Evidence-Based Practices and Service Outcomes in Usual Care for ASA

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DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to examine the fidelity and effectiveness of evidence-based practices (EBPs) for adolescent substance abuse when implemented by community therapists in usual care. Although clinicians and treatment programs espouse allegiance to various EBPs, and a large proportion report using manualized treatments in routine practice, there is little reliable knowledge about the treatment ingredients actually delivered in community settings. To support adoption and training efforts, it is critical to know whether EBPs retain their integrity and potency in the hands of end users. The proposed study would be the first to examine implementation effects of EBPs for ASA in natural service conditions using rigorous observational methods. The study will leverage the resources of CASALEAP, an ongoing randomized trial testing the effectiveness of existing ASA treatment services in four clinical sites. Each site endorses at least two of the following EBPs as a primary treatment approach for ASA: cognitive-behavioral therapy (CBT), family therapy (FT), 12-step drug counseling (DC), and motivational interviewing (MI). The CASALEAP trial is collecting the following implementation data on a projected N = 205 participants: videotapes of three treatment sessions (2, 6,10) and a pilot therapist self-report checklist of EBP adherence after every session. At minimal cost, the proposed study will augment CASALEAP assessment procedures in two innovative ways. First, videotaped sessions will be coded by clinically trained raters using validated observational measures of adherence and competence for all four EBPs: CBT, FT, DC, and MI. Tapes will also be rated for therapeutic alliance with adolescents and caregivers. Second, data from completed pilot versions of the therapist-report checklist will be analyzed, participating therapists will be trained to reliably complete a reduced-item version of the checklist, and the new brief version will be tested for reliability and construct and criterion validity. The first aim of the study is to determine whether EBP adherence, competence, and alliance predict service utilization and one-year outcomes for ASA in usual care. The second aim is to develop and test a brief, psychometrically sound therapist-report measure of adherence to EBPs for ASA that can be included in program evaluation toolkits for monitoring treatment service implementation in systems of care. The third aim is to examine whether routine implementation of EBPs in community agencies approaches fidelity benchmarks set by research-trained therapists in controlled studies. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse (ASA) continues to be a highly prevalent, often life-threatening, and costly public health problem. The costs of ASA include those associated with treatment and prevention, crime, and lost productivity; recent estimates of ASA-related costs, available for alcohol consumption only, total $58 billion dollars per year. Also, co-occurrence of ASA with other psychiatric disorders has been established in both community and clinical samples. Adolescent drug abusers with comorbid conduct disorders create a significant burden on the juvenile justice system; for example, in the year 2000 over 203,000 juveniles were arrested for drug abuse violations. For all these reasons, ASA treatment is among the most pressing youth mental health needs in the country. However little is known about the nature and quality of ASA services currently available in usual care settings. This study will begin to fill this gap by providing a rigorous evaluation of the implementation of evidence-based practices for ASA in usual care.