The 4The 4thth Annual Research and Evaluation of Annual Research and Evaluation of

Adventure Programs SymposiumAdventure Programs Symposium

Programs, Process, & Programs, Process, & Progress: The March Progress: The March

Towards Evidence-Based Towards Evidence-Based

DesignationDesignation

Matt Claybaugh, Ph.D. & Matt Claybaugh, Ph.D. &

A. Scott Allred, LMFTA. Scott Allred, LMFT

Marimed Foundation Marimed Foundation

ProgramProgram

►Who we are and what we do.Who we are and what we do.

ProcessProcess

►Data in – Data OutData in – Data Out

►Moving towards EBP designationMoving towards EBP designation

ProgressProgress

►Where are we nowWhere are we now►Barriers to success Barriers to success

ProgramsPrograms

►How many of you believe/know you How many of you believe/know you are using an evidence-based model in are using an evidence-based model in your program(s)?your program(s)?

►How many of you are replicating a How many of you are replicating a “best practice,” “evidence-based” or “best practice,” “evidence-based” or “model program?”“model program?”

Marimed’s Residential Marimed’s Residential ProgramsPrograms

KailanaKailana ((Calm Seas) (est.Calm Seas) (est.1993 on O`ahu)1993 on O`ahu) and and

Wahiolanona`opioWahiolanona`opio ((A Healing Place for A Healing Place for Youth) (est. Youth) (est. 2004 on Hawai`i Island) 2004 on Hawai`i Island)

Residential treatment programs for Residential treatment programs for adolescents needing comprehensive adolescents needing comprehensive treatment and education, including mental treatment and education, including mental health and substance abuse services.health and substance abuse services.

Kailana Main Kailana Main CampusCampus

Kailana Voyaging HousesKailana Voyaging Houses

Hale Ho`ohua“House to Bear Fruit”

Hale Kauoha Kākou“House of Our Will”

Wahiolanona`opio Voyaging Wahiolanona`opio Voyaging HousesHouses

Wahiolanona`opio `O Kea`au:Girls House

Wahiolanona`opio `O Kapehu:Boys House

Integrated ServicesIntegrated ServicesExperiential

ClinicalEducational

Marimed’s

Model

Culturally Aligned with Youth Culturally Aligned with Youth PopulationPopulation

Mauka to MakaiMauka to Makai

Lo`i – Kalo, Animal Lo`i – Kalo, Animal Husbandry &FarmingHusbandry &Farming

Culinary ArtsCulinary Arts

Ocean-Based Ocean-Based ProgrammingProgramming

Small Boat SailingSmall Boat Sailing

Outrigger Canoe Outrigger Canoe PaddlingPaddling

Kiakahi Sailing CanoeKiakahi Sailing Canoe

Ho`ailona: Sailing CanoeHo`ailona: Sailing Canoe

S.S.V. Makani OluS.S.V. Makani Olu(gracious wind)(gracious wind)

Five 5sFive 5s

►Organizational ValuesOrganizational Values►Experiential ModelExperiential Model► Interwoven Phase and Level SystemInterwoven Phase and Level System►CPI (Non Violent Crisis Intervention)CPI (Non Violent Crisis Intervention)►Behavioral SupportsBehavioral Supports

#1: Organizational Values#1: Organizational Values

►CommunityCommunity►HonestyHonesty►AlohaAloha►RespectRespect►TeamworkTeamwork

#2: Experiential Model#2: Experiential Model

►Welcome Aboard / Preparing for SeaWelcome Aboard / Preparing for Sea►Departure / Commitment to the Departure / Commitment to the

VoyageVoyage►Challenge / Windward LegChallenge / Windward Leg►Mastery / WayfindingMastery / Wayfinding►Reflection / StorytellingReflection / Storytelling

#3: Phase and Level System#3: Phase and Level System

► Phases of Treatment:Phases of Treatment:I. Rapport Building: Roles and RulesI. Rapport Building: Roles and Rules

