Franklin County Adolescent Substance Abuse Facility (1424 year old)
Proposal Abstract
Franklin County, Maine is seeking a grant to launch and open a new substance abuse treatment facility for those aged 14‐24, with the objective of providing services like, drug‐free counseling, treatment and drug education to those in need. These tools will help adolescents become more knowledgeable about drugs and drug abuse but at the same time it will also help get them on the right path to leading a substance‐ free life. Funding in the amount of $344,540 is requested for the lease of a facility, staff hiring, drug‐detoxification supplies, test supplies, therapeutic recreation therapist and the daily running of treatment at the facility.
Needs Assessment
It is estimated that there are currently 15.9 million Americans aged 12 years and older who are illicit drug users. Maine has the third highest rate of reported illicit drug use among 18‐25 year olds in the Nation. The growing drug abuse problem amongst Maine youth has increased over the last few years. The Maine Office of Substance Abuse released data in April of 2008 on Substance Abuse Trends in Maine:
v About 30% of students in grades 6‐12 reported using alcohol within the past 30 days.
v Over 14% of students in grades 6‐12 reported using Marijuana within the past 30 days.
v 12% of students in grades 6‐12 reported using prescription pills for purposes other than their intended use at some point in their lives. v 5% of Mainers ages 12 and older reported recreational use of pain relievers in the past year. v 67% of young adults ages 18‐25 in Maine reported using alcohol in the past month compared to 60% nationally. v 28% of the 18‐25 year olds reported that they had used Marijuana in the past month, the second highest rate in the nation among this age group. v Almost 40% of Maine’s youth reported using Marijuana in the past year. 1 1 Maine Office of Substance Abuse, April 2008
These trends have spread across the state of Maine. Maine’s accidental drug overdose rate has increased from 19 deaths in 1997, to 126 deaths in 2002, according to the state medical examiners office. As the age of overdose victims stays the same in Maine, the age of kids becoming addicted to drugs is dropping. According to the Substance Abuse and Mental Health Services Administration, some children are already abusing drugs at age 12 or 13.
These issues are more of a problem in Maine’s rurally populated counties, like Franklin County where there are traditional jobs like logging, farming and working in factories and mills. Franklin County covers approximately 1,750 square miles, with a population of about 30,000 (17 people per square mile). This is quite low considering that 90 miles south, Maine’s largest city of Portland has about 3,000 people per square mile. Rural places, like Franklin County, still lack many of the public services and access to these services that are much more commonplace in metropolitan areas, like Portland. Studies show that rural and urban places today have similar rates of substance use and abuse, but rural Americans are at an even higher risk then their urban neighbors. According to Bill Lowenstein, the associate director of the Maine Office of Substance Abuse, “Maine was one of the first places to identify oxycontin abuse.” In 2000, the United States Substance Abuse and Mental Health Services Administration conducted a study and found that Maine leads the nation in drug treatment for oxycontin and other opiates at a rate of 63 per 100,000 people.
There are a number of different treatment facilities available in the state of Maine. The number of facilities in Maine providing substance abuse treatment has increased from 177 in 2002, to 191 in 2006. Recent studies have indicated that there are approximately 440 mental health workers for every 100,000 people in Franklin County. This is below the state average of 535 for ever 100,000 people. Studies have also indicated that only one in four teens that enter treatment in Maine will complete it. The statistics clearly demonstrate the significant need for more mental health professionals and the services they provide in Franklin County. The state of Maine currently has four methadone clinics, which are located in South Portland, Westbrook, Winslow and Bangor. Drug counselors and doctors at clinics have witnessed a steady flow of young heroin and oxycontin addicts seeking help from small rural towns. In the past three years the people receiving methadone has skyrocketed from 300 to 1,600. Dr. Stanley Evans, former medical director at Mercy Hospitals Recovery Center, said “I have patients who tell me that cant get away from these drugs in tiny little towns. Lured by drugs are ranges of young people: straight A‐students as well as troubled kids, cheerleaders and sports stars, as well as dropouts. And when they need treatment in rural Maine, most of them cannot find it because the resources are few.” Non‐profit facilities have decreased from 100 in 2002, to 90 in 2006 but admission to treatment in Maine has increased from 9,125 in 2002, to 13,683 in 2005. 2
In rural Maine, mental health services to kids are extremely difficult to provide. Research has shown that shortages of mental health practitioners, such as social workers, psychologists, counselors and psychiatrists are directly related to lower use of services, resulting in delayed or forgone treatment. For children, the rates of relapse are higher and they also tend to be harder to encourage and motivate than adults who possess similar substance use histories. These issues are due to the treatment systems incapability to meet the needs of adolescents. Most of the time adolescents are treated in counseling groups with adults with whom most if not all see themselves having very little in common. The issue is that “the quality of adolescent specific services is questionable because most treatment providers have not been trained in adolescent development and in specific techniques that are effective with youth” (Maine Office of Substance Abuse). There have also been instances of a number of teenagers that needed detoxification that could not gain access because of their age, with the one exception of a residential program in Portland. This information obviously reflects the sad disservice to adolescents in dire need of treatment. The primary objective of this treatment center for adolescents ages 14‐24 is to provide services for youth who are battling substance abuse through community awareness, education and through clinical services in a safe and stable environment.
