HomeMy WebLinkAboutRES 170 Draft 01 2002-2004 COUNTY OF HAWAII STATE OF HAWAII
RESOLUTION NO. 1'70 0`I
RESOLUTION AUTHORIZING THE OFFICE OF THE MAYOR TO ENTER INTO AN
AGREEMENT WITH THE UNITED STATES OF AMERICA, PURSUANT TO HRS 46-
7, FOR THE SUBSTANCE ABUSE & MENTAL HEALTH SERVICES
ADMINISTRATION (SAMHSA) GRANT FOR THE HAWAI`1 ISLAND ADOLESCENT
TREATMENT PROGRAM
WHEREAS, the Substance Abuse & Mental Health Services Administration (SAMHSA), an
agency of the U.S. Department of Health & Human Services, through its sub-agency, Center for
Substance Abuse Treatment (CSAT), has authorized funding to the County of Hawaii for an
adolescent treatment program; and
WHEREAS, SAMHSA is an agency charged with improving the quality and availability of
prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost
to society resulting from substance abuse and mental illnesses; and
WHEREAS, the County will be using these grant funds, in addition to other outside sources of
funding, to set up a residential substance abuse treatment program for youth on the Island of Hawaii;
and
WHEREAS, Hawaii Revised Statutes, Section 46-7, requires that county departments obtain
the consent of the council to enter into agreements with the federal or state governments respecting
action to be taken pursuant to any of the powers granted by law to furnish, expend, and receive any
funds or other assistance in connection with projects being or to be undertaken pursuant to those
powers.
NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE COUNTY OF HAWAII,
in accordance with section 46-7, Hawaii Revised Statutes, that the Mayor of the County of Hawaii is
authorized to execute, on behalf of the County, an agreement and related documents, to enable the
County to use SAMHSA grant funds for its adolescent treatment program as described in the
program abstract of the County's application to CSAT, attached hereto and incorporated herein by
reference as Exhibit "A".
~E IT FURTHER RESOLVED that the County Clerk of the County of Hawaii shall transmit
copies of this resolution to the Office of the Mayor and to the Department of Financ .
Dated at xilo ,Hawaii, this 7th day of April , 2004.
INTRODUCED HY:
COUNCIL. MEMHER, C NTY OF HAWAII
COUNTY COUNCIL ROLL CAL VOTE
County of Hawaii
Hilo, Hawaii AYES N ES ABS EX
ARAKAKI X
I hereby certify that the foregoing RESOLUTION was by the CHUNG X
vote indicated to the right hereof adopted by the COUNCIL of ELARIONOFF
the County ofHawai`i on April 7 , 2004 HOLSCHUH X
JACOBSON X
ATTEST
REYNOLDS X
- SAFARIK X
~ TUL.ANG X
~~~i. ~ TYLER
~ ~ 7 1 1 0
j C-550/Lil. 246/FC
Reference
NTY CLERK CHAIRMAN & PRESIDING OFFICER RESOLUTION NO. ~•c ®
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
Project Abstract
The Ke Ola Hou "To Heal; To Restore to Health" project will be a program administered
by a partnership of Adolescent Treatment Specialists with the County of Hawaii. Adolescent
treatment providers agree to work together to provide the youth from the Island of Hawaii with a
residential treatment program that is both experientially and culturally based. This substance
abuse treatment program will not only heal our youth, but also provide them with the tools to
restore their identity, self-respect, and digpity.
In August of 2001, the Hawaii Island Meth Summit was convened, one of the first four
held throughout the country. The community was fed up with having the highest rates of
adolescent ice use in the State of Hawaii. The community found it unacceptable that although
their youth had the highest rates of drug abuse in the entire state, there were no adolescent
residential treatment programs on the Island of Hawaii.
Hawaii County, an Island of 4,028 square miles populated by a little over 140,000 people,
was recently identified as the most racially diverse county in the United States. This
geographically'challenged and diverse community was confronted by various factors that left it
vulnerable to the impact of drugs and substance abuse. The Island of Hawaii was found to have
twice the state average of population living 100% below the federal poverty level; the highest
percentage of births to teen mothers (51 % higher than the state average); the highest percentage
in the state of those over 18 years of age without a high school diploma; the highest illiteracy
rates in the state; the highest percentage of residents who believed that crime had become worse;
the highest percentage in the state of households receiving financial aid; and the lowest per
capita income in the State of Hawaii.
Already suffering from significant social-economic factors, the Island of Hawaii became
a breeding ground for the crystal meth or ICE drug trade. The Hawaii County Police Department
reported that arrests for ICE distribution increased 431 % from 1997 to 2000. In 1997, there were
55 arrests for ICE. In 2000, the number of arrests rose to 292. The Child Protective Service for
Hawaii Island reported in 2000 that 85-90% of their caseload was ICE or drug related. In 2000,
22% of Hawaii County high school seniors answered that ICE was "fairly easy to get". Clearly
there was trouble in paradise and there was no program to adequately address it.
With the support of Federal, State, County, and Community members, Hawaii Island
began collectively working to heal the Island, and more importantly, protect its children.
Working to identify problems, solutions, barriers to solutions, and resources, the community
worked to begin addressing this critical problem. In community meetings held throughout the
Island, the lack of any adolescent residential treatment programs for our youth emerged as a high
priority. How could we ask our children to step forward and get help for their ICE addiction if
we sent them away when they did so? How could we claim to have the best interests of our
children at heart if we failed to provide them a place to heal surrounded by family and loved
ones? The answer lies in a collaborative approach to residential substance abuse treatment for
adolescents.
EXHIBIT "A"
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
TABLE OF CONTENTS
I. Face Page (Standard Form 424)
II. Abstract ...................................................................................................................................1
III. Table of Contents ....................................................................................................................2
IV. Budget Form (Standardized Form 424A)
V. Project Narrative and Support Documentation
a. Section A: Project Description, Goals and Objectives ..................................................3
b. Section B: Project Approach and Evaluation .................................................................6
c. Section C: Project Management: Organization, Staff, Timelines, etc .........................15
d. Section D: Literature Citations ....................................................................................18
e. Section E: Budget Justification, Existing Resources, Other Support ..........................19
f. Section F: Biographical Sketches and Job Description ...............................................20
g. Section G: Confidentiality/SAMHSA Participant Protection (SPP) ...........................22
h. Section H: Data Collection Instruments/Interview Protocols and Consent Forms......29
VI. Appendices ............................................................................................................................32
VII. Assurance -Non-Construction Programs (Standard Form 424B)
VIII. Certifications
IX. Disclosure of Lobbying Activities
X. Checklist
XI. Attachments
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SAMHSA Youtfi Residential Program
County of Hawaii
Ke Ola Hou Project
Section A: Project Description Goals and Objectives
• Problem to be addressed:
Methamphetamine, particularly high purity crystal methamphetamine, also known as
ICE, poses the greatest threat to Hawaii. The number of treatment admissions for
methamphetamine abuse more than doubled from 1994 through 2000. Honolulu had the highest
percentage of male arrestees who tested positive for methamphetamine among cities reporting to
the Arrestee Drug Abuse Monitoring program in 2000. According to the 1999 National
Household Survey on Drug Abuse (NHSDA), 6.7 percent of the respondents aged 12 and older
in Hawaii reported using any drug in the past month compared to 6.3 percent nationally.
According to the Treatment Episode Data Set (TEDS), the total number of treatment admissions
for drug and alcohol abuse in Hawaii increased over 50 percent from 1994 through 1999. During
this same period, the number of treatment admissions for drug and alcohol abuse remained stable
nationwide. The number ofinethamphetamine-related treatment admissions to publicly funded
facilities in Hawaii in 1994 numbered 644. In 2000 that number had risen to 1,548.
In 2000, the Hawaii Student Alcohol, Tobacco, and other drug use study was conducted
in the Spring of 2000. The purpose of this study was to assess adolescent substance use and
related behaviors, and risk and protective factors that predict those behaviors among Hawaii
students in grades 6, 8, 10, and 12. The survey was administered anonymously to a total of 23,
170 public school students and 4,347 private school students in 237 schools across the state. The
project was a cooperative effort of the Hawaii State Department of Health, Alcohol and Drug
Abuse Division (ADAD) and researchers at the Social Science Research Institute and the
Department of Speech at the University of Hawaii at Manoa. Funding for this survey was
provided by the Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration, Center for Substance Abuse Prevention, Contract No. 277-98-6019.
The 2000 ADAD Study produced some startling results relating to methamphetamine
abuse and students in Hawaii County as compared to the rest of the State. Hawaii County had
over twice the statewide average of 6`h graders who reported using ice (1.0% v. 0.4%). Hawaii
County had one third more 8`h graders using ice than the rest of the State (3.0% v. 2.3%). Hawaii
County had one third more 10`h graders using ice than the rest of the State (6.0% v. 4.5%). 22%
of Hawaii County high school seniors answered that ice was "fairly easy to get". 10.6% of
Hawaii County seniors answered in the affirmative to "frequent drug use -more than 20 times in
the past 30 days", compared to just 5.6% statewide. In every grade, Hawaii County exceeded the
rest of the state in treatment needs for adolescents - 6'h (3.5% v. 1.4%); 8`h (13.8% v. 7.6%); 10`h
(27.0% v. 18.4%); and 12`" (40.5% v. 27.0%). Clearly, Hawaii County has a higher rate of both
methamphetamine abuse and treatment needs than anywhere else in the State ofHawaii.
Ironically, adolescents in treatment programs on Oahu are predominantly from the Island of
Hawaii. Two of the largest adolescent residential treatment programs on Oahu, The Bobby
Benson Center and The Marimed Foundation, both report that adolescents from Hawaii County
can range from 1/4th up to 2/3 of their bed spaces.
• Describe the Goals and Objectives of the Project and how they will be addressed:
The goal of this program is simple: to heal our adolescents who suffer from the disease of
addiction, especially to the powerful stimulant crystal methamphetamine or ice. This drug
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SAMHSA You[h Residential Program
County of Hawaii
Ke Ola Hou Project
threatens the future of our youth, our families, and our communities. The violence and anti-
social behavior surrounding the prolonged use of this drug has led to multiple communities in
Hawaii County to form community coalitions called CRI, or Community Response to ICE
groups. Other communities have formed ICE task forces or Power of Choice grass roots
organizations to mobilize against this growing menace in our neighborhoods. However, all the
resources that are focused on enforcement or prevention will not help our youth in dire need of
intensive substance abuse treatment now. Currently, Hawaii County lacks the infrastructure for
the entire continuum of care vital to providing adolescents comprehensive treatment.
Hawaii County's proposed adolescent residential treatment program, Ke Ola Hou, would
focus on keeping our children on the Island of Hawaii and providing the necessary skills and
tools to recover and rejoin the community as a productive member. Treatment specialists with
adolescents understand that it is difficult to work with a child in isolation or separated from
familiar surroundings and put into a hostile or unfamiliar environment. Pioneers in the treatment
of adolescents know that scaled down versions of adult programs just don't work
developmentally, socially, or intellectually for adolescents. The program services proposed for
enhancement by Hawaii County, collaboratively with its treatment partners, is to address the
need for a more effective approach to adolescent substance abuse treatment and continuing care;
the development of a more multi-cultural approach to treatment and aftercare; expansion and
testing of an experiential model, and an approach to address the continuing care needs of a
diverse population isolated by geography to maintain and maximize the gains made in treatment.
This new residential treatment program based on experiential and culturally based
models, recognizes that addiction may best be viewed as the result of some combination of
genetic predisposition and environmental factoring and that it is possible for all people to remain
drug-free. The most effective means for long term abstinence from methamphetamine and other
drugs is through lifestyle changes including but not limited to; active participation in a twelve
step program; association with recovering individuals and the establishment of healthy,
meaningful relationships with family and others; channeling energy into positive, constructive
endeavors and activities; and, the recognition and ability to cope with feelings and emotions.
Treating the whole family in concert with the adolescent is of primary concern. This includes
diverse multi-cultural issues as well as intergenerational exploration and healing. Reunification
of family is the goal wherever possible utilizing cultural theory in combination with traditional
substance abuse and treatment concepts. From assessment to discharge is to provide a plan that
will enhance the adolescent's chances for ongoing abstinence including follow up and continuing
care for the adolescent and his/her family and or support system. For adolescents, an integral
element of recovery concerns the involvement and support of family and/or significant others
incorporating cultural re-enhancement for family and client. The treatment program's goal is to
educate and involve the family in therapy.
The approach to substance abuse treatment is the belief that addiction is a disease
affecting the body, mind, and spirit. Treatment consists of five basic components: 1) an
experiential learning componenC in which youth participate in a variety of activities designed to
expand interest in, and foster, Teaming life skills and values; 2) Education -schooling is
provided, which the Department of Education will accept, so when clients have completed their
treatment, they will be on grade level when and if they return to their regular school. An
educational component is presented providing youth with extensive knowledge and
understanding of substance use and abuse, while addressing the importance of learning, and
expanding the skills needed for effective living along with a cognitive educational approach to
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SAMHSA Youth Residential Program
County or Hawaii
Ke Ola Hou Project
all curriculum; 3) A spiritual component designed to effectively include culture and instill an
awareness of ell-being and facilitate individual recognition of personal mastery; 4) Counseling to
address underlying feelings that may have led the youth to escape rather than cope with issues; 5)
Intensive family involvement using traditional Hawaiian concepts as well as theories that address
open communication, build trust, and provide a common goal to work through issues.
Ho'oponopono (to make right), is a Hawaiian method of conflict resolution by which grievances
maybe aired and harmony restored.
• Provide a literature review that describes the context of the problem to be addressed
and the underlying issues:
The treatment philosophy that Ke Ola Hou will employ is amulti-systemic approach to
adolescent treatment and substance abuse and co-existing disorders. Youth in the child welfare
and juvenile justice systems are particularly at high risk for developing a substance abuse
disorder. In support of an NIMH grant, Loeber, Bruke, Lahey, Winters and Zera (2000)
reviewed the empirical findings on oppositional and defiant disorder and conduct disorder for the
last 10 years. The results concluded that these disorders placed children and adolescents at a
high risk for school incompletion, family conflict, criminal acts, substance abuse and further acts
of aggression and violence.
They also point to a reciprocal relationship between drug use and criminality. Drug use
often predicted criminal offenses and conduct disorder was associated (but not necessary
predictive) with substance use. The relationship between CD and substance use is often
aggravated by co-occumng depression including frequent self-medicating behaviors. A vicious
cycle of substance use may often lead to criminal acts to support an addictive habit or to
medicate chronic psychiatric symptoms. More importantly, the level of aggressive symptoms
systemically appeared to have an effect on adolescents who become frequent offenders in the
juvenile justice system. Psychologically these youths are trapped in a persistent cycle of
negativistic, defiant, disobedience and hostile behavior towards others. They are generally
lacking in social skills, often aggressive, avoidant, and highly impulsive. The are often hard to
engage.
In the Treatment ofAdolescents with Substance Use Disorders (1997), the authors aim to
help treatment providers with an understanding of the way adolescent users differ from adults.
First their drug and alcohol use often comes from many causes (family, peer influence,
developmental and biological delays). They tend to have more trouble projecting the
consequences of their use, making insight development impaired and decision making short
sighted. In treatment they must be approached differently than adults because of their ever
evolving and unique development.
Adolescents have different values and belief systems and environmental concerns (strong
peer pressure, violence in the home or school, or the community at large). They tend to have
smaller developing body sizes and lower tolerances. They are at a greater risk for alcohol and
drug related problems even at lower levels of consumption. Finally, the vicious cycle of
substance abuse and dependence compromise their mental and emotional development. This
impacts their interpersonal skills and denies them access to peer and adult resources.
They often end up relating to others with increasing levels of aggression or dishonesty,
and interactions with others are conflicting at best. Longitudinal studies have established
associations between adolescent substance use and impulsivity, alienation and psychological
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SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Projec[
distress along with delinquency and criminal behavior. Other results include irresponsible sexual
activity and increasing the susceptability to AIDS and finally psychiatric or neurological
impairments associated with drug use and other medical complications.
The goal of the Ke Ola Hou project is to design and deliver better services to the
adolescent population that take these issues under consideration in a unique, innovative and life
changing environment. This program seeks to invest substance users with co-existing disorders
with the combined use of evidence based treatments that include: Use of family therapy that
impacts and changes the family enabling system; and Non traditional residential programming of
experiential therapy. Research has indicated strong support for family based therapy. That there
is a link between changes in core issues of family functioning and changes in substance use and
problem behaviors in the adolescent.
There is a growing body of literature that indicates that family therapy can change family
behaviors. According to the Surgeon General's report of 1999, adolescents in an experiential
educational model called Project Re-Education focused on training teacher-counselors with the
support of consulting mental health specialists. These schools were located within communities
and facilitated therapeutic work with the family, allowed home visits and used experiential
components inspired by the Outward Bound Schools. The results were that treated adolescents
improved in self-esteem, control of impulsiveness and internal control. A follow up component
of six months maintained results with a predictive factor of providing community support.
• Define the Target Population in terms of gender, race, ethnicity, culture, and age.
Provide justification for any population exclusion.
The Ke Ola Hou program, an adolescent residential treatment program planned for
Hawaii Island, will focus on teens, both males and females, between the ages of 12-17 from the
Island of Hawaii. 59.6% of teens admitted into treatment in the State of Hawaii in 2001 were
Native Hawaiian/Asian/Pacific Islander so this program will ensure that there are culturally
appropriate components integrated into the planned progran~.
