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Center for Mental Health Policy Center for Mental Health PolicyVanderbilt Institute for Public Policy Studies Vanderbilt Institute for Public Policy StudiesVanderbilt University Vanderbilt University Tennessee's Adolescents in
Publicly-Funded Treatment for
Substance Abuse Problems:
Baseline Interview Findings for
TennCare Beneficiaries
The IMPACT Study Craig Anne Heflinger, Ph.D., Principal Investigator Celeste G. Simpkins, Research Associate Center for Mental Health Policy Vanderbilt Institute for Public Policy Studies Vanderbilt University Tennessee's Adolescents in
Publicly-Funded Treatment for
Substance Abuse Problems:
Baseline Interview Findings for
TennCare Beneficiaries
The IMPACT Study Craig Anne Heflinger, Ph.D., Principal Investigator Celeste G. Simpkins, Research Associate For questions or comments, please contact Dr. Heflinger at (615) 322-8275 or [email protected]. For additional copies of this report: FREE at www.vanderbilt.edu/VIPPS/CMHP/AdolSA.pdf or send $15 to Vanderbilt University attn: Resource Specialist, Center for Mental Health Policy, 1207 18th Avenue, South, Nashville, TN 37212.
TENNESSEE'S ADOLESCENTS IN PUBLICLY-FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FI NDINGS FOR TENNCARE BENEFICIARIES
Table of Contents
Executive Summary.i Purpose and Overall Design of the IMPACT Study .1 Data Collection Methods.5 Youth Behavioral Health Status: Substance Use, Symptoms, Psychosocial Functioning, and SED Status.6 Alcohol or Drug Use.6 Type, Amount and Method of Substance Use .7 Consequences of Alcohol or Drug Use .11 Diagnostic Indicators of Substance Abuse or Dependence.13 Emotional and Behavioral Symptoms .14 Psychosocial Functioning .16 Classification of Youth as Having a Serious Emotional Disorder .16 Youth Taking Medication for Emotional and Behavioral Problems.18 Co-Occurring Substance and Mental Disorders.20 Issues Surrounding Admission to Current Treatment .20 Type of Current Treatment and Referral Source.20 Waiting for and Coming to Treatment Admission.22 Residence Immediately Prior to Treatment Admission.23 Satisfaction with the Intake Process.25 Current Motivation for Substance Abuse Treatment.26 Length of Stay at Current Treatment .27 Youth Health Issues.28 Global Ratings of Health Status .28 Weight Status.28 Chronic Health Conditions and Injuries .29 Risk Behavior .29 History of Behavioral Health Services Use.32 Educational Status .34 History of Juvenile Court Involvement .35 Table of Tables
Table 1: Demographic Characteristics of the Interview Sample.4 Table 2. Alcohol or Drug Use.7 Table 3. Substances Used.8 Table 4. Level and Method of Use (for those with any use of the drug during the past 6 Table 5. Consequences of Alcohol or Drug Use During Past 6 Months.11 Table 6. Consequences of Substance Use: Summary Scores.12 Table 7: Diagnostic Indicators .13 Table 8: Youth Scores on the Youth Self Report (YSR) .14 Table 9. Youth with Scores in the Borderline or Clinical Range on the YSR Subscales .15 Table 10. Columbia Impairment Scale (CIS).16 Table 11. Emotional/Behavioral Symptoms by Level of Psychosocial Functioning .17 Table 12. Psychotropic Medication.18 Table 13. Psychotropic Medication: Type Prescribed as a Proportion of all Youth.19 Table 14. Co-Occurring Emotional/Behavioral and Substance Abuse or Dependence.20 Table 15. Issues Surrounding Treatment .21 Table 16. Admission Issues.23 Table 17. Residence Immediately Prior to Treatment Admission.24 Table 18. Satisfaction with Intake Process at Current Provider .25 Table 19. Motivation for Treatment.26 Table 20. Length of Stay .27 Table 21. Youth Global Health Status .28 Table 22. Weight Status Rating .28 Table 23. Chronic Health Conditions and Injuries Past 6 Months .29 Table 24. Risk Behaviors.30 Table 25. Ever Used Services for Substance Abuse, Emotional or Behavioral Problems.32 Table 26. Residential Treatment and Other Residences in Past 6 Months.33 Table 27. Highest Grade Completed .34 Table 28. Criminal Justice History.35 TENNESSEE'S ADOLESCENTS IN PUBLICLY-FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FI NDINGS FOR TENNCARE BENEFICIARIES
Tennessee's Adolescents in Publicly-Funded Treatment For Substance Use Problems The IMPACT Study Baseline Report on Interview Data For TennCare Beneficiaries Executive Summary The IMPACT Study was funded by the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration as part of a national study of the impact of managed care on vulnerable populations.1 The Center for Mental Health Policy at Vanderbilt University's Institute for Public Policy Studies, under the direction of Dr. Craig Anne Heflinger, is conducting an evaluation of the Medicaid programs in Mississippi and Tennessee (TennCare). The Impact Study is a collaboration between academic, government, providers, and consumer and advocacy groups in both states. The TennCare program participates as a managed care site since the state received a HCFA 1115 Medicaid waiver in 1994; in 1996 the mental health and substance abuse services became a managed care carve out program called TennCare Partners. The focus of the project is on TennCare behavioral health services; however, all services under the TennCare program will be included in several components of the study. In addition, all publicly-funded treatment programs for adolescents with substance abuse problems are included. This report focuses on information from a baseline interview with 262 TennCare youth who were entering publicly-funded treatment for substance use problems. Publicly-funded treatment included inpatient, residential, and outpatient services provided through the TennCare Partners Program, the Substance Abuse Prevention and Treatment Block Grant administered by the Tennessee Department of Health Bureau of Alcohol and Drug Abuse Services, and contracts with the Tennessee Department of Children's Services. All youth were TennCare beneficiaries, although their treatment was most often paid by another source (see pages 4-5). Findings are reported in detail in the accompanying report. Highlighted findings include: ♦ Youth in publicly funded treatment were primarily male and white. The male to female ratio was approximately 3:1. The white to African-American ratio was approximately 2:1 (see pages 3-4). ♦ While youth in outpatient treatment were generally able to access treatment close to home, some youth had to travel up to 200 miles from home for inpatient or residential treatment for substance use problems (see pages 4-5). 1 UR7 TI11304 from the Center for Substance Abuse Prevention and UR7 TI11332 from the Center for Substance Abuse Treatment (Principal Investigator: Craig Anne Heflinger). See www.hsri.org/coord.html for more information. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
♦ Although all youth in treatment had a history of substance use, only 40% reported active use during the month immediately prior to admission (see page 7). Half (48%) of the youth were in some type of restrictive or "controlled" placement immediately prior to being admitted to treatment for substance abuse problems (see page 24), which influenced their reports of recent substance use. ♦ Primary substance use reported by Tennessee youth in publicly-funded treatment was alcohol and cannabis. Most youth reported poly-substance use, with one third using 4 different types of substances over the past 6 months (see pages 6-10). ♦ The most frequently reported consequences of substance use among all youth were interpersonal problems related to use, dangerous behavior, interference with role obligations (family, work, school), and excessive use (see pages 11-12). ♦ Based on reported substance use and related consequences, 92% appeared to meet diagnostic criteria for substance abuse or dependence (see page 13). Approximately 21% of the inpatient/residential youth, and 25% of those admitted to outpatient programs met criteria for substance abuse. Seven of ten (70%) of the youth admitted to inpatient/residential, and 67% of the youth admitted to outpatient programs could be classified as having substance dependence. ♦ One quarter of the youth in publicly-funded substance use treatment had co-occurring substance and mental disorders (see page 20). Note that this is considered lower than actual prevalence of co-occurrence since many youth with co-occurring disorders are not admitted to substance abuse treatment (see page 20). § Over one-third (35%) of the youth were exhibiting emotional and behavioral problems of a high enough level to be classified as in the "clinical" range, in need of treatment. Problems with delinquent behavior were the most prevalent type of emotional/behavioral problems reported in this population, followed by attention and aggression problems (see pages 14-15). § Overall, more than one-quarter (27%) of the total youth who had been admitted to publicly-funded services for substance use problems also met criteria as having a serious emotional disorder at the time of the interview (see pages 16-17) . § Over one quarter of youth in treatment for substance use problems had been prescribed medication for emotional or behavioral problems. The most frequently prescribed type of medication for emotional and behavioral problems was antidepressants. Almost one quarter (21%) of all youth in treatment for substance use problems were taking prescribed antidepressants (see pages 18-19). ♦ Youth in substance abuse treatment frequently had co-occurring physical health problems, as well. One in six (16%) of the youth in treatment were overweight or obese. Many reported chronic diseases or injuries in need of medical treatment. This group of youth also reported health risks regarding unsafe sexual practices (see pages 28-31). ♦ Youth in state custody, and youth who were admitted to inpatient/residential treatment were significantly more likely to have been in controlled settings, such as juvenile detention or diagnostic shelters, while they waited to be admitted to treatment (see pages 22-24). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
♦ Almost half of the youth (45%) reported a history of residential services at some point prior to the current admission for substance use treatment (see pages 32-34). ♦ Educational problems were also evident for this population of youth. Two-thirds (69%) of the youth in treatment were placed one to two years behind their age-determined grade level (see page 34). ♦ The juvenile court system played a key role for youth admitted to treatment: § Overall, almost two thirds (64%) of the youth reported that they had been court-ordered into treatment (see page 21). § Approximately one in five (17% of the youth overall, 22% of those in custody) of the youth waited in juvenile detention centers an average of 29 days before being admitted to treatment (see page 24). § Almost all the youth had recent contact with the juvenile courts. The most frequent contact with the juvenile justice system over the past 6 months was some type of status or criminal charges (73%) – including drug-related offenses, property crimes, and crimes against persons -- or time in a jail/detention or correctional facility (72%) (see pages 35-36). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Tennessee's Adolescents in Publicly-Funded Treatment for Substance Use Problems: Baseline Interview Findings Purpose and Overall Design of the IMPACT Study The IMPACT Study was funded by the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) as part of a national study of the impact of managed care on vulnerable populations.2 In response to GFAs TI 96-01 and 97-001 from the Substance Abuse and Mental Health Services Administration (SAMHSA) (U.S. Department of Health and Humans Services) and as part of their Cooperative Agreements for Managed Care, the Center for Mental Health Policy at Vanderbilt University's Institute for Public Policy Studies (VIPPS) is conducting an evaluation of the Medicaid programs in Mississippi and Tennessee. The TennCare program participates as a managed care site since the state received a HCFA 1115 Medicaid waiver in 1994; in 1996 the mental health and substance abuse services became a managed care carve out program called TennCare Partners. The focus of the project is on TennCare behavioral health services; however, all services under the TennCare program will be included in several components of the study. 3 In addition, all publicly-funded treatment programs for adolescents with substance abuse problems are included. This project is part of a national study that includes 13 states and examines four population groups: children with serious emotional disorders, adolescents with substance abuse problems, adults with serious mental illness, and adults with chemical dependence. Information on the national study is available at www.hsri.org/coord.html. To meet the overarching goals, this project is organized into four related components: 1) The Standardized Interview component is a prospective study based on the national common protocol. This component follows a sample of publicly funded adolescents entering treatment for substance abuse problems.4 Interviews were held with all adolescents and, when available and the youth gave consent, their parents (or the designated most knowledgeable caregiver) at three points in time, six months apart over the course of a year.5 This report focuses on information from a baseline interview with 262 TennCare youth who were entering publicly-funded treatment for substance use problems. Publicly-funded treatment included inpatient, residential, and outpatient services provided through the TennCare Partners Program, the Substance Abuse Prevention and Treatment Block Grant administered by the Tennessee Department of Health 2 UR7 TI11304 from the Center for Substance Abuse Prevention and UR7 TI11332 from the Center for Substance Abuse Treatment (Principal Investigator: Craig Anne Heflinger). 3 See www.vanderbilt.edu/VIPPS/CMHP/publications.html for a link to the IMPACT Study reports that are available on various aspects of the study. 