How do we ensure that our systems of care are implementing effective and long-lasting treatment interventions for youth and families?

Part Three: The critical components toward developing integrated treatment services for youth

The following paragraphs describe program components ensuring the appropriate long-term delivery of care throughout the system.

Care Management and Coordination

Youth and families entering into the system of care need a person who will be accountable throughout the duration of their services regardless of amount, type, or location of the treatment.  

A treatment care manager needs to be identified at the coordinating treatment site to undertake the following tasks:

•  Follow up with and motivate the youth throughout his or her treatment and recovery

•  Refer and link the youth to any adjunctive services, such as medication evaluation, vocational assistance, special education, and transitional living services

•  Refer and link the youth to differing levels of care (e.g., outpatient, residential, and continued care)

•  Ensure the integration of services for co-occurring mental health and substance use disorders

Training, Staff, Supervision, Quality Assurance, and Other Systems Issues

Training needs to be revolutionized throughout systems of care. Training needs to consist of three phases:

•  An exposure phase that presents new effective practice

•  An implementation phase that helps programs and staff adopt and implement the changes in practice

•  A follow-up phase to support and guarantee fidelity of the new knowledge and skills

Workforce development is a key concern owing to the diverse experience and educational backgrounds of families and all professional staff. The field is becoming more evidence based, which increases the demands on programs and staff to provide the most current researched, effective, and developmentally and culturally appropriate treatment.  

Family advocates and staff need training on this new clinical information. They need ongoing clinical supervision to learn to apply and hone the new skill sets and to practice the elements of effective treatments. Many professional organizations and agencies specify a set of criteria necessary to work well with special populations. A good systemwide norm for staff already credentialed in mental health and/or substance abuse who want to work with youth and families is a minimum of 2 years of supervised training experience with that population.

Supervision and clinical management should become protocol driven so that all administrators and clinical staff understand and can easily access clinical information across clients and the types of services delivered. Performance- and client-based monitoring procedures such as therapeutic alliance, treatment, and follow-up logs are necessary tools to support this agenda. The Center for Substance Abuse (CSAT) requires its grantee programs to continually monitor clinical services, setting engagement and retention goals and the acquisition and delivery of evidence-based treatment.

Supervision needs to address the administrative elements as well as the clinical elements. Often programs integrate these two components of service delivery without allowing enough time for either one. A good rule of thumb is a minimum of 1 to 3 hours of individual clinical supervision for any staff involved in service delivery to youth and families. The start-up phase of the implementation of evidence-based services will dramatically increase the amount of time needed for supervision; many sites do not allow for this and try to adopt the new clinical protocols into the older staffing and staff support patterns.

Program Evaluation

All substance abuse programs should be engaged in a process of continual learning directly from clients, staff, academic and clinical research institutions, national agencies (CSAT, CSAP, DDMHS, and NIDA), other affiliated nonprofits, stakeholders, and the community at large. The theme "what gets measured gets done" should drive the system change. Programs should use clinical management strategies to monitor services for engagement, retention, and performance. CSAT requires programs to use time periods of 3, 6, and 12 months after intake to follow up with youth and families on how they are doing.