II. Accepting Responsibility and Expressing Needs and IssuesII. Accepting Responsibility and Expressing Needs and Issues

III. Coping SkillsIII. Coping Skills

IV. Dealing with Past Issues that Continue to Impede ProgressIV. Dealing with Past Issues that Continue to Impede Progress

V. Transferring Learning to New Life SettingsV. Transferring Learning to New Life Settings

#4. Crisis Prevention #4. Crisis Prevention Institute Institute

►Non-Violent Crisis InterventionNon-Violent Crisis Intervention

#5. Behavioral Supports#5. Behavioral Supports

►Making it RightMaking it Right►Restorative JusticeRestorative Justice►Cadet CouncilCadet Council►Positive Incident ReportsPositive Incident Reports

I Mua Mau `Ohana: IMOI Mua Mau `Ohana: IMO

►SAMHSA TCE: Targeted Capacity SAMHSA TCE: Targeted Capacity ExpansionExpansion

► Joint Program Enhancement Award: Joint Program Enhancement Award: 2002 Marimed Foundation and Maui 2002 Marimed Foundation and Maui Youth and Family ServicesYouth and Family ServicesVoyaging (For MYFS)Voyaging (For MYFS)12 month Continuing Care (All Islands)12 month Continuing Care (All Islands)

InstrumentInstrument

►Utilized the Global Appraisal of Utilized the Global Appraisal of Individual Needs (GAIN) Core VersionIndividual Needs (GAIN) Core Version

►GAIN also contains GAIN also contains SAMHSASAMHSA Government Performance and Results Government Performance and Results Act (GPRA) InstrumentAct (GPRA) Instrument

Baseline FindingsBaseline Findings

DemographicsDemographics

► Gender: 71% male, 29% female, 1% TGGender: 71% male, 29% female, 1% TG► Average age = 16 years oldAverage age = 16 years old► Ethnicity: 62% Native Hawaiian, 41% Ethnicity: 62% Native Hawaiian, 41%

Caucasian, 37% Asian, 24% other Pacific Caucasian, 37% Asian, 24% other Pacific Islander, and 24% Hispanic (many multi-Islander, and 24% Hispanic (many multi-ethnic)ethnic)

► Past 12 months living with: 71% parent(s) Past 12 months living with: 71% parent(s) ► Treatment prior to intake: Treatment prior to intake:

58% received treatment before; 58% received treatment before; average=1.2 admissionsaverage=1.2 admissions

51% felt they needed treatment51% felt they needed treatment

Criminal Justice InvolvementCriminal Justice Involvement

46% 41%

73%

0%

100%

% Y

ou

th -

Pas

t 90

Day

s

Arrested JuvenileDetention

Any ControlledEnv.

► 87% had lifetime arrests87% had lifetime arrests

Education & EmploymentEducation & Employment

► 89% of youth were enrolled in school or 89% of youth were enrolled in school or trainingtraining

► Only 5% reported engaging in some Only 5% reported engaging in some type of “non-full-time work”type of “non-full-time work”

Substance Use at IntakeSubstance Use at Intake

58.8%65.0%

28.8%

0%

100%

% U

sed

in

Pas

t 90

Day

s

Alcohol Marijuana Ice/Stimulants

Mental Health at IntakeMental Health at Intake

33.3%

58.2%

40.1%

22.0%

42.4%

0%

100%

% S

cori

ng

"H

igh

"

ConductDisorder

ADHD Depression Anxiety TraumaticStress

General Crime at IntakeGeneral Crime at Intake

62.7%

48.6%

22.0%28.8%

0%

100%

% S

co

rin

g "

Hig

h"

on

In

dic

es

GeneralCrime

PropertyCrime

Interpers.Crime

Drug Crime

Outcome FindingsOutcome Findings

Arrests – Past 90 DaysArrests – Past 90 Days

34.9%

14.0%20.9%

11.6%

0%

100%

% A

rres

ted

in P

ast

90 D

ays

Intake 3 month 6 month 12 month

Days in Juvenile Detention – Days in Juvenile Detention – Past 90 DaysPast 90 Days

