Case management services for adolescent substance abusers: a program description.

A case management model for adolescent substance abusers whose problems are severe enough to warrant residential treatment is presented, based on the experience of a demonstration project. The five integral functions of case management (assessment, planning, linking, advocacy, and support) are described within the framework of each phase of an adolescent's treatment program (screening, residential treatment, and continuing care). Detailed descriptions of case management activities and the philosophy underlying case management are addressed. The integrated client tracking and program evaluation monitoring system developed for the case management project is described, and evaluation data are presented. Among the advantages case managers are able to offer to the entire treatment process include encouragement of family involvement in the youth's recovery; providing support; tracking substance abuse relapse episodes following treatment; connecting the youth with school, work, and community resources; and helping youth to fulfill legal obligations.

Advances in behavioral approaches to adolescent health care.

Behavior change professionals have developed treatment programs for a wide variety of health care problems affecting adolescents. Although a substantial data base of experimentally tested techniques exists for obesity, smoking prevention, and dysmenorrhea, much work remains in other areas. For example, the case studies reported on neurodermatitis and the survey work in teenage alcohol abuse must give way to systematic interventions employing group experimental designs. In addition, behavioral procedures should be compared to other treatments. Also, component analysis should be performed when multiple treatment strategies are used. Finally, strategies aimed at increasing the generalization of treatment, such as from classrooms to different community settings in substance abuse prevention programs and maintenance of treatment effects over long follow-up periods, are necessary. Only in this way will the efficacy of behavioral interventions for specific health problems be established. The leading causes of mortality among adolescents are due to accidents. Of the total number of deaths due to accidents, approximately 50% are attributed to motor vehicle accidents (National Safety Council, 1977). Many of these accidents are due to negligence, substance abuse, and, in general, immature behavior (Bakwin & Bakwin, 1972). In spite of a slow but consistent trend toward lower accidental deaths over time (National Safety Council, 1977), there still is a need for interventions designed to decrease risk-taking behavior, substance abuse, and carelessness in adolescents. Again, behavior change professionals might follow the example set by researchers who have begun to develop successful strategies for decreasing onset of cigarette smoking. These interventions and research methods, designed for use in schools, may provide a promising approach for addressing other kinds of prevention problems. It also seems appropriate to categorize cigarette smoking not only as a risk factor in the development of cardiovascular disease (Kuller, 1976), but also as a member of the risk-taking behaviors. Thus, procedures used to prevent cigarette smoking might also be adapted to prevent other kinds of risk-taking behaviors among adolescents. The work of McAlister et al. (1980), in preventing alcohol abuse as well as cigarette smoking by use of the same or similar procedures, is a case in point. Use of a procedure designed to train competency in refusing peer pressure has clear implications for reducing other risk-taking behaviors, such as reckless driving, drug abuse, and swimming and boating accidents.(ABSTRACT TRUNCATED AT 400 WORDS)