A: First, you have to be committed to the project and to the kids. It takes a huge amount of effort to keep them in a study, particularly if they are substance-abusers. But if you are committed, from day one, it works. As part of our project that examined the psychometric properties of the Comprehensive Adolescent Severity Inventory (CASI -- an instrument that assesses an adolescent’s health status, educational status, stressful life events, substance use, use of free time, peer relationships, sexual behavior, family/household member relationships, legal status, and mental health functioning) among over 200 substance-abusing youth in a residential treatment program, we collected a variety of information on the ways in which we tracked the youth for follow-up evaluations. Because follow-up was so labor intensive, we wanted to inform others about what constituted successful tracking procedures for this population of kids. What is important for people to know is that tracking begins before you even start recruiting and continues until you close the case.

Before the study:
First, the research team acquired street maps, internet directories and community directories. We met with the staff at the residential treatment program to introduce them to the study. We asked for their help with follow-up, and identified someone at the site to be the contact person. We also reviewed consent forms to make sure that they were sufficient to obtain release of information. We then developed a tracking form to make sure we collected every conceivable piece of information that might be needed to find someone.

During recruitment:
Youth were recruited while they were in the residential program. For each participant, we conducted a locator interview that included typical contact information (address, phone), information common among adolescents today (e.g., cell phone numbers, beeper numbers, instant messages screen names, e-mail addresses, etc.), as well as names of teachers or coaches, local and out-of-town relatives, friends especially girlfriends or boyfriends and neighbors, sports team schedules, place of employment, and hangouts, including street corners and arcades.

After residential treatment:
A succession of four tracking procedures was used after the youth left the treatment program.
1) Phone tracking: We first made phone calls to the youth’s house, leaving a message if necessary. If caller ID was suspected to be a problem (by alerting the household to the identity of the caller) then we called from pay phones.

2) Tracking through other contacts: Using the locator form and information obtained from the locator interview, we contacted relatives, friends, and neighbors by phone or email, and used directory assistance.

3) Institutional tracking: We contacted social services agencies involved with the teen, and if necessary, arranged interviews to coincide with a teen’s previous appointment with the agency (e.g., probation appointments, court dates).

4) Field tracking: If all else failed, we used the information from the tracking forms to go to the teen’s hangout.

A: Set up your timeline before you begin the study. When will you begin the tracking process? How long will you wait between contacts? We actually began before the youth left the treatment program. We set up the first interview with them while they were still in residence. It’s also a good idea to keep a log book. You can record all your attempts to make contact, take notice of which procedures worked for each participant, what times of the day you may not have called.

Send birthday and holiday cards. First, sometimes it is the only card the youth receives. Second, it shows that you are interested in them at times other then when you need their information. And third, if the card is returned, you know that you need to start to find them immediately, even if their follow-up window hasn’t opened.

Incentives are another essential part of retention, especially for youth. We gave them $20 cash for each interview, reimbursed for travel, and, because many interviews were conducted in fast food places, we bought them meals. But it is becoming more difficult to give cash incentives. In a current study, we are giving gift certificates individualized to the youth. That means, we ask where they want the gift certificate from and then purchase it. It takes more work , but having them pick from a handful of gift certificates that we had on hand was not working. There were times we did not have anything the youth wanted. That made the next follow-up interview more difficult to complete. With this new approach, the kids are sure when they are finished, there is something they want waiting for them.

A: 92% of the youth stayed in the study, and we wanted to find out how much it cost us to achieve such a good retention rate. First, we looked at how many contacts were required for each participant. Most (61%) required 1-5 contacts for each interview; 23% required 6-10 contacts; and 16% were designated as difficult-to-retain, taking more than 10 contacts. Youth in our study were difficult to track for many reasons, including having unstable households, changing or dropping out of school, moving out of the area, and engaging in criminal behavior and drug/alcohol use. We then calculated costs to the team, including staff time, postage for reminders and thank yous, phone costs, travel costs, meals purchased at interviews, and incentives.

We found that it cost approximately $85 per youth per contact point (interview). Thus, a study with 200 participants would need to include in its budget $17,000 for each contact point. This was about 18% of our project’s yearly budget, and in my opinion, very much worth it to achieve the 92% retention rate.

Retaining substance-abusing youth in a research projects takes, time, money, and a lot of effort. You need think creatively; if you just rely on school or home contact information, you’ll lose many of these kids. Know where they hang out, what they like, and who their friends are. Be persistent; don’t give up after a few tries, and work as a team to track the difficult-to-retain youth. In the end, it’s worth it, and you will have a better data set, and a better study.