Evidence-Based Programs in S.C.

A number of evidence-based interventions for youth with Behavioral Health and Substance Use Problems are being used by select providers and organizations in South Carolina.

Adolescent Community Reinforcement Approach (A-CRA)

The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral intervention that focuses on prosocial activities and behaviors that support recovery. The program targets youth 12 to 22 years old with cannabis, alcohol and or other substance use disorders. A­CRA involves parents/caregivers in the treatment program. A-CRA is delivered in weekly sessions over an approximately 3-month period. Therapists establish goals for treatment and select from 17 procedures to guide the intervention, ranging from problem-solving skills to pro-social activities. Counseling Goals can include behavioral skills training, job skills training, social and recreational counseling, relapse prevention, and/or relationship counseling.

A-CRA is available through the SC Department of Alcohol and Other Drug Use (DAODAS) community-based service centers: http://www.daodas.state.sc.us/LocalResources.asp. Please visit these websites for additional details regarding A-CRA training: http://www.robertjmeyersphd.com; http://training.gaincc.org/.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) was developed in the 1980’s and was published as a manualized evidence based treatment in 1993 (Linehan, Cognitive behavioral treatment of borderline personality disorder). Since it was originally tested at the University of Washington, 36 randomized trials and numerous non-randomized trials have demonstrated DBT’s efficacy in treating out of control behaviors, including suicide, self-harm, other behaviors requiring medical and/or psychiatric hospitalization, treatment drop-out, substance abuse, binge eating, binging and purging and significant isolation.

Often, those behaviors (suicide, self-harm, substance abuse, etc.) are both a consequence of extreme emotion dysregulation and an attempt to avoid emotions. Although DBT was originally developed for adult populations, it is currently being used extensively in adolescent outpatient and residential treatment programs. To date, there have been numerous non-randomized trials, one randomized trial for DBT with suicidal adolescents and a multi-site randomized trial for DBT with adolescent clients with multiple, out of control behaviors including suicide and self-harm. Standard, comprehensive DBT includes a weekly multi-family (at least one caretaker is required to attend), 2 hour skills training group, individual therapy with a DBT psychotherapist for one hour per week, coaching via telephone, text or other technology as needed 24-hours-per day and participation by the DBT Skills Trainers and Psychotherapists in a once weekly DBT consultation team for providers.

Currently DBT individual psychotherapists and DBT programs can be certified through the DBT-Linehan Board of Certification. Although there are other certifying bodies, the DBT-LBC is the only certification that has been vetted by the DBT treatment developer, Marsha Linehan and a group of DBT researchers and experts. For information on DBT training, two of the organizations that provide training accepted by the certifying board are:

High Fidelity Wraparound

High Fidelity Wraparound is a care planning process that is integrated, multi-agency, and community-based. This care planning process is grounded in a philosophy of unconditional commitment to support families to safely and competently care for their children. The single most important outcome of the Wraparound approach is a child thriving in their home with their family and maintained by normal community services and supports.

Wraparound is a planning process that follows a series of steps to help children and families who have complicated needs. The Wraparound process also helps make sure children and youth grow up in their homes and communities and works to bring people together from different parts of the whole family’s life. With help from one or more facilitators, people from the family’s life work together, coordinate their activities, and blend their perspectives of the family’s situation.

The South Carolina Continuum of Care uses this approach to support the youth that they serve. For more information, please visit the SC Continuum of Care website at: http://coc.sc.gov/

For additional information on the High Fidelity Wraparound process, please visit: https://msp.scdhhs.gov/pcsc/site-page/high-fidelity-wraparound

Incredible Years Series (IY)

The IY Series is designed to increase social and emotional competence and prevent, reduce, and treat behavioral and emotional problems in children up to twelve years of age. IY interventions are group-based interventions and include a parent training program, a child program, and a teacher training program.

The child program consists of 45 minute sessions delivered twice weekly for consecutive years. Small group treatment is also provided in 2 hour sessions for 18-22 weeks.The parent training program consists of 2-3 hour sessions over the period of 12 to 20 weeks. The teacher training program includes 42 hours of monthly training delivered over the course of 6 days. Please visit the website for additional details: http://incredibleyears.com.

Modular Approach to Therapy for Children with Anxiety, Depression, Traumatic Stress, and Conduct Problems (MATCH-ADTC)

MATCH-ADTC is an evidence-based approach to treatment for youth ages 8-13 experiencing anxiety, depression, traumatic stress, and/or conduct problems. This modular form of treatment is designed to be flexibly applied in a manner best suited to client and family needs. Each module contains elements of common practices that have been demonstrated in research to be effective; the order in which modules are used is determined by the presenting concerns of the client and family.

MATCH-ADTC includes guidelines for intervention delivery as well as resources that can be used directly with families in treatment delivery; a web-based system is available for tracking client outcomes. The MATCH-ADTC protocol are directly available (see http://www.practicewise.com/portals/0/MATCH_public/index.html).

