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An Intervention Model for the High Rate User -SAPs-

An Intervention Model for the High Rate User -SAPs-. Presentation to the California County Coordinators January 20, 2005 Presented by: Joël L. Phillips Community Prevention Institute (CPI) (CARS, Inc.). What we have learned… about underage AOD use/users. . AOD use/Binge Drinking

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An Intervention Model for the High Rate User -SAPs-

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  1. An Intervention Modelfor the High Rate User-SAPs- Presentation to the California County Coordinators January 20, 2005 Presented by: Joël L. Phillips Community Prevention Institute (CPI) (CARS, Inc.)

  2. What we have learned… about underage AOD use/users. AOD use/Binge Drinking Despite emphasis on AOD prevention, percentage of students who report high rate use has been relatively constant over past decades. • A substantial percentage of California secondary school students report they are high rate users (30% for EAUs, 20% for HRUs) • Excessive alcohol use is more prevalent than high risk drug use • Approximately a quarter of 11th graders binge once a month, 12% binge 3 or more times per month. For 9th graders, 11.5% binge once a month, 7.2% binge 3 or more times per month.

  3. Consequences of Binge Drinking • Social Harm • Binge drinkers are more likely involved in gangs and potential violence than students who do not binge • One third of binge drinkers have reported being in a drink/drive situation three or more times (nearly triple the rate of the total sample) • Binge drinkers are more likely to be involved in relationship violence than non-binge drinkers

  4. Consequences of Binge Drinking(continued) • School Related Harm • Binge drinkers are more likely to use substances at (23.6%), or before school (30.4%) • Some are more likely to engage in violent or destructive behavior at school • Much more likely to skip school or cut class (one estimate is 3.7 million missed days for California high rate users) • Tend to have lower connectedness to school

  5. High Risk Drug Users (HRU)Profile – 11th Grade • One quarter: • Used marijuana and alcohol at school, past 20 days • Drunk/high at school 7+ times • One third: • 3 or more dependency indicators • 2 or more use-related problems • Drinking/driving 3+times • One half or more: • Regularly (c. weekly) binge drink (5+ drinks/row) • Weekly marijuana use • High on drugs 7+ times • Sold drugs *Source: West Ed 12/2/2004

  6. New Analysis (West Ed) • Document clear association between a number of student AOD • risk factors and overall school performance. FINDING Higher rates of AOD use resulted in lower levels of academic performance measured by changes in SAT 9

  7. Summary of HRUCharacteristics • Endemic and resistant heavy alcohol and drug use • Poorer school attendance and performance • Multiple risk factors in lives, including early onset • High correlation with violence on and off school • Less positive response to prevention • Open to cessation but little follow through and low perception of help from school *Source: West Ed 12/2/2004

  8. Program Implications • Efforts to raise test scores and improve schools – as well as create safe and drug free campuses – need to address needs of heavy substance users • Different approaches from standard prevention • Early intervention addressing multiple risk factors • Need to address wide range of substance use behaviors and other problems • Need to identify, support cessation, and provide referral to services – Student Assistance * Source: West Ed 12/2/2004

  9. Estimating Need for Services HRU Plus: (HRU +2 or more consequences (WestEd ) 4.5% 9th 8.6% 11th Binge Drinkers Plus (BDP): (Binge Drinking Plus 2 or more problems) 4.4 % 9th (2.3% binged 3+ times) 10.7% 11th (6.4% binged 3+ times) Overlap: HRU Plus, Binge Drinkers Plus 75% 9th (BDP) were also HRU Plus 60% 11th (BDP) were also HRU Plus Result: We estimate 6.1% of 9th graders and 13.1% of 11th graders ARE IN PARTICULAR NEED OF INTERVENTION

  10. Summary of the Estimates • High School Binge Drinkers: 356,000 • High School Problematic Use: • (2 or more problems/issues) 114,700 • Serious Alcohol Use (GW) • 16-17 yrs 83,750 • Dependent/Abuse (National Household Survey Extrapolations) • Alcohol Dependency 12-17 yrs 50,000 • Alcohol Dependency/Abuse 12-17 yrs 138,000 • Alcohol or Illicit Dependence/Abuse 12-17 yrs 221,000

  11. Issues • Who do we target? • How do we screen? • What intervention services can we use? • SAP’s, others • How can we structure service delivery?

  12. None Mild Moderate Substantial Severe Specialized Treatment Brief Intervention Primary Prevention Who do we Target? -Points of Intervention Individual Needs and Levels of Service: Exhibit 1 Needs Services IOM Model Universal – everyone Selected – sub-groups Indicated – Individuals with risks/problem behaviors

  13. Points of Intervention (cont) Implications: • IOM categorization at selected/indicated requires screening and identification Question: What are we doing in our schools to screen students before they participate in one of our Model Programs designated “selective” or “indicated”? • Based on our estimates there are thousands of youths in need of intervention services

  14. Promising Interventions • Project Brief Interventions – K. Winters • 2-3 sessions • Strong Points • For adolescents • Can be used by paraprofessionals • Good evaluation results • Student Assistance programs (SAPs) • Project SUCCESS • A SAP program, but has some solid evidence, experience • Recovery High Schools • More intensive option

  15. The SAP Model What is a Student Assistance Program? • SAPs are a school-based approach to providing focused services to students needing interventions for substance abuse or other problems. • SAPs are a process (not a curriculum or treatment center) that connects education, programs, and services within and across systems to aid students and their families.

