1. MATRIX INTENSIVE OUTPATIENT TREATMENT WITH ADOLESCENTS Martin Moskowitz, LCSW, CASAC Seamus McEntee, LMSW

2. Outpatient Substance Abuse Treatment Serves Adolescents and Adults
MINEOLA COMMUNITY TREATMENT CENTER ADDICTION TREATMENT SERVICES ZUCKER HILLSIDE HOSPITAL NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM
Outpatient Substance Abuse Treatment
Serves Adolescents and Adults
Medication Mgmt, Groups, Family Tx
STAFF: Social Workers, Counselor, Psychiatrists, Teachers, Interns
Medically supervised
OASAS Licensed

3. INTENSIVE OUTPATIENT PROGRAM DESCRIPTION
Treatment for Teenagers ages 13 – 18 with Substance Abuse, Mental Health and behavioral problems
Clients attend 5 days / week, Monday – Friday, 9:00 AM – 3:00 PM
Treatment for abuse of any Substance
Psychiatric: ADHD, ODD, Conduct Disorder, Bipolar, LD, H/O SI, Self-Cutting and Inpt, Trauma Hx
Behavioral: Truancy, Failing School, Defiance, Legal Involvement,
Parents required to attend weekly groups

4. EXPLORATION STAGE WHY NOW
Program was experiencing low completion rate – Concerns that current program was not working
Below census and underutilized
Desire to move from Punitive, Consequence-oriented (TC) to Supportive
Program’s high hurdles – lengthy, at-home client supervision – deterred many families
Greater Awareness of Evidenced-Based Practices

5. WHY MATRIX
As reported by NIDA, studies by Rawson, et al, Matrix was an approach that demonstrated effectiveness
Current program and Matrix model shared some similarities: Didactic, Workbooks, Structured, Tx provided through Groups, Self Help
Training materials for clinicians, treatment materials for clients, manuals for both make Matrix user-friendly

6. MATRIX COMPONENTS Family Sessions
Early Recovery Skills Groups and Relapse Prevention Groups in Intensive Outpatient Level
Social Support Groups following IOP
Urinalysis Screens
Positive Client/Therapist Relationship
Substance Abuse Education for Client & Family
Self-Help Involvement
Manuals, Workbooks, Handouts, Assignments
Time-Limited

7. ADAPTING THE MATRIX MODEL
Developed for Cocaine and other stimulant abusers
Focus on adult populations
MCTC implementing for general substance abuse
MCTC using for adolescent population

8. PROGRAMMATIC DIFFERENCES
PRE MATRIX
Duration of Tx = 8-12 Mon
More and longer restrictions
Harsher consequences
3-6 mon parental at-home supervision
More focus on confronting defenses
Lingering TC model
Greater potential for fostering dependence
POST MATRIX
Tx Duration = 4-6 Mon
Fewer and shorter restrictions
Supportive and E-B practices: MI, CM, RP
1-2 mon parental supervision
More focus on abstinence skills (“The Why” of CD and “The How” of Recovery)
Better adapted to treat Co-occurring disorders

9. INSTALLATION STAGE
Multiple sessions with staff reviewing Matrix material
Re-structuring current IOP
Changed program guidelines, and expectations, rules, privileges, consequences, rewards and length of Tx

10. IMPLEMENTATION STAGE Fidelity Addressed Fidelity Challenges
Consistent at the beginning through supervision and staff meetings
Fidelity Challenges
As supervision focusing on Matrix Maintenance decreased, fidelity also decreased

11. STAFF EXPERIENCE PROS: CONS: Group Modality Measurable interventions
Material is organized and focused on relapse prevention
Offered direction and support
CONS:
Clients complained of repetitive information
Minimal focus on insight
Concerns that lack of consequences will lead to disruptive behavior and compromise safety
Less insight into individual and family dynamics

12. STAFF ACCEPTANCE Tended to alternate between resistance and acceptance
Initial trepidation followed by acceptance, then commitment  disappointment  perhaps trending to realistic expectations and hope
Overall staff level of Matrix acceptance =
6-7 (0=No Tx Value; 10=Best Tx)

13. Supervision
Much time devoted initially in team meetings as well as individual supervision
Once program was installed, less follow up in meetings or supervision
Focus became group, family and individual psychodynamics

14. SUPERVISION AND FIDELITY GRAPH

15. SUMMARY OF DATA: 1 YEAR PRE & 1 YEAR POST MATRIX IMPLEMENTATION DATE 7/09
PRE MATRIX
7/08-7/09
POST MATRIX
7/09-7/10
% & DIRECTION CHANGE
SCREENINGS 30 45
50%
STARTED IOP 13 23
77%
% STARTING IOP
43%
51%
19%
1 MONTH RETENTION 11 15
36%
% RETAINED 1 MONTH
85%
65%
34%
% RELAPSED
17%
48%
# CLIENTS COMPLETED 2
550%
% COMPLETED
18%
267%

16. TOTAL CLIENTS 1 MONTH COMPLETED STARTING PROG. RETENTION PROGRAM

17. PERCENT RELAPSE RATES: PRE & POST MATRIX

18. Lessons Learned
Include consistent Matrix Model review in individual and group supervision sessions
Develop tool to measure Matrix fidelity
Design survey for follow up with clients post treatment
Continue to collect and analyze data on rates of abstinence, retention, completion, improved grades, decreased psychiatric sx’s, decrease in family conflicts
Insight-oriented therapy also needs to be provided as it relates to psychological obstacles to tx and recovery