An Intervention Model for the High Rate User -SAPs-

An Intervention Modelfor the High Rate User

-SAPs-Presentation to the

California County CoordinatorsJanuary 20, 2005

Presented by:Joël L. Phillips

Community Prevention Institute (CPI)(CARS, Inc.)

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What we have learned… about underage AOD use/users.

AOD use/Binge DrinkingDespite 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.

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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

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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

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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

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New Analysis (West Ed)

•Document clear association between a number of student AOD risk factors and overall school performance.

FINDINGHigher rates of AOD use

resulted inlower levels of academic

performancemeasured by changes in SAT 9

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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

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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

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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 Plus75% 9th (BDP) were also HRU Plus60% 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

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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

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Issues

Who do we target? How do we screen? What intervention services can we use?

SAP’s, others How can we structure service delivery?

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None

MildModerate

Substantial

Severe

Primary Prevention

Brief Intervention

Specialized Treatment

Who do we Target? -Points of Intervention

Exhibit 1

IOM Model Universal – everyone Selected – sub-groups Indicated – Individuals with risks/problem behaviors

Individual Needs and Levels of Service:

Needs

Services

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Points of Intervention (cont)

Implications: IOM categorization at selected/indicated requires

screening and identificationQuestion: 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

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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

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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.

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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.

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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

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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 a core 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).

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What have we learned…about SAPs in California?Survey/Site Visit Results:1. 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)

2. Multiple Names3. Problems (Top 3 co-equal) at 92%

AOD Mental Health Academic 20 plus other issues addressed by 1 or more schools

4. Services Offered Support Peer Groups 97% AOD Problem Identified 94% School Counselor Consults 86% Prevention Education (classrooms) 83%11 plus additional services

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What have we learned…about SAPs in California? (cont)

5. SAPs (80%) work with community agencies6. Students are referred through 4 ways:

Use Account forTeachers 100% of schools 41% of referralsSelf Referral 89% of schools 32% of referralsCounselor 97% of schools 24% of referralsParent 97% of schools 7% of referrals

7. Service size varied greatly (from small numbers 6-32 youth to district size

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What have we learned…about SAPs in California? (cont)8. Participation:

Most reported engagement (42%) 4-12 weeks 12% - all school year, 12% 1-4 weeks

9. Problems: Funding – low, piecemeal Staffing – burdened teacher staff Program awareness/buy-in Minimal evaluations – most process oriented

10. Need: Better statewide sharing of information between SAP

providers

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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 carryingA reduction in school infractions, including: Less than half the disciplinary actions Less vandalismA 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

1. We found only one rigorous study of a SAP.2. We did find three statewide studies of SAPs. Vermont (comparative study) - Having a SAP counselor:

A reduction in violence, including:

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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 schoolWashington 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”

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What did we learn about evaluation? (continued)

37 % decrease in substance use23 % 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).

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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.

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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?

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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