Adolescents with drug abuse disorders typically are involved in multiple systems of care, including drug abuse and mental health treatment, juvenile justice, and child welfare. Despite extensive efforts to integrate these systems of care, however, little work has focused on improving quality of care specifically around transitions between these systems. My long-range goal is to conduct clinical research to increase quality of care for adolescents and their families in drug abuse treatment. This career development plan proposes three related educational goals: (a) increase data analysis and clinical intervention skills;(b) increase knowledge of drug treatment and process improvement;and (c) increase knowledge of community-based services for adolescents with drug problems. I also propose clinical research activities to (a) identify service use patterns, treatment experiences, and quality-of-care related needs of adolescents, families, and service providers in drug treatment systems and (b) develop and pilot an intervention to increase quality of care around transition issues for adolescents in drug treatment. I hypothesize that different adolescent attributes such as gender and co-occurring mental health problems will be associated with service utilization patterns. I also hypothesize that despite challenges in integrating systems of care;process improvement techniques can improve quality of care for adolescents and their families during these transitions. The clinical research plan includes 3 studies: (1) a retrospective cohort study identifying service utilization patterns of adolescents in state-funded health systems including drug abuse and mental health treatment, juvenile justice, and child welfare;(2) a qualitative needs assessment of adolescents in drug abuse treatment, their families, and service providers at drug treatment agencies to determine their beliefs, needs, treatment barriers and preferences regarding transitions in care;and (3) development and pilot-test of a process improvement intervention to improve quality of care to assess its acceptability and feasibility. This work's significance lies in its potential to contribute to improved drug abuse treatment services for adolescents. Its interdisciplinary application of process improvement techniques to an understudied and challenging population will provide the necessary training, experience, and preliminary data for an R01 proposal to conduct a clinical trial testing the process improvement model to improve service transitions for adolescents in drug abuse treatment.
