Composite of Evidence for The Seven Challenges®

Note:  When programs and other organizations make claims that they say are research backed, we want to see the research.  We have found far too many situations where research claims are either blatantly false or misleading.  When we requested research backing for claims made by The Seven Challenges, what follows is what we received.  

Information on this page has been supplied by Robert Schwebel, Ph. D.  and his associates.   FamilyLight has not fully verified what is stated, although we have no reason to doubt its accuracy.   This content printed is copyright by Robert Schwebel, Ph. D.  What is on this page may not be reproduced without permission of Dr. Schwebel.   FamilyLight holds no claim of copyright on this page.  Inquiries should be directed to Sharon Conner, Director of Program Services, (520) 405-4559.  sconner  at sevenchallenges dot com, www.sevenchallenges.com

Return to The Seven Challenges Article  (member access)

Return to The Seven Challenges -- Introduction (public access)

The Seven Challenges program was developed by Robert Schwebel, Ph.D., who remains actively involved with clinical aspects of the Program.  Dr. Schwebel initially created The Seven Challenges while working with adolescents in an Arizona residential setting.  Shortly thereafter, program development continued in day treatment, juvenile justice, and intensive outpatient settings.  Dr. Schwebel firmly believed that a substance abuse counseling program for adolescents must be developmentally appropriate; based upon psychological research and science, include the study of what has been proven to be effective in bringing about change; and holistic – that is, addressing substance abuse issues as well as co-occurring problems and life skills deficits.  While writing the Program he was working with substantial numbers of Hispanic, African American, and Native American youth.  He saw the need for a Program that would be respectful and sensitive to a variety of cultures.

In terms of outcomes studies, The Seven Challenges was fortunate to have been rolled into studies, funded by The Center for Substance Abuse Treatment (CSAT), as a comparison group.  These research studies were completed at the University of Arizona and at the University of Iowa.  The reference information for the published studies is listed below.  Both studies showed substantial reduction in substance abuse and impressive mental health improvements. The Stevens (2007) study had the unusual and very positive finding of continued mental health improvement between three and six months post-treatment.  The positive outcomes of The Seven Challenges in the Smith (2006) study were paired with positive outcomes in a family program, though Seven Challenges clients received substantially fewer sessions in counseling than did the family program youth (19 compared to 26.)

In 2005, at the SAMHSA Joint Meeting on Adolescent Treatment Effectiveness (JMATE), Michael Dennis presented data comparing manualized treatment in outpatient settings for youth with serious trauma issues.  The Seven Challenges had a significantly larger effect than all the other programs and was the most effective outpatient approach for reducing substance use among adolescents with high victimization scores.  At the 2010 JMATE, Randy Muck presented data showing The Seven Challenges to be highly effective in addressing adolescent co-occurring and trauma issues.  As a result of this finding, funding has been provided to further the research of the Program in 2011.  The executive summaries for these presentations appear below.

The Seven Challenges is listed on SAMHSA’s National Registry of Evidence-based Programs and Practices – visit http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=159.  You are welcome to contact me with any questions regarding The Seven Challenges implementation, or adaptation.  We appreciate your interest!

Composite of Evidence for The Seven Challenges®
By:  Sharon Conner, Director of Program Services
        The Seven Challenges®, LLC
        431 S. Brighton Lane
        Tucson, Arizona  85711
        sconner at sevenchallenges dot com 
        (520) 405-4559

 The Seven Challenges®
An Effective Treatment for Adolescents with Co-occurring Substance Abuse and
Mental Health Problems

Stevens, S., Schwebel, R., and Ruiz, B. (2007).  Journal of Social Work Practice in the Addictions, 7, 3, 29- 49.
1Sally J. Stevens, Ph.D.
2Robert Schwebel, Ph.D.
1Bridget Ruiz, B.A.

1 Sally J. Stevens, Ph.D., and Bridget S. Ruiz, B.A. are affiliated with the University of Arizona Southwest Institute for Research on Women - 1103 E. University, P.O. Box 210025, Communications 108, Tucson, AZ 85721.

