Strengths-oriented referrals for teens (SORT): giving balanced feedback to teens and families.

Despite the great advances in the development of assessment procedures for adolescent substance abuse (Dennis, 1998; Rahdert, 1991; Winters, 1992), very little literature exists that informs clinicians about how to best deliver clinical feedback from substance abuse evaluations to teens and families. We address this gap in the literature by describing a strengths-based protocol called Strengths-Oriented Referral for Teens (SORT). Following is a look at the theoretical basis for SORT, a description of the intervention, and a discussion of quality assurance procedures used in training therapists. SORT was developed through a project funded by the Substance Abuse and Mental Health Services Administration, which sought to expand and enhance adolescent substance abuse treatment. It is a clinical feedback session that occurs after an initial substance abuse evaluation at our comprehensive assessment center. Modeled after Dembo's Juvenile Assessment Center concept (Dembo & Brown, 1994), this one-stop assessment program is structured specifically to help teens navigate the fragmented service delivery system, reduce duplication in assessment across the system of care, and provide targeted referrals. MOTIVATIONAL INTERVIEWING A major component of SORT is motivational interviewing (MI), which combines elements of client-centered therapy with behavioral principles (Miller & Rollnick, 2002). The major concepts underpinning this approach include empathic listening, rolling with resistance, providing feedback, and offering a menu of options. This model can be contrasted with the Minnesota Model of substance abuse (Winters, Stinchfield, Opland, Weller, & Latimer, 2000), which emphasizes clients' acceptance of their substance abuse as a disease. In the Minnesota Model, which was heavily influenced by 12-step philosophy, abstinence from chemicals was the only viable goal. One of the major strategies in treatment was confronting clients' denial related to their substance use. In MI the emphasis is on getting the client to elicit self-change statements through careful questioning and active listening. Thus, mutually developed and appropriate treatment goals emerge and facilitate behavior change. MI has only recently been applied to adolescent populations. Some adaptations exist, including a five- and 12-session intervention (that is, the Motivational Enhancement Therapy/Cognitive Behavioral Therapy [MET/CBT5, MET/CBT12]) developed in the Cannabis Youth Treatment study (Dennis, Titus, Diamond, et al., 2002; Diamond et al., 2002). These two MI-based interventions are cost-effective and were found to reduce substance use and abuse or dependency problems in a large randomized trial (Dennis et al., 2004). Our application of MI elements in SORT is designed to increase an adolescent's motivation to use services (particularly drug treatment) beyond the initial assessment. SOLUTION-FOCUSED THERAPY In solution-focused therapy (Berg & Miller, 1992; deShazer, 1988), therapists use carefully constructed questions that presuppose action and active problem solving. It is inherently present focused and action oriented. Techniques in solution-focused therapy include asking scaling questions, exception-finding questions, and other questions designed to elicit the clients' goals. A scaling question used in our intervention is, "On a scale of one to 10 where one is 'not willing at all' and 10 is 'completely ready,' how ready are you to follow through with this referral?" This question can be followed up with a question to gauge what would make the client more willing to use a service. For example, if a client responds that he or she is a three on this scale, a therapist might ask, "What would have to be different for you to move up to a four or a five?" In this way, barriers to going to treatment are explored in greater depth. Exception-finding questions are designed to elicit the client's strengths by asking what they have done to prevent their problems from becoming worse. …