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Assertive Continuing Care (ACC)
The Adolescent Community Reinforcement Approach (A-CRA) is a developmentally-appropriate behavioral treatment for youth and young adults 12 to 24 years old with substance use disorders. A-CRA seeks to increase the family, social, and educational/vocational reinforcers to support recovery. This intervention has been implemented in outpatient, intensive outpatient, and residential treatment settings. A-CRA includes guidelines for three types of sessions: individuals alone, parents/caregivers alone, and individuals and parents/caregivers together. According to the individual?s needs and self-assessment of happiness in multiple life areas, clinicians choose from a variety of A-CRA procedures that address, for example, problem-solving skills to cope with day-to-day stressors, communication skills, and active participation in positive social and recreational activities with the goal of improving life satisfaction and eliminating alcohol and substance use problems. Practicing new skills during sessions is a critical component of the skills training used in A-CRA. Every session ends with a mutually-agreed upon homework assignment to practice skills learned during sessions. Often these homework assignments include participation in pro-social activities. Likewise, each session begins with a review of the homework assignment from the previous session.
The Community Reinforcement Approach (CRA) is a behavioral treatment for adults with substance use disorders. CRA seeks to increase the family, social, and educational/vocational reinforcers to support recovery. According to the individual?s needs and self-assessment of happiness in multiple life areas, clinicians choose from a variety of CRA procedures that improve social skills, coping with day-to-day stressors, couples relationship skills, and increasing participation in positive social and recreational activities with the goal of improving life satisfaction and eliminating alcohol and substance use problems. Practicing new skills during sessions is a critical component of the skills training used in CRA. Every session ends with a mutually-agreed upon homework assignment to practice skills learned during sessions. Likewise, each session begins with a review of the homework assignment from the previous session. The goal of CRA is to make life in recovery more rewarding than using alcohol and other drugs.
CRA or A-CRA procedures also are used as part of Assertive Continuing Care (ACC), which includes home visits and case management following a primary treatment episode for substance abuse or dependence. ACC is primarily used as continuing care. As such, it stresses rapid initiation of services after discharge from residential, intensive outpatient, or regular outpatient treatment in order to prevent or reduce the likelihood of relapse. In clinical trials research, ACC was evaluated for a 90-day period, but it can be extended for additional weeks or months as needed.
An initial four-day initial training workshop is designed for clinical staff who plan to implement A-CRA/ACC with adolescent treatment participants and/or provide clinical supervision of A-CRA/ACC cases, as well as those in support and administrative roles for programs implementing A-CRA/ACC. The training uses demonstrations to model how A-CRA and ACC are used with adolescents and their families, and participants have an opportunity to practice procedures. Clinical and supervisor trainees are required to participate in a series of coaching calls and reviews of their clincial/supervisory session recordings as they progress through a certification process. See Certification in A-CRA, CRA, and ACC below.
A-CRA Manual: 255-page manual that outlines 19 individual procedures for adolescents and their parents or caregivers and provides detailed instruction on how to help the client learn more effective coping skills.
A-CRA Manual in Dutch: translated by Novadic-Kentron in the Netherlands
A-CRA Manual in French: translated by Dave Smith Youth Treatment Centre with the financial assistance of the Champlain Local Health Integration Network in Ottawa, Canada
A-CRA Manual in Portuguese: translated by Maria Cristina S. Dias, with assistance from Lily Anderson, and supported by Jim Fraser with Chestnut Global Partners in Bloomington, IL and the staff of Hospital Samaritano and SAID in São Paulo, Brazil
A-CRA Manual in Spanish: translated by Sergio Fernández-Artamendi and José Ramón Fernández-Hermida with the Addictive Behavior Research Group at the University of Oviedo in Spain, and supported by the Ministry of Education and Science in Spain"
CRA Manual: See Meyers and Smith (1995) under Reference Books section below
ACC Manual: 60-page manual that describes procedures and techniques for initiating and providing community-based services to adolescents with substance use disorders. The practice of Assertive Continuing Care requires the use of the A-CRA manual listed above.
