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Proposal for day treatment in rae

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Aboriginal Family Treatment Model

Aboriginal Family Treatment Model

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  • 1. A Proposal for Integrated Treatment for Aboriginal Youth with Concurrent Disorders in the NWT Site Location: Tlicho Residential Dorms Area At Chief Jimmy Bruneau Regional High School in Edzo December 2005 Ray Pidzamecky M.S.W. RSW raypidzamecky@gmail.com 1
  • 2. Table of ContentsIntroduction ........................................................................................................ Page 3Background ........................................................................................................ Page 4Service Availability Summary of Limitations of Current Service Options ............ Page 8Proposed System Improvements...................................................................... Page 11 Service Delivery Component ................................................ Page 11 Linkage Component ............................................................. Page 12 System Level Component .................................................... Page 12 Service Structure.................................................................. Page 13 Staffing ................................................................................. Page 17Budget ................................................................................................................. Page 19 2
  • 3. AppendicesAppendix 1 – Definition of Terms ........................................................................ Page 21Appendix 2 – Logic Model ................................................................................... Page 22Appendix 3 – Excerpt from Provincial Rationalization Project............................. Page 23Appendix 4 – Elements of a Day Treatment Program ........................................ Page 25Appendix 5 – Community Advisory Committee Flowchart .................................. Page 26 3
  • 4. A Proposal for Integrated Treatment for Aboriginal Youth with Concurrent Disorders in the NWTIntroductionThere is a need for Day Treatment and service integration/co-ordination for Aboriginalyouth with concurrent disorders (see definitions Appendix 1) and their families.Aboriginal youth and their families require an integrated, broad system of supports thatwill work with families and youth who have mental illness, addictions and behaviourproblems or combinations thereof. The current system of service delivery is notmeeting the needs of all Aboriginal families and youth in the NWT. Co-ordination andcommunication within the system that exists is problematic because of the territorialstructure related to screening children and youth with addictions and mental healthissues. At present all referrals to out of territory placement must go through acommittee at the Department of Health and Social Services in Yellowknife. Thatcommittee does not include an Aboriginal representative. In addition, the committeeonly accepts referrals through the mechanism associated with protection services.Unfortunately the GNWT process put in place to ensure efficiency and accessibility ofservices has no relationship to Aboriginal treatment/healing philosophy or needs. Thisproposal describes a plan with three elements (see Appendix 2 for logic model): Service delivery component that provides intensive family- and culturally relevant community-based treatment that addresses the multiple determinants of substance abuse, mental illness and serious antisocial behaviour in young people, the family and extra-familial (peer, school and neighbourhood) contacts/supports Linkage components that ensure common goals, objectives, training and service co- ordination System level components that ensure communication, co-ordination and integration of servicesBackground 4
  • 5. In August 1998, because of growing concerns about addictions in Tlichocommunities the Treaty 11 Chiefs asked the Dogrib Community Services Board to developan addictions strategy. This strategy was presented to the Tlicho leaders and people atthe general Assembly in Gameti in August 1999. A Steering Committee was appointed afew weeks later.Over the next six months, all the communities were visited to consult with the people. Thisresulted in a report entitled, “For the sake of Our Children…The Dogrib AddictionsStrategy” 1999. The publication was the outcome of responses from students from ChiefJimmy Bruneau Regional High School in Edzo, the Elizabeth Mackenzie ElementarySchool in Rae, the Mezi Community School in Wha Ti, the Alexis Arrowmaker School inWekweti and the Jean Wetrade Gameti School in Gameti.Their responses were candid and spoke to the heart of the matter.The youth identified a number of key issues including: 1) alcohol and drug abuse whichlead to the breakdown of the family support system including both discipline andparental guidance and support; 2) a loss in the Tlicho traditions of language, culturalbeliefs and life skills 3) a lack of social supports for the youth 