Adolescent Substance Abuse Treatment: A Family Centered Holistic Approach

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1 Adolescent Substance Abuse Treatment: A Family Centered Holistic Approach Kaylum Paletta, SUDC, Prevention Specialist Adolescent Substance Abuse Treatment Coordinator Cultural Competency Chair Four Corners Community Behavioral Health Inc. Price Utah

2 Presuppositions Culturally competent services are best Adolescents are different than adults Evidence based treatment is best Treat Mental health and Substance diagnoses at the same time You can t help the adolescent with out helping the family Prevention services, Substance Abuse services, and Mental services can all mesh and fit together in unity

3 FCCBH Inc Level 0.5, Level I, and Level II.1 Tx only Court referred population Co- Ed groups year old mix 14 year olds rare

4 The beginning of the journey Adolescence is just one big walking pimple. Carol Burnett

5 Addiction lies in the organ of the brain, we know that! Brain development is not completed until 25 year of age. (Parentsempowered.org) A 15 year old female s brain works different than a 35 year old male s Services should be provided in different conduits of learning styles Rural, urban, suburban, etc.. Referral source Take developmental stages into consideration Cultural and family needs assessment and screening

6 The Journey includes others The second most beautiful thing in the world is to see your parents smiling The most beautiful thing is to know that you re the reason behind that smile! Anonymous

7 Family involvement should be an expectation for every State/Tribe and local adolescent substance abuse treatment system, and for the providers who deliver treatment and recovery services. Sharon Smith, Steve Hornberg M.S.W., Doreen Cavanuagh Ph.D.

8 However, the Adolescent SA treatment filed, in general, has lacked a common vision, specific expectations, and clearly defined roles and responsibilities for family members and professionals (ibid). If the therapeutic goals are sustainable out comes that improve health and well being [of client], then the family, which may or may not be part of the problem, MUST be part of the solution (Hornberger, Smith)

9 Parental involvement is critical to successful treatment of adolescents with alcohol and other chemical dependency issues. Research shows that family-based interventions can be very effective in reducing current alcohol and other drug problem behavior and future risk. Research shows that adolescents are often attracted to substance-using peers as a result of conflicted family and school environments. Environmental conflicts, especially in the family, raise risk factors for drug abuse in adolescence. Poor parent-child relationships, poor parental limit setting, and weak problem solving and communication skills within families all predict higher use

10 Because they feel they have tried everything and they have become powerless in changing their child.* Feel that their child has gotten in trouble and it is their responsibility to get themselves out of it. * This hands-off attitude is evidenced by parents who drop their kids off for chemical dependency treatment and want the therapist to 'fix' the adolescent.* * (Rhonda Bohs)

11 Research indicates that when families are involved in Substance Abuse treatment, however, short or long term, outcomes are improved for both the individuals and their families (Wittinghill, 2002).

12 Families play an important role in the recovery of substance abusing juveniles, but this influence can be either positive or negative. Parental substance abuse or criminal involvement, physical or sexual abuse by family members, and lack of parental involvement or supervision are all risk factors for adolescent substance abuse and delinquent behavior.

13 Thus, the effective treatment of juvenile substance abusers often requires a family based treatment model that targets family functioning and the increased involvement of family members. Effective adolescent treatment approaches include individual family therapy, group family therapy, and functional family therapy. These interventions show promise in strengthening families and decreasing juvenile substance abuse and delinquent behavior.

14 We want to avoid family members feeling unsafe or violated by working with different configurations of the family. The idea behind this 'team' approach is that the adolescent feels enough safety to engage in the therapeutic process and begin to look at reducing his/her alcohol or other drug use. Meaning, all family members must FEEL that they are an equal part of the treatment process

15 Adolescents need to feel cared about, listened to and respected in order to engage completely in the therapy process. It becomes less about what the parents want the adolescent to do and more about getting the adolescent the help that he/she needs in order to make better choices. Meaning the Adolescent needs to understand the entire treatment process is about them getting better because WE CARE

16 All agency need to support the entire family involvement in the treatment process All Agencies need to understand the demands of the others agencies in the family's life Treatment needs to be holistic We need to work towards treating each family individually, and make their individual treatment needs accessible and as convenient as possible Family treatment CAN NOT stop at the treatment facility!