Reference Books (Available at bookstores and online retailers)
Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach (1995)
A Community Reinforcement Approach to Addiction Treatment (2006)
Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening (2003)
Motivating Substance Abusers to Enter Treatment: Working with Family Members (2007)
Adolescent Community Reinforcement Approach (chapter) in D.W. Springer & A. Rubin (eds.),
There are dual certification processes for A-CRA/CRA and ACC. Each has a clinical and supervisor certification process. Please note that A-CRA/CRA certification is part of ACC certification, as an ACC clinician uses A-CRA/CRA procedures and reinforces their use during their meetings with clients. Please see A-CRA_ACC Certification Requirements for details regarding the certification process and read below for details about the tools used in this process.
EBTx.org: Secure website used by clinicians and clinical supervisors to upload recordings of clinical sessions and enter session data. Clinical sessions are reviewed by an expert rater, who provides numeric ratings and narrative feedback. Session data (procedures completed during the session, urinalysis results, etc.) is used for the creation of management reports (used by clinicians, supervisors, and administrators) and the case review report (used by clinicians and clinical supervisors). The EBTx session data can also be used by each site for program evaluation purposes (evaluate number of clients seen, how many sessions each client received, etc.). For further information about data evaluation, contact the EBT Coordinator (firstname.lastname@example.org).
Session data: Clinicians enter data for each clinical session into EBTx.org. Data entered includes if the session was completed face-to-face or via telephone; if the clinician met with the adolescent only, the caregiver only, or the adolescent and caregiver together; if the session was recorded; if homework was assigned during the session and if homework from the previous session was reviewed; results of urinalysis, if completed; the number of minutes spent on various A-CRA procedures; and the overall difficulty of the session. It only takes a minute to enter data for each session.
Case Review Report: Generated in EBTx.org from the session data entered by clinicians, the Case Review Report is a cumulative report that shows the status of each open A-CRA/ACC case. With one keystroke, a clinician or supervisor can create this report and review the following for each open case: How long the adolescent has been in A-CRA or ACC, the total number of sessions attended, how many of those sessions were with or without the caregiver, which A-CRA procedures have been completed, how many times homework has been assigned and completed, results of urine tests, and more.
Digital Session Recording (DSR): Clinicians record each session using a digital recorder and upload the session to EBTx.org for review by an expert rater or their local supervisor. Clinical supervisors also record supervision sessions with their clinicians using a digital recorder, and upload recorded sessions to EBTx.org to be reviewed by an expert rater.
EBTx.org Access to DSRs: By uploading clinical sessions to EBTx.org, clinical supervisors also can listen to their clinicians’ sessions, as well as rate the sessions and provide feedback as part of clinical supervisor certification.
EBTx.org Access to Review Feedback: Once a clinician uploads a clinical session, it is assigned to an expert rater, who listens to the session. The rater then uploads his/her numeric ratings and narrative feedback. The clinician can view the feedback on the website after it is uploaded.
Digital Recorders: A digital recorder is used instead of a tape recorder when recording clinical sessions. The recording can be saved as a WMA file, which can then be downloaded to a computer and then uploaded to the website.
A-CRA Procedures Checklist, Certification Workbook, and Consistency Calculator: The A-CRA Procedures Checklist lists each component of all 19 A-CRA procedures. The Certification Workbook is a Microsoft Excel© spreadsheet that raters use to enter numeric ratings of completed procedures within a clinical session. The Consistency Calculator is used to compare ratings between the expert rater and the clinical supervisor.
Community Reinforcement Approach (CRA) and Adolescent Community Reinforcement Approach (A-CRA) Therapist Coding Manual by Jane E. Smith, S. Laura Lundy, and Loren Gianini: Smith et al. (2008) have developed a manual which provides anchors for ratings for each procedure. This manual is made available to clinical supervisors during their clinical supervision process.
Narrative Feedback: Whenever a clinician or supervisor submits a recording for review, they receive ratings and narrative feedback. Raters are trained to provide specific feedback about what was done well during the session and how the clinician can improve delivery of the procedures.
