project s.t.e.p. Status Report School-based Addictions Intervention September 2011 August 2012

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1 project s.t.e.p. Status Report School-based Addictions Intervention September 2011 August 2012

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3 TABLE OF CONTENTS Executive Summary...1 Introduction and background...2 Overview of School-Based Counselling in Substance abuse counseling in the Ottawa Mainstream Schools and the Says Coalition...4 Substance Abuse Counselling in Non-Mainstream Academic Settings... 4 Results for Increased school-based substance abuse counselling, education and prevention in mainstream schools...6 Increased school-based substance abuse counselling, education and prevention in Section 23 (non-mainstream) schools...7 Increased investment, system stability and planning...8 Increased program evaluation capacity...8 Positive academic outcomes and decreases in substance use... 9 Looking ahead: Objectives for Contacts...14 Appendix A - Partners...15 Appendix B Additional Data Tables...16

4 EXECUTIVE SUMMARY The project s.t.e.p. (support, treatment, education, prevention) initiative is the Ottawa community's response to addressing the need for substance abuse treatment as well as prevention and early intervention for youth in both mainstream and non-mainstream academic settings. It is a community investment involving community partners, local champions and leaders. One of project s.t.e.p. s goals is to have school-based addictions counselling support for every publicly-funded high school and non-mainstream academic setting in Ottawa. Community stakeholders, individual donors and grants have contributed towards this goal. Sustainable investment has allowed project s.t.e.p. to realize the following results for : 1) increased school-based substance abuse counselling in mainstream high schools An increase in the number of counselling hours to 720 hours/week which represents an overall 82% increase in system capacity compared to ,500 students were connected to school-based counselling across all four school boards. This includes over 900 new students. 5,400 students participated in prevention and education sessions 500 parents of youth with addictions issues were offered counselling support 2) increased school-based substance abuse counselling in non-mainstream high schools Over 200 youth served and more than 50 hours per week of addictions counselor time (up from 3 hours per week in 2009) 3) Increased investment, system stability and planning The contributions of the funders have provided stability to the addictions counselling programming such that the school boards have increased their investment by more than $700K per year over and above their matched funding. 4) increased program evaluation capacity United Way Ottawa secured an $18K donation to hire a consulting firm to implement an evaluation framework and a data collection platform for the agencies serving youth from non-mainstream high school settings 5) positive academic and substance use outcomes for youth in school-based counselling Of the students in the sample group admitted for counselling, 89% completed the school year. In all, 71% of unique clients in the sample group were able to reduce or stop using one or more drugs 2

5 INTRODUCTION & BACKGROUND In 2008, partners from the Government of Ontario through the Champlain Local Health Integration Network, the City of Ottawa through Ottawa Public Health, all four local school boards (Conseil des écoles catholiques du Centre-Est, Conseil des écoles publiques de l Est de l Ontario, Ottawa Catholic School Board, Ottawa-Carleton District School Board), community agencies and United Way Ottawa launched project s.t.e.p. This initiative is the Ottawa community's response to addressing the need for support, treatment, education and prevention of substance abuse among youth. According to the 2011 Ontario Student Drug Use and Health Survey 1, 37% of students in grades 7-12 report using an illicit drug in past year, 55% have consumed alcohol (more than a sip) and at least 22% have engaged in binge drinking. One in eight Ontario students (Grades 7 12) may have a drug use problem, but only a small fraction of students have received treatment. Research shows that 90% of adults struggling with addiction began using when they were teenagers. 2 Ontario students, grades 7-12, substance use in past year 1 Illicit Drug Use (tobacco and alcohol not included) 37% Alcohol (more than a sip) 55% Binge drinking (5+ drinks on one occasion) 22%* *occurrence in 4 weeks prior to survey Before project s.t.e.p., young people in Ottawa had to go to hundreds of kilometres away, often to the United States, far from family and friends, to combat serious substance abuse issues. By the end of 2011, project s.t.e.p. had raised $3 million to help build two residential facilities providing specialized treatment and counseling to youth with addictions on a 24-7 basis one for Francophone youth operated by Maison Fraternité and one for Anglophone youth run by the Dave Smith Youth Treatment Centre. With the completion of the capital fundraising campaign, project s.t.e.p. is now focused on its support, treatment, education and prevention program in area high schools (referred to here as mainstream settings) and other youth academic settings (referred to as non-mainstream ) operated by Operation Come Home, the Youville Centre and the Wabano Centre for Aboriginal Health. Although school-based counselling for students was available in some schools prior to the current program, funding was inconsistent and coordination was fragmented. In 2006, the Substance Abuse and Youth in Schools (SAYS) Coalition was formed by the Ottawa Network for Education (ONFE). The SAYS Coalition brought together fifteen organizations, including all four local school boards, youth- 1 Paglia-Boak, A., Adlaf, E.M., & Mann, R.E. (2011). Drug use among Ontario students, : OSDUHS highlights (CAMH Research Document Series 33). Toronto, ON: Centre for Addiction and Mental Health. 2 National Centre on Addiction and Substance Abuse at Columbia University (June 2011). Adolescent Substance Use: America s #1 Public Health Problem 3