2 Robert Schwebel, Ph.D. is a private practice psychologist and the developer of The Seven Challenges Program - 431 S. Brighton Lane Tucson, AZ 85711.

Comparative Efficacy of Family and Group Treatment for Adolescent Substance Abuse

Smith, D. C., Hall, J. A., Williams, J., An, H. & Gotman N. (2006.)  The American Journal on Addictions, volume 15(6), 131-136.

University of Iowa

Author Note:  Douglas C. Smith is Project Director of Project Iowa SCY; James A. Hall is Professor of Pediatrics, Social Work, Public Health & Nursing; Julie K Williams is Evaluation Coordinator for Project Iowa SCY; Hyonggin An is Assistant Professor of Biostatistics; Nathan Gotman is a student in the biostatistics program.

This study was funded by a cooperative agreement from SAMHSA’s Center for Substance Abuse Treatment, TI13354.  The opinions are those of the authors and do not reflect official positions of the government.

Correspondence may be directed to James A. Hall, Ph.D., LISW, Department of Pediatrics, 2559 JCP, University of Iowa, Iowa City, IA  52242; email: james-a-hall at  uiowa dot edu; business phone: (319) 335-4922; or fax: (319) 335-4662.

 EXECUTIVE SUMMARY

Traumatic Victimization Among Adolescents Presenting for Substance Abuse Treatment: It is Time to Stop Ignoring the Elephant in our Counseling Room

Michael Dennis, Ph.D. and Melissa Ives, MSW, Chestnut Health Systems,

Bloomington, IL

Presentation for the 2005 Joint Meeting on Adolescent Treatment Effectiveness, Washington, DC, March 21-23, 2005. Sponsored by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA)

THE STUDY

This study used the GAIN general victimization scale (GVS) to examine the implications of traumatic victimization for treatment outcome and matching among with adolescent clients with substance use disorders (SUDS).

VICTIMIZATION RATES AMONG ADOLESCENT CLIENTS WITH SUDS

Victimization (including physical, sexual, and emotional abuse) is the norm for adolescents presenting to substance abuse treatment. The prevalence rates are as follows:

l It is estimated that 826,000 to 3,000,000 (3-12%) adolescents (age 12 to 17) have been victimized (DHHS, 2001; Sedlack & Broadhurst, 1996).

l Among adolescents presenting for substance abuse treatment, the rates ranged from 40 to 80% - varying by gender, timing, definition, and level of care (Dennis & Stevens, 2003)

l 39% of male & 59% of females acknowledged a lifetime history of physical or sexual victimization when interviewed a few questions in DATOS-A a month after intake (Grella & Joshi, 2003).

l 48% of the males and 80% of the females acknowledged a lifetime history of physical, sexual, or emotional victimization when interviewed with the GAIN at intake (Titus, Dennis, White, Scott & Funk, 2003).

DATA SET FOR THIS STUDY

The Center for Substance Abuse Treatment (CSAT) adolescent treatment data set includes data on 5,468 adolescents from 67 local evaluations from the following initiatives:

EAT: Effective Adolescent Treatment (2003-2007)

CYT: Cannabis Youth Treatment (1997-2001)

TCE: Targeted Capacity Expansion (2002-2007)

SCY: Strengthening Communities-Youth (2002-2007)

ATM: Adolescent Treatment Model (1998-2002)

ART: Adolescent Residential Treatment (2003-2006)

Composite of Evidence for The Seven Challenges®

FINDINGS SPECIFIC TO THE SEVEN CHALLENGES

When adolescents had high victimization scores, manualized outpatient programs had little (Cohen's effect size d= .18)to moderate  (d=.35) impact on substance use.  The Seven Challenges® intensive outpatient (IOP) program, however, had a significantly larger effect (d=1.8) and was the most effective outpatient approach for reducing substance use among adolescents with high victimization scores.

