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Intervention Summary

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Residential Student Assistance Program (RSAP)

The Residential Student Assistance Program (RSAP) is designed to prevent and reduce alcohol and other drug (AOD) use among high-risk multiproblem youth ages 12 to 18 years who have been placed voluntarily or involuntarily in a residential child care facility (e.g., foster care facility, treatment center for adolescents with mental health problems, juvenile correctional facility). Based on the Employee Assistance Program (EAP) model, the intervention focuses on wellness and addresses factors that hinder adolescents from being free from AOD use, such as emotional problems and mental disabilities, parental abuse and neglect, and parental substance abuse. The program is delivered in residential facilities by masters-level counselors who use a combination of strategies, including assessment of each youth entering the facility, an eight-session prevention education series, group and/or individual counseling for youth who have chemically dependent parents and/or are using substances, and referral to substance abuse treatment programs. These services are delivered over 20-24 weeks and are fully integrated into the adolescent's overall experience at the residential facility. The counselors also conduct facility-wide awareness activities, provide training and consultation on AOD prevention to facility staff, and lead a task force for staff and one for residents, both of which aim to change the facility's culture and norms around substance use and facilitate referrals to the program.

Descriptive Information

Areas of Interest Substance abuse prevention
Substance abuse treatment
Outcomes Review Date: June 2009
1: AOD use
Outcome Categories Alcohol
Drugs
Ages 13-17 (Adolescent)
18-25 (Young adult)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Residential
Correctional
Other community settings
Geographic Locations Urban
Suburban
Implementation History Since RSAP was first implemented in 1988, 25 sites in 8 States have used the program, reaching an estimated 15,000 youth. Three evaluations of the program have been conducted.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective
Indicated

Quality of Research
Review Date: June 2009

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Morehouse, E., & Tobler, N. S. (2000). Preventing and reducing substance use among institutionalized adolescents. Adolescence, 35(137), 1-28.  Pub Med icon

Supplementary Materials

Morehouse, E. (1998). Lessons learned: Collecting child and adolescent outcomes data. Behavioral Healthcare Tomorrow, 7(5), 45-46, 54.

Outcomes

Outcome 1: AOD use
Description of Measures AOD use in the past 30 days was measured using a revised version of the Monitoring the Future (MTF) questionnaire, a tool administered to 8th-, 10th-, and 12th-grade students nationwide. The seven frequency categories were collapsed into five: 0 times, 1-2 times, 3-8 times, 9-29 times, and daily. Using these AOD use data, scores on two indices were computed:

  • The quantity-frequency index was based on the mean number of days a drug was used, summed across 12 types of drugs: alcohol, marijuana, hallucinogens, crack, cocaine, heroin, inhalants, quaaludes, barbiturates, tranquilizers, amphetamines, and other opiates. For example, a youth who used alcohol on 3-8 days (mean of 5.5 days) and marijuana on 1-2 days (mean of 1.5 days) would have a score of 7.0.
  • The number-of-drugs index was based on how many types of drugs were used of the 12 listed above.
Scores on the quantity-frequency index and number-of-drugs index were then used to determine the proportion of nonusers at pretest who remained nonusers at posttest and the proportion of users at pretest who decreased use at posttest.

In addition, to determine dosage effects on AOD use, counselor logbooks were used to determine the number of hours each RSAP participant was exposed to the program. Dosage included the number of hourly sessions received during the assessment (up to 3), number of hourly group counseling sessions attended (up to 10), and number of hourly individual counseling sessions attended. Youth were classified into groups receiving low dosage (1-4 hours), medium dosage (5-11 hours), and high dosage (12-30 hours). Youth from the low-dosage group received an individual assessment in which the counselor determined the appropriate counseling group and/or they received individual counseling. Youth from the medium-dosage group received an individual assessment and group counseling sessions. Youth from the high-dosage group received an individual assessment and group and individual counseling sessions.
Key Findings Youth who participated in RSAP had a significant reduction in AOD use from pretest to posttest as measured by the quantity-frequency index (p < .001) and the number-of-drugs index (p < .001), whereas youth from the comparison group, which did not participate in RSAP, did not have a significant change in scores on either index.

Mean scores on the quantity-frequency index did not differ significantly between the RSAP and comparison groups at pretest (11.32 vs. 12.32, respectively) but did at posttest (3.76 vs. 11.77, respectively; p < .001). RSAP participants showed significant reduction in AOD use on the quantity-frequency index relative to the comparison group, a finding associated with a medium effect size (Hedges' g = 0.51).