6 One of Project s.t.e.p. s goals is to have at least two days per week worth of schoolbased addictions counselling support for every high school and non-mainstream academic setting in Ottawa. focused addiction treatment agencies, enforcement, and allied professionals to enhance communication and find ways to work together more effectively. The Coalition has been working to develop, resource and implement comprehensive drug and alcohol abuse prevention and treatment programs for students at the Grade 7 12 levels in area high schools. A much broader implementation was made possible through new funding announced in At that time, four partners committed to a total of one million dollars annually to support school-based education, prevention and treatment services. The funding partners are the four local school boards (Conseil des écoles catholiques du Centre-Est, Conseil des écoles publiques de l'est de l'ontario, Ottawa Carleton District School Board, and the Ottawa Catholic School Board), Ottawa Public Health, the Champlain LHIN (Local Health Integration Network) and United Way Ottawa s project s.t.e.p. The project s.t.e.p. name now refers to the overall collective effort. The school-based substance abuse program is the result of a multi-sector community partnership brought together to address the issue of substance abuse among students in Ottawa. By bringing prevention, education and treatment services into the school setting, the program makes services universally accessible and convenient for students. The overall objective is to improve health, wellbeing and academic outcomes for students. One of Project s.t.e.p. s goals is to have at least two days per week of school-based addictions counselling support for every high school and nonmainstream academic setting in Ottawa. In the mainstream settings, the program is run as a close partnership between the schools and the two service providers, Rideauwood Addiction and Family Services and Maison Fraternité. This model has overcome many of the barriers typically preventing youth from getting the services they need. Program oversight in the mainstream settings is provided by the SAYS Coalition, facilitated by the Ottawa Network for Education (ONFE). ONFE also provides administrative services for the schoolbased program. In addition to coordinating ongoing overall fundraising efforts and administering the Health Canada Drug Treatment Funding Program grant, United Way Ottawa provides oversight for the programs in the non-mainstream settings. 4

7 OVERVIEW OF SCHOOL-BASED COUNSELLING IN SUBSTANCE ABUSE COUNSELLING IN OTTAWA MAINSTREAM SCHOOLS AND THE SAYS COALITION On behalf of Project s.t.e.p., substance abuse counsellors from Rideauwood Addiction & Family Services and Maison Fraternité provided counselling, education and prevention services to students in 51 high schools and offer support for their parents. These activities are overseen by the Substance Abuse and Youth in School (SAYS) coalition, which consists of 15 organizations (see Appendix A) and is coordinated by the Ottawa Network for Education (ONFE). In the school year, the overall monetary investment for the substance abuse program was $948,825 through Project s.t.e.p. and its partners, which contributed towards the 720 hours per week of counselor time in 51 high schools. To varying degrees, the school boards top up this amount to provide for additional counselling hours and additional investment was made such that the total investment in school-based counselling and prevention was well over $1.6M per year. MAINSTREAM SERVICE DELIVERY PARTNERS Maison Fraternité Maison Fraternité is a not- for-profit community agency that helps members of the francophone population of the province of Ontario who have a substance use problem. It offers residential treatment for men, women and youth as well as counselling and prevention services for individuals and families. Rideauwood Addiction & Family Services Rideauwood serves individuals and families dealing with addictions issues. Including its school-based program, Rideauwood provides a total of 14 programs and services for youth, families and adults. These include addictions-related programming for Ontario Works, Ottawa Drug Treatment Court, problem gambling, concurrent disorders and much more. SUBSTANCE ABUSE COUNSELLING IN NON-MAINSTREAM ACADEMIC SETTINGS In addition to the successful implementation of increased substance abuse services in mainstream academic settings, Project s.t.e.p. also seeks to support the development of addictions counselling for youth in non-mainstream classrooms. These academic settings provide opportunities for young people facing challenges in their lives, to continue their education towards achievement of high school equivalency. Supported by school boards, these classrooms encounter additional barriers in that their student population is comprised of a much greater proportion of young people facing multiple, complex barriers to educational and life success. 5