Coaching Calls: After attending training and as trainees begin their certification process, they have the opportunity to attend biweekly or monthly coaching calls led by experts in the model. These calls include reviews of therapy sessions and the opportunity for therapists to ask questions of the expert about specific procedures or other items related to implementation. Often, these calls include other trainees from other sites.
Data Sharing Agreements: Before agencies can use EBTx.org, a data sharing agreement must be completed between Chestnut Health Systems and the agency. This agreement permits the sharing of confidential client data as necessary to fulfill the purposes of certification and implementation.
As of December 2011, over 100 agencies have implemented or are in the process of implementing A-CRA/ACC in their programs.
From Mike Beauchesne, Executive Vice President of Clinical Services at the Dave Smith Youth Treatment Centre and A-CRA Certified Local Supervisor: In 2008, we at the Dave Smith Youth Treatment Centre, an intensive outpatient treatment provider for youth and families in Ottawa, Ontario, Canada, was selected to oversee the planning, development and operation of residential treatment services in our community. After intensive research and consideration, we chose to implement the empirically-supported clinical models, Adolescent Community Reinforcement Approach (A-CRA) and Assertive Continuing Care (ACC). With the professional and thorough training services offered through our friends at Chestnut Health Systems, we have worked to enhance our clinical competencies in A-CRA/ACC. As a result of the knowledge, expertise, and passion of the tremendous team at Chestnut, our clinical staff have attained extensive clinical and supervisory certification in A-CRA, and this central element of our treatment offering has been successfully implemented with demonstrable benefits. It is both our sincere belief and expectation that the continued and consistent application of A-CRA will help facilitate the positive treatment outcomes our clients deserve.
From a clinician in New York: I had a great experience throughout the certification process. The initial training provided me with a terrific foundation of the A-CRA model. Naturally, I had my reservations about integrating the procedures and tape recording sessions at first. I was concerned that the structure of the model would have a negative impact on therapeutic alliance. However, I was pleasantly surprised when this wasn’t the case. After I became more comfortable and gained confidence in myself with the procedures, everything began running smoothly and I feel my clinical skills have notably improved. I was very impressed and comforted by the guidance and support I received from my coordinator at Chestnut. She was always available to assist me with any questions or concerns; she was patient and genuinely eager to help. In addition, the coaching calls were helpful to learn about the obstacles and solutions experienced by other A-CRA clinicians. I was very pleased with my experience throughout the process, I feel honored to be a certified A-CRA clinician.
From a clinical supervisor in Virginia: I think this is an excellent process that thoroughly prepares clinicians to learn and to implement A-CRA. I have been trained and implemented four to five evidence-based models in the past ten years, and the A-CRA/ACC training and certification process is far and away the strongest of any model that I have been involved in. Specifically, the EBTx system of recording/uploading/reviewing client sessions makes this model stand out.
From a clinican in California: The A-CRA/ACC Certification Team was very helpful to me. The training, materials, coaching calls, and individual members of the team were and continue to be an outstanding source of information and support. I am very grateful for all of the knowledge and wisdom that I received during this project.
From a clinical supervisor in Arizona: Thank you all so much for your training, support, and help through the certification process. I am excited to be certified as a clinical supervisor in both the Adolescent Community Reinforcement Approach and Assertive Continuing Care! The continual assistance and support has been great, and I look forward to continuing to help our staff here through the certification process and participating in the coaching and supervisor calls.
From a clinical supervisor in California: I want to take this chance to thank all of you for putting together and running this program. As I shared with some of you at the training, I think this type of training is overdue and sadly missing in the substance abuse and even in mental health treatment fields. I am glad that my agency and myself have this opportunity to train in the intervention.