7.655.184.99

18.48

0

5

10

15

20

Intake 3 month 6 month 12 month

Mea

n D

ays

in J

Din

Pas

t 90

Day

s

EducationEducation

83.3%90.7%

72.1%

39.5%

0%

100%

% E

nro

lled

in

Sch

oo

lo

r Jo

b T

rain

ing

Intake 3 month 6 month 12 month

EmploymentEmployment

9.60%2.30%

11.60%

41.8%

0%

100%

% E

ng

aged

in

or

Lo

oki

ng

F

or

Wo

rk

Intake 3 month 6 month 12 month

Substance UseSubstance Use

0

5

10

15

20

25

30

35

Intake 3 Months 6 Months 12 Months

Mea

n D

ays

Use

d

in P

ast

90 D

ays

Alcohol Marijuana Crack Hallucinogens Ice

Substance Problem ScalesSubstance Problem Scales

00.5

11.5

22.5

33.5

4

Intake 3 Months 6 Months 12 Months

Mea

n S

core

s

SUBSTANCE PROBLEMS Substance Issues

Substance Abuse Substance Dependence

Emotional Problem ScaleEmotional Problem Scale

0

0.05

0.1

0.15

0.2

0.25

0.3

Intake 3 Months 6 Months 12 Months

Mea

n S

core

s

Emotional Problem Scale

SummarySummary

► Youth mostly Native Hawaiian and other Youth mostly Native Hawaiian and other Pacific IslanderPacific Islander

► Youth at intake showed high levels of Youth at intake showed high levels of criminal justice involvement, criminal justice involvement, substancesubstance use, and both internal and external use, and both internal and external behavior problems.behavior problems.

► Significant rSignificant reduction in arrests and days in eduction in arrests and days in juvenile detentionjuvenile detention

► Significant rSignificant reductions in substance use and eductions in substance use and related substance problemsrelated substance problems

► Significant rSignificant reduction in emotional problemseduction in emotional problems

Wahiolanona`opioWahiolanona`opio►Received SAMHSA TCE Earmark for Received SAMHSA TCE Earmark for

Methamphetamine Treatment 2004Methamphetamine Treatment 2004

InstrumentsInstruments►Wahiolanona`opio Survey Wahiolanona`opio Survey

GAIN-QGAIN-Q Family Management, Family Bonding, Self-Family Management, Family Bonding, Self-

Efficacy, Cultural Pride, & School BondingEfficacy, Cultural Pride, & School Bonding

►Government Performance and Results Act Government Performance and Results Act (GPRA) Instrument(GPRA) Instrument

Data CollectionData Collection► From July 1, 2004 to September 30, 2006From July 1, 2004 to September 30, 2006► 58 total admissions58 total admissions► Baseline assessmentsBaseline assessments

52 GPRA 52 GPRA 46 Wahiolanona’opio surveys46 Wahiolanona’opio surveys

► Three-month assessmentsThree-month assessments 39 GPRA39 GPRA 34 Wahiolanona’opio surveys34 Wahiolanona’opio surveys

► Six-month assessmentsSix-month assessments 32 GPRA32 GPRA 27 Wahiolanona’opio surveys27 Wahiolanona’opio surveys

► 12-month assessments12-month assessments 16 GPRA16 GPRA 11 Wahiolanona’opio surveys11 Wahiolanona’opio surveys

DemographicsDemographics► Gender: 69% male; 31% femaleGender: 69% male; 31% female► Age: range=13-18, avg.=15.7 years oldAge: range=13-18, avg.=15.7 years old► Education: range=6th-11th grade, Education: range=6th-11th grade,

avg.=9.2 yearsavg.=9.2 years

EthnicityEthnicity

2.4%

2.4%

7.3%

19.5%

19.5%

78.0%

0% 20% 40% 60% 80% 100%

Black/African American

American Indian

Asian

White

Hispanic

Hawaiian or Pacific Isl.

