Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32, 1237-1251

Human Development and Family Science, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210, USA.
Addictive Behaviors (Impact Factor: 2.76). 07/2007; 32(6):1237-51. DOI: 10.1016/j.addbeh.2006.08.010
Source: PubMed


Comprehensive intervention for homeless, street living youth that addresses substance use, social stability, physical and mental health issues has received very little attention. In this study, street living youth aged 14-22 were recruited from a drop-in center and randomly assigned to the Community Reinforcement Approach (CRA) or treatment as usual (TAU) through a drop-in center. Findings showed that youth assigned to CRA, compared to TAU, reported significantly reduced substance use (37% vs. 17% reduction), depression (40% vs. 23%) and increased social stability (58% vs. 13%). Youth in both conditions improved in many other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task oriented coping. This study indicates that homeless youth can be engaged into treatment and respond favorably to intervention efforts. However, more treatment development research is needed to address the barriers associated with serving these youth.

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    • "In future experiences, utilizing other formats for A-CRA could help delivering treatment to broader samples in these public contexts. Previous experiences using group format with A-CRA in the US (Godley, Smith, Meyers, & Godley, 2009; Slesnick et al., 2007), and CRA in Spain (Garcia-Fernandez et al., 2011) have obtained positive results. Other approaches such as telehealth procedures have shown to be effective for psychological treatments (Peñate, 2012). "
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    ABSTRACT: El objetivo de este estudio era describir la implementación en el Sistema Público de Salud de dos programas basados en la evidencia (PBE) para adolescentes con trastornos por consumo de cannabis, y sus principales resultados. La Aproximación de Reforzamiento Comunitario para Adolescentes (A-CRA) y el Control de Contingencias (MC) fueron elegidos como los programas de intervención más eficaces para esta población. Un total de 26 adolescentes participaron en el estudio (91.7% chicos; edad media = 16.50 años) en dos centros de carácter ambulatorio en España. Se utilizó un diseño cuasi-experimental, donde un grupo recibió A-CRA y el otro A-CRA + MC. La implementación de ambos programas resultó factible, con resultados clínicos positivos. El A-CRA ofreció buenas tasas de retención (81.3%) y abstinencia (68.6%). Los resultados del grupo A-CRA + MC no fueron significativamente mejores que los del A-CRA en retención (100%) o abstinencia (75.5%), aunque el limitado tamaño muestral no permite establecer conclusiones firmes. Los problemas asociados al cannabis y la sintomatología depresiva se redujeron durante el tratamiento. Varias limitaciones nos impiden determinar la eficacia clínica del A-CRA en este estudio. El proceso de traslación de los PBE al contexto clínico presentó múltiples dificultades que deben ser abordadas. Se discuten recomendaciones para futuros intentos de implementación de PBE en estos contextos.
    International Journal of Clinical and Health Psychology 09/2014; 14(3). DOI:10.1016/j.ijchp.2014.04.001 · 2.79 Impact Factor
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    • "Aboriginal survey participants also expressed a preference for clients completing CRA or CRAFT to receive follow-up support, and a need for CRA/CRAFT programs targeting young people. Consistent with these views of Aboriginal survey participants, follow-up support at 6 weeks post program completion was incorporated into protocols for CRA and CRAFT delivery, and an adolescent version of CRA shown to reduce substance misuse in high risk young people identified [17,18]. The acceptability of the adolescent version of CRA to Aboriginal Australian adolescents should be examined before tailoring the program. "
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    ABSTRACT: Aboriginal Australians experience a disproportionately high burden of alcohol-related harm compared to the general Australian population. Alcohol treatment approaches that simultaneously target individuals and families offer considerable potential to reduce these harms if they can be successfully tailored for routine delivery to Aboriginal Australians. The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT) are two related interventions that are consistent with Aboriginal Australians' notions of health and wellbeing. This paper aims to describe the process of tailoring CRA and CRAFT for delivery to Aboriginal Australians, explore the perceptions of health care providers participating in the tailoring process, and their experiences of participating in CRA and CRAFT counsellor certification. Data sources included notes recorded from eight working group meetings with 22 health care providers of a drug and alcohol treatment agency and Aboriginal Community Controlled Health Service (November 2009-February 2013), and transcripts of semi-structured interviews with seven health care providers participating in CRA and CRAFT counsellor certification (May 2012). Qualitative content analysis was used to categorise working group meeting notes and interview transcripts were into key themes. Modifying technical language, reducing the number of treatment sessions, and including an option for treatment of clients in groups, were key recommendations by health care providers for improving the feasibility and applicability of delivering CRA and CRAFT to Aboriginal Australians. Health care providers perceived counsellor certification to be beneficial for developing their skills and confidence in delivering CRA and CRAFT, but identified time constraints and competing tasks as key challenges. The tailoring process resulted in Aboriginal Australian-specific CRA and CRAFT resources. The process also resulted in the training and certification of health care providers in CRA and CRAFT and the establishment of a local training and certification program.
    BMC Public Health 04/2014; 14(1):322. DOI:10.1186/1471-2458-14-322 · 2.26 Impact Factor
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    • "Based upon the Community Reinforcement Approach (CRA) originally developed for treating substance abuse with adults (Azrin, Sisson, Meyers, & Godley, 1982; Higgins et al., 1991; Hunt & Azrin, 1973; Meyers, Dominguez, & Smith, 1996; Meyers & Smith, 1997; Smith, Meyers, & Delaney, 1998), A-CRA/ACC are adolescent adaptations of CRA that some studies have reported to be both effective and cost-effective(Dennis et al., 2004; S. H. Godley et al., 2010), while other studies have examined effectiveness alone (Garner, Godley, Funk, Dennis, & Godley, 2007; M. D. Godley, Godley, Dennis, Funk, & Passetti, 2002, 2007; Slesnick, Prestopnik, Meyers, & Glassman, 2007). In contrast to session-based EBPs, which deliver treatment procedures to all clients in the same prescribed order, A- CRA/ACC are procedure-based interventions that require therapists to be able to not only deliver the treatment procedures, but also determine which procedure(s) are most appropriate, based on what the adolescent says during each treatment session. "
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    ABSTRACT: Although several costing instruments have been previously developed, few have been validated or applied systematically to the delivery of evidence-based practices (EBPs). Using data collected from 26 organizations implementing the same EBP, this paper examined the reliability, validity, and applicability of the brief Treatment Cost Analysis Tool (TCAT-Lite). The TCAT-Lite demonstrated good reliability-correlations between replications averaged 0.61. Validity also was high, with correlation of treated episodes per $100,000 between the TCAT-Lite and independent data of 0.57. In terms of applicability, cost calculations found that if all organizations had operated at optimal scale (124 client episodes per year), existing funds could have supported 64% more clients.
    Alcoholism Treatment Quarterly 10/2012; 30(4):377-396. DOI:10.1080/07347324.2012.719425
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