adolescent development and effectively engaging/retaining ... adolescent training/adolescent...
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12/11/2017
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Adolescent DevelopmentandEffectively Engaging/Retaining Adolescents in Treatment
Jason Burrow‐Sánchez, PhDProfessorDept. of Educational Psychology University of Utah
Presentation Overview
• Utah Substance Abuse Treatment Demographics
• Biology & Environment
• Stress & Problem‐Solving
• Retaining Engaging Adolescents in Treatment
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Disclaimer
This presentation will not:Fix all of your engagement and retention “issues” (sorry!)
This presentation will:Provide you with ideas, principles, and practical examples of ways to address engagement & retention “issues” in your treatment programs
**It’s up to you to apply the ideas and principles**
Utah Substance Abuse Treatment Demographics
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12,080
1,326
SUD
Number of Youth
Utah Youth Treatment Need vs. Received
NEED TX RECEIVE TX
Source: Utah DSAMH 2016 Annual Report – 2014/15 SAMHSA & SHARP Data
Levels of Intervention
85%
10%
5%
Primary or (Universal)
Secondary or (Selected)
Tertiary (Indicated)
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4
461
372
2511
58
162
101
8 10 15
WHITE LATINO BLACK AM INDIAN OTHER
Number of Youth
Utah Youth Treatment Admissions: SUDs (N=1,226)
MALE FEMALE
Source: TEDS‐A, 2014 ‐ SAMHSA
766
126
12 5 3
224
57
8 3 1
MARIJUANA ALCOHOL METH HEROIN OPIATES
Number of Youth
Utah Youth Treatment Admissions: Primary Drug (N=1,226)
MALE FEMALE
Source: TEDS‐A, 2014 ‐ SAMHSA
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5
120
250 0 0
663
79
10 6 0
207
79
10 2 4
MARIJUANA ALCOHOL METH HEROIN OPIATES
Number of Youth
Utah Youth Treatment Admissions: Age 1st Use (N=1,226)
11 or Less 12 to 14 15 to 17
Source: TEDS‐A, 2014 ‐ SAMHSA
179
223 0 0
873
111
334 1
SOP IOP RES (<30) RES (>30) DETOX
Number of Youth
Utah Youth Treatment Admissions: Setting (N=1,226)
12 to 14 15 to 17
Source: TEDS‐A, 2014 ‐ SAMHSA
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449
290
17 12
40
400
301
1727
53
WHITE LATINO BLACK AM INDIAN OTHER
Number of Youth
Utah Youth Treatment Discharge: SUDs (N=1,606)
COM NOT_C
Source: TEDS‐D, 2013 ‐ SAMHSA
Biology and Environment
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Social Markers of Development
• Age‐based social markers:– 13: Teenager
– 16: Driver’s License
– 18: Adult• Vote
• May or may not be eligible for youth/adolescent programming
• Join Military
– 21: Use Alcohol Legally
Why is Adolescent Brain Development Important?
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Major Parts of the Brain• Brain Stem
– Keeps us alive (breathing, heartbeat, safety responses)
• Limbic Area– Emotion
• Amygdala (fear, anger)• Hippocampus (new memories)• Hypothalamus (endocrine system ‐ hormones)• Ventral Striatal (motivation)
• Cortex Area– Prefrontal Cortex (planning, considering consequences,
decision‐making, managing emotions)
Source: Walsh, 2013
Adolescent Development
Birth Puberty Adolescence Young Adulthood
0 11‐13 13‐18 19 >
Brain Stem Limbic Area Pre Frontal Cortex
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Puberty
Adolescent
Family
Peers
School
Community
Neighborhood
Societal Norms
Laws
Geographic Differences
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Psychological Tasks
• Identity Development
– Self
– Others
– World
Identity Worksheet
Source: Burrow‐Sánchez & Searcy, 2015
Descriptors (Visual)
Evaluation
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Adolescent Stress & Problem Solving
Stress & Problem Solving
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Social Problem Solving
• Positive Problem Orientation
– Rational Problem Solving
• Negative Problem Orientation
– Impulsive/Careless Style
– Avoidance Style
Source: Nezu, Nezu & D ‘Zurilla (2013)
16
18
12
10
14
PPO PPS NPO IC AV
Score
Problem Solving Survey
Source: Nezu, Nezu & D ‘Zurilla (2013)
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Engagement and Retention
• Engaging Participants• What does this mean?
• Retaining Participants• What does this mean?
Why Don’t Adolescents Attend Treatment Programs?
• Is it due to motivation?
• Is it due to characteristics?
– Participants
• Youth, parents, families
– Psychological Factors
– Socio‐economic factors
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Micro and Macro Levels
Person(Adolescent)
Environment(Program)
Targeting Specific Behavior(aka Contingency Management or Motivational Incentives)
Contingency ManagementBased on principles of learning and models of behavior change
Evidence-based practice in the addictions field
Target a specific behavior to changeTypically: goal is to increase a desirable behavior by modifying the contingencies that maintain it.Provides tangible reinforcers or privileges for desired behavior
Use as an adjunct to treatmentIntegrate into existing practicesIncrease specific client behaviors
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Models of Behavior Change
• Operant Conditioning
– Person is acting upon the environment
– Consequence of voluntary behavior will influence its frequency
– Involves: Antecedents – Behavior – Consequences
– Re‐occurrence (or non‐occurrence) of behavior is influenced by the contingency that maintains it
• Contingency = a future possible event
Contingencies
• Reinforcement– Positive:
• Consequence of behavior is addition of something positive – increases the likelihood that behavior will occur again
– Negative
• Consequence of behavior is removal of something negative – increases the likelihood that behavior will occur again
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Contingencies
• Punishment
– Addition
• Consequence of behavior is addition of something negative – decreases likelihood that behavior will occur again
– Subtraction
• Consequence of behavior is removal of something positive – decreases likelihood that behavior will occur again
Example Antecedent Behavior Consequence Likelihood of Behavior Occurring Again?