3) some youth feelunimportant, unhappy, alone and 4) a need for youth to have a voice in theircommunitiesRecommendations from the youth included: 1) support to encourage peers to stop the abuseof tobacco, alcohol and drugs; 2) the need for safe meeting places where social activitiescould take place, to encourage a positive lifestyle free from tobacco, alcohol and drugs; 3) therange of community activities should go beyond sports (such as arts, music and drama) toentice those who were non-athletic; 4) supports needed to combat suicidal tendencies; 5) theuse of cultural events to help them better understand their culture and history werewarranted. Most of the youth respondents were willing to volunteer and become involved increating solutions.As a result of that report and continuing lack of treatment for aboriginal youth in theirown communities the Tlicho have developed this proposal for Day Treatment. Leadingup to this proposal, the group: conducted a scan of current programs for youth with concurrent disorders in NWT secured a model for a comprehensive system of services for youth with concurrent disorders and their families that addresses individual/family as well as systems issues(Appendix 2) conducted a scan of adolescent mental health and addiction treatment centres in the vicinity of NWT reviewed the following documents/references: 5
  • 6. 1 Working Together Because We Care (Suicide Prevention Regional Forums, 1992) o Community participation in regional forums to come up with recommendations to address high NWT suicide rates o Forums held in Rankin Inlet, Baker Lake, Coppermine, Iqaluit, Fort Simpson, Inuvik, Fort Smith & Yellowknife o Recommended: Training for community caregivers (lay and professional) Promotion of healthy lifestyles; Focus on the problems youth face; and, Better referral, treatment and follow-up for suicidal clients 2 Working Together for Community Wellness: A Directions Document (1995) o Collaboration between GNWT Departments of Education, Culture & Employment; Health and Social Services; Municipal and Community Affairs; NWT Housing Corporation; Justice; and Intergovernmental and Aboriginal Affairs o Recommended four areas of change: Prevention, Healing and Treatment Education and Training Interagency Collaboration Community Empowerment 3 Our Communities, Our Decisions: Final Report of the Minister’s Forum on Health and Social Services (1999) 4 Mental Health Services in the NWT: A Discussion Document (1999) o Consultation with Health & Social Services Boards (CEO’s & clinical staff comprised territorial steering committee) recommended increased integration between MH, addictions & family violence o Document described a continuum of mental health services for all populations/age groups. 5 Alternative Programming Initiative (1999-2000) o Consultation on challenges and alternatives for addictions programming & re-profiling existing buildings/programs o Changes with Northern Addictions Services (board moved toward contract with Corrections Canada) Recommendations to address needs of children & youth, women & children, men Women & Children’s Healing & Recovery Program initiated (women’s trauma treatment, join project with YWCA of Yellowknife & Yellowknife Women’s Centre/Centre for Northern Families) Children’s Assessment Centre proposed (not completed) Mobile Addictions Treatment (women, youth) pilot projects completed 2000/01 Men’s healing (not completed) 6
  • 7. 6 Toward a Better Tomorrow (2000) o Cabinet released their vision document o One of the stated priorities was to build healthy people and communities who could benefit from economic opportunities 7 Children and Youth Strategy (Draft document) (2000) o Drafted by Children & Family Services, with statistical support from Health Analyst 8 Mental Health Needs Assessment (2001) o Mental health had been neglected from the Disability Needs Assessment, so a separate contract was established to assess MH needs o Focus groups were held in Fort Simpson, Rae-Edzo, Fort Smith, Hay River, Jean Marie River, Inuvik, Deline, and Yellowknife. o Results: people saw mental health interconnected with addictions, violence, physical and population health. People requested improved integration and increased range of services. 9 Working Together for Community Wellness: A Draft Strategy for Addictions, Mental Health and Family Violence (2001) o Adapted from the 1999 Mental Health Discussion Document o Used Community Wellness Document as integrated framework o Extensive public consultation (plain language document mailed out, focus groups and fax-in feedback) o Feedback supported the proposed directions and priorities: Prevention; Services for families and children; Education, training and support for workers; Building community capacity to deal with problems; and, A better integrated system. 10 Social Agenda: A Draft for the People of the NWT (2002) o Territorial working group established to implement recommendations from Social Agenda Conference o Ten high-level, system recommendations to GNWT social envelope departments 11 State of Emergency: Evaluation of Addictions Services in the NWT (2002) Community addictions programs & mobile treatment programs received failing grade.o Recommendations to begin with building a community based counseling program. Also called for improvements in system coordination, staff training and support 12 DHSS Integrated Service Delivery Model (2002) o Need for updated and inter-connected core services. 7
