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RAND Drug Policy Research Center (DPRC) Newsletter, June 1999

New Projects: Collaborating with Phoenix House on a Treatment Research Agenda

Two years ago DPRC entered into a partnership with Phoenix House, a nonprofit organization providing drug use treatment, prevention, and education services for adults and juveniles in several states. A primary goal of our collaboration has been to develop a program of treatment research and secure outside funding for it. Two successful ventures along these lines have been initiated.

Comparing Substance Abuse Treatments for Adolescent Probationers

Adolescent abuse of alcohol and other drugs is prevalent, costly, and a growing public health problem. In part, these costs are exacerbated by the fact that adolescents with the most severe problems often do not receive treatment until they come under the supervision of juvenile courts. In California, for instance, almost half of all teenagers receiving drug treatment services were referred by the court system. Unfortunately, by the time drug-using adolescents reach the criminal justice system, they tend to be alienated from their families and extensively involved in truancy and delinquent behavior, violence, and other dangerous or destructive activities. As such, they are in grave need of treatment services that do more than eliminate substance abuse; treatments must challenge teenagers to accept greater responsibility for their lives and help them to better address the problems contributing to their drug use.

Recognizing the obvious importance of understanding the need for adolescent treatment programs and evaluating their outcomes, the federal Center for Substance Abuse Treatment (CSAT) has awarded DPRC over a million dollars to study the effects of "suitable placements," or group treatment homes, on the treatment outcomes of adolescent probationers who have a history of drug use. This RAND Adolescent Outcomes Project is led by principal investigator Andrew Morral and survey director Pat Ebener. It is being carried out in cooperation with the Los Angeles Juvenile Courts, the Los Angeles County Department of Probation, the Phoenix Academy of Lake View Terrace, and six other adolescent group homes in Los Angeles County.

The RAND research team will interview 400 drug-using adolescent probationers before, during, and after they receive rehabilitation services either at Phoenix Academy or at comparison group homes. Questions cover a range of issues such as drug use, school performance, criminal behavior, family and living environment, and psychosocial functioning and productive activity. To ensure a complete and effective evaluation, the experiences of probationers who drop out of the programs will also be evaluated. The dropout problem is not inconsequential: Attrition rates at some group homes are expected to be well over 50 percent.

DPRC believes the results of this study will shed light on a number of critical questions with respect to improving adolescent substance abuse programs:

• What types of adolescents are most helped by extensive social rehabilitation, such as that provided at Phoenix Academy? What problems are likely to be most amenable to this type of therapeutic-community treatment?
• Are there important differences among group homes? What program characteristics are most beneficial to probationers?
• What are the relative benefits of shorter versus longer stays in homes? Most treatment lengths now average one year, but there is growing pressure on the providers of residential programs for adolescents to provide shorter treatments.

The RAND Adolescent Outcomes Project represents the largest externally funded project that has yet resulted from the RAND–Phoenix House partnership begun just two years ago. Both organizations hope to build on this collaborative effort toward improving adolescent drug use treatment and prevention.

How Well Are Juvenile Drug Treatment Programs Doing?

Although young drug offenders have increasing access to treatment, judges, prosecutors, and probation officers in the juvenile justice system have little empirical evidence on which to assess treatment options. Phoenix House and RAND are collaborating to address this need in a study funded by the National Institute of Justice under its Juvenile Accountability Incentive Block Grant program. The new study will identify

• what kinds of offenders benefit from what kinds of services
• how long and how well offenders engage in different programs
• what kinds of outcomes should be expected, given differences in adolescents, services, and costs
• how those outcomes can be measured.

In the last six months, the DPRC project team, led by Patricia Ebener, has conducted a large-scale trial of Phoenix House's system for tracking treatment process and outcomes from the time juveniles are admitted to a program through posttreatment follow-up. Working from data on 120 youths referred to Phoenix House in Los Angeles and Yorktown, New York, the project team has

• developed preliminary profiles of applicants and identified characteristics that predict admission to treatment and retention
• developed and tested tools for measuring the treatment process and monitoring outcomes.

The next step will be to use the data to assess the validity of juvenile offenders' self-reported criminal history. Since criminal status is a principal outcome measure for youths in drug treatment, it is important to determine whether the information they provide about themselves through routine monitoring is reliable.

This research will help Phoenix House understand and improve its clients' responses to treatment and demonstrate program effectiveness to potential funders. We also hope that research results will provide a model that other treatment providers can adapt to their needs.

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