From a clinical supervisor in California: I can assure you that all of my Adolescent Community Reinforcement Approach staff members feel that they have grown as clinicians during the certifying process. The substance of the training has added value to the clinical structure of my agency as a whole by providing a way to define and organize clinical interventions and facilitating clinical communication. There is an added benefit to the model in its time-limited, curriculum-oriented format, which I think can do much to lower the barrier of treatment acceptance by non-Western populations. This is a problem that has stymied the field for a long time. Thank you again for the opportunity to be a part of this project. I look forward to continued collaboration and successes.
From a clinician in California: I really appreciate the time and care you provide for all of us undergoing the Adolescent Community Reinforcement Approach and Assertive Continuing Care certification. I want you all to know that I felt fully supported from the beginning, and I still feel that way today. There was always someone available to answer all of my questions, and I never felt like I was alone in this process. I am very proud of this accomplishment, and it is a wonderful feeling to be a part of this program. I am seeing first-hand the opportunities and client empowerment this program provides for our youth, their families, and our community, and it's amazing. Thank you all for this remarkable opportunity - I am truly grateful to be a part of this team.
From a clinician/clinical supervisor in Virginia: The team has provided valuable support and assistance in learning the Adolescent Community Reinforcement Approach and Assertive Continuing Care models. I am so pleased to be a part of this grant and I can see positive results already from the adolescents and families we are working with. I am a true supporter and believer in the Adolescent Community Reinforcement Approach.
From the August 2008 initial A-CRA/ACC training in Albuquerque, NM: This was my first experience being trained in a specific counseling model. It was such a positive experience! What I appreciated most was the humility of the staff. It has been my experience that the world is not short on knowledgeable people, but knowledge and humility are hard to come by. Thank you!
From the June 2008 initial A-CRA/ACC training in Natick, MA: This was one of the best trainings I have been to. I believe it has to do with a combination of factors including that it was very well organized, had trainers who work well together and with us, and have a sense of humor, very knowledgeable trainers experienced at what they are teaching, and a nice combination of didactive and interactive teaching. Thank you to you all!
From the June 2008 initial A-CRA training in Bloomington, IL: I thoroughly enjoyed and feel I gained so much information and knowledge. The trainers were friendly, approachable, knowledgeable, and willing to share. I want them to know how thankful I am for them and all their hard work.
From the January 2008 initial A-CRA/ACC training in Lynchburg, VA: I really enjoyed learning with everyone. I think this model will have a big impact on my community. It just makes sense. I also feel confident that if I have a question, I can email or call someone from Chestnut. You did a good job at creating that type of environment.
From the May 2010 initial A-CRA/ACC training in Bloomington-Normal, IL: The trainers are doing an amazing job! I’ve never experienced this level of training in over 20 years in the addiction field... I am extremely impressed and grateful to have been a part of this training.
From a clinician/clinical supervisor in Missouri: I truly enjoyed the certification process. Initially, it was very stressful because I was responsible for getting certified as a clinician and as a supervisor (at the same time). However, I really feel like it was my EBT Coordinator's patience that got me through. It was a real pleasure working with her. She was always available for questions, as well as concerns... The trainings were very informative! Chestnut is definitely one of the most professional, caring, and patient groups I have ever worked with.
From a clinician in Canada: I wanted to take the time to let you know how appreciative I have been of the feedback given by the A-CRA reviewers assigned to rate our sessions. I have found that they have a gentle approach while providing us specific ways to improve our sessions. This has been encouraging and motivating. I also found their suggestions very helpful. I am learning a lot about myself, and at the same time, feeling validated in my work.
From the parent of a teenage boy: A-CRA/ACC has truly been a blessing to our family...the tension in our house has decreased. We have used communication skills with not only our child in treatment, but with his brother as well. A-CRA/ACC helped us get back on track.
From a fifteen-year-old male who completed treatment: There are a lot of things you think you can deal with on your own and take care of it yourself. But A-CRA/ACC helped me out and opened my eyes to a lot of things...it helped me solve problems better and go about things differently. It’s not like what I thought it would be; it was really helpful.
From divorced parents of an adolescent client who completed treatment: The A-CRA/ACC approach can work for divorced families who are willing to come together for the child. I really appreciate how you included us both and how you adjusted when it was needed...the tools put in place really do work once the intervention is over.
