How do we ensure our mental health and substance abuse treatment services have long lasting effects?

Research demonstrates that recovery from most mental health and substance abuse disorders is likely to be life-long. Even when a youth or family is satisfied that improvements have occurred, complete recovery may take years and may never be fully sustained. In fact, most people relapse into old behavior patterns or addiction. Thus, our care for these problems must be thought of as continual and not episodic. Developing effective youth treatment systems of care must include service practices that focus on continued care and recovery monitoring strategies.

Continued Care - Due to changes in developmental and environmental strengths and challenges,   service supports for youth and families should be delivered over extended periods of time with structured activity and treatment components. Rather than "passive," our field is moving toward "assertive" models of care. These models place more of the engagement responsibility on the service providers. "Assertive" means the clinician initiates more of the contacts, sets up meetings with referral sources, sets up support programs through outreach (e.g., multi-family groups, Alcoholics Anonymous, Narcotics Anonymous, prosocial activities), rather than assuming the family will structure these meetings. Service delivery models of assertive continued care now exist. For a detailed discussion of assertive continued care, refer to Mark Godley's research and manual at the Lighthouse Institute's section of the Chestnut Health System's Web site: www.chestnut.org.

Mark Godley (2003) has constructed a set of necessary and essential continued care activities including:

•  Encouraging and priming prosocial activities

•  Reduce social risk

•  Social skill development

•  Monitoring to prevent relapse*

•  Support*

•  Linkage to other services

•  Re-intervention for major relapse*

*Essential continued care functions

The following graph demonstrates the types and expected service delivery in a study of community based continued care.

Research findings illustrate the effectiveness of assertive continued care in increasing referrals, stalling and/or reducing relapse, and increasing engagement and retention in continued community supports.

Conducting Recovery Management Check Ups -Due to the chronic nature of substance disorders, one must check on the availability of the recovery environment and support, check on how old lapses are handled, and develop plans with new approaches to proactively encourage re-intervention if needed. Programs are advised to meet the new federal standards for client follow-up at 3, 6, 9, and 12 months post discharge.

Resources focusing on recovery check ups and continued care include (Godley, 2003):

• Recovery management check ups (Dennis, Scott, & Funk, 2003)
• Multisystemic therapy (Henggeler, 1999)
• Tarrant Co. Juvenile Services-TCAP; Family preservation (Woods & Haene, 2002)
• Case monitoring and telephone support (Foote & Erfurt, 1991; Stout et al., 1999)
• Assertive Continuing Care Study (Godley et al., 2002)