Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care
Rieckmann, Traci, Fussell, Holly, Doyle, Kevin, Ford, Jay, Riley, Katherine J., Henderson, Stuart, Journal of Addictions & Offender Counseling
Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives.
Adolescent substance abuse is an emotional and challenging issue for youth, their families, schools, and the community at large. According to the National Survey on Drug Use and Health, 9.8% of youth ages 12 to 17 years use illicit substances (Substance Abuse and Mental Health Services Administration [SAMHSA], 2008). Although overall rates of use declined between 2002 and 2007, more recently, adolescent use of illicit substances and alcohol has remained stable. Between 2007 and 2008, adolescent substance abuse or dependence displayed minimal change, with a rate of 7.7% in 2007 and 7.6% in 2008 (SAMHSA, 2008). In terms of treatment needs, current national data report that 23.1 million people ages 12 or older (9.2% of the population) report needing treatment for substance abuse-related problems (SAMHSA, 2008). Unfortunately, only 2.3 million of these individuals actually received treatment, leaving 20.8 million people who need treatment, which, in turn, affects their families and the rising cost of health care because the severity of the abuse is likely to increase in the absence of treatment. A similar pattern exists for adolescents, with as few as 10% of the youth who need help for substance abuse disorders actually receiving services (Join Together Report, 2006).
Overall, there is a significant need to improve treatment for youth with substance abuse disorders, including increasing engagement, retention, and the quality of care. One initial step is to examine the characteristics and service use patterns of youth who are treated for illicit substance use disorders. On the basis of National Survey of Substance Abuse Treatment Services (N-SSATS) and Treatment Episode Data Set (TEDS) data, nearly all of the adolescents treated within the United States receive addiction services in publicly funded programs and many are referred by the criminal justice system (Godley & White, 2005). Youth often access substance abuse treatment services through multiple referral sources, such as the school system, juvenile court, family interventions, physicians, and social service programs (Brannigan, Schackman, Falco, & Millman, 2004). This great number of referral sources may contribute to conflicting policies, practices, and paperwork within youth treatment programs, which serve as barriers to providing effective and efficient services.
Similar to the challenges in adult services, youth treatment providers also face programmatic "business process" barriers, such as overbooked staff, poorly designed telephone systems, burdensome intake procedures, and repetitive paperwork (Ford et al., 2007). When adults were asked about their experiences seeking alcohol and drug treatment services, 51% stated that organizational barriers interfered with their ability to engage in treatment (Ebener & Kilmer, 2003). Another study reported that over 50% of adults who contacted a clinic to schedule an appointment did not attend the first intake session, and the rates are likely higher for youth (Farabee, Leukefeld, & Hays, 1998). Complicated family and guardianship dynamics also create additional communication challenges and time-intensive documentation. Finally, most youth in need of substance abuse treatment services have yet to recognize the impact of their use and rarely seek treatment on their own. In fact, the National Survey on Drug Use and Health (SAMHSA, 2008) reported that the number one reason why persons ages 12 years and older have not received treatment is because they are not ready to stop using, and have not yet recognized the need for assistance.
Despite increases in admissions between 1987 and 2003, only one third of substance abuse treatment centers have adolescent specialty programs (Godley & White, 2005). …