Continuing Care for Adolescents with Substance Use Disorders:

Opportunities for Health Services Research

Thomas M. Brady, Ph.D.

Division of Epidemiology, Services and Prevention ResearchNational Institute on Drug Abuse

Department of Health and Human Services

AcademyHealth Annual Research Meeting Washington, D.C., June 9, 2008

National Institute on Drug Abuse

Cynthia Campbell, Kaiser Permanente Divisionof Research

“Continuing Care & Three-Year Outcomes in Adolescents Who Entered Chemical Dependency Treatment”

Susan Godley, Chestnut Health Systems“Preliminary Findings from a Randomized Clinical Trial Examining Assertive Continuing Care with Two Types of Outpatient Treatment for Adolescents with Substance Use Disorders”

D. Paul Moberg, University of Wisconsin“Recovery High Schools as Continuing Care for Adolescents with Substance Use Disorders”

Session Objectives

• Outline examples of continuing care models serving adolescents at risk for substance use disorders

• Highlight some analytic approaches to study continuing care models

• Discuss possible health services research questions for further study

Learning Objectives

• Describe at least two continuing care models serving adolescents at risk for substance use disorders

• Discuss at least one approach to study continuing care

• Develop possible health services research questions for further study

Introduction

• Evidence suggests that treatment programs routinely engaging patients in continuing care are likely to have better outcomes than programs that do not offer these services.

• Although findings of the effectiveness of continuing care approaches with adult populations continues to grow,

– Much less is known about the effects of continuing care with adolescents, and very few outcome studies with this population exist.

Continuing Care

• A lower intensity phase of treatment that follows an initial high-intensity form of treatment

– Often delivered after an outpatient service after an initial residential treatment episode

– More recently, an outpatient treatment episode of lower intensity which follows intensive outpatient treatment

French, McKay (2008)

How Do We Define Continuing Care?

• When does treatment end and continuing care begin?

• What are the active ingredients of continuing care?

• How long do we provide treatment and with what resources?

M. Godley & Kaminer (2008)

Range of Definitions

• Continuing care

• Assertive continuing care

• Aftercare

• Disease management

• Step-down care

• Stepped care

• Extended interventions

McKay (2008)

Continuing Care Models for Adolescents: Great Deal of Programmatic Diversity

Services and treatment approaches range from – primary care– mental health– chemical dependency services– community reinforcement approach– case management– home visitation– motivational interviewing – cognitive behavioral therapy– educational counseling

Additional Health Services Research is Needed…

• Study key dimensions of continuing care in adolescent addiction treatment

– Such as access,

– cost-effectiveness,

– quality and

– cultural competency

• At the conclusion of the panel presentations

– We hope to have a discussion on future approaches and

– questions for health services research

Multidisciplinary field of scientific inquiry that:

Cost of Care

FinancingFinancing

OrganizationOrganization

ManagementManagement

Social Factors

Technologies

Access & Utilization

Quality of Care

For individuals, families, organizations & institutions, and communities & populations

Personal & public health & well being

Examines how: Affect:

Individual Factors

Defining Health Services Research