4 See Appendix A for a list of participating provider agencies. 5 See Appendix B for a description of the interview components. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Bureau of Alcohol and Drug Abuse Services, and contracts with the Tennessee Department of Children's Services. 2) The In-Depth component is an addendum to the standardized interview data and was collected at 6 months after the baseline interview for a subsample of adolescents. For these youth, the standardized interview was enhanced by a series of professional treatment-related interviews and record reviews to provide a comprehensive description of their experiences during the six months between admission to treatment (at Wave 1 interview) and the Wave 2 interview. This component will be the focus of a future report. 3) The Administrative Data component relies on TennCare enrollment and claims data and management information system data from the Tennessee Department of Health Bureau of Alcohol and Drug Abuse Services about services funded through the Substance Abuse Prevention and Treatment Block Grant (from SAMHSA), both statewide and for a subsample of children and adolescents that participated in the standardized interview component. There will be series of future reports on administrative data. 4) The Implementation Study component builds on stakeholder interviews and document analyses to describe the system of publicly-funded treatment for adolescents with substance abuse problems in Tennessee. This will also be the focus of a future report. The Impact Study is a collaboration between academic, government, providers, and consumer and advocacy groups in the states of Tennessee and Mississippi. The VIPPS Center for Mental Health Policy has collaborated with: ♦ State agencies that provided data and other support for the project: the Tennessee Department of Mental Health and Mental Retardation, Tennessee Department of Health Bureau of Alcohol and Drug Abuse Services, Tennessee Department of Children's Services, the TennCare Bureau; and the Tennessee Commission on Children and Youth, which collected interview and in-depth case review data for the project; ♦ Advocacy agencies and provider groups: Tennessee Voices for Children, which also collected interview data using the standardized interview protocol; the Alcohol and Drug Council of Middle Tennessee, which helped with participant recruitment and in-depth case reviews; and a network of mental health and substance abuse providers across the state. It should be noted that the IMPACT Study also follows a representative sample of TennCare children and youth that are the focus of another series of reports.6 This report is the first in a series of reports about Tennessee's publicly-funded adolescents with substance use problems and includes information from a baseline youth interview on their behavioral health issues, health status, history of past service use, and satisfaction with intake to the target provider. 6 See www.vanderbilt.edu/VIPPS/CMHP/publications.html for a link to the IMPACT Study reports that are available on various aspects of the study. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
All youth were recruited from Tennessee behavioral health providers who were serving youth with substance abuse problems through public funds (see Appendix A for a listing). Providers were asked to refer youth who met the following criteria: ♦ Had just entered treatment for substance use issues and/or had a primary or secondary diagnosis of some type of substance abuse or dependence; ♦ Were TennCare beneficiaries at the time of admission (whether or not TennCare was paying for the treatment);7 and ♦ Were between the ages of 12 and 17 years at the date of their first interview. A total of 421 referrals were received and 262 youth were interviewed.8 Information below is presented in the following manner: First, information is provided by the type of service to which the youth were admitted (inpatient/residential service, n=214; some type of outpatient treatment, n=48). The next set of columns presents information on youth by custody status (in state custody, n=174; not in custody, n=88). The last column indicates the information for all youth who participated in the study (n=262). A series of tables is also included in Appendix C that displays the findings by custody status within service type, so that youth in custody and not in custody can be compared with those in inpatient/residential services and in outpatient treatment. Table 1 describes demographic characteristics of the youth. ♦ Youth in publicly funded treatment were primarily male and white. The male to female ratio was approximately 3:1. The white to African-American ratio was approximately 2:1. The youth interviewed from inpatient/residential services were three-quarters male (78%), corresponding to those in all treatment settings (76%) and slightly more than those in outpatient programs (65%). Females outnumbered males only for those in outpatient programs who were in state custody (58% female) (see Appendix C-1). A proportion of 3:1 male:female is similar to other reports of treated children and youth. Youth were almost two-thirds white (63%) and one quarter (28%) African-American. This proportion differs somewhat from census reports for this age group for all Tennesseans of 79% white and 20% African-American. All youth ranged in age from 12 to 17 years of age, with a mean age of 15 years and 11 months. Youth in outpatient services tended to be younger than those in inpatient/residential programs. ♦ While youth in outpatient treatment were generally able to access treatment close to home, some youth had to travel up to 200 miles from home for inpatient or residential treatment for substance use problems. Youth came from a variety of home counties, with three quarters (77%) in urban or mixed (those counties surrounding an urban area) settings. Those attending outpatient programs generally traveled less distance to the service, on average 12.68 miles, with a range of 0 to 39 miles. 7 See Table 1 for information on expected payment sources. 8 Note that this is a "convenience" sample of youth who were referred by their treatment providers, rather than a random or representative sample. The representativeness of this sample will be the subject of future analyses. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Table 1: Demographic Characteristics of the Interview Sample Custody Status
Inpatient/
Outpatient
All Youth
Race/ Ethnicity
Asian/Pacific Islander African-American 14 Years and Younger 17 Years and Older Mean Age (Years) Traveled Less Than 60 Miles to Treatment Mixed Traveled Less Than 30 Miles to Treatment Distance from Home Mean # Miles (range) Custody Status
In State Custody Expected Primary
Payment Source10
TennCare
Number of Youth
1Note, youth were designated as Hispanic in addition to their primary racial group, so race sums to 100% and youth designated as Hispanic is additional. * Differences were tested within service (Inpatient/Residential versus Outpatient) and custody status (In Custody versus Not) by chi-square tests for categorical variables and analysis of variance with t-tests for continuous variables. An asterisk (*) indicates differences a re significant at p < .05 for this, and all future tables. 9 Thirty-two (32) youth or 12% of the overall sample were in inpatient settings and 182 youth (70%) were in residential treatment. Since some of the inpatient providers were RTC-IV contractors for DCS, these levels of care were combined for this report. 10 This information was supplied by the provider agency at the time of recruitment. Further analyses of actual service files from BADAS and TennCare will be analyzed for more information. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
The distance to inpatient/residential from the youth's homes ranged from 0 to 201 miles, with an average of 33.1 miles. Long distances between treatment and the youth's home community can interfere with family involvement, transition planning, and aftercare. Some states have adopted standards for their managed care Medicaid programs that patients in urban areas be served by providers within 30 miles and those in rural areas, within 60 miles. When payment source (see discussion below) and miles traveled to treatment is examined, rural youth in block grant services meet the standard best: • Block grant: rural youth 100% within 60 miles, urban youth 100% within 30 miles, and youth from mixed counties (surrounding urban areas) 44% within 30 miles or 94% within 60 miles; • DCS contractors (all residential treatment): rural youth 71% within 60 miles, urban youth 86% within 30 miles, and youth from mixed counties 46% within 30 miles or 70% within 60 miles; and • TennCare-paid services: rural youth 77% within 60 miles, urban youth 100% within 30 miles, and youth from mixed counties 53% within 30 miles or 70% within 60 miles. According to the above information, block grant-provided services most often met the criteria for rural youth or those from rural counties surrounding major metropolitan areas (using the 60 mile criteria) and urban youth (using the 30 mile criteria). For all three funding sources, the youth in mixed counties (rural counties surrounding major metropolitan areas) appeared to have the most problems meeting the 30 mile or 60 mile criteria for service delivery. Expected primary payment source is also listed in Table 1. Although all youth had TennCare, only one third of them (32%) were expected to be paid for by TennCare. The primary payment source was expected to be contracts with the Tennessee Department of Children's Services (DCS), which was due to the large proportion of youth in custody and in residential treatment (see Appendix C-1). The block grant funds from the Tennessee Department of Health, Bureau of Alcohol and Drug Abuse Services were considered primary payment source for only 9% of the youth, but all block grant providers confirmed that block grant support of their programs was necessary even when TennCare or DCS contract funding was available.11 Three-quarters (72%) of the youth in the sample were being treated in programs that received block grants (see Appendix A for a listing of the programs). Data Collection Methods A two-step process was used to recruit potential participants and inform them about the study. Participating providers (see Appendix A) were trained on the study and given packets of recruitment material. They were asked to identify youth who were entering treatment at their agency who met the study criteria (see above) within two weeks of admission. At that time, they told the youth about the study and if the youth was interested in finding out more about the study, he/she gave written consent to the referring provider agency to provide background information to the study (for example: demographics, contact information, type of treatment, anticipated payment source) and to be contacted about the study. Providers were also asked to contact the youth's parent or legal guardian about the study and, in a few cases, written consent was also obtained from the parent/guardian. 11 This issue will be discussed in detail in Northrup and Heflinger (in preparation). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Once the IMPACT Study staff had the recruitment materials, they contacted the youth and made arrangements to schedule an in-person informed consent process. If the youth continued to agree to participate, the interview was administered. If parent/guardian participation had not yet been obtained, the interviewer obtained their contact information from the youth and got written consent from the youth to contact that person. On several occasions, the youth refused to give such consent, and Vanderbilt did not contact the parent/guardian. When parent/guardian contact information was given, the IMPACT Study staff similarly called and made arrangements for an in-person informed consent process. If the parent/guardian agreed to participate at that point, the interview was administered. Several (15%) parents/guardians were unable to be contacted after multiple attempts, some (10%) refused to participate after being contacted, and 118 participated in interviews. The information from this report is from the baseline youth interview, which was obtained from all youth, unless specifically otherwise noted. These interviews took place, on average, after the youth had been in treatment at the referring substance abuse program for four weeks. The youth were asked to describe their level of substance use prior to starting treatment to function as a baseline for future examination of treatment outcomes. Interviews were scheduled again approximately 6 months after the date of admission, and 1 year after the date of admission. The information from the follow -up interviews will be the subject of future reports. The Interview Protocols contained a series of standardized questionnaires (see Appendix B for a listing and description), other items included as part of the national study, and a series of site-specific questions. Interviews were conducted by trained interviewers who were required to attend and complete training, then conduct and be screened on pilot administrations of the interview. Youth Behavioral Health Status: Substance Use, Symptoms, Psychosocial Functioning, and SED Status Youth behavioral health status was measured in several ways. First, patterns of substance use are described. Next, emotional and behavioral symptoms and the youth's psychosocial functioning levels are reported. This information is used to determine whether the youth met the criteria to be classified as having a serious emotional disorder and the prevalence of co-occurring substance and mental disorders among this population. Alcohol or Drug Use
Types and amount of substance use was determined through subscales of the Addiction
Severity Index (ASI)12 and the Comprehensive Addiction Severity Index for Adolescents
(CASI)13 (see Appendix B). This information is presented in Table 2.
