Cannabis Youth Treatment (CYT) Interventions and Their Implementation with Multicultural Groups Susan Harrington Godley, Rh.D. Chestnut Health Systems.

Cannabis Youth Treatment (CYT)

Interventions and Their Implementation

with Multicultural Groups

Susan Harrington Godley, Rh.D.Chestnut Health Systems’ Lighthouse Institute

Funded by: The Center for Substance Abuse Treatment (CSAT)Substance Abuse and Mental Health Services Administration

(SAMHSA)U.S. Department of Health & Human Services (DHHS)

Surveyed EATS sites, otherselected sites using other CYT Interventions,

and developers

EATS goals Adopt/Adapt an effective (individual

outcomes/cost) substance abuse treatment intervention for youth (MET/CBT 5)

Expand the availability of substance abuse treatment for youth

Providers Responding to E-Mail Inquiries

Sponsored by: Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services

Populations Served(in site descriptors)

Butler County, Ohio: Most are of Appalachian descent, few AA and Hispanic**Culver City, CA: 40 to 50% Latino and 40% AADC: 42% AA, 33% White, 8% AsiaDenver: 33% White, 23% Hispanic, 2.5% Native American, 12.5% BiracialDenver TASC: Hispanic 51-52%Houston, TX: 45% Hispanic, 45% Caucasian, Non-Hispanic, 10% African American spread across a large geographic county—much of it urban

Populations Served(in site descriptors)

Lansing, MI: 53% AA; 21% Hispanic, 5% Asian American, 21% Caucasian; split between urban and rural youthLaredo, TX: 95% Mexican –American and bilingual; many speak Tex-Mex; large percentage of counseling sessions are in Spanish; half urban—half rural; some live in “colonias”; also has satellite offices in rural locations**Norwalk, CT: Urban youth with a number of AA and Hispanic referrals NYC: Primarily Latino and AA, inner-city youth, ages 12-17

Other Sites

Bloomington, IL Student Assistance Program and OP

Little Rock, AR

Orlando, FL

Pinellas Park, FL

Comments aboutCultural Groups 

“We also identified the Teen Culture, Gang culture, Gender Specific issues, Gay, Lesbian, and transgender, and the Drug culture as important issues to be aware of for our clients.”

“We haven’t found any major differences between cultural groups, the issues are general adolescent issues/behaviors.”

Discussion PointsCan you be more confrontative with certain populations?What is the interaction between resistance to manual-guided therapy and cultural relevance of an approach?Commonality among adolescent issues vs. cultural issues—which is greater?Culture often interacts with socio-economic factors—e.g., when planning alternative activities—this may be a problem due lack of funds—not culture

No Adaptations(may have added to the intervention, but did not adapt)

Arapahoe House; Denver, Co.Operation Par; Pinellas Park, FLBEST Adolescent Initiative; Orlando, FLUAMS; Little Rock, ARDuke University; Durham, NCProject TEMPO; Norwalk, CTTake Five Program; Houston, TXButler County, OHNY (East & Central Harlem), NY -- None yet, but plan to adopt the Hip Hop version.Prototypes; Culver City, CAProject BEAT; Washington, DC

Why no adaptations 

“I think the intervention is general enough to allow for normal variances in our approach taken with individual students.  The biggest differences…don't have to do with ethnicity or socio-economic issues.  Instead, the support environment and motivation, both internal and external, appear to be the keys.  For example, a Caucasian female student with using parents did not do as well when the intervention was complete as did an AA male with an extremely supportive (meaning supporting his goal to remain abstinent) mother.  As far as internal and external motivation, the two AA males I had did well in the intervention.  One did not think using fit with his self-image and the other was on probation and being tested.”

Comments About Staff

Comments aboutStaff 

“Our counseling staff is diverse, young, and energetic.”

“We have not made any changes…because we are accustomed to working with this particular population.”

“A few of our staff members are fluent in Spanish. Our agency also coordinated with a local university to provide Spanish classes to staff members. We have a staff member that can interpret and is available to give us insight whenever needed. In our ABT program, we have an AA primary counselor that provides direct service and is able to give us insight as well.”

Staff 

“We feel strongly that it is most important to have clinically sound staff that are Hispanic acculturated and Non-Hispanic acculturated, knowledgeable of African American culture, the differences in the many Anglo cultures as well as the different Asian populations we see. It is important that staff are trained in and culturally competent in order to deal with our very diverse population…it is important…to state that just because a counselor is of Hispanic or AA background does not mean they are culturally competent to work with that population. Training is the most important.”