Type of Contingency
1 Group Meeting Tues @ 6pm
Adolescent attends group
Warm welcome and acceptance by therapist and other members
Increase Positive Reinforcement
2 Group Meeting Tues @ 6pm
Adolescent attends group
Chastised by therapist for missing last group
Decrease Punishment (Addition)
3 Client has a lot of anxiety about attending group meeting Tues @ 6pm
Adolescent attends group
Warm welcome and acceptance by therapist and other members – client anxiety diminishes
Increase Negative Reinforcement
4 Group Meeting Tues @ 6pm
Adolescent arrives 10 minute late to group
Group room door is locked and client cannot attend group
Decrease Punishment (Subtraction)
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Principles of Contingency Management (aka Motivational Incentives)
1. Identity the target behavior
2. Identity the population
3. Identify the reinforcers (aka incentives)
4. Identify the magnitude of the reinforcers
5. Identity the schedule of reinforcement
6. Identity timing for delivery of reinforcers
7. Identify length of time to deliver reinforcers
Example: Fishbowl Method (Petry et al.)
• Fishbowl Method
– Client picks slip of paper from fishbowl
• Slip of paper indicates incentive
• Incentive can be intangible (e.g., “good job”) or tangible (size of tangible should vary)
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Fishbowl Method cont.
Paper Slip Cost Percent Available
Intangible (e.g., praise) $0 50%
Tangible (small) $1‐2 35%
Tangible (medium) $5‐10 10%
Tangible (large) $20‐25 5%
Take Home Message for Contingency Management
Reinforce the behavior you want to occur!!
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Micro and Macro Levels
Person(Adolescent)
Environment(Program)
What is Social Validity?(Targeting Program Behavior)
• Social Validity
– Increase the social attractiveness of the program for participants.
– Social attractiveness:• Program Relevance
• Program Benefits
– Program Rationale
• Program Staff
• Logistics
– Time
– Location
– Cost
• Other things?
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Defining Social Validity for Your Program
• Who are your participants or consumers?
• Is your treatment program relevant for them?
– How do you know this?
Social Validity: Goal
Be on the same page with your clients, consumers or participants!
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Enhancing the Social Validity of Your Program
• Ways to Enhance Social Validity:
– Review the literature
– Review the demographics for the geographic location
– Ask others who have done this before
– Ask potential, current and past consumers of your
– program (or a similar program)
– Other ways?
CAM‐SAT
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• Study 1: Focus Groups– Develop Culturally Accommodated Treatment
• Study 2: Pilot Study, 35 Latino Adolescents– Feasibility Trial
• Study 3: Randomized Clinical Trial, 70 Latino Adolescents– Efficacy Trial
Sources of Information
• Review the literature
• Expert opinion
• Staff experience and discussion
• Focus groups (ask the participants)
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VIDA Focus Groups (Burrow‐Sanchez et al., 2011)
• Local Latino Community:• Latino Parents• Latino Adolescents• Latino Community Leaders
• Juvenile Justice:• Probation Officers
• Substance Abuse Providers:• Therapists
Variables of Interest and Major Themes
Perspectives on: ◦ Latino adolescents◦ Substance Abuse Treatment for Latino Adolescents ◦ Latino Families◦ Acculturation◦ Ethnic Identity
Major Themes:◦ Family◦ Acculturation◦ Ethnic Identity◦ Substance Abuse Treatment◦ Barriers to Treatment
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Changes to Treatment and Delivery
• Treatment:– Infuse culturally relevant elements– Include ethnic identity and adjustment module
• Delivery:– Bilingual staff (including therapists)– All written materials available in English/Spanish– Family Information Meeting– Regular contact with parents– Location: Community Center– Time: evenings and weekends
• Consumer Based Perspective
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Influence of Cultural Variables on Retention and Engagement (Burrow‐Sánchez et al., 2015)
Retention: # of treatment sessions attended• Exploration = predicted increase in attendance
• Familism = predicted increase in attendance
• Anglo Orientation = predicted decrease in attendance
Engagement: # of practice sheets completed• Exploration = predicted increase in practice sheets
• Familism = predicted increase in practice sheets
• Drug Use and AOS = predicted decrease in practice sheets
Micro and Macro Levels
Person(Adolescent)
Environment(Program)
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Four Step Plan to Increase Retention/Engagement
1) Examine the data
2) Enhance the micro‐ and macro‐levels for your program (Social Validity – e.g., CAM‐SAT)
3) Take data
4) Revise as needed
Contact Information
Jason Burrow-Sánchez, PhDProfessor
Dept. of Educational Psychology
University of Utah
801.581.6212
jason.burrow‐[email protected]