Many adolescents with substance abuse problems do not obtain treatment, and there has been no systematic exploration of perceived barriers to starting care from multiple stakeholders This article describes adolescent, parent, and treatment staff perceptions of barriers and facilitators to treatment We interviewed 87 adolescents, their parents, and agency staff from three residential substance abuse treatment agencies in two states to explore barriers and facilitators to care in seeking, finding, and initiating substance abuse treatment Youth, parent, and staff reports of barriers to treatment (n = 128) far outnumbered facilitators to treatment (n = 6) Staff perceived primarily family barriers to seeking treatment (eg, denial, stigma); parents stated challenges finding treatment (eg, lack of knowledge), and all three groups reported barriers to initiating treatment (eg, lack of motivation) Findings suggest structural and perceptual barriers to adolescent services vary by respondent and by the re

Barriers and facilitators to adolescent drug treatment: Youth, family, and staff reports

Youth engagement in substance use treatment is an important construct for research and practice, but it has been thinly and inconsistently defined in the literature. Most research has measured engagement by initiation, attendance, and retention in treatment. Because youth generally enter substance use treatment as a result of compliance with external requirements, defining engagement in this way might be insufficient. This qualitative participatory research study describes five focus groups with 31 adults working with youth in substance use treatment. Focus groups were designed and conducted by youth researchers in collaboration with university-based partners. We categorized participants’ descriptions of engagement into five domains, identified as “CARES”: Conduct, Attitudes, Relationships, Empowerment, and Social Context. These domains represent a comprehensive and ecologically-based definition of engagement that situates engagement in the context and trajectory of youth development, has clear implications for assertive clinical practice, and provides a foundation for developing an operationalized measure.

Defining Engagement in Adolescent Substance Abuse Treatment

This study examined U.S. state laws regarding parental and adolescent decision making for substance use and mental health inpatient and outpatient treatment. State statutes for requiring parental consent favored mental health over drug abuse treatment and inpatient over outpatient modalities. Parental consent was sufficient in 53% to 61% of the states for inpatient treatment, but only for 39% to 46% of the states for outpatient treatment. State laws favored the rights of minors to access drug treatment without parental consent, and to do so at a younger age than for mental health treatment. Implications for how these laws may impact parents seeking help for their children are discussed.

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What Can Parents Do? A Review of State Laws Regarding Decision Making for Adolescent Drug Abuse and Mental Health Treatment

Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges to providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue. This qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes. We found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services. Our findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings.

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Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: perspectives of staff from 18 treatment centers

Community outreach and focus groups were conducted in an impoverished multi-cultural urban neighborhood to develop a local, culturally-sensitive and community-responsive adaptation of Greenwald’s (Child trauma handbook: A guide for helping trauma-exposed children and adolescents. Haworth, New York, 2005) phase model of trauma-informed treatment. Fifty-nine children with a wide range of presenting problems were referred for treatment. Outcomes included 87% retention rate of participants treated to successful termination, as well as clinically significant reduction of post-traumatic stress symptoms. This project demonstrates that hard-to-reach disenfranchised urban children can benefit from trauma-informed treatment when it is appropriately adapted and presented.

Trauma-Informed Treatment for Disenfranchised Urban Children and Youth: An Open Trial

While outreach and case management services have been shown to improve retention of at-risk youth in behavioral health treatment, these important support services are challenging to implement. The Hartford Youth Project (HYP), established by the Connecticut Department of Children and Families as a pilot for the state adolescent substance abuse treatment system, made outreach and engagement integral to its system of care. HYPbrought together a network of stakeholders: referral sources (juvenile justice, schools, community agencies, child welfare, and families); community-based outreach agencies; treatment providers; and an administrative service organization responsible for project coordination. Culturally competent Engagement Specialists located in community agencies were responsible for: cultivation of referral sources; community outreach; screening and assessment; engagement of youth and families in treatment; case management; service planning; recovery support; and advocacy. This article describes HYP's approach to identifying and engaging youth in treatment, as well as its challenges. Use of family-based treatment models, expectations of referral sources, limited service capacity, youth and family problems, and staff turnover were all factors that affected the outreach and engagement process. Process, baseline assessment and case study data are used to describe the needs and issues specific to Hartford's substance-abusing Latino and African-American youth.

http://www.journalofpsychoactivedrugs.com/Articles/Simmons401.pdf

Bringing adolescents into substance abuse treatment through community outreach and engagement: the Hartford Youth Project.

African-American and Latinx enrollment in higher education has increased dramatically in recent years at many predominantly White institutions. However, the graduation rates of these students are substantially lower than the general student population at many of these institutions. This study introduces “Success Central,” an innovative peer coaching initiative offered at a mid-size, comprehensive regional institution. Instead of post-graduate professionals employed as success coaches, which is the typical practice, upper-class undergraduate students were selected and trained in an innovative life coaching intervention designed to address the root causes of student attrition as established in the literature examining the academic and non-academic factors that contribute to early departure. Students met regularly with assigned peer coaches who supported them to address their challenges and accomplishment of their desired goals. The results of this program exceeded the objective of equal persistence rates between the underrepresented students of color who had received peer-coaching and their majority counterparts. Additionally, students who experienced this intervention reported an improvement in their perception of their college experiences and academic skills.

Reginald Simmons

Papers

Bringing adolescents into substance abuse treatment through community outreach and engagement: the Hartford Youth Project.

Success Central: Addressing the Persistence of African-American and Latinx College Students Using a Peer Success Coaching Intervention.