REFERENCES

Dennis, M. L., & Stevens, S. J., (Eds.). (2003). Maltreatment issues and outcomes of adolescents enrolled in substance abuse treatment [special issue]. Journal of Child Maltreatment, 8(1): 3-6.  See http://www.sagepub.com/journalIssue.aspx?pid=15&jiid=6072

Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN) Administration guide for the GAIN and related measures. (Version 5 ed.). Bloomington, IL Chestnut Health Systems. Retrieve from http//www.chestnut.org/li/gain

Grella, C. E., & Joshi, V. (2003). Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Journal of Child Maltreatment, 8(1): 7-18.

Titus, J.C., Dennis, M.L., White, W.L., Scott, C.K., & Funk, R.R. (2003).  Gender Differences in Victimization Severity and Outcomes Among Adolescents Treated for Substance Abuse. Journal of Child Maltreatment, 8(1), 19-35.

U.S. Department of Health and Human Services. (2001). Child Maltreatment 1999. Washington, DC: U.S. Government Printing Office.

EXECUTIVE SUMMARY

Adolescent Treatment Effectiveness
Second Chance Act Grantee Meeting
Presented by Randy Muck, M.Ed.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration, Rockville, MD

Also presented as a Keynote for the 2011 Joint Meeting on Adolescent Treatment Effectiveness, Baltimore, MD December 14, 2011 Sponsored by Center and the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), and OJJDP, and ONDCP

THE KEYNOTE PURPOSE

To take stock of how far the field of adolescent treatment has progressed, particularly in the last few years; and to identify Evidence-Based Treatments that are the most effective for populations with co-occurring mental health and trauma related problems that are manualized, replicable, and have training/certification

The field now has pooled data from 19,229 youth assessed with the Global Appraisal of Individual Needs (GAIN), including 88% with one or more follow-up, made available for program evaluation and secondary analysis, which has helped to generate over 200 publications. Studies include male and female, culturally diverse youth, ages 12-17. Found that multiple clinical problems are the norm for these youth.

 PREDICTORS OF BIGGER EFFECTS

Found the major predictors of bigger effects in multiple meta analyses (Lipsey, 1997, 2005)

  1. A strong intervention protocol based on prior evidence
  2. Quality assurance to ensure protocol adherence and project implementation
  3. Proactive case supervision of individual
  4. Triage to focus on the highest severity subgroup

EVIDENCE BASED PROGRAMS THAT WORK

Evidenced Based Treatment (EBT) Programs that typically do better than usual practice in reducing juvenile use & recidivism. Listed alphabetically (Small or no differences in mean effect size between these brand names)

  • Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)
  • Motivational Interviewing (MI)
  • Multi Systemic Therapy (MST)
  • Multidimensional Family Therapy (MDFT)
  • Reasoning & Rehabilitation (RR)
  • Seven Challenges (7C)

EVIDENCE BASED APPROACHES THAT ADDRESS CO-OCCURRING MENTAL HEALTH/TRAUMA ISSUES

  • Seven Challenges (Schwebel, 2004) (n=114)
  • Chestnut Health Systems (CHS; Godley et al. 2002) Treatment (n=192)
  • Adolescent Community Reinforcement Approach (A-CRA; Godley et al., 2001) -CYT/AAFT (n=2144) and -Other (n=276)
  • Multi-Systemic Therapy

(MST; Henggeler et al., 1998) (n=85)

  • Multi-Dimensional Family Therapy

(MDFT; Liddle, 2002) (n=258)

  • Motivational Enhancement Therapy-Cognitive Behavior Therapy (METCBT; Sampl & Kadden, 2001)-CYT/EAT (n=5262) and -Other (n=878)
  • Family Support Network

(FSN; Hamilton et al., 2001) (n=369)

MENTAL HEALTH SCALES ON THE GAIN INVENTORY

  • Emotional Problems Scale
  • Days of Victimization
  • Days of Traumatic Memories

FINDINGS SPECIFIC TO THE SEVEN CHALLENGES (see slides 11 and 12)

All programs reduced mental health / trauma problems with 4 doing particularly well: Seven Challenges, CHS, A-CRA, & MST.

The Seven Challenges did exceptionally well on the emotional problems scale.

References (see slides)

Return to The Seven Challenges Article  (member access)

Return to The Seven Challenges -- Introduction (public access)

Last Update October 8, 2014

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