12 Fureman, Parikh, Bragg, & McLellan (1990). 13 Meyers (1996). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Table 2. Alcohol or Drug Use Custody Status
Inpatient/
Outpatient
All Youth
Residential
Alcohol or Drug Use*
Yes, Past 6 mos. AoD Use Consequences14
Age at First Use (mean
Number of Children All of the youth reported using alcohol or other drugs at some point during their lifetime. ♦ The average age of first use for this group of youth was 11.4 years with a range from 4 ♦ Although all youth in treatment had a history of substance use, only 40% reported active use during the month immediately prior to admission. Most (90%) of the youth reported using alcohol or other drugs during the past six months. Fewer (40%) reported use in the month prior to admission to treatm ent. Those from inpatient/residential services settings who were in state custody (see Appendix C-2) reported less use during the month prior to admission (29%), while those in outpatient programs who were not in state custody report greater use (62%) during the month prior to treatment. The drops in the percentages who used any alcohol or drugs (from past 6 months to past month use) are likely related to the placements in which these youth were living in the month prior to the current treatment admission (see section on Service Use, Table 17, below) and the lesser likelihood of use in "controlled" settings such as hospitals, residential treatment facilities, and jail, where the youth were monitored 24 hours per day. Type, Amount and Method of Substance Use
Table 3 shows the types of substances reported by the youth, and whether they reported their use ever, in the past six months, or the past month prior to admission to treatment. ♦ Primary substance use reported by Tennessee youth in publicly-funded treatment was alcohol and cannabis. ♦ Most youth reported poly-substance use, with one third using 4 different types of substances over the past 6 months. Although a wide variety and combinations of substance use was reported by these youth, the primary substances reported (ever, past 6 months, past month) were some form of cannabis and alcohol. Three quarters of the youth reported drinking (75%) in the past 6 months with more (84%) smoking cannabis. One quarter of the youth reported cocaine (29%) or opiate (22%) use in the past 6 months by either nasal or smoking. Other drugs reported by over 10% of the youth for the past 6 months included amphetamines, barbiturates, inhalants, hallucinogens, methamphetamines, and prescription/over the counter drugs. 14 Consequences were formed from items designed to measure the interference in daily living that have come about as a result of alcohol or drug use: for example, being fired from a job or expelled from school. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Table 3. Substances Used Custody Status
Inpatient/
Outpatient
All Youth
Residential
Used past 6 mos Used past month Cannabis
Used past 6 mos Used past month Used past 6 mos Used past month Used past 6 mos Used past month Used past 6 mos Used past month Other Amphetamines
Used past 6 mos Used past month Used past 6 mos Used past month Inhalants
Used past 6 mos Used past month Used past 6 mos Used past month Used past 6 mos Used past month Methadone
Used past 6 mos Used past month Prescription drugs /OTC drugs
Ever used "to get high" Used past 6 months Used past month TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Custody Status
Inpatient/
Outpatient
All Youth
Residential
Poly-Substance Use (past 6 months)
No, only 1 substance used Two substances used Three substances used Four or more substances used Total Youth
More than three-quarters (77%) of the youth reported using more than one type of substance in the past 6 months, and one-third used four or more substances during this period. The most prevalent combinations were alcohol and cannabis (70%); cannabis and cocaine (30%); alcohol and cocaine (29%). More than one-quarter (28%) reported using alcohol, cannabis and cocaine during 6 months prior to admission. Table 4 provides information on the level and method of substance use for those youth who had any substance use within the past 6 months. Table 4. Level and Method of Use (for those with any use of the drug during the past 6 months) Custody Status
All Youth
Inpatient/
Outpatient
Residential
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Mean days used in past month More than 5 drinks per day
Once a month or less 2-3 times times a month 2-6 times a week Cannabis
Once a month or less 2-3 times a month 2-6 times a week Daily or more th an once daily Mean days used in past month Cocaine and Crack
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Mean days used in past month TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Custody Status
All Youth
Inpatient/
Outpatient
Residential
Meth- & Other Amphetamines
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Mean days used in past month Inhalants
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Mean days used in past month Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Mean days used in past month Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Mean days used in past month Tobacco Use
Smoking Cigarettes (% yes) Other tobacco use (snuff, dipping, chewing)(% yes) TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Consequences of Alcohol or Drug Use

The youth were also asked about a series of consequences of their substance use, using items
from the Substance Use Disorders Diagnostic Schedule (SUDDS)15 (see Appendix B). Often,
the severity of alcohol or drug use is examined by including information on the consequences of
use. The consequences of alcohol or drug use for these youth are reported in Table 5.
Information on consequences for the past 6 months is reported.
Table 5. Consequences of Alcohol or Drug Use During Past 6 Months Custody Status
Inpatient/
Outpatient
Residential
All Youth
Took more for same effect Withdrawal symptoms Used to avoid or reduce hangover Used when not intended to Used longer than intended Wanted to stop but couldn't Set rules but failed to follow Two days without sobering up Unable to do something planned Couldn't remember what said/done Missed work or school because of Trouble at work or school Kicked out of school So reckless someone could be hurt Driven/ridden while using Auto accident as a result Arrested or stopped Possession / sale Family/friend objected to use Became violent while using consequences endorsed Total Youth 15 Harrison & Hoffman (1987). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Three quarters of the youth (76%) admitted that their families or friends had objected to their substance use during the past 6 months. They also reported many other consequences and risky behavior associated with their substance use: ♦ Three quarters (75%) admitted to either driving or riding in a car while using, with 19% being involved in an automobile accident as a result of substance use. ♦ They reported having to use more to get the same effect (56%), going at least two days without sobering up (50%), using longer than intended (57%), and using even when they had not intended to do so (44%). ♦ Two-thirds reported school or work problems related to substance use: 53% had missed school or work, 41% had gotten in trouble because of their use, and one quarter (26%) said they had been kicked out of school in the past 6 months due to substance use. Another way to look at consequences is to summarize the different types of consequences of substance use reported by the youth. Table 6 summarizes the information presented above. ♦ The most frequently reported consequences of substance use among all youth were interpersonal problems related to use, dangerous behavior, interference with role obligations (family, work, school), and excessive use. Table 6. Consequences of Substance Use : Summary Scores Custody Status
Inpatient/
Outpatient
Residential
All Youth
Tolerance Problems Time Spent in Use Sacrifice Activities for Use Counter Indicators to Use Role Obligations Interfered With Dangerous Behavior While Using Substance-Related Legal Problems Interpersonal Problems TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Diagnostic Indicators of Substance Abuse or Dependence

Levels of substance use were determined using a combination of information on amount of use
and consequences of use. This approach was based on that of the DSM-IV16 that requires the
following criteria to be met:
Substance Abuse: documentation of substance use and impairment, based on at least one of the following consequences: failure to fulfill major role obligations at work, school, or home; recurrent used in situations where it is physically hazardous; substance-related legal problems; or continued use despite interpersonal problems related to use. ♦ Approximately 21% of the inpatient/residential youth, and 25% of those admitted to outpatient programs met criteria for substance abuse (see Table 7). Substance Dependence: documentation of substance use and impairment indicated on at least three of the following: tolerance; withdrawal; excessive use; unsuccessful attempts to stop use; great deal of time spent in obtaining the substance or using; social, occupational, or recreational activities are given up or reduced due to use; or the substance is continued to be used despite knowledge of harmful effects. ♦ Based on reported substance use and related consequences, seven of ten (70%) of the youth admitted to inpatient/residential , and 67% of the youth admitted to outpatient programs could be classified as having substance dependence (see Table 7). 17 Table 7. Diagnostic Indicators Custody Status
Inpatient/
Outpatient
Residential
All Youth
Diagnostic Indicator
Overall, 9% of the youth admitted to inpatient/residential, and 8% of those admitted to outpatient programs were rated as "no diagnosis" or only "possible abuse" since their level of substance use over the past 6 months was reported as none and they reported no or limited consequences of substance use over that time period. 18 16 American Psychiatric Association (1994). 17 We want to thank consultant Norman Hoffman, Ph.D., who developed the analyses plans for determining diagnostic indicators of substance use. 18 Reports of no substance use correspond with the youth being placed in restrictive settings (inpatient hospital, residential treatment facility, jail, diagnostic shelter) over the past 6 months. This is discussed in more detail under Services Use below. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Emotional and Behavioral Symptoms
Symptoms, or types of behavioral health problems, were described using the scales on the
Youth Self Report (see Appendix B). Three general scores summarize overall behavioral health:
the Total score reports overall symptom levels; the Internalizing score shows problems overall
with anxiety, depression, and similar issues, and the Externalizing score gives information on the
level of problems with conduct disorders, attention problems, and other "acting out" behavior.
