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Intervention Summary

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The Seven Challenges

The Seven Challenges is designed to treat adolescents with drug and other behavioral problems. Rather than using prestructured sessions, counselors and clients identify the most important issues at the moment and discuss these issues while the counselor seamlessly integrates a set of concepts called the seven challenges into the conversation. The challenges include (1) talking honestly about themselves and about alcohol and other drugs; (2) looking at what they like about alcohol and other drugs and why they are using them; (3) looking at the impact of drugs and alcohol on their lives; (4) looking at their responsibility and the responsibility of others for their problems; (5) thinking about where they are headed, where they want to go, and what they want to accomplish; (6) making thoughtful decisions about their lives and their use of alcohol and other drugs; and (7) following through on those decisions. These concepts are woven into counseling to help youth make decisions and follow through on them. Skills training, problem solving, and sometimes family participation are integrated into sessions that address drug problems, co-occurring problems, and life skills deficits. The Seven Challenges reader, a book of experiences told from the perspective of adolescents who have been successful in overcoming problems, is used by clients to generate ideas and inspiration related to their own lives. In addition to participating in counseling sessions, youth write in a set of nine Seven Challenges Journals, and counselors and youth engage in a written process called cooperative journaling. The program is flexible and can be implemented in an array of settings, including inpatient, outpatient, home-based, juvenile justice, day treatment, and school. The number, length, and frequency of sessions depend on the setting. Counselors with various levels of experience in working with mental health and substance abuse problems are trained in program implementation.

Descriptive Information

Areas of Interest Co-occurring disorders
Outcomes Review Date: January 2009
1: Substance use and related problems
2: Symptoms of mental health problems
Outcome Categories Alcohol
Drugs
Mental health
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Hispanic or Latino
White
Race/ethnicity unspecified
Settings Outpatient
School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History The Seven Challenges has been used in at least 35 States by more than 300 agencies and organizations, as well as in Canada and in Puerto Rico, using the Spanish-language version.

Implementation settings have included outpatient and intensive outpatient programs, hospitals, group homes, residential treatment programs, day treatment programs, home-based services, drug courts, public and private juvenile justice facilities, probation departments, schools, and a wilderness program. 
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations Several licensed implementation sites in California, Idaho, Indiana, Missouri, and North Carolina, including drug courts, have worked with the developer to adapt the program for use with young adults or adolescents. Using the program with these age groups requires counselors to adjust how they introduce and talk about some of the content that is geared to a younger audience (e.g., references to school, parents, being a minor or underage). Program materials are available in Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: January 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

Smith, C. D., Hall, J. A., Williams, J. K., An, H., & Gotman, N. (2006). Comparative efficacy of family and group treatment for adolescent substance abuse. American Journal on Addictions, 15(Suppl. 1), 131-136.  Pub Med icon

Study 2

Stevens, S. J., Schwebel, R., & Ruiz, B. (2007). The Seven Challenges: An effective treatment for adolescents with co-occurring substance abuse and mental health problems. Journal of Social Work Practice in the Addictions, 7(3), 29-49.

Supplementary Materials

Becker, S. J., & Curry, J. F. (2008). Outpatient interventions for adolescent substance abuse: A quality of evidence review. Journal of Consulting and Clinical Psychology, 76(4), 531-543.  Pub Med icon

Conrad, K. J., Conrad, K. M., Dennis, M. L., & Riley, B. B. (2008). GAIN working papers: Rasch analysis of the Substance Problem Scale. Chicago: Chestnut Health Systems.

Dennis, M. L., Funk, R., Godley, S. H., Godley, M. D., & Waldron, H. (2004). Cross-validation of the alcohol and cannabis use measures in the Global Appraisal of Individual Needs (GAIN) and Timeline Followback (TLFB; Form 90) among adolescents in substance use treatment. Addiction, 99(Suppl. 2), 120-128.  Pub Med icon

Stevens, S. J., Murphy, B. S., & Schaller, R. (1998). Seven Challenges: Annual Report. Tucson: University of Arizona.

