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Intervention Summary

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Teen Intervene

Teen Intervene is a brief, early intervention program for 12- to 19-year-olds who display the early stages of alcohol or drug involvement. Integrating stages of change theory, motivational enhancement, and cognitive-behavioral therapy, the intervention aims to help teens reduce and ultimately eliminate their substance use.

The program is typically administered in an outpatient, school, or juvenile detention setting by a trained professional in three 1-hour sessions conducted 10 days apart. During session 1, an individual session with the adolescent, the therapist elicits information about the adolescent's substance use and related consequences, examines the costs and benefits of the substance use, and helps the adolescent set goals of behavior change, including goals to reduce or eliminate substance use. In session 2, the therapist assesses the adolescent's progress, discusses strategies for overcoming barriers, and negotiates the adolescent's continued work toward meeting goals. Session 3 is an individual counseling session with the teenager's parent (or guardian); this session addresses parent-child communication and discipline practices, and specific ways for the parent to support the child's goals. The third session also includes a brief wrap-up conversation with the parent and adolescent.

The study reviewed for this summary, which was conducted in a school setting, evaluated the three-session intervention as well as a two-session version of the intervention that omitted parent counseling.

Descriptive Information

Areas of Interest Substance abuse prevention
Substance abuse treatment
Outcomes Review Date: June 2012
1: Frequency of substance use
2: Symptoms of substance abuse and dependence
3: Negative consequences related to alcohol and other drug involvement

Review Date: August 2007
1: Number of days of alcohol use
2: Number of days of binge drinking
3: Number of days of illicit drug use
4: Negative consequences related to alcohol and other drug involvement
Outcome Categories Alcohol
Drugs
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities White
Race/ethnicity unspecified
Settings Outpatient
School
Geographic Locations Urban
Suburban
Implementation History Since its development in early 2000, Teen Intervene has been implemented with more than 75,000 students in more than 1,000 sites in all 50 States and Guam, as well as in Australia, Barbados, Canada, the Cayman Islands, Greece, Ireland, Japan, Mexico, New Zealand, Singapore, South Africa, and the United Kingdom.
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 Indicated

Quality of Research
Review Date: June 2012

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

Winters, K. C., Fahnhorst, T., Botzet, A., Lee, S., & Lalone, B. (2012). Brief intervention for drug-abusing adolescents in a school setting: Outcomes and mediating factors. Journal of Substance Abuse Treatment, 42(3), 279–288.  Pub Med icon

Outcomes

Outcome 1: Frequency of substance use
Description of Measures The Timeline Followback (TLFB) structured interview technique was used to measure how often adolescents used alcohol, cannabis, and other illicit drugs in the past 90 days. In the TLFB method, the interviewer and respondent look at a calendar marked with memorable dates (e.g., high school homecoming, birthdays), and the respondent reports his or her substance use for each day.
Key Findings

Participants were 13- to 18-year olds referred to the research staff by a school counselor following suspected or confirmed drug use or possession. Study eligibility required that participants have at least a mild drug abuse problem, as indicated by scores on the Personal Experience Screening Questionnaire (PESQ), which measures self-reported drug involvement and personal and environmental problems associated with drug use. Youth with acute psychiatric or medical conditions or currently receiving drug treatment were excluded. Participants were randomly assigned to two intervention groups, one receiving the full three-session intervention including the parent component (BI-AP) and one receiving a two-session version with the adolescent only (BI-A). Once target numbers for the intervention groups were met, participants were separately recruited for an assessment-only control condition.

For alcohol use, both intervention groups had a significantly greater reduction in the frequency of use from intake to 6-month follow-up compared with the control group (p < .05), after controlling for differences in baseline PESQ scores. This finding is associated with a small effect size (eta squared = .03).

Likewise, for cannabis use, both intervention groups had a significantly greater reduction in the frequency of use from intake to 6-month follow-up compared with the control group (p < .05), after controlling for differences in baseline PESQ scores. The group receiving all three sessions (BI-AP) reported significantly fewer cannabis use days at 6-month follow-up than the group receiving two sessions (BI-A; p < .05). These findings are associated with small effect sizes (eta squared = .02).

Further, at 6-month follow-up, both intervention groups had higher percentages of participants reporting they abstained in the past 90 days from using alcohol (p < .01) and cannabis (p < .05), compared with the control group. These findings are associated with large effect sizes (Cohen's d = 2.1 and 1.8 for alcohol and cannabis abstinence, respectively).

Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 2: Symptoms of substance abuse and dependence
Description of Measures The substance use disorder module of the Adolescent Diagnostic Interview (ADI) was used to measure symptoms related to substance abuse and dependence. This highly structured interview assesses all abuse and dependence criteria for any substance used five or more times during the prior 12 months.
Key Findings

Participants were 13- to 18-year olds referred to the research staff by a school counselor following suspected or confirmed drug use or possession. Study eligibility required that participants have at least a mild drug abuse problem, as indicated by scores on the Personal Experience Screening Questionnaire (PESQ), which measures self-reported drug involvement and personal and environmental problems associated with drug use. Youth with acute psychiatric or medical conditions or currently receiving drug treatment were excluded. Participants were randomly assigned to two intervention groups, one receiving the full three-session intervention including the parent component (BI-AP) and one receiving a two-session version with the adolescent only (BI-A). Once target numbers for the intervention groups were met, participants were separately recruited for an assessment-only control condition.

For alcohol abuse and dependence symptoms, both intervention groups showed a significant reduction in symptoms from intake to 6-month follow-up compared with the control group (p < .05 for both alcohol abuse and dependence), after controlling for differences in baseline PESQ scores. These findings are associated with large (eta squared = .17) and medium (eta squared = .06) effect sizes for alcohol abuse and alcohol dependence symptoms, respectively.

For cannabis abuse and dependence symptoms, the group receiving the three-session intervention (BI-AP) had a significantly greater reduction in symptoms from intake to 6-month follow-up than the other two study groups (p < .05), after controlling for differences in baseline PESQ scores. These findings are associated with small effect sizes (eta squared = .03) for both cannabis abuse and cannabis dependence symptoms.

Further, at 6-month follow-up, both intervention groups had higher percentages of participants reporting no symptoms of alcohol abuse (p < .01), alcohol dependence (p < .01), or cannabis abuse (p < .05) in the past 6 months, compared with the control group. These findings are associated with large effect sizes (Cohen's d = 2.0, 2.1, and 1.8 for alcohol abuse, alcohol dependence, and cannabis abuse symptoms, respectively).

Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)
Outcome 3: Negative consequences related to alcohol and other drug involvement
Description of Measures Adolescents completed the 11-item Personal Consequences Scale from the Personal Experience Inventory. This scale focuses on the negative consequences of alcohol and other drug involvement, such as legal, motor vehicle, and social consequences and effects on health and the family. Items were rated on a 4-point scale from 1 (strongly disagree) to 4 (strongly agree), resulting in a total score ranging from 11 to 44.
Key Findings

Participants were 13- to 18-year olds referred to the research staff by a school counselor following suspected or confirmed drug use or possession. Study eligibility required that participants have at least a mild drug abuse problem, as indicated by scores on the Personal Experience Screening Questionnaire (PESQ), which measures self-reported drug involvement and personal and environmental problems associated with drug use. Youth with acute psychiatric or medical conditions or currently receiving drug treatment were excluded. Participants were randomly assigned to two intervention groups, one receiving the full three-session intervention including the parent component (BI-AP) and one receiving a two-session version with the adolescent only (BI-A). Once target numbers for the intervention groups were met, participants were separately recruited for an assessment-only control condition.

Both intervention groups had a significant decrease in negative consequences of alcohol and other drug involvement from intake to 6-month follow-up compared with the control group (p < .05), after controlling for differences in baseline PESQ scores. This finding is associated with a medium effect size (eta squared = .11).

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) 52% Male
48% Female
68% White
32% 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: Frequency of substance use 3.8 3.0 3.6 4.0 2.5 3.0 3.3
2: Symptoms of substance abuse and dependence 3.8 3.3 3.6 4.0 2.5 3.0 3.4
3: Negative consequences related to alcohol and other drug involvement 3.5 3.3 3.6 4.0 2.5 3.0 3.3

Study Strengths

The reliability of the Timeline Followback and Adolescent Diagnostic Interview is well documented in independent sources. Reliability information for the full Personal Experience Inventory (PEI) also appears extensive, and the authors report good internal consistency and test-retest reliability for the Personal Consequences Scale component of the PEI used in the study reviewed. All measures have face validity, and other forms of validity are documented in earlier studies. The interventions were delivered by trained therapists in a crossed design, whereby each therapist implemented each of the two interventions (BI-A and BI-AP). Therapists were experienced in giving structured manualized treatment and were supervised. Session adherence checklists were completed by research assistants who reviewed audiotapes of the sessions, and ratings indicated that 98% of key components were covered. Missing data and attrition were very low and did not need adjustment. There were no baseline differences among the three study groups.

