Short Description of Package: The Adolescent Community Reinforcement Approach (A-CRA) to alcohol and substance use treatment is a behavioral intervention that seeks to increase the family, social, and educational/vocational reinforcers of an adolescent to support recovery; conversely, if an adolescent uses alcohol or other drugs, then a time-out from these reinforcers occurs (based on Hunt & Azrin, 1973). The manual outlines an outpatient program that targets youth 12 to 22 years old with DSM-IV cannabis, alcohol, and/or other substance use disorders. However, A-CRA also has been implemented in intensive outpatient and residential treatment settings. A-CRA includes guidelines for three types of sessions: adolescents alone, parents/caregivers alone, and adolescents and parents/caregivers together. According to the adolescent's needs and self-assessment of happiness in multiple areas of functioning, therapists choose from among 17 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. Role-playing/behavioral rehearsal is a critical component of the skills training used in A-CRA (e.g., drug refusal, problem solving, and communication skills). 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. A-CRA procedures have been evaluated with street-living, homeless youth in a drop-in center to reduce substance use, increase social stability, and improve physical and mental health.

A-CRA procedures also are used as part of Assertive Continuing Care (ACC), which includes home visits and case management for youth 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.

The A-CRA/ACC service package includes the cost for:

1. Training, quality assurance, coaching, certification, and on-going monitoring of seven staff (two clinical supervisor and five clinicians) for initial training over the course of the grant. This training includes:
   a.   Training manual for each participant
   b.   Two digital audio recorders per grantee site
   c.   Up to 12 audio recordings reviewed for clinical supervisor
   d.   Up to 20 audio recordings reviewed, with written feedback for each clinician
   e.   Computing agreement rate between supervisor and expert rater on A-CRA recordings
   
   
2. Attendance for two staff at advanced training over the course of the grant. Training materials included.
3. Attendance for two staff at intermediate training over the course of the grant. Training materials included.
4. Travel expenses for grantee staff to attend the above training events and the cost of calls and teleconferences.
5. Use of www.EBTx.org to transmit audio files and session data and to receive feedback on audio recordings for both clinical supervisor and clinicians. The cost includes:
   a.   IT-related support costs, including software license fees, server
          and bandwidth fees, and storage allocation fee.
   b.   Technical assistance from EBT Coordinator on use of the website,
          including email and telephone support.
   
   
6. Participation during coaching calls following the training event (two per month for first year of grant; one per month after the first year).
7. Site-wide and individual coaching sessions to be conducted as needed (offered if clinical supervisor and/or clinicians experience difficulty during the certification process).
8. Project coordination, monitoring, and feedback to support quality implementation of the model.
9. All of the above services are designed to help the grantee sustain A-CRA/ACC beyond the grant term.

Cost of A-CRA/ACC Package: Chestnut will provide this service package to CSAT-JTDC grantees at the price of $20,262 per year, billed once per year contingent on grant funding (total cost over 3 years = $60,786).

Supporting Materials: Use the links below to view any of the following items:

• Adolescent Community Reinforcement Approach (A-CRA) manual
• Assertive Continuing Care (ACC) manual
• A-CRA/ACC certification requirements
• Itemized A-CRA/ACC cost sheet for JTDC grantees
• Subcontract for JTDC grantees for A-CRA/ACC

Contact Information: If you have any additional questions about A-CRA/ACC for the JTDC grant or in general, please contact Ms. Brandi Barnes, M.S. at bbarnes@chestnut.org, (309) 451-7791, or ebtxquestions@chestnut.org.

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