Baseline ATOD UseBaseline ATOD UsePast 30 Days – % YouthPast 30 Days – % Youth

31.7%

92.7%

92.7%

61.0%

70.7%

0% 20% 40% 60% 80% 100%

% Youth Used

Ice

Marijuana

Other Illegal Drugs

Alcohol to Intox.

Alcohol

Qualitative Findings IQualitative Findings I► Sample of participants from the residential and day Sample of participants from the residential and day

treatment programs were interviewedtreatment programs were interviewed► Most participants felt they had changed positively, Most participants felt they had changed positively,

including increased acceptance of responsibility, including increased acceptance of responsibility, honesty, problem solving, anger management, self-honesty, problem solving, anger management, self-esteem, patience, positive attitudes, pro-social esteem, patience, positive attitudes, pro-social behaviors, academic performance, and remaining behaviors, academic performance, and remaining drug freedrug free

► Some participants also felt their families and their Some participants also felt their families and their relationships with their families changed for the betterrelationships with their families changed for the better

Qualitative Findings IIQualitative Findings II►Participants felt staff gave them support, Participants felt staff gave them support,

hope, and skills to deal with their problemshope, and skills to deal with their problems►Participants enjoyed the learning and Participants enjoyed the learning and

experiences they acquiredexperiences they acquired►When asked what was difficult about When asked what was difficult about

working with staff, participants mentioned working with staff, participants mentioned lack of consistency and organizationlack of consistency and organization

►Other concerns related to theOther concerns related to the location and location and living conditions of the homeliving conditions of the home

Limitations of FindingsLimitations of Findings►Small sample sizeSmall sample size►““Selection bias” due to follow-up survey Selection bias” due to follow-up survey

completion ratecompletion rate►Cultural sensitivity of required measuresCultural sensitivity of required measures►Social desirabilitySocial desirability

Summary ISummary I► Substantial decreases in AOD use at all follow-ups Substantial decreases in AOD use at all follow-ups

and reduced impact of AOD use at both 6- and 12-and reduced impact of AOD use at both 6- and 12-month follow-ups.month follow-ups.

► Increasing improvements in high-risk behaviors at Increasing improvements in high-risk behaviors at each follow-up.each follow-up.

► Although decreases in enrollment in school, there Although decreases in enrollment in school, there was increased school functioning for youth still in was increased school functioning for youth still in school and increased engagement in work for other school and increased engagement in work for other youth. Qualitative data also suggests some youth. Qualitative data also suggests some improvement in academics.improvement in academics.

Summary IISummary II► While some increases in psychological/emotional While some increases in psychological/emotional

problems revealed, decreases in external behavior problems revealed, decreases in external behavior problems also revealed. By 12 months, problems also revealed. By 12 months, improvements shown in both internal and external improvements shown in both internal and external behavior.behavior.

► Increases in self-efficacy and cultural pride Increases in self-efficacy and cultural pride also shown at all follow-ups.also shown at all follow-ups.

►Although family functioning scales showed Although family functioning scales showed only slight improvements, qualitative data only slight improvements, qualitative data suggests some improvements.suggests some improvements.

► Improvements in living conditions and Improvements in living conditions and number of youth receiving various types of number of youth receiving various types of treatment.treatment.

Where Are We Now?Where Are We Now?►Next StepsNext Steps►BarriersBarriers

T. S. EliotT. S. Eliot

“We shall not cease from explorationAnd the end of all our exploringWill be to arrive where we startedAnd know the place for the first time.”

T.S. Eliot

Thank YouThank You

Senator Daniel Inouye

Mayor Harry Kim (Hawai`i County)

Billy Kenoi

Char Shigemura

All Hawai`i Treatment Providers and Educators

Richard Kim, Ph.D., The Catalyst Group, LLC

Mahalo Mahalo

The endThe end