Among RSAP participants, the group receiving a low dosage of the intervention was compared with the group receiving a medium or high dosage. At posttest, the medium- to high-dosage group had a significant reduction in AOD use on the quantity-frequency index (p = .001) and number-of-drugs index (p = .035) compared with the low-dosage group. In addition, among participants receiving a medium to high dosage of RSAP, 71% of nonusers remained nonusers, and 68% of users decreased their AOD use after the intervention. These medium- to high-dosage participants were more likely to remain nonusers or decrease their AOD use compared with those who received a low dosage (p < .01), a finding associated with a small effect size (odds ratio = 1.8).

On the basis of pretest scores on the quantity-frequency index and number-of-drugs index, RSAP participants who reported AOD use were categorized into two groups: experimental users and users/abusers. From pre- to posttest, 56% of experimental users decreased their AOD use, compared with 81% of users/abusers. The effect size was medium (Cohen's d = 0.55). This finding suggests RSAP was more successful in decreasing AOD use among youth who engaged in heavier use of drugs than among experimental drug users.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent)
18-25 (Young adult)
83% Male
17% Female
59% Black or African American
26% Hispanic or Latino
9% White
6% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: AOD use 3.0 3.0 3.0 2.5 2.8 3.5 3.0

Study Strengths

The intervention was implemented with attention to process documentation, which afforded the ability to assess outcomes by level of participation (i.e., dosage). Considerable attention was focused on key differences across the six implementation sites, variables that are typically ignored in similar studies. The Community Oriented Program Evaluation Scales (COPES) were used to measure resident and staff perception of the site environment. At each facility, the counselor met weekly with the liaison from that facility, a high-level administrator, to discuss implementation problems and barriers as well as policies and procedures. These efforts contributed to implementation fidelity. No significant baseline differences in demographics or pretest scores were identified between the intervention and comparison groups, minimizing some potential sources of bias. The study used appropriate analyses for the data collected.

Study Weaknesses

The reliability and validity of the Monitoring the Future questionnaire are well established, but the two indices derived from the questionnaire for this study (the quantity-frequency index and the number-of-drugs index) may not have those same psychometric properties. Attrition was relatively high, and differential attrition could not be assessed because cross-sectional comparison groups were used (i.e., a different comparison group sample was used at each data collection period). Use of the cross-sectional design also contributed to the potential for confounding variables. Some threats to internal validity, such as statistical regression and self-selection of participants, were not adequately addressed.

Readiness for Dissemination
Review Date: June 2009

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Program Web site, http://www.sascorp.org/residesap.htm

Student Assistance Services Corp. (n.d.). Residential Student Assistance Program: Implementation manual. Tarrytown, NY: Author.

Student Assistance Services Corp. (n.d.). Residential Student Assistance Program: Preventing and reducing substance abuse in residential facilities [VHS]. Ardsley, NY: Author.

Student Assistance Services Corp. (n.d.). Residential Student Assistance Program: Resource manual. Tarrytown, NY: Author.

Student Assistance Services Corp. (n.d.). Student Assistance Services Corporation: Process evaluation data collection log. Tarrytown, NY: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.3 3.0 3.5 3.3

Dissemination Strengths

The implementation manual is comprehensive, clear, and well organized. The resource manual contains various forms, process outlines, and sample program policies as well as templates (e.g., confidentiality forms, assessments, agreements, reports) to aid implementation. The available training appears to be very comprehensive. Information on training opportunities is readily available on the program Web site. The video provides good information for prospective implementers and can be used as a training tool. The implementation checklists are easy to follow, and the Process Evaluation Data Collection Log provides a practical mechanism for documenting important process activities.

Dissemination Weaknesses

The implementation materials include a combination of older photocopied pages and newer materials, giving the materials a less than unified appearance. Although the program developer makes information on training and technical assistance available upon request, this type of information is not easy to discern from primary program materials or other information on the program Web site.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Implementation manual (includes implementation checklists) $150 each Yes
3-day training in Tarrytown, NY (includes implementation manual and resource manual) $350 per person No
On-site training (includes implementation manual and resource manual) $4,200 for up to 30 participants, plus travel expenses No
Scheduled telephone conference calls $150 per hour No
On-site consultation $200 per hour plus travel expenses No
Process evaluation data collection log $50 each No
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Ellen Morehouse, LCSW, CASAC, CPP
(914) 332-1300
sascorp@aol.com

To learn more about research, contact:
Bonnie Fenster, Ph.D.
(914) 332-1300
bonnie.fenster@sascorp.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):