Summary of Seven Challenges Integrity Scale

Outcomes

Outcome 1: Substance use and related problems
Description of Measures Substance use and related problems were assessed using semi-structured interviews conducted by trained interviewers. These measures included:

  • Global Appraisal of Individual Needs (GAIN) Substance Frequency Scale (GAIN-SFS), an 8-item scale measuring the frequency and severity of alcohol and other drug use (average percent of days reported of any use; days of heavy use; and days of alcohol, marijuana, crack/cocaine, and heroin use) and the days of problems associated with use.
  • GAIN Substance Problem Scale (GAIN-SPS), which comprises 16 recency items (e.g., "when was the last time you…?") based on DSM-IV criteria for dependence (7 items), abuse (4 items), substance-induced problems (2 items), and lower severity symptoms of use, such as the hiding of substance use, complaints by others about use, and weekly use (3 items).
Key Findings In one study, youth were randomly assigned to a group receiving The Seven Challenges or an active family therapy comparison group. On average, The Seven Challenges group received 15 hours of counseling, and the family therapy group received 23 hours of counseling. Findings included the following:

  • In both groups, the percentage of abstinent youth increased significantly from baseline to the 3- and 6-month follow-up. In The Seven Challenges group, 8% of participants were abstinent at baseline, compared with 34% at 3-month follow-up (p = .01) and 39% at 6-month follow-up (p < .01). In the comparison group, 3% were abstinent at baseline, compared with 27% at 3-month follow-up (p = .01) and 31% at 6-month follow-up (p < .01).
  • Similar results were found for the percentage of symptom-free youth. In The Seven Challenges group, 33% were symptom free at baseline, compared with 50% at 3-month follow-up (p = .03) and 61% at 6-month follow-up (p < .01). Likewise, in the comparison group, 26% were symptom free at baseline, compared with 60% at 3-month follow-up (p < .01) and 6-month follow-up (p < .01).
  • There were no statistically significant differences between the two groups in the percentage of abstinent and symptom-free participants from baseline to either follow-up.
Another study examined substance use among youth participating in The Seven Challenges at baseline and 3 and 6 months after treatment. From baseline to the 3-month follow-up, participants had significantly decreased substance use severity and related problems (SPS, p = .038; SFS, p = .001). From baseline to the 6-month follow-up, they had a significant decrease in substance-related problems (SPS, p = .004); a decrease in substance use severity was found but was not statistically significant.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental, Preexperimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 2: Symptoms of mental health problems
Description of Measures Symptoms of mental health problems were assessed using semi-structured interviews conducted by trained interviewers. These measures included:

  • GAIN General Mental Distress Index (GAIN-GMDI), a 22-item index based on the Symptom Checklist--90 (SCL-90), with higher scores indicating a greater breadth and severity of internal mental distress (e.g., somatic, depression, anxiety).
  • GAIN Depressive Symptom Index (GAIN-DSI), a 9-item index that provides a count of past-year symptoms commonly associated with depression, with higher scores suggesting a higher level of indecisiveness and hopelessness.
  • GAIN Anxiety Symptom Index (GAIN-ASI), a 12-item index that provides a count of past-year symptoms commonly associated with an anxiety disorder, with higher scores suggesting a higher level of psychoticism.
Key Findings One study examined the symptoms of mental health problems among youth participating in The Seven Challenges at baseline and 3 and 6 months after treatment. From baseline to the 3-month follow-up and from baseline to the 6-month follow-up, participants had improved symptoms, with scores on all three measures decreasing significantly (all p values < .001).
Studies Measuring Outcome Study 2
Study Designs Preexperimental
Quality of Research Rating 2.3 (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) 71% Male
29% Female
76% White
24% Race/ethnicity unspecified
Study 2 13-17 (Adolescent) 75% Male
25% Female
53% White
31% Hispanic or Latino
17% 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: Substance use and related problems 4.0 4.0 2.0 3.0 2.5 1.5 2.8
2: Symptoms of mental health problems 4.0 3.5 1.0 2.0 2.0 1.5 2.3

Study Strengths

The measures used for both studies were appropriate and have well-established psychometric properties. One study used urinalysis to support the validity of the self-report data. The manualized nature of the intervention and the systematic training provided to therapists contributed to fidelity. Both studies had relatively low attrition rates.

