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The author describes innovative school programs for students at risk for alcohol and other drug problems. Training at the University of Washington with 1,000 school personnel and a meta-analysis of current research has lead to a synthesis of Student Assistance and Case Management technology. Model programs in Puget Sound school

districts involve school, families, community agencies, and youth in efforts to create school environments free of substance abuse and violence.

Since the United States Congress enacted the Education for All Handicapped Children Act in 1976, an entire service delivery system has developed to aid disabled students. A decade later, in 1986, Congress passed Public Law 99-570, the Drug-Free Schools and Communities Act (DFSC). Over the last seven years, this act has stimulated the development of new services for at-risk students, much as earlier legislation did for the handicapped.

The DFSC Act established "Drug-Free Schools and Campuses Regulations" (34 CFR, part 86, subpart 86.200) to guide the development of prevention programs. These are key legislative mandates that schools must address:

1. Provide alcohol and other drug-prevention programs from early childhood level through grade 12. Schools re-

28.JEB-P

sponded quickly to this mandate, and alcohol and other drug-abuse prevention curricula have proliferated (Klitzner, 1987). The Department of Education provided guidelines for selecting materials and training staff.

2. Establish student codes of conduct with clear disciplinary consequences for use or possession of alcohol and illicit drugs on school premises or at school activities. School districts have attached sanctions for substance use and possession to existing codes of conduct. Model disciplinary policies were widely disseminated (Anderson, 1986).

3. Use student drug and alcohol counseling programs as a component of education and/or disciplinary reentry contracts. This mandate for rehabilitative counseling clearly fell outside of traditional school services. Government

regulations called for school-community-family partnerships (Bennett, 1986), but schools were provided very few specific methods for accomplishing this task.

The Department of Education designated five regional training centers to disseminate alcohol and other drug-abuse prevention programming to schools. These regional centers have compiled research that has shaped an extensive national training system.

THE SEARCH FOR NEW APPROACHES

The University of Washington Center for the Study and Teaching of At-Risk Students conducted a meta-analysis of the DFSC research projects conducted between 1989 and 1991 (Moore, 1992). The center also has drawn insights from more than 1,000 school district staff who participated in focus groups during on-campus training activities.

Two interconnected service models for assisting students atrisk of, or involved in, substance abuse emerged in this review:

The interdisciplinary "case management model" and the "student assistance model," which often are used in combination.

The "Case Management Model" (Rothman, 1992) was developed to meet the need for holistic service planning involving schools with other social, health, and community service agencies. Unlike special education programs based mainly within schools, case management involves interdisciplinary programs where many (if not most) services are provided by community agencies. The technology of case management is designed to make these interdisciplinary systems operate smoothly and efficiently.

The "Student Assistance Model" (Moore and Forster, 1993), like the Employee Assistance approach for adults, operates from the premise that persons abusing alcohol or other drugs are likely to resist receiving help because of "problem denial" (Kinney and Leaton, 1987). Whether substance abuse is present in the family, among peers, or isolated to the student, self-referral is unlikely. Student Assistance Program methods penetrate problem denial, motivate referral into a service plan, and maintain ongoing involvement with the service system.

Certain principles consistently underlie effective programs that combine interdisciplinary case management technology with student assistance programs. This is what we have learned about these programs:

Following are five structural principles which undergird successful programs for students at-risk of, or involved in, substance abuse.

1. Clear school district policies. Problems in student functioning are viewed as a school responsibility. Serious health and safety issues (for example, substance use and physical aggression) are immediately addressed from two perspectives: a) emergency expulsion; and b) a health

and social services plan that, when possible, brings the student back into the school system. This response mirrors the DFSC mandate. Often an interdisciplinary task force or technical review panel develops these policies. Involving parents and community agencies in the task force broadens program advocacy.

2. Site-based student assistance teams. These teams serve students whose identified behavioral problems place them at risk for substance abuse and/or school failure. These teams are analogous to the IEP team in special education, which matches students' needs with school and community resources. The student assistance team initiates on-campus interventions, which usually include group counseling. The team also locates community counseling, health, and social services to augment services available at the school. Finally, the team provides faculty with a student referral process and often has overlapping membership with the special education team.

