Clean&Cool in Orange, N.J., Helps Teenagers with Life Skills, Substance Abuse
In 2003, Family Connections, a social services agency in Orange, N.J., launched Clean&Cool, a research-based outpatient substance abuse treatment and life skills training program for teenagers involved with alcohol, drugs and other high-risk behaviors. It subcontracted with BuenaOnda Pictures to produce a documentary about the program.
- The Clean&Cool program served 212 high-risk teenagers over a three-year period; 62 percent of the participants were drug/alcohol free upon program completion.
- The project produced a film documentary and a companion workshop presenting the lessons of the Clean&Cool program to other organizations.
RWJF provided a grant of $418,937 to support the implementation of Clean&Cool from 2003 to 2006. It provided a second grant of $70,000 to support creation of the documentary.
Teenagers in Essex County's urban communities (Orange, East Orange, Irvington and Newark) face a bleak and dangerous world, according to statistics gathered in the Association for Children of New Jersey's Newark Kids Count 20022003 report. Those four municipalities suffer among New Jersey's highest rates of poverty, crime, child abuse and neglect, unemployment, AIDS, teen abuse of alcohol and other drugs and teen deaths.
The county had a shortage of outpatient substance abuse treatment programs for adolescents, according to Family Connections, an Orange-based nonprofit agency offering educational, social and mental health services. The two countywide agencies that provided substance abuse treatment to youth had only 20 outpatient slots. These agencies lacked staff to provide mental health counseling and turned away teens with mental health as well as substance abuse problems.
To help meet this need, Family Connections developed Clean&Cool, a substance abuse treatment and life skills training program for teenagers. Clean&Cool was based on recent research in treatment, including:
- The Cannabis Youth Treatment study funded by the federal Center for Substance Abuse Treatment.
- The Adolescent Treatment Models evaluation by the federal Substance Abuse and Mental Health Services Administration, in particular the CHS Treatment Manual developed by Chestnut Health Systems, one of the evaluation sites.
Elements of the Clean&Cool program include:
- Individual, group and family counseling
- Recreational field trips
- Family nights
- Coordination with and referrals to other services
- Life skills training on drug resistance, self-management and social skills.
For more details on the program, see the Appendix.
In 2003, RWJF gave Family Connections a three-year grant (ID# 049991) to implement the Clean&Cool program for adolescents in Essex County, N.J. Family Connections established a set of measurable outcomes for the program after 180 days of participation (or at graduation, if that came first):
- 60 percent of participants would be drug/alcohol free.
- 50 percent of participants who were not drug/alcohol free would have cut their number of days of use per month in half.
- 75 percent of participants with mental health problems would show a reduction in psychiatric symptoms.
- 80 percent of participants would demonstrate increased ability to resist pressure to use alcohol or drugs.
- 85 percent of participants would demonstrate increased self-management and social skills.
- 85 percent of participants whose families participated in treatment would demonstrate reduced family conflict and improved family functioning.
During the project, Family Connections held eight community breakfasts to bring together representatives from organizations involved with high-risk adolescents to market the Clean&Cool program and assess and improve the program's effectiveness in meeting community needs. Attendees included representatives of the New Jersey Division of Youth and Family Services, Essex County Youth Services Commission, state politicians, area schools, churches and service providers.
The biggest challenge for programs treating high-risk teenagers is getting them to attend and continue attending treatment, according to the project director. Clean&Cool's initial design included some incentives for participation, such as field trips and family nights. To further promote attendance, Family Connections made several adjustments in the second and third years of the project:
- It instituted a merit system that awarded points for program attendance and participation. Specific point totals were required for participation in field trips and other recreational activities, and points could be redeemed for gifts cards to the movies and clothing stores.
- It offered African drumming workshops and a poetry slam as expressive arts activities.
- It provided Clean&Cool staff with an intensive four-day training in Motivational Enhancement Therapy and its applications with high-risk youth. Motivational Enhancement Therapy seeks to evoke from clients their own motivation for change and to consolidate a personal decision and plan for change.
- It hired a community resource specialist to assist Clean&Cool teens and their families in obtaining other assistance, including vocational training, employment, legal assistance, financial assistance and housing.
In the first year of the project, Family Connections dropped one of the elements of the Clean&Cool design, peer mentoring, because of logistical problems in trying to match mentors and mentees and maintain those pairings.
In the second year of the project, Family Connections secured funding for Clean&Cool from two public sources:
- The New Jersey Division of Addiction Services provided $208,000.