Because Hawaii Island is so diverse, it is anticipated that this program will involve youth
of every possible ethnicity: Hawaiian, Caucasion, Japanese, Chinese, Filipino, Samoan, Tongan,
Micronesian, Korean, and many others. Because Hawaii has experienced generations of a multi-
cultural society, most of the consumer population will be of mixed race or ethnicity. There will
be absolutely no exclusion on the basis of race or ethnicity to the Ke Ola Hou Adolescent
Residential Treatment Program.
Section B: Project Approach & Evaluation•
• Describe the approach that will be employed to carry out the project:
1. Assessment of adolescent and how assessment relates to treatment elan
All youth must be free of significant health or mental issues that warrant a higher level or more
specialized care. We will request a referral form, a psychological assessment, and a chemical
dependency evaluation. Assessment will determine if youth requires residential treatment.
Youth must not have had recent violence or suicide attempts. If eligible, the youth must be
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SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
willing to enter treatment and agree to follow the rules. Once this is determined, a request for a
current physical, current TB test, Individual Education Plan (IEP) or school records, a copy of
the social security card, copy of birth certificate, health insurance card for medical emergencies,
and immunization records is made.
2. Treatment planning for adolescent.
Information gathering and planning begins when the youth arrives with parent or legal guardian.
Rights and rules are covered. Family fills oat Behavioral Emotional Rating Scale test to
determine where family work is needed. Family history and medical history is covered.
Treatment planning is ongoing and continuous to ensure that positive progress is made and that
continuing care is provided following residential treatment.
3. Imnlementation of treatment interventions
Treatment interventions are addressed in group therapy, individual, skill groups, drug free
activities, recreational group to increase bonding, increase trust, and develop peer ability to have
fun without drugs, education group to learn about the disease of addiction and cognitive
behavioral therapy interventions as well as anger management role playing. Psychodrama is
used to assist the client in resolving losses that have occurred due to drug use. The twelve-step
program is incorporated in the treatment and intervention of the youth's addiction.
• Demonstrate how the approach appropriately addresses factors such as
race/ethnicity/culture/language/age and gender of the target population
Native Hawaiians have historically and statistically the highest rate of suicide,
depression, substance abuse and addiction, imprisonment, and death than any other ethnic group
residing in the Hawaiian Islands. Therefore, Hawaiian based treatment and prevention methods
will be utilized as a component of the experiential component of this program.
This will include but not limited to Pacific Voyaging using traditional and customary
practices ofnon-instrument navigation. Hawaiian voyaging embodies all the aspects of
Hawaiian cultural traditions and practices and has been shown to have a profound effect on
Hawaiian youth who are considered at-risk. These activities are geared to students of all ages
and ethnic backgrounds who experience positive change when they are allowed to walk in the
footsteps of the ancient sea voyagers. Activities will include oral histories of the Islands, the
practice of cultural values, Teaming traditional chants and dances, the study of voyaging and
learning traditional constellations, weather forecasting, and seamanship. A greater
understanding of the Hawaiian culture will hopefully lead to a greater sense of identity, self-
esteem, and self-respect.
The family is central to the native Hawaiian and Asian-Pacific Islander's identity and
overall psychological health. There is a cultural process where the combination of honoring the
hierarchy of the family, valuing spiritual powers and ancestors and reaching out for support with
extended family members is used in aiding long-term recovery. Such traditional healing arts as
Ho'oponopono (developed from the ritualistic practices of addressing conflict and forgiveness in
Hawaiian culture) and Restorative Justice (developed from the Maori people of New Zealand)
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SAMI{SA Youlh Residential Program
County of Hawaii
Ke Ola Hou Project
aid in this recovery process. This healing process is non-shaming, uses problem solving skills
and emphasizes positive actions to resolve conflicts.
In the Ke Ola Hou project, the adolescent and their family will choose and be trained in
the use of a Restorative Justice of Ho'oponopono model. In this model, the family members
work toward identifying cultural values and norms that are honored by the local community
culture. These cari include the value of the land, the ocean, listening to the ancestral spirits,
ceremonial dances (hula and chant) and the aloha spirit. Differences between cultural groups is
addressed by working with partental figures, cimmunity elders, and extended families to denote
the "tone and direction" of the meetings. The goal is to provide a system of change that values
each family member and focuses on "making it pono" (make it right) the wrong that occurred.
Over time, this system becomes a valued family tradition for resolving conflict and continues
even after discharge and aftercare are complete. Interwoven in this process ispsycho-education
about drug use, prevention and ceasing enabling systems that maintain drug dependency. Asian
Pacific islander values are honored along with western approaches to understanding and ceasing
drug use and dependency.
It is anticipated that there will be both a male and a female component to the residential
program. Both male and female adolescents shared many similar features including a
dependency syndrome of narrowing their behavioral repertoire and having equal levels of loss of
control. Both groups respond with social reasons for their use and become invested in the drug
culture over time when they do not have long-term treatment.
Treatment implications of these gender findings direct the clinician to focus on core
issues for female and male adolescents. Male adolescents will need to focus on earlier use, anger
control methods, terminate physical aggression and take responsibility for intimidating and
provoking behaviors. Female adolescents who use drugs to escape emotionally need to focus on
emotional and interpersonal conflicts. Coping strategies for both populations will be paramount
but will vary to encapsulate both population reasons for usage (males -power dominance, thrill
seeking, association with violence and females -need to escape emotional issues and potential
histories of abuse). Motivational enhancers need to be taken into consideration for both genders.
• Describe how the proposed activities will meet the goals and objectives of the project
Plans for implementation of treatment interventions that is designed to meet the Goals and
Objectives of the Ke Ola Hou Project is described below -Treatment interventions are addressed
in group therapy, individual, skill groups, drug free activities, i.e., recreational group to enhance
bonding, increase trust, and develop peer ability to have fun without drugs, education group to
learn about the disease of addiction and cognitive behavioral therapy interventions as well as
anger management role-play and experiential modalities are used to enhance the clients
continued interest in recovery and desire to change. Psychodrama is used to assist the client in
resolving losses that have occurred due to drug use. The twelve-step program is incorporated in
the treatment and intervention of the youth's addiction. Proposed services are consistent with
program activities and documentation citations for the evidence base of any current or proposed
services to be expanded:
1) Evidence Based and Cost Effective Methods for substance abuse of adolescents
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SAMHSA Youth Residential Program
County oC Hawai'i
Ke Ola Hou Project
There is strong evidence an adolescent's ability to maintain abstinence following
treatment is incorporated in a vulnerability model that occurs before, during and
especially after treatment. (Hawkins, Catalano & Miller, 1992; Jessor &Jessor, 1977). A
longer stay in residential treatment has been consistently associated with increased
retention, (Wexler & De Leon, 1977) lower arrests, a decrease in psychological
disturbance and lower relapse rates (Condell & Hubbard, 1997; De Leon, 1973).
Latimer, Winters, Stinchfield, and Traver, 2000 reported several factors in their
findings of 225 adolescents with substance abuse problems admitted to residential and
nonresidential treatment. Overall, these findings suggested continuing to reduce the
length of adolescent treatment maybe overlooking heightened relapse rates and
associated high-risk behavior. In summary, sufficient treatment length is crucial to the
maintenance of abstinence throughout the first post-treatment year, where continued
reductions in treatment length foster relapse among significant groups of recovering
youth. Yet, with the cost of residential treatment finding a way to maintain the length of
caze is troubling and expensive. Aftercare participation should also consistent of fonnal
and informal networks that have the ability to provide a continuum of care and support to
families past the discharge date. With this system in place adolescents could be provided
with 1-3 years ofpost-treatment in acost-effective manner to meet the need for increased
length of stay and effectiveness of treatment (De Leon, 1991b.)
2) Coordination of treatment services with other agencies (education, juvenile justice, child
welfare and mental health agencies)
The Ke Ola Hou Project provides intensive coordination with other state
wideagencies regarding education, mental health, juvenile justice and child welfare.
Youth who are referred to treatment aze managed by a system of school and mental
health care coordinators from the Department of Education and Department of Health. In
Hawaii their purpose under the Felix Decree is to provide essential mental health and
educational services so that identified special need youth aze able to participate and
succeed in their pursuit of educational credits toward a high school diploma or
certification barring their mental health issues. Youth who come from the Department of
Child Protective Services (youth with active child neglect and abuse cases), Department
of Health Services (youth with legal guardians) and the Office of Youth Services (for
juvenile offenders) also provide a coordinator and case worker to refer for these services.
Each youth who is referred into The Ke Ola Hou Project aze provided with an IEP
(Individualized Educational Plan) and includes a team of mental health, educational and
ancillary staff with direct attendance and input of the youth and his/her legal guardians.
This IEP team meets and develops a 6 domain plan that covers Family, School,
Community, Individual, Social and Legal goals along with an extensive crisis and
discharge plan. As a youth steps down in a therapeutic group home or foster care
placement this mental health treatment plan continues to be used in context with an
evolving IEP team. With the family and youth's approval, the child welfare system,
school officials and juvenile justice system will be utilized in providing the resources a
youth needs to maintain a clean and sober lifestyle. This includes providing assistance
with applying for social service supports for youth and family, applying to community
college, Q year university and trade training programs, continued support from informal
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SAMHSA Youth Residential Program
County of Hawaii
Ke Ola liou Project
psychooocial support networks (local Hawaiian cultural groups, paddling clubs, sailing,
fishing, agricultural co-ops) and continued vocational pursuits with local jobs, attending
cultural enrichment events, job training, and life skills internships.
3) Continuum of integrated treatment services including case management for adolescents
and their families
Research suggests there are a number of factors that are associated with higher
alcohol and marijuana use 6 - 12 months after treatment. Findings suggest that sibling
substance use (Latimer, et. al) and peer use (Myers et al, 1993) directly affect higher
relapse in youth. Coexisting disorders can also interfere with treatment for substance
abuse disorders and if, not treated, places the client at risk for relapse (NCADI TIP 4
revised, 2002). The findings for family based and group interventions for substance abuse
with adolescents showed significant reductions in substance use after treatment in a
number of studies (Kaminer, Burleson, Blitz, Sussman, Y& Rounsaville, 1998; Lewis,
Piercy, Sprenkle & Trepper, 1990 & Waldron, Slesnick, Brody, Turner & Peterson,
2001).
Overall, these findings introduce the need for strong family interventions,
establishing a health peer network and providing vocational training that leads to a
continued clean and sober lifestyle. The key is to address the interpersonal relationships
of family and peers that support this change in treatment especially during aftercare. This
process begins in the therapeutic community that is established as part of the residential
program. Induction and primary treatment is a staple of residential care. Unfortunately,
the weakest link is the connection with a culturally aligned aftercare that keeps the
process of change going. Effective aftercare systems match the interpersonal, gender and
culturally appropriate needs of the youth and families served to receive maximum results.
This occurs within The Ke Ola Hou Project where youth and families are identified with
a Transition Team of a CSAC family therapist and Case Manager with vocational and
educational after care links. Family members and the youth within the bi-monthly family
therapy, have the opportunity to learn and practice new behaviors such as a
communication skills and problem solving immediately through multigenerational
sessions. The youth and families are introduced and encouraged to join 12-step meetings
in the community. The case manager will provide direct case management through life
skills intemships, job training and employment in the youth's Local community.
4) Provide treatment that is gender-specific and culturally appropriate
Although the majority of the literature has been focused on male substance abuse
adolescents, researchers (Brunswick, 1991 and Opland, Winters and Stinchfield, 1995)
have noted that substance use and gender correspond to a variety of situational and
contextual differences of drug seeking behavior.
These differences in gender along with substance use naturally involve social and
cultural roles. They not only influence psychological and physical health risks but also
may lead to male and female adolescents experiencing different personal and
environmental challenges related to how they develop drug problems, seek and respond
to treatment.
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SAME{SA Youth Residential Program
County oCHawai'i
Ke Ola Hou Project
Treatment implications of gender findings direct the clinician to focus on core
issues for female and male adolescents. Male adolescents will need to focus on earlier
use, anger control methods, terminate physical aggression and take responsibility for
intimidating and provoking behaviors. Female adolescents who use drugs to escape
emotionally need to focus on emotional and interpersonal conflicts. Motivational
enhancers need to be taken into consideration for both genders.
Treatment is more effective when it is compatible with client culture patterns
(Tharp, 1991). Without cultural alignment, the treatment approach may discourage
clients from attending and completing treatment.
The Ke Ola Hou Project recognizes Hawaii's unique cultural diversity as
America's only majority minority state, with a multicultural society that has Asian,
Polynesian, Native Hawaiian and Anglo-American groups. It is not surprising that
Native Hawaiians have higher rates of suicide, depression, substance abuse,
imprisonment and death than other immigrant groups (Gaughen &Gaughen 1996).
In the Ke Ola Hou Project, the adolescent and their family will choose and be
trained in the use of Restorative Justice or Ho'oponopono mode]. In this model family
members work toward identifying cultural values and norms that are honored by the local
community culture. Differences between cultural groups is addressed by working with
parental figures, community elders, and extended families to denote the "tone and
direction" of the meetings. The goal is to provide a system of change that values each
family member and focuses on "making it pono" (make it right) the wrong that had
occurred. Over time, this system becomes a valued family tradition for resolving conflict
and continues even after discharge and aftercaze are complete. Interwoven in this process
is psycho-education about drug use, prevention and ceasing enabling systems that
maintain drug dependency. Asian Pacific Islander values aze honored along with
Western approaches to understanding and ceasing drug use and dependency.
Matching culturally aligned treatment with treatment strategies can also be
enhanced by reviewing coping skills. Experiential educational components in the Ke Ola
Hou Project utilize rational coping skills by providing a positive, action-oriented and
flexible approach to help deter an adolescent from relying on substances as a coping
mechanism. In the Ke Ola Hou Project, youth will gradually assume the role of a marine
cadet and will prepare for experiential land activities (ropes, agriculture, experiential
games, camping, etc.) and ocean voyages between the Hawaiian islands as a team. This
enhances the use of motivational enhancement strategies proposed by Miller and Rollnick
(1991) in helping adolescents to reflect on their role which defers to a new peer group,
help them gain vocational skills and creates an identity that proposes positive change.
5) Involve and work with families of adolescents and siblings who need treatment
The Ke Ola Hou Project acknowledges the importance of the family system in the
overall recovery of the youth served. The Ke Ola Hou Project attempts to involve the
family in bi-monthly family therapy sessions as a part of discharge along bi-monthly
attendance to an ohana family association that engages family with local cultural
activities with a series of support groups and speakers for continued treatment. In
summary, drug abuse is decreased by improving family management practices,
decreasing family conflict and improving the bonding of family members. This leads to
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SAMHSA You[h Residential Program
County of Hawaii
Ke Ola Hou Project
internalization of traditional values of parent and child that lead to the development of a
strong parent-child attachment which ultimately lead to a youth associating with non-
drug-using peers and healthy extended family members.
6) Address the relationship between substance and violence
In the last 10 years, there has been a steady increase in the study of oppositional
defiant (negative, hostile and defiant youth) and conduct disorder (youth who violates the
rights of others through violent acts). Loeber, Bruke, Lahey, Winters, and Zera (2000)
reviewed the empirical findings of these disorders for the last 10 years and concluded that
these disorders placed children and adolescents at high risk for school incompletion,
family conflict, criminal acts, substance use and further acts of aggression and violence.
Substance use appears to be associated strongly with both violence toward self and
violence towards others (Rezzo & Popp, 2000). Co-morbidity of Conduct Disorder with
substance use and psychiatric disorders presents a significant challenge in treating
adolescents. Dangerous youths are hard to treat and have more mental health problems,
less developed peer relationship skills or moral/spiritual strengths to participate in
treatment fully. (Lyons & Schaefer, 2000). Studies point to a reciprocal relationship
between drug use and criminality. Drug use often predicts criminal offenses and conduct
disorder is associated (but not necessary predictive) of substance use. The relationship
between CD and substance use is often aggravated by co-occurring depression including
frequent self-medicating behaviors. A vicious cycle of substance use may often lead to
criminal acts to support an addictive habit or to medicate chronic psychiatric symptoms.
More importantly, the level of aggressive symptoms systematically appeared to have an
effect on adolescents who become frequent offenders in the juvenile justice system.
• Describe how members of the target population will be involved in the project
As indicated previously, the Ke Ola Hou project will be administered by a partnership of
Adolescent Treatment Specialist. This partnership will initially meet at least on a monthly basis
to address project planning, logistics, and implementation issues. These partnership meetings
will also be attended by the members of the target population, including their parents or legal
guardians to ensure that they have a "voice" throughout the process. Transportation will be
offered to increase their likelihood of participation. Their opinion, suggestions, and feedback
will be actively sought in these meetings. They will be respected as equal members. Such efforts
will ensure that the project's activities are congruent with the community values and needs.
• Describe approach to Evaluation
Comprehensive evaluation efforts of the Ke OIa Hou Project will assess the project's
efficacy and efficiency in implementing its cultural based model in treating substance abuse
among adolescents in a residential treatment setting in the island of Hawaii. Evaluation of the
project will be conducted by The Catalyst Group; lead by Dr. Richard Kim. He and his research
team have the cultural expertise and numerous years of experience in conducting comprehensive
evaluation ofprojects such as this. The primary objectives of this project's evaluation includes
(1) the assessment ofproject's implementation of it's proposed activities as according to its goals
12
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
and objectives utilizing qualitative and quantitative methodology and (2) providing on-going and
user-friendly feedback to the project staff based on evaluation findings to improve its efforts.