  • 8. o Chapter 6, ISDM = Mental Health and Addictions Core Services drafted. o Community Counselling Program implemented (begin 2003) o Key components of mental health/addictions to be added (children/youth, withdrawal management, crisis services) Summary of Limitations of Current Service OptionsSeveral issues have been identified as needed in Tlicho to service youth withconcurrent disorders and their families. The following shortfalls should be noted: Services generally will work with the young person only and only minimally with the family and not at all with any peer or support systems in the young persons life Many service providers have specialized skills in either mental health counselling or addictions, rarely both Most services target specific populations e.g. only women, only men, under 16 years or over 18 years. In particular, many of the addictions services target individuals over the age of 16 but the bulk of those admitted to treatment are adults with very different issues and experiences to the young person aged 17 or 18. Follow-up or aftercare that ensures the young person can integrate back into school and home are limited or not available for those who have had intensive treatment outside of their home community. In addition, there may be differing treatment philosophies between the intensive treatment centre and the follow-up or aftercare facility that can impact on the young persons ability to practice the skills they have learned in treatment For a young person to be able to successfully complete a day treatment program (usually lasting one school semester) they need to be able to easily access the service. Day treatment greater than a one hour commute from the young persons home will increase the likelihood they will not complete the course of treatment and or have difficulty re-integrating back into their communityIt is quite clear that the GWT has limited resources for adolescents who areexperiencing mental illness/behaviour and substance abuse problems. Currentservices are limited to individual counselling, both school based and on an out patientbasis related to either the young persons mental health/behavioural problem. One ofthe few options available to adolescents who require a more intensive form of treatmentis limited to residential treatment outside of their community and the NWT.Unfortunately for adolescents in the NWT, there is no middle ground in terms of offeringtreatment for those who fit the middle of the continuum, i.e. adolescents whose 8
  • 9. substance abuse is too serious for out patient counselling, but do not requireinpatient treatment. In addition, those adolescents who return to NWT following a stayin an out of area residential facility do not have programs available to support theirtransition back into their community.Substance abuse frequently co-exists with mental health difficulties (depression, lowself-esteem, anxiety, behavioural problems etc.) In addition, many adolescents whohave been diagnosed with a psychiatric disorder also have substance abuse difficulties.This has become a treatment dilemma for those particular young people because of thetwo separate service systems (addictions and mental health) and theterritorial mandates and funding requirements that govern them. Unfortunately forthese adolescents, it is difficult for them to receive service with one service providerdue to the complex relationship between mental health difficulties and substance use.Many of these adolescents spend a great deal of time being referred back and forthbetween addictions and mental health centres, eventually being sent to inpatienttreatment outside NWT only to return to the same confusion.Providing a day-treatment program in Tlicho would allow all service providers(addictions, mental health, child welfare, education, probation, corrections and families)the opportunity to work together and allow these particular adolescents to receivetreatment under “one roof”. The program would incorporate both addictions and mentalhealth theory and practice to ensure treatment needs of concurrent disorders are met.Adolescents would remain in their community (NWT) and work intensively with theirfamilies and significant others to attain their goals, ensuring a better outcome for allconcerned.A day-treatment program would target adolescents who have “dropped out” or havebegun to drop out of school or who may have displayed delinquent behaviour, theirfamilies and the community they interact with. These particular adolescents requiredaily structure that would focus on regaining their self-confidence and reconnectingthem with their family and community. The program would focus on substance usereduction, education remediation, vocational planning and re-introduction of social, lifeand leisure skills. In addition, the program would work with families to empower them tobuild an environment that promotes the health of the family unit.The systems improvements inherent in the model would provide a transition back intoAboriginal communities for those adolescents who may require inpatient treatment out 9