Adaptations

Lansing, MI

TASC, Denver

Provide services in alternative settings—in an alternative school, day program; do more of the CBT individually

Minor changes in educational materials, Welcome; uses sculpting to act out what a support group is like

Adaptations

Bloomington, IL

SCAN; Laredo

Adapted MET/CBT5 for school setting by changing many forms to reflect students and offering CBT in individual sessions

Combine ACRA and ACC for rural area; translation of some materials in Spanish

Didn’t necessarily adapt, but added to the

interventionArapahoe House, Denver

TASC, Denver, CO

Little Rock, AR

Durham, NC

Norwalk, CT

Houston, TX

Bloomington, IL

Butler County, OH

Laredo, TX

Culver City, CA

Additions—Family Sessions (9 sites)

Family sessions when needed, involve family, family psychotherapy (2)Add FSN sessions (2)Family sessions at the beginning and end of treatment to orient to the treatment and review progressTwo parent education sessions, done in a group that meets twice per month, education about the treatment, about monitoring adolescent substance use and consequences for use, and about parent-adolescent communication

Additions—Family Sessions (9 sites)

Added a family component, which runs concurrently with the first two CBT sections. It is a support/education group for parents of program participants.After MET/CBT 5—case manager has 2 family appointments—preferably in the home, clients come back for one more booster session, and then one last family/case management session.

Other AdditionsCBT7 sessions (2) CM which starts with their first MET session either case management every week for 2

months and 2 X the third month + phone CM

2 in-home sessions and then phone for the rest of the year—depending on assessment

Hip Hop MET/CBT5

Hip Hop MET/CBT5Used old school hip hop music to start sessions—chosen to fit the themes—very positiveChange words to fit urban slang, e.g., Drug refusal, AKA ‘How to represent’ Problem solving, AKA ‘Breaking it Down’ Social Support, AKA ‘My Peeps’ Anger Management, AKA ‘Chilling’

Participant folders were customized—colorful—with graffiti from the city and a rapper guy

Contact for Hip Hop Information

John Callas

CT Juvenile Training School

Wk No. 860-638-2722

MDFT(information courtesy of Dr.

Cindy Rowe)Developed and first tested in San Francisco with a largely Caucasian sample

“Temple University” study: 75% African-American

University of Miami Center for Treatment Research on Adolescent Drug Abuse

FAMILY THERAPY WITH AFRICAN AMERICAN YOUTH

Jackson-Gilfort, Liddle, Dakof, & Tejeda

(in press):

Does inclusion of culturally relevant themes facilitate engagement of African-American male adolescents in family therapy?

Trust/Mistrust

Anger/rageAlienation

Respect/disrespectSpirituality

Boyhood to manhoodRacial identity

Racism

Hopelessness 

LINKING CULTURAL THEME EXPLORATION AND

OUTCOMES Results:

Journey from Boyhood to Manhood: improved quality of therapeutic relationship; increased participation in therapy, and facilitated deeper exploration of issues generally

Anger/rage: increased engagement in therapy and facilitated deeper exploration of issues

Alienation: increased participation and engagement in therapy

Racial Identity: increased participation General Issues of Racism: increased

participation in therapy

LINKING CULTURAL THEME EXPLORATION AND

OUTCOMES Results:

Exploration of cultural themes was associated with increased participation and decreased negativity of youth in the next treatment session

Conclusion: Exploring culturally meaningful themes is directly linked to investment in treatment for African-American youth

ACRA/ACC in Laredo

Used for primary OP and stepping down (there is no IOP)Use home-based modelSpanish translation of certain tools—especially important for parents who may be first generationAdded FSN family night in conjunction and for those on waiting list—important for a sense of community and belonging—snacks are provided and all family members are welcome

Spanish PublicationsFrom SAMHSA’s National Clearinghouse for Alcohol and Drug Information:

La marihuana: Información para los adolescentes (Marijuana: Facts for Teens) - Order pamphlet free of charge at: http://store.health.org/catalog/ProductDetails.aspx?ProductID=14609

Marijuana: lo que los padres deben saber (Marijuana: Facts Parents Should Know) - Order pamphlet free of charge at: http://store.health.org/catalog/ProductDetails.aspx?ProductID=14606

From Chestnut Health Systems: Folleto de Información General (General FAQ designed for parents

with questions about adolescent substance use in general or for those participating in an initial substance use assessment): http://www.chestnut.org/Adolescent/Folleto_Uno.pdf

Folleto de Tratamiento (Residential treatment FAQ designed for parents whose adolescent is entering residential treatment): http://www.chestnut.org/Adolescent/Folleto_Dos.pdf

Contact Information

Susan H. Godley, Rh.D.

Chestnut Health Systems

720 W. Chestnut St.

Bloomington, IL 61704

309.829.3543 ext.83343

[email protected]