Program Narrative/Goals & Objectives
The Franklin County Adolescent Substance Abuse Facility would look to provide a service to those individuals living in Franklin County. It would provide adolescents with strategies in living a drug‐free existence, it would assist patients in developing alternative behaviors to drug use, it will help clients develop self‐awareness in themselves and it would help adolescents rehabilitate into having a productive and healthy lifestyle.
The program revolves around four major Goals in mind. They are as follows:
1) To promote a DrugFree existence.
This part of the program begins with an Intervention. A parent, a physician, school, police or probation officer, usually identifies individuals 14‐24 who may have a substance abuse issue. The individual would then be referred to a Maine Juvenile Treatment Network (MJTN, Provides education, assessments, screenings, referrals and treatment to get these young individuals drug abuse under control) who may then assess the problem using the Juvenile Automated Substance Abuse Evaluation (JASAE). JASAE evaluates adolescent alcohol and drug experiences, as well as attitudes and life stress issues to determine if, and to what degree, problems exist in these areas. Screenings are another part of the program that is essential. The screenings would focus on the severity of use and core associated factors such as mental health status, family history of parental addiction, functioning in school and any legal problems. Referrals are yet another large part of this section. Adolescents
would be referred to a comprehensive assessment if whose screening reveals indicators of a serious substance abuse problem (Daily use of one or more substances). The program would also offer detoxification treatment such medical detox (3‐5 days), short‐term detox (30 days) and long‐term detox (60 days). Last but not least this section of the program offers drug‐free counseling. Treatment providers that are trained in adolescent development and specific techniques that work for kids will run support groups. Adolescents will be informed about life skills, relapse prevention and gender specific.
2) To assist patients in developing alternative behavior to drug abuse and its negative effects.
The purpose of this section of the program is to present alternative behaviors to drug abuse for adolescents. The first alternative is having individual counseling for the adolescent. Having the one‐on‐one relationship with a helper can be very beneficial. A counselor would assist the client in clarifying concerns, examining solutions and developing new coping strategies. The counselor and the client will also develop goals for counseling. One of the largest pieces of this section is having a therapeutic recreation specialist. Therapeutic recreation therapists help individuals reduce depression, stress and anxiety. Having this therapist working with adolescents will help them build confidence and socialization skills. The therapist would use interventions to develop specific skills but at the same time provide opportunities for exercise, mental stimulation, creativity and fun. This section would provide structured activities as well as information about drugs and encouragement
to participate in alternative activities. Some activities include games, cooking, team sports and team building. These activities will reduce time of exposure to at‐risk situations and also provide the skills needed to pursue healthy activities. Another section of the program would be school education. The program would work with schools to offer student assistance programs, counseling on substance abuse and confidential referral to treatment and recovery resources in the community. The program would also like to work together with surrounding schools in developing necessary classroom time and sufficient and accurate resources to address the substance abuse prevention or treatment needs of students. The last piece of this section is having outdoor recreation available to all adolescents. Outdoor activities include snowshoeing, fishing, hiking, walking, outdoor skills, survival skills and team work just to name a few. These activities are all good techniques in reducing substance abuse temptations amongst adolescents. 3) To develop selfawareness in clients The third goal of the program is to have adolescents develop some self‐awareness. The goal of self‐awareness is the realization of one’s ongoing feeling and emotional experiences. The adolescent would gain knowledge of the reasons for drug use, the effects of drugs, and their addictive potential. In developing self‐awareness in clients there would be individual counseling, having one‐on‐one counseling with clients. The last piece of this particular goal is having drug‐education. The drug education that would be provided would present honest and balanced information for all clients. Drug education will be and interactive process that promotes involvement,
trust and mutual respect between adolescents and helpers. Honesty means examining both sides of all issues related to alcohol or other illicit drugs. By having the concept of honesty the program would encourage participation by the clients in setting the agenda, sharing experiences, having the freedom to ask any questions, flexibility in the order of topics and the opportunity to share responsibility for making the process a success.
