Designing a short-term residential withdrawal service delivery model for adolescent substance abuse

The Adolescent Drug and Alcohol Withdrawal Service (ADAWS) was set up as a pilot project in March 2001 in Brisbane, Queensland to trial a new treatment intervention for adolescent substance abusers. Short-term residential withdrawal services for adolescent substance abusers such as ADAWS are a relatively new treatment option in Australia, and there has been no research conducted into the design of such services. Therefore, the aim of this thesis was to critically examine the design of a service delivery model for a short-term residential withdrawal service for adolescent substance abuse located in Brisbane at the Mater Children's Hospital.

The author performed the dual roles of Team Leader of ADAWS and principal researcher for this thesis.

As the result of an identified need to provide more treatment options to adolescent substance abusers in Brisbane, a working party was formed to develop a proposal for the design and implementation of a residential withdrawal service for adolescent substance abusers. The proposal was informed by the available literature reported in Chapter 2, which suggested that causes and correlates of adolescent substance abuse were complex, and young people from at-risk populations were more likely to abuse substances at a higher rate than adolescents in the general population. Adolescents require different treatment to adults, and there were significant barriers that prevented young people from accessing adult drug treatment services. The literature also supported the use of residential services for adolescent substance abusers, even though very few exist in Australia. A review of gaps in services for adolescent substance abusers in Brisbane was presented, providing evidence that there are no withdrawal services available, and young people do not successfully access hospital-based detoxification services predominately used by adults. A detailed description of ADAWS was presented in Chapter 3 following the literature review.

The research methodology was outlined in Chapter 4. The methodology involved the use of both quantitative and qualitative methods. Staff were surveyed using an indepth Staff Questionnaire and the Community Orientated Program Scale (COPES}. Staff also participated in two Service Reviews conducted by external facilitators. Young people's experiences of the service were assessed via an in-depth Client Interview conducted prior to their discharge from ADAWS. The data collection took place over an 18 month period.

Based on the experiences of staff and adolescents, the results identified a number of key features of the ADA WS model for a short-term residential withdrawal service for adolescent substance abusers, and these were presented in Chapter 5. In Chapter 6 an analysis of the research questions was conducted in light of the reported results. Overall these findings described the conceptual attributes of service delivery model rather than the issues related to day-to-day management of service delivery.

There was a high level of agreement between staff and young people about the design of the ADA WS model of service. The philosophical orientation of ADA WS was identified and described by staff as being youth-focussed and holistic, with the purpose of providing safe residential care for young people withdrawing from substances. Young people were positive in their responses about the appropriateness of this philosophical approach.

The two main treatment components were identified and described in detail. The first related to program environment, specifically the of use a residential setting. There was a high level of agreement among staff and young people that a non-institutional setting created a developmentally appropriate environment that was acceptable to young people and able to meet many of their basic needs.

The second treatment component related to specific program characteristics that were considered to be important features of the model of service. This included the use of a relationship-based approach by staff to establish supportive connections with young people. The inclusion of a range of recreational activities was another important characteristic of the service, and staff and young people believed the availability of recreational activities should be expanded. A focus on client-directed outcomes in the case management process was necessary. Working inclusively with a young person's support networks such as family and other service providers was also an important feature of the service model. Results indicated there were some differences between the staffs ideal perception of a residential withdrawal service, and their actual perception of ADAWS. Evidence for effectiveness of the ADAWS model of service was cited in relation to strengths identified by staff and young people, while weaknesses of the program that interfered with effective service delivery were also discussed.

The future direction of ADAWS was described. It involved the availability of follow-up support provided by ADAWS, along with the establishment of new services to provide a continuum of treatment options for adolescent substance abusers after they had completed withdrawing from substance abuse.

Conclusions and implications of the thesis were considered in Chapter 7. The model of service delivery designed during the ADAWS pilot project was presented as making a new contribution to the field of treatment services for adolescent substance abusers. Limitations of the study in relation to the sample of young people and dual role of the author as Team Leader and principal researcher were discussed. Implications for ongoing service delivery were described. These included the introduction of new treatment options such as a medium-term residential rehabilitation program and a non-residential community-based follow-up program.

Further research was suggested in relation to measuring outcomes for young people who were clients of short-term residential withdrawal services like ADAWS. Another area of proposed research involved investigating the circumstances around unplanned departures from the program by young people, with the aim of improving retention rates for those young people at risk of leaving the program early.