  • 10. of the area. This would allow adolescents to begin to put in place manyof the changes they made while they were away.Quite clearly, NWT has many Aboriginal adolescents that fit the above description andwho do not, at the present time, fit into the regular school environment. Unfortunately,without appropriate day treatment, these particular adolescents will most likely maketheir way into the correctional system where treatment, as we know, is minimal.We know that treating these young people in separate systems is not ideal. Theadditional advantage of integrating the expertise is a cross learning that can occurwhen professionals from the mental health and addictions sectors form one treatmentteam. The exchange of knowledge and expertise is synergistic because theseprofessionals will have an increased understanding of how to treat concurrentdisorders. Recognition of the inter-relatedness of addictions and mental illness isreflected in the recent integration of Mental Health and Addictions Core Services(Department of Health and Social Services, GNWT).Proposed System ImprovementsLoosely based on Multi Systemic Therapy, the proposed model for Tlicho willincorporate a Day Treatment component and provide a practical, goal-orientedtreatment that specifically targets those factors in the young person’s social networkthat are contributing to his/her behaviour. In addition, services will work withfamilies/caregivers to support discipline practices, enhance family relations, decreaseyouth association with deviant peers, increase youth association with pro-social peers,improve youth school or vocational performance, engage youth in pro-socialrecreational outlets, and develop support network of extended family, neighbours, andfriends to help all involved achieve and maintain change.To address the needs of Aboriginal youth with concurrent disorders and to rectify theabove barriers, there needs to be a service model with three main components: servicedelivery, service/systems links and systems integration is needed to address thefollowing long and short term goals (see Logic Model Appendix 2). Service Delivery Component 10
  • 11. Goal: To ensure that youth with or at risk (of concurrent disorders) and theirfamilies have access to an integrated, accessible and comprehensive system ofservicesLong Tern Objectives:- Improved healthy adolescent development- Removal of psychosocial barriers that inhibit the ability of youth to learn- Improved parenting capacity and problem solving- Short Term Objectives- Increased access to appropriate services for youth and their families- Increased identification of youth at risk- Increased referral to appropriate community resources, including Day Treatment, for youth identified at risk- Increased parenting confidence, knowledge and skills- Increased linkages between agencies of other providers (wrap around)- Increased accessibility tom discharge planning and appropriate ongoing care/support Linkage ComponentGoal: As for Service Delivery ComponentLong Term Objectives- Increased knowledge of services that exist in the system- Increased appropriate service utilization in NWTShort Term Objectives- Increased awareness of community at large of the impact of mental illness and addiction on youth- Increased consultation between the mental health and addictions providers- Increased awareness of a variety of service providers regarding potential risk in youth- Increased collaboration between agencies and organizations- Increased awareness of the community at large re the influence and challenges to parenting System Level Component:Goal: To ensure communication, co-ordination and integration of effectiveservices funded through Health, Education and Justice thereby reducing costsrelated to family breakdown and youth criminalityLong term Objectives: 11
  • 12. - Increased co-ordination of services within the community - Decreased percentage of youth who prematurely leave school and are at risk of developing criminal behaviour Short Term Objectives: - Increased integration between interagency groups - Decreased duplication of service - Increased number of common policies and procedures within the interagency group(s) - Increased knowledge and understanding of roles by service providers within the interagency group(s) Service Structure1. Community Advisory Committee (See structure model in Appendix 5)Overseeing, administering and providing direction to the program would be aCommunity Advisory Committee. The committee would be made up of organizationsproviding services to the target population as well as parents and youth. The role of theCommunity Advisory Committee would be ensure that the appropriate processes andprocedures are in place to meet the mandate of the program - the provision of acomprehensive system of services for youth with concurrent disorders and their familiesand, specifically, the management of the day treatment