Who Pays for Teen Drug Treatment?

They thought it was an idea whose time had come. Faced with rising drug abuse among adolescents, the school districts in Independence, Mo., and Little Rock, Ark., decided the solution was to offer all parents health insurance for drug abuse treatment.

The cost to parents would be nominal, and private donations would help jump-start the program.

The idea fizzled in both cities.

The failures highlight a central problem in tackling rising adolescent drug use: how to pay for and manage adolescent drug treatment. Presidential candidates may squabble over methods to help young people, but in the meantime, it falls to many communities and school districts to determine on their own how to make prevention work, or when that fails, to fund adolescent treatment. And as Independence and Little Rock discovered, it's often difficult to stay ahead of the problem.

"In Little Rock, the problem exceeded the funds," says Debbi Rushing, program coordinator for Insure the Children at Arkansas Children's Hospital.

In Independence, it was the same story. Not enough parents and community groups participated to match the size of the problem. "It became too costly for the district to take on when the support wasn't there," says Patty Schumacher, director of students for Independence City Schools.

Few and far between

Adult treatment facilities, public and private, are fairly plentiful throughout the United States. But adolescent facilities are mostly too few, private, full, and expensive.

Even though last year more than $12 billion in federal funds was distributed to states for their drug- abuse treatment and prevention programs, there is no fund allocation breakdown according to age. A little more than $3 million was earmarked specifically for state demonstration projects in adolescent drug treatment.

After the insurance program failed, Little Rock, and the school district, decided to turn to a unique funding source for drug treatment avoiding any federal involvement.

"Little Rock passed a half-cent sales tax, recommended by a citizen task force, to fund some 21 community programs," says Rick Colclasure, acting director of community programs.

"The first thing they wanted was more police," he says, "but over $500,000 now goes to adolescent drug and alcohol treatment." Another $50,000 was allocated for an evaluation of the program by an independent agency.

The city now contracts with Arkansas Children's Hospital for services. After nearly a year of operation 132 youths have participated, out of 180 initial referrals.

"What we learned from the insurance program was that kids did need intensive treatment," says Ms. Rushing. "The problems out there are severe, and we are busting at the seams. Parents' denial - it's not my kid - is our No. 1 problem."

There are state agencies that do have beds for adolescent treatment in Little Rock. "But the waiting list is a mile long, and if you are using drugs or alcohol, and you need treatment, you can't wait," Rushing says.

The hospital's approach to treatment is a combination of the 12-step model based on the Alcoholics Anonymous program, group therapy, and adventure-based counseling featuring active group games and puzzles.

Teen support

"What we don't have yet here," says Rushing," is a kind of strong, young people's community of recovering kids. The social aspect is so important in recovery. We have kids who come here after school just to hang out and wait for group to start. They do their homework or watch TV. We are looking for space to have a clubhouse."

In Independence, the school district decided to bring abuse counseling and the students closer together rather than send youths out of the school environment when problems first arise.

"Rather than have the district foot the bill for a treatment program," says Pam Diecidue, Substance Abuse Counselor for the Independence Public School District, "we provide free counseling for kids and families. I see the kids right here, and the parents don't have to take them somewhere else. It's more effective this way."

The program is funded by the federal Drug Free Schools program. The school district has 11,000 children, and Ms. Diecidue is available in the afternoons to schoolteachers and counselors, and works with a network of community resources.

The objective is to respond quickly when kids and families have problems in order to prevent more serious problems later. "I'm from the school of substance-abuse counseling that believes you have to have kids practically beg you to put them in a treatment center before it really works," says Diecidue.

Looking the other way

What alarms her and other substance-abuse experts is the ease with which many parents today look the other way at the presence of drugs and alcohol in their children's lives.

"Kids have parties on the weekends," she says, "and the parents are upstairs not having much to say about the drunken party downstairs or the marijuana-smoke-filled rec room."

Diecidue counsels between 10 and 15 children a week and has referred as many as 100 students during a school year to other resources. "There is a big problem out there," she says, "and the kids I see tend to be the marijuana and alcohol crowd."

Patty Schumacher, director of students for the Independence school district, says, "There are parents who skip [Diecidue's] level of help and go right to more serious hospitalization or private counselors. This is not just a school problem, but a community problem."

If a student comes to school tipsy or on drugs, the parents are contacted. The child would be suspended in most cases, and placed in an out-of-school classroom where Diecidue works with the parents and student to make a commitment to return the student to regular classes.

"So many students don't have people to go home to," Mrs. Schumacher says, "maybe because both parents are working. Or they haven't had much success in school and they turn to something like drugs.

"It is a multifaceted problem, and I think Pam is probably dealing with the more crisis situations, the tip of the iceberg."