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Hanie Edalati, PhD, & Patricia J. Conrod, PhD
Department of psychiatry, University of Montreal
Centre de recherche du CHU ...
One in 5 adolescents involved
in child welfare system
struggle with a substance use
problem.
(Aarons, Brown, Hough, Garlan...
More problems with drugs than alcohol.
(Singh et al., 2011)
Higher diagnosis of substance use
disorders compared to youth ...
Several factors contribute to the increased risk of substance use
problems in youth involved in child welfare system:
• La...
Less than 10% of adolescents and young adults in need
receiving such interventions (SAMHSA, 2009).
Personality Risk Profiles as Targets for Reducing
Substance Use Problems in Adolescents Involved in
Child-welfare System
PERSONALITY
TRAITS
CO-OCCURING
DISORDER
Sensation
Seeking
Negative
Thinking
Anxiety
Sensitivity
Externalising
Problems
Poo...
• Exposure to adverse childhood experiences and trauma is
associated with development of maladaptive personality
patterns ...
What are the Personality-targeted Interventions
(i.e., Preventure Program)?
Dr. Patricia Conrod
Department of Psychiatry
U...
Space:
• One roomin
school,clinic
Outputs
Participants:
• Adolescents who scored
one standard deviation
above the mean of ...
Validated Prevention Program through 8 Randomised Trials
Curr Addict Rq:, (20 16)3:426--436
00 ! I0.1007/s40429-016-0 127-6
ADOLESCENT SUBSTANCE ABUSE (f CHUNG, SECTION EDITOR)
Pe...
Well-Venture Project
❖ This project aims to adapt personality-targeted
interventions for youth in child welfare system.
• ...
Well-Venture Project
• Content of interventions
• Assessments
• Procedure
• Starting date
First working group
meeting
Well-Venture Working Group
Dr. Patricia Conrod
University of Montréal
Dr. Delphine Collin-vézina
McGill University
Dr. Chr...
Well-Venture Project
Ethics approval
Pilot Trial
• Content of interventions
• Assessments
• Procedure
• Starting date
Firs...
200 invited to participate
~ 160 meet personality risk criteria
Randomized
~ 80 Control
- treatment as usual
~ 80 Interven...
Well-Venture Project
Ethics approval
Pilot Trial
Focus group with
participating youth
Second working group
meeting
• Conte...
Conclusions
• Help reducing existing barriers in delivering effective
substance use and mental health services to adolesce...
Thank You!
Hanie Edalati, PhD
Postdoctoral Research Fellow
Centre de recherche du CHU
Sainte-Justine
Département de psychi...
ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health P...
ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health P...
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ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System

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Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System

Hanie Edalati, Patricia Conrod

Published in: Health & Medicine
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ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System

  1. 1. Hanie Edalati, PhD, & Patricia J. Conrod, PhD Department of psychiatry, University of Montreal Centre de recherche du CHU Sainte-Justine Personality-Targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System ISPCAN Caribbean Conference, December 2018
  2. 2. One in 5 adolescents involved in child welfare system struggle with a substance use problem. (Aarons, Brown, Hough, Garland, & Wood, 2001) Substance misuse and related problems are major concerns in adolescents involved in child welfare system. Living in foster homes increases the likelihood of substance abuse by 5X compared to no history of removal. (Pilowsky & Wu, 2006)
  3. 3. More problems with drugs than alcohol. (Singh et al., 2011) Higher diagnosis of substance use disorders compared to youth in the general population. (Aarons et al., 2001; Aarons et al., 2008; Braciszewski & Stout, 2012; Narendorf & McMillen, 2010; Pilowsky & Wu, 2006; Vaughn, Ollie, McMillen, Scott, & Munson, 2007; Wall & Kohl, 2007) Canadian Incidence Study of Reported Child Abuse and Neglect- 2003: 14% of all 10-15 year old individuals investigated for maltreatment and 16% of individuals with substantiated cases had substance abuse problem (Trocmé et al., 2005; Singh, Thornton, & Tonmyr, 2011).