8 NON-MAINSTREAM SERVICE DELIVERY PARTNERS The three non-traditional partners currently providing services within Project s.t.e.p. are Youville Centre, Operation Come Home (OCH) and Wabano Centre for Aboriginal Health. Operation Come Home OCH prevents homeless youth from becoming homeless adults by providing homeless youth ages 16 to 30 with a variety of unique programs and services, including the Rogers Achievement Center. Wabano Centre for Aboriginal Health Wabano provides community-based, holistic health care, bridging Native cultural practices with Western medicine to combat poverty and illness in Canada s First Peoples. Each year, Wabano provides professional services and cultural events to over 10,000 Aboriginal and non-aboriginal people. Youville Centre Youville helps young single mothers attain a brighter future for themselves and their children through quality, accredited high school education, parenting courses, on-site daycare for infants and toddlers and early childhood learning program that addresses the needs of each child. Staff provide crisis intervention counselling, advocacy and referrals. 6

9 RESULTS FOR From data collected from October 1, 2011 to August 31, 2012, the following results were identified: 1) Increased school-based substance abuse counselling, education and prevention in mainstream schools The number of hours per week of school-based addictions intervention has increased by 82% since , from 396 hrs/wk to 720 hrs/wk. Thanks to our generous donors and funders, we have seen an increase in school-based treatment, education and prevention programming, the number of schools reached and the number of counselling hours provided. In , before the program started, there were hours of school-based counselling per week across the high schools administered by the four school boards. In that figure increased to 609 hours/week, to 715 hours/week by the end of and to 720 hours/week in This represents an overall 82% increase in system capacity. Counselling services were available in 51 of the 56 Ottawa high schools in In all, 1,500 students were connected to school-based counselling across all four school boards during the 2011/12 school year. This includes over 900 new students (others continue with their counselling from the previous school year). In addition, 500 of their parents were also offered counselling support during the year and almost half (45%) of these parents subsequently participated in 7

10 counselling or other agency services to help them to support their children and/or address their own addiction-related mental health issues. Another 5,400 students participated in prevention and education sessions, and the school-based counsellors also delivered training and education sessions to hundreds of teachers and parents through various school and community events. This training helps them identify high-risk students and make referrals to the school based substance abuse counselors. Counsellors also delivered presentations at approximately 30 community-based events In , there was almost no dedicated addictions intervention support in nonmainstream academic settings such as at Operation Come Home s Achievement Centre. There are now over 50 hours per week of such support plus wraparound services tied to organizations serving teen mothers, Aboriginal youth and homeless youth. (mainly for parents). Since the beginning of the program in , addictions counselors have provided training to over 3,000 school personnel, youth service providers, students and parents. 2) Increased school-based substance abuse counselling, education and prevention in Section 23 schools and Achievement Centres (non-mainstream schools) Project s.t.e.p. has expanded to provide services in three non-mainstream school programs serving the following vulnerable populations: 1) young mothers and expecting young women, facilitated by Youville Centre 2) homeless youth, facilitated by Operation Come Home 3) Aboriginal youth, facilitated by Odawa Native Friendship Centre and Wabano Centre for Aboriginal Health (Wabano) All three sites provide high-school education in non-traditional settings. Delivery of addictions counselling and support began in the October to December 2011 timeframe. Before this new investment, there was no addictions intervention counselling available to these high-risk youth. United Way / Project s.t.e.p. has now committed over $160K for these programs in 2012 and $201K in Preliminary data shows that these programs are already making a significant impact for some of the most vulnerable youth in our city. Operation Come Home was able to substantially increase the number of counselling hours provided to youth from 3 hours/week to 20 hours/week. During the period of October 2011 through August 2012, over 250 hours of counselling were provided and 112 youth participated in harm reduction programming. A total of 29 youth received counselling support. Wabano Centre for Aboriginal Health has developed its comprehensive program, called Working Hope, to approach mental health and addictions issues from a holistic Aboriginal perspective. Since the program s inception less than a year ago, the Working Hope program has provided services to over 200 children and youth and 8 families including case management, individual and group 8