Table 8: Youth Scores on the Youth Self Report (YSR)19 Custody Status
Inpatient/
Outpatient
Residential
All Youth
Total Problems Score
Total Externalizing Score
Total Internalizing Score
Youth with Both Externalizing and Internalizing Scores in the Clinical Note: Standard scores reported in Table 8 have a mean of 50 and a standard deviation of 15. A standardized T-score of 65 or greater on the Total, Externalizing, or Internalizing scales marks the clinical cutoff. ♦ Over one-third (35%) of the youth were exhibiting emotional and behavioral problems of a high enough level to be classified as in the "clinical" range, in need of treatment. Over one-third (35%) of the youth were exhibiting emotional and behavioral problems of a high enough level to be classified as in the "clinical" range, in need of treatment for emotions or behavior, with an additional 16% at the "borderline" range, in need of at least screening for treatment. Externalizing problems were the most frequent. Almost half (46%) of the youth were in the clinical range for Externalizing Problems, with an additional 12% in the borderline range. One-fifth (21%) of the youth were in the clinical range for Internalizing Problems. Eighteen percent (18%) of the youth exhibited problems in the clinical range for both Externalizing and Internalizing Problems. Youth in outpatient services who were not in state cus tody (see Appendix C-8) tended to have the highest numbers (greatest mean score) of emotional/behavioral problems reported. These outpatient treatment programs were primarily in mental health centers that also served a 19 A score of 65 or greater on the Total Problem, Externalizing, or Internalizing scales is considered to be in the clinical range according to the author (Achenbach, 1991a, 1991b). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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population of children with serious emotional disorders. The prevalence of co-occurring substance and mental disorders is discussed below. Table 9 shows the proportion of youth who were in the borderline or clinical range for the subscales of the YSR, which show the specific types of problems being reported. Table 9. Youth with Scores in the Borderline or Clinical Range on the YSR Subscales Custody Status
All Youth
Inpatient/
Outpatient
Residential
Withdrawn
Social Problems
Thought Problems
Attention Problems
Delinquency
Somatic Problems
Aggression
% of youth with 3 or more
subscales in borderline or
clinical
♦ Problems with delinquent behavior were the most prevalent type of emotional/behavioral problems reported in this population, followed by attention and aggression problems. Almost three quarters (70%) of the youth in treatment for substance use problems scored in the clinical or borderline range of the YSR's delinquency subscale (see Table 9). One in five or more of the youth showed problems with each of the following: thought, aggression, or attention problems. More than one third of the youth (39%) reported high levels of problems in multiple areas. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Psychosocial Functioning

Broadly defined, psychosocial functioning is the level at which an individual meets age-
appropriate expectations in a number of domains. Both social and psychological aspects of the
child's functioning are taken into account. Success in relationships and activities at home,
school, and in the community is the goal for children. When significant problems exist in one or
more of these settings, psychosocial impairment is said to be present. Psychosocial functioning
is considered separately from diagnosis or symptoms because diagnoses of mental illness are
generally considered to be long term since the illness is often chronic in nature; however, an
individual's level of functioning may differ greatly during the course of the illness.20
The Columbia Impairment Scale (CIS) was used in this project to describe psychosocial functioning (see Appendix B). The CIS provides an overall score for psychosocial functioning and a cutoff for "impaired" versus "non-impaired" has been determined in a national epidemiological study21. Users of mental health services were more often scored as impaired on the CIS than non-users. ♦ More than half (53%) of the youth had significantly impaired psychosocial functioning, with those not in state custody being more impaired than those who were in state custody for both the inpatient/residential and the outpatient groups (see Appendix C-10). Table 10. Columbia Impairment Scale (CIS) Custody Status
All Youth
Inpatient/
Outpatient
Residential
CIS Rating
Not impaired (0-15) Classification of Youth as Having a Serious Emotional Disorder

Information on youth symptoms and psychosocial functioning is used to determine whether they
meet federal criteria to be classified as having a serious emotional disorder (SED). Federal
mental health block grant funding22 for mental health required that the assessment of functional
impairments be a component of applications for federal assistance, and the definition includes
both a DSM-IV23 diagnosis and an impairment in psychosocial functioning. Symptomatology or
diagnosis provides a direction or category of emotional/behavioral problems and level of
functioning provides the depth or degree of impairment. The Tennessee Department of Mental
Health24 also applies the two-part definition for classification as SED.
Federal SED status for this project was determined from baseline data from the parent/caregiver interview using scores on the Columbia Impairment Scale (CIS) and the Youth Self Report (YSR). Taken together, these two scales (CIS and YSR) measure the child's ability or inability to 20 Canino, Costello, & Angold (1999). 21 E.g., Flisher et al. (1997). 22 Federal Register (1993). 23 American Psychiatric Association (1994). 24 See the TDMHMR Annual Block Grant Reports (e.g., 1998). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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function in his or her community in a variety of age appropriate ways. A score in the impaired range on the CIS indicated impairment in psychosocial functioning. The YSR was used to identify significant emotional or behavioral problems as a proxy for diagnosis in the two-part federal definition of SED. A score on the total YSR in the clinical range was used to identify a significant behavioral or emotional problem. Findings specifically from the CIS and YSR are presented in more depth below. If a youth had both psychosocial impairment (on the CIS) AND significant emotional and behavioral problems (on the YSR), he/she was classified as meeting SED criteria (see Table 11). The presence of one dimension in the absence of the other (i.e., impaired functioning on the CIS OR significant behavioral or emotional problems on the YSR) indicates a problem but of lesser degree than SED and is designated in the tables that follow as "any problem". Table 11. Emotional/Behavioral Symptoms by Level of Psychosocial Functioning Total Emotional/Behavioral Symptoms
Borderline
Clinical
Behavior
Problems
Functioning (CIS)
Not impaired (0-15) ♦ Overall, more than one-quarter (27%) of the total youth who had been admitted to publicly- funded services for substance use problems also met criteria as having a serious emotional disorder at the time of the interview. These youth, in addition to their substance use, were reporting high levels of emotional and behavioral symptoms and severely impaired functioning in home, school, community, and/or with peers. § 26% of youth admitted to inpatient/residential services were rated as SED. § 32% of youth admitted to outpatient services were rated as SED. § 38% of those not in state custody were rated as SED, a significantly25 greater proportion than those in state custody (22%). 25 X2=7.898, p=.005. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Youth Taking Medication for Emotional and Behavioral Problems

Another indicator of severe emotional or behavioral problems is the proportion of youth in
substance abuse treatment who had been prescribed psychotropic medication.
♦ Over one quarter of youth in treatment for substance use problems had been prescribed medication for emotional or behavioral problems. Table 12 shows that over all youth, 29% had been taking psychotrophic medication. Of those taking medication, one in four (7% of all youth, which equates with 25% of those on psychotropic medication) were prescribed three or more of these medications. Table 13 shows the specific types of medication prescribed. Table 12. Psychotropic Medication Custody Status
All Youth
Inpatient/
Outpatient
Residential
Any Medications
Number of Medications
% of Youth with
Medications who were
SED
Almost half (45%) of the youth taking medication for emotional or behavioral problems also met criteria for SED at the time of the interview (see Table 12). Of the youth on medications, those not in state custody were more likely to meet the SED criteria (56% of those not in custody in inpatient/residential programs, and 64% of those not in custody but in outpatient programs) (see Appendix C-12). ♦ The most frequently prescribed type of medication for emotional and behavioral problems was antidepressants. Almost one quarter (21%) of all youth in treatment for substance use problems were taking prescribed antidepressants. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Table 13. Psychotropic Medication : Type Prescribed as a Proportion of all Youth Custody Status
All Youth
Inpatient/
Outpatient
Residential
Anti Hypertensive
Clonidine (Catapres) Anti Psychotic
Olanzepine (Zyprexia) Lithium (Eskalith, Lithobid) Risperdone (Risperdal) Quentiapine (Seroqual) Buspirone (Buspar) Lorazepam (Ativan) Anti Depressants
Nortryptyline (Aventyl, Pamelor) Busproprione (Wellbutrin) Sertraline (Zoloft) Paroxetine (Paxil) Mirtazpine (Remoran) Nefazodone (Serzone) Amitriptyline (Elavil, Endep, Entraphon) Disipramine (Norpramin, Pertofrane) Impramine (Tofranil) Fluxetine (Prozac) Trazodone (Desyrel) Venlafaxine (Effexor) Amoxapine (Asendin) Anti Anxiety Agents
Hydroxyzine (Vistaril) Anti Convulsants
Carbamazepine (Epitol, Tegretol) Valproic Acid (Depakote) CNS Stimulants
Pemoline (Cylert) Methylphenidate (Ritalin) Dextroamphetamine (Dexedrine) Amphetamines (Adderall, Adarol)
Sedatives
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Co-Occurring Substance and Mental Disorders
Information from Tables 7 (Substance Use Diagnosis) and 11 (SED Status) was combined to
examine the proportion of youth admitted to publicly-funded substance use treatment who could
be described as having co-occurring substance and mental disorders.
♦ One quarter of the youth in publicly-funded substance use treatment had co-occurring substance and mental disorders. This rate is considered lower than actual prevalence of co-occurring substance and mental disorders among Tennessee youth because this is a sample of youth already in treatment. Many youth with co-occurring disorders are not receiving substance abuse treatment because the current provider network is hesitant to accept them into treatment due to clinical, staff training, medical coverage, and reimbursement issues.26 Approximately one-quarter (26%) of the youth had an emotional or behavior disorder sufficiently severe to be classified as SED and a co-occurring substance abuse disorder classified as abuse or dependence. Those not in state custody were significantly more likely to have co-occurring disorders than those youth in treatment who were in state custody (see Table 14). Table 14. Co-Occurring Emotional/Behavioral and Substance Abuse or Dependence Custody Status
All Youth
Inpatient/
Outpatient
Residential
Disorders
No
Issues Surrounding Admission to Current Treatment The next section describes various issues related to the current treatment episode, including referral source and previous placement, activities involved in getting to treatment, and experiences during the first month of treatment. Type of Current Treatment and Referral Source
The youth included in the inpatient/residential treatment columns were primarily participating in a
residential treatment program (85%) but several (15%) were in an inpatient treatment program
for substance abuse issues. All youth admitted to outpatient programs were participating in
either intensive outpatient or day treatment programs. Table 15 also shows referral information,
as provided by the youth.