- The Essex County Office of Addiction Services provided $30,000.
Both agencies renewed this funding for the third year of the project.
A Follow-Up RWJF Grant
In 2005, RWJF provided a second grant (ID# 056144) for the development of a documentary about Clean&Cool. Family Connections subcontracted with BuenaOnda Pictures to produce the film. Clean&Cool teens and their families participated in the filmmaking process from preproduction through final screening. BuenaOnda taught the teens the fundamentals of filmmaking as well as on-camera interview skills so that they could interview family members and program staff.
Project staff reported the following results in a report to RWJF:
- The Clean&Cool program served 212 high-risk teenagers over a three-year period. The program met three of its six measurable objectives for teens after 180 days of participation (or at graduation, if that came first) and came close to meeting the other three objectives (met objectives are set bold):
Health Outcome Objective Result Participants who were drug/alcohol free 60% 62% Participants not drug/alcohol free who reduced their number of days of use per month by half 50% 65% Participants with a mental health diagnosis who had a statistically significant reduction in psychiatric symptoms 75% 60% Participants who demonstrated increased refusal skills in dealing with pressure to abuse drugs/alcohol 80% 62% Participants who demonstrated increased self-management and social skills 85% 73% Participants who demonstrated reduced family conflict 85% 86%
- BuenaOnda Pictures produced the "Clean&Cool" documentary. The film follows 15 participants in the Clean&Cool program. A film clip is available online. See Bibliography for details.
- Family Connections developed a workshop to present the model of the Clean&Cool program to other organizations. The workshop, at which a version of the documentary is shown, discusses the major lessons of the Clean&Cool program:
- How to bundle a range of services to increase treatment efficacy.
- How to motivate defiant, antisocial teenagers to show up for treatment. How to motivate disorganized families to participate in their teens' treatment.
- How to engage other systems (child welfare, schools and juvenile justice) as true partners with a joint goal of helping kids succeed.
- How to use a lessons learned approach to adapt/enhance a program continually.
- When working with teens, it is important to involve the family. Holding monthly family nights that are informal dinner, games and interaction between counselors and families is better than having a formal speaker. (Project Director)
- Build incentives into the treatment program. Providing teenagers with tangible rewards such as field trips and gift cards for food, movies and clothes can go a long way in changing behavior. (Project Director)
AFTER THE GRANT
Family Connections continues to operate the Clean&Cool program with funding from the Essex County Office of Addiction Services, the New Jersey State Division of Addiction Services and the Essex County Youth Services Commission. In 2007, Family Connections presented the film and workshop material at seven venues in New Jersey.
GRANT DETAILS & CONTACT INFORMATION
Clean&Cool: Teenage Life Skills Training and Substance Abuse Treatment
Family Connections (Orange, NJ)
- Reducing the Harm to Adolescents by the Abuse of Tobacco, Alcohol and Illicit Drugs
Amount: $ 418,937
Dates: December 2003 to November 2006
- Production of a Film to Help Disseminate the Clean and Cool Substance Abuse Treatment and Life Skills Training Model for High-Risk Teenagers
Amount: $ 70,000
Dates: December 2005 to December 2006
John Surface, L.C.S.W.
Elements of the Clean&Cool Program
The key elements of the Clean&Cool program are:
- A bio-psycho-social intake assessment.
- Weekly individual counseling, to develop and track progress on an individualized treatment plan.
- Weekly group counseling, plus quarterly motivational group training for older adolescents in job-search and employability skills.
- LifeSkills Training, covering:
- Drug resistance
- Personal self-management
- General social skills.
- Family involvement, including "family night" discussions and family therapy when appropriate.
- Random monthly alcohol and drug screening.
- Field trips to reward program participation.
- Fast-track referrals to mental health services when necessary.
- Case management and advocacy for youth making the transition from residential treatment programs or incarceration.
- HIV counseling and testing.
- Access to other needed services (e.g., day care, tutoring, vocational training, legal assistance).
- Peer mentoring, by a program participant who has tested drug free for at least three months. (This element was dropped early in the project because of logistical problems in trying to match mentors and mentees and maintain those pairings.)
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Audio-Visuals and Computer Software
Clean&Cool. A documentary highlighting the Clean&Cool teenage substance abuse treatment and life skills training program. New Jersey: BuenaOnda Pictures, 2007. A clip is available online.
Report prepared by: Barbara Matacera Barr
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Pamela S. Dickson