11 counselling as well as cultural reclamation services. In addition, 42 youth participated in the March Break Cultural Camp which focused on reintegration and diversion. On average, 17 youth have received weekly counselling services at the Odawa Alternative school since December Wabano has also provided substance abuse intervention services to youth at Rideau High School, Youth Services Bureau (YSB) and Ottawa Technical Secondary School. Wabano actively continues to engage with partners in the community to expand their reach of service to support urban Aboriginal youth. Youville Centre saw the number of substance abuse counselling hours that could be provided to students double from 10 hours/week to 20 hours/week. Three years ago, there were no dedicated addictions counselling hours. During the period from October 2011 June 2012, Youville served 31 students (including 19 new students and 6 alumni) on a weekly basis. 3) Increased investment, system stability and planning The Substance Abuse and Youth in School (SAYS) coalition provides a structure through which the four Ottawa area school boards, counselling agencies and funders can collaborate on a shared strategy to provide a consistent service delivery model across the system. It is important that this program maintain a constant and reliable source of funding. All four partners Champlain Local Health Integration Network, Ottawa Public Health, United Way Ottawa and the four school boards - have each committed to providing at least $250,000 annually to fund Project s.t.e.p. programming and counselling services. The contribution of the matching granters has continued to provide stability to the offering of schoolbased addictions counselling in Ottawa. This stability has provided the impetus for the school boards to increase their investment incrementally to close the gaps in many of the schools where counselling had not been provided at a full two days per week. This amounts to well over $700K in increased investment by the school boards. It has also allowed the school boards and agencies to carry out better planning they can recruit and retain staff in the knowledge that there will be program continuity and sustainability. 4) Increased program evaluation capacity Rideauwood Addiction & Family Services, along with coordinating help from the Ottawa Network for Education (ONFE, formerly a branch of Ottawa Centre for Research and Innovation-OCRI), has developed a comprehensive evaluation framework for the traditional school-based treatment, prevention and education programming. The framework includes measurement of outcomes and indicators highlighting changes on the part of youth in difficulties in daily living factors, substance use, school performance and motivation to participate in treatment and counselling. Measures relating to parenting skills and family functioning are also included in the evaluation framework. Of further note, the design of a culturally appropriate evaluation framework for the Aboriginal programming for addictions prevention and intervention for youth in non-traditional academic settings was completed. 9

12 The launch of programs in the non-traditional academic settings has also highlighted the need for a comprehensive evaluation framework to measure the outcomes and indicators of these programs as collective. While each program will report on results individually, it is also important to be able to report on the collective impact. To this end, United Way Ottawa was able to secure an $18K donation from a philanthropist to cover the services of an evaluation consulting firm. The firm s work will include carrying out an analysis of the evaluation needs of the individual agencies, the design of an evaluation framework, the trial and implementation of data gathering tools, online input and analysis as well as the production of an evaluation report after one year s time. 5) Positive academic outcomes and decreases in substance use MAINSTREAM SETTINGS Data was collected from a sample of the students receiving counselling to measure outcomes in the following areas: reduction or cessation of drug and alcohol use, academic achievement and health and well-being. Alcohol and drug use The Drug Taking History Questionnaire (DTHQ) was used to compare students use of alcohol and drugs upon admission and again in a 30-day period near the end of the school year. Each substance is examined separately, although clients may have used multiple substances over the same period. Although the ultimate goal is abstinence from all substances, this may not be possible in one step. For over 55% of students in the sample group had noticeably decreased or stopped their use of cannabis with decreases in both frequency and quantity. clients who use multiple substances, counsellors focus most urgently on the drugs that do the most harm. The most commonly used substances were cannabis and alcohol, followed by hallucinogens, ecstasy and cocaine. Baseline data is available for 193 students (based on combined data from both 2010/11 and 2011/12), and all of these substances were reported among this group. Over 80% used both cannabis and alcohol, and of those who used cannabis, almost half did so daily. Upon readministration of the DTHQ near the end of the school year, over 55% of students in the sample group had noticeably decreased or stopped their use of cannabis with decreases in both frequency and quantity. Another 40% had reduced or stopped using alcohol. For clients who used hallucinogens, 80% had become abstinent, with an additional 13% who decreased use. There were also dramatic drops in the use of cocaine and ecstasy, with over 70% of previous users achieving abstinence from these drugs. 10