Study Weaknesses

It does not appear that the study employed the type of fidelity ratings that are frequently used in studies involving motivational interviewing, and the extent to which the therapists were trained specifically in motivational interviewing is unknown. Participants were randomly assigned only to the two active treatment groups; control participants were recruited specifically for the control condition to minimize refusal rates. While there are benefits to this approach, controlling recruitment in this way could have introduced selection biases, although baseline equivalence across groups was not discussed. No corrections were applied to the repeated-measures ANOVAs, which is problematic given the possibility that the data are not normally distributed, particularly for the Timeline Followback. No adjustments were made to control for differences in the size of the three study groups.

Review Date: August 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

Winters, K. C., & Leitten, W. (2007). Brief intervention for drug-abusing adolescents in a school setting. Psychology of Addictive Behaviors, 21(2), 249-254.  Pub Med icon

Supplementary Materials

Independent Ratings for Therapist Fidelity instruments (sessions 1-3)

Outcomes

Outcome 1: Number of days of alcohol use
Description of Measures The Timeline Followback (TLFB) structured interview technique was used to measure the number of days of adolescent alcohol use in the previous 6 months. Using TLFB, the interviewer and adolescent look at a calendar marked with dates that are memorable for the community (e.g., high school homecoming) and the individual (e.g., birthdays). The adolescent reports his or her alcohol and drug use for each day.
Key Findings Adolescents in the early stages of alcohol or drug use problems who received either the two- or three-session Teen Intervene program reported significantly fewer days of alcohol use compared with peers who received usual care (p < .05). The effect size was large (eta-squared = 0.29). Adolescents who received the three-session program reported even fewer days of alcohol use than those who received the two-session program (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 2: Number of days of binge drinking
Description of Measures The TLFB structured interview technique was used to measure the number of days of adolescent binge drinking in the previous 6 months. An alcohol binge was defined as five or more drinks per occasion for boys and four or more drinks per occasion for girls.
Key Findings Adolescents in the early stages of alcohol or drug use problems who received the three-session Teen Intervene program reported significantly fewer days of binge drinking compared with peers who received usual care (p < .05). The effect size was large (eta-squared = 0.31).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 3: Number of days of illicit drug use
Description of Measures The TLFB structured interview technique was used to measure the number of days of adolescent illicit drug use in the previous 6 months.
Key Findings Adolescents in the early stages of alcohol or drug use problems who received the three-session Teen Intervene program reported significantly fewer days of illicit drug use compared with peers who received usual care (p < .05). The effect size was large (eta-squared = 0.60).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 4: Negative consequences related to alcohol and other drug involvement
Description of Measures Adolescents completed the 11-item Personal Consequences Scale from the Personal Experience Inventory. This scale focuses on the negative consequences of alcohol and other drug involvement, such as legal, motor vehicle, and social consequences and effects on health and the family. Items were rated on a 4-point scale from 1 (strongly disagree) to 4 (strongly agree), resulting in a total score ranging from 11 to 44.
Key Findings Adolescents in the early stages of alcohol or drug use problems who received either the two- or three-session Teen Intervene program reported significantly fewer negative consequences associated with alcohol and other drug involvement compared with peers who received usual care (p < .05). The effect size was large (eta-squared = 0.41). Negative consequence ratings did not differ between adolescents who received the two-session program and those who received the three-session program.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.4 (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) 62.3% Male
37.7% Female
81% White
19% 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: Number of days of alcohol use 3.0 3.0 3.5 3.5 3.3 3.8 3.3
2: Number of days of binge drinking 3.0 3.0 3.5 3.5 3.3 3.8 3.3
3: Number of days of illicit drug use 3.0 3.0 3.5 3.5 3.3 3.8 3.3
4: Negative consequences related to alcohol and other drug involvement 3.5 3.0 3.5 3.5 3.3 3.8 3.4

Study Strengths

Researchers employed the Timeline Followback method, a commonly used assessment with good psychometric properties. Intervention fidelity was enhanced through training; appropriate monitoring and supervision, including reviews of audiotaped sessions; manualized treatment; and therapist checklists. Subject retention was excellent, with no substantial missing data. Many procedures, such as random assignment, equated groups at baseline, and blinded research assistants, were used to avoid or reduce possible confounding. Analyses were appropriate for the study design.

Study Weaknesses

The sample size was small. No fidelity data were provided. One cannot attribute results of the intervention to the parent component because contact type (i.e., contact with the child versus contact with the child and parent) and time were not controlled. It is also possible that the observed differences in effects between the two intervention groups and the comparison group were due to the time and attention given to the youth rather than to the actual intervention.

