On the first anniversary of his death, several of us who knew and worked with Randy write this tribute to remember and honor the impact he had on so many people. Randy provided much needed leadership from within the federal government for the development and dissemination of evidence-based substance use treatments designed for adolescents and their families. He was successful because he had a rare ability to connect with all the groups important to improving adolescent treatment: provider organizations, schools, juvenile justice, counselors, federal agency decision-makers, researchers, private foundations, and most importantly—adolescents and their families. He saw how these groups could align their different interests and collaborate. This, in turn, helped youth, families, and systems of care in ways that continue to have an impact.
It was months after his death before we learned of Randy’s passing because he had discontinued contact with many of his friends and former colleagues, characteristic of the relationship between addiction and shame. Randy had a long-term struggle with addiction, with periods of remission, and that struggle continued until he died from heart disease. We want to highlight some of his significant contributions, but we also want to acknowledge that those of us in the field can do better in supporting colleagues we see struggling with addiction—just as we would support one with cancer. We can honor Randy by trying to do better.
Randy began his career in the U.S. Army as a counselor in Pirmasens, Germany, and eventually moved on to civil service, working for the U.S. Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT). At this time, community-based treatment practices for adolescents followed those common in adult treatment and were characterized by confronting denial and poor life choices, prescriptive treatment goals, “not working harder than the client,” and terminating treatment for missed appointments or relapse. Juvenile justice was the primary path through which many adolescents entered addiction treatment, and there was little distance between these two systems. Clinical rapport and trust were secondary to compliance with court orders. Randy’s first adolescent treatment project as a CSAT project officer was the Adolescent Treatment Models (ATM) grant program that manualized and evaluated ten existing promising adolescent programs. He convinced the ten independent grantees to use the same evaluation design and instrument in the Cannabis Youth Treatment (CYT) experiment, which began two years earlier. CYT was the largest multisite experiment to manualize and evaluate the cost-effectiveness of five promising research-based adolescent outpatient modalities. This harmonization increased the value of both efforts and set a pattern in the CSAT adolescent treatment programs for the next decade.
The CYT study helped establish the viability of science-based assessment and treatments for adolescents, but Randy realized that it meant little to youth and families without dissemination efforts. To address this need, Randy developed and managed two grant programs to help provider organizations adopt and implement two of the most cost-effective CYT treatment approaches: Motivational Enhancement Therapy/Cognitive Behavior Therapy 5 sessions (MET/CBT5) and the Adolescent Community Reinforcement Approach (A-CRA). To facilitate comparisons to the original implementation of CYT treatments and outcomes, these grantees used similar fidelity metrics, the same standardized measure (the Global Appraisal of Individual Needs; GAIN), and measurement intervals. Both programs also supported adaptations in collaboration with the treatment developers to specific contexts (e.g., schools), populations (e.g., Latinx), and substantive issues (e.g., co-occurring problems, more family engagement). The MET/CBT5 grants funded 37 provider organizations and reached over 6,500 youth/families between 2003 and 2008. The A-CRA grants funded 78 provider organizations and reached over 7,400 youth/families between 2006 and 2013.
Randy was always learning from his experience and making improvements to his grant initiatives. Based on lessons learned from the MET/CBT5 initiative, he wanted a stronger technical assistance program to help grantees better learn and implement the treatment, assessment, and outcome monitoring protocols. Those of us providing technical assistance to his grantees found this opportunity to be the most challenging and professionally fulfilling project of our careers. Most grantees rose to the challenge and implemented both the A-CRA and GAIN with fidelity; moreover, they achieved similar or better outcomes than the original CYT experiment. Almost 15 years later, youth, providers, and researchers are still benefiting from the implementation of these practices, and the project resulted in dozens of scientific articles advancing our understanding of evidence-based practice implementation, sustainment, and outcome.
Randy also developed and oversaw multiple grant programs related to regional- and state-level improvement and coordination of adolescent substance use treatment. These initiatives provided policy and practice incentives for single state authorities and communities to conduct needs assessments, financial mapping, and workforce development, as well as to disseminate evidence-based practices for youth and family treatment. Results of these and subsequent state grants assisted several hundred U.S. adolescent treatment programs and trained thousands of counselors to provide science-based assessment and treatment to youth and families.
Concurrent with his innovative funding initiatives, Randy used the SAMHSA contract mechanism to convene a multi-year series of national conferences known as the Joint Meeting on Adolescent Treatment Effectiveness (JMATE) and invited federal, state, and local agencies, researchers, foundations, and policy makers to contribute and attend. These conferences significantly advanced adolescent treatment because they convened clinical personnel, treatment researchers, parents, adolescents, and policymakers from across the U.S., Canada, and abroad. The meetings catalyzed research and practice collaborations, empowered parents and youth as they influenced policy, research, and practice, and provided all these groups an ongoing forum to share, network, and grow in their commitment and service to adolescent treatment and recovery. That JMATE has not convened since Randy’s retirement in 2011 is a testament to his leadership and advocacy for the field, and a reminder of the difference one person can make.
We remember Randy’s intelligence and his collegiality. If you sent Randy a journal article, or several, you could expect questions or comments on them. We also remember his humor (which was not for the faint of heart). We remember his sincere interest in making treatments better and his empathy for adolescents and their families facing challenges that he too ultimately faced, reminding us that addiction is not just a problem for others, but that we all are vulnerable. His life and his work made a tremendous difference in the lives of many. We miss him and we wish his family sincere condolences for their loss.
Jennifer Corvalan-Wood, Michael L. Dennis1, Mark D. Godley1, and Susan H. Godley1 on behalf of many others
1Chestnut Health Systems, Bloomington-Normal, IL, USA