Process Evaluation Methodology
Process evaluation provides information on project planning, development, and
implementation. This level of evaluation describes successes, barriers, and the "process" by
which the project is administered. Process evaluation of this project will include collecting
information and documenting: (1) Project staffing, including training, (2) Intervention
characteristics and strategies, (3) Utilization of the type and amount of services by youth, (4)
Involvement of the family and community, (5) Youth and parent satisfaction with the project
services, (6) Program completion rate as well as drop out rates, and (7) Collaboration efforts with
other community organizations. The value in this type of information is that it provides feedback
that guides the project as it evolves and it will enable the assessment of the project's efficiency,
efficacy, and fidelity in achieving its goals and objectives.
Outcome Evaluation Methodology
In contrast to process evaluation, outcome evaluation is primarily concerned with the
efficacy of the project. Outcome evaluation assesses the attainment of measurable project goals
and objectives. The proposed evaluation design contains features of the within-subjects
comparison method since the youth will be assessed at baseline, discharge, and 6-month follow-
up to determine change over time.
Qualitative Evaluation
Qualitative evaluation is primarily concerned with better understanding the project and its
impact on the youth in the program. Such a level of understanding will be gained through the
use of periodic observation of project activities and conducting semi-structured interviews and
focus groups to assess youths' perceptions about the program, their personal progress, and
factors related to ATOD use. Semi-structured interviews will also be held with the youths'
parents to assess their perceptions about the program and their Childs' progress in the program.
Additionally, staff members and other key community members will be interviewed to solicit
their perspectives. These interviews and focus groups will be invaluable in better understanding
the youth of Hawaii county who are faced with substance abuse problems.
Data Collection Instruments
The Global Appraisal of Individual Need (GAIN), which is copyrighted by Chestnut
Health Systems, has been proposed as the primary data collection instrument for this project.
Among other populations, the GAIN has been used with adolescents in outpatient, intensive
outpatient, short-term residential, and therapeutic community programs. It is used as a core
measure across several major multi-site studies funded by the Center for Substance Abuse
Treatment (CSAT). The GAIN contains eight core sections that include background, substance
use, physical health, risk behaviors, mental health, environment, legal, and vocational. Each
section contains questions on the recency of problems, breadth of symptoms, and recent
prevalence in days or times, as well as lifetime service utilization, recency of utilization, and
frequency of utilization. Additionally, the GAIN incorporates a section on dosage data
collection. The evaluation team will provide the program staff with outcome findings based on
13
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
the statistical analyses of the individual GAIN scales. This shall allow for further assessment
within each of the different component areas of the program.
The project also calls for the use of the Government Performance and Results Act
(GPRA) Client Outcome Measures. Beyond the requirement, the GPRA is consistent with the
goals and objectives of the Ke Ola Hou Project. The evaluation team will ensure that the
GPRA data is being collected as iruended, by including it in the proposed instrument package
and will fully cooperate with CSAT by providing appropriate GPRA data and reports on a timely
basis. In their previous work with similar projects, the proposed evaluation team has had about
80% response rate for collecting program exit (posttest) data using the GPRA and other tools to
determine program outcomes. Psychometric properties such as reliability and validity estimates
for each measure will be provided for this population upon completion of data collection.
Data Collection Procedure
Data will be collected from youth at baseline, discharge, and 6-month follow-up
measurement points. Process data, on the other hand, will be collected on an on-going basis.
The proposed methodology utilizes amulti-method approach that plans to collect various types
of data from different sources such as self-reports, reports from parents, reports from staff, and
observations through participation. The evaluation team, project staff, and other involved
organizations will work in collaboration to ensure an appropriate, efficient, and timely system of
data collection.
Under the guidance and supervision of the lead Program Evaluator and Research
Associate, the research assistant will primarily be responsible in ensuring the collection of all
necessary data. This individual will be provided with additional training on issues such as: (1)
Using proper data collection procedures and guidelines, including legal and ethical issues, (2)
Using care and sensitivity (particulazly from gender and cultural stand point) when collecting
data, (3) Providing proper and consistent instruction to participants, (4) Minimizing missing data,
and (5) Assuring anonymity to each youth so that their response can be as honest znd accurate as
possible.
Upon collection, all original data will be temporarily stored in the project office in a
locked filing cabinet. The data will be identified only by a unique identification number to
protect youths' anonymity. A master list containing names and corresponding ID numbers will
only be accessible to evaluation staff and project administration. Periodically, all data will be
data entered by a member of the evaluation team. During this time and until analysis with the
data is complete, all data will be secured in a locked filing cabinet. The evaluation team will also
conduct quality control of the data collection and data entry process. Moreover, the evaluation
team will collaborate with the project staff to conduct periodic quality assurance reviews of the
evaluation efforts to ensure that evaluation is being implemented as planned and as appropriate
to the project, the youth, and the community needs as well as to obtain feedback from these
stakeholders about evaluation and make modifications as necessary.
Data Analysis Plau
In analyzing the data, process and outcome analyses will be performed. Process data
analysis will include descriptive statistical procedures on various participant demographic and
dosage variables. Descriptive analysis will also be performed for the measure of satisfaction
with the program.
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SAMHSA Youth Residential Program
County o(Hawai'i
Ke Ola Hou Project
Outcome analysis will include a series of correlational analyses to test whether there are
significant relationships between the service dosage and each outcome indicator. Such an
analysis will allow for determining the relationship between the youths' involvement in project
activities and measured changes in substance abuse. Comparative analysis such as dependent
samples t-tests and trend analysis will be performed to determine the changes in youths'
perception on the different measures over time. Series of Multiple Regression Analysis for each
outcome variable will be also performed to assess project effect on that particular outcome
variable. These quantitative data will be integrated with qualitative findings as part of
comprehensive evaluation methodology. This information will be vital to understanding how the
project is being implemented as related to its goals and objectives.
Interpreting and Reporting Findings
The findings will be reported in various formats, including written reports and oral
presentations. Moreover, the findings will be related to previous scientific literature in the field.
Concise written reports will be produced that are user-friendly by minimizing technical jargon
and long narratives while utilizing graphs, charts, tables, and illustrations that summarize data
and makes data more useful. These reports will be done on a periodic basis for the project staff
as means of providing on-going feedback. Reports will also be completed for CSAT as
according to CSAT requirements on a timely basis; this includes quarterly and annual reports.
Along with the reports, the evaluation team will also provide oral presentations that summarize
findings and provide recommendations for modification, if necessary, to improve the project.
Appealing presentation graphics and slide shows will be utilized to better communicate the
findings. Finally, the findings from the project may be disseminated in scientific journals and
perhaps even in CSAT publications.
Description of How Members of Target Population will be Involved in Evaluation
The members of the target population along with other stakeholders, as part of their role
in the advisory group, will be involved with the evaluation process in the following manner: (1)
Selecting evaluation measures and possibly modifying these measures to ensure adequate
linguistic and cultural capacities for the participants, (2) ensure culturally and gender
appropriate, efficient, and timely system of data collection, (3) input will be sought from the
project staff and other stakeholders, including target population, in interpreting the data, who
often provide invaluable insights about the findings, and (4) participate in periodic quality
assurance review of the overall evaluation efforts to ensure that evaluation is being implemented
as planned and as appropriate to the project, the participants, and community needs.
Section C: Project Management
• Project Management and Implementation Plan
Grant management, including but not limited to review of systems, contract management,
reports, equal employment opportunity and grievance procedures, is the responsibility of the
Executive Assistant to the Mayor of Hawaii. The Executive Assistant reviews administrative
policies and procedures and supervised the project coordinator. Administrative responsibility for
human resources and fiscal services are assigned to the appropriate Hawaii County departments.
15
SAMHSA Youth Residential Program
County oC Hawai'i
Ke Ola Hou Projcc[
The project coordinator will be responsible for the development, implementation,
monitoring and direct supervision of staff and all contract services and activities of the project.
The project coordinator will report to the Executive Assistant and be responsible for program
management, including review of eligibility determinations, verification, intake procedures,
provider selection, case documentation, support services, and training activities.
The project coordinator will work in collaboration with contract staff to coordinate
linkages and network with existing community organizations to build consensus regarding
interventions needed in the community and the involvement of community members and leaders.
These include an interagency support network of approximately 20 members, the Department of
Education, District Council, public housing tenant associations, faith-based organizations and the
County Board of Supervisors. The Executive Assistant will conduct desk reviews and monitor
according to contract requirements the following areas: data collection, scheduling ofproject
activities, participant records, staff reports, and other program records.
Monthly program coordinator's meetings will be held and written monthly progress
reports will be submitted to the Executive Assistant. Quarterly meetings will be held with all
program and contract staff to discuss common issues among the different aspects of the program.
• Reports and Dissemination
The project coordinator will be responsible for preparing and submitting all required
grant reports and products. These include annual reports, quarterly reports for the first year,
semi-annual reports for the second and third year. The final evaluation report will summarize
accomplishments and outcomes.
The project coordinator will work with the evaluator, and contractors in establishing data
collection procedures and review on a monthly basis of data collected. The project coordinator
will also monitor compliance with all data reporting requirements. The assistant will be
primarily responsible for ensuring that data is collected from the participants. The assistant will
insure proper recordation of information. The project coordinator will also with the assistance of
the contractors ensure the development of a manual for potential replication describing the
developmental history of the project and provide detail instructions on the implementation of all
project interventions.
Information on the project will be disseminated through publications and presentations at
conferences or meetings with the American Psychological Association, Hawaii Psychological
Association, American Evaluators Association, and the National Association of Social Workers.
I{nowledge of the information will be made available through the Website.
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SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
• Timelines
YEAR1 YEAR2 YEAR3
MONTH MONTH MONTH ACTIVITIES
1 Upon notice of grant award, recruitment of new staff will begin, and
network of partners, services providers, schools, faith-based and grassroot
community groups will be noti5ed.
I-2 1 1 Finalize and sign contracts.
2-3 Hire and orient new staff.
2-3 1-2 1-2 Project staff will be trained on project requirements. Meetings will be held
with the evaluator and training resources.
3 3 3 Conduct joint meetings among project staff. Contact staff and other
program staff to establish working relationships/procedures, inform of
program and participant eligibility requirements, and initiate recruitment
process of participants.
3-4 3-4 3-4 New project staff will coordinate with existing staff in establishing and
implementing working relationships/procedures with the network of
partners and resources.
3-12 3-12 3-12 Agency staff will begin recruitment of potential youth participants.
3-12 3-12 3-12 Project staff will set up and implement project procedures including intake,
group selection and assessments/tesCmg.
4 4 4 Conduct prevention or project intervention activities including use of
community resources.
4, 7, 10, 13 4, 7, 10, 4, 7, 10, Review and assess project progress. Implement recommended changes.
13 13
4, 7, 10, 13 7, 13 7, 13 Complete progress reports.
14 14 14 Annual evaluation report is completed by the Evaluator.
• Staff
Project staff will be employed as follows: a project coordinator and a half time project assistant
will provide data collection and logistical support. The executive assistant will also provide
partial time on the project. Administrative staff will include senior management, human
resources and fiscal services.
17
SAMHSA You[h Residential Program
County of Hawaii
Ke Ola Hou Projec[
Section D: Literature Citations
1. State of Hawaii Primary Care Needs Assessment Databook, 2001, Department of Health,
State of Hawaii
2. Hawaii County Police Department, Records
3. Hawaii Drug Threat Assessment, National Drug Intelligence Center, Department of Justice
4. US Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration, Treatment Episode Data Set.
5. State of Hawaii, Alcohol and Drug Abuse Division (ADAD), 2000 Hawaii Student Alcohol,
Tobacco and Other Drug Use Study
6. Bobby Benson Treatment Center 2001 Annual Report; Interview of Marimed Foundation
Executive Director Matthew Claybaugh, May 1, 2003.
7. Loeber, R. Burke, J.D., Lahey, B.B., Winers, A, & Zera, M. (2000) Oppositional Defiant and
Conduct Disorder: A Review of the Past 10 Years, Part I. Journal of the American Academy
of Child and Adolescent Psychiatry
8. National Institute of Justice (1994)
1S
SAMHSA Youth Residential Pro~~am
County of Hawaii
Ke Ola Hou Project
Section E: Budeet Justification Existine Resources Other Support
Personnel -Project director oversees staff and program development and implementation as
well as work in collaboration with program evaluation team. The %2 time administrative assistant
provides general clerical duties, including maintaining client files.
Fringe Benefits at 30% -Breakdown includes: payroll taxes 8%, pension at 5%,
medicaUdental/life at 13% and liability insurance 4%.
Travel -Mandatory project travel to Washington D.C. and local travel at $0.33 per mile.
Project staff will travel to youth schools, youth homes, activity events, evaluation meetings,
network building gatherings with community and administration staff to project related meetings.
Equipment -Two computers for 2 project staff, including software.
Supplies -Genera] necessary office supplies, including printed materials for use in project such
as: business cards, letterhead, evaluation packets, referral forms, flyers, brochures and other
related items.
Contractual Costs - To include:
1. Certified Substance Abuse Counselors
2. Cultural Practitioners
3. Cultural Experiential Practitioners
4. Evaluator
Indirect Costs -The Hawaii County has a 15% indirect cost.
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SAMIiSA Youth Residential Program
County of Hawaii
Ke Ola llou Project
Section F: Biographical Sketches and Job Descriptions
Biographical Sketches:
Project Coordinator
Upon receipt of funding for this project, an appropriate individual will be recruited to serve as
the Project Coordinator. This individual will be responsible for program development,
implementation, and supervision for the proposed project. Such an individual will need to have
experience and demonstrated competence in the area of developing and managing federally
funded grants as well as working with the target population in a culturally competent manner for
the proposed community.
Project Evaluator
Richard Kim, Ph.D. of The Catalyst Group, will serve as the Program Evaluator. He will be
responsible for designing, supervising and overseeing the conduct and implementation of all
relevant evaluation research activities for the proposed project.
Dr. Kim has demonstrated competence in the area of evaluation of various health, social, and
community based prevention services for multi-ethnic populations. He had been involved in
numerous evaluation projects similar to the current proposed project which have focused on the
culturally based programming for youth with substance abuse problems. Many of these projects
were federally funded and involved multi-site data collection on issues related to delinquency
prevention, substance abuse prevention, and other high risk youth issues.
Dr. Kim was born in Republic of Korea but spent most of his life in Hawaii. He is fully bilingual
and bicultural. He obtained a Bachelor of Arts degree in psychology from the University of
Hawaii and M.A. and Ph.D. in Clinical Psychology at the California School of Professional
Psychology -Los Angeles. His training and experiences emphasized multicultural and
community psychology. He is currently the Program Director of an adolescent residential
treatment program in Honolulu, Hawaii. The program provides comprehensive treatment
services to adolescents who are experiencing emotional, behavioral, family, legal, and academic
difficulties. Most of these youths also have significant history of substance abuse or dependence.
He also has several years of experience in community mental health where experiences included
clinical services in various modalities, psychological testing and evaluation, program
development, program evaluation, quality assurance, staff training and supervision, and number
of other administrative duties.
Dr. Kim also has an extensive consulting practice. He provides consultation services for
organizations in the areas of applied research and program evaluation with specialty in cultural
issues. Types of work involves developing qualitative and quantitative research design and
methodology, data collection, data analyses, producing user-friendly reports, and providing
timely feedback to programs regarding how they are meeting their goals and objectives as well
as on how to improve their programs based on objective information. Clients include for-profit
companies and non-profit organizations. Past and current projects included customer satisfaction
survey research, leadership training outcome study, Southeast Asian cancer prevention and early
intervention program evaluation, and evaluation of numerous high-risk youth (e.g., substance
abuse, gangs, crime) prevention programs. Some of the high-risk youth projects were multi-site
20
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
evaluations. He is also experienced in grant writing responding to request for proposals from
local, state, and federal governments as well as private foundations for program evaluation. His
professional memberships include Asian American Psychological Association (AAPA),
American Psychological Association (APA), and the American Evaluators Association (AEA).
He is currently the Vice-President of AAPA.
Job Descriptions:
Proiect Coordinator
• Responsible for program development, implementation and supervision
• Recruit and hire program staff
• Train and/or oversee training of staff
• Work with coordinating site on grant project -attend meetings and trainings
• Supervise recruitment of youth/family participants
• Supervise recruitment of comparison groupAttend CSAP meetings and conferences
• Work with program evaluator on evaluation component
• Develop and implement program intervention
• Supervise program staff, consultants and subcontractors
• Responsible for grants management
• Provide mandatory reports to CSAP and coordinating site
• Report to project monitor from CSAP
• Submit final report and evaluation publications with program evaluator
• Report to OCBF executive director on program development, implementation and evaluation
• Work with controller and bookkeeper to distribute and report out on program expenditures
Proiect Evaluator
• Design and implement evaluation methodology, data collection, and performance monitoring
• Develop databases to collect evaluation information
• Train and supervise staff on obtaining data from youths and family members
• Develop procedures to ensure confidentiality and data storage and security
• Develop and supervise all data entry
• Conduct data analysis according to evaluation methodology prescribed for project
• Produce written reports to appropriate individuals and agencies on results of evaluation
• Provide periodic reports from collected data to aid in ongoing program planning,
development, and implementation
• Provide assistance to Project Director on planning staff training
2t
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
Section G: Confidentiality/SAMHSA Participant Protection (SSPI
All proposed participants in the Ke Ola Hou Project regazds the treatment records of youth and
families served by the agency, as well as the identity of persons served, as sensitive and
confidential information. In addition, all employees and contractors will be subject to state and
federal laws and regulations governing the confidentiality ofinedical records. All participating
organizations recognize the obligation to protect the individuals and their information contained
in its records as well as to be aware of any possible risks for individuals in this project.
