The Adolescent Project: DATAR Phase 5 (2010-2015)
This project was funded by NIDA in January 2010 and proposes to adapt, for adolescent treatment, evidence-based induction and readiness tools that have been tested and effectively implemented with adult and young adult treatment samples. These are packaged as a Treatment Readiness and Induction Program (TRIP) that agencies can easily adopt and incorporate into routine clinical practice with limited disruption to their existing treatment curricula.
The research has 2 major segments. The first segment (TRIP Effectiveness Study) is aimed at determining the effectiveness of TRIP as it is being delivered in 10 adolescent residential treatment centers located across the U.S. The second segment (TRIP Implementation Study) is designed to address the wider scale implementation of TRIP in other adolescent settings including outpatient and juvenile justice facilities.
Studies examining the effectiveness of TRIP are underway. Findings suggest that when compared to standard operating practice (SOP), the TRIP intervention improves readiness by promoting problem recognition and better decision making among teens during early phases of treatment. Consequently, enhanced levels of readiness are expected to be associated with higher engagement in treatment.
The Treatment Readiness and Induction Program (TRIP)
TRIP consists of 8 modules that can be used in open groups (new members join throughout) or closed groups (group membership is predetermined). The 8 modules are organized around 4 main themes related to the primary components of the Integrated Judgment and Decision Model (IJDM; Dansereau et al., 2013). These themes include (1) Mapping (graphically enhanced analytic decision making), (2) Nudges (practice identifying, developing, and using cues and signals to enhance metacognition), (3) Downward Spiral (understanding the consequences of poor decision making through the use of an experiential board game), and (4) WORK IT (repetitive use of structured maps or templates to foster development of a coherent schema to enhance wisdom/expertise). The TRIP Intervention (Bartholomew et al., 2012) contains a syllabus outline and rationale for each module, detailed instructions for leading interactive activities, discussion and processing questions that correspond with activities, and templates for all handouts.
Adapted for use with adolescent clients, TCU Mapping-Enhanced Counseling forms the core of TRIP and serves to focus attention, facilitate communication, and visually illustrate concepts and ideas for better decision making. Mapping is particularly effective for clients with problems from poor attention or cognitive functioning and leads to a more engaging counseling approach, especially when included with interactive games and peer mentoring.
TCU Adolescent Screening and Assessment Package (TCU-ASAP)
The TCU Adolescent Screening and Assessment Package (TCU-ASAP; D. Knight et al., 2014) includes a collection of assessments that have demonstrated good reliability and validity in adult treatment populations and been adapted for use in adolescent treatment settings: the TCU RISK form (client demographics, criminal involvement), the TCU Drug Screen II, the TCU Client Evaluation of Self and Treatment CEST, and the TCU Criminal Thinking Scales (CTS). Minor modifications were made to some items to simplify language and some references to work or employment were replaced with references to school. Additional instruments include the TCU Family Friends and Self (FFS) form. To more fully understand judgment and decision-making processes among youth in substance abuse treatment, existing scales measuring criminal thinking were modified and new scales addressing general thinking and thoughts about drug use norms and expectancies were created (THK forms). Psychometric analyses indicate good reliability. The Adolescent Screening and Assessment Package including forms and scoring guides are available at ibr.tcu.edu.
Segment 1: TRIP Effectiveness
The effectiveness of the core components of TRIP, including TCU Mapping-Enhanced Counseling and the Downward Spiral Game, has been established with older and younger adult populations. Formal adaptations to these materials for adolescents have been made a part of this project.
Each treatment program participated in two research segments (1) assessment only and (2) assessment plus TRIP curriculum. Throughout segments 1 and 2, programs were granted access to the TCU Adolescent Screening and Assessment Package (TCU-ASAP). In segment 2, program staff were trained on TRIP and clients were placed in TRIP groups immediately upon completion of intake assessments. Participants entering treatment during the assessment only segment were classified as the standard operating practice (SOP) group; clients with treatment admission dates after program implementation of the TRIP curriculum were classified as the TRIP group.
Effectiveness studies examine the progress of 519 adolescents enrolled in 6 community-based treatment programs in 2011 and 2012 who completed assessments at admission (Time 1) and again between 30-60 days in treatment (Time 2). Measures of change over time on judgment and decision making and treatment motivation were compared among youth receiving standard operating practice (SOP; n = 281) versus those receiving SOP plus TRIP (n = 238). D. Knight and colleagues (D. Knight et al., 2015) demonstrate that the TRIP curriculum is effective for improving adolescent decision making, including self-awareness, positive-focused thinking (e.g., positive self-talk, goal setting), and recognition of the negative effects of drug use on thinking. Becan and colleagues (Becan et al., 2015 show that TRIP directly affects problem recognition and indirectly affects later stages of change (desire for help and treatment readiness).
Segment 2: TRIP Implementation
Using a “Train the Trainer” model, 2 key program staff from 54 adolescent substance abuse treatment programs (representing outpatient, residential, or corrections-based modalities) received training on implementing the TRIP curriculum, within their program. Regional trainings were co-sponsored by the Pacific Southwest, Great Lakes, South Southwest, and Northeast/Caribbean ATTCs in 2013. Program staff members from the participating programs completed a series of 4 assessments over a 14-month period. The first time point is prior to the training and includes a staff survey of organizational functioning and transformational leadership (SOF form, STL form) and a director survey on organizational structure and operations (SSO form). The second time point was at the training and included assessment of initial attitudes toward TRIP (WEVAL form). The third and fourth time points occur at 4 and 12 months post training and assess sustainability of the TRIP curriculum (WAFU form). Data collection was completed in 2014.
Programs with greater training needs specific to retention, higher staff functioning, and higher ratings of TRIP workshop quality are expected to respond more favorably to TRIP and report greater readiness to adopt TRIP components. Likewise, those with greater readiness to adopt and lower perceived barriers are more likely to determine greater implementation progress.
Crawley, R. D., Becan, J. E., Knight, D. K., Joe, G. W., & Flynn, P. M. (in press). Predictors of physical altercation among adolescents in residential substance abuse treatment. Deviant Behavior.
Landrum, B., Knight, D. K., Becan, J. E., & Flynn, P. M. (in press). To stay or not to stay: Adolescent client, parent, and counselor perspectives on leaving substance abuse treatment early. Journal of Child and Adolescent Substance Abuse.
Becan, J. E., Knight, D. K., Crawley, R. D., Joe, G. W., & Flynn, P. M. (2015). Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change. Journal of Substance Abuse Treatment, 50, 38-49. PMCID: PMC4304896
[Available on 2016/3/1] abstract
Knight, D. K., Dansereau, D. F., Becan, J. E., Rowan, G. A., & Flynn, P. M. (2015). Effectiveness of a theoretically-based judgment and decision making intervention for adolescents. Journal of Youth and Adolescence, 44, 1024-1038. PMCID: PMC4208977 [Available on 2016-05-01] abstract
Knight, D. K., Becan, J. E., Landrum, B., Joe, G. W., & Flynn, P. M. (2014. Screening and assessment tools for measuring adolescent client needs and functioning in substance abuse treatment. Substance Use & Misuse, 49(7), 902-918. PMCID: PMC3998717 [Available on 2015/6/1] abstract
Dansereau, D. F., Knight, D. K., & Flynn, P. M. (2013). Improving adolescent judgment and decision making. Professional Psychology Research and Practice, 44(4), 274-282. PMCID: PMC3877916 abstract