13 Substance use by counselling participants at year end, compared to baseline, , mainstream settings. Substance use in four weeks prior to assessment Cannabis n=152 Alcohol n=127 Cocaine n=14 Hallucinogen n=15 Ecstasy n=15 Abstinent 18% 19% 71% 80% 73% Decreased Use* 38% 21% 14% 13% 13% No Change 30% 35% 14% 0 7% Increased Use* 14% 24% 0 7% 7% * Change greater than 5 grams or 5 drinks per month as measured by Drug Taking History Questionnaire. Student academic outcomes For students referred to the school-based counselling program, staying engaged in learning is very difficult since they typically face multiple risk factors for early school leaving yet the school environment can be a critical source of support. One of the key goals of the school-based program is to keep students in school even if it means decreasing course load while they take time to focus on their health and wellbeing. Of the students participating in school-based counselling, very few withdraw from school during the year. Of the students in the sample group admitted for counselling, 89% completed the school year. Although some students did unfortunately leave school, this is not necessarily a permanent status. There are supports in place within the school system to help students Of the students in the sample group admitted for counselling, 89% completed the school year. Furthermore, the 179 students for whom academic data was available before and after engagement in counselling continued to earn credits at the same rate they did during the term immediately prior to the start of counselling. transition back to school, and in some cases students have reconnected with their addiction counselor during this transition. Students may begin participating in school-based counselling at any point during the school year, so students in the sample group had varying lengths of time in counselling prior to the end of the school year. In some cases, the evaluation period was too short to allow noticeable improvements in academic results to be observed. The 179 students for whom academic data was available before and after engagement in counselling continued to earn credits at the same rate they did during the term immediately prior to the start of counselling. In addition, there was no notable difference in average 11

14 grades. This is considered to be a positive result as no further deterioration in academic achievement was observed. It should also be noted that the students in the school-based counselling program benefit from a number of additional support programs within their schools. Although we have no clear way of attributing student success to one program or another, the addiction counsellors work in close partnership with school and school board staff to leverage all the services available to a student so that the maximum positive benefit is achieved. Student mental health and well-being Two clinical tools (BASIS 32 and Modified GAIN SS) were used to assess student mental health and wellbeing during the evaluation period. These were administered to students upon admission to counselling, and then again near the end of the school year. Outcomes were mixed in these areas and may be affected by where students are in their process of dealing with their substance abuse. In other words, youth who are in denial with respect to their addictions issues may be less likely to self-identify as having little to no problems on the elements (e.g. relation to self/others, daily living/functioning) measured by the assessment tools. As clients become engaged with the counselling process, a first step is for them to be able to acknowledge their issues. After this point, it is expected that they will become more realistic in assessing their situation and may recognize that they are having difficulties thus lower scores at subsequent testing. One pattern, however, does seem to emerge: students with poorer initial scores experienced a much higher degree of improvement than the average. NON-MAINSTREAM SETTINGS Operation Come Home At Operation Come Home, 23 youth succeeded in addressing their substance use (stopped use, reduced use, or used more safely). Ten (10) youth were able to improve their housing situation. Twenty (20) youth were referred to addiction serving agencies and six youth entered treatment. One client is in residential treatment and two others have completed residential or 2nd stage treatment and returned to OCH. As well, one student participating in addictions programming has completed the GED. Ten youth were connected to ongoing outreach services; this includes: methadone appointments, medical appointments & emergency medical care, hospital and treatment centre visits, wrap around/connecting with client s case managers, doctors, nurse practitioners, social workers, housing workers, mental health workers, other addiction serving agencies. The addictions counselor has increased OCH s capacity as a whole to support its youth in dealing with addiction by training eighteen staff and volunteers in harm reduction. 12

15 Wabano Centre for Aboriginal Health As programming at Wabano came online only in the past year (has been running at OCH & Youville for almost three), collection of outcome data is still in development. Early indicators are very encouraging and suggest that this program will achieve notable results in its ability to impact high-risk Aboriginal youth in a holistic and culturally sensitive way. Youville Centre During this period, two students were referred and admitted to the Ottawa Withdrawal Management Center and one to a residential treatment facility. At least 50% of participants improved their school attendance records and eight students achieved their Ontario Secondary School Diploma this year. Of the alumni, two students are currently pursuing post-graduate studies. At Youville, 50% of participants improved their school attendance records and 8 students accessing the addictions counselor obtained their Ontario Secondary School Diploma this year. Of the alumni, two students are currently pursuing post-graduate studies. Over the first three months of the year, out of 26 young women seeing the addictions counselor, four have been referred to SMART recovery, two to community addictions treatments and two to residential treatment. The shared evaluation work currently being undertaken by Operation Come Home, Wabano, Youville and new partner Eastern Ottawa Youth Justice Agency, with the support of consulting firm Measured Outcome, will enable far more robust outcomes data. The test phase is currently underway and full implementation is slated to commence as of January