A. Protect Clients and Staff from Potential Risks
Identify and describe foreseeable risks or affects
This project provides minimal risks to the subject. The examination is a survey of youth's
substance abuse and its impact on his/her life. The risks are minor and include fatigue from the
length of the exam or the triggering ofpsychological issues. However, these are countered with
the availability of counseling, adapting the examination procedure (breaking it up into
manageable periods) and the strictly voluntary participation of the subject in the project. Youth
will be participating in a substance abuse/dependency and mental health treatment program.
This youth is provided with trained clinical personnel for chemical dependency, psychological,
social, legal, physical, and medical needs.
Risks due to participation or in the evaluation activities
Youth who participate in the project are receiving after care links and community vocational
supports. In this role, the youth is receiving the resources he needs to be successful and continue
his stability. Youth and parents/guardians will be encouraged to participate. However, they will
also be informed that they can choose to decline participation at any time. They youth and his
guazdians will sign consent forms upon youth's admission to the program allowing the program
and/or program representatives to administer psychological assessments and other measures to
youth and parents/legal guardians in conjunction with outcome research. No investigator may
involve a youth or family in research unless the investigator has obtained the legally effective
informed consent of the subjects and their guardian.
Procedures to minimize and protect participants
All foreseeable measures will be taken to protect participants and their confidentiality in
accordance with OHRP (Office of Human Research Protections) in compliance with the Division
of Human Subject Protections. All subjects identified will be given a corresponding number.
These numbers will be used to discuss and analyze the data provided and at the same time
provide anonymity to the individual subject. The research committee, made of administrative
and clinical personnel, will analyze this information by the subject's number. No personal
identifying information such as date of birth, name, social security number or significant
personal history will be used in the data collection system. Subject names will be documented
into a computer software program where security and passwords are required to have access to
this information. All written information that may provide identifying information about the
subjects will be kept in a secure cabinet with double locks to safeguard personal information and
z2
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
provide the highest level of confidentiality. Access to this secure cabinet is provided only the to
the outcome research team.
Plans to provide help if there are adverse effects
If the youth and family state they aze experiencing adverse effects they will be provided with
counseling services as needed. In the process of assessment, there is the chance that a youth will
disclose crisis information that includes a danger to himself, to others or grave psychological or
physical danger. If emergency medical or psychological care is needed the assessor will utilize
clinical members to provide further evaluation and contact with the Crisis team personnel. All
efforts will be made to protect this youth's confidential information while at the same time
providing him services to stabilize any eminent danger that they maybe experiencing. The
assessor will be provided with an on-call clinical and a list of emergency services numbers
should this need arise.
Describe alternative treatments or procedures when needed
No deception will be employed in conducting outcome research. Only youth that are accepted to
the program and admitted will be involved in the GAINS and GPRA assessment and continuing
evaluation process. All youth will be provided with equal treatment in substance abuse and
mental health issues whether or not they participate in the outcome research. If a youth is
discharged voluntazily or involuntarily (due to court or transfer to alternative treatment models)
he will be given a number of community resources for substance abuse treatment, counseling,
and afrercare links that provide for adequate standards of living.
B. Fair Selection ofParticinants
Target populations and important factors
The tazget populations for this proposed project are 12-17 year old male and female adolescents
who aze enrolled and admitted into the Ke Ola Hou Programs. Racial and ethnic and
backgrounds typically consist ofmulti-cultural ancestry including Asian-Pacific Islander,
Hawaiian, Portuguese, Caucasian, Black, American, Hispanic, Maori, Tongan, Filipino and other
Asian-Pacific races. They youth come from a variety of backgrounds including homelessness,
domestic violence, poverty, loss of one or more parental figures, learning disability, substance
abuse in the home and legal involvement with the court system. Many youth are referred from
Hawaii Youth Correctional Facility, Detention Home, Foster Caze, Mental health Treatment
Centers, local island public and private schools, and private homes. The project preserve to
provide substance abuse/dependency and mental health counseling to each youth that applies.
The non-admission of a youth is usually the result of their refusal to participate in treatment or
requiring a different (often higher) level of care. If a youth is refused admittance, the youth, his
family and department of health care coordinator is given a specific list of written
recommendations for continued treatment at other levels of care.
Reasons for Using Specialized Treatment for Youth Served
23
SAMHSA Youth Residential Program
County of Hawei'i
Ke Ola Hou Project
Youth provided treatment with Ke Ola Hou services need a multidimensional approach to
treatment due to their developmental and psychological needs t the time of admission. The youth
frequently are engaged in a chronic substance use and dependency problem, have been straggling
in school for 1-2 year minimally, come from a conflictual home that lacks adequate resources
and trouble with the law. Many youth had biological parents who used alcohol and drugs that
lead to the neurological impairment or learning disabilities. These youth are likely to be
vulnerable to law violations, have long-standing academic incompletion, lack basic skills in self-
sufficiency and demonstrate the potential for long-term psychiatric impairment if left untreated.
Potential reasons for including or excluding participants
Youth will be informed that they may decline to participate with no loss of mental
health/substance abuse treatment or additional benefits as standards in treatment at Ke Ola Hou
Project. Youth who are excluded are those who refused to participate and youth who are not
admitted to these programs.
Recruit and Select Participants
All youth will be encouraged to participate in the outcome research. There is no random
selection but all youths are welcome to apply to enter treatment who needs it. Youth admitted to
Ke Ola Hou Project are referred by a number of sources -the Department of Health, Department
of Education, Mental Health Counselors, Community Providers, Parents and Families, Probation
Officers, Family Court and other mental health agencies.
C. Absence of Coercion
Voluntary or required participation
Participation in the outcome studies research although encouraged is strictly voluntary.
Although youth maybe court ordered to treatment, he/she is given leeway to be evaluated and
choose an appropriate mental health treatment facility as needed. Al] youth in the Ke Ola Hou
programs are voluntarily admitted.
Awarding participants and methods to receive incentives if they do not complete the study
Participants are awarded small rewards for their continued participation in the study. This
includes for example $5.00 phone cards, McDonalds' coupons or 2 movie tickets. Youth may
choose to decline the reward or their participation at any time in the research study. All youth
will continue to receive treatment in programming with or without their participation in the
study.
D. Data Collection
From whom is the data collected
24
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
Data will be collected from a variety of sources during the psychosocial and substance abuse
assessment. This includes aface-to-face interview with the participant, family members in
attendance, department of health care coordinator, probation officer and therapists. During the
initial interview, the youth and support members are asked for supporting data and goals for
treatment. Youth and family members are also interviewed privately and an assessment is
written during this process. Information is reviewed and confirmed during an exit interview.
Continued data collection will occur within the first 30 days of a youth's admission and assist in
the formulation of a preliminary mental health treatment plan. GAINS and GPRA measures will
be given after a youth is accepted and admitted into the program.
The use of collaborating information
Collaborating information is provided by telephone, face to face and records review with family
members, care coordinators, probation officers, child protective service workers, teachers, school
administrators and medical personnel. To protect the confidentiality ofthe youth, the examiner
will take precautions to protect alcohoUdrug and mental health information unless given specific
written consent to release the information to a specific individual or agency. Observations of
when a youth enters the assessment process (i.e. arrives intoxicated or impaired), questionnaires
given to the youth, past psychosocial and substance abuse assessments and school records can
and often are used during the evaluation process. This process continues after the youth is
discharge from the program and if he/she continues to voluntarily participate in the outcome
research.
Types of specimens used in the project
Youth are not required to provide specimens for this project. However, youth in the program are
given randomized drug testing as part of their treatment plan. This information is recorded in a
youth's chart and can be used as collateral information as part of the assessment process while in
treatment. Youth may also have randomized drug testing as part of their probationary or
treatment plan in step-down facilities. This information may therefore be used as collateral
information provided specific written informed consents are given.
E. Privacv and Confidentiality
Data collection by the research team
Data is collected by a research team consisting of the original assessor, the GAINS examiner, the
outcome research team and the transitional team through the data collection instruments. Data
information will be collected using face-to-face, telephone and written correspondence. Data
will be stored in a double locked file cabinet with access given only to the reseazch team -the
statistician, two research assistants, the GAINS examiner (if not a member of the transitional
team or outcome research team) and the transitional team.
Who has access to this information and who does not
25
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
Individualized information is provided to the participant and his/her legal guardians. A youth
can deny aparent/legal guardian as stated in Federal Law to have access to substance abuse
information after the age of 15 unless the youth gives specified written informed consent. Youth
are asked to give written consent to family and appropriate parties in writing when he/she enters
the program. The GAINS assessment tool is used in the overall evaluation of a youth as he/she
enters the program and becomes a summary of results become part of the medical record. These
records are not released unless specific written informed consent is provided or by a written
order directly from the Court. Attorneys who request this information by subpoena, school
administrators, employers, universities, and other mental health agencies will not have access to
this information unless they provide a specific written informed consent that includes the youth
and parenUlegal guardian's signature. If the youth is of legal age (18 years or older) he may
provide written informed consent. The identity of the participants will be kept private through
the use of a coding system identifying each youth with a 3 digit number and 2 letters on the data
records with no other identifying information such as a social security number, date of birth, etc.
Identifiers are stored in separate areas in a double locked cabinet from the data collected. Data
stored on a computer will use a security password system accessible to the research team only.
The password will be changed randomly and minimally every 6 months.
F. Adequate Consent Procedures
Information given to those who participate in the project
Participants will be given the information about the transitional project in a summarized form.
This includes the type and purpose of their participation. Youth, parent and legal guardians will
be told that they will be interviewed at regular interviews for the outcome research -intake,
discharge and at 6-month intervals for up to 3 years. The purpose of their participation is to
provide a greater understanding of drug and alcohol use of adolescents, the impact it has on their
everyday lives, what treatment is effective in reducing these effects and how community
supports assist in the overall rehabilitation process. They are informed through the written
consent that their data will be used by the research team and that their individual data will be
kept private and confidential. They are told that their participation is always voluntary through
the length of this project and does not impact their access to needed and equal treatment. Risks
of fatigue or experiencing minor psychological stress will be reviewed along with the availability
of counseling, reducing or taking the exam at a later date, if these risks occur.
Providing appropriate specific written informed consent for youth and their families
With all releases of information, the youth and parents/legal guardians must sign a specific
release of information that includes the following criteria:
1. A beginning and end date for the release of information. Statements such as "when the
outcome research is completed" will not be accepted. Specific dates will be sued up to
one year from the last signed release of information.
2. A witness signature is required for a youth who is legally an adult. This signature can be
the parent/legal guardian or another adult family member. The witness must be an adult
and not a minor.
26
SAMHSA Youth Residential Program
Counly of Hawaii
Ke Ola liou Project
3. Specific individuals or agencies are identified. This information is directly released to
these parties only unless an additional release of information is signed.
4. The release details what information (i.e. drug history, school participation, psychological
and/or mental health needs, etc) will be released.
5. The written consent contains the purpose of why this information is being released and/or
requested.
6. Written releases are written in clear and easy to understand language for the participant
and his parent/legal guardian.
7. If information is not clear, the youth and family are encouraged to ask questions and
clarify the information so that an informed written consent can be given.
8. For youth and parents/legal guardians with limited reading or comprehension skills the
examiner will be made available along with an interpreter if needed to explain each item.
9. Separate consents will be obtained for Treatment at the facility and for participation on
outcome studies. Individuals who do not consent to having individually identifiable data
collected for evaluation purposes will be allowed to participate in treatment.
G. Storing and Reviewing Data and Releases of Information
Storing Data and Releases
All releases of information are kept in a secure double locked file for a minimum of 3 years and
records relating to research which is conducted be retained for at least 3 years after completion of
the research as in compliance with OHRP standards of compliance. All records must be
accessible for inspection and copying, at reasonable times and in a reasonable manner, by
authorized representatives ofthe Human Subjects Research Committee formulated between Ke
Ola Hou personnel.
Human Subjects Research Committee
The Human Subjects Research Committee will consist of the management team for the project
and the outcome studies and transitional team along with consultants, as needed in the area of
research in substance abuse and mental health issues. The committee will meet annually and
more frequently if deemed necessary to maintain the highest standards of protection for
confidentiality and safety of research subjects. Minutes will be taken and specific
recommendations will be made. Two co-chairs (one from each facility) will be used to assure
the recommendations are completed in a timely manner and reported back to the committee
members. These minutes are maintained in the same fashion as the data collection and
accessible for inspection at least 3 years after the completion of the research project.
Risks compared to expected benefits of the project
There are only minor foreseeable risks or adverse effects in completing the assessment process.
The assessment itself derives from the youth answering questions about his present and past
drug/alcohol use and the impact it has had on his/her past and current level f functioning. Some
anticipated minor risks are that the youth and family may become fatigued from the length of the
survey or it may arouse an awareness of psychological issues. To counter any potential for risks,
27
SAMHSA You[h Residential Program
County of Hawaii
Ke Ola Hou Project
a youth will be allowed to complete the survey in shorter sections and when he is psychological
capable of doing so. Counseling will also be offered as necessary to manage any potential
psychological stress. Assessors are masters' level or higher trained therapists and can provide
counseling. No mental health or substance abuse treatment services are withheld, denied or
reduced if a youth does not participate. Confidentiality is maximized. In return, the benefits of
the project are powerful. This information will be able to provide consistent and long lasting
support systems for youth in the area of substance abuse and dependency treatment, family
therapy, culturally aligned experiential therapy and vocational supports to provide a greater level
of potential success. In addition, these supports will be validated in a study which offers
multivariate analysis to validate or deny the value of these supports. Long-term supports will
continue after the study if completed in the form of an ohana association of family, extended
family, mental health chemical dependency support networks and business groups to assist these
youth and others in their own local communities.
28
SAMHSA Youth Residential Program
County of Hawaii
Ke OIa Hou Project
Section H -Data Collection Instruments/Interview Protocols and Consent Forms
Two levels of outcome data will be collected as recommended by CSAP. The first level
of assessment will pertain to the Government Performance and Results Act (GPRA), which is
required by SAMHSA funded programs. The GPRA includes five indicators: Monthly use,
perception of harm, disapproval of use, future intention to use, and age of first use. The second
level of assessment pertains to program specific measures, which will be primarily be conducted
utilizing the GAIN tool. We did not include a copy of GAIN here as it is over 100 pages in
length. A copy of the tool can be obtained at the following website:
www.chestnut.org/li/gain.html. The proposed comprehensive instrument package will assist
with determining the impact level of specific Ke Ola Hou Project goals and objectives and they
have been selected to be consistent with these objectives. In some instances, these instruments
will be modified to ensure adequate linguistic and cultural capacities for the target population.
Demographic Information
This will be a section of the Instrument Package that will be developed that will include all of the
proposed instruments. This section's main purpose is to obtain information on socio-
demographic factors that place these participants at risk for substance abuse. Items in this
section will assess socio-demographic characteristics (including household composition and
stability, income, age, ethnicity, and education) and other ATOD risk factors. Because
individual level outcomes may vary depending on the number of risk factors faced by these
participants, risk levels identified in these sections will be used as covariates ("control
variables") in assessing the impact of program interventions on intermediate and ultimate
outcomes. In other words, identified demographic variables among these youths will be taken
into account in outcome analyses.
Client Satisfaction Questionnaire (CSQ-81
Several studies have used the CSQ-8 to measure client satisfaction with program services. The
CSQ-8 is a short form designed from the original 31-item instrument. The short-form version is
a good subsititute for the long form because of the instrument's consistent psychometric
properties (Attkisson, 1987). The questionnaire has widespread use in clinical settings in both
inpatient and outpatient community agencies. It was nonmed using 3,628 subjects 76 clinical
settings (community mental health centers) in the Western U.S. The CSQ-8 was found to have
high internal reliability (alpha = ~0.8), This assessment will only be collected at posttest level.
Cultural Pride
The Ke Ola Hou project emphasizes cultural competencies that are known to be important
protective factor against drug and alcohol use. The Cultural Pride Scale (Nolan Zane, Four
Winds Research Corporation) is a 10-item measure of cultural identity that has adequate
reliability (a = .82). It includes questions that assess the participant's general feelings and
acceptance about his culture.
Interviews
Face-to-face interviews individually and/or in focus groups. These interviews will be done with
participants to assess from qualitative perspective the impact of the program, the perception
about the program, service satisfaction, and suggestions for improvement.
29
SAMHSA Youth Residential Program
County of Hawaii
Ke Ola Hou Project
KE OLA HOU INFORMED CONSENT FORM
Program Director:
Program Evaluator: Richard Kim, Ph.D., The Catalyst Group, (808) 593-1998
The purpose of the program evaluation of Ke Ola Hou of County of Hawaii is to find out if the
services of the program are useful and actually help people. The program evaluation team,
headed by Dr. Richazd Kim will be asking you to answer questionnaires and interview questions
regarding your background, life experiences, and experiences with using services before, during
and afer your participation in the youth residential program.
If you decide to participate in this study, you are asked to answer questionnaires a total of three
times. We will ask you to answer the initial questionnaire that will give us an idea of how you
aze doing before the start of the program. To measure changes in your situation over time, we
will be asking you to answer a questionnaire immediately after you complete the program. We
will also ask you to complete follow-up questionnaires at 6-months after you complete the
program. Each of these questionnaires will take about one and half hours to complete. An
evaluation team member will also interview you for about 30 minutes to an hour about your
personal experiences after you complete the program. Each time that you finish answering these
questionnaires and participate in interviews, you will receive a $20 grocery certificate.
The things you tell us in the questionnaires and during the interviews will be kept confidential.