service.Funding for the program would be flowed to a lead administrating agency (or agencies).This organization would be responsible for:  Budget  implementing program set by the CAC  day to day interactions with the program managersA community partnership model would be considered for this project. This model wouldpull the stakeholders together into a structure that would oversee the implementation ofthe program and give the implementation to the lead agencies. The communitypartners come together out of interest in or an ability to commit resources to theprogram. A common ground or shared vision keeps these partners working together.The model for day-treatment being proposed incorporates three major functions: (1) traditional intervention that includes: education, life skills training and therapy (individual and group) 12
  • 13. (2) working with extended family, neighbours and friends to help achieve and maintain change and (3) case co-ordination by a continuity team undertaken before, during and following the intervention.The following describes the intensive intervention portion of the model.2. Referral & Intake anyone can refer a youth for concerns related to mental health and addictions identified need including but not limited to:  weak interpersonal relationship skills such as initiating conversation, joining a group, or acquiring attention  weak in communication skills such as asking questions, self-disclosure, advice giving  weak sharing and co-operation skills like co-operation, sharing, give-and- take, reciprocal interactions, fair play  weak problem-solving and conflict resolution skills for example considering and appraising alternative courses of action when presented with interpersonal problem situations.  problem behaviour associated with substance use  age - 14-18 (high school aged) male & female  geographic area – NWT  program plan (content) - mental health & addictions  administration/accountability - one agency/organizational structure  build on existing resources, specifically Tlicho healing Path-Wellness Centre  family willingness to be involved with treatment3. Assessment data gathering from:  other agencies who have a history with the client  the family  the individual  Assessment measures will include  Intellectual and academic abilities:  Mental health and psychosocial functioning:  Family functioning: 13
  • 14.  The learning environment:  Family-school linkage:4. Treatment  Components  academics (including credit courses)  life skills (cooking, budgeting, etc.)  counselling – individual, family and group  duration  available 11 months of the year - closed August for day treatment but open for intake, follow-up and staff training  approximately 60 young people would be seen annually5. Discharge planning (Follow-up) adolescent readiness community (including school) readiness (systems issues) family readiness (systems issues)6. The Continuity Team (Case Co-ordination)The uniqueness of the model being proposed is the concept of a Continuity Team.Experience has shown that young people with concurrent disorders are verychallenging to manage and treat. The challenges include but are not limited to: the nature of the concurrent mental health, substance abuse and behavioural problems the different mandates of service providers funding from three separate ministries (Education, Health and Justice) adolescent and family relationships limitations within the school system to deal with adolescents with psycho-social problemsAs indicated earlier in this document, young people with concurrent disorders receivingservices are seen by multiple care givers and many sites. While attempts are made tocommunicate between service providers, there is currently no co-ordinated system inplace to facilitate this process. The purpose of the Continuity Team would be to provideone stop shopping for the individual, the family as well as service providers to ensurethat a young person with a concurrent disorder receives the most appropriate care, inNWT and in a timely manner. That care (treatment) could include outpatientcounselling, day treatment or residential treatment or any combination thereof. 14
  • 15. The continuity team would serve approximately 200 young people and their familiesannually and fulfil several functions. ensure education to the community at large about youth with concurrent disorders receive enquiries regarding admission to the Day Treatment component of the program facilitate referral to, and that linkages are made with, appropriate community resources if Day Treatment is not the most appropriate service consultation (out reach) to other organizations in the community (system) working with youth with mental health and addictions  education of staff from community organizations  treatment planning with other organizations  opportunities for groups for youth ensure a supportive environment for the individual and family following discharge. This could include working with families, schools, workplaces, sport and social networks the youth is connected to prior to discharge. case management & co-ordination including setting up planning meetings with the individual, family and identified service providers ensuring that appropriate aftercare is in place and working following discharge Program evaluation would be the responsibility of the Manager. Components being evaluated based on the short term objectives of the Logic Model (see Appendix 2) 15