4) To rehabilitate the individual into having a productive and healthy lifestyle. The final goal is to not only rehabilitate but also assist the adolescent in living a productive and healthy lifestyle. The first thing that would be helpful would be to make sure the adolescent is either still in high school or about to finish high school. The program would assist the individual in completing high school or if they haven’t or have dropped out then we would work together to see that the individual worked toward taking the High School Equivalency Test. This test consists of five individual sections; mathematics, social studies, science, reading skills and writing. Having the individual work toward their education would also be considered a behavioral modification and it will greatly benefit the adolescent in the long run. The program would also get those who have graduated high school started in college placement groups for instance, SAT preparation classes, Individual tutoring and college placement counseling assistance. Another piece of this section is job placement. The program would work with individuals interested in working; together we would look for job vacancy postings, local career fair’s, possibly student employment and even develop an organized system and a schedule to follow and map out the steps
that are needed in obtaining a job. The organization would also offer some basic skills training for individuals, which may include, reading, writing, spoken English and communication skills, math and quantitative operations and problem solving and technology. Lastly there would be job training assistance, which would help the client find work through employment services and job training programs. These training programs include job readiness and job placement assistance.
Impact Statement
There is a significant gap that exists between the number of adolescents who need substance abuse treatment and those who actually receive it. According to a recent study approximately one‐fourth of youth age 14‐18 who need substance abuse treatment received it. Having substance abuse treatment facilities for adolescents has proven to be effective. “A national study of community‐based treatment programs for adolescents found that reported weekly marijuana use dropped by more than half in the year following treatment. Clients also reported less heavy drinking, less use of hard drugs, and less criminal involvement. Other benefits included better psychological adjustment and improved school performance after treatment.” 3
Other benefits of this facility are that it also gives adolescents a place to go and learn about themselves and what they are doing to themselves. This facility will have a positive impact not only on the lives of the clients and their families but the community as well. Clients in the program will be able to go back into the community and confidently make their own personal changes. These kids will not only discover the true potential that they possess but they will be able to use that potential towards more positive choices in their future. Obtaining life skills and
3 Hser, Y‐I., Grella, C., Hsieh, S‐C., Anglin, M.D. National Evaluation of Drug Treatment for Adolescents. Presented at the College on Problems of Drug Dependence Annual Meeting, June 1999.
other socialization skills will greatly benefit them in living a long and productive life substance‐free.
Evaluation
Success of the program will be determined by whether or not the program goals and objectives have been met. Data will initially be collected at the start of the program by using the MTJN and JASAE tests which will then be re‐administered halfway through the program to reevaluate the client’s progress. These tests will reveal how many clients have stayed chemical free and if they seek further help. This data will help the program supervisor determine whether or not the clients are getting something out of what they have learned in the past few weeks. “The more clients who are at all the meetings, chemical free, and looking for more help, the more effective the program has been at educating the individuals about the harmful nature of their drug use” (Service Grant 10).
Those who are in charge of evaluating clients and collecting data are the program supervisor, the therapeutic recreation therapist and the counselor. Together they will evaluate the client’s progress, the program and the data collected to determine whether or not the program has been successful and or beneficial. The program supervisor will also keep a record of how many clients return to the program and seek additional help. They will also survey their clients mid‐way through the program to see how they feel about the program and how the feel they are benefiting from it.
Ultimately the data will all be used to measure the programs efficiency and success. The findings will be made well known to all employees by the program supervisor. They will all be well aware of the programs strengths and what the program needs to improve on to be more efficient.
To determine whether project objectives are being met, someone from the Department of Health and Human Services will formally evaluate the project. The evaluation that has been proposed consists of two strategies for assessing the projects success. This data will also be presented to the funders to give them a clear picture of what is being done at the facility. Another thing that the data will be very useful for is acquiring future funding once the grant runs out. The findings could potentially secure future funding for the program to ensure that it helps serving Franklin County adolescents. All in all these techniques will ultimately determine if the clients who have stayed with the program fully are using their new gained knowledge to stay chemical‐free and healthy.
Of primary interest is whether the proposed substance abuse facility actually decreases the use and abuse of substances by adolescents. To determine the extent to which the project is responsible for the improved wellbeing of those addicted, extensive data will be collected on the pre‐screening statistics of the participants. Variables will include: indentifying the youth has a problem, screenings, referrals, treatment, outdoor recreation, therapeutic recreation, individual counseling,
surveys, questioners, interviews and drug‐free counseling. After a six‐week period, an evaluator will collect the same data on all participants.