That means we will not tell anyone what you have told us and your records will be kept in a
locked file cabinet. However, we want you to know that there are some rare times when we
cannot promise to keep information private. The law says that the program staff and the study
team must report when a person lets us know that a child, elderly person, or sick adult has been
abused or neglected. We must also report if we believe you are a serious danger to yourself or to
other people.
Also, since the program is being supported by federal money received from the Substance Abuse
and Mental Health Services Administration (SAMHSA), we will need to send reports to this
agency regarding how well the program is providing services to you. We may also publish some
of the findings about this program in a journal. However, all of the information in our reports
will be summaries of what many people have told us or responded to on the questionnaires.
Your answers will always be grouped with other peoples answers and will never include your
name.
You are completely free to decide whether or not to be in this program evaluation study. The
services you receive from the program will not depend on, nor be affected by your decision to
participate in this study. If you decide to participate, you can also choose, at any time, to skip
any questions you do not want to answer or stop being in the study altogether. You have the
right to drop out at any Time.
We do not anticipate any serious risks, discomforts, or inconveniences to you or your family as a
result of your participation in this study. However, you may experience some anxiety in relation
30
SAMiiSA YouOi Residential Program
County o(Hawai'i
Ke Ola Hou Project
to discussing personal history or filling out questionnaires. Although participation in this study
most likely will not harm you, you can always contact the Program Director, , at
to arrange for a meeting if you have any concerns. You can also call Dr.
at directly who is the Chair of the "Institutional Review Soazd" which is
the committee that he]ps protect people who are in research studies. The review board will then
investigate your complaint. We encourage you to ask questions, give us suggestions, or tell us
your concerns about the study.
If you agree to be in this program evaluation study, please sign your name below. If you sign, it
means that you understand what we have told you in this form and you are willing and are giving
permission to be in this study.
(Youth Name, Printed) (Youth Signature & Date)
(Pazent or Legal Guardian Name, Printed) (Parent or Legal Guardian Signature & Date)
(Staff's Name, Printed) (Staffs Name, Signature & Date)
(Approved Research Committee Chairperson, Printed) (Approved Research Committee
Chairperson, Signature & Date)
IA#:
31
~ ~ ~Yr_~
~ - ~~~t~yyyp
CHARTING THE COURSE
xy..-=- ~ F' 47g LT IiT Y~ ~ 'E` Z ® I~~ FOR I-~AWAII~S ISO UTH
~
September 30, 2003
Grants Management Branch,
OPS,SAMHSA
Rockwall II Bldg, Suite 630
5515 Security Lane
Rockville, MD 20852
ATTN: Cheryl Gallagher
Dear Ms. Gallagher:
On behalf of the partnering agencies I'm fiorwarding the corrective action plan for Grant
#1 H79 TI 15338-01 - Ke Ola Hou, and all necessary attachments. We believe this
addresses all the issues outlined in the special conditions of award, but if you have
additional questions please don't hesitate to contact us.
Sincerely,
Fr nk .Shivers
V c resident & Treasurer
4!' 1F, t.~~,~a, F . ii n =~neE, h&r.~~.+n :)t~7:<a ti fF,(i~t}2il i-?2871 ° ? t i ,i`rC ~ t, , ,-e~=. . ~ =e=.,~ f r,~
Ke Ola Hou Corrective Action Response
Ke Ola Hou Youth Residential Treatment Program
Corrective Action Plan: Response to SAMHSA
1. Amore complete description of the goals and objectives of the project and how they will
be addressed and measured. Provide a description of any collaborative agency's role in
the project and how they will meet the overall goals and objectives of the program.
Each numbered item describes a goal along with objectives specifying the methods of how
each goal will be achieved. Below each goal, indicated in alphabets, are specific objectives or
program activities that are to be provided toward reaching each goal:
l) Seventy percent (70%) of intake youth will successfully complete Ke Ola Hou residential
treatment program as measured by program graduation statistics, including provision of:
a. State-of--the-art clinical assessment of all intakes with the Adolescent Residential
Treatment (ART) GAIN-I (including all items for GPRA website reporting);
b. Individualized Treatment Planning (ITP) following all intakes;
c. Evidence-based, cost effective treatment services that includes individual, group, and
family therapy addressing both substance abuse and mental health issues;
d. Culturally appropriate and gender-specific treatment and healing practices, including
voyaging and other experiential activities (navigational ropes, agriculture projects,
games, camping, hula, etc.);
e. Case management to ensure a complete and seamless continuum of care addressing
all assessed educational, treatment and other service needs with other agencies
(education, juvenile justice, child welfare and mental health agencies); and
f. Successful follow-up of four-fifrhs (80%) of youth that the Ke Ola Hou program
intakes with the GAIN-M90 (which includes all GPRA items) under the GPRA model
at 3, 6 and 12 months.
2) Three-fourths (75%) of graduating youth will maintain sobriety and abstinence from all
drugs and alcohol at each (3, 6, and 12 months) follow-up assessment, through:
a. Appropriate linkage to aftercare services for all youth completing treatment;
b. Appropriate linkage with community positive peer and alternative activities with an
identifiable community organization (e.g., YWCA and YMCA, sports, arts,
volunteering, hula, paddling, water sports, surfing, Boys and Girls club, etc.) for all
youth completing treatment; and
c. Three-fourths (75%) of youth will maintain active participation in substance abuse
recovery systems (N.A., A.A.) for a period of at least one year following graduation
from treatment.
3) Three-fourths (75%) of graduating youth will not have engaged in high-risk behaviors,
including a variety of criminal activities, violence to self and others and truancy, at each
follow-ups, through provision of:
a. Psycho-educational interventions on high risk circumstances to all clients;
b. Treatment interventions addressing the relationship between substance use and
violence to all clients; and
c. Interventions using role playing and modeling to enhance the self-efficacy of all
clients' negotiation skills in avoiding and/or escaping high risk sihiations.
Ke Ola I lou Corrective Action Response
4) Three-fourths (75%) of youth completing treatment will return to public education setting
or maintain employment as indicated in each youth's chart and during each follow-up
assessment, through provision of:
a. Development of Individualized Education Plans (1F,Ps) for all youth upon admission
into the program;
b. Identification of potential barriers for each client's graduation from the school system
with a diploma and development of strategies to overcome those barriers; and
c. Offering life skills internships vocational training and employment.
All youth participating iu trcmncnt Nill report signilicon( improvement in their health
and mental health status as a result of receiving treatment services, through provision of:
a. Comprehensive health and mental health assessments to all clients;
h. Referral and transportation to publicly-funded medical services; and
c. Referral and transportation to publicly-funded psychiatric services which include
provision of any appropriate psychotropic medications.
6) Statistically significant proportions of participating youth and families will report
improved family functioning with significantly lowered conflicts as a result of receiving
treatment services through the provision of:
a. Therapy with families of all participating adolescents;
b. Cultural interventions, including Hooponopono ("making things right") encouraging
harmonious family relationships; and
c. Collateral intervention services to address conflict resolution and problem solving
The program model is designed to take advantage of the special and unique expertise of the
varied partners in the project. The simple goal is to provide Big Island youth with an exceptional
substance abuse treatment design that is culturally aligned, hands on, and experiential in nature.
Those who have decided to partner with the county have agreed on these seemingly simple yet
challenging to achieve goals.
Due to the immediate availability of SAMHSA funding and the rigors of opening a Hawaii
Department of Health, Office of Health Care Assurance (OHCA) licensed facility, the project
will be implemented in three stages. In stage One (approximately November 1, 2003 through
March 30, 2004) Ke Ola Hou will offer outpatient substance abuse treatment with an
experiential educational component to Big Island youth (groups of no more than 12, for 3 to 6
month periods). In Stage Two (approximately March 30, 2004 through March 30, 2005) an 8
bed residential facility for boys will be opened and will include the same services listed above.
In Stage Three (approximately March 30, 2005 through the completion of the SAMHSA contract
September 30, 2006) an 8 bed residential facility for boys and an 8 bed facility for girls will
provide these treatment services. This three-stage approach provides a realistic timeline for
service implementation and allows Ke Ola Hou to begin serving the needs of Big island youth
and families almost immediately. (See Timeline section #7.)
There will be five primary partners in the provision of these services: the County of Hawaii,
The Catalyst Group LLC, Marimed Foundation, Big Island Substance Abuse Council, and Na
Kalai Wa'a. The County of Hawaii will act as the fiscal agent for the project. The Catalyst
Group LLC (Catalyst) will act as the lead evaluator for the project, and hire and train all related
staff in this area. Marimed Foundation (Marimed) will act as the lead agency in the delivery of
services. Marimed will be ultimately responsible for assuring that all program goals and
objective are met and reported in a timely manner. Marimed will also provide the Project
2
Kc C)I? I luu Corrective Action Response
Director, management and staff for all residential components, educational staff and curriculum,
and primary supervision of all Ke Ola Hou staff. Marimed will subcontract substance abuse
therapy and treatment to the Big Island Substance Abuse Council (BISAC). B[SAC will staff the
Clinical Director and Substance Abuse Case Managers positions; although the Project Director
will directly supervise these individuals they will remain employees of BISAC. BISAC will
develop and implement all substance abuse curriculum, case management, and provide
individual and family counseling within the best practices and cvidenco-based models described
in section #3. Proposed "frcatment Approach. Marimed will also subcontract Na Kalai Wa'a
(Makali~i) to provide experiential and culturally rdcvant services to youth served. Makali~i will
hire and train a Marine Skills InstructorNoyaging Coordinatur responsible to leach navigational
skills, maritime and cultural history, service learning projects, voyage preparation, and canoe
paddling and sailing skills to enrolled youth. (For Further dctai/s on these organisations sec
section #6 Management Plan and OrganizaGonai Chart).
SAMHSA funds will be utilized for cvahintion services, and to hire and train three primary
positions which will be included in each stage of the program's development: the Project
Director (Marimed), one Substance Abuse Case Manager (BISAC), the Marine Skills
InstructorNoyaging Coordinator (Makali'i). (See attached, Job Description). SAMHSA funding
will also support the voyaging component of the program. (See attachment, Revised Budget).
During Stage One, Ke Ola Hou will be staffed by the Project Director (Masters Level CSAC
[Certified Substance Abuse Counselor]), the Substance Abuse Case Manager (CSAC Certified),
and the Marine Skills InstructorNoyaging Coordinator. The program will receive referral
applications from the family courts, probation, local schools, other non-governmental
community agencies, faith organizations, and directly from families. Programming will be
offered after school and on weekends following a Tuesday through Saturday schedule.
Accommodations will be made for youth who are not currently attending school on an altered
schedule. Youth will engage in individual, group and family treatment sessions, academic
ttrtoring, experiential activities (canoe paddling. canoe maintenance and construction, hiking
etc.), service Teaming projects in the community, and voyage preparation classes.
During Stage Two, boys will be offered residential programming with regular and special
education classes .uid the above mentioned therapeutic and experiential offerings. Girls will be
offered the same services as described in Stage One. This is planned due to the present higher
need for boys residential services in the community.
During Stage Three, all of the above mentioned services will be available for boys and girls
with an outpatient and continuing care component included as per the overall program
description included in Section #3: proposed Treatment Approach.
The Ke Ola Hou Administrative Oversight Committee (AOC) will be made up of
representatives of the partnership and will provide program oversight. Those employed by the
program will be supervised by the protocols of the program and receive the relevant benefits of
their specific agency. However, the AOC will have strong oversight and may recommend
personnel and budgetary choices and/or changes as necessary and mutually agreed upon.
2. Provide information on how the goals and objectives will be measured. Provide
information on any instruments that will be used.
See above 1) and also Section #3: Proposed Treatment Approach (below).
3
Kc OIa 1 lou Con~cctivc Action Response
3. Give a detailed description of the proposed treatment approach that will be used to
carry out the project. If different collaborating agencies are using different
approaches, please describe each approach used and identify the collaborating agency.
Cive information that supports the approach(s) as evidence based treatment Include
information on the cultural aspects of the approach. Has the approach been used with
this target population before? List the activities that will be used with the approach(s)
and describe how they will meet the goals and objectives of the project.
7 he purpose of the Ke Ola Hou project is to address the need for a more effective approach
to residential adolescent substance abuse trcannent and continuing care through the development
of a more multi-cultural approach to treatment; expansion and testing of an experiential model,
and the cast management and continuing care needs of a diverse population isolated by
geography to maintain and maximize the gains made in treatment rbr many years Marimed has
provided residential treahment options on other Hawaiian Islands (O'ahu and Maui), blending
elements ofstate-of-the-art treatment techniques with experiential therapy based on activities
rooted in the local cultural milieu (voyaging, paddling, hula, Kalo (taro) cultivation, outdoor
exploration). Until now, there has been no residential substance abuse treatment on the Big
Island of Hawaii. Ke Ola Ilou is establishing these services in the local tradition of substance
abuse treatment with the collaboration, advice and guidance of experienced Big Island providers.
Ke OIa Hou's approach to substance abuse and xreatment is consistent with the
biopsychosocial concept of addiction, as it is rooted' in the belief that addiction is a disease
affecting the body, mind, and spirit. Treatment consists of five basic components: 1) an
experiential learning component in which youth participate in a variety of activities designed to
motivate and foster learning life skills and values; 2) a continuing education component that the
Department of Education of the State of Hawaii will accept, so that when clients have completed
their treatment, they will be on grade level when and if they return to their regular school. In
addition to the traditional education curriculum, the educational component being proposed will
also provide youth with extensive knowledge and understanding of substance use and abuse,
while addressing the importance of learning, and expanding the skills needed for effective living
along with a cognitive educational approach to all curriculum: A spirihial component dcsi~ncd
to effectively include culture and instill an awareness of well-being and facilitate individual
recognition of personal mastery; 4) Counseling to address underlying feelings that may have led
the youth to escape rather than cope with issues; and 5) Intensive family involvement using
traditional Hawaiian concepts as well as theories that address open communication, trust
building, and using a common goal to work through issues.
The treatment philosophy that Ke Ola Hou will employ, via BISAC Case Managers, is a
multi-systemic approach to adolescent treatment and substance abuse and co-occurring disorders.
There are many reasons why treatment services need to be specifically tailored to the adolescent
age group. Youth in the child welfare and juvenile justice systems arc particularly at high risk for
developing a substance abuse disorder (Dembo et a] 1991). The literature also points to a
reciprocal relationship between drug use and criminality. Drug use often predicted criminal
offenses and conduct disorder was associated (but not necessarily predictive) with substance use.
The relationship between co-existing disorders and substance use is often aggravated by co-
occurring depression including frequent self-medicating behaviors. A vicious cycle of substance
use may often lead to criminal acts to support an addictive habit or to medicate chronic
psychiatric symptoms. More importantly, the level of aggressive symptoms systemically
appeared to have an effect on adolescents who become frequent offenders in the juvenile justice
4
Ke Ola I lou Corrective Action Respunae
system. Psydrologically these youths are trapped in a persistent cycle of negativistic, defiant,
disobedience and hostile behavior towards others. They generally lack social skills, often
aggressive, avoidant, highly impulsive and are often hard to engage.
In implementing a more effective approach to treatment and continuing care, the program
aims to address these types of youth as the program targets the different needs and characteristics
of adolescent drug users as opposed to adult users. As reviewed in Treatment ofAdolescents
wish SUbstonce Use Disorders (1997), practitioners assert that scaled down versions of adult
treatment programs do not work with adolescents as their drug and alcohol use often comes Crom
many causes (family, peer influence, de~~clopmental and biological delays). They tend to have
inure trouble projecting the consequences of their use, making insight devclopmcnt impaired and
decision making short sighted. Tn treatment they must be approached differently than adults
because of their ever evolving and unique devclopmcnt.
Adolescents have different values and belief systems and environmental concerns (strong
peer pressure, violence in the home or school or the community at large). They tend to have
smaller developing body sizes and lower tolerances. They are at a greater risk for alcohol and
drug related problems even at lower levels of consumption. Finally, the vicious cycle of
substance abuse and dependence compromise their mental and emotional development. This
impacts their interpersonal skills and denies them access to peer and adult resources. They often
end up relating to others with increasing levels of aggression or dishonesty, and interactions with
others are conflicting at best. Longitudinal studies have established associations between
adolescent substance use and impulsivity, alienation and psychological distress (Hansen and
White, 1991: Shedler and Block, 1990) along with delinquency and criminal behavior (National
Institute of Justice, 1994). Other results include irresponsible sexual activity increasing the
susceptibility to AIDS (DiClemente, 1990) and finally psychiatric or neurological impairments
associated with drug use and other medical complications (SAMHSA, 1996).
The goal of Ke Ola Ilou is to deliver residential substance abuse services on the Big Island
of Hawaii where none previously existed. Residential services for the adolescent population that
take these issues under consideration in a unique, innovative and life-changing environment.
This program seeks to invest substance users with co-existing disorders with the combined use of
evidence based treatments that include: Use of family therapy that impacts and changes the
family enabling system; and non-traditional residential programming of experiential therapy.
The project is based on experiential and culturally based models that recognize that addiction
may best be viewed as the result of the combination of genetic predisposition and environmental
factoring and that it is possible for all people to remain drug-free. The most effective means for
long term abstinence from methamphetamine and other drugs is through lifestyle changes
including but not limited to; active participation in a twelve step program, association with
recovering individuals and the establishment of healthy, meaningful relationships with family
and others, channeling energy into positive, constructive endeavors and activities, and, the
recognition and ability to cope with feelings and emotions.
Treating the whole family in concert with the adolescent is of primary concern. This
includes diverse multi-cultural issues as well as intergenerational exploration and healing.
