Preventing and Reducing Substance Use among Institutionalized Adolescents
Morehouse, Ellen, Tobler, Nancy S., Adolescence
The Residential Student Assistance Program, serving high-risk, multiproblem, inner-city, primarily African-American and Latino youth, was evaluated for its ability to prevent and decrease alcohol and other drug use. Participants were drawn from several adolescent residential facilities: three foster care sites for abused, neglected, orphaned, or troubled adolescents, a nonsecure facility for adjudicated juvenile offenders, a treatment center for teens with severe psychiatric problems, and a locked county correctional facility. In addition, comparison groups were employed. A 5th-year outcome evaluation documented the program's effectiveness in both preventing and reducing substance use among participants, with impact related to program dosage. Qualitative process data clarified and strengthened confidence in the quantitative outcomes.
RESIDENTIAL STUDENT ASSISTANCE PROGRAM
The Comprehensive Student Assistance in Residential Settings Project, referred to as the Residential Student Assistance Program (RSAP), began in 1988 in six New York residential child-care facilities as part of a five-year Center for Substance Abuse Prevention (CSAP) grant targeting high-risk youth. The RSAP, like the original Westchester County Public School's Student Assistance Program (SAP), is modeled after the Employee Assistance Program (EAP), which has been used successfully by businesses to identify and aid employees whose work performance has been negatively affected by alcohol, other drugs, or personal and family problems. The RSAP uses highly trained (master of social work) counselors, placed full- or part-time in the residential facilities, to provide culturally sensitive alcohol and other drug (AOD) use prevention and intervention services. (AOD use does not include tobacco; when tobacco is included, it is referred to as ATOD use.) These professional counselors work with youth individually and i n small groups, conduct training for facility staff, coordinate programs and services directed at decreasing the incidence and prevalence of AOD use among youth, and provide follow-up treatment and referrals.
The RSAP is directed at extremely high-risk adolescents while they are a "captive audience." As a group, adolescents in residential facilities have multiple risk factors for AOD use, with most falling somewhere on the continuum from experimental use to dependency. It is often thought that institutionalized adolescents cannot obtain alcohol and other drugs, but access is available through home visits, friends and family visiting the facility, facility staff, and, with the exception of the locked correctional facility, from authorized and unauthorized trips "off-campus." The latter category includes runaway incidents, cutting class or skipping an activity and briefly leaving the facility, and authorized off-facility work.
These adolescents have "fallen between the cracks" of the ATOD prevention system because of their problems. Before residential placement, they generally did not attend school regularly and thus missed being exposed to ATOD prevention curricula. Further, the nature of their problems has resulted in their inability to remain at home and the need for high levels of state-mandated services, of which ATOD prevention is often at the lower end of a long list of priorities.
Youth in residential facilities in New York State were surveyed in late 1988 (Morehouse & Kleinman, 1990) and were found to be more likely to use drugs, and at a much earlier age, than were youth surveyed in high schools nationwide (Johnston, O'Malley, & Bachman, 1989). This confirmed what is known about high school dropouts and truants and other out-of-school adolescents (Josephson & Rosen, 1978; Kandel, 1975).
Over the five-year funding period for the RSAP, the Office of Substance Abuse Prevention's expectations changed. In addition to providing and accounting for services to high-risk youth, in 1989 both process and outcome evaluations were included (Lorion & Ross, 1992). …