1) Indentify the youth who can benefit from substance abuse supports and services via network partners (i.e. Juvenile corrections offices, local law enforcement and parents)
The data collection methods that will be used here are that the client will be interviewed and then required to submit to a drug test. A counselor will interview those associated with the client (i.e. parents, teachers, law enforcement) to find out some background information on the individual and some family history as well. All of this will be collected upon entry to treatment. This information will be the first step in knowing 1) if the individual has a substance abuse issue and 2) if and what is the appropriate treatment for them.
2) JASAE evaluates adolescent alcohol and drug experiences, as well as attitude and life stress issues to determine if, and to what degree, problems exist in theses areas.
The data collection methods that will be used here are that the client will be tested using the JASAE tests, which will evaluate adolescent’s drug and alcohol experiences. These results will ultimately help the program determine what treatment is necessary for their particular client. The program will also implement surveys, which will determine use, the extent of use and consistency of use. Lastly the program will use testimonials not only from family, teachers and law
enforcement but also from the individual in question. This is yet again considered another first step, which will indicate the individual’s use and abuse of substances. This data will in the end give us a thorough understanding of the nature of the problem and how long this problem has been going on.
3) Screenings should focus on the severity of use and core associated factors such as mental health status, family history of parental addiction, functioning and any legal problems.
The data collection methods that will be used here are that the client will be drug tested once a week for six consecutive weeks. Another method that will be used is observations. The program supervisor, counselors, therapeutic recreation therapist and interns observe their clients and they will be keeping notes on them. These notes will be shared with the client and together the helper and the client will review the notes and agree on them. These observations will give the program employees a great sense of their client’s severity of use and other core associated factors. Counselors and the program supervisor will also conduct interviews of family, friends, law enforcement and the client. These interviews will give the staff a good understanding of family history, current history and parental addiction. Another great tool are school grades and or report cards. By having the adolescents educational history (past and present) the program will be able to determine when this issue may have started and how it correlates to his or her performance in school. Another tool, which is beneficial to the client’s pursuit to recovery, is medical reports and or family history. Having this data could help the program determine
the client’s personal and family medical history and if his or her history is at all linked to a mental illness. This is yet again another first step tool that will evaluate the extent or severity of addiction via family history of addiction and school performance. This summative data will give us a thorough background of the individual and may potentially direct the employees to the leading factors of the client’s use and abuse.
4) Referral to a comprehensive assessment should be made for all adolescents whose screening reveals indicators (daily use of one or more substances) of serious substance abuse issues.
The data collection methods that will be used here are that the client will be administered tests, which will determine if a referral to a comprehensive assessment is needed. The use of more screenings will help the counselors and other employees gain a better understanding of an individual’s daily use of one or more substances. Interviews will also be conducted to discuss the seriousness of the individual’s addiction. Interviews will be conducted with teachers, parents, friends local law enforcement if necessary. This is considered to be one of the finals steps of the introduction of the program. This final bit of data will allow the facilities professionals to determine what the first step of the individual’s treatment will consist of. The counselor and the client will design a treatment plan with reachable goals that they both agree on.
5) Treatment
The data collection methods that will be used here are document review and analysis. The data from surveys, tests, interviews and testimonials will be evaluated in determining appropriate detoxification (if needed), counseling placement, and treatment duration. By utilizing group techniques and group counseling, adolescents are given the chance to ask question and be heard. Clients will be ask to perform simulated problems related to substance use and the counselor and the clients will break down the scenarios while educating the clients in the negative effects of adolescent substance abuse. Once the referral period is over, counselors will determine what kind of treatment to use next. Hopefully with the correct treatment plan the individual will come out more aware of the negative affects substance use has on the body and the mind.
6) Drug free counseling
The data collection methods that will be used here are other organizations counseling techniques. Counseling would focus on short‐term and long‐term personal, family, job, school and other problems and their relationship to substance abuse. The organization will conduct interviews of clients mid‐way through counseling in determining if they have or will use what that have learned or discussed in a substance free life. This would be taking place while treatment is going on. This is yet another great form of treatment, which will have great benefits to those individuals who stay with the program. This will hopefully have a positive outcome on the individuals outlook on life and will give them support and guidance.