Study Weaknesses

No analytical information was provided to document the fidelity of the intervention, although one study provided minimal, ongoing monitoring of treatment implementation. One study did not have a true control condition, and the other did not have a control or comparison condition, raising concerns about potential confounding variables. One study had a small sample size and lacked the power to distinguish treatment effects. The analytical approaches did not allow for causal inference.

Readiness for Dissemination
Review Date: January 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.

Schwebel, R. (1995). The Seven Challenges poster. Tucson, AZ: Author.

Schwebel, R. (2000). The Seven Challenges Journals (2nd ed.). Tucson, AZ: Viva Press.

  • Challenge One, Part 1
  • Challenge One, Part 2
  • Challenge Two
  • Challenge Three
  • Challenge Four
  • Challenge Five
  • Challenge Six
  • Challenge Seven, Part 1
  • Challenge Seven, Part 2

Schwebel, R. (2004). The Seven Challenges manual. Tucson, AZ: Viva Press.

Schwebel, R. (2005). The Seven Challenges: Challenging ourselves to make wise decisions about alcohol and other drugs (6th ed.). Tucson, AZ: Viva Press.

Schwebel, R. (n.d.). Addendums to The Seven Challenges manual. Tucson, AZ: Author.

Schwebel, R. (n.d.). Clinical supervision of The Seven Challenges program. Tucson, AZ: Author.

Schwebel, R. (n.d.). Implementation announcement to staff. Tucson, AZ: Author.

Schwebel, R. (n.d.). Implementation procedures. Tucson, AZ: Author.

Schwebel, R. (n.d.). Learning aids for youth. Tucson, AZ: Author.

Schwebel, R. (n.d.). Outline of services. Tucson, AZ: Author.

Schwebel, R. (n.d.). Sample short statements to help with implementation. Tucson, AZ: Author.

Schwebel, R. (n.d.). The Seven Challenges [DVD]. Tucson, AZ: Viva Press.

Schwebel, R. (n.d.). The Seven Challenges counselor skills rating form. Tucson, AZ: Author.

Schwebel, R. (n.d.). Training materials. Tucson, AZ: Author.

The Seven Challenges Web site, http://www.sevenchallenges.com

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
4.0 4.0 4.0 4.0

Dissemination Strengths

Clear, logically organized, and comprehensive materials are provided to support implementers, supervisors, and administrators. Materials address potential planning issues and thoroughly explain organizational and clinical requisites for successful implementation. The developer provides a robust training and support program to implementers, including an online forum and quarterly calls to assist with overcoming challenges in initial implementation. Quality assurance tools are addressed during training and are built into regular implementation procedures. Complete protocols for tracking client outcomes and monitoring fidelity are also provided.

Dissemination Weaknesses

No weaknesses were noted by reviewers.

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
Youth journals set $29.95 per participant Yes
Book of readings for youth $19.95 each Yes
Posters $10 each Yes
Counselors manual $25.95 each Yes
Counselors training DVD $68.95 each Yes
Counselors activity book $47.95 each No
3-day, on-site initial training and agency license $8,700 per agency plus travel expenses Yes
3-day, off-site leader training $700 per person Yes, one leader training option is required
3-day, on-site leader training $6,400 per agency plus travel expenses Yes, one leader training option is required
Telephone support and mentoring Included in initial training and annual fidelity fee Yes
First-year support/fidelity site visit $2,000 plus travel expenses Yes
Annual fidelity fee beginning in second year (includes license, telephone support, and site visit) $5,000 per year Yes
All quality assurance materials and nonpublished supportive documents Free Yes

Additional Information

Quantity discounts are available for the published materials. Interest-free payment arrangements can be negotiated for the initial license fee.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Smith, C. D., Hall, J. A., Williams, J. K., An, H., & Gotman, N. (2006). Comparative efficacy of family and group treatment for adolescent substance abuse. American Journal on Addictions, 15(Suppl. 1), 131-136.  Pub Med icon

* Stevens, S. J., Schwebel, R., & Ruiz, B. (2007). The Seven Challenges: An effective treatment for adolescents with co-occurring substance abuse and mental health problems. Journal of Social Work Practice in the Addictions, 7(3), 29-49.

Contact Information

To learn more about implementation or research, contact:
Sharon Conner
(520) 405-4559
sconner@sevenchallenges.com

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

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