Recently I gave a presentation to a countywide group of school social workers in Long Island, New York on the topic of clinical practice with adolescents with substance use disorders. Many of these social work positions were funded by a federal grant to offer school-based prevention and intervention services to the county's middle school and high school students (sadly, one announced that she had been informed that she would not have a position during the next academic year because of funding cuts).
During the question and answer period, we had moved into a conversation about lack of high quality treatment programs and other barriers to effective treatment such as inadequate insurance coverage. One of the participants suggested that we spur our professional organizations to educate our policy makers at the state and federal levels to effect change in health care coverage for substance abuse treatment for teens. I pointed out that we have compelling research, often funded and produced by government agencies such as SAMSHA but also grants from charitable foundations such as The Robert Wood Johnson Foundation that inform us to what is needed for effective intervention and treatment. We have what is referred to as an evidence/practice gap because it appears that our private and government health care insurers are not aware of these studies, or have not read them, or read them and decided that effective treatment is too costly. Is this being penny wise but pound foolish?
A study conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University declared adolescent substance use an epidemic and America's # 1 public health problem. In addition to the human toll, the CASA study found that the financial costs of adolescent substance use disorders per year include an estimated $68 billion associated with underage drinking and $14.4 billion for substance-related juvenile justice programs (where it seems many teens have to end up to receive any treatment). Furthermore, the estimated total costs to federal, state, and local governments of substance abuse and addiction among the entire U.S. population are at least $467.7 billion per year!
Since addiction is now considered a chronic brain disease with origins in adolescence (the CASA study found that 9 out of 10 adults with addiction began using substance before the age of 18) it makes economic sense to provide teens with effective treatment and prevent the progression of substance use into adult addiction or adequately treat those teens who are already addicted to prevent further costs and damage to human lives. But this is not the case.
At our research-informed residential program for adolescent males in Central Connecticut, I work with families trying to get insurance coverage for residential treatment for their sons. The minimum length of stay is 30 days (which we designate "Assessment & Intervention") and the recommended length of stay is minimally 90 days. We designed the program in this way because research tells us unequivocally that good outcomes depend on adequate treatment length; for residential and outpatient treatment, participation for less than 90 days is of limited to no effectiveness. However, with the exception of self-insured EAP's, it is nearly impossible to obtain insurance authorization for 30 days--even in severe cases. Why? Because many insurers use very stringent criteria to justify residential treatment, typically "imminent danger to self or others" and high risk of relapse and/or overdose does not meet their definition of imminent. We have experienced many situations in which parents have sought help for their son and convinced him to engage in residential treatment only to discover that based on their insurance policy their son is not eligible for residential treatment because he has not received intensive outpatient therapy first. What this means is that the teen, even when it seems contraindicated, must try and fail at intensive outpatient treatment before he will even be considered for residential treatment. What if we had a similar approach to a person who enters an emergency room with severe chest pains? "I'm sorry Mr. Jones, we cannot admit you; please return when you are in full cardiac arrest."
Needless to say, all of this is enormously confusing and frustrating for parents, who are often told that they have generous insurance coverage, without being informed about the rigid criteria. Parents then must decide whether to use personal funds such as college savings to get their son helpful treatment which inherently involves an adequate length of stay. It is similarly frustrating for clinicians who are trying to provide effective care in the context of insurance uncertainty.
The CASA study revealed that only 6.4% of high school students who meet the criteria for a substance use disorder received any formal treatment--and those who did rarely received quality care. This is a travesty because adolescent substance abuse is a treatable and preventable condition. The school social workers I met with recently, who were so passionate about the importance of prevention services were right that we need to involve our professional organizations and our state and federal politicians to fight for rational health care policy with respect to teen substance use and addiction. As health care professionals, we need to mobilize, raise awareness, and influence public perceptions and health care policy. It just makes sense.
Frank Bartolomeo, PhD, Vice President, Child & Adolescent Services, Rushford
Frank Bartolomeo, PhD. is blogging on behalf of Rushford. You can find Rushford on Facebook and on Twitter.
During the question and answer period, we had moved into a conversation about lack of high quality treatment programs and other barriers to effective treatment such as inadequate insurance coverage. One of the participants suggested that we spur our professional organizations to educate our policy makers at the state and federal levels to effect change in health care coverage for substance abuse treatment for teens. I pointed out that we have compelling research, often funded and produced by government agencies such as SAMSHA but also grants from charitable foundations such as The Robert Wood Johnson Foundation that inform us to what is needed for effective intervention and treatment. We have what is referred to as an evidence/practice gap because it appears that our private and government health care insurers are not aware of these studies, or have not read them, or read them and decided that effective treatment is too costly. Is this being penny wise but pound foolish?
A study conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University declared adolescent substance use an epidemic and America's # 1 public health problem. In addition to the human toll, the CASA study found that the financial costs of adolescent substance use disorders per year include an estimated $68 billion associated with underage drinking and $14.4 billion for substance-related juvenile justice programs (where it seems many teens have to end up to receive any treatment). Furthermore, the estimated total costs to federal, state, and local governments of substance abuse and addiction among the entire U.S. population are at least $467.7 billion per year!
Since addiction is now considered a chronic brain disease with origins in adolescence (the CASA study found that 9 out of 10 adults with addiction began using substance before the age of 18) it makes economic sense to provide teens with effective treatment and prevent the progression of substance use into adult addiction or adequately treat those teens who are already addicted to prevent further costs and damage to human lives. But this is not the case.