  4. 4. Several factors contribute to the increased risk of substance use problems in youth involved in child welfare system: • Lagging behind their peers from the general population, lower educational outcomes, higher rates of homelessness, and criminal justice involvement (Gypen, Vanderfaeillie, De Maeyer, Belenger, & Van Holen, 2017). • Child maltreatment, parental substance use, multiple placement changes, and lack of family support when transitioning into independent living situations (Aarons et al., 2008; McCoy, McMillen, & Spitznagel, 2008; Walsh, MacMillan, & Jamieson, 2003) . • 49% meet the criteria for a current mental disorder, mainly externalising disorders, following by anxiety, depression, and ADHD (results from a systematic review and meta-analysis; Bronsard et al., 2016).
  5. 5. Less than 10% of adolescents and young adults in need receiving such interventions (SAMHSA, 2009).
  6. 6. Personality Risk Profiles as Targets for Reducing Substance Use Problems in Adolescents Involved in Child-welfare System
  7. 7. PERSONALITY TRAITS CO-OCCURING DISORDER Sensation Seeking Negative Thinking Anxiety Sensitivity Externalising Problems Poor response inhibition and emotional reactivity Sensitivity to reward and the incentive/reinforcing properties of substances Negative affect regulation Anxiety Disorders Mood Disorders Hyperarousal and sensitivity to dampening effects of substances/ increased withdrawal symptoms MOTIVATIONAL PROFILE DISINHIBITEDTRAITSINHIBITED/NEUROTICTRAITS Conrod and Nikolaou, Journal of Child Psychology and Psychiatry,2016 Stimulant- ------- Drug/ Alcohol Misuse ------- Sedative SUBSTANCE USE
  8. 8. • Exposure to adverse childhood experiences and trauma is associated with development of maladaptive personality patterns (Kim, Cicchetti, Rogosch, & Manly, 2009; Nakao et al., 2000). Childhood Adversity and Development of Personality • Cross-sectional and longitudinal studies have indicated that personality risk profiles mediate the association of childhood maltreatment with subsequent substance use and psychopathology in adolescents (Bailey & McCloskey, 2005; Oshri, Rogosch, & Cicchetti, 2013; Edalati & Krank, 2015; Spinhoven, Elzinga, Van Hemert, de Rooij, & Penninx, 2016).
  9. 9. What are the Personality-targeted Interventions (i.e., Preventure Program)? Dr. Patricia Conrod Department of Psychiatry University of Montréal
  10. 10. Space: • One roomin school,clinic Outputs Participants: • Adolescents who scored one standard deviation above the mean of their population on one ofthe SURPS measures • A trained facilitator anda trained co-facilitator Activities: • Two 90-minute individual- or group-basedworkshops • Interventions are conducted usingmanuals that include: o Psycho-educational component o Motivational enhancement therapy (MET) o Cognitive behavioural therapy (CBT) o Real life ‘scenarios’ shared by local youth with similar personalityprofiles Direct Product: Participants learn howtheir personality profile leads to certain emotional and behavioural reactions and adverse consequences Impact Outcomes Short and Intermediate Outcomes: • Delaying the ageof onset • Decrease in the rates of illicit drug use and binge drinking • Decrease inescalation of substancemisuse • Reduction in likelihood of transitioning to significant mental health problems including anxiety, depression, suicidal ideation, and conduct problems • Effects last for upto three