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Service Delivery and Use of Evidence-Based Treatment Practice in Adolescent Substance Abuse Treatment Settings

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Project Summary:

Background Adolescent substance abuse, including illegal drugs, alcohol, and tobacco, is a major public health problem in the United States. Given the unique needs of substance-abusing adolescents, substance abuse treatment programs have been developed to serve this population. To date, there are little nationally representative data on the services delivered within the adolescent treatment system. It is unknown the extent to which these programs provide evidence-based, high-quality treatment programming. Furthermore, it is unclear if the availability of such programming varies by state-level policies and organizational characteristics. This study will address these major gaps in the existing knowledge base regarding adolescent substance abuse treatment in the United States. The collection of such data is critical for policy-making, since policy-makers must know the current “state of the field” if they want to design policies that can improve the quality of and access to adolescent treatment. Specific Aims The project has four research objectives: 1. Describe the structure of adolescent substance abuse treatment in publicly and privately funded specialty substance abuse treatment facilities. 2. Measure the adoption and implementation of evidence-based and high-quality treatment practices. 3. Estimate the associations between state-level policies, state funding, services offered, and adoption of innovations. 4. Examine the organizational factors associated with patterns of service delivery and innovation adoption. Methods We will use a quantitative, cross-sectional design to address the four aims. Telephone interviews will be conducted with adolescent treatment program managers at approximately 361 community-based substance abuse treatment centers in the United States. These centers represent adolescent treatment providers in existing nationally representative random samples of publicly funded and privately funded substance abuse treatment centers. The interviews will include measures of 1. program structure (levels of care, lengths of stay); 2. nine dimensions of effective adolescent treatment (assessment and treatment matching; a comprehensive treatment; family involvement; developmentally appropriate programming; strategies to engage and retain adolescents; the hiring of qualified staff; gender and cultural competence; continuing care; and program evaluations of treatment outcomes); 3. specific psychosocial (for example, motivational enhancement therapy, cognitive-behavioral therapy, 12-step approaches) and family based interventions (for example, multidimensional family therapy, brief strategic family therapy); 4. comprehensive wraparound services (including psychiatric services, HIV/AIDS prevention/intervention); 5. state policies and funding of adolescent treatment. Analyses of these data will utilize statistical software packages, such as Stata® and SPSS, and will include basic descriptive statistics, negative binomial regression for count data models, logistic regression for binary dependent variables, and multinomial logistic regression for categorical dependent variables. The appropriate statistical technique will be employed based on the measurement of the dependent variables of interest in order to address the project’s specific aims.

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