniel Wermeling, Pharm.D.
Professor, College of Pharmacy
42

43. Potential
Indications/Populations
1. Patient release after emergency medical
care involving opioid
poisoning/intoxication
2. Suspected history of illicit or nonmedical
opioid use
3. Any opioid prescription and …
concurrent alcohol, benzodiazepine or
SSRI prescription
Would discussing this with the family
heighten safety measures with opiates?

44. January 6, 2014 – FRANKFORT, KY — Gov.
Steve Beshear, First Lady Jane Beshear, and
Attorney General Jack Conway today
announced that heroin overdose reversal kits
will be purchased for Kentucky hospitals with
the highest rates of heroin overdose
deaths. Overdose patients will receive a kit
free of charge when they leave the hospital, so
they or a loved one can prevent another
overdose event and possibly save a life. The
funding is provided through the Substance
Abuse Treatment Advisory Committee (SATAC).

45. Contingency
Management
45

47. Contingency
Management
Fish Bowl
# of chips Value
49 $0
45 $5
5 $10
1 $25

48. CC: Community Recovery
• Faith-based youth groups provide
buses & transportation
• Churches host 12-step programs,
including some for adolescents
• Peer support
• Advisory Board

49. Comments and questions….and
ANSWERS!!!!!

50. Community Roll out and next steps
• Outreach to Primary Care, Pharmacists, Dentists,
Community Mental Health Centers
• Establish referrals with agencies, such as:
– Department for Juvenile Justice
– Family Resource and Youth Service Centers
(in schools)
– Administrative Office of the Courts
– Department for Community Based Services
– Department for Public Health
• Create Advisory Board
• Operationalize Model Clinic for duplication in other
areas of the state

51. NCAA Championship