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Intervention Summary

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Phoenix House Academy

Phoenix House Academy (formerly known as Phoenix Academy) is a therapeutic community (TC) model enhanced to meet the developmental needs of adolescents ages 13-17 with substance abuse and other co-occurring mental health and behavioral disorders. The Phoenix House Academy model integrates residential treatment with an on-site public junior high and high school (grades 8-12). Some Phoenix House Academy programs also include trade or technical training sponsored by local community colleges. The community campus receives most of its referrals from juvenile probation, family, and self-referrals, with the remaining youth coming from social service agencies (e.g., departments of mental health, children and family services), health care providers, and educational institutions. Professional program staff include psychiatrists, psychologists, social workers, and counselors, many of whom are in recovery themselves.

The Phoenix House Academy TC model maintains that substance abuse is an outward manifestation of a broad set of personal and developmental problems in the adolescent and that successful recovery is built upon change involving the whole person--psychologically, socially, and behaviorally. Participants learn to embrace honesty, focus on effective living in the present moment (rather than in the past), accept personal responsibility for their own actions, develop a strong work ethic, and adhere to a strict moral code known as right living. The process for change is behavioral social learning, which takes place in a community of supportive peers and staff who model and support the rehearsal of effective behaviors. Each residential member earns status promotions and other privileges by complying with program rules and expectations and demonstrating specific behaviors toward attaining treatment goals, such as attending school. Behavior that deviates from the community's sober-living norms results in sanctions or loss of previously earned privileges. During treatment, youth progress through treatment phases with increasing program privileges and responsibilities. Days are highly structured, with most waking hours spent in school, community meetings, lectures, groups, individual and family counseling, community service, aftercare services, and recreation. In some programs, other types of scientifically sound and empirically tested interventions may be incorporated into treatment as well. Phoenix House Academy programs offer gender-specific services, and some can provide treatment for individuals up to 20 years of age.

Descriptive Information

Areas of Interest Substance abuse treatment
Co-occurring disorders
Outcomes Review Date: December 2007
1: Substance use
2: Psychological functioning
Outcome Categories Alcohol
Drugs
Mental health
Tobacco
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Residential
Geographic Locations Urban
Suburban
Implementation History Since 1980, Phoenix House Academy has been implemented in 11 residential community facilities in 7 States: California, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Texas. Each program has differing treatment lengths. To date, approximately 20,275 adolescents have participated in and completed the Phoenix House Academy treatment program.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
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 IOM prevention categories are not applicable.

Quality of Research
Review Date: December 2007

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

Morral, A. R., McCaffrey, D. F., & Ridgeway, G. (2004). Effectiveness of community-based treatment for substance-abusing adolescents: 12-month outcomes of youths entering Phoenix Academy or alternative probation dispositions. Psychology of Addictive Behaviors, 18(3), 257-268.  Pub Med icon

Supplementary Materials

Dennis, M. L., Dawud-Noursi, S., Muck, R., & McDermeit, M. (2003). The need for developing and evaluating adolescent treatment models. In S. J. Stevens & A. R. Morral (Eds.), Adolescent substance abuse treatment in the United States: Exemplary models from a national evaluation study (pp. 3-34). Binghamton, NY: Haworth Press.

Engberg, J., & Morral, A. R. (2006). Reducing substance use improves adolescents' school attendance. Addiction, 101(12), 1741-1751.  Pub Med icon

McCaffrey, D. F., Ridgeway, G., & Morral, A. R. (2004). Propensity score estimation with boosted regression for evaluating causal effects in observational studies. Psychological Methods, 9(4), 403-425.  Pub Med icon

Morral, A. R., Jaycox, L. H., Smith, W., Becker, K., & Ebener, P. (2003). An evaluation of substance abuse treatment services for juvenile probationers at Phoenix Academy of Los Angeles. In S. J. Stevens & A. R. Morral (Eds.), Adolescent substance abuse treatment in the United States: Exemplary models from a national evaluation study (pp. 213-233). Binghamton, NY: Haworth Press.

Outcomes

Outcome 1: Substance use
Description of Measures The Global Appraisal of Individual Needs (GAIN) was used to measure substance use along three dimensions: substance problems (symptoms from the DSM-IV) in the previous month, the extent of substance use (total days of reported use of 12 classes of drugs) in the past 3 months, and substance involvement (range of use across 12 classes of drugs) in the past 3 months. The GAIN is a standardized interview that assesses eight functional domains: background, substance use, physical health, risk behaviors, mental health, environment, legal, and vocational.

A fourth measure of substance use was recent tobacco smoking. A single question was answered on a 7-point Likert-type scale from 0 (never) to 6 (past 2 days).
Key Findings Adolescent probationers assigned to Phoenix House Academy showed a larger reduction in the reported extent of substance use, substance involvement, and recent smoking from baseline to the 3-month follow-up than adolescents assigned to the comparison condition, an alternative probation disposition (p < .05). The effect sizes for the extent of substance use (Cohen's d = 0.32), substance involvement (Cohen's d = 0.29), and recent tobacco smoking (Cohen's d = 0.30) were small.