26 See Northrup and Heflinger (in preparation) for more details. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Table 15. Issues Surrounding Treatment Custody Status
All Youth
Inpatient/
Outpatient
Residential
Current Treatment
Intensive Outpatient or Day Treatment Inpatient Court Order Requiring
Treatment ( % yes)
Reason for Treatment
Who Recommended Treatment
School personnel
Juvenile court/detention Parole/probation officer Parent or guardian Another MH/SA provider Other family member Case worker or Case Manager Another provider Priest / counselor Choice in Place of
Treatment (% yes)
Who Arranged Appointment
School
Juvenile court/detention Parole/probation officer Case Manager or Case Worker Other Provider TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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♦ Overall, almost two thirds (64%) of the youth reported that they had been court-ordered Youth in residential treatment (70%) and those in state custody (70%) were the most likely to be court-ordered. Within inpatient/residential treatment, youth in state custody were more likely to be court-ordered (see Appendix C-15). Another report on this population that is in preparation27 describes the practice of juvenile court judges ordering treatment and putting adolescents into custody to receive it. ♦ Primary referral sources were most often juvenile court-related. Primary referral sources were most often juvenile court-related (35% for all youth; 59% for youth in inpatient/residential who were in custody – see Appendix C-15). The next most frequent referral source was the youth's parole or probation officer (26%) or DCS case worker (or, in a few instances, their case manager from the community mental health center) (19%). Several youth (19%) said their parent or guardian was the person who arranged the appointment for treatment. Half of the youth in outpatient services who were not in custody (see Appendix C-15) said their parent had made the arrangements, a significantly higher level of parent referral than the other youth. Most youth (85%) said they were not given a choice about where to go to treatment, but were just told to go to the specific inpatient/residential facility or outpatient facility by their referral source. However, the group of youth with the greatest likelihood of being given a choice of treatment options were youth who ended up in outpatient services and were not in state custody (see Appendix C-15). Case workers and case managers were reported by the youth to be the persons who most often were responsible for actually setting up the admission appointment (28%) with parole/probation officers (23%), parents (19%), or juvenile facilities (14%) essentially accounting for the remainder. Waiting for and Coming to Treatment Admission
Table 16 provides information about the admission. More than one-quarter (27%) of the youth who were eventually admitted to inpatient/residential or outpatient programs said they had to wait for an admission because there was no space available. Various other problems associated with waiting for admission were also reported (see Table 16). Almost half (40%) of the youth who reported they had to wait for a space said they stayed in some group placement while waiting (see Table 17 for pre-treatment residence). In total, a family member accompanied the youth to admission for approximately one-third (33%); 28% said they came alone (or with a transportation worker) and one-quarter (26%) reported they came with their case worker or case manager. 27 Northrup & Heflinger (in preparation). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Table 16. Admission Issues Custody Status
All Youth
Inpatient/
Outpatient
Residential
Had to Wait for Admission (% yes)
No space available
Not enough money Transportation problems Insurance would not pay Missed appointment While Waiting for Treatment Did You:
Stay somewhere else
Get any other help Who Came with You:
Came alone
Case Manager or Case Worker Other Relative Transportation worker Named person, role NS Residence Immediately Prior to Treatment Admission
♦ Half (48%) of the youth who were eventually admitted to inpatient/residential treatment programs were in some type of restrictive or "controlled" placement immediately prior to being admitted to treatment for substance abuse problems. ♦ Approximately one in five (17% of the youth overall, 22% of those in custody) of the youth waited in juvenile detention centers an average of 29 days before being admitted to treatment. Table 17 shows the where the youth resided or was placed immediately prior to being admitted to treatment. Half (48%) of the youth who were eventually admitted to inpatient/residential treatment programs (40% of overall youth) were in some type of restrictive or "controlled" placement immediately prior to being admitted to treatment for substance abuse problems. These controlled settings included general hospitals (<1%), inpatient psychiatric or residential treatment (7%), juvenile detention (17%), and diagnostic or emergency shelters (15%). ♦ Youth in state custody, and youth who were admitted to inpatient/residential treatment were significantly more likely to have been in controlled settings, such as juvenile detention or diagnostic shelters, while they waited to be admitted to treatment. Most youth not in state custody said they had been staying at their parent's home while waiting placement (79% of those admitted to inpatient/residential and 93% of those admitted to outpatient programs; see Appendix C-17). Those in state custody who were eventually admitted TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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to inpatient/residential services (see Appendix C-17) were more likely to have stayed in a diagnostic or emergency shelter (26%) or juvenile detention (24%) waiting for a placement at an inpatient/residential program. Those who were in custody and eventually admitted to an outpatient program were more likely to have stayed in a group home (47%) or a foster home (37%) while waiting for placement (see Appendix C-17). Of those eventually placed in inpatient/residential programs, 3% of those not in custody and 10% of those in state custody reported they had been in another inpatient or residential treatment program for mental health or alcohol or drug treatment immediately before coming to an inpatient/residential program (see Appendix C-17). Table 17. Residence Immediately Prior to Treatment Admission Custody Status
All Youth
Inpatient/
Outpatient
Residential
Residence at the Time Treatme nt Started:
General Hospital**
IP/RTC for Psych** Juvenile Detention** Diagnostic/Emergency Shelter** **Total in Controlled Setting Length of Time at Above Out-of- Home Residence Prior to Admission within Past 6 Months:
117 youth 129 youth > 1 week, < 1 month > 1 month < 3 months > 3 months, < 6 months For Youth Waiting in Juvenile
Detention: Mean days
Time in Controlled Setting in Month Prior to Treatment (see ** above)
(for those who provided the information)
1 day
1 Only out-of-home placements are included. All youth living in parent's homes immediately preceding admission and those who had always lived in foster homes were omitted from calculation of these means. *Differences statistically significant (p<.05) between groups. ** Placements designated as "controlled" settings. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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On average, the youth who had had out-of-home placements had been in that placement for a little more than one month prior to admission (37 days). The high proportion of youth in "controlled" settings for at least one month and up to 6 months helps explain the low proportion of youth reporting any substance use (see discussion above) during the month prior to admission. Satisfaction with the Intake Process
Youth were asked to share information on the admission process at their treatment program. Table 18 summarizes the youths' experience with their diagnosis, treatment plan, and availability of staff. The interviews took place, on average, 4 weeks after their admission date. Table 18. Satisfaction with Intake Process at Current Provider Custody Status
All Youth
Inpatient/
Outpatient
Residential
Told What Diagnosis Was
(% yes)
Satisfied with Explanation
of Diagnosis
Satisfied
Have a Treatment Plan (%
yes)
Treatment Plan Explained
(% yes)
Clarity of Explanation
Satisfaction with Treatment
Plan
Satisfied
Involved with Development
of Treatment Plan
Involved
Satisfaction with
Involvement
Satisfied
Availability of Staff
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
♦ Half of the youth (47%) said they had been told what their diagnosis was. Client involvement in treatment planning is required by all public agencies and 100% of the youth should have been so involved and be able to explain their diagnosis. Most (74%) who had been told their diagnosis reported they were satisfied with their diagnosis. More youth (77%) were aware that they had a treatment plan, and almost all (95%) reported it had been explained to them. Clarity of the explanation was rated "clearly" or "very clearly" by 91% of the youth. Most youth (91%) said they were satisfied with their treatment plan. Most of those with a treatment plan (71%) said they had been involved in its development. ♦ Almost all (89%) of the youth who reported they had been involved in the development of their treatment plan said they were satisfied with their level of involvement. The youth rated the staff as "available" or "very available" most (77%) of the time. There was little difference in these satisfaction ratings by inpatient/residential and outpatient status, or by custody status (see Table 18). Current Motivation for Substance Abuse Treatment
Youth were asked about their motivation for their treatment for the program they were admitted
to using items from the Adolescent Circumstances, Motivation, Readiness, and Suitability
Scales for Substance Abuse Treatment (A-CMHS) (see Appendix B).
Table 19. Motivation for Treatment % Agree or Strongly
Custody Status
All Youth
Inpatient/
Outpatient
Residential
Would have come without pressure Could not live at home Family/friends will make me stop Too many outside problems Do not need treatment Will stay in treatment regardless of family or friends Use is serious problem Can use and still get life together Do not like self because of use Life is okay but still have to make changes Can stop any time Need treatment to stop Would try other treatment TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Eighty-seven percent of the youth acknowledged that they have to make changes in their life, almost three quarters (70%) admitted they wanted to change, and two thirds (62%) said that their substance use was a serious problem. Forty percent of the youth said they would have entered treatment without pressure (usually from the courts, as shown above), and more of them (65%) reported (approximately 4 weeks into treatment) that they would stay in treatment regardless of what their family or friends said to them about quitting. Length of Stay at Current Treatment
Table 20 shows the length of stay for this treatment admission.28 The youth stayed an average
of 66 days in inpatient/residential when not in custody compared to 88 days for those who were
in custody (see Appendix C-20). Those in outpatient programs stayed an average of 5 ½ weeks
(39 days) when not in state custody and 11 ½ weeks (82 days) when in state custody (see
Appendix C-20). The average stay for all youth was 81 days or 11 ½ weeks.
Table 20. Length of Stay 28 Custody Status
All Youth
Inpatient/
Outpatient
Residential
Two weeks or less 15 days to 21 days 22 days – 28 days 29 days – 35 days 36 days – 42 days 43 days or more (more than 6 weeks) Mean days of care 28 This table contains data supplied by the providers for 193 of the 262 youth. Mean days of care was calculated from admitting and discharge dates and was not available for 35% (13 youth) admitted to outpatient care because the youth were still in the outpatient care. In addition, discharge date was not reported for 56 youth (26%) admitted to inpatient/residential care. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Youth Health Issues Youth were asked to provide information on health issues through a variety of questions. Issues with obesity and chronic health conditions were reported and have implications for service providers. Global Ratings of Health Status
First, they were asked to assess their overall health status, on a rating scale from poor to excellent (see Table 21). Approximately half (47%) reported their health status as "very good" or "excellent." One in six (16%) rated their health status as "fair" or "poor." This is similar to youth self-reports in the IMPACT Study of a representative sample of TennCare youth,29 where 50% of the 12-17 year old respondents rated their own health as "excellent" or "very good." Table 21. Youth Global Health Status Custody Status
All Youth
Inpatient/
Outpatient
Residential
Weight Status
Youth provided information on their height and weight to determine weight status (see Table 22).
The weight status ratings are based on the body mass index.30
♦ One in six (16%) of the youth in treatment were overweight or obese. Although most of the youth (84%) fell in the normal or borderline weight range, based on their height, almost one in six (16%) were rated in the overweight or obese range. Nine percent did fall into the obese category, indicating significant risk for health problems. Youth in inpatient/residential facilities tended to be more overweight than those in outpatient treatment programs. Table 22. Weight Status Rating Custody Status
All Youth
Inpatient/
Outpatient
Residential
Borderline 20-24 Overweight 25-29 Total Youth
29 See Heflinger, et al., (2000). 30 Ellis, Abrams, & Wong (1999). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Chronic Health Conditions and Injuries
Youth were also asked to provide information on chronic health problems and injuries (see
Table 23). Most youth (81%) endorsed at least one of the health conditions that were probed.
The most frequently reported health conditions, during the past 6 months, were neurological
problems (including convulsions or migraines) (21%), gynecological problems for the female
youth (39% of the female youth), followed by attention deficit disorder (17%) and physical
injuries (16%).
Table 23. Chronic Health Conditions and Injuries Past 6 Months Custody Status
All Youth
Inpatient/
Outpatient
Residential
Any Chronic Problem Total Youth
Types of Health Conditions (%
of all youth) Asthma/Respiratory Allergies (other than asthma) Major Dental Problem Physical Injuries Neurologic Problems (Convulsions, Migraines) Attention Deficit Disorder Sexually Transmitted Heart/blood/ or Circulatory Diabetes / thyroid Vitamin Deficiencies Stomach / Digestive Tract Problems Bone / Muscle Problems Other Medical Problem Risk Behavior
The youth were also asked about risk behavior that was associated with their substance use
and posed a concern about health issues, using items from the Risk Assessment Battery (see
Appendix B). Table 24 summarizes the responses of the youth.
Only 4% of the youth said they had injected drugs within the past 6 months, and one quarter of these youth (1%) had shared needles. The previous section on mode of drug use (Table 4) was based on the usual mode of use. This section is based on a report of drug injection at least once during the past 6 months, whether injection is the usual method or not. Seven percent (7%) said they had been to a shooting gallery, whether or not they had injected drugs themselves. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Table 24. Risk Behaviors Custody Status
All Youth
Inpatient/
Outpatient
Residential
Injected Drugs (% of all youth)
Past 6 months
Shared Needles (% of all youth)
Past 6 months
Number of People Shared Needles With
Past 6 Months (1 or more)
Past Month (1 or more) Been to a "Shooting Gallery"
Past 6 months
Been to a "Crack House"
Past 6 months
Ever had Sex (% yes)
# People had Sex with in Past 6 Months (% of those who had ever had sex)
None in past 6 mos.