Reunification of family is the goal wherever possible utilizing cultural healing practices in
combination with traditional substance abuse and treatment concepts. Therefore, from
assessment to discharge the goal is to provide a plan that will enhance the adolescent's chances
for ongoing abstinence including follow up and continuing care for the adolescent and his/her
family and support system. For adolescents, an integral element of recovery concerns the
5
Kc l)I? I lou Corrccti~~c Action Response
involvement and support of family and/or significant others incorporating cultural re-
enhancement for family and client. The treatment program's goal is to educate and involve the
family throughout treatment process.
Because family is essential in moderating the other problems associated with drug use
(Latimer et al., Locber, et al., 2000; Myers ct al., 1993; NCADI TIP 4 revised, 2002), family
involvement in treatment is crucial. Research indicates strong support for family-based therapy.
Data support the link between changes in core issues of family functioning and adolescent
changes in substance use and problem behaviors (Schmidt ct al, 1996). Over the past 20 years,
carefully constricted and controlled research studies indicate how a family therapist can
intervene to help family change behaviors (Stanton and "fodd, 1979; Stanton and Shadish, 1997;
Gurman et al., 1986: Liddle, 1992). Family therapy in an experiential setting has also proven to
be effective.
BISAC Case Managers will utilize family therapy in Ke Ola Hou because family is a
strength that the target population often relics on. Families within the Hawaiian Islands typically
live together in extended family living situations and share many of the same psychological and
physical conditions. Native Hawaiians have historically and statistically the highest rate of
suicide, depression, substance abuse and addiction, imprisonment, and death than any other
ethnic group residing in the Hawaiian Islands. Therefore, Hawaiian based treatment and
prevention methods will be utilized as a component of the experiential component of this
program as it has been shown that treatment is more effective when it is compatible with client
culture patterns (Tharp, 199]). Ho'oponopono (to make right) is a Hawaiian method of conflict
resolution that uses the concepts of open communication, trust building, and having a common
goal to work through issues within the family to help air grievances and restore harmony. This
cultural process combines honoring the hierarchy of the family, valuing spiritual powers and
ancestors and reaching out for support with extended family members to aid in long-term
recovery for the youth and family.
1n Ke Ola Hou, the adolescent and their family will choose and be trained in the use of
Ho'oponopono. In this model, the family members work toward identifying cultural values and
norms that are honored by the local community culture. These can include the value of the land,
the ocean, listening to the ancestral spirits, ceremonial dances (hula and chant) and the aloha
spirit. Differences between cultural groups is addressed by working with parental figures,
community elders, and extended families to denote the "tone and direction" of the meetings. The
goal is to provide a system of change that values each family member and focuses on "making it
pono" (make it right) the wrong that occurred. Over time, this system becomes a valued family
tradition for resolving conflict and continues even after discharge and aftercare are complete.
Interwoven in this process is psycho-education about drug use, prevention and ceasing enabling
systems that maintain drug dependency. Asian Pacific islander values are honored along with
western approaches to understanding and ceasing drug use and dependency.
In the diverse environment of Hawaii, gender sensitivity is as essential as cultural sensitivity.
Female and male substance users have different factors associated with their dependence
(Brunswick, 1991; Opland, Winters and Stinchfield, 1995) and therapy must address these
differences. It is anticipated that there will be both a male and a female component to the
residential program. Treatment implications of gender findings will direct the clinicians to focus
on core issues for female and male adolescents. Male adolescents will need to focus on earlier
use, anger control methods, terminate physical aggression and take responsibility for
intimidating and provoking behaviors. Female adolescents who use drugs to escape emotionally
6
Inc (>la Ilou (OITCCII~~C Action Rcspon,c
need to focus on emotional and interpersonal conflicts. Coping strategics for both populations
will be paramount but will vary to encapsulate both population reasons for usage (males -power
dominance, thrill seeking, association with violence and females -need to escape emotional
issues and potential histories of abuse). Motivational enhancers need to be taken into
consideration for both genders.
BISAC's treatment interventions in Ke Ola Hou will be provided utilizing research-based
models of care to include: the Cannabis Youth Treatment Model, Motivational [enhancement,
Adolescent Based Cognitive Behavioral ~t~herapy, and Community Reintegration. "hhe twelve-
step program will alao be incorporated in the treatment and unervaition of the ~~outh's addiction.
fhcuu interventions will be addressed in individual and group therapy scssious, skill building
groups, dnag free activities, recreational groups to increase bonding and trust, and the ability to
have fim without drugs, educational group to Icuro about the disease of addiction and cognitive
behavioral therapy interventions as well as anger management role playing and psychodrama to
assist the client in resolving losses that have occurred due to drug use. These youths' needs
provided outside of the residential setting will be managed through a referral process with
agencies utilizing Memorandum of Agreements. Implementation of the treatment plan will
include the full continuum of care with formal transition planning to identify continued-care
services once discharged from the residential facility. All except the residential option will be
provided during Stage One of program development.
Matching culturally aligned treatment with treatment strategies can also be enhanced by
reviewing coping skills. According to Constructive Thinking Theory, youth generally cope in
two fashions: Experiential Coping and Rational Coping. Experiential responses to stressful
events are characterized by immediate emotional reactions, rapid processing, holistic, and
intuitive appraisals. Results indicate a crude structure of cognitive integration of experiences
that happen on the pre-conscious Icvcl. The reaction to a stressful situation is generally
impulsive, rigid and reactive. The theory supports the use of automatic thoughts and emotional
reactions that occur with conduct disorder and substance abuse youth (e.g., Wills & Pifer, 1996).
Rational coping entails the use of reasoning and didactic processes (talking the situation through
with others). Experiential components of Ke Ola Hou will utilize rational coping skills by
providing a positive, action-oriented and flexible approach to help deter an adolescent from
relying on substances as a coping mechanism. Adventure therapy, through ocean-related,
agricultural, and traditional (cultural) activities; help substance-using youth to engage in hands-
on projects that offer immediate feedback and challenges them to learn new interpersonal styles
of coping. In Ke Ola Hou youth will gradually assume the role of voyager and will prepare for
land activities (service learning, agriculture, experiential games, camping, hiking) and ocean
voyages as a team. This enhances the use of motivational enhancement strategies proposed by
Miller and Rollneck (1991), and provided by BISAC Case Managers, in helping adolescent to
reflect on their role which defers to a new peer group. It also helps them gain vocational skills
and creates an identity that proposes positive change. De Leon (1998) postulates that sclf-
selection or enhanced motivation and readiness for treatment arc evident among groups that are
court mandated to a community residential treatment program.
Marimed has over ten years of experience in providing ocean-related experiential therapy
directly to high-risk youth with co-occurring psychiatric and substance abuse/dependency issues.
The voyaging component, as Ke Ola Hou will provide, has always set Marimed apart from
traditional community-based residential treatment models. Program success is based on the
ability to recreate attachment of antisocial youth in their interpersonal relationships with
7
Ke Ula Hou Corrective Action lZespunse
authority figures under the conceptual framework of using cultural reality based experiences of
land and ocean that offer immediate feedback and help develop the role of aself-sustaining and
independently functioning young adult. Mpofu and Crystal (2001) concur that the use of active
peer team building helps to foster apro-social training system to decrease cognitive distortions
and events of peer and family violence. Youth not only gain stability but long-term vocational,
psychological and social support systems which are infused with pro-social values and help a
youth to internalize and practice his/her change in the real world. Thus, character and maturity
may be practiced repeatedly in die program, community, ,drool and home settings so that youth
can transition gradually back iuto their local communities without chronic relapse and regression
that is characteristic of traditional models of treatment.
Marimed's experiential treatment model is consistent with those mentioned as research based
practices. According to the Surgeon General's report of 1999, adolescents in an experiential
educational model called Project Rc-Education focused on training teacher-counselors with the
support of consulting mental health specialists. These schools were located within communities
and facilitated therapeutic work with the family, allowed home visits and used experiential
components inspired by the Outward Bound Schools. The results were that treated adolescents
improved in self-esteem, control of impulsiveness and internal control. A follow up component
of six months maintained results with a predictive factor of providing community support.
Marimed will employ this model in Ke Ola Hou in a culturally aligned manner in order to
successfully address the unique disposition of island youth.
Other culturally based interventions will include but are not limited to Pacific Voyaging
using traditional and customary practices ofnon-instrument navigation via Makali'i. Hawaiian
voyaging embodies all the aspects of Hawaiian cultural traditions and practices and has been
shown to have a profound effect on Hawaii youth who are considered at-risk. The Makali'i
Marine Skills InstructorNoyaging Coordinator will provide activities geared to students of all
ages and ethnic backgrounds who experience positive growth and change as they are allowed to
walk in the footsteps of the ancient sea vova4=crs ~ctivitics ill include oral histories of the
islands, the practice of cultural values, learning traditional chants and dances, the study of
voyaging and learning traditional constellations, weather forecasting, and seamanship. A greater
understanding of the Hawaiian culture will lead to a greater sense of identity, self-esteem, and
self-respect as youth assume the role of a voyager themselves.
It is important to remember that substance abuse is often an effort by youth to self medicate
an underlying trauma. Therefore, Ke Ola Hou will request a referral form, a psychological
assessment, and a chemical dependency evaluation For all youth to be considered for admission
to the program. The first criterion is the youth must be judged to be dependent on a drug. Youth
must have had three months without violence and six months without suicidal attempts. All
youth must be free of significant health or mental health issues that would warrant a more
specialized level of care. If eligible per the psychological and chemical dependency evaluation
(meeting DSM-IV criteria for abuse and/or dependence), a therapist does apre-screen to
determine if the youth is willing to enter treatment and follow the rules and guidelines set forth.
Acceptance into the program also requires the consent of the legal guardian. Once this is
determined, a request for a current physical, current TB test, Individual Education Plan (fEP)-
504 or school records, a copy of a social security card, copy of birth certificate, health insurance
card for medical emergencies, and immunization records is made. Certified Substance Abuse
Counselors (CSAC) will provide assessment services utilizing multiple diagnostic tools and
techniques. Outcome of the assessment will be a Diagnostic and Statistical Manual, DSM-N,
8
Ke Ola Hou Corrective Action Response
diagnosis, if appropriate, and a recommendation for care based on the American Society
of Addiction Medicine, ASAM, PPC-2R.
Information gathering and planning begins when the youth arrives with parent or legal
guardian. Rights and rules are covered along with family history and medical history.
Counselors will utilize the results of the assessment diagnosis and recommendations to develop
strength based treatment plans to include all areas of need related to ASAM, ~PPC-2R, the
consumer's family needs, educational requirements, and legal responsibilities. All treatment
planning activities will be completed on a continuous basis to demonstrate progress, ensure
appropriate care, and that continuing care is provided following residential treatment.
Youths may be discharged when they complete the treatment goals and objectives or if they
refuse to participate in their treatment plan, i.e., refuse services, or if a client's behavior is
determined to~be a danger to themselves or other clients and staff This includes, but is not
limited to behavior that is severe enough to warrant arrest, and/or produce an unsafe environment
for other clients and staff. Discharge may also occur when it is determined that the client has
received maximum benefits from the program. The substance abuse program is a 24-hour
residential facility with 24-hour supervision for client's safety. Weekly team meetings with the
CSAC and master level therapist will continually assess progress and need for additional
services. When an adolescent needs further care, e.g., psychiatric monitoring of medication, an
on call psychiatrist is available for emergency. Working closely with family court probation
officers, when there are legal issues, assist the clients to act responsibly for law violations. Ke
Ola Hou staff will work with the Department of Education (DOE), Department of Health
(DOH), probation officers, and other community agencies.
Plans for implementation of treatment interventions that is designed to meet the Goals and
Objectives of Ke OIa Hou are described below. Proposed services arc consistent with program
activities and documentation citations for the evidence base of any current or proposed services
to be expanded:
Goal l: Seventy percent (70%) of intake youth will successfully complete Ke Ola Hou residential
treatment program as measured by program graduation statistics.
Ke Ola Hou will pursue the realization of this goal by providing treatment including the
array of elements recommended in NIDAs Principles of Effective Treatment and drawing from
various empirically-based models currently recommended by LSAT. The first step in ensuring
retention and ultimately completion for as many clients as possible will be the comprehensive
state-of--the-art clinical assessments of all youth, using the Adolescent Residential Treatment
(ART) GAIN-I, which includes all items for GPRA website reporting. Upon completion of each
intake, the CSAC, in collaboration with a master level therapist, will develop an Individualized
Treatment Plan (ITP) for each client. Depending on the type and intensity of treatment deemed
necessary from the assessments, a variety ofevidence-based, cost effective treatment services
will be included in the ]TP. These services will include individual, group, and family therapy by
CSACs and master level therapists who will address both substance and mental health issues.
Culturally appropriate and gender-specific treatment and healing practices will also be
included in the ITP. These services include voyaging seven day trips every other month, and
shorter voyages and camping as available. Each youth would be required to voyage on at least
two day trips as a way of developing the necessary skills for voyaging before being allowed to
voyage on a seven-day trip. Other experiential activities will include the ropes courses and
agriculture projects taught by cultural practitioners. While on voyage, the cultural approach
n
Kc UI? I lou ('urrccii~~c :Action Response
involves teaching the youth how to navigate by using the stars, as opposed to using a compass.
In agriculture classes, the youth are taught that certain plants and trees will be more fruitful if
they are planted on certain days, as determined by the cycle of the moon. Kalo (taro), a
Hawaiian staple, will be cultivated by participants. There arc certain hula dances that will only
be taught to the males and others to females, depending on the purpose of the hula. As part of
the hula lesson, the youth will not only Icarn the motions involved in dancing the hula, but will
also learn the reason why the song was written and the pwposc and meaning of the words in the
song. ~l'hese traditional practices reinforce ~~alue of hcalth~ lifc,aylcs and harmonious family and
social relationships.
Case management kill be an integral part of the youths I I I'_ Case management will be
provided to ensure a complete and seamless continuum of care addressing all assessed
educational, treatment and other service needs between all agencies involved in each youth's
I'fP. Referred from a variety of sources including the Department of Education (DOE),
Department of Health (DOH), probation officers, and other community agencies will also
necessitate case management to address the variety of needs and requirements identified by those
referral agencies and the relationship between the referral agencies and Ke Ola Hou.
Youth who are referred to treatment are managed by a system of school and mental health
care coordinators from the Department of Education and Department of Health. In Hawaii, their
purpose under the Felix Decree is to provide essential mental health and educational services so
that identified special need youth are able to participate and succeed in their pursuit of
educational credits toward a high school diploma or certification barring their mental health
issues. Youth who come from the Department of Child Protective Services (youth with active
child neglect and abuse cases), Department of Health Services (youth with legal guardians) and
the Office of Youth Services (for juvenile offenders) also provide a coordinator and caseworker
to refer for these services.
Each youth who is referred into project is provided with an IEP (Individualized Educational
Plan) and includes a team of mental health, educational and ancillary staff with direct attendance
and input of the youth and his/her legal guardians. This IEP team meets and develops a 6-
domain plan that covers Family, School, Community, Individual, Social and Legal goals along
with an extensive crisis and discharge plmi. 'fhe plan will serve as a preliminary context for each
client case in developing the Individualized Treatment Plan. As a youth steps down in a
therapeutic group home or foster care placement this mental health treatment plan continues to
be used in context with an evolving iEP team. With the family and youth's approval, the child
welfare system, school officials and juvenilejustice system will be utilized in providing the
resources a youth needs to maintain a clean and sober lifestyle. This includes providing
assistance with applying for social service supports for youth and family, applying to
college/university and/or trade training programs, continued support from informal psychosocial
support networks (local Hawaiian cultural groups, paddling clubs, sailing, fishing, agricultural
co-ops) and continued vocational pursuits with local jobs, attending cultural enrichment events,
job training, and life skills internships.
These types of system-wide collaborations between Ke Ola Hou and the different
community agencies shall not only prove successful during the youth's stay at the residential
treatment center, but they will continue to benefit the youths after graduation from treatment.
The relationships established through the case management process shall assist in the follow-up
process for all youth who successfully graduate or prematurely Icave treatment, as Ke Ola Hou
staff will already be linked with other agencies involved in providing other services to the youth.
]0
Kc Ola Hou Corrccliv~ Action Itcsponac
These relationships will enable staff to be able to track and obtain 3, 6, and 12-month follow-up
data from at least four-fifths (80%) of youth who completed intakes, once they are no longer in
the residential treatment setting. Follow-up data will be used to revise treatment plans, identify
needs to step-up or step-down treatment, assess data pertinent to on-going family therapy and
aftercare, and support the required parameters of follow-up for the evaluation of the project.
Goal 2: Three fourths (75%) ofgraduating youth will maintain sobriety and abstinence from all
drugs and alcohol al ent~h (3, 6, and 12 months) ~~Ilow-ut~ ac.ce.rsmenl.
In addition to un-going contact ~~~ilh the program, tallow-up will be supported by contacts
~+~ith other agencies who the youth may receive services tiom after graduating or leaving the
program are established as a result of case management efforts. It is through these collateral
contacts, that appropriate linkages to aftercare services may be made for youth who successfully
graduate from the program. Case managers will ensure verified engagement with an appropriate
aftercare program, prior to graduation from treatment.
Youth will also be appropriately linked with positive peer and alternative activities with
identifiable community organizations. While some of the youth may have been involved with
some of the community organizations before receiving residential treatment, it will be highly
beneficial for all youth who graduate from treatment to become involved with community
agencies that support the positive efforts of youth. For example, graduating youth maybe
referred to the local YWCA and YMCA or one of the local Youth Centers whose primary goals
is to sponsor drug-free events specifically for youth. In addition to referrals to local community
agencies, youth graduating from treatment will also likely benefit from actively participating in
substance abuse recovery systems. While in treatment, CSACs will introduce youth to the
concept of these substance abuse recovery systems and as part of their iTPs, youth will be
required to attend numerous local NA and AA groups, even before graduating.