At our research-informed residential program for adolescent males in Central Connecticut, I work with families trying to get insurance coverage for residential treatment for their sons. The minimum length of stay is 30 days (which we designate "Assessment & Intervention") and the recommended length of stay is minimally 90 days. We designed the program in this way because research tells us unequivocally that good outcomes depend on adequate treatment length; for residential and outpatient treatment, participation for less than 90 days is of limited to no effectiveness. However, with the exception of self-insured EAP's, it is nearly impossible to obtain insurance authorization for 30 days--even in severe cases. Why? Because many insurers use very stringent criteria to justify residential treatment, typically "imminent danger to self or others" and high risk of relapse and/or overdose does not meet their definition of imminent. We have experienced many situations in which parents have sought help for their son and convinced him to engage in residential treatment only to discover that based on their insurance policy their son is not eligible for residential treatment because he has not received intensive outpatient therapy first. What this means is that the teen, even when it seems contraindicated, must try and fail at intensive outpatient treatment before he will even be considered for residential treatment. What if we had a similar approach to a person who enters an emergency room with severe chest pains? "I'm sorry Mr. Jones, we cannot admit you; please return when you are in full cardiac arrest."
Needless to say, all of this is enormously confusing and frustrating for parents, who are often told that they have generous insurance coverage, without being informed about the rigid criteria. Parents then must decide whether to use personal funds such as college savings to get their son helpful treatment which inherently involves an adequate length of stay. It is similarly frustrating for clinicians who are trying to provide effective care in the context of insurance uncertainty.
The CASA study revealed that only 6.4% of high school students who meet the criteria for a substance use disorder received any formal treatment--and those who did rarely received quality care. This is a travesty because adolescent substance abuse is a treatable and preventable condition. The school social workers I met with recently, who were so passionate about the importance of prevention services were right that we need to involve our professional organizations and our state and federal politicians to fight for rational health care policy with respect to teen substance use and addiction. As health care professionals, we need to mobilize, raise awareness, and influence public perceptions and health care policy. It just makes sense.
Frank Bartolomeo, PhD, Vice President, Child & Adolescent Services, Rushford
Frank Bartolomeo, PhD. is blogging on behalf of Rushford. You can find Rushford on Facebook and on Twitter.
Hello:
I am totally in sync with your Evidence/Practice Gap post. Unless we submit alternatives to our resource lists, outreach all concerned and educate politicians and policy writers about this gap - our children will continue to suffer unassisted.
Perhaps San Patrignano can help.
San Patrignano’s NY office acts as a referral agency for those young addicts who need additional longer term residential
and vocational training without putting a strain on our insurance systems or requiring additional state funding.
The four year program is completely free of charge. At San Patrignano guests are involved in an educational and professional
training program aimed to produce a drug free reintegration into society.
The San Patrignano program has three locations in Italy with the main location in Rimini, Italy: provides room and board, and all other necessities. The San Patrignano community is supported by fund raising and the goods/services they produce through the professional training of the residents. Some of the work groups a recovering addict can join are pedigree dog breeding, building and grounds maintenance, graphic/web design or publishing, plumbing or electrical, carpentry or metal crafting, hand crafted furniture, bicycle fabrication, food preparation/serving and bakery, office work, weaving, leather work, plush toys, giftware production and more. This list is not representative of all the vocational and educational possibilities at San Patrignano.
The San Patrignano objective is to introduce those admitted (families with children are also accepted on a case-by-case basis) to a lifestyle rooted in personal interaction which is open, promotes connection, a deeper understanding of themselves and their actions. The primary tool to promote this behavior is work, study, and athletic activity as well as promoting personal interests. Our goal is to assist residents to live with a set of universally recognized values: honesty, responsibility, stability, purpose and a respect for self and others. The program of recovery takes into account each person’s individual differences and therefore a standard length of stay cannot be predefined but is usually four years.
San Patrignano does not subscribe to and does not wish to instill any single ideology, political agenda, philosophy, or religion through its program. The community believes the first thing a person must do is get to know themselves to develop or rediscover their moral, human and social values. Although the community cooperates fully with government and social services, it does not accept any public funding – even in cases when the addicted person comes to the community by way of these institutions.
Productive work is considered one of the vital means through which someone can express themselves, gain an identity, and develop talents and interests which lead to a fulfilling life. A myriad of opportunities for career training using the latest technologies have been created at San Patrignano. Those who wish to complete their studies may attend (at no cost to them) school up to and including college. Of course, learning Italian while in the community happens naturally as well as in school, if one desires classes. There are many who speak English in the community and who will assist throughout. This adds an additional level of education to those entering who are not Italian speaking.
The program is free of charge. A travel visa is arranged via the San Patrignano NY office and your states Italian Embassy.
Admission takes place after screening with San Patrignano New York personnel. Upon entrance each new resident completes a comprehensive physical exam and they are matched with someone further along in their recovery. This person helps them on a daily basis, assists them in facing difficulties of the new environment, and provides orientation, support and encouragement.
One of the main objectives is to rebuild family relationships, which frequently have become strained or non-existent. To achieve this, the New York office conducts family sessions to provide information and support before, during and after admission and treatment. The services offered by the New York office are $35 per month with unlimited supportive, educational sessions monthly.
Referrals
To make a referral or for further information email
Deborah Lombardi, LCSW, MS at
dlombardi@sanpatrignano.org or call (646) 246-1257
San Patrignano New York
Please call for an appointment.