Catherine Martin, MD
Ginny Sprang, PhD
Lisa Clark
Miriam Silman, MSW
Jennifer Cole, PhD
Kristin Dawson, MD
Greg Guenthner, MLIS
Cindy Taylor
Goals and Objectives
• Assess and treat adolescent substance abusers and their families
• Model evidence-based state of the art treatment and educate providers
• Disseminate model treatment interventions to communities with the highest need
• Evaluate and determine the most effective routes of treatment and education
AHARTT
• KY Kids Recovery program
• Senate Bill 200
• Mental health and Substance Abuse Parity & Affordable Care Act that require SA coverage
• Promising Science in Adolescent Substance Abuse
• Wonderful scientific and clinical colleagues
About AHARTT funding:
Kentucky Attorney General Jack Conway's actions:
• Against Merck, which failed to disclose to doctors and patients that taking Vioxx significantly raised the risk of heart attack. Settled for $25M.
• Against GlaxoSmithKline for allegedly failing to disclose that patients taking its diabetes drug, Avandia, were at a higher risk for cardiovascular problems. Settled for $15M.
• The court orders filed in both settlements require that the funds be spent on drug treatment programs.
• 19 substance abuse treatment grant proposals from across the Commonwealth
• KY Kids Recovery program of the Cabinet for Health and Family Services and the Office of Attorney General Jack Conway
• Governor’s Substance Abuse Treatment Advisory Committee (SATAC) chaired by Attorney General Jack Conway
SB 200 SummaryAttempts to ensure improved effectiveness and outcomes in adjudicate youth-
• Focuses the most expensive resources on more serious offenders.
• Provides for earlier access to treatment/supervision and increases funding for services in local communities.
• Establishes oversight and performance measurement for the
FAIR Team
Each judicial district will have a family accountability, intervention, and response team that “shall develop enhanced case management plans and opportunities for services for children.”
Stakeholder Community Conversation
So far we have had 4 stakeholder meetings
• Lexington
• Morehead
• Hopkinsville
• Covington
What are we learning??
Audience Questions
What barriers have you encountered delivering or obtaining treatment for adolescent substance use?
What resources or supports are available to adolescents in recovery in your community?
Who are the key players we should be talking to (other than the ones in this room today)?
Community Conversation:Access to treatment
• Satellite sites out in communities
• Transportation
• Take the service to the child –home-based
• Utilize Telehealth more
• Quick response
Community Conversation: Teamwork—Who should be talking
• Legislators
• Parks & Recreation; other community non-profits
• Businesses (need skilled workers; clients need jobs and employment)
•MCO support (care delays and denials)
AHARTT Scholars are working directly in 92 counties from Paducah to Pikeville. Plus 3 programs that draw clients statewide.
Training to be the Best:
• Building Capacity through Learning Community Approach
• Two EBPs Disseminated1) Functional Family Therapy2) CBT (ENCOMPASS)
• Continuing Education Modules
• Embedded in learning communities
Evidence-Based Psychiatric and Substance
Treatments for Adolescents
Substance Use Disorders
• Family-based
• Behavioral (CM, incentives)
• Cognitive Behavioral Therapy (CBT)+ MET
Psychiatric Disorders
Conduct Disorder (60-80%)• Family-Based•CBT
Depression, Anxiety(30-40%)•CBT
•Pharmacotherapy
ADHD (30-50%)
•CBT•Pharmacotherapy
Individual CBT is consistently associated with greater sustained or increasing decrease in substance abuse than other evidence-based substance treatment interventions for adolescents (Tripodi et al 2010; Waldron et al., 2008).
Strengths of ENCOMPASS CBT
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These procedures include:
• 3-day face-to-face training followed by weekly clinical supervision and fidelity/adherence monitoring.
• Randomly selected audio-recorded sessions from each therapist are reviewed, rated for fidelity/adherence and provided written and oral feedback by the Encompass MET/CBT supervisor
Strengths of ENCOMPASS CBT
• Encompass MET/CBT can be individually tailored for patients by selecting the modules (from a menu of modules) that are most clinically relevant for individual patients.
• Depression: negative mood states often trigger substance use. Focus on mood regulation skills.
• ADHD: focus on organizational skills, impulse control, anticipation and planning ahead for high risk situations.
Strengths of ENCOMPASS CBT
Functional Family Therapy
• Comprehensive, family-focused, evidence-based model addressing co-occurring disorders
• Flexible & adaptive to fit clients across range of cultural contexts, clinic or in-home delivery, voluntary & court-ordered families
• Uses data to drive decisions & improve fidelity
FFT Core Principles
• Problems are embedded in multisystemic, relational risk and protective factors.
• Families are the primary focus of treatment and assessment.
• Obtainable Change Goals are family based.
• Alliance Based Motivation creates positive engagement and lasting change.
• Evidence based clinical decision making results in better community based outcomes.
Stages
Delivered weekly sessions in each treatment phase occur in a successful treatment episode
Engagement Motivation
Behavior Change
Generalization
• Fidelity is tracked with both of these models with individual and group review of cases and tapes of sessions and self monitoring and patient monitoring of progress.
• Also training the trainer for CBT.
Adolescent Kentucky Treatment Outcome Study (AKTOS)
• Severity of use, withdrawal
• Physical health problems
• Mental health problems
• Clinicians complete intake survey using a secure, online system
• Narrative report is generated
• Research team at UK CDAR completes follow-up at 12 months
Model Clinic
• Assessment and Treatment
• Goal is to manualize and to have onsite clinical experiences
Treatment
Functional Family
Therapy
Encompass
Cognitive
Behavioral
Therapy
Contingency
ManagementPharmacotherapy
Comorbidity, Medication, Psychiatric Disorders & Substance Use
Co-Morbidity
Medication
Psychiatric SxSubstance
Use
Bipolar Lithium Stabilized Mania SU
ADHD Stimulants Impulsivity Attention
Smoking in the lab
No change SU
ADHD + Depression
Bupropion Depression Attention
Smoking
Depression sertraline DepressionNo change inSA
Naloxone NS: You Can Be Saved By A Nose!!! Daniel Wermeling, Pharm.D.Professor, College of Pharmacy
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Potential Indications/Populations
1. Patient release after emergency medical care involving opioid poisoning/intoxication
2. Suspected history of illicit or nonmedical opioid use
3. Any opioid prescription and … concurrent alcohol, benzodiazepine or SSRI prescription
Would discussing this with the family heighten safety measures with opiates?
January 6, 2014 – FRANKFORT, KY — Gov.
Steve Beshear, First Lady Jane Beshear, and
Attorney General Jack Conway today
announced that heroin overdose reversal kits
will be purchased for Kentucky hospitals with
the highest rates of heroin overdose
deaths. Overdose patients will receive a kit
free of charge when they leave the hospital, so
they or a loved one can prevent another
overdose event and possibly save a life. The
funding is provided through the Substance
Abuse Treatment Advisory Committee (SATAC).
CC: Community Recovery
• Faith-based youth groups provide buses & transportation
• Churches host 12-step programs, including some for adolescents
• Peer support
• Advisory Board
Community Roll out and next steps
• Outreach to Primary Care, Pharmacists, Dentists,
Community Mental Health Centers
• Establish referrals with agencies, such as:
– Department for Juvenile Justice
– Family Resource and Youth Service Centers
(in schools)
– Administrative Office of the Courts
– Department for Community Based Services
– Department for Public Health
• Create Advisory Board
• Operationalize Model Clinic for duplication in other
areas of the state
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