16 LOOKING AHEAD: OBJECTIVES FOR The school year is well underway and the following objectives are already in sight or are being targeted: The extension of counselling to all 56 mainstream high schools (in fact this has now been achieved). The implementation of an evaluation framework and data collection platform for nonmainstream school settings (already in test phase as of November 2012) The expansion to a fourth non-mainstream high school setting the John Bosco Achievement Centre at the Eastern Ottawa Youth Justice Agency Continued consolidation / sustainability of the funding model with input from all of the partners: service delivery providers, school boards, affiliated organizations and funders/donors. 14

17 CONTACTS For more information on the contents of this report, please contact: Matt Beutel, Director, Community Initiatives, United Way / Centraide Ottawa For information related to fundraising for or donating to Project s.t.e.p., please contact: Vanessa Herman, Manager, Targeted Community Investment, United Way / Centraide Ottawa

18 APPENDIX A PARTNERS Funding partners Champlain Local Health Integration Network Conseil des écoles catholiques du centre-est Conseil des écoles publiques de l est de l Ontario Cowan Foundation Ottawa-Carleton District School Board Ottawa Catholic School Board Ottawa Public Health Ottawa Senators Foundation United Way Ottawa Service delivery partners Maison Fraternité Operation Come Home Ottawa Network for Education Rideauwood Addiction and Family Services Wabano Centre for Aboriginal Health Youville Centre Substance Abuse and Youth in Schools (SAYS) Coalition Centre for Addictions & Mental Health Champlain Local Health Integration Network Conseil des écoles catholiques du centre-est Conseil des écoles publiques de l est de l Ontario Crime Prevention Ottawa Maison Fraternité Ottawa-Carleton District School Board Ottawa Catholic School Board Ottawa Network for Education Ottawa Police Services Ottawa Public Health Rideauwood Addiction and Family Services RCMP United Way / Centraide Ottawa 16

19 APPENDIX B ADDITIONAL DATA TABLES TABLE I, Age distribution of students at admission (%), , mainstream settings or less or over TABLE II, Profile of students identified for ongoing follow-up and counseling, , mainstream settings Gain SS* at Baseline Scores (n=150) % Flagged for Follow-up Internalizing Disorder Screener 61% Externalizing Disorder Screener 76% Substance Disorder Screener 68% Crime/Violence Screener 33% Eating Disorder Screener 31% Post Traumatic Stress Disorder Screener 49% Psychosis Screener 41% Problem Gaming and Internet Usage 22% Gambling Screener 2% *The GAIN Short Screener is a screening tool used to identify psychological, behavioural and personal issues 17

20 TABLE III, Changes in student mental health and wellbeing at year end as compared to baseline, , mainstream settings (n = 144, changes +/- 0.25) Changes in BASIS 32* results Deteriorated Unchanged Improved Relation to Self/Others 33% 24% 42% Daily Living/Role Functioning 31% 23% 46% Depression/Anxiety 29% 30% 41% Impulsive/Addictive 26% 34% 40% Psychosis 20% 51% 28% *The BASIS 32 questionnaire addresses five parameters: relation to self/others, daily living/functioning, depression/ anxiety, impulsiveness and psychosis. This tool was used at the could be used to assess the degree of change in student wellbeing. TABLE IV, Changes in mental health and wellbeing among participants displaying moderate to extreme severity, , mainstream settings (n = 22) BASIS 32* comparison for clients with overall baseline scores of moderate to extreme severity Baseline Reassessment Change Relation to Self/Others Daily Living/Role Functioning Depression/Anxiety Impulsive/Addictive Psychosis Average *The BASIS 32 questionnaire addresses five parameters: relation to self/others, daily living/functioning, depression/ anxiety, impulsiveness and psychosis. This tool was used to assess the degree of change in student wellbeing. 18

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