7) Therapeutic Recreation
The data collection methods that will be used here are the use of photographs, videotapes and slide shows. The therapeutic recreation therapist will take photographs and or videotape of therapeutic recreation activities being done by those in the program. The group would then sift threw photographs and videos and create a PowerPoint demonstrating the benefits of therapeutic recreation. The PowerPoint will be viewed by funders and parents, which would demonstrate what the kids have learned about teamwork and team building at treatment. These will be a visual history of the many activates that adolescents will participate in while involved in the program. Many of these activities will revolve around teamwork and team building. Kids will have to work together to succeed in certain simulated problems related to substance abuse. Having these simulations are terrific, not only do they build self‐esteem and self‐realization but also they are a good educational and alternative behavior tactic. Midway threw treatment the program would administer a questionnaire and reaction survey of clients first hand experiences of what they have done while participating in therapeutic recreation activities and what their likes and dislikes were about the program. This evaluation will be conducted at the halfway point of treatment. This is one of the most important objectives in successfully treating adolescent substance abuse. This is so beneficial because it gives the adolescents alternative behaviors to the use of substances.
8) School Education/Drug Education
The data collection methods that will be used here are the use of tests and observations. Drug education will be daily at the facility and clients will be tested on the material. Besides taking a few tests, clients will have to do some written work as well. At the very beginning of the program the client would have to write a one‐page paper one why he or she is in the facility. Another written assignment would be having the clients do research on the addiction in question and to then write a paper relating their findings to how they initially felt about their use and abuse. Speakers will also be available at the facility where they will hear some first hand experiences of substance use and will then be required to write reaction papers to these speakers. Midway through treatment clients will be asked to fill out a survey or reaction paper addressing what they have learned in their first six weeks of treatment in drug education and how they feel about there addiction now as compared to before. This is very important objective because it makes drug education better known throughout adolescents and is vital in stopping substance abuse early.
9) Outdoor Recreation
The data collection methods that will be used here are the use of photographs, videotapes and slideshows. Having footage of adolescents working together and participating in group activities will give parents, teachers and clients a visual presentation of their interests, accomplishments and struggles. The therapeutic recreation therapist will keep notes regarding client’s actions, decisions and
motivation. At the midpoint of treatment the therapist will evaluate his or her notes and record and submit behavioral changes on each client to the program supervisor. The program supervisor will then relay the data to not only the parents but the client as well. This evaluation will be conducted at the midpoint and at the end of treatment. This is also an essential tool in creating alternative behaviors to the use and abuse of drugs and alcohol.
Budget Narrative
The budget for the Franklin County Adolescent Substance Abuse Facility proposal reflects an inclusive summary of program expenses, which will enable the program to be effective and successful in treating adolescent substance abuse. This budget is a response to the needs expressed by Franklin County parents, doctors and teachers who have a keen interest in the well being of adolescents in need. The 12‐month budget of $344,540 will provide enough resources to serve 100 adolescents ages 14‐ 24.
1) Program Personnel
The program would like to acquire two counselors who are trained in adolescent development and in specific techniques that are effective with youth. These two professionals run the individual counseling and drug counseling sessions. The program also call for two therapeutic recreation therapists who will be running the therapeutic recreation and outdoor recreation activities. The facility would also need one program supervisor whose job is to make sure the daily running of the facility goes well. The program supervisor will also be communicating with the counselors and therapists in making sure that all clients are receiving the necessary treatment. And lastly they would need to acquire a secretary who will answer calls, schedule appointments and conduct attendance with clients.
2) Program Supplies
Program supplies include textbooks, computers, projector, software, methadone detoxification and outdoor recreation and therapeutic recreation supplies (i.e. snowshoes, compasses, balls, Frisbees, miscellaneous outdoor play equipment. Other supplies consist of paint, paper, pencils, markers and other office supplies. All of these items are necessary in the daily running of the facility; most of these items are for clients and they could greatly benefit from having these tools and accomplishing treatment goals and objectives.
3) Program Space
The program will obviously need a facility in able to distribute its services. A facility with 3,200 square feet is readily available. A facility with some space inside and outside is desired considering how important therapeutic and outdoor recreation is to the success of the program.
4) Program Travel
These costs include mileage for field trips with the two therapeutic recreation therapists to Tumbledown Mountain, Titcomb Mountain, Mt. Blue State Park and Baxter State Park. Each trip will be made twice a year, totaling eight trips a year.
5) Transportation Purchase
In the therapeutic and outdoor recreation aspects of the proposal there is a good amount of traveling. The program has suggested that clients go on eight trips a year to various hiking locations throughout the state of Maine. The program would like to acquire a Renault Master Minibus, the vehicle accommodates 18 people. These trips are necessary for adolescents in developing a better understanding of hard work and determination.