  • 16. Staffing (See attached staffing schematic) Title Qualifications FTE/costProgram Manager Mental Health 1 FTE @$80,000 Professional*Co-ordinator/Team Leader Mental Health 1 FTE @$65,000(Intake/Discharge Follow- Professional*up)Co-ordinator/Team Leader Mental Health 1 FTE @$65,000(Day Treatment) Professional*Nurse/Social Worker Mental Health 2 FTE @$65,000 Professional*Child & Youth Worker Community College 6 FTE @$45,000Administrative Support Community College 1 FTE @$40,000Psychologist Sessionals $25,000Psychiatrist Sessionals $25,000Teacher Education 1 FTESub Total 11 FTE $905,000Benefits @ 15% $135,750Sub- Total 7.5 FTE $1,040,750* Note: A Mental Health Professional includes but is not limited to Nurses, SocialWorkers and other Health Care practitioners with a minimum of an under graduatedegree and experience in the mental health and/or addictions field. 16
  • 17. COMMUNITY ADVISORY COMMITTEE Lead Administrative Agency: Wellness Centre Program Manager Continuity Team Treatment Leader Team LeaderNurse/Social Worker 6 Child & Youth Workers Teacher (Employed by Education) Psychiatry Psychology } Sessionals { Psychology Psychiatry Administrative Support 17
  • 18. BudgetRent $36,000Salaries $1,040,750Travel $7,500Training & development $4,500Program Expenses $11,500Office Administration $41,000(Supplies, audit, legal, evaluation)Promotion & public education $10,000Total $1,184,978ConclusionOver the past several years organizations that provide youth mental health andaddictions services have been located out of territory. Better co-ordination of servicesfor Aboriginal youth with concurrent disorders in the NWT and their families is required.While there have been some improvements because of increased co-operation, thereare still no resources dedicated to this target population. Specifically, added resourcesare needed to work intensively with aboriginal youth with concurrent disorders and theirfamilies to empower the young person and his/her parents with resources and skills.The long term cost savings in future productivity for the young person and theprevention of the development of deviant behaviours and their resulting costs will morethan pay for the investment now in this initiative. 18
  • 19. AppendicesAppendix 1 – Definition of Terms ........................................................................ Page 21Appendix 2 – Logic Model ................................................................................... Page 22Appendix 3 – Excerpt from Provincial Rationalization Project............................. Page 23Appendix 4 – Elements of a Day Treatment Program ........................................ Page 25Appendix 5 – Community Advisory Committee Flowchart .................................. Page 26 19
  • 20. Appendix 1 Definition of TermsDefinitionsConcurrent Disorders:Individuals having both mental health and substance abuse problems.Dual Diagnosis:Individuals having both mental illness and a developmental handicap.Mental Disorder (Illness):A mental disorder is a recognized medically diagnosable illness that results in thesignificant impairment of individuals cognitive, affective or relational abilities. Mentaldisorders result from biological, developmental and/or psycho-social factors and can, inprinciple, be managed using approaches comparable to those applied to physicaldisease, that is: prevention, diagnosis, treatment and rehabilitation.AddictionsPhysiologic or psychologic dependence on some agent (e.g. alcohol, drug, work, sex,food etc) with a tendency to increase its useBehavioural PatternsThe dependent adolescent displays behaviour significantly different from behaviour thatpredated his use. The adolescent frequently displays aggressive behaviour under theinfluence that includes threats toward or physical altercations with family or peers,burglary vandalism or thefts. Behaviours displayed when the adolescents are not underthe influence include irritability, hostility and anger towards authority figures, steelingfrom friends and friends lying to cover up use and dealing drugs to support a drug habitMultiple DiagnosisAny combination of the aboveMental HealthMental health is the capacity of the individual, the group and the environment to interactwith one another in ways that promote subjective well-being, the optimal developmentand use of mental abilities (cognitive, affective and relational), the achievement ofindividual and collective goals consistent with justice and the attainment andpreservation of conditions of fundamental equityYouthFor the purpose of this initiative, youth is defined as individuals between the age of 12and 21 20
