RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
The Vera Institute of Justice partnered with the New York City Department of Juvenile Justice to develop, implement and conduct an outcomes evaluation of a model treatment program for juvenile offenders in the New York City juvenile justice system who meet clinical criteria for substance abuse or dependence.
Adolescent Portable Therapy or APT, as the model is known, provides drug treatment services to serious adolescent drug users under age 16. Services begin as soon as youths enter detention and continue without interruption through institutionalization and their return to family and community. The same therapist works with a youth throughout the treatment period.
Between 1999 and 2004, the Robert Wood Johnson Foundation (RWJF) supported the development and evaluation of the Adolescent Portable Therapy model through three grants to the Vera Institute of Justice totaling $1,107,930.
Adolescents involved in the juvenile justice system are more likely than other adolescents to use and abuse drugs. A 1997 study by the National Institute of Justice and the Research, Development, and Evaluation Agency of the U.S. Department of Justice, found that more than 60 percent of juvenile offenders in eight of 12 cities surveyed tested positive for some illicit substance.
In recent years, the juvenile justice system has made progress in developing effective drug prevention and early intervention models. However, it has been less successful with a particularly troubled subpopulation: juvenile offenders who meet clinical criteria for substance abuse and dependence. These youth are likely to become adult addicts and to re-offend.
According to researchers at the Vera Institute of Justice, a New York City-based organization that researches and develops solutions to problems in the administration of justice, most juvenile justice systems lack:
RWJF has funded an array of projects focused on prisoners and prisons, including some supporting release and aftercare programs, and some focused on youth. Among the projects and programs RWJF has supported are:
The Vera Institute of Justice partnered with the New York City Department of Juvenile Justice to develop, implement and test Adolescent Portable Therapy, a model treatment program for clinically dependent, substance-using offenders in the juvenile justice system.
The model emphasizes continuity of care and family-based services, providing adolescents with a single therapist as they move through different settings including detention, residential programs and back to their homes.
A national advisory board provided guidance throughout the project, in both formal meetings and individual consultations with Vera staff and government agency partners. See Appendix 1 for a list of advisory board members.
Under the three RWJF grants, Vera Institute project staff:
Under the planning grant (ID# 036510), researchers had intended to conduct a large survey of New York City's juvenile detention population to assess drug use. However, initial information-gathering identified the work of Linda Teplin, Ph.D., a researcher at Northwestern University (Evanston, Ill.), who had collected data from more than 1,800 teenage offenders in Chicago.
RWJF provided partial funding for Teplin's work (see Grant Results on ID# 041942). By adjusting the Chicago data to reflect the demographic characteristics (age, gender and race) of New York's juvenile offender population, Vera Institute staff was able to use these data, rather than conduct a separate survey.
To design and implement the intervention, Vera project staff:
The New York City Department of Juvenile Justice provides $1 million annually to operate the Adolescent Portable Therapy program. The federal Office of Juvenile Justice and Delinquency Prevention matched RWJF's first grant (ID# 036510) of $131,250 to plan the project. The New York State Division of Criminal Justice Services provided $400,000 in startup funding and the Center for Substance Abuse Treatment at SAMHSA provided $69,000 in funds for technical assistance.
Vera Institute staff estimated drug use in New York City under the planning grant (ID# 036510) and reported these findings in a proposal to RWJF for follow-up funding:
Over all three grants, the project accomplished the following:
Project staff evaluated the Adolescent Portable Therapy model under Grant ID# 042697. Juvenile offenders were randomly assigned either to receive Adolescent Portable Therapy (247 people) or to a control group (245 people) that typically received no drug treatment services at all.
Using two standardized assessment tools the Global Appraisal of Individual Needs (GAIN) and the Family Adaptability and Cohesion Evaluation Scale (FACES) staff interviewed participants four times: at baseline when they entered detention, and at three, nine and 15 months after their release from detention.
Because the living situations of many youth and their families are unstable, ongoing participation is often a challenge. Staff worked to keep participants engaged by collecting extensive contact information, sending birthday cards and making regular home visits, among other strategies.
Among the evaluation findings reported in an online report and to RWJF:
The research team offered these conclusions about Adolescent Portable Therapy in a report to RWJF:
Adolescent Portable Therapy continues in New York City with support from the Department of Juvenile Justice and other city agencies. Some of these funds will be used to conduct further analyses of recidivism findings.
Vera Institute also received a grant from SAMHSA's Young Offender Reentry Program to study the process by which youth offenders reenter the community.
With a grant from the federal Temporary Assistance to Needy Families (TANF) program, Vera will provide family-based treatment to assist youth returning home from congregate care or to prevent them from entering congregate care. The goal is to institutionalize Adolescent Portable Therapy and to provide services before youth enter the juvenile justice system.
Project staff is replicating the Adolescent Portable Therapy model in rural northern New Hampshire, demonstrating that the model can be applied outside urban environments, where culture and interagency relationships differ. Other states have also expressed interest in the program.