17 Make Parents feel they know what is happening in their Child s treatment This should lead to increased motivation for involvement A minimum of weekly contact with parents to provide updates on the child s progress and to receive parent feedback on the child s behavior and process is necessary to maintain parental engagement (Bohs, 2).

18 Increase communication with entire family through out entire treatment process From Orientation to discharge parents need to be involved and communicated with. Weekly update reports to family Facilitated through increased parental involvement Bi-weekly Family Psychotherapy Group (Week 1,3) Monthly Family contact call (Week 2) Monthly family individual sessions (week4) Al-anon meetings

19 Weekly report card For Parents and all agencies Add child and family needs assessment to orientation Provide resources for parents Empower them to not feel alone, ashamed, embarrassed Level II.1 commencement celebration Involve family

20 Support! Court ordered support of parental involvement Understanding of the intensity and demands of the Level II.1 treatment program Communication Two ways, FCCBH needs clear understanding of other agencies requirements Collaboration Work hour consideration School District support Probation meetings involving FCCBH staff Phone or in person

21 The Map to the journey A wise man proportions his belief to the evidence. David Hume

22 Program is based on the American Society of Addiction Medicine Levels of care Levels 0.5, I, II.1 Stages of Change Level I Level II.1 Level I

23 Matrix Model The core of the treatment program Case Management Botvin Life Skills Both Individually and in group settings The educational component of the program Mental Health Therapy CBT Family Therapy Individual therapies based on clients needs Mind over mood, Med management, etc.

24 Group Monday Tuesday Wednesday Thursday Friday AIOP Level II.1 Relapse Prevention Skills 3:30 5: 30 A & D Education 3:30 5: 30 Family Recovery Group 6:00-7:30 Advanced Recovery Skills 3:30 5: 30 Advanced Life Skills 3:30-5:00 OP Level I NO GROUP A & D Education 3:30 5: 30 Family Recovery Group 6:00-7:30 Advanced Recovery Skills 3:30 5: 30 Advanced Life Skills 3:30-5:00 Only if referred Relapse Prevention Level I Relapse Prevention Skills 3:30 5: 30 NO GROUP Family Recovery Group 6:00-7:30 Only if referred Advanced Recovery Skills 3:30 5: 30 Advanced Life Skills 3:30-5:00 Only if referred Step down care Level I Depends on Clients need and referral Depends on Clients need and referral Family Recovery Group 6:00-7:30 Only if referred Depends on Clients need and referral Depends on Clients need and referral

25 Group Tuesday Wednesday Wednesday Thursday Friday AIOP Level II.1 OP Level I Relapse Prevention Level I Step down care Level I Relapse Prevention Skills 10:00-12:00 NO GROUP Relapse Prevention Skills 10:00-12:00 Education group 10:00-12:00 Education group 10:00-12:00 NO GROUP NO GROUP NO GROUP Family Recovery Group 6:00-7:30 Only if referred Family Recovery Group 6:00-7:30 Only if referred Family Recovery Group 6:00-7:30 Only if referred Family Recovery Group 6:00-7:30 Only if referred SUMMER GROUP VARIOUS TIMES SUMMER GROUP VARIOUS TIMES SUMMER GROUP VARIOUS TIMES SUMMER GROUP VARIOUS TIMES Life Skills 10:00-12:00 Only if referred Life Skills 10:00-12:00 Only if referred Life Skills 10:00-12:00 Only if referred Life Skills 10:00-12:00 Only if referred

26 More free time for teenagers Introduce more programming to meet needs of patients Outdoor Experiential Therapy We live in Utah, the out doors are calling! OET groups Serve as metaphor for life and a challenging learning opportunity Builds confidence, pro-social interests, recreational experiences, stress management, new activities.

