Substance Abuse Day Treatment Program. Jennifer Moore CYC Paul Pereira CYC

Transcription

1 Substance Abuse Day Treatment Program Jennifer Moore CYC Paul Pereira CYC

2 Objectives To describe the Substance Abuse Day Treatment Program To describe the characteristics of youth who attend the program To review the specific role of the Child and Youth Counsellor working in the Substance Abuse Day Treatment Program

3 Ontario Drug Use Survey 2003 Past Year Drug Use (Q: Have you used this substance at least once in the past year? ) Note: Groups not included in this data include: street youth, youth on aboriginal reserves, youth residing in correctional facilities--all these groups have higher rates of use Alcohol 66.2% Cannabis 29.6% Tobacco 19.2% Hallucinogens 10% Stimulants 5.8% Solvents 6.1% Ketamine 2.2% LSD 2.9% Methamphetamine 3.3% Ecstasy 4.1% Cocaine 4.8% Heroin 1.4% GHB 0.7%

4 History of Day Treatment Program at Sick Kids Outpatient program established 1988 as part of Teen Clinic services Identification of patients who required more intensive treatment than could be provided in once weekly counselling Development of plan for Day Treatment model Funding through HSC Foundation identified Day Treatment program opened for business September 1995

5 Program Data Approximately 200 adolescent admitted to program over past 10 years Recent study revealed that 57% complete at least 8 weeks of the program

6 Demographics Male 57% Any involvement with CAS 38% Any legal involvement 68% Psychiatric diagnosis prior to program entry 41% (depression, anxiety, ADHD most common) Any use of tobacco 93% Any use of alcohol 93% Any use of cannabis 100%

7 Program Description The philosophy of the program is harm reduction. This means that adolescents enrolled in the program will be working toward the goal of eliminating and/or reducing their substance use. The program runs Mon-Fri 9:00-3:00pm with a maximum of 8-10 clients. Offers ministry of education curriculum, life skills training, group therapy, individual counselling and support. The program offers comprehensive medical care, family and individual counselling and planning for discharge into a community school or alternative academic program. The Day Treatment Team consists of 2 Child and Youth Counsellors, a Toronto District School Board Teacher, and a Social Worker, Nurse, and a Physician who are part-time with the program.

8 1:40-2:30 REVIEW RECREATION PLANNING TIME MONDAY TUESDAY WEDNESDA Y THURSDAY FRIDAY 9:00-9:30 CHECK-IN (9:45) CHECK-IN CHECK-IN CHECK-IN CHECK-IN LEARNINg 9:30-10:30 STRATEGIES ACADEMICS ACADEMICS ACADEMICS ACADEMICS 10:30-10:45 BREAK BREAK BREAK BREAK BREAK SHOPPING/ COOKING/ 10:45-12:00 ACADEMICS ACADEMICS ACADEMICS ACADEMICS ACADEMICS 12:00-12:30 LUNCH LUNCH LUNCH LUNCH (11:45) LUNCH 12:30-12:45 BREAK BREAK BREAK BREAK BREAK STUDENT MEETIN G CONSTRUCTI NG RELATIONSHI P Learning Strategies 12:45-1:40 GOAL SETTING JOURNALS GROUP RECREATION Goal Review D'n'A HEALTH GOAL WEEKEND

9 Levels of Treatment Outpatient client/patient attends regular visits with counsellor frequency of visits based on need/schedules may be long-term, or brief, crisis oriented may be viewed as motivational, if client/patient is considering other treatments but not ready yet may be relapse-prevention focused if client/patient has completed another program

10 Levels of Treatment Day treatment attend 5 days a week program must involve academics and therapeutic groups must be motivated to attend regularly on a voluntary basis harm reduction or abstinence based

11 Levels of Treatment Residential structured 7 days a week highest risk clients voluntary and involuntary programs treatment time usually longer than day treatment (often up to 6 mos.) although some only 21 days *note: Only 3 residential programs in Ontario for adolescents..need to be 16+ for one of them, need to have broken the law or be under 16 yrs and involved with CAS to get into another, remaining program is 21 days and in Thunder Bay

12 Levels of Treatment Detoxification usually implies a need for supervision of withdrawal medical vs.. nonmedical with adolescents, usually for cocaine/heroin (less for alcohol, cannabis)

13 Issues to consider Evidence to suggest that Day Treatment can be as effective as Residential and is a more cost effective way of providing treatment All of the currently available treatment options are voluntary programs (with the exception of Portage residential program to which some youth are court sentenced)

14 Additional kinds of assessment/treatment required psychiatric assessment - co-morbidity is common (30-50% in the literature) medical/health issues - other high risk behaviours are frequent

15 The Role of the Child and Youth Counsellor Intake Case Management Develop and implement treatment groups Assist youth in creating appropriate strategies to reduce or eliminate substance use Individual and group therapy Life skills training Providing appropriate referrals re: housing, continued education, ongoing support or additional treatment options Facilitate after-care/graduate goal-setting group

16 Motivation - State of Change Contemplation aware that there is a problem; no commitment to change yet can remain stuck in this state weigh pros and cons of treatment versus no treatment more open to suggestions

17 Motivation - States of change Preparation/Determination serious intention to change is made, steps made to stop addictive behaviour substance use may decrease may appear to want to change but may still be ambivalent

18 Motivation - States of Change Maintenance working to prevent relapse and consolidate gains work to stabilize their behaviour change sense that one is belonging the kind of person one wants to be

19 Motivation - States of Change Relapse distinguish between a slip and a relapse (*difference between abstinence and harm reduction) slip is a temporary return to their problem substance relapse is a return to a problematic pattern of use clients may return to precontemplation state or may reinstate at different levels