  • 21. Appendix 2 Tlicho Concurrent Disorders ProposalProgram Service Delivery Links System LevelComponents: Components Components  Services to Youth and FamiliesResponsibility: Continuity Team Continuity Team Service Coordination Teams Community Advisory Committee  Case managementActivities: INTAKE & REFERRAL & DISCHARGE PLANNING PARENTAL TRAINING/EDUCATION ASSESSMENT LINKAGE DAY TREATMENT AFTER CARE SUPPORT EDUCATION CONSULTATION LOCAL VISION PROMOTION OF INTEGRATION TO SERVICE PROVIDERS  Coordinated planning OF SERVICES PROVIDED BY: WITHIN ALL SYSTEMS  Telephone  Referral &  Education mediation with all who support  Individual  Parenting  Awareness  Access to consultation and  For services for youth and their Access 1- Linkage to - academics youth and family  Group  Education campaign to professional by community families  Health & Social Services  Common tools 800 needs based  Skills development - formal and CAL re: normal organizations who service - common processes  Assessment  Universal programs and - Social skills informal youth youth and their families - policies and procedures  Health processes Intake services - Life skills - community development - education to staff of developed  Education - all systems  Ongoing  Therapy organizations and concurrent organizations  Police  Education support to youth - Individual - youth disorders - planning appropriate  Referral to and parents - Group - family interventions community until linkage is - school resources if complete - service providers no intervention requiredTarget  Individuals  A variety of community agencies  Organizations and Agencies funded throughGroup:  Youth  Organizations who work with youth (wrap around) - GWT  Family  Community at large - Health  Parents - Education  CaregiversShort Term  Increase access to appropriate services for youth and their families  Increase awareness of community at large of the impact  Increase integration within human service systemOutcome  Increase identification of youth at risk (of concurrent disorders) of Mental Illness and Addiction on Youth  Decrease duplication of serviceObjectives:  Increase referral to appropriate community resources, including to Day Treatment, for youth identified at risk  Increase consultation/substance abuse and awareness to  Increase number of common policies and procedures within Human Service System  Increase parenting confidence, knowledge and skills a variety of services regarding potential risk in youth  Increase knowledge and understanding of roles by service providers within the Human Service System  Increase linkages between agencies of other providers (wraparound)  Increase collaboration between agencies and  Increase accessibility to discharge planning and ongoing care/support organizationsLong Term  Improved healthy adolescent development  Increased knowledge of services that exist in the system  Increased coordination of services within communityOutcome  Removal of psycho-social barriers that inhibit the ability of youth to learn  Increased appropriate service utilization in Halton  Decreased % of youth who prematurely leave school and are at risk of developing criminal behaviourObjectives:  Improved parenting capacity  Improved service linkagesGoals:  To ensure that youth with or at risk (of concurrent disorders) and their families have access to an integrated, accessible and comprehensive system of services  To ensure communication, coordination and integration of effective services funded through: - GWT - - Health Education 21 Thereby reducing costs related to family breakdown and criminality.
  • 22. 22 Appendix 3YouthIntroduction“Youth” (usually understood to be under 25 years of age), are themselves aheterogeneous group that can be subdivided according to a number of characteristics.An important one is developmental stage, which includes latency, adolescence andyoung adult stages. Agencies offering services to youth should be multifunctional andmultidimensional in recognizing and offering specialized services to these three majorage categories. This does not necessarily mean that each youth treatment agencyshould have a full continuum of services for all age groups, but they should be linked toother services so that the full continuum of services is readily accessible.Issues Regarding Appropriateness and Accessibility of the Treatment SystemRecently, there has been an increasing emphasis on developing services for under 19year olds. Programs for this population should demonstrate their commitment todeveloping age-appropriate programming linkages with other children’s and familyservices in the community and procedures for involving the family in the treatmentprocess.In the addictions treatment field, it is essential that services for youth are seen asdiscreet and specialized from the more generic adult-oriented services. This isnot meant to imply that every youth service must be a stand-alone entity, but doesmean that there should be special programs and staff dedicated to youth.Other issues in treating youth who require special attention are ethnicity, sexualorientation, homelessness, concurrent mental health problems such as eating disordersand depression, family violence and sexual abuse. Programs must address thesespecial needs by either offering issue-specific responses within their own services or bylinking with other appropriate resources in the community.System Issues