From the 3- to 12-month follow-up, the reported extent of substance use and substance involvement remained lower among adolescents assigned to Phoenix House Academy than among those in the comparison group (p < .05). The associated effect sizes for these group differences were small (Cohen's d = 0.25 and 0.24 for the extent of substance use and substance involvement, respectively). However, during the same timeframe, Phoenix House Academy adolescents showed increases in recent tobacco smoking relative to adolescents in the comparison group (p < .005). A small effect size was associated with this finding (Cohen's d = 0.45).

Adolescents in Phoenix House Academy showed a greater reduction in substance problems from baseline to the 12-month follow-up than adolescents in the comparison group (p < .05). A small effect size was associated with this group difference (Cohen's d = 0.27).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 2: Psychological functioning
Description of Measures Psychological functioning was measured using three subscales of the GAIN: somatic symptoms, depressive symptoms, and anxiety symptoms. The GAIN is a standardized interview that assesses eight functional domains: background, substance use, physical health, risk behaviors, mental health, environment, legal, and vocational.

Another form of psychological functioning, recent experience of psychological distress, was measured using a single item: "When was the last time (if ever) your life was disturbed by emotional, nerve, mental, or psychological problems, or that you felt you could not go on?" Responses were on a Likert-type scale ranging from 0 (never) to 6 (within the past 2 days).
Key Findings Adolescent probationers assigned to Phoenix House Academy showed greater decreases in somatic (p < .05), depressive (p < .005), and anxiety (p < .005) symptoms from the 3- to 12-month follow-up than adolescents assigned to the comparison condition, an alternative probation disposition. These group differences were associated with small effect sizes (Cohen's d = 0.27, 0.34, and 0.39 for somatic, depressive, and anxiety symptoms, respectively). From baseline to the 12-month follow-up, adolescents in Phoenix House Academy showed larger reductions in somatic (p < .01) and anxiety (p < .05) symptoms than adolescents in the comparison group. A small effect size also was associated with these group differences (Cohen's d = 0.32 and 0.29 for somatic and anxiety symptoms, respectively).

Recent experience of psychological distress declined from the 3- to 12-month follow-up for adolescents in the Phoenix House Academy and comparison groups, with no significant group differences detected.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 3.3 (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) 87.3% Male
12.7% Female
55.2% Hispanic or Latino
16% White
14.7% Black or African American
14% 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 4.0 4.0 1.5 4.0 2.5 4.0 3.3
2: Psychological functioning 4.0 4.0 1.5 4.0 2.5 4.0 3.3

Study Strengths

The measures used were psychometrically sound. Use of the GAIN adds to the confidence that outcomes could be measured with reliability and internal validity. Additionally, the GAIN measures screen for symptoms associated with DSM-IV disorders. The study employed accepted techniques for analysis of observational data that adjust for pretreatment group differences when random assignment is not feasible.

Study Weaknesses

The comparison condition represented different types of residential treatment using a wide range of therapeutic approaches. The fidelity of the treatment programs was not evaluated, and no information was provided about the qualifications or training of the staff. The analyses were global tests of the effects of one type of residential treatment against those of a group of other types of residential treatment, some of which were not centered on treating substance abuse.

Readiness for Dissemination
Review Date: December 2007

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.

Description of training and support resources

Jaycox, L. H., Marshall, G. N., & Morral, A. R. (n.d.). Phoenix Academy at Lake View Terrace, California: Clinical manual and program description of an adolescent therapeutic community. Santa Monica, CA: RAND.

Phoenix House Foundation, Inc. (1998). Therapeutic communities for adolescents: A clinical manual. New York: Author.

Phoenix House Foundation, Inc. (2006). Phoenix House residential program quality improvement instrument. New York: 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
3.0 2.5 4.0 3.2

Dissemination Strengths

Program materials include helpful information about staff selection, training, and supervision. Initial training is followed by planned inservice training sessions, and additional follow-up support is available as needed. An excellent quality assurance review process is in place to support both fidelity and outcome monitoring.

Dissemination Weaknesses

Very little guidance is provided to assist a new organization in selecting and preparing to implement this model. More substantial guidance for staff coaching is needed.

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
Clinical manual Free Yes
1- to 5-week, on-site training Varies depending on site needs Yes
On-site posttraining technical assistance and/or phone consultation Varies depending on site needs No

Additional Information

Start-up costs vary by region, facility size, resources, and implementation stage.

Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Deni Carise, Ph.D.
(646) 505-2165
dcarise@phoenixhouse.org

To learn more about research, contact:
Jennifer Butler
(646) 505-2168
jbutler@phoenixhouse.org

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

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