3. The student assistance case manager. In order to coordinate community services with school services, at least one person from a community agency is brought into the system. This individual typically provides assessment and service planning and often is called the student assistance case manager. In intervention strategies, it is necessary for responsibility to be delineated clearly. However, case management is a team process, and other personnel also play pivotal roles in serving referred students.

4. A standardized service menu. There must be a range of options for developing service plans, particularly when the case management student assistance program will be used for disciplinary referrals. This menu of possible interventions is often written directly into the facilitating policies (Moore, 1992).

5. A standardized evaluation process. A method must be established to match client needs to related resources. Because problem denial is likely with student and family substance abuse, a sophisticated evaluation may be required. Standardized evaluation using a multiple gates approach might include these steps:

a. Identify a problem using a brief initial screening test with a follow-up interview.

b. Match the problem to a service employing a comprehensive diagnostic test and a 60-minute clinical interview.

c. Develop a comprehensive treatment plan through multiple assessments and ongoing student and family contacts.

The student assistance case management model incorporates these five principles to provide a range of innovative services for students and families. Table 1 summarizes the service activities identified in our study.

FALL 1993 .... 29

Table 1

Case Management Activities (Rothman, 1992)

1. Family Identification and Outreach: Identify families needing services and reach out to those who do not seek help.

2. Assessment: Provide evaluation of youth and family including social supports, service needs, and attitudes toward service.

3. Service Planning: Develop individualized service plan including steps for service delivery, monitoring, and evaluation.

4. Service Linkage and Coordination: Connect families with services ensuring that agency interactions benefit families.

5. Follow-up, Monitoring, and Evaluation: Assure that the family is receiving the expected and appropriate services.

6. Advocacy: Work to advance the best interests of the family in meeting its needs.

7. Family Mentoring Self-Management: Families are encouraged to develop self-efficacy skills and assume their own case management.

THE PUGET SOUND PROGRAMS IN ACTION The U.S. Department of Education awarded a three-year demonstration grant to study the Case Management Student Assistance Program in four Puget Sound (Washington) area school districts with a combined enrollment of 59,000 students and a 23% minority population. One district was rural, one was urban, and two were urban-suburban. The University of Washington's Center for the Study and Teaching of AtRisk Students provided the technical assistance; and its associate community service agency, Olympic Counseling Services, provided agency personnel to all four districts. Approximately 3,000 students were referred into the Case Management Student Assistance Program each year. The following discussion summarizes the operation of the Puget Sound programs.

Each of the four school districts selected referral policies from the University of Washington's Mastery Educator Institute's manual (Moore, 1992), which corresponded to the DFSC mandates. In addition to disciplinary referrals for substance use, cases are referred to the Student Assistance Team in such problem situations as:

1. a health care concern, corroborated by the school nurse,

2. an acute social or family problem, corroborated by the school counselor, or

3. behavior indicating a chronic maladaptive response to stress, corroborated by the classroom teacher.

30JJ..JEB-P

Besides using standard behavior checklists (for example, Anderson, 1986; Newsam, 1992), teachers look for the five patterns of behavior summarized in Table 2. These patterns indicate high levels of personal discomfort and are predictive of both school failure and substance use.

Each school assembled a student assistance team that represented the potential referral sources: school administrator (discipline), teacher representative (classroom behavior profile), school counselor (family and emotional crisis), and nurse (health problems). In some schools without a full-time counselor or nurse, other personnel represent these referral areas. Support groups in each school are operated by trained faculty or para-professionals. The student assistance teams contacted various community agencies to augment these oncampus groups.

The next step in the process was to develop a service menu for developing individualized student plans see Table 3. This comprehensive list of possible services includes schoolbased groups and mentoring activities, agency-based youth development and treatment programs, family empowerment and counseling programs, and other services individualized to student and family needs.