From a seventeen-year-old male, 12 months after beginning treatment: I learned coping skills that not only helped me with my treatment, but also with living life. So to the person who might not want to come in, I'd ask, 'What do you have to lose?' You get someone to talk to and get stuff off your back.
From a fifteen-year-old female during her last A-CRA/ACC session: You can really get a lot of help from A-CRA/ACC...I learned a lot about myself. I learned a lot of skills that can help me in life in general. It's not just about not using drugs; it's about changing your life for the better. Fifteen-year-old female during her last A-CRA/ACC session.
From the parent of a seventeen-year-old male: My son learned how to communicate. He got a band scholarship because he did so well in the interview; this was because of the skills he learned from the therapist.
From a seventeen-year-old female: I am closer to my family now and that is what matters most.
From the parent of a seventeen-year-old male: We learned how to communicate. Kids are different these days; we were parenting the way that our parents did - you just tell them to do something and they do it. We learned how our whole family can talk.
From a single parent of a thirteen-year-old male: Thank you for everything the A-CRA/ACC program has done to help my son and I communicate better with one another. I appreciate you as a counselor, being more than someone we had to see, but that you were just as transparent with yourself in all aspects. I thank you for being so kind, coming out to the football games and helping my son get off probation. Thank you so much we really, really have love for you.
From a thirteen-year-old male who completed treatment: I appreciate you coming to my house and helping me with all the different ACRA/ACC skills like, drink/drug refusal skills, communication, anger management, and all that type of stuff. I appreciate you and the A-CRA/ACC program.
Through funding provided by the Center for Substance Abuse Treatment (CSAT) via the Assertive Adolescent and Family Treatment (AAFT) project, the University of Arizona’s Southwest Institute for Research on Women (SIROW) and Compass Behavioral Health created podcasts for adolescents working with clinicians in the Adolescent Community Reinforcement Approach (A-CRA). You may want to consider asking your treatment participants if they would be interested in reviewing podcasts for homework as they feature various skills and procedures learned during A-CRA, including communication skills, problem solving skills, job seeking skills, happiness scale, and functional analysis. All downloads are free of charge. See Using iTunes U for download instructions to hand out to participants.
In two trials of the Cannabis Youth Treatment study, a randomized controlled study, five manual-driven treatment interventions for adolescents with cannabis-related disorders were compared: Adolescent Community Reinforcement Approach (A-CRA), Family Support Network (FSN), Motivational Enhancement Therapy/Cognitive Behavior Therapy with 5 sessions (MET/CBT5), MET/CBT with 12 sessions (MET/CBT12), and Multidimensional Family Therapy (MDFT).
The 12-month findings from the CYT study suggested that all five tested interventions demonstrated significant improvements after treatment in the main outcome measures of days abstinent and percent of adolescents in recovery, which was defined as no use or abuse/dependence problems and living in the community (Dennis et al., 2004). However, while clinical outcomes were similar for all the interventions, A-CRA was one of the most cost-effective interventions. In addition, thirty-month follow-up data revealed that A-CRA had a significant long-term clinical advantage when compared to one other intervention and a non-significant advantage compared to a family systems approach. A-CRA has also been effective as a continuing care approach, paired with home visits and case management (Assertive Continuing Care or ACC) for adolescents following residential treatment, and in a randomized clinical trial targeting homeless, street-living youth. In the latter study, street-living youth aged 14 to 22 were recruited from a drop-in center and randomly assigned to A-CRA or treatment as usual through a drop-in center. Since these youth did not live with their families, the sessions designed for caregivers and the adolescents and their caregivers together were not implemented. Findings showed that youth assigned to A-CRA reported significantly reduced substance use (37% v. 17% reduction), depression (40% v. 23%), and increased social stability (58% v. 13%). Youth in both conditions improved in many other behavioral domains, including substance use, internalizing and externalizing problems, and emotion and task-oriented coping (Slesnick, Prestopnik, Meyers, & Glassman, 2007). See Reference List for supporting research.
