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 1Smith, 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.  Study 2Stevens, 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.
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.
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 |
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Description of Measures
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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).
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Key Findings
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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.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental, Preexperimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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| Outcome 2: Symptoms of mental health problems |
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Description of Measures
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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.
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Key Findings
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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).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Preexperimental
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Quality of Research Rating
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2.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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13-17 (Adolescent)
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71% Male
29% Female
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76% White
24% Race/ethnicity unspecified
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Study 2
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13-17 (Adolescent)
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75% Male
25% Female
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53% White
31% Hispanic or Latino
17% Race/ethnicity unspecified
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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:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Substance use and related problems
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4.0
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4.0
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2.0
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3.0
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2.5
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1.5
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2.8
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2: Symptoms of mental health problems
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4.0
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3.5
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1.0
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2.0
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2.0
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1.5
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2.3
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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.
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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:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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4.0
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4.0
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4.0
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4.0
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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.
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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.
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Item Description
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Cost
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Required by Developer
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Youth journals set
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$29.95 per participant
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Yes
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Book of readings for youth
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$19.95 each
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Yes
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Posters
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$10 each
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Yes
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Counselors manual
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$25.95 each
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Yes
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Counselors training DVD
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$68.95 each
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Yes
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Counselors activity book
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$47.95 each
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No
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3-day, on-site initial training and agency license
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$8,700 per agency plus travel expenses
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Yes
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3-day, off-site leader training
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$700 per person
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Yes, one leader training option is required
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3-day, on-site leader training
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$6,400 per agency plus travel expenses
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Yes, one leader training option is required
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Telephone support and mentoring
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Included in initial training and annual fidelity fee
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Yes
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First-year support/fidelity site visit
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$2,000 plus travel expenses
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Yes
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Annual fidelity fee beginning in second year (includes license, telephone support, and site visit)
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$5,000 per year
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Yes
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All quality assurance materials and nonpublished supportive documents
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Free
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Yes
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Additional Information Quantity discounts are available for the published materials. Interest-free payment arrangements can be negotiated for the initial license fee.
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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.
* 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.
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