ENCOMPASS is an evidence-based integrated intervention for adolescents and young adults with co-occurring substance abuse and mental health problems that can be feasibly implemented in university or community-based mental health or substance treatment settings.
ENCOMPASS is compatible with existing treatment program components, but is ideally implemented as a "front-end" treatment for all youth with co-occurring psychiatric and substance use disorders.
The core components of ENCOMPASS are:
- Comprehensive Diagnostic Evaluation for Psychiatric and Substance Use Disorders.
The initial clinical and diagnostic evaluation and clinical assessment is conducted by a psychiatrist or other qualified physician or prescribing nurse practitioner with a CBT therapist. The joint clinical evaluation is an important key to coordination and integration of psychiatric and substance treatment at the beginning and throughout the 16 week course of treatment.
ENCOMPASS utilizes a standard assessment battery that includes:
- Kiddie Schedule for Affective Disorders and Schizophrenia for School-aged Children (KSADS): lifetime and current DSM IV substance and psychiatric diagnoses (can be modified/adapted by clinician interviewers for developmental appropriateness across a broad range of adolescents and young adults)
- Other standard measures to monitor clinical progress and target symptom response are utilized based on the presence of specific co-occurring psychiatric disorders as determined by KSADS including:
- ADHD: DSM IV ADHD Symptom Checklist
- Major Depressive Disorder: Childhood Depression Rating Scale – Revised (CDRS-R)
- Anxiety Disorders: Multidimensional Anxiety Scale for Children (MASC)
- Timeline Follow Back (TLFB): assesses self-reported past 28 day nicotine, alcohol, drug use at baseline and each month of treatment to monitor change in substance use/abstinence
- Urine Drug Screening (UDS): On-site urine drug screening is performed throughout treatment as a biological measure of substance use and validity check for self-reported drug use. The UDS is also used to determine the number of weekly draws earned from the incentives "fishbowl" (described below) for which the patient is eligible each week.
- Individual Cognitive Behavioral Therapy (CBT)
The outpatient, manual-standardized CBT component of ENCOMPASS is one of the evidence-based treatment modalities for adolescent SUD with proven effectiveness. Weekly individual CBT sessions may be combined with up to 2-4 family sessions as clinically indicated. The CBT targets substance abuse and addresses psychiatric symptoms that are often triggers for substance use/relapse (e.g. depressed mood; anxiety, impulsivity, frustration intolerance).
- Motivational Incentives ("fish bowl")
The use of motivational incentives is one of the most robust empirically supported modalities used to enhance treatment compliance and abstinence in the treatment of both adolescents and adults with substance use disorders. ENCOMPASS utilizes motivational incentives to reinforce both treatment compliance and abstinence. Patients draw chips from a "fishbowl" labeled with positive verbal reinforcement or the chance to select a small or larger prize from a prize cabinet. Patients earn one draw each week they attend their scheduled CBT session. Patients earn an additional draw from the "fishbowl" when they produce their first drug-free urine (determined by a rapid test urine drug screen (UDS). The number of drawings increases for each consecutive week they produce a negative UDS. If the string of negative UDS is broken by a positive drug screen, they may again earn the right to draw from the "fishbowl" for the next drug free urine produced, again increasing the number of draws with consecutive negative weekly urine drug screens. The average dollar amount of prizes earned during 16 weeks of treatment is approximately $135. The administrative and actual costs to maintain the motivational incentives component are covered by treatment fees.
- Engagement in Pro-social Community-Based Activities
By the time adolescents or young adults enter drug treatment, they often have few non-substance using peers and have become socially marginalized from pro-social activities that do not involve drugs or alcohol. An important component of ENCOMPASS is to involve young patients in pro-social activities that enhance self-esteem and mastery and strengthen affiliation with non-drug using peers and positive adult role models. Involving youth in such activities early in treatment facilitates recovery and maintenance of treatment gains and augments continuing care resources and treatment services. The ENCOMPASS Consulting Team works closely with treatment programs to identify a "menu" of existing community-based partners and resources offering a variety of appropriate activities with the aforementioned characteristics (e.g. principle-based martial arts, junior golf programs, activities offered through community recreation centers, etc.)
- Weekly treatment review and clinical supervision
Close clinical coordination, management, and evaluation of treatment progress proceeds on three levels:
- ENCOMPASS Consultants and the site clinical team (the medical director, CBT therapists and administrative coordinator) meet weekly on a conference call to review cases, medication management issues, and implementation issues
- The clinic medical director and the CBT therapists meet in a brief separate weekly review of all cases
- The CBT therapists receive additional monthly clinical supervision and fidelity adherence from the ENCOMPASS Consultant Team CBT trainer/supervisor