A study published in 2002 by French et al. (see Reference List below) assessed the economic costs of A-CRA. The average cost per completed treatment episode was $1,237 at one site and $1,608 at another site. Costs were established by using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and included personnel, materials and supplies, contracted services, buildings and facilities, equipment, and miscellaneous items. The main findings of the CYT study revealed that A-CRA was more cost effective than MET/CBT5 and both were more cost effective than MDFT, based on the cost per day of abstinence and the cost per person in recovery (Dennis et al., 2004).
In 2006, the Center for Substance Abuse Treatment (CSAT) funded 15 sites around the country as part of the Assertive Adolescent and Family Treatment (AAFT) initiative to implement A-CRA and ACC. In 2007, 2009, and 2010, an additional 65 more sites were funded. Chestnut Health Systems has provided these sites with training and certification in A-CRA/ACC. Through the years another 22 sites have been funded, either through federal or local dollars. Chestnut has worked with many sites in the U.S. who mostly serve or serve a large percentage of individuals who have emigrated from Spanish-speaking countries; therefore, all forms are in Spanish and we are able to review Spanish language therapy sessions. We also have worked with sites in Canada and Portuguese-speaking Brazilian sites.
Based on 4,314 adolescents who have participated in A-CRA in these projects and interviewed with the Global Appraisal of Individual Needs (GAIN, Dennis et al., 2003) at intake, we know that 28% of the adolescents who participated were female, 29% were Hispanic, 17% were African-American, 4% were Native American or Native Alaskan, 1.4% were Asian, and 16.6% endorsed “other” or multiple races. Fourteen percent were 12-14 years old, 70% were 15-17 years old, and 16% were 18-25 years old. Eighty-five percent received A-CRA in outpatient treatment, 8% in intensive outpatient, 3% in long-term residential, and 4% in outpatient continuing care. A-CRA was originally designed as an outpatient intervention, but Chestnut provides the intervention in its own residential treatment programs and we are able to provide consultation using the intervention in this level of care.
Eighty percent of the adolescents treated in these projects had been diagnosed with a substance use disorder in the past year, 58% reported three or more years of use, and 37% had participated in substance use treatment previously. Sixty-seven percent reported co-occurring psychiatric disorders, and 64% reported physical, sexual, and/or mental victimization in their lifetimes. Forty percent reported they had been homeless or a runaway in their lifetimes. Forty-three percent indicated they had prior mental health treatment. Eighty-six percent reported they had been involved in violent or illegal activities, and eighty-four percent reported juvenile justice involvement during their lifetimes. Fifty-five percent reported thirteen or more days of any substance use in the past 90 days upon intake.
Based on the first three CSAT funded cohorts (a total of 45 sites), 44 sites were able to achieve certification of at least one local supervisor. All sites were able to achieve certification of at least one A-CRA clinician. It took an average of 21.4 DSRs and eight and a half months (36.79 weeks) for basic clinician certification (nine procedures). Seven of the 45 sites worked with transition age youth (18 to 24 years of age) and clinicians at these sites are required to demonstrate competency across 11 procedures for basic certification. For these clinicians, it took an average of 27 DSRs and seven months (30.5 weeks) for basic clinician certification (11 procedures). For supervisors, it took an average of three supervision session DSR reviews, 11 DSR ratings, and eight months (35 weeks) to achieve clinical supervisor certification. We routinely prepare monthly implementation reports for site managers and funders (if desired) that summarize the progress of each clinician and supervisor who is going through the certification process.
Post-treatment outcome data shows that 65% of adolescents were abstinent or had reduced their use by 50% based on follow-up data collected 12 months after their treatment intake. Ninety-six percent reported treatment satisfaction three months post-intake to treatment. Fifty percent reported that they had not engaged in illegal activity or had reduced their illegal activity by 50% at 12 month follow up. Seventy-five percent reported no family/home problems or that these problems had reduced by 50% at 12 month follow up.
