title: The Washington circle engagement performance measures' association with adolescent treatment outcomes.
abstract: BACKGROUND
  For adolescents, substance use disorder (SUD) treatment outcomes (e.g., abstinence, problematic behaviors) often cannot be measured soon enough to influence treatment trajectory. Although process measures (e.g., treatment engagement) can play an important role, it is essential to demonstrate their association with outcomes. This study explored the extent to which engagement in outpatient treatment was associated with outcomes and whether demographic/clinical characteristics moderated these relationships.
  
  
  METHODS
  This is a prospective study of adolescents (N=1491) who received outpatient treatment for SUDs at one of 28 treatment sites taking part in a national evidence-based practice implementation initiative. Information from the Global Appraisal of Individual Needs interviews at intake and six-month follow-up, as well as encounter data, were used. Adjusted hierarchical logistic models were used to estimate effects of engagement on six-month outcomes.
  
  
  RESULTS
  Sixty-one percent of adolescents engaged in outpatient treatment. Adolescents engaging in treatment had significantly lower likelihoods of reporting any substance use (OR 0.60, 95% CI 0.41, 0.87), alcohol use (OR 0.63, 95% CI 0.45, 0.87), heavy alcohol use (OR 0.53, 95% CI 0.33, 0.86), and marijuana use (OR 0.64, 95% CI 0.45, 0.93). This association of engagement with abstinence outcomes was not limited to any particular group. Treatment engagement, however, was not associated with adolescents' self-report of illegal activity or trouble controlling behavior at follow-up.
  
  
  CONCLUSIONS
  At the individual level, the Washington Circle engagement measure was a predictor of some positive outcomes for adolescents in outpatient treatment. Efforts to better engage adolescents in treatment could improve quality of care.
authors.affiliation: Institute for Behavioral Health, Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110, USA. garnick@brandeis.edu
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Garnick
authors.forename: Margaret T
authors.initials: MT
authors.lastname: Lee
authors.forename: Peggy L
authors.initials: PL
authors.lastname: O'Brien
authors.forename: Lee
authors.initials: L
authors.lastname: Panas
authors.forename: Grant A
authors.initials: GA
authors.lastname: Ritter
authors.forename: Andrea
authors.initials: A
authors.lastname: Acevedo
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Garner
authors.forename: Rodney R
authors.initials: RR
authors.lastname: Funk
authors.forename: Mark D
authors.initials: MD
authors.lastname: Godley
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010045:Outpatients; D011446:Prospective Studies; D012309:Risk-Taking; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome