Slides from Mental Health update conference presentation, Texarkana Tx 4-13-18 Brentwood Hospital Shreveport La

1. Adolescent substance
abuse treatment
with/out parental
involvement
Bill Dockett MA, LAC, SAP
Counselor Brentwood
Hospital, Shreveport, La.
Presentation date 4/13/18
Texarkana, Tx.

2. What does
parental
involvement
count as?
• Parental involvement can be a mixed bag of
outcomes. You also have to decide what counts
as involvement based on program and
treatment goals.

3. What is?
NIMS
Not in my school
NIMBY
Not in my back Yard
NIMF
Not in my family

4. Patients
reported
concerns with
parental
involvement
• Parents using treatment as a punishment
• Not recognizing progress
• Attempting to manipulate tje therapist
• Guilting them about their attendance
• Guilting them about their progress
• Refusing to attend family therapy sessions

5. Developmental
Issues
• Puberty
• Individuation
• Peers as primary reference group
• Emergence of sexual awareness & identity
• Increased cognitive powers, formal operational
thought (e.g., logic, future orientation,
reasoning)
• Imaginary audience (self-centered & self-
critical)

6. Do motivations for treatment matter?
Internal locus of control
• Goals
• Self Concept
• Emotional stability
• Faith/religious beliefs
• Desire to change behaviors
• Family
External locus of control
• Peers
• Parents/family
• Social media
• Cultural identity issues
• Faith/religious beliefs
• Expectations of
change/compliance
• School

7. Stages of
change
1 Pre-
contemplation
“What
problem?”
2
Contemplation
•Ok I might have a
problem
3
Determination
•OK I need to do
something
4 Action
•This is what I plan
to do
5 Maintainance
•I need to keep
this up
6 Relapse
•oops I did it again

8. Power
dynamics and
conflict
management
• With adolescents you have to remember
everything is a potential power struggle
• What is a power struggle at heart?
• Elements of a power struggle
• How to defuse/secure buy-in
• Basic concepts of conflict management
• Conflict management and MH/addiction issues
• Importance of acceptance
• What is your conflict tolerance and
management type?

9. 5 Conflict Management Styles
• Here are the five conflict management styles according to Thomas,
K.W., and R.H. Kilmann:
5 Conflict Management Styles

10. 1. Accommodating
This is when you cooperate to a high-degree, and
it may be at your own expense, and actually work
against your own goals, objectives, and desired
outcomes. This approach is effective when the
other party is the expert or has a better
solution. It can also be effective for preserving
future relations with the other party.

11. 2. Avoiding
This is when you simply avoid the issue. You
aren’t helping the other party reach their goals,
and you aren’t assertively pursuing your
own. This works when the issue is trivial or when
you have no chance of winning. It can also be
effective when the issue would be very costly. It’s
also very effective when the atmosphere is
emotionally charged and you need to create
some space. Sometimes issues will resolve
themselves, but “hope is not a strategy”, and, in
general, avoiding is not a good long term strategy.

12. 3.
Collaborating
This is where you partner or pair up with the
other party to achieve both of your goals. This is
how you break free of the “win-lose” paradigm
and seek the “win-win.” This can be effective for
complex scenarios where you need to find a novel
solution. This can also mean re-framing the
challenge to create a bigger space and room for
everybody’s ideas. The downside is that it
requires a high-degree of trust and reaching a
consensus can require a lot of time and effort to
get everybody on board and to synthesize all the
ideas.

13. 4. Competing
This is the “win-lose” approach. You act in a very
assertive way to achieve your goals, without
seeking to cooperate with the other party, and it
may be at the expense of the other party. This
approach may be appropriate for emergencies
when time is of the essence, or when you need
quick, decisive action, and people are aware of
and support the approach.

14. 5.
Compromising
This is the “lose-lose” scenario where neither
party really achieves what they want. This
requires a moderate level of assertiveness and
cooperation. It may be appropriate for scenarios
where you need a temporary solution, or where
both sides have equally important goals. The
trap is to fall into compromising as an easy way
out, when collaborating would produce a better
solution.

15. Know your
style
By knowing your own default patterns
you improve your self-awareness. Once
you are aware of your own patterns,
you can pay attention to whether they
are working for you and you can explore
alternatives.
By using a scenario-based approach,
you can choose more effective conflict
management styles and test their
effectiveness for you and your
situations.

16. Tobacco use as Vaping
• Survey: 1.7 million high school students used e-cigarettes in previous 30
days
• Vapor product supporters say their aim is to provide tools that adults need
to quit smoking
• (CNN)A sharp spike in vaping and the use of e-cigarettes by students has
grabbed the attention of the US Food and Drug Administration.
• a 2016 reportfrom the US surgeon general. It cited a 900% increase in e-
cigarette use by high school students from 2011 to 2015
• 2016 National Youth Tobacco Survey noted that 1.7 million high school
students said they had used e-cigarettes in the previous 30 days.
• For middle school students, the number was 500,000

17. Confidentiality
and who is the
client
• This answer can vary due to setting and
circumstance of treatment.
• Probation/Parole involvement
• Drug Court
• Voluntary involvement
• Family mandated
• In patient vs. out patient setting
• Child Protective Services/DCFS
• School infraction

18. Legalization/medical
use issue
Currently:
Texas and Louisiana: None
Arkansas: Medical with restrictions
Louisiana: Pending medical, with military
PTSD inclusion
Note: Neither Arkansas or Louisiana allow for Mental Health issues

19. Barriers to
parental
involvement
• Employers can terminate a parent for taking
time off to attend program services.
• Program funding does not include budgets for
incentives to engage parents into treatment.
• Program funding also needs to include budgets
for case management as a separate service.
• Dual diagnosis cases are complicated.
• In many programs, case management services
are intertwined with therapy and counseling
services.
• Family dynamics are complicated.

20. Barriers
• Judges and Department of Juvenile Justice
Probation Officers do not see the importance of
parental involvement.
• Limited leverage to getting parents who are
abusing drugs or alcohol into adult treatment
programs
• Providers delivering services in school settings
report cases where Principals have denied them
access to youth.
• Limited opportunities for early intervention
youth drug and alcohol abuse
• Many managed care health insurance
companies do not cover family services.

21. What the data
says:
• Frequent and consistent contact with parents is
deemed to be a vital component of parental
involvement by both providers and parents
alike.
• Parental involvement can enhance treatment
outcomes.

22. Recommendations
• Adjust funding of programs to include
incentives.
• Educate judges and probation/parole officers on
importance of family involvement.
• Mandate the entire family to treatment.
• Educate teachers and administration on the
importance of early intervention.
• Treatment for children must involve the parents
to increase effectiveness.

23. Recommendations
Modify existing programs to be family
friendly.
Realistic expectations of success
Conduct alcohol and drug use risk
assessments in middle school.
Secure community resources and
stakeholders.
Defeat NIMS, NIMBY and NIMF.

24. References
• Bohs, R. (2007). Parental Involvement in Adolescent Substance
AbuseTreatment Programs: . Retrieved from Florida:
http://attcnetwork.org/userfiles/file/SouthernCoast/Parent%20Focus%20G
roup%20Report%20Final.pdf
• Norcross, J. C., & Prochaska, J. O. (2002). Using the Stages of Change.
Harvard Mental Health Letter, 18(11), 5.
• Roni Selig, D. C. a. C. H. (2018). Vaping now an epidemic among US high
schoolers. Retrieved from
https://www.cnn.com/2018/04/06/health/high-schools-vaping-
epidemic/index.html
• Kenneth W. Thomas, R. H. K. (2007). Thomas-Kilmann Conflict Mode
Instrument. USA: CPP Inc.

25. Thank you for
attending
Bill Dockett MA, LAC, SAP
Bill.dockett@uhsinc.com