Project staff wrote a treatment manual, Adolescent Portable Therapy: A Practical Guide for Service Providers, as a practice and reference guide. The manual can be downloaded without charge from the section of the Vera Institute Web site devoted to APT. See the Bibliography for details.
Staff made presentations about the model and evaluation findings at the 2005 annual meeting of the American Society of Criminology and at the SAMHSA 2005 Joint Meeting on Adolescent Treatment Effectiveness.
Staff will also present at SAMHSA's 2006 Joint Meeting. The SAMHSA meetings are sponsored by multiple federal agencies and other organizations involved in substance abuse prevention and treatment. See the Bibliography for details.
Development, Implementation and Evaluation of A Portable Adolescent Treatment Model for the Juvenile Justice System
Vera Institute of Justice (New York, NY)
Adolescent Portable Therapy Advisors
Joyce L. Burrell
Former Deputy Commissioner of Human Services
Division of Juvenile Justice Services
William P. Dickey
Dermot Company, Inc.
New York, N.Y.
Katherine Kraft, Ph.D.
Robert Wood Johnson Foundation
Juvenile Division Director
Santa Cruz County Probation Department
Santa Cruz, Calif.
Legal Action Center
New York, N.Y.
Daniel Medeiros, M.D.
Medical Director, Behavioral and Mental Health Services
Mount Sinai Adolescent Health Center
New York, N.Y.
Public Health Advisor
Center for Substance Abuse Treatment
Laura Burney Nissen, Ph.D.
Reclaiming Futures: Building Community Solutions to Substance Abuse and Delinquency
Portland State University
Counselor to the Chancellor and Visiting Professor of Law
University of Kansas
Sr. Catherine Ryan
Juvenile Justice Bureau-Child Protection and Delinquency Division
States Attorney's Office
Cook County, Ill.
Clinical criteria for drug abuse and dependence specific criteria defined in the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (1994), the DSM-IV. As reported by the Vera Institute of Justice, the DSM-IV defines the criteria for substance abuse as one or more of the following occurring over a 12-month period:
The DSM-IV defines the criteria for drug dependence as three or more of the following manifested over a 12-month period:
Global Appraisal of Individual Needs (GAIN) a series of measures and computer applications used clinically and in research with adolescents and adults that addresses substance use, physical health, risk behaviors, mental health, legal concerns and other topics.
Family Adaptability and Cohesion Evaluation Scale (FACES) an instrument designed to assess family functioning by measuring family cohesion (the extent of attachment between family members) and family adaptability (a family's ability to change power structure, leadership roles and rules in response to situations and stress). Family type, determined from these two scales, ranges from rigidly disengaged to chaotically enmeshed. Higher functioning families generally fall in a midrange.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Latif Z and Parsons J. "Predictors of Engagement: Factors Influencing Youths' Adherence to Drug Treatment." Unpublished.
Parsons J. "Prevalence of Psychiatric Problems Amongst a Detained Population of Juvenile Drug Users." Unpublished.
Parsons J, Klossou E and Latif Z. "Predictors of Recidivism: Factors Influencing Juvenile Recidivism." Unpublished.
Adolescent Portable Therapy (APT). New York: Vera Institute of Justice, 2004. Available online.
Adolescent Portable Therapy: A Practical Guide for Service Providers. New York: Vera Institute of Justice, 2005. Available online.
Callahan J. Portable Drug Treatment for the Juvenile Justice System. New York: Vera Institute of Justice, 2000.
Callahan J and Froehle M. Arrested Development: Substance Abuse and Mental Illness Among Juveniles Detained in New York City. New York: Vera Institute of Justice, 2000. Available online.
Evaluating Portable, Family-Based Drug Treatment for Juveniles: Findings. New York: Vera Institute of Justice, 2005. Available online.
www.vera.org/project/project1_1.asp?section_id=5&project_id=4. The Adolescent Portable Therapy (APT) page on the Vera Institute of Justice Web site includes an overview of the model, downloadable copies of the treatment manual and other publications, a list of the project advisors and results of the Adolescent Portable Therapy evaluation. New York: Vera Institute of Justice.
Latif Z and Parsons J. "Predicting Recidivism: Lessons from a Strength-Based Drug Treatment Program," at the SAMSHA 2005 Joint Meeting on Adolescent Treatment Effectiveness, March 22, 2005, Washington. Presentation available online.
Ross T, Mino M and Flores E. "Client Identification Problems," at the 2002 American Society for Criminology Conference, November 15, 2002, Chicago. Abstract available online.
Ross T, Mino M and Flores E. "Initial Findings from the Evaluation of APT: A Drug Treatment Program for NYC Adolescents in Detention," at the 2002 American Society for Criminology Conference, November 15, 2002, Chicago. Abstract available online.
Report prepared by: Mary B. Geisz
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: M. Katherine Kraft
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