How Often Used Condoms in Past 6 Months (% of those who had sex in past 6 months)
All the time
Most of the time Some of the time Ever been Pregnant (% females only)
Yes
2 or more times Currently Pregnant (%
yes)
Discussed with Health Care Professional in the Past 6 Months (% yes)
Family planning
Alcohol/drug Problem Tobacco problems Tested for HIV/AIDS
Ever
Yes, In past month
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
♦ Almost one-third (32%) reported they had been to a crack house in the past six months – a much higher rate than reported using crack, but they apparently frequented these establishments for other reasons as well. ♦ This group of youth reported high levels of sexual activity with limited protection. Almost all of the youth (95%) said they had been sexually active, with many (49%) reporting two or more partners. Only half (51%) reported that they had used condoms all of the time. Over one-fifth of the female youth (28%) reported they had been pregnant at least once before. Many youth said they had received some type of preventive health information during the past 6 months from a doctor, nurse, or some other health professional. The most frequent type of preventive health service was discussion of or information on "safe sex" (66%). Approximately half had a discussion with a health professional about alcohol or drug problems (44%) or tobacco use (51%). Almost half (43%) had had an HIV/AIDs test in the past month. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
History of Behavioral Health Services Use The youth also provided information on their history of services for substance abuse, emotional or behavioral problems. Table 25 shows the services they reported to have ever used prior to entering treatment. Table 25. Ever Used Services for Substance Abuse, Emotional or Behavioral Problems Custody Status
All Youth
Inpatient/
Outpatient
Residential
Ever Used Residential
Services
No
Type of Residential
Service Used
General Hospital
Psych Hospital or RTC Other Residential Tx Ever used Non-
Residential
No
Type of Service Used
Counseling at Clinic Support Groups (AA, CA, etc) Other Support Groups Other Non-residential TX Note: Jail, Detention, or Correctional Facility is included in these tables only if the youth reported that he or she had received some type of substance abuse or mental health treatment while there. The percentages shown here differ from those in earlier tables showing types of placements that were not restricted to placements providing treatment. ♦ Half of the youth (48%) reported a history of residential treatment at some point in the past, prior to admission to the current treatment program. Over one-third reported use in either a psychiatric hospital or RTC (37%), and one in six (16%) used some other type of residential facility (diagnostic or emergency shelters, miscellaneous). Youth in state custody were significantly more likely to have had previous residential treatment services. Two-thirds of the youth (67%) reported some past non-residential or outpatient treatment related to alcohol and drug problems or emotional/behavioral problems. One-third (34%) said they had attended some type of support group. Two in five (40%) had partic ipated in some type of counseling in the past. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Table 26 shows the types of residential services used and other places where youth had lived during the past 6 months. Table 26. Residential Treatment and Other Residences During Past 6 Months Custody Status
All Youth
Inpatient/
Outpatient
Residential
Type of Residential
Service Used
General Hospital
Psych Hospital or RTC Other Placements
Juvenile Detention Other Residential Placement
Other Residences
Parent's/Relative's Home Hotel or Rooming House Homeless Shelter Homeless on Streets One quarter of the youth (23%) had spent time in the past 6 months in a psychiatric hospital or residential treatment center for emotional or substance abuse problems. Almost three quarters (72%) had been placed in a juvenile detention or youth corrections facility at least once in the past 6 months. For youth not in state custody, most of them had lived with parents or relatives over the past 6 months prior to entering treatment.
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Educational Status Youth were asked to provide information on their educational background (see Table 27). They reported a range of grade placements from 5th to 12th grades. Two percent reported having completed 12th grade or a GED to date. ♦ Over two thirds (69%) of the youth in treatment were placed one to two years behind their age-determined grade level. Table 27. Highest Grade Completed Custody Status
All Youth
Inpatient/
Outpatient
Residential
Highest Grade Completed
Working at Grade Level
No, 2 or more years below level No, 1 year below grade level Yes, on grade level Yes, above grade level Type of School
Vocational Education Regular tutoring/Home School Alternative School School at Treatment Facility School at Juvenile Facility Other regular school Suspended/Expelled – 6
Months
School Counseling for
Substance Use – Past 6
Months
School Counseling for Other
Reason – Past 6 Months
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
History of Juvenile Court Involvement Almost all of the youth (93%) reported they had had contact with the juvenile court system during the 6 months prior to admission (see Table 28). Table 28. Criminal Justice History Custody Status
Inpatient/
Outpatient
Residential
Any Contact
Probation or parole past 6
months
Yes, past 6 months
Yes, past month Any Charges past 6 months
Yes, past 6 months Yes, past month Any Jail or Detention past 6
months
Yes, past 6 months
Yes, past month Probation/parole officer
visits (% of those on
probation or parole)
2 or more per week
Once every 2 weeks Less than monthly Probation or parole officer
help with D/A problem (%
yes)
Status Offense: Ever picked
up and charged
Past 6 months (% yes)
Past month (% yes) Drug/alcohol related crime:
Ever charged
Past 6 months (% yes)
Past month (% yes) Property crime: Ever charged
Past 6 months (% yes) Past month (% yes) Crime against a person:
Ever charged
Past 6 months (% yes)
Past month (% yes) TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Juvenile courts played a significant role in admission to treatment. As discussed above, two-thirds of the youth were court-referred to treatment and the juvenile court system was the primary referral source. The most frequent contact with the juvenile justice system over the past 6 months was some type of status or criminal charges (73%) or time in a jail/detention or correctional facility (72%). One-third of the youth had charges in the past 6 months for a drug-related offense (33%) or a status offense (36%). Almost one third (30%) had been charged with a property crime and more than one in five (28%) with a crime against a person. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Achenbach, T.M. (1991a). Manual for the Child Behavior Checklist/4-18 & 1991 Profile. Burlington, VT: University of Vermont Department of Psychiatry. Achenbach, T.M. (1991b). Manual for the Youth Self-Report Form and 1991 Profile. Burlington, VT: University of Vermont Department of Psychiatry. Achenbach, T. M., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: Author. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association. Armsden, G., Pecora, P.J., & Payne, V. (1996). A profile of youth placed with the Casey Family Program using the Child Behavior Checklist/4-18 and the Teachers Report Form. Seattle, WA: The Casey Family Program, Research Department. Beman, Deane Scott. (1995). Risk factors leading to adolescent substance abuse. Adolescence, 30 (117), 201-208. Canino, G., Costello, E.J., & Angold, A. (1999). Assessing functional impairment and social adaptation for child mental health services research :A review of the measures. Mental Health Services Research,1(2), 93-108. Community Health Research Group (1998). Alcohol, Tobacco and Other Drug Use, Abuse and Problems among Tennessee High School Students, 1995/1997. Knoxville, TN: University of Tennessee. DeLeon, George. Adolescent Circumstances, Motivation, Readiness, and Suitability Scales for Substance Abuse Treatment (A-CMRS). New York: Center for Therapeutic Research, National Development and Research Institutes, Inc. DeWitt, D.J., Silverman, G., Goodstadt, M. & Stoduto, G. (1995). The construction of risk and protection indices for adolescent alcohol and other drug use. Journal of Drug Issues, 25 (4), 837-863. Edelbrock, C. & Costello, A.J. (1988). Convergence between statistically derived behavior problem syndromes and child psychiatric diagnoses. Journal of Abnormal Child Psychology, 16(2), 219-231. Ellis, K.J., Abrams, S.A., & Wong, W.W. (1999). Monitoring childhood obesity: Assessment of the weight/height index. American Journal of Epidemiology, 150 (9), 939-946. Federal Register, (1993) pp 29425. Fureman B., Parikh, G., Bragg, A., McLellan, A.T. (1990) Addiction Severity Index, fifth edition with preface: a guide to training and supervising ASI interviews based on the past ten years. The University of Pennsylvania/Veterans Administration Center for Studies of Addiction. Flisher, A.J. et al. (1997). Psychosocial Characteristics of Physically Abused Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 36 (1), 123-131. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Fureman B., Parikh, G., Bragg, A., McLellan, A.T. (1990) Addiction Severity Index, fifth edition with preface: a guide to training and supervising ASI interviews based on the past ten years. The University of Pennsylvania/Veterans Administration Center for Studies on Addiction. Glied, S., Hoven, C.W., Garrett, A.B., & Moore, R.E. (1997). Measuring child mental health status for services research. Journal of Child and Family Studies, 6 (2), 177-190. Harrison, P.A. & Hoffman, N.G. (1987). Substance Use Disorder Diagnosis Schedule (SUDDS). St. Paul, MN: Norman G. Hoffman. Heflinger, C.A., Simpkins, C.G., Northrup, D.A., Saunders, R.S., & Renfrew, W. (2000, May). The Status of TennCare Children and Adolescents: Behavioral Health, Health, Service Use, and Consumer Satisfaction: The IMPACT Study Baseline Report on Interview Data. Nashville, TN: Vanderbilt Institute for Public Policy Studies, Center for Mental Health Policy. McLellan, A.T., Luborsky, L., Cacciola, J., Fureman, I. (1980) The Addiction Severity Index. See McLellan, A.T., Luborsky, L., O'Brien C.P., Woody, G.E. (1980) An improved evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous Mental Disorders, 168, 26-33. Melnick, G, DeLeon, G., Hawke, J, Jainchill, N. & Kressel, D. (1997). Motivation and readiness for therapeutic community treatment among adolescents and adult substance abusers. American Journal of Drug and Alcohol Abuse, 23(4), 485-506. Mesker, D. (1992). Risk Assessment Battery (RAB). University of Pennsylvania/Veteran's Administration Center for Studies on Addiction. Meyers, K. (1996). Comprehensive Adolescent Severity Inventory (CASI) Administration Manual. Philadelphia, PA: University of Pennsylvania, Treatment Research Institute. McConaughy, S.H., & Achenbach, T. M. (1988). Practical guide for the Child Behavior Checklist and related materials. Burlington, VT: University of Vermont Department of Psychiatry. Metropolitan Nashville Health Department (2000). 1999 Youth Risk Behavior Survey. Nashville, TN: Author. Meyers, K. (1996). Comprehensive Adolescent Severity Inventory (CASI). Philadelphia, PA: Author. Moos, R.H. & Moos, B.S. (1976). A typology of family social environments. Family Process, 15, 357-371. Moos, R.H. & Moos, B.S. (1981). Family Environment Scale Manual. Palo Alto, CA: Consulting Psychologists Press. Northrup, D.A., & Heflinger, C.A. (in preparation). Substance Abuse Treatment Services for Publicly-Funded Adolescents in Tennessee. Nashville, TN: Vanderbilt Center for Mental Health Policy. Rey, J.M., & Morris-Yates, A. (1992). Diagnostic accuracy in adolescents of several depression rating scales extracted from a general purpose behavior checklist. Journal of Affective Disorders, 26, 7-16. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Slee, P.T. (1996). Family climate and behavior in families with conduct disordered children. Child Psychiatry and Human Development, 26(4), 255-266. Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Applied Studies (1999). The Relationship Between Mental Health and Substance Use Among Adolescents. Rockville, MD: Author. Tennessee Department of Mental Health (1998). Annual Plan for a Comprehensive System of Mental Health Services in Tennessee 1997-1998. Nashville, TN: Author. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix A: List of Referring Providers Provider Name
