Researchers have questioned whether the addictions treatment infrastructure will be able to deliver high quality care to the large numbers of people in need. In this context, the Robert Wood Johnson Foundation (RWJF) and Center for Substance Abuse Treatment (CSAT) created a nationwide network to improve access and retention in treatment. Applicant agencies described results of an admissions process "walk-through." This qualitative study used narrative text from 327 applications to RWJF, focusing on admissions-related problems. We developed and applied a coding scheme, then extracted themes from code-derived text. Primary themes described problems reported during treatment admissions: poor staff engagement with clients, burdensome procedures and processes, difficulties addressing the clients' complex lives and needs, and infrastructure problems. Sub-themes elucidated specific process-related problems. Though findings from our analyses are descriptive and exploratory, they suggest the value of walk-through exercises for program assessment and programlevel factors that may affect treatment access and retention.

Implementation of effective substance abuse treatment programs in community settings is a high priority. The selection of a proven cost-effective model is a first step; however, difficulty arises when the model is imported into a community setting. The Center on Substance Abuse Treatment selected a brief substance abuse treatment program for adolescents, the MET/CBT-5 program, determined to be the most cost-effective protocol in the Cannabis Youth Treatment trial, for implementation in two cohorts of Effective Adolescent Treatment grantees. A qualitative investigation of the protocol implementation with nine sites in the second cohort chronicled adaptations made by grantees and prospects for sustainability. The study found that agencies introduced adaptations without seeming to be aware of potential effects on validity. In most sites, sessions were lengthened or added to accommodate individual client needs, address barriers to client participation, and provide consistency with current norms of treatment. Implications for fidelity of future implementation projects are addressed.

Gender-specific attributes and socialization influence the development of depression in adolescents, but little research has addressed adolescents' views on this topic. We interviewed 22 adolescents regarding their views on the impact of sex and gender role influence in depression. Male and female participants: (a) described societal expectations and cultural messages, including high and conflicting expectations for girls, and consistent messages of being "macho" and unemotional for boys, as related to adolescent depression; (b) perceived physical changes during puberty as contributors to depression for girls, but not for boys; and (c) associated loneliness and rejection with depression for both boys and girls. We discuss implications for treatment that include directly addressing gender roles with depressed adolescents.

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues impacted treatment delivery. Programs report organizational change efforts with implications for future process improvement initiatives.

BackgroundAdaptations to evidence-based substance abuse treatment programs may impact their effectiveness. A qualitative study of MET/CBT-5 implementation in community agencies treating adolescents found that the majority of the agencies made adaptations and that the most frequent adaptation was to provide more than five treatment sessions.MethodsBaseline and outcome data from SAMHSA’s Effective Adolescent Treatment demonstration were analyzed to assess associations between length of treatment, client characteristics, and outcomes at three months.ResultsAdolescents who received more or less than the protocol length of 5 sessions were less likely to be discharged to the community than those who received the 5 session protocol. Those who received more than five sessions were more likely to have higher severity scores at intake but almost 50% of those with more than five sessions had low intake severity scores. Clients who received less than five sessions tended to have lower severity scores than clients who received more than five sessions.ConclusionsLength of treatment tended to vary by site rather than severity of substance problems or frequency of use. There was no significant improvement of substance abuse problems or decrease in frequency of use with longer treatment. Implementation of the MET/CBT-5 component of the Cannabis Youth Treatment trial in the EAT project illustrates the difficulty of adherence to an evidence based protocol in the field.