Becoming a MATCH Therapist requires participation in a MATCH Direct Service Workshop and completion of post-training requirements. Additional training to become a MATCH Supervisor is also available from Practicewise.

Multisystemic Therapy for Juvenile Offenders (MST)

MST for juvenile offenders is an intensive home and community based intervention designed to reduce antisocial behavior and other clinical problems for youth involved in the juvenile justice system for serious offenses. Thus, the typical target population is for youth ages 12-17 with a significant history of arrests. Youth with severe conduct problems or substance abuse may also be served using MST. MST is designed to be delivered in natural environments where influences on antisocial or problem behaviors occur: home, school, neighborhood, and the community. The goal of MST is to reduce antisocial behavior (delinquency and recidivism) and to prevent out of home placement. The intervention typically lasts approximately 4 months with therapists having frequent contact with the youth and family and being on call 24/7 during the intervention period.

A brief history of MST in South Carolina:

The Family Services Research Center (located at the Medical University of South Carolina) was the nexus of the research trials on MST. These trials provided the evidence that MST was an effective treatment model for youth with conduct problems. MST offered the youth and families in South Carolina an alternative to juvenile detention – providing evidence-based treatment in the communities where the youth and family lived. MST was successful at keeping youth with at home, in school or working, and out of trouble with the law.

As the research trials ended, South Carolina began a state-wide initiative to support the use of evidence-based practices – and one of those practices was MST. Funding for this initiative came from Mental Health Block Grants, State Funds, Medicaid, and Department of Juvenile Justice. At its peak, there were seven MST teams operating in the state – all at Community Mental Health Centers. These included Columbia Area, Lexington County, Orangeburg, Pee Dee, Catawba, and Waccamaw. As time passed, the process for funding the MST changed – and some teams were forced to shutter their MST teams.

Over that past 14 years, the MST programs in these different communities (operating at different times) have served over 1100 youth and families – with 87% living at home, 88% in school or working, and 88% not having been re-arrested (at case closure).

MST is being provided at select Community Mental Health Centers in our state. (http://www.state.sc.us/dmh/center_inpatient.htm)

Please see the MST website (http://mstservices.com) for details including training and service delivery locations.

Download more information about MST.

Parent-Child Interaction Therapy (PCIT)

PCIT is a clinic-based therapy program for children 2-7 years old with conduct disorder. Parents are taught skill building and positive relationship strategies. The aim of the program is to increase the pro-social behaviors and strengthen family functioning.

Therapy involves 2 phases of intense direct coaching which usually requires about 15 sessions. The first phase, Child-Directed Interaction, is focused on improving the parent–child relationship and attending to positive child behavior. The second phase, Parent-Directed Interaction focuses on providing parents with skills for managing misbehavior.

PCIT is currently being provided by select South Carolina Community Mental Health Centers in South Carolina: http://www.state.sc.us/dmh/center_inpatient.htm as well as by several additional organizations and providers. Please see the PCIT website for further details on the intervention: http://www.pcit.org/.

Strengthening Families Program 6-11

Strengthening Families is a 14-week multiple group program designed to improve parenting skills, children’s social skills, and family life skills. The program targets high risk families and children in the 6-11 year old age range and is being implemented in South Carolina through the Children’s Trust (https://scchildren.org/). The program is also available for families of children ages 3-17; visit the Strengthening Families Program website for additional details: http://www.strengtheningfamiliesprogram.org/.

Trauma Focused CBT (TF-CBT)

TF-CBT is designed to treat children and youth who are victims of sexual abuse or who have been exposed to trauma. This method is used to treat PTSD and related emotional and behavioral problems for youth ages 3-18. Both individual and parent-child sessions are central to this therapy. Parallel child and parent therapy sessions are given each week with psycho education, parenting skills, regulation strategies, and cognitive coping and processing being discussed.

The program typically runs for 12-16 sessions, with one one-hour session each week. For additional information on TF-CBT in South Carolina, please visit the website of Project Best at the Medical University of South Carolina (MUSC): http://academicdepartments.musc.edu/projectbest.

Triple P Positive Parenting Program (Triple P)

Triple P is a suite of parent-only interventions designed to improve parenting confidence and competence on a broad scale. Interventions of varying levels of intensity can be delivered in home or community settings and range from single session individual or group meetings to 8-14 week interventions. Using a self-regulatory framework, parents are taught a wide range of strategies for promoting desirable behavior and for managing misbehavior.

The Triple P System is ideally designed to be delivered as a population-level approach, in which all families of children ages 0-17 can access the level and type of support that best suits their needs. See the website for further details: www.triplep.net. Please also visit the website of the Children’s Trust for details on Triple P in South Carolina: https://scchildren.org/.