In analyses conducted by Godley, Hedges, & Hunter (2011) using data from AAFT Cohorts 1 and 2, A-CRA participants had similar in-treatment and outcome findings regardless of their gender or race. The study included 2,141 participants and employed a series of hierarchical linear models, which revealed that A-CRA could be successfully implemented across gender and racial groups, and that male and female adolescents had similar overall improvement in their substance use outcomes across the measurement period. In addition to the results of hierarchical linear models, the results of equivalence testing also supported findings that racial groups had equivalent substance use outcomes at six months post intake to treatment.
As reported in Archives of Pediatrics & Adolescent Medicine (Garner et al., 2012), results of a cluster randomized experiment funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) provided support for the effectiveness of using pay-for-performance (P4P) methods to improve implementation of A-CRA. More specifically, relative to therapists in the control condition, therapists in the P4P condition were significantly more likely to demonstrate fidelity to A-CRA. Additionally, relative to patients in the control condition, patients in the P4P condition were significantly more likely to receive a threshold level of A-CRA found to be associated with significantly better patient outcomes.
Robert J. Meyers, Ph.D., is currently the director of Robert J. Meyers, Ph.D. & Associates and a Research Associate Professor Emeritus in Psychology at the University of New Mexico's Center on Alcoholism, Substance Abuse and Addiction. Dr. Meyers began his work with the Community Reinforcement Approach (CRA) in 1976. At that time, he helped develop the first CRA outpatient procedures, which were used in the seminal study published in 1982. In the late 1990's, he helped establish the adolescent version of CRA (A-CRA). Dr. Meyers also developed the new intervention program for engaging resistant substance abusers to enter treatment. This new intervention, called Community Reinforcement and Family Training (CRAFT), is an evidence-based intervention, which has been shown to be superior to more traditional interventions in several empirical studies. His CRAFT work has led to Dr. Meyers being featured in an Oprah magazine article in late 2006. Furthermore, one entire segment of the recent Emmy Award-winning HBO Addiction series was devoted to Dr. Meyers and CRAFT. Dr. Meyers is the winner of the 2002 Dan Anderson Research Award from the Hazelden Foundation, the 2003 Young Investigator Award from the Research Society on Alcoholism, and 2005 Alumni Achievement Award from the School of Social Work at Southern Illinois University. Dr. Meyers is an internationally known speaker and trainer who has delivered training in 29 different states in the USA, and in 11 different countries on four continents. He has published over 70 scientific articles and papers and co-authored five books on addiction treatment, including Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening and Motivating Substance Abusers to Enter Treatment: Working with Family Members. Dr. Meyers has been in the addiction field for over thirty years and at the University of New Mexico for over twenty years.
Jane Ellen Smith, Ph.D., is currently the Chair and a Professor in the Psychology Department at the University of New Mexico in Albuquerque, where she has also served as the Director of Clinical Training. She received her Ph.D. in Clinical Psychology from the State University of New York at Binghamton. Specializing in both alcoholism and eating disorders, Dr. Smith has written over 50 articles or chapters on these topics. She is also the first author of a 2004 book, Motivating Substance Abusers to Enter Treatment: Working with Family Members, and the co-author of a 1995 book, Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach. She has received federal grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to test the CRA program with homeless individuals.
Mark D. Godley, Ph.D., received his MSW in 1975 from the Worden School of Social Service and his Ph.D. in 1984 from Southern Illinois University. Since 1987, he has been the Director of the Lighthouse Institute, the research and training division of Chestnut Health Systems. Dr. Godley oversees the work of more than 80 research and training staff conducting NIH and SAMHSA funded research on recovery management, continuing care, and the biopsychosocial assessment of patients with substance use disorders. He was one of the research scientists who worked on the early clinical trials (1975-1982) of the Community Reinforcement Approach (CRA) for alcohol use disorders and is currently leading clinical trials on the Assertive Continuing Care (ACC) model. Over the past 30 years, Dr. Godley has served as a clinician, program director, research scientist, and research administrator in the addictions field.