27 Date Group Location And subject 6/7 Unnamed trail walk and work! Price Utah Community attachment 6/14 Lagoon Day Drug Free Experiences, the Thrill of life above the influence 7/12 Arches Moab, Utah Effects of Drugs on the brain and behavior 7/26 Fire Side Group, Marshmallows, Relationships 8/2 Sports and Sidewalk Chalk picture Leaving your mark Time Details 10:30 am 2:30 pm Bring water, NO Flip fops dress weather appropriate Bring Water Bottle 8:30 8:00pm Bring your own water bottle Dress weather appropriate BRING YOUR OWN LUNCH Pay your own way 8:45 am 5 pm Bring your own water bottle Dress weather appropriate NO Flip flops BRING YOUR OWN LUNCH 7 pm 10:pm Dress weather appropriate NO Flip flops 10:30 am 2 pm Wear appropriate cloths

28 Documented sociological, psychological, and physiological benefits (Ewert, McCormick, and Voight) Sociological- Group process is most important, social skills, problem solving (stranded hike, which is Adventure therapy) Psychological- Chance for old coopers to be tossed and new ones learned, trait building (Arches) Physiological- Physical health improvement, eating skills. See Outdoor Experiential Therapies: Implications for TR Practice

29 The Vehicle for the journey

30 Take evidence based practices and provide them with fidelity Journal though out the whole process! Journal assignments outside the box What FCCBH Substance Abuse Program does 2 hour groups broke into shorter sections! Different learning formats and styles Same concept delivered in different interventions

31 Week 1- Relapse Prevention session Matrix RP worksheet 1: When did you start using Word find Drug use history time line Treatment Video Deadly Highs Week 14 A & D Education session Stress management activity: Water fill Botvin Stress Management Worksheet Breathing Meditation Botvin Stress Management Worksheet Stress Management activity: Tape Box Physical activity of group choice Week 6- Advanced Recovery Skills session Matrix RP Worksheet 11: Twelve Step Tips Asking for help Hula hoop, Tie up, and plate walk Hazelden Video Step 1 for adolescents Step 1 poem, story, or picture Week 7- Advanced Recovery Skills session Hazelden Video Step 2 for adolescents Step 2 Hidden message puzzle Collage of higher Power Personal formation of Higher Power worksheet

32 Ingoldsby, Erin M. Review of Interventions to Improve Family Engagement and Retention in Parent and Child Mental Health Programs. Journal of Child and Family Studies : Ewert, Alan W., Brayan P. McCormick, and Alison E. Voight. Outdoor Experiential Therapies: Implications for the TR Practice. Theraputic Recreational Jounral , Parentsempowered.org Hornberger, Steve, and Sharon L. Smith. Family involvement in adolescent substance abuse treatment and recovery: What do we know? What lies ahead? Children and Youth Services Review. 33,2011. S70 S76 Bohs, Rhonda. Parental Involvement in Adolescent Substance Abuse Treatment Programs: Synopsis of Focus Groups Conducted with Florida Adolescent Treatment Providers and Parents. Florida Certification Board/Southern Coast Addiction Technology Transfer Center Smith, Sharon L., Steve Hornberger, M.S.W., Sherese Brewington-Carr, M.H.S., Cathy Finck, Cassandra O Neill, M.A., Doreen Cavanaugh, Ph.D., Christopher Bender, M.P.P. Family Involvement in Adolescent Substance Abuse Treatment. Improving Access to and Quality of Treatment for Adolescents with Substance Use/Co-occurring Mental Health Disorders. Volume 1, Number Smith, Sharon L., Steve Hornberger, MSW, Sherese Brewington-Carr, M.H.S. Cathy Finck,Cassandra O Neill, MA, Doreen Cavanaugh, Ph.D., and Christopher Bender, M.P.P. Family Involvement in Adolescent Substance Abuse Treatment. Family Involvement Issue Brief February 2008.

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