Table 2

Maladaptive Stress Response Profiles (Chandler, 1986)

Profile Description

Acting-Out Student Socially non-conforming, aggressive to others

Over-Active Student Impulsive, off-task, inability to concentrate or maintain control, immature

Passive-Aggressive Student Fails to meet adult requests, rejects standard goals, forms alternate internal reward system

Repressive Student Over-involved, low level

of relaxation and leisure, compulsive behavior with low recognition of feelings

Dependent Student Withdrawn, passive, little social interaction, resignation

Developmental Risk

Juvenile delinquency, conduct disorder

Attention deficit disorders in adolescence, social skills delay

Narcissistic, potentially exploitive, may progress to an acting-out profile

Anxiety or panic disorders, eating disorders, and other obsessive-compulsive behavior patterns

Depression, thought disorders, dysfunctional intimate relationships

SUMMER 1993 JJ.. 30

Table 3

Menu of Student Assistance Services

I. School-Based Services

Diagnostic Profile

a. "Boundaries" group

for children of alcoholics home

Risk profile and alcoholic

b. "Transitions" group

for divorce or remarriage

Risk profile and family change

c. "Pass insurance" group for students in conflict with school rules

Passive-aggressive, acting

out, and overactive risk profiles

d. "Good grief' group

for students experiencing dependent, repressive profiles

e. "Candle" group

for sexual victimization

Any student experiencing serious loss, particularly death

f. "Insight" group

for students evaluating their own substance use or risk (can also be agency based)

g. "Bridges" group

for students in or returning from community substance use treatment. (can also be agency based)

h. Individualized mentoring

Any sexually victimized student

Students who are too defensive to evaluate

Students who are substance abusers or are chemically dependent

Dependent risk profile; others as available

II. Agency-Based Services

Diagnostic Profile

1. "Adolescent Development" group needing youth who have misused

j. Young Men's or Women's groups for youth or their partners

k. Intensive Outpatient workshops Workshops for substance-abusing or chemically dependent youth

1. Residential treatment

for serious mental health and/or substance use disorders

Families needing information, for youth and families intensive prevention education substances

Substance-abusing youth

disengaging from the substance abuse subculture

Substance abuse or chemical dependency diagnosis

Middle-stage chemical dependency or multiple diagnoses

m. Family counseling

n. Family Empowerment Program.

Multifamily support group offering

parent training, babysitting, and free meals from community service/church groups

o. Medical, nutritional, housing, services.

All risk profiles and substance use disorders All risk profiles and substance use disorders

Site specific, individualized to family needs and other sociallhealth services.

. .. ", ....

FALL 1993 ... 31

When students first are referred to the program, the student assistance case manager uses a standardized screening to identify risk profiles and substance use problems. The results of this screening help determine which interventions from the service menu will be used.

The students' risk profiles are identified through Chandler's Stress Response Scale (1986). Initial substance use disorders are identified by a group of items excerpted from the Client Substance Index (Moore, 1989), used by the National Center for Juvenile Justice as a screening instrument (Thomas, 1992). Measurements were keyed to one of three diagnostic levels:

Level I: Substance MISUSE. Developmental delay due to using substances in a culturally inappropriate manner (WHO, 1957).

Level II: Substance ABUSE. Person continues substance use despite recurring threats to physical or psychological wellbeing (APA, 1987).

Level III: Chemical DEPENDENCY. Substance abuse with the addition of loss of control and/or tolerance (APA, 1987).

When the service plan includes the use of community agencies, an agency specialist completes a more extensive evaluation for planning treatment. The school counselor or school social worker monitors the on-campus components of the service plan, and the student assistance case manager monitors the overall plan and facilitates the community service components.

VISION FOR THE FUTURE

Initial data confirm the operational effectiveness of Case Management Student Assistance Programs. The four participating Puget Sound districts represent only 30 % of the student population in the training cooperative, but they identified and referred 62% of all students who received services in 1990-1991.

A focus group of school, community, and university staff conducted a formative evaluation of the program to identify areas for further refinement. The major identified need for staff skills was the area of multicultural competence. Five other areas of projected need for staff development were:

• self-care/wellness planning for professionals

• confidentialityllegal issues

• group facilitation/group work

• supervision and supervisory process

• staffing for difficult/complex family situations.