  16. What do SAPs do? • SAPs… • Identify troubled students • Assess students’ needs • Provide support and referral to school, family, and community resources to address these needs • The overarching goal of SAPs is to remove barriers to education so that a student may achieve academically.

  17. What does a SAP look like?There are several possibilities….. • Core Team Model, which is founded on a central group of school personnel, including: • Student Assistance Coordinator • Vice Principal • School Counselors • School Social Workers and Psychologists • Classroom and Special Ed Teachers • Student Services Staff • The Core Team works collaboratively to identify and assist students. • Counselor Model, which is founded on an outside contracted body serving as the source for SAP services. • It requires a certified, experienced counselor to serve as program coordinator. • It effectively removes the SAP from the hands of school personnel. SAP’s can be: • School-based model, where each school has an independent SAP • District-based model, where a centralized SAP serves schools throughout the district

  18. Identification of Services How are students identified for SAP services? • Referral of students comes from classroom teachers, school counselors, through school disciplinary processes, by parents, and occasionally by students themselves. (Ideal: Behavioral checklist) • Students then proceed through the SAP process in a typical manner. Who delivers SAP services? • Services are delivered by acore group of individuals, typically a combination of school personnel (administrators, nurses, counselors, teachers) and external service providers (community-based organizations, community health providers). What services are provided? • Services provided include educational support groups, referral to outside agencies, tutoring, after-school activities, peer mediation and conflict resolution, and career services an family conferences, which are the heart of some SAP’s. What issues are addressed? • Issues addressed by many SAPs are: • prevention (AOD, tobacco, drop-out, pregnancy, & STDs), • violence/bullying, • academics/attendance, and/or • behavior and mental health (grief, anger management, relationships, self-harm).

  19. What have we learned…about SAPs in California? Survey/Site Visit Results: • Not sure about numbers – identified 100 plus schools with SAPs – 40 High Schools offering SAP type services (CDE estimates: 353/1298 LEA’s had a SAP in 2003-2004) • Multiple Names • Problems (Top 3 co-equal) at 92% • AOD • Mental Health • Academic • 20 plus other issues addressed by 1 or more schools • Services Offered • Support Peer Groups 97% • AOD Problem Identified 94% • School Counselor Consults 86% • Prevention Education (classrooms) 83% 11 plus additional services

  20. What have we learned…about SAPs in California? (cont) • SAPs (80%) work with community agencies • Students are referred through 4 ways: Use Account for Teachers 100% of schools 41% of referrals Self Referral 89% of schools 32% of referrals Counselor 97% of schools 24% of referrals Parent 97% of schools 7% of referrals • Service size varied greatly (from small numbers 6-32 youth to district size

  21. What have we learned…about SAPs in California? (cont) • Participation: • Most reported engagement (42%) 4-12 weeks • 12% - all school year, 12% 1-4 weeks • Problems: • Funding – low, piecemeal • Staffing – burdened teacher staff • Program awareness/buy-in • Minimal evaluations – most process oriented • Need: • Better statewide sharing of information between SAP providers

  22. Evaluations of SAP’s • 13 times fewer physical assaults • 7 times fewer threats to staff by students • Half the physical threats to students by other students • Fewer fights and weapon carrying A reduction in school infractions, including: • Less than half the disciplinary actions • Less vandalism A reduction in incidences of substance use, including: • Almost half the suspensions for drug use and drug sales by students • Four times more student self-referrals for drug use • Less drinking • We found only one rigorous study of a SAP. • We did find three statewide studies of SAPs. • Vermont (comparative study) • - Having a SAP counselor: A reduction in violence, including:

  23. What did we learn about evaluation? (continued) Pennsylvania (3 year retrospective) 83-90 % referred were linked to a service 73-90 % assessments completed 60 % of referred students had no further disciplinary suspension 63-68 % of SAP students either were promoted or graduated from high school Washington State Increased protective factors (i.e., self-esteem, self-control, assertiveness, cooperation and bonding) Reductions in 7 anti-social behaviors – including truancy, fighting, and vandalism Reductions in use of 7 substances - 33 % reduction in marijuana use - 40 % reduction in amphetamine use Positive school behavior and academic “dramatic long-term improvements in attendance and grades”

  24. What did we learn about evaluation? (continued) • 37 % decrease in substance use 23 % of those using, stop Second Year Project SUCCESS • 33 % no longer used alcohol • 45% no longer used marijuana • 23 % no longer used tobacco Other Evaluation Results - Vermont evaluators cited the following: Schools with SAPs experience: • Reductions in overall substance use (Washington) • Reductions in alcohol and marijuana use (New York, Wisconsin) • Increases in school attendance (New York, Wisconsin, California) • Decreases in drop-outs (California, Pennsylvania) • Decreases in disciplinary actions (Wisconsin and Pennsylvania) and vandalism (Wisconsin) • Project SUCCESS (continued) • One SAP model rigorously evaluated – Project SUCCESS (control • study).

  25. What did we learn about evaluation? (continued) Conclusions: Evaluations used varying methodology (some better) but a consistent picture of positive outcomes emerge for youth participating in a SAP type program.

  26. Issues Do we know enough to feel comfortable with recommending SAPs? How can we support more rigorous studies? More technical – do SAPs work better with certain problems/populations? Other issues? What are the key service components of a SAP?

  27. Summary Points • Serious problems with high rate AOD users in our High Schools • A population in need of intervention services. • Intervention services requires individual screening • Two promising program models • Brief Intervention Services (K. Winters) • SAP’s

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