ADOLESCENT COMMUNITY REINFORCEMENT APPROACH
OVERVIEW
The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral, outpatient intervention aimed at providing continuing care for adolescents, youth, and young adults who have received residential treatment for substance use disorders. The goal of the program is patient recovery from the disorder. In an evaluation of the program, 183 adolescents were randomly assigned to receive either Assertive Continuing Care (ACC) with A-CRA, or the Usual Continuing Care, which served as the control condition. Results indicated that adolescents in the ACC/A-CRA condition experienced significantly greater continuing care linkage and retention, significantly better adherence to continuing care criteria, and longer abstinence from marijuana than adolescents receiving usual care. However, there were no differences in abstinence from alcohol or other drugs between the two groups of adolescents.
DESCRIPTION OF PROGRAM
Target population: individuals between the ages of 12 and 22 in residential treatment for substance use disorders.
The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral, outpatient intervention for adolescents, youth, and young adults who have completed a residential care program for substance use disorders. The program is designed to encourage recovery and abstinence from substance use, and to promote linkage to, and participation in, continuing care services.
In the A-CRA program, the patient's therapist selects procedures and treatments that are tailored to the individual's needs. Seventeen different skills training topics are available, some of which include problem-solving skills to cope with day-to-day stressors, communication skills, and active participation in pro-social activities. Role-playing and behavioral rehearsal are critical components of the skills training sessions.
The average cost of implementing the treatment is between $1,200 and $1,600 per person. The cost includes personnel, materials and supplies, contracted services, buildings and facilities, equipment, and miscellaneous items.
EVALUATION(S) OF PROGRAM
Godley, M.D., Godley, S.H., Dennis, M.L., Funk, R.R., & Passetti, L.L. (2007). The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Addiction, 102, 81-93.
Evaluated population: 183 adolescents between
the ages of 12 and 17 receiving residential treatment for substance use or
dependence disorders and residing in
Approach: Prior to discharge from residential treatment, participants were randomly assigned to receive one of the following two treatments: 1) Assertive Continuing Care with an A-CRA component, or 2) the Usual Continuing Care, which served as the control condition. At discharge, adolescents in the UCC condition received referrals to outpatient providers of continuing care. Adolescents in the ACC condition received the same continuing care referrals as the adolescents in the UCC condition. Additionally, these adolescents were assigned to a case manager for a 90-day period following residential treatment discharge. During this 90-day period, the case managers met weekly with the adolescents and/or their caregivers.
The case managers used both standard case management techniques and the A-CRA therapy techniques in their intervention for the adolescents in the ACC condition. Case management services included the following: 1) Home visits, 2) help linking the adolescents to necessary services, 3) transportation to needed services, 4) advocacy for the client to access services when needed, 5) monitoring lapse cues and attendance at other needed services and activities, and 6) social support for coping with a lapse or other challenging issue.
The A-CRA intervention included assessing the individual as a means of targeting problem areas. Throughout the course of the intervention, caseworkers implemented the client-specific skills training. Towards the end of the 90-day continuing care phase, case managers met twice with the caregiver and adolescent together to practice behavioral skills. Adolescents were given these self-assessments for success monitoring three, six, and nine months after residential treatment discharge.
Results: Results indicated that adolescents in the ACC/A-CRA condition experienced significantly greater continuing care linkage and retention, significantly better adherence to continuing care criteria, and longer abstinence from marijuana than adolescents receiving usual care. However, there were no differences in abstinence from alcohol or other drugs between the two groups of adolescents.
SOURCES FOR MORE INFORMATION
Link to program manual:
www.bhrm.org/guidelines/CRAmanual.pdf
Information on implementing this program can be obtained from:
Brandi Barnes
EBT Coordinator
Chestnut Health Systems, Inc.
Phone: (309) 820-3543
E-mail: bbarnes@chestnut.org
References:
Godley, M.D., Godley, S.H., Dennis, M.L., Funk, R.R., & Passetti, L.L. (2007). The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Addiction, 102, 81-93.
Program categorized in this guide according to the following:
Evaluated participant ages: 12-22
Evaluated participant grades: N/A
Program age ranges in the guide: Adolescence, Youth, Young Adults
Program components: Counseling/Therapy, Clinic/Provider-Based, Home Visiting, Parent or Family Component
Measured outcomes: Behavioral Problems
KEYWORDS: Adolescence (12-17), Youth (16+), Young Adults (18-24), Black or African American, White or Caucasian, Hispanic or Latino, Middle School, High School, Clinic-based, Home Visitation, Mentoring, Substance Use, Alcohol Use, Marijuana Use, manual, co-ed, cost, any substance use.
Program information last updated on 8/13/08.
|
|
|
© Child Trends 2003 |
|
|
|