Readiness for Dissemination
Review Date: June 2012

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.

Winters, K. (2004). Personal experience screening questionnaire (PESQ): Brief. Minneapolis: Center for Adolescent Substance Abuse Research, University of Minnesota.

Winters, K. (2011). Teen Intervene: Using brief intervention with substance-abusing adolescents: Facilitator guide (2nd ed., with CD-ROM). Center City, MN: Hazelden.

Winters, K. C., & Stinchfield, R. D., Fahnhorst, T., & Botzet, A. (2005). Alcohol diagnostic interview: Parent follow-up. Minneapolis: Center for Adolescent Substance Abuse Research, University of Minnesota Medical School.

Winters, K. C., & Stinchfield, R. D., Fahnhorst, T., & Botzet, A. (2005). Alcohol diagnostic interview: Youth follow-up. Minneapolis: Center for Adolescent Substance Abuse Research, University of Minnesota Medical School.

Other program materials:

  • Agenda: Teen Intervene One-Day Workshop
  • Brief Intervention with Alcohol and Drug Abusing Adolescents: Clinical Applications of Teen Intervene [PowerPoint]
  • Case Study: Lynette (2010)
  • Independent Ratings for Therapist Fidelity: Session 1
  • Independent Ratings for Therapist Fidelity: Session 2
  • Independent Ratings for Therapist Fidelity: Session 3
  • Post-Intervention Outcome Questionnaire

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
3.9 4.0 3.9 3.9

Dissemination Strengths

The facilitator guide is well organized and contains easy-to-follow, step-by-step implementation instructions. It includes background information on the intervention, time frames for each exercise, sample dialogue scripts, and suggested phrases to frame questions and responses. A CD-ROM contains all reproducible worksheets and questionnaires, as well as supplemental resources for implementers, including information on adolescent brain development. An optional, 1-day implementer training and a 2-day training-of-trainers are available from the developer. The therapist fidelity checklists include rating options for adherence delivery, content, and quality. The facilitator guide lists optional screening instruments for the intervention; many of these are public domain and free of charge. In addition, the developer offers brief client outcome measures upon request.

Dissemination Weaknesses

Little guidance is provided to implementers on managing timing restrictions for session exercises. No guidance is available on interpreting the fidelity checklist and using this information to improve program delivery.

Review Date: August 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.

Teen Intervene forms:

  • Continuing Education Test
  • Customer Satisfaction and Implementation Survey
  • Independent Ratings for Therapist Fidelity instruments (sessions 1-3)

Teen Intervene program summary

Teen Intervene training packet

Winters, K. C. (2003). Teen Intervene program kit. Center City, MN: Hazelden.

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
3.1 3.3 3.5 3.3

Dissemination Strengths

Program materials are well organized and conceptually clear. Guidance for overcoming potential obstacles is provided in the program kit. On-site training and technical assistance are available to implementers. Fidelity instruments and a customer satisfaction survey are available to support quality assurance.

Dissemination Weaknesses

Little information is provided on adapting the program to various settings and cultural groups. There is no defined training curriculum for this program. While measures may be created from the existing materials, there is no clear mechanism for assessing treatment outcomes.

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
Facilitator guide (includes reproducible worksheets, forms, and supplemental materials) $249 each Yes
1-day, off-site implementer training Varies depending on site needs No
2-day, off-site training for trainers Varies depending on site needs No
Technical assistance via email Free No
Quality assurance items (therapist fidelity checklists, postintervention outcome questionnaire, PESQ) Free No

Additional Information

Orders placed through Hazelden's online bookstore receive free shipping. Discounts are available for bulk orders.

Replications

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

Dembo, R., Gulledge, L., Karas, I., Winters, K. C., & Belenko, S. (2012). Impact of brief intervention on drug using truant youth arrests over time. Manuscript submitted for publication.

* Winters, K. C., Fahnhorst, T., Botzet, A., Lee, S., & Lalone, B. (2012). Brief intervention for drug-abusing adolescents in a school setting: Outcomes and mediating factors. Journal of Substance Abuse Treatment, 42(3), 279–288.   Pub Med icon

Winters, K. C., & Leitten, W. (2007). Brief intervention for drug-abusing adolescents in a school setting. Psychology of Addictive Behaviors, 21(2), 249–254.  Pub Med icon

Contact Information

To learn more about implementation, contact:
Kaylene McElfresh
(651) 213-4324
kmcelfresh@hazelden.org

To learn more about research, contact:
Ken C. Winters, Ph.D.
(612) 273-9815
winte001@umn.edu

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

Web Site(s):