One district (Tacoma Schools) involved school, community, university, and agency leaders in a strategic planning process. The vision statement prepared by this group can serve as a guide for all schools starting similar programs:

"We envision a systemic change inclusive of students, school personnel, families, and communities working in partnership

32 .... JEB-P

to advocate, cooperate, and coordinate services for the community's children and youth. This effort will empower students to attend school ready to learn, thereby enabling them to contribute to society with respect for diversity and hope for the future."

David P. Moore is Executive Director of Olympic Counseling Services in Tacoma, Washington, and a research associate with the University of Washington. His Ph.D is in counseling psychology, and he is a Certified Chemical Dependency Counselor III. For further information, contact the author at Olympic Counseling Services, 1215 Regents Blvd., A & B, Tacoma, WA 98466-6032. Fax (206) 565 4940.

BIBLIOGRAPHY

American Psychiatric Association (1987). Diagnostic and statistical manual, third edition. Washington, D.C.: APA.

Anderson, Gary L. (1987). When chemicals come to school: The student assistance program model. Milwaukee, WI: Community Recovery Press.

Benishek, L.A. (1989). A summary of adolescent substance abuse assessment instruments. Health Care Study Project. Lansing, MI: Michigan State University, Department of Psychiatry.

Bennett, William J. (1986). What works: Schools without drugs. Washington, D.C.:

U.S. Department of Education.

Chandler, L.A. (1986). The stress response scale. Pittsburgh, PA: University of Pittsburgh, The Psychoeducational Clinic.

Hawkins, J.D., Lishner, D. and Catalano, R.F. (1985). Childhood predictors and the prevention of adolescent substance abuse. In: Jones, C.L. and Battjes, R.J. (Eds.). Etiology of drug abuse: implications for prevention. NIDA Research Monograph No. 56, DHHS Publication (ADM) 85-1335, Washington, D.C.: U.S. Government Printing Office.75-126.

Kinney, Jean and Leaton, Gwen (1987). Loosening the grip, third edition. SI. Louis:

Times Mirror/Mosby College Publishing.

Klitzner, M.D. (1987). Report to Congress on the nature and effectiveness of federal, state, and local drug prevention/education programs. Part 2: An assessment of the research on school-based prevention programs. Prepared for U.S. Department of Education, Office of Planning, Budget and Evaluation.

Moore, David D. (1989). The client substance index. Tacoma, W A: Olympic Counseling Services.

Moore, David D. (1992). Mastery educator institute for K-I2 drug and alcohol programs. Seattle, WA: University of Washington's Center for the Study and Teaching of At-Risk Students.

Moore, David D. and Forster, Jerald R. (1993). Student Assistance Programs: New approaches for reducing adolescent substance abuse. Journal of Counseling & Development, Jan-Feb;7I:326-329.

Newsam, Barbara Sprague (1992). Complete Student Assistance Program handbook:

Techniques and materials for alcohol/drug prevention and intervention in grades 7-12. West Nyack, NY: The Center for Applied Research in Education.

Rothman, Jack (1992). Guidelines for case management: Putting research to professional use. Itasca, IL: F.E. Peacock Publishers, Inc.

Seligman, Milton (Ed.)(1975). The family with a handicapped child: Understanding and treatment. Orlando, FL: Grune & Stratton, Inc.

Thomas, Doug (1992). Implementation manual: Substance abuse screening protocol. Pittsburgh, PA: National Center for Juvenile Justice.

U.S. Department of Education (1992). Progress report and year three continuation grant proposal re: USDOE Grant No. S20lCI2560 entitled "Washington State coordinated service initiative for at-risk youth and families" (CFDA No. 84.201). Seattle, WA:University of Washington's Center for the Study and Teaching of At-Risk Students.

World Health Organization (1957). Producing drugs: Seventh report. W.H.O. Technical Report Service, 116:9.

Wright, B.D. (1991). Rasch analysis for all two-facet models: Person measurement, item & step calibration, person & item fit analysis. Chicago, IL: Mesa Press.

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