Susan H. Godley, Rh.D., is a Senior Research Scientist at the Lighthouse Institute of Chestnut Health Systems in Bloomington, IL. She has been a Principal or Co-principal Investigator on several CSAT, NIAAA, and NIDA adolescent studies. She received her doctorate in rehabilitation from Southern Illinois University. Dr. Godley is one of the authors of the Adolescent Community Reinforcement Approach (ACRA) for Adolescent Cannabis Users, one of the five Cannabis Youth Treatment (CYT) study treatment manuals, and was the Principal Investigator of one of the four CYT study sites. She is also an author on the companion case management manual used in the Assertive Continuing Care (ACC) approach. Dr. Godley directs the Evidence-Based Coordinating Center at Chestnut, which has supported the wide-scale implementation of A-CRA and ACC. Her research interests include studying dissemination, implementation, and adoption in order to improve treatment services and outcomes for adolescents with substance use problems and their families.
Brandi Barnes, M.S., is an EBT Coordinator at the Lighthouse Institute of Chestnut Health Systems in Bloomington/Normal, IL. She coordinates and oversees the activities of consultants who provide training, certification, and ongoing coaching of clinical staff responsible for implementing EBT. Ms. Barnes received her Bachelor of Science degree and her Master of Science degree in Health Policy and Administration, both from the University of Illinois at Champaign-Urbana, Illinois.
Courtney Hupp, MSW, LCSW, CADC, is an EBT Clinical Coordinator at the Lighthouse Institute of Chestnut Health Systems in Maryville, IL. She had an active role in the Assertive Continuing Care (ACC) study, funded by NIAAA, in which she administered the ACC and A-CRA protocols to residential clients post-discharge, as well as supervised other case managers. Ms. Hupp has over ten years of clinical experience, including working with chemically dependent adolescents, disabled adults, victims of domestic violence, persons with HIV/AIDS, incarcerated adults, and mentally ill adults.
Christin Libernini Bair, B.S., is an EBT Coordinator at the Lighthouse Institute of Chestnut Health Systems in Bloomington, IL. She had an active role in the second Assertive Continuing Care (ACC2) study, funded by NIAAA, in which she administered the ACC and A-CRA protocols to residential clients post-discharge. She is also a session rater for A-CRA/ACC. She received her Bachelor of Science degree in Human Development and Family Studies from the Pennsylvania State University. Ms. Bair also has experience as a therapy instructor, as she taught horseback riding lessons to people with a variety of disabilities.
Karen Malek, B.A., is a Data Collection Coordinator at the Lighthouse Institute of Chestnut Health Systems in Bloomington/Normal, IL. She is responsible for collecting data from clinical staff responsible for implementing EBTs. She prepares and completes several monthly reports for the EBT projects and also maintains several certification databases and tracking sheets. Ms. Malek received her Bachelor of Arts degree in Psychology from Illinois Wesleyan University, Bloomington, Illinois.
Laura Reichel, B.A., is a Research Project Assistant at the Lighthouse Institute of Chestnut Health Systems in Bloomington, IL. She provides support to the EBT team with various tasks concerning training and certification. Ms. Reichel is responsible for assigning DSRs, updating clinician workbooks, and tracking certifications and feedback. She received her Bachelor of Arts degree in International Studies from Roosevelt University, Chicago, Illinois.
Kelli Wright, B.S., is a Research Services Coordinator at the Lighthouse Institute of Chestnut Health Systems in Bloomington/Normal, IL. She assists in the coordination of local and national EBT trainings, and provides support to the sites implementing A-CRA and ACC. Ms. Wright is a co-author on the companion case management manual used in the ACC approach, and a co-author on a peer-reviewed article regarding the use of contingency management with ACC. She received her Bachelor of Science degree in Law Enforcement and Justice Administration from Western Illinois University.
Over 20 consultants who serve as trainers, coaches, and/or session raters in the model support the team above. These individuals have been chosen due to their demonstrated expertise using the model(s) as clinicians or supervisors.
A-CRA is included in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).
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