Goa13: Three foz~rths (75%) of
graduating youth will not have engaged in high-risk behaviors,
including a variety of cr~irninul activities, violence to self and others and truancy, at follow-uTs.
This goal will be achieved through the intense teaching of a variety of curriculum while the
youth are in residential treatment All youth will receive, through the course of their treatment, a
variety ofpsycho-educational interventions on high-risk circumstances. As part of their ITP,
they will be required to participate in educational, relapse prevention, and skill building groups.
On one level, a variety of activities will be assigned to the youth that will require them to be able
to identify dangerous situations and role-play different types of scenarios that might present
themselves in these dangerous situations. CSACs will repeatedly discuss and role play these
types of situations in individual and group settings. A series of locally produced, culturally
appropriate videotapes relating to substance abuse and domestic violence will be played For the
youth in group sessions. Debriefing and process sessions will then be held to discuss youth's
thoughts and feelings regarding the videotapes and all youth will be given the opportunity to
relate to the videotapes in the group setting, or in an individual session if deemed necessary by
the CSAC. In addition to the education, relapse prevention, process, and skill building groups, as
noted above, youth will be required to participate in the 12-step program of self help. All of
these activities that the youth are exposed to and expected to participate in during their treatment
are intended to build their knowledge and provide modeling and practice of a skill base so that
upon completion of the program, the youth will be independently able to identify and avoid,
I1
Kc Uln I lou Corrccti~c Action Response
detach from, and, if necessary, negotiate their ways through dangerous and high-risk
circumstances safely.
Goal 4: Three fourths (75%) of
youth comple[ing treatment will return [o public education
setting or maintain employment as indicated in each youth's cJ~art and during Hach follow-uh
assessment.
As part of the comprehensive admission process, the GAIN-based intake assessment
development of Individual Treatment Plan by the CSAC will be developed collaterally
incurporating the results of an Individualized Education Plan (IEP) developed for all youth
admitted into the program as required by the DOE. Individuals involved iu the process of
developing an IEP are the youth's teachers and administrators, other community service
providers, and Ke Ola Hou staff that make up the youth's treatment team. Those youth who
have already been identified by the Department of Education ur Department of Health may come
to treatment with an existing IEP. [t is through the IEP process that potential barriers for each
youth's graduation from the school system with a diploma can be identified and strategies to
overcome those barriers can be formulated. Ke Ola Hou treatment and educational staff will
actively engage in assisting the youth to develop these necessary strategies through individual,
group, and family sessions, and through educational and skill building sessions.
An important component of the experiential approach is to provide training and skill building
for the youth through a variety of hands-on experiences. Through networking with other
community agencies and collaborating on different events and activities, Ke Ola Hou staff
members will not only expose the youth to the diverse local work force, but will also form
relationships with some of them that offer internships, vocational training, and possibly
employment, upon graduation from treatment. Locally, there arc a number of resorts and golf
courses, fruit and vegetable farmers, fast-food chains, locally owned restaurants, and department
and grocery stores all located within a 20-mile radius of the project site that might be a good
represen4ition of the diverse work force.
Goal S.• All youth participating in treatmen! will report significant improvement in their health
and mental health .ctatu.c ac a result of receiving treatment services_
As part of the admission process, all youth are required to undergo a comprehensive health
and mental health assessment by a physician and a psychiatrist, respectively. Ke Ola Hou will
case manage these services that are available through publicly-funded agencies in Hawaii
(including psychotropic medication). These services will be provided for the youth upon
admission to the program (after Stage One), and Ke Ola Hou will ensure that these health and
mental health services (including transportation to services) will remain available and accessible
for the youth for the duration of their stay in treatment. In addition, a limited level of immediate
health and mental health services that are provided on site by trained nurses and/or doctors, and,
of course, licensed counselor on site will address mental health issues in addition to substance
abuse in collaboration with any mental treatment required from outside sources. During
educational individual and group sessions, CSACs will also discuss the importance of
maintaining physical and mental health. Guest speakers maybe brought in to talk on this topic
to the youth and videotapes may also be shown in group sessions.
Goal 6: Statistically sign fcant proportions of
participating youth and
families will report
improved
family functioning with significantly lowered conflicts as a result of receiving
treatment services.
12
Ke Ola I lou Corrective Action Response
Ke Ola Hou acknowledges the importance of the family system in the overall recovery of
the youth served. In Ke Ola Hou, the adolescent and their family will be trained iu the use of
Ho'oponopono. In this model, family members work toward identifying cultural values and
nouns that are honored by the local community culture. Differences between cultural groups is
addressed by working with parental figures, community elders, and extended families to denote
the "tone and direction" of the meetings. The goal is to provide a system of change that values
each family member and focuses on "making it pono" (make i~ right) ~hc ~~~ron~ that had
occurred. Over time, this system becomes a valued family tradition for resolving conflict and
continues even after discharge and aftercare arc complete. Interwoven in this process is psycho-
education about drug use, prevention and ceasing enabling systems that maintain drug
dependency. Asian and Pacific Islander values are honored along with Western approaches to
understanding and ceasing drug use and dependency.
Ke Ola Hou will attempt to involve the family in local cultural activities with a series of
support groups and speakers for treatment and exposure to these groups for aftercare. Drug
abuse is reduced by improving family management practices and conflicts, along with improving
family bonding, which leads to internalization of traditional values of parent and child that lead
to the development of a strong parent-child attachment. This ultimately leads to a youth
associating with non-drug-using peers and healthy extended family members.
4. Describe the design of the process evaluation and explain how it will be conducted.
Who will be responsible for carrying out the process evaluation? Will the evaluation go
beyond the required Government Performance and Results Act (GPRA) measures?
Provide information on the qualitative and quantitative data, what will be collected, the
instruments to be used and any adaptations/modifications to instruments for special
populations and how it will be analyzed.
The evaluation of Ke Ola Ilou gill be performed by The Catalyst Group under the
leadership of Dr. Richard Kim. The evaluation will encompass formative and summative process
evaluation and outcome evaluation. The formative process evaluation will monitor
"implementation fidelity" by measuring and documenting the extent to which the program
implements the planned objectives, on a timely basis, and in compliance with project plans as
well as the extent to which the implementation of those objectives contributes to the achievement
of the planned operational objectives of the project. This continuous monitoring of project stah~s
will also serve to alert administrators and project staff of problems before or as they develop to
enable early immediate remedial actions to ensure the integrity and success of the project.
The summative approach provides quarterly cumulative inventories of the number and cost
of the variety of project services delivered, including the context in which they were delivered,
the clients to whom they were delivered and by which staff. in other words, what r/id the project
actually achieve and how? This central process research question must be answered in order to
determine the extent to which the completion of planned activities resulted in the realization of
overall project goals and objectives. Both approaches will quantify the extent to which
measurable behavioral management objectives were met.
The outcome evaluation will primarily measure and document client outcomes. Outcomes
refer to direct results such as completion of intervention activities (e.g. retention in treatment)
and changes in client characteristics and behaviors (e.g. cessation of substance abuse). The
outcome evaluation will be built around the basic Government Performance and Results Act
13
Kc Ola I loo Conecti~c Action Rcspuusc
(GPRA) evaluation design, using the GPRA Client Outcomes mcasw~e. However, the proposed
evaluation methodology will go beyond the required GPRA measures by including a
compreheusive tool called "Core GAIN" or GAIN-I and GAIN M-90 -the version of the Globa]
Appraisal of Individual Needs tool that is currently adopted by CSAT cross-site evaluations on
Adolescent Residential Treatment (AR'f) projects (see Dennis, et al., 1999; Dennis, ct al., 1995;
Dennis, et al., 1996) to assess changes in client characteristics Gom intake to three, six and 12
mouths post-intuke. Thus, the outcome evaluation will also Curther assess the extent to which the
implementation and operation of the project contributed to ?chieving the planned objectives or
outcomes for clieni.r. Project will also participate fully in any other CSAT moss-site evaluation
activities and other mandated models of datii collection and evaluation. 'The GA W will be
utilized for clinical assessment as well as project evaluation purposes.
Instrumentation. The primary instruments for process evaluation will be the Behavioral
Management Plan and a crosswalk of the plan to the critical details of implementation (described
below under data collection), including all activities specified in the goals and objectives,
contractual obligations, reporting and deliverables required of Ke Ola Hou to successfully
implement the project.
As stated above, outcome instrumentation will consist of (1) the Global Appraisal of
Individual Needs (GAIN) (Dennis, et. al., 1995), which includes the (2) CSAT required
(treatment) items from the SAMSHA GPRA, Client Outcome Measures. The Core GAIN is
based on a wealth of research on assessment of substance abusers. The full GAIN has been used
in numerous NIDA-funded projects as well as other SAMSHA, CSAT and other federally-
sponsored research projects. The Evaluator is a GAIN licensee for other projects and one of The
Catalyst Group staff member is developing a certification as a GAIN trainer from Chestnut
Health Systems, the developer of GAIN. Staff will be trained and utilize the existing ABS
automated data system for that instrumentation.
The CSAT required items on the SAMSHA GPRA are predominantly derived from
McClellan's Addiction Severity Index (ASI; McClellan, et al , 1996). The GPRA is mandated for
most CSAT adolescent projects; and it has been used widely in NIDA, SAMSHA, CSAT and
other federally-sponsored research. GPRA data will be submitted under the required timelines
via the GPRA Website. The major outcome measures from the GAIN will include the following:
The Substance Problems Index (Chronbach's alpha = .82) composed of the DSM-IV-based
substance use and abuse index (alpha=.67) and the substance dependence index (alpha = .79)
will be used in conjunction with the originally ASI items on frequency of substance use among
the LSAT required items on the SAMSHA GPRA to measure substance use and substance
problem severity. The Internal Behavioral index (IBI)(alpha = .90) composed of indices of
depression (.84), suicide risk (.81) and anxiety (.88) will serve as measures of mental health.
Outcomes will also be measured on mental health by the External Behavioral Index (EBI) (alpha
_ .88) composed of indices of ADHD (.82), aggressive behavior (.78) and general criminal
behavior (.69). Arrest data will be provided by intensive supervision and probation (iSP), and
education and employment data will be collected on the GPRA. The evaluation team will
engage provider staff in an exploration of existing culturally-specific measures which might be
most critical to add to the already extensive planned data collection effort.
Process Evaluation. As stated above, the process evaluation will assess the extent to which
project implementation objectives are achieved as planned as well as the problems, opportunities
and barriers associated with implementing the intervention activities. The process evaluation will
be based on the Project Implementation Evaluation Strategies (PIES) model developed at
14
Ke Ula l lou Corrective Action Response
Research Triangle Institute (RTI; see Rachel, Dennis, Woods and Becnel, 1997). The process
evaluation will also document the solutions formulated and "lessons learned" as a result of
coping with those problems and barriers to the completion of the project. The major evaluation
objectives include:
(1) complete start-up activities and first year contracts and hiring (first quarter);
(2) develop a Behavioral Management Plan to support process evaluation (first quarter);
(3) train staff on GPRA and GAIN data collection and entry procedures and implement those
procedwcs (lust quarter);
(4) complete and submit the lust quarterly process evaluation reports (second quarter);
monitor data cullection, processing, verilicatiou and maintenance (on-going);
complete quarterly, annual and final process and outcome evaluation reports, including:
(a) program data specified in the goals and objectives, including rates of treatment
completion, intake assessment (GAIN-I and physical and psychiatric assessment),
treatment planning, educational planning, provision of treatment services, including
culturally appropriate and gender-specific experiential interventions and family
therapy and hooponopono, case management, referrals to educational, health, mental
health and social services, linkages to aftercare, positive peer activities and self-
help/recovery meetings, return to public education, and quarterly follow-up
assessment/evaluations), and
(b) progress on goals and objectives measured by GAIN (including GPRA) outcomes
(substance use, criminal justice involvement, education and employment, physical
and mental health, and family and social functioning); and
(7) submit quarterly and annual administrative reports/reapplications and a final report to
CSAT, specifying the extent to which all project goals and objectives are realized.
The primary process evaluation question, therefore, is to what extent were these objectives
achieved and documented, on time, and what were their intended and unintended consequences?
In answering this question, the specified procedures will determine how closely implementation
activities matched plans, the types of deviations that occurred, the causes of the deviations and
their impacts on the intervention and the evaluation.
Qualitative Evaluation. In contrast to the specific measurement of quantity, frequency, or
even intensity of project processes and outcomes, the qualitative methods attempt to gain more
in-depth understanding of the project and its impact on its participants and the community that
they live in (benzin and Lincoln, 1994). Such level of understanding will be gained through the
use of periodic observation of project activities and conducting semi-structured participant
interviews and focus groups to assess participants' perceptions about the program, their personal
progress, school/vocational-related issues, factors related to substance abuse/dependence, family
functioning, life skills issues, and general life functioning changes. Staff members and youth
family members will also be interviewed to solicit their perspectives.
Qualitative data is particularly important since normative data and research basis for most of
the quantitative measures, including the GPRA and GAIN, for Asian and Pacific Islander
adolescents are still quite inadequate. While this evaluation study is an effort to add to the body
of scientific literature for this population utilizing these measures, the qualitative methods will
need to appropriately complement the proposed quantitative methods. These observations and
interviews will be invaluable in better understanding these adolescents of Hawaii who are faced
with not only substance abuse problems but host of other challenges by learning about how they
perceive, construct, and interact within their social and cultural environment (James, 1977).
IS
Kc Ula I lou Corrective Action IZosponsc
Data Collection. This approach will break down the project into the objectives required W
successfully implement the program. These objectives will include all contractual obligations,
reporting and deliverables required of Ke Ola Hou to successfully implement and operate the
project. Each project objective will be cross-walked to the: (l) acti~m steps required to meet the
objective, (2) person(s) responsible for each action step, (3) deadlines for completion of each
action step, (4) actual completion dates of all program activities, and (5) documentation data
required to verify the completion of each program objective.
Data sources for this study will include administrative program records (c.g. client records,
meeting minutes, group therapy and training attendance roster,), interviews with key program
personnel and participants (e.g. Project Director, case managers, collaborating partners, clients,
parents), other administrative records (e.g. accounting reports) and the standardized pre and post-
test (outcome data) interviews with clients.
Project stahis will be quantified each quarter on the basis of the cross-walks of project
objectives to activities. Process data will also be enhanced by qualitative data designed to reflect
primarily on outcomes. Thus, the quantification of the PIES/MBO model process analysis will be
cloaked in a narrative description of the progress and developments in the implementation of the
project. The reports will attempt not only to provide the numbers required to describe the
program, but also to tell the story of the implementation and operation of the project. Process
evaluation reports will alternately incorporate new (1) vignettes on individual client cases, (2)
ethnographic style open-ended interviews with staff; and (3) reporting of antidotal data.
Data Analysis. Pre and post test scores from the specified instruments in the five functional
domains will be assessed in a (1X4) MANOVA design (Figure [above), including multivariate
and univariate significance testing. Completion status of clients introduces another factor, and
comparison of those completing and not-completing will be achieved in two level (2X2), (2X3)
and (2X4) MANOVAs (Figure II below). Additional comparisons of clients on the basis of
demographic and other characteristic (e.g. criminal justice status) will be made under the same
analytic model.
The relatively large numbers of subjects described above in the process objectives will
ensure well over .80 power in the in the single level analyses described above (see tables in
Dennis, Lennox and Foss, 1997). Certain outcomes (e.g. alcohol and drug use) will
Figure II
Intake 3 Month 6 Month 12 Month
Completers X X X X
Non-Completers X X X X
also be examined as dichotomous (continuance/cessation) as well as continuous (frequency
of use) data. Dichotomous outcomes will be examined using linear regression techniques of
discriminant and log-linear analyses as well as traditional contingency table statistics.
5. Certify that the project will provide the GPRA data to the CSAT web based data
collection system. Identify the person who will enter the data.
Two of the research assistants from the proposed evaluation team, The Catalyst Group,
already have the training and the experience in submitting GPRA data to the CSAT GPRA
Website. Ms. Farrah-Marie Gomes, who is one of these individuals, will be responsible for such
16
Ke Ola I loo Corrective Adiou Response
tasks for this project. She will submit GPRA data for each youth at intake and at each follow-
ups (3, 6, and 12 months) as soon as they are collected but certainly within a week. Dr. Kim, the
lead evaluator, will review the record in the website on a monthly basis to ensure the consistency
between the number-of admitted youths into the prograrn against the data that was submitted.
6. Provide a complete management plan for the project. Provide the names of the
organizations (not the practitioners or clinicians) who are collaborating with your
urganizatim~ for this project. Provide licenses and certifications Tor these organizations.
Provide letters of conunitment fi•om these organizations that include the level of effort.
1 ou must describe all collaborating agencies that n~ill be involved in the project.
Present their individual roles in the project. Describe all activities that they will
perform regarding the project. Provide an organizational chart that shows the
relationships behveen the various agencies.
The project will be tiscally managed by the County otHuwui'i. The Catalyst Group will be
contracted by the County to provide all relevant and/or required evaluation and GPRA reporting.
A Ke Ola Hou Administrative Oversight Committee will be formed including representatives
from: The County of Hawaii, The Catalyst Group, Marimed, Na Kalai Wa'a (Makali'i), and
BISAC. Marimed will provide primary supervision for all program staff via the Project Director.