Provider Location
Bradford Health Services CADAS (Scholze Center) Centerpoint/Helen Ross McNabb MHC Centerstone – Observation, Assessment & Treatment Center Charter Lakeside Cherokee Health Systems Comprehensive Community Services Cumberland Heights Lloyd Elam MHC – Adolescent Services Unit Frayser Family Counseling Center Frontier Community Mental Health Center - Adventure Program Guidance Center - Stepping Stones Harriett Cohn MHC/ Centerstone Memphis Recovery Middle Tennessee Mental Health Institute Jackson & Lexington St. Joseph's Hospital Volunteer MHC/Plateau MHC Western Mental Health Institute - Timbersprings Woodridge Hospital TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix B: Interview Components The Interview Protocols that were developed for youth and adults contained several standardized questionnaires that had been developed for other projects and are widely used in the field of children's research. These measures are presented here in alphabetical order (according to their acronyms). Addiction Severity Index (ASI) Researchers designed the ASI31 to assess the frequency, duration, and severity of symptoms related to substance abuse both historically – i.e. over the substance abuser's lifetime – and during the thirty days prior to the interview. The ASI examines, individually and separately, parallel information on seven functional areas affected among substance abusers: medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. A semi-structured interview rather than a questionnaire, the ASI requires administration by a trained interviewer. Several interviewers have demonstrated the ASI's excellent test-retest and interrater reliability as well as its predictive, concurrent, and discriminant validity across patient types. The strength of the ASI is its ability to measure both improvement over time as well as outcome from treatment. Its weaknesses stem from the nature of substance abuse: because disclosure about addictive behavior requires an environment of trust, the ASI is generally ineffective with those substance abusers who have not sought treatment; moreover, self-administration of the measure is discouraged for everyone. Adolescent Circumstances, Motivation, Readiness, and Suitability Scales for Substance Abuse Treatment (A-CMRS) The 42-item CMRS32 was developed to measure drug abusers' motivation and readiness for seeking, complying with, and remaining in treatment. The A-CMRS, a 25-item form, was designed especially to assess these factors in adolescents, who have been found to be more likely to enter treatment due to external factors (such as family pressure or legal referral) and therefore reveal less internal motivation than adult drug abusers. The instrument measures client perceptions of circumstances (extrinsic factors, such as family or legal pressures), motivation (intrinsic factors, such as fears about health or safety or a desire to make positive changes), readiness (perceived necessity for treatment in order to change), and suitability (perceived appropriateness of therapeutic community treatment). The A-CMRS instrument has been found to demonstrate adequate total score reliability as well as predictive validity.33 Comprehensive Adolescent Severity Index (CASI) The CASI is a semi-structured interview designed to measure clinical assessment and outcomes and provide a range of information on the adolescent's life. Aside from demographic and administrative data, this instrument garners "standard, comprehensive, and clinically pertinent information in ten life areas: health; stressful life events; education; drug and alcohol use; use of free time; peer relationships; sexual behavior; family/household member relationships; legal issues; and mental health." 34 Independent modules are used to assess the various key dimensions of functioning, particularly whether the adolescent acknowledges the presence of problems as well as the level of his/her level of discomfort due to problems. Subjective questions are considered central because they allow the adolescent to convey not only how often problems occurred but also the extent to which such problems were experienced and the extent to which treatment is viewed as important. Questions have been designed to assess the regularity of a symptom or behavior, the age of onset of 31 McLellan, Luborsky, Cacciola, & Fureman (1980). 33 Melnick et al. (1997). 34 Meyers (1996), 1. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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this regularity, and the level of regularity over the past year, both within the past month and over the other eleven months. The CASI's comprehensive and flexible design make it an effective measure for the assessment of virtually all adolescents regardless of their setting. Columbia Impairment Scale (CIS) The CIS is a 13-item scale designed to provide a global measure of psychosocial impairment. It originally was developed for the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA).35 The scale was designed to assess four major areas of functioning: interpersonal relations; certain broad areas of psychopathology; functioning at school or work; and use of leisure time. Items are scored on a Likert scale ranging from 0, "no problem", to 4, "a very big problem" with the potential total score ranging from a minimum of 0 to a maximum of 52. It was determined that a score of ≥ 16 would be most indicative of definite impairment;36 thus, higher scores indicate greater level of impairment. There are two parallel versions of the instrument, one designed to be administered directly to a child or adolescent respondent (YCIS) and the other to his/her parent or to another knowledgeable caregiver (PCIS). A card with the five possible options is provided to the respondent, allowing him/her to point to the score s/he gives each item. In this way the CIS yields a respondent-based rating. It has been demonstrated that the CIS provides an adequately reliable and valid measure of impairment as well as correlates highly with the clinician-determined scores of the CGAS (Children's Global Assessment Scale).37 Risk Assessment Battery (RAB) Currently there is no specific literature on the RAB,38 which was designed in 1992 by David Mesker of the Center for Studies on Addiction at the University of Pennsylvania. However, at the time that the SAMHSA adolescent interview protocol was being developed, it was vital that measures of risk and protective factors in adolescent substance abuse be included. Substance Use Disorders Diagnostic Schedule (SUDDS-IV) The SUDDS was designed to gather information necessary for the diagnosis of substance use disorders in accordance with DSM-III criteria. The SUDDS-IV,39 used in this study, was created to correspond to DSM-IV criteria. The original scale was a modified version of the SAMDIS (Substance Abuse Modified Diagnostic Interview Schedule), which was developed out of a specialized need for a structured diagnostic interview that focused particularly on the detection of substance abuse, rather than psychiatric, disorders. Harrison and Hoffman developed the SUDDS by expanding and clarifying criteria applied to alcohol abuse and dependence and by adding questions regarding use patterns and consequences of drugs other than alcohol. The measure uses direct, event- and behavior-oriented questions – which do not require value judgments by the interviewer – regarding personal demographics, especially significant relationships; psychosocial stressors; potential depressive symptoms; and the use of alcohol and other drugs as well as coffee consumption and smoking. The scale has been found to be reliable and valid in epidemiological surveys. 35 See, for example, Flisher et al. (1997) and Glied, Hoven, Garrett, & Moore (1997). 36 Bird et al. (1996). 37 Shaffer et al. (1983), Bird et al. (1993). 38 Mesker, D. (1992). 39 Harrison & Hoffman (1985). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Youth Self Report (YSR) and Child Behavior Checklist (CBCL) The YSR40 is an empirically derived measure that is completed by the youth (ages 11-18 years), and the CBCL is the parent version completed by the youth's parent (for ages 4-18 years), or by a caretaker who has known the youth for 3 months or more. Information is included on the child's academic performance, social and peer relationships, and family relationships, and indicates how true a series of 112 problem behavior items are for the child. It has been norm referenced for large populations.41 The YSR and CBCL provide a total problem score indicative of clinical status, two broad-band scores (Externalizing, Internalizing) and scale scores for eight syndromes (Withdrawn, Somatic Complaints, Anxious/Depressed, Social Problems, Thought Problems, Attention Problems, Delinquent Behavior, and Aggressive Behavior). The cut points for borderline clinical and clinical range designations are based on T scores formed on a clinical population.42 For the YSR and CBCL, high scores indicate more clinical behavior and low scores indicate age appropriate normal behavior. Furthermore, many studies have shown the relationship between their subscale scores and diagnoses.43 The YSR and CBCL have major advantages as a measure of the behavioral health symptoms for children and youth, including extensive support for its psychometric properties and national norms based on thousands of non-referred and referred children. Standardized scores permit comparisons between gender and across age groups. The author44 provided cutoff scores based on national norms to classify children as in the "clinical" range (> 64 for Total, Externalizing, and Internalizing; >70 for the eight syndrome scales) where they score similar to or report more problems than children in the normative sample who were receiving formal treatment, or in the "borderline" range (60-63 for broad band scores, 67-69 for syndromes) where children score similar to children who were judged in need of treatment. For many behavioral health professionals, the functional (as opposed to diagnostic) approach of the YSR and CBCL provides important and more useful information about how children meet their developmental tasks in the areas of behavior and social problems than do psychiatric diagnoses. Other Issues Included in the Interview Protocol In addition to the questionnaires described above, there were many items included to describe a variety of youth and family issues. For instance, parent/caregiver and youth demographic information included age, race, gender, education, income and other family resources, marital status, religious preference, family constellation, and family use of mental health services in the past. At the youth level, series of questions were included about the types and amounts of health and behavioral health services they had received in the past, with a focus on the last six months. Also, youth involvement in other service systems was examined through items on educational services, juvenile justice involvement, and contact with social service agencies. 40 Achenbach (1991a, 1991b); Achenbach & Edelbrock (1983). 41 Achenbach (1991a); Zima, Wells, & Freeman (1994). 42 Achenbach (1991a); Armsden, Pecora, & Payne (1996); McConaughy & Achenbach (1988). 43 For instance, the syndrome Anxiety/Depressed was strongly associated with a diagnosis of Depression (Achenbach, 1993; Rey & Morris-Yates, 1992), attention problems with a diagnosis of Attention Deficit Disorder and delinquent behavior with Conduct Disorder (Edelbrock & Costello, 1988). 44 Achenbach (1991a, 1991b). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C: Custody Status within Inpatient/Residential or Outpatient Placements Appendix C-1: Demographic Characteristics of the Interview Sample Outpatient
All Youth
Race/ Ethnicity
Asian/Pacific Islander African-American 14 Years and Younger 17 Years and Older Mean Age (Years) Distance from Home Custody Status
Not in State Custody In State Custody Expected Primary
Payment Source45
TennCare
Number of Youth
1 Note, youth were designated as Hispanic in addition to their primary racial group, so race sums to 100% and youth designated as Hispanic is additional. * An asterisk within a cell, for this and all further tables, indicates that differences were statistically significant using Chi-Square tests for categorical variables or Anova's for Means at p< .01. 45 This information was supplied by the provider agency at the time of recruitment. Further analyses of actual service files from BADAS and TennCare will be analyzed for more information. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-2. Alcohol or Drug Use Outpatient