and Program ModelsWith regard to the adolescent age group, there is increasing evidence that briefoutpatient treatments are appealing and appropriate alternatives to day and residentialtreatments. At this time, there is a pressing need and ready market for brief outpatienttreatment protocols (e.g.: 4-8 sessions), that address not only substance use but alsoother interconnected issues such as motivation to change, family relationships, peernetworks, physical and emotional health, education and leisure. The reality is thatsome youth will require additional, highly focused, supplemental treatment and thus astepped-care approach in which specialized treatments such as family therapy, grouptherapy, day programs and residential support should be available to build on the brief 22
  • 23. 23outpatient treatment, which can be seen as the cornerstone of a youth treatmentsystem.There are several different theoretical approaches for working with youth (e.g.:cognitive-behavioural, 12 step, solution-focused, psychodynamic). Ideally, a communityshould have a variety of treatment approaches for youth to access according to theircapabilities and preferences. Generally speaking, youth seem to prefer treatments thatare brief, skill enhancing, self-affirming and focused on day-to-day life events.A community that is responsive to youth must also offer them a choice in terms ofsubstance use goals, ranging from abstinence, to reduced use, to harm reduction. It isnot necessary that this choice be available within each individual agency, but it shouldbe accessible within the treatment system. Goals of non-abstinence give rise to specialconcerns when it comes to treating minors, and therefore agencies offering such goalsmust have explicit policies and procedures to deal with this issue. Agencies must alsohave in place policies and procedures that are sensitive to the frequently occurringissues of confidentiality of information between parents/guardians and the youth.RecommendationsThere is a tremendous opportunity to broaden and enhance existing non-addiction-specific youth services (e.g.: Health, Protection, Family Services) by embracing andintegrating the assessment and treatment of substance use within the context of theiroverall treatment services. Such initiatives should be seen as a priority within eachcommunity.Involvement in the Planning and Consultation Process“Youth” is a visible high-priority population whose unique needs and attributesnecessitate treatment approaches that are distinct from those for adults. The field hasrelied too extensively on generalizing experiences drawn from treating adult populationsto plan and develop youth services. Instead, greater emphasis should be placed onlearning from youth themselves and from the experience of youth service providers,both in the substance abuse and other treatment fields. It is our recommendation thatspecial youth-specific outreach, assessment procedures, treatment protocols andevaluation methods be developed and disseminated to enhance the quality of treatmentservices for youth.References and other ResourcesTupker, E. (1994). Youth & Drug Abuse: A Planner’s Guide to Multi-FunctionalTreatment. Toronto: Addiction Research Foundation.Appendix 4 Elements of a Day Treatment Program 23
  • 24. 24Assessment including collection of existing data, screening for eligibility/priority, admission decision, alternative recommendations/redirection.Therapeutic/behavioural interventions including;Individual work including: goal setting/review discharge follow-up plans to support gains made.Family work including: psycho-education re: nature of mental health disorders*, treatment alternatives, how parents can help improve outcomes, traditonal healing family therapy, Follow-up planning.Group work including: psycho-education re: the nature of mental health disorders*, treatment alternatives, how the individual can help improve outcomes, traditonal healing Life skills including communications, stress management, problem-solving strategies, conflict resolution/anger management, building self-esteem, values clarification, making the most of community resources, etc.Education including: individualized instruction, linkage to school for continuity of content, recommendations for follow-up by feeder school/board to support academic and social reintegration in the school setting post-discharge.Social/Recreational activities including: physical exercise culturally expressive arts (arts, crafts, drama, music, etc)*Includes psychiatric behavioural, substance abuse, learning disorders and any combination thereof Appendix 5 Community Advisory Committee 24
  • 25. 25 Community Advisory Committee (Treatment Sub-committee or something new) Lead Administrative Agency Day Treatment Community Intake & Assessment & Discharge & Education Referral Treatment Follow-up (Awareness) Singl Ongoing training in Mental Health & Addictions (Staff & Community professionals) e ol Ass Outreach to other organization c Proto essm ent Continuity Team Kids IntegratedFamily & Friends Hospital Schools Agencies Employers Recreation ? A Model for Integrated Treatment for Youth with Concurrent Disorders 25