BISAC will provide the substance abuse treatment model and the Substance Abuse Case
Manager. Makali'i will provide experiential programming and educational services through the
Marine Skills InstructorNoyaging Coordinator. (For further information see Section #1:
Description of Collaborative Agency's Roles, attached Organizational Chart and Job
Descriptions). Letters of Commitment are attached for each participating agency.
Agency Descriptions:
Marimed Foundation has 13 years of experience in pro~~iding various treatment and
education services to "at risk" youth in Hawaii. Its primary efforts for the last nine years have
been concentrated on the Kailana (calm seas) Program, contracted through the Child and
Adolescent Menta] Health Division (CAMHD) of the Hawai' i Department of Health. This
unique and highly successful community-based residential program helps moderately to severely
challenged adolescents in their personal development and family relationships. Kailana
facilitates the youths' successful reintegration into home, school or appropriate community
placements. The Kailana Program serves "at risk" adolescent males, 14-18, from all of all of the
Hawaiian islands. Marimed currently is contracted tp run community-based residential treatment
homes and a therapeutic group home.
Through the years Marimed has increased its training, credentialed staffing, and clinical
capacity to manage some of Hawai'i's most challenging youth in least restrictive settings.
Kailana currently serves youth referred by CAMI ID including a number of youth from the
Hawaii Youth Correctional Facility. The program uses amulti-faceted experiential ]earning and
traditional DOE approved education program for severely emotionally disturbed adolescent
males, including those diagnosed with severe conduct disorder and those dually diagnosed with
chemical dependency. Marimed is fully accredited through Council on Accreditation (COA) as a
provider of adolescent residential services, and as a provider of Therapeutic Wilderness Services.
Additionally, recent private foundation funding and state and federal contracts, have allowed
Marimed to expand its scope of services to include the following:
17
Kc Ola I lou Cou~cctivc Action Rc,punse
I Mua Mau `Ghana (Families Moving Forward), a continuing after care service for
youth and their 'Ghana following intensive residential treatment. This program funded
by a three year SAMHSA grant is a joint partnership with Maui Youth and Family
Services and provides services on all the islands.
The fiolopono Program (To Set on the Right Com•se) - a preventative youth
development program for public school youth.
The Family Life Skills Program - a family enhancement programs for "at risk" youth
and youth in residential treatment.
Hui Hdopona (A Group %7~a1 /3onds) - an experiartiul program fur fostea care youth,
identified as abused.
Ho'o Ma'a (To F,xperieneeJ- an outreach counseling with awilderness/ocean
experiential component program for youth referred by the Judicial System for law
violation and status offenses.
The Holu Program (Resilience) - a pilot project that serves youth in the final phase of
Drug Court through positive outdoor experiential activities, youth development, and
effective community adult mentorship.
96744 (96744 geographic area) is a collaborative community program that provides
preventative experiential activities to promote youth development and leadership for
Kaneohe youth.
Following is a list of pertinent Marimed contracts over the past five years:
• CAMHD Log No. 03-037, November 1, 2002, to provide Community Based Treatment
Services.
• Grant No. 1 H79 TH4261-O1, September 29, 2002, with U.S. Department of Health,
SAMHSA, to provide enhanced adolescent residential treatment and aftercare services in
collaboration with MYFS.
• ASO Log No. YO-064, Modification Order No. 4, July 12, 2002, extension contract with
CAMHD to provide Special Treatment Facility and Intensive In-Home Services.
• ASO Log No. YO-064, Modification Order No. 3, December 4, 200], extension contract
with CAMHD to provide Special Treatment Facility and Intensive In-Home Services.
• EDN Log No. 150-02-24T, July 1, 2001, transition contract with HDOE to provide
Community Based Day Treatment services.
• ASO Log No. YO-064, Modification Order No. 2, July 1, 2001, extension contract with
CAMHD to provide Special Treatment Facility and Intensive In-Home services.
• ASO Log No. YO-064, Modification Order No. i, July 1, 2000, extension contract with
CAMHD to provide Special Treatment Facility, Community Based Day Treatment, and
Intensive In-Home services.
• ASO Log No. YO-064, July 1, 1999, conU~act with CAMI ID to provide Special Treatment
Facility, Community Based Day Trcat~nent, and Intensive In-Home services.
• ASO Log No. 98-] 43, Modification Order No. 2, July 1, 1998, contract with CAMHD to
provide Residential Treatment, Partial Hospitalization, and Intensive Support services.
• ASO Log No. 98-143 and Modification Order No. 1, July 1, 1997, contracts with CAMHD
to provide Residential Treatment, Partial Hospitalization, and Intensive Support services.
• Oahu Provider Group (OPG) Memorandum of Agreements, July 1, 1997 and July 1, 1999,
with Catholic Charities, Parents and Children Together, and Hale Kipa Youth Services, to
18
Inc Ula llou C'orrcctivc Action Response
provide intensive in home services and out patient scrviecs for CAMHD (Catholic Charities,
as Icad OPG agency, contracted with CAMHD).
Marimed owns and operates 8 buildings in the Kaneohe area. Five are licensed as Special
Treatment Facilities'(STF) by the Department of 1{ealth and contain 8 beds each. Marimed's
headquarters consist of three adjacent ocean front properties; an education center with
classrooms and offices, a clinical facility, and a building that contains administrative offices
downstairs and a Therapeutic Group I tome upstairs. Marimed also o~n-ns and operates the Coast
Guard Certified Sailing School Vessel iNakmri Olu (Gracious Wind), a 96 foot three-masted
staysail schooner.
Marimed Foundation's mission is to provide programs that promote the health and well-
being of youth, with an emphasis on Native Hawaiians, Pacific Islanders, ethnic minorities, and
other youth in Hawaii meeting an accepted definition of "at risk," by offering comprehensive
services to youth and families centered around marine-based experiential education.
Big Island Substance Abuse Council has successfully been in operation since May of 1964.
For almost forty (40) years BISAC, through difficult times and economic challenges, has kept
our focus on our mission which is to provide "substance abuse treatment to all those in need."
The extend and degree of substance abuse on the Big Island is reflective of the need to expand
the Big Island Substance Abuse Council's substance abuse treatment services and sites on the
Big Island, from two (2) sites in 1997 to twenty one(21) sites in 2003. Programs include:
• Three (3) free standing outpatient locations: Hilo, Waimea, and Kealakekua
• Eight (8) therapeutic programs in Hilo and North Kohala
• Two (2) Baby S.A.F.E. Programs in East and West Hawaii
• Eight (8) school based programs in High Schools island wide
BISAC's Mission: BISAC strives to enhance the quality of care and innovative services in the
areas of Substance Abuse Education, Intervention, and Treatment. Dedicated to the healing of
mind, body and spirits of individuals, families and others who suffer as a result of alcohol and
other substance use, abuse and addiction. (See also attached BISAC's Description of Services)
Na Kalai Wa'a Moku O lixwai~i (Makali~i) was formed in 1994, on the Big Island of
Hawaii. The purpose of this nonprofit was to construct a double hulled voyaging canoe for the
communities on the island of Hawaii. This would spark an interest in the community where
individuals could reconnect with the Hawaiian culture through open ocean voyaging and the art
of celestial navigation. Other topics of interest that we aim to cover are, the ahupua'a system
how our ancestors lived in harmony in the mountains and near the sea, and most important, to
provide a safe and sound environment where our island children would feel proud and unihibited
to learn the ways of our kupuna (elders). (See attached Na Kalai Wa ~a Description of Services)
In 1995 Makali'i, a double hulled voyaging canoe was completed. Tn 1995 she joined other
Polynesian canoes on a voyage throughout the central pacific ocean. The Makali'i Voyaging
Program was later established to provide voyaging, wayfinding, and seafaring arts to the children
of Hawaii. Environmental activities are a central part of the curriculum. Preserving and
enriching the life of the land and sea are emphasized as primary responsibilities. Each learner is
expected to assume stewardship of the islands and understand how to live in balance with nature.
Schools Served include: Waimea Elementary and Intermediate, Na Huakai (Honoka'a High
School) Program, Na'imiloa (Waiakea High School) Program, Ho'olokahi (Hilo High School)
Program, Pahoa High School, Ho'aIa Napua (Konawaena High School) Program, University of
19
Ke Ola Hou Corrective Action Response
Hawaii Hilo, Kohala High School Academy, Ifawai'i Community College, Hilo Union
Elementary School, Kohala Elementary School, Ha aheo Elementary School, Kamehameha
Schools, Department of Education Kupuna Program, Lanai Elementary School, Queen
Lili'u'okalani Children's Center, YMCA of Hilo, Waimea, and Kona.
Goals of Na Kalai Wa'a:
• To preserve, protect and perpetuate the Hawaiian culture and contribute towards a safe and
healthy future for Hawaii.
• To generate appreciation of the Hawaiian culture through education, culture of values and
personal pride.
• To Provide high quality educational experiences within the Hawaiian culture for persons of
all ages and all levels of proficiency, to preserve traditional values.
• 'fo contribute to preservation of Hawai' is environment through education programs.
• "Ib bring about unity, harmony and aloha.
7. Provide a timeline for the management plan and discuss how it is achievable and
realistic. All staff for the project should be hired within the first 60 days of the project.
The timeline submitted with the application does not adequately describe the ongoing
nature of the project. Provide a narrative description of the timeline.
The project will develop over a period of two and a half years; primary staff of a Project
Director, one Substance Abuse Case Manager, and a Marine Skills InstructorlVoyaging
Coordinator will be present throughout. In the first five months the recipients of the award will
develop and Administrative Oversight Committee, hire primary staff, and begin to provide
outpatient substance abuse therapy and experiential offerings including voyages. By March
2004 Ke Ola Hou will be providing 8 residential beds for boys while continuing therapeutic and
experiential offerings to girls on an outpatient basis. By March of 2005 Ke Ole Hou will offer
1 G residential beds (boys and girls) and continue the above mentioned services to others on a
outpatient and/or continuing care basis.
This timeline is consistent with the partners' experiences in program development in the past.
Marimed currently operates five 8 bed residential facilities on Oahu and is very familiar with
the licensing process and the necessary rigors involved. Marimed, BISAC, and Makali'i have
identified current staff who are interested, qualified, and capable of performing the duties of the
primary positions described, job descriptions arc attached.
20
Ke Oln I lou Corrective Action Kespun~e
Period Action Introduction Date Completion Partners
Date Involved
Stage Release of County October 15, 2003 November 1, 2003 County of Hawai' i
One: RFP
Review and Award November I0, 2003 County of Hawaii
Recipients _
DcSign AOC & November 10, 2003 November 12, 2003 County, Marimed,
Meeting Catalyst, Makali'i,
BISAC
Hiring of initial November 1 Q, 2003 November 30, 2003 Marimed,
staff Makali'i, BISAC
Marketing and November 20, 2003 December I5, 2003 Marimed,
Recei t of referrals Makali i, BISAC
First Treatment December 1, 2003 September 30, 2006 Marimed,
Day Makali i, B[SAC
First Vo a e Februar 2, 2004 Februar 9, 2004 Makali'i
Search For November ] 0, 2003 November 30, 2003 Ke Ola Hou AOC
Residential Site (Marimed)
Stage License Residential November 30, 2003 March 30, 2004 Marimed
Two: Home (8 Beds)
Open Boys March 30, 2004 March 30, 2004 Marimed
Residential Home
Stage Search For 2" March 3Q 2004 November 30, 2004 Ke Ola Hou AOC
Three: Residential Site Marimed
License 2" November 3Q 2004 March 30, 2005 Marimed
Residential Home
(8 Beds
Open Girls March 30, 2005 March 30, 2005 Marimed
Residential Home
8. Provide a staffing plan, including the level of effort and qualifications of the Project
Director and other key personnel, including evidence of the appropriateness of the
proposed staff to the language, age, gender and cultural factors of the target population.
Provide an organizational chart and staffing plan for each agency collaborating on the
project.
SAMHSA fiords will be utilized to support three primary positions in the project: Project
Director, One Substance Abuse Case Manager, and the Marine Skills Instructor/Voyaging
Coordinator. These positions will be filled by November 30, 2003 and provide services through
all three stage of the program's development. Level of effort, qualifications appropriate to the
program model and clientele are included in the attached job descriptions.
Organizational charts are included for each participating agencies as well as the overall
Organizational Chart for Ke Ola Hou.
21
Kc l)la I lou Conccti~c i~ction IZcspunnc
Describe how the results of the project in meeting the goals and objectives will be
provided in a final report.
Based on the analyses of both quantitative and qualitative data, each question for the
evaluation study canbe answered. Any interpretation of data will be done with caution
especially in light of inadequate normative data and research basis of some of the measures for
the target population. Input will be sought from the project staff and other stakeholders,
including participating youths and their family members, in intc~preting the data. These
individuals can often provide invaluable insights about the findings.
The final CSAI process and outcome evaluation report ill include (I) program data
specified in the goals and objectives, including sates of treatment completion, intake assessment
(GA W-1 and physical and psychiatric assessment), treatment planning, educations] planning,
provision of treatment services, including culturally appropriate and gender-specific experiential
interventions and family therapy and hooponopono, case managanent, referrals to educational,
health, mental h~ilth and social services, linkages to aftercare, positive peer activities and self-
help/recovery meetings, return to public education, and quarterly follow-up
assessment/evaluations), and (2) progress on goals and objectives measured by GAIN and GPRA
outcomes (substance use, criminal justice involvement, education and employment, physical and
mental health, and family and social functioning).
10. Regarding the diverse population described ip the application, please address the
cultural cmnpetence regarding the groups listed in addition to Native Hawaiians.
As stated in the original proposal, the project plans to recruit and serve youths and families of
various ethnic backgrounds that is typical of this State's population in general. The experience
of Marimed and other partners, however, is that over 50 percent of the clients served were of
Native lawaiian ancestry. 'fo this regard, the project has decided on the need to focus on this
population. However, it is important to explicitly point out that the Ke Ola Hou project will not
discriminate on the basin of a youth's age, gender, gender identity, race, ethnicity, religion,
and/or sexual orientation. What this means, for example, is that the referral process will be non-
biased and all partnering agencies have non-discrimination and equal opportunity staff hiring
practices as a part of their policies and procedures. All of the partnering agencies have very
diverse staff members that are representative of the client and family ethnic backgrounds.
Efforts will also be made to ensure the linguistic needs of the youths and their family members
are taken care of Tf they have limited capacity to speak English and the project does not have
staff member who do not speak their language, the project will recruit someone in the
community, including possibly hiring a translator, to assist with the treatment process for the
youth. The project will seek cultural consultation, as necessary, from experts in the youth's
community to better serve theyouth and his/her family.
The focus on certain Hawaiian traditions and values does not marginalize non-Hawaiian
participants; rather it recognizes and celebrates the host culture. Part of being consistent with the
Native Hawaiian culture is embracing diverse cultures. In fact, although the project's cultural
practices focus on the Hawaiian culture, there are significant amount of commonality between
this culture and many of the Asian and Pacific [slander cultures, including but not limited to,
focus on family, community, ancestry, rather than on the self or individual; respect and regard
for nature and elders; deep sense of responsibility and concern For others, etc. As part of the
program activities, there will be numerous opportunities to explore, celebrate, and increase sense
of pride for the various cultures that we have on the islands, notjust the Native Hawaiian culture.
22
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PROPOSED BUDGET-YEAR 1
Project Staff:
CSAC Therapist 45,000
CSAC Case Manager 32,000
Marine Skills Instructor 30,000
Half Time Administrative Assistant (1) 15,000
Toia I 122, 000
Fringe Benefits 25% 30,500
Total Project Staff $ 152,500
Travel Costs:
Trips to Washington D.C. (2)
Airfare $900 x 2 x 2 3,600
Per Diem $130 x 2 x 2 x 6 days 3,120
Local Travel
425 Miles x 2 x 12 x .33 3,366
Total Travel Costs $ 10,086
Equipment:
Desk $400 x 2 800
Chair $200 x 2 400
Filing Cabinets $275 x 3 825
Computer /Printer $2000 x 2 4,000
Total Equipment $ 6,025
Supplies:
Office Supplies $200 x 12 2,400
Photo Copy /Printing $150 x 12 1,800
Total Supplies $ 4,200
Contractual:
Evaluation 30,000
Voyaging - 42 days @ $1,250 per day 52,500
Total Contractual $ 82,500
Other:
Telephone $ 2,047
Insurance $ 3.512
Total Other $ 5,559
Total $ 260,870
Overhead 15% $ 39,130
TOTAL $ 300,000
PROPOSED BUDGET-YEAR 3
Project Staff:
CSAC Therapist 47,741
CSAC Case Manager 33,949
Marine Skills Instructor 31,827
Half Time AdministrativeAssistant(1) 15,914
Total 129,430
Fringe Benefits 25%
. . 32, 357
Total Projecl Staff . _ $ 161,787
Travel Costs:
Trips to Washington D.C. (2)
Airfare $900 x 2 x 2 3,600
Per Diem $130 x 2 x 2 x 6 days 3,120
Local Travel
425 Miles x 2 x 12 x .33 3,366
Total Travel Costs $ 10,086
Equipment:
Total Equipment $ -
Supplies:
Office Supplies $100 x 12 1,200
Photo Copy /Printing $100 x 12 1,200
Total Supplies $ 2,400
Contractual:
Evaluation 30,000
Voyaging - 42 days @ $1,250 per day 52,500
Total Contractual $ 82,500
Other:
Telephone $ 2,080
Insurance $ 3.615
Total Other $ 5,694
Total $ 262,467
Overhead 14.3% $ 37,533
TOTAL $ 300,000