All Youth
Alcohol or Drug Use*
Yes, Past 6 mos. Yes, Past month* Consequences46
Number of Children
Appendix C-3. Substances Used Outpatient
All Youth
Used past 6 mos Used past month Cannabis
Used past 6 mos Used past month Used past 6 mos Used past month Used past 6 mos Used past month Used past 6 mos Used past month* Other Amphetamines
Used past 6 mos Used past month Used past 6 mos Used past month 46 Consequences were formed from items designed to measure the interference in daily living that have come about as a res ult of alcohol or drug use: for example, being fired from a job or expelled from school. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-3
Outpatient
(Continued)

Inhalants
Used past 6 mos Used past month Used past 6 mos Used past month Used past 6 mos Used past month* Methadone
Used past 6 mos Used past month Prescription drugs /OTC
Ever used "to get high" Used past 6 months Used past month Other Drugs
Used past 6 mos Used past month TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-4. Level and Method of Use (for those with any use of the drug) Outpatient
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily More than 5 drinks per day
Once a month or less 2-3 times times a month 2-6 times a week Cannabis
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Cocaine and Crack
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Other Amphetamines
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Inhalants
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Outpatient
Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Once a month or less 2-3 times a month 2-6 times a week Daily or more than once daily Tobacco Use
Smoking Cigarettes (% yes) Other tobacco use (snuff, dipping, chewing)(% yes) TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-5. Consequences of Alcohol or Drug Use During Past 6 Months Outpatient
Took more for same effect Withdrawal symptoms Used to avoid or reduce hangover Used when not intended to* Used longer than intended Wanted to stop but couldn't Set rules but failed to follow Two days without sobering up Unable to do something planned Couldn't remember what said/done Missed work or school because of Trouble at work or school Kicked out of school So reckless someone could be hurt Driven/ridden while using* Auto accident as a result Arrested or stopped Possession / sale Family/friend objected to use* Became violent while using* Mean # of Consequences * Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-6. Consequences of Substance Use : Summary Scores Outpatient
Tolerance Problems Time Spent in Use Sacrifice Activities for Use Counter Indicators to Use Role Obligations Interfered With Dangerous Behavior While Using Substance-Related Legal Problems Interpersonal Problems Appendix C-7. Diagnostic Indicators Outpatient
Diagnostic Indicator
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Appendix C-8: Youth Scores on the Youth Self Report (YSR)47 Outpatient
Total Problems Score
Total Externalizing Score
Total Internalizing Score
Youth with Both Externalizing and Internalizing Scores in the Clinical 47 A score of 65 or greater on the Total Problem, Externalizing, or Internalizing scales is considered to be in the clinical range according to the author (Achenbach, 1991a, 1991b). TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-9. Youth with Scores in the Borderline or Clinical Range on the YSR Subscales Outpatient
All Youth
Withdrawn
Social Problems
Thought Problems
Attention Problems
Delinquency
Somatic Problems
Aggression
% of youth with 3 or more
subscales in borderline or
clinical
* Differences statistically significant (p<.05) between groups. Appendix C-10. Columbia Impairment Scale (CIS) Outpatient
CIS Rating
Not impaired (0-15) TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
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Appendix C-11. SED Classification Proportion of Youth Classified as SED
Inpatient/Residential – Inpatient/Residential – In Custody Outpatient – Not in Custody Outpatient – In Custody Total Appendix C-12. Psychotropic Medication Outpatient
All Youth
Any Medications
Number of Medications
% of Youth with
Medications who were
SED
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-13. Psychotropic Medication : Type Prescribed as a Proportion of all Youth Outpatient
All Youth
Anti Hypertensive
Clonidine (Catapres) Anti Psychotic
Olanzepine (Zyprexia) Lithium (Eskalith, Lithobid) Risperdone (Risperdal) Quentiapine (Seroqual) Buspirone (Buspar) Lorazepam (Ativan) Anti Depressants
Nortryptyline (Aventyl, Pamelor) Busproprione (Wellbutrin) Sertraline (Zoloft) Paroxetine (Paxil) Mirtazpine (Remoran) Nefazodone (Serzone) Amitriptyline (Elavil, Endep, Entraphon) Disipramine (Norpramin, Pertofrane) Impramine (Tofranil) Fluxetine (Prozac) Trazodone (Desyrel) Venlafaxine (Effexor) Amoxapine (Asendin) Anti Anxiety Agents
Hydroxyzine (Vistaril) Anti Convulsants
Carbamazepine (Epitol, Tegretol) Valproic Acid (Depakote) CNS Stimulants
Pemoline (Cylert) Methylphenidate (Ritalin) Dextroamphetamine (Dexedrine) Amphetamines (Adderall, Adarol)
Sedatives
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-14. Co-occurring Emotional/Behavioral and Substance Abuse or Dependence Outpatient
All Youth
Co-Occurring Disorders
* Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-15. Issues Surrounding Treatment Outpatient
All Youth
Current Treatment
Intensive Outpatient or Day Court Order Requiring
Treatment ( % yes)*
Reason for Treatment
Who Recommended
Treatment
School personnel Juvenile court/detention* Parole/probation officer* Parent or guardian* Another MH/SA provider Other family member Case worker or Case Manager* Another provider Priest / counselor Choice in place of treatment
Who arranged appointment
Juvenile facility Parole/probation officer Case Manager or Case Worker* * Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-16. Admission Issues Outpatient
All Youth
Had to Wait for
Admission (% yes)
No space available*
Not enough money Transportation problems Insurance would not pay Missed appointment While Waiting for
Treatment Did You:
Stay somewhere else*
Get any other help Who came with you:
Case Manager or Case Worker Other Relative Transportation worker Named person, role NS * Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-17. Residence Immediately Prior to Treatment Admission Outpatient
All Youth
Residence at the Time
Treatment Started
General Hospital**
Inpatient/ RTC for Psych** Juvenile Detention** Diagnostic/Emergency Shelter* ** **Total in Controlled Setting Length of Time at Above Out-of-
Home Residence Prior to
Admission within Past 6 Months
> 1 week, < 1 month > 1 month < 3 months > 3 months, < 6 months Time in Controlled Setting in
Month Prior to Treatment (for
those who provided the
information)
1 day
* Differences statistically significant (p<.05) between groups. ** Placements designated as "controlled" settings. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-18. Satisfaction with Intake Process at Current Provider Outpatient
All Youth
Told what diagnosis was (%
yes)
Satisfied with explanation
of diagnosis
Satisfied
Have a treatment plan (%
yes)
Treatment Plan explained
(% yes)
Clarity of Explanation
Satisfaction with Treatment
Plan
Satisfied
Involved with development
of tx plan
Involved
Satisfaction with
involvement
Satisfied
Availability of Staff
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-19. Motivation for Treatment % Agree or Strongly
Outpatient
All Youth
Would have come without pressure Could not live at home Family/friends will make me stop Too many outside problems Do not need treatment Will stay in treatment regardless of family or friends Use is serious problem Can use and still get life together Do not like self because of use Life is okay but still have to make changes Can stop any time Need treatment to stop Would try other treatment TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-20. Length of Stay 48 Outpatient
All Youth
Two weeks or less 15 days to 21 days 22 days – 28 days 29 days – 35 days 36 days – 42 days 43 days or more (more than 6 weeks)* Mean days of stay or care Appendix C-21. Youth Global Health Status Outpatient
All Youth
Appendix C-22. Weight Status Rating Outpatient
All Youth
Borderline 20-24 Overweight 25-29 Total Youth
* Differences statistically significant (p<.05) between groups. 48 This table contains data supplied by the providers for 193 of the 262 youth. Mean days of care was calculated from admitting and discharge dates and was not available for 35% (13 youth) admitted to outpatient care because the youth were still in the outpatient care. In addition, discharge date was not reported for 56 youth (26%) admitted to inpatient/residential care. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-23. Chronic Health Conditions and Injuries Past 6 Months Outpatient
All Youth
Any Chronic Problem Total Youth
Types of Health Conditions (%
of all youth) Asthma/Respiratory Allergies (other than asthma) Major Dental Problem Physical Injuries Neurologic Problems (Convulsions, Migraines) Attention Deficit Disorder Sexually Transmitted Heart/blood/ or Circulatory Diabetes / thyroid Vitamin Deficiencies Stomach / Digestive Tract Problems Bone / Muscle Problems Other Medical Problem TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-24. Risk Behaviors Outpatient
All Youth
Injected drugs (% of all youth)
Past 6 months
Shared needles (% of all youth)
Past 6 months
Number of people shared needled with
Past 6 Months (1 or more)
Past Month (1 or more) Been to a shooting gallery
Past 6 months
Been to a crack house
Past 6 months
Ever had sex (% yes)*
# People had sex with in past 6 months
1 person*
How often used condoms in past 6 months (% of those who had sex)
All the time*
Most of the time Some of the time Ever been Pregnant (females only)
Yes
2 or more times Currently pregnant (%
yes)
Discuss with health care professional in the past 6 months (% yes)
Family planning
Alcohol/drug Problem Tobacco problems Tested for HIV/AIDS
Ever
Yes, In past month
* Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-25. Ever Used Services Outpatient
All Youth
Ever Used Residential
Services
No
Type of Residential
Service Used
General Hospital
Psych Hospital or RTC Other Residential Tx Ever used Non-
Residential
No
Type of Service Used
Counseling at Clinic Support Groups (AA, CA, etc) Other Support Groups Other Non-residential TX * Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-26. Residential Treatment and Other Residences in Past 6 Months Outpatient
All Youth
Type of Residential
Service Used
General Hospital
Psych Hospital or RTC* Other Residential
Placements
Group Homes
Juvenile Detention Other Residential Tx* Other Residences
Parent's/Relative's Home* Hotel or Rooming House Homeless Shelter Homeless on Streets * Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-27. Highest Grade completed Outpatient
All Youth
Highest Grade Completed
Working at Grade Level
No, 2 or more years below level No, 1 year below grade level Yes, on grade level Yes, above grade level Type of School
Vocational Education Regular tutoring/Home School Alternative School School at Treatment Facility School at Juvenile Facility Other regular school Suspended/Expelled – 6
Months
School Counseling for
Substance Use – Past 6
Months
School Counseling for Other
Reason – Past 6 Months
TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES
Appendix C-28. Criminal Justice History Outpatient
All Youth
Any Contact
Probation or parole past
6 months
Yes, past 6 months
Yes, past month Any Charges past 6
months
Yes, past 6 months
Yes, past month Any Jail or Detention
past 6 months
Yes, past 6 months
Yes, past month Probation/parole officer
visits (% of those on
probation or parole)
2 or more per week
Once every 2 weeks Less than monthly Probation or parole
officer help with D/A
problem (% yes)
Status Offense: Ever
picked up and charged*
Past 6 months (%
yes)* Past month (% yes)* Drug/alcohol related
crime: Ever charged
Past 6 months (% yes)
Past month (% yes) Property crime: Ever
charged
Past 6 months (% yes)
Past month (% yes) Crime against a person:
Ever charged
Past 6 months (% yes)
Past month (% yes) * Differences statistically significant (p<.05) between groups. TENNESSEE'S ADOLESCENTS IN PUBLICLY—FUNDED TREATMENT FOR SUBSTANCE
ABUSE PROBLEMS: BASELINE INTERVIEW FINDINGS FOR TENNCARE BENEFICIARIES

Source: http://peabody.vanderbilt.edu/docs/pdf/cepi/AdolSA.pdf