years Participants Learn How To: • Set long-termgoals • Cope withtheir personality • Weight theconsequences of their actions • Challenge hot thoughts related to their personalityprofile • Break down their experience with risky situations into physical sensations, thoughts,and actions • Make healthydecisions The Logic Model for the Preventure Programme Long-term Outcomes: • Reduce underage substance use harms • Improvemental health of youth Input Human Resources: • 2-3 day workshops for training the facilitators(e.g., teachers, counsellors, social workers, clinicians) Products: • SubstanceUse Risk Profile Scale (SURPS) • Manuals for each typeof personality profile: o Impulsivity o Sensation- seeking o Anxiety sensitivity o Negative Thinking Edalati & Conrod, International Journal of Child and Adolescent Resilience, 2017
  11. 11. Validated Prevention Program through 8 Randomised Trials
  12. 12. Curr Addict Rq:, (20 16)3:426--436 00 ! I0.1007/s40429-016-0 127-6 ADOLESCENT SUBSTANCE ABUSE (f CHUNG, SECTION EDITOR) Personality-Targeted Interventions for Substance Use and Misuse Table 1 Summary of eight random.ized trials of personality-targe ted interventions for ubstance misuse a.oc!standardized effoct s i:zesCohen'sd Pat ricia J . C onrod 1 equivalent) Trial Personality trait,; PopuJation targeted Behaviouml outcomes targeted targetoo Effect rz.esait reported as Cohen's d 1. Monlreal Prescription Drug and Alcohol Dependence Trial [22] 2. Canadian Prevenrure Trial [60] 3. College AS Trial" [78] 4. UK Preventure Triabl [61,62•,81] S. Dutch Preventuree Trial [77] 6. Advenrure Triael[24, 63•] 7. Austmlian Srudy [SI] 8. CBT for HighAS [64] IMP/SS, AS, HOP AS, SS, HOP AS AS, IMP,HOP, SS AS, IMP,HOP, SS AS, IMP,HOP, SS AS, IMP,HOP, SS AS Alcohol and/or prescription drug- dependent women Int: 11 = 78 Ctr. 11 =45 HR secondarysrudents (drinkers) Int: N= 166 Ctr. 11 =131 College student,; Int: 11= 51 Ctr: 11=56 HR secondary srudents Int: 11 = 190 Ctr: 11=157 HR secondary srudents (drinkers) Int: 11=343 Ctr: 11 =356 HR secondary srudents Int: 11=558 Ctr. 11 =437 HR secondary srudents Int: 11=202 Ctr: 11 = 291 Community-recruited adults Alcoholuse AlcoholQF Dependence symptoms Remission prescription drug use Alcohol use 4 months) Binge drinking (4months ) Drinking problems 4 months) Drinking frequency Binge drinking Drinking problems Alcohol use 6 months) Binge drinking (6 months) Drinking problems (6 month ) Drinking problems (2 years Drug use frequency 2 years) Cannabis use (2 years) Cocaine use 2 years) Alcohol use (12 months Binge drinking (12 months) Drinking problems ( 12 months) Alcohol use (2 year ) Drinking Q (2 years) Binge drinking (2 years Binge drinking-freq (2 years) Binge drinking-g rowth 2 yea.r.i) Drinking problems (2 years Cannabis use (2 years) Alcohol use (3 years) Binge drinking (3years) Drinking problems (3 year ) Alcohol use Binge drinking Drinking problems (phy) Drinking problems(interper) 0 .4 7 0.10 to 0.84)* 0.02 --OJS to OJ9) 0 .47 (0.10 to 0.84)* 0.46 0.10 to 0.83)* 0.58 0.03 to 1.13)* 020 --0.02 10 0.43) OJ7 0.14 to 0.60)* OJ2 0.09 to 0.55)* 00 ns) ot reported OJ 7 (--0.02 to O.75) 022 0.00 to 0.43)* 02 1(0.00 to 0.42)* OJS (0.00 to0.42)* OJ3 (0.12 to 0.54)* 025 (0.10 to 0.40)* 0.16 (0.04 to OJ4)*d 0.80 (0.94 to 1.17)*d 0.02 OJ3(0.17 to 0.4 7)* 00 ns) 0.68 (0.55 to 0.8 1)* OJ6 (023 to 0.49)* 0.88 0.75 to 1.0 * OJ8 (02 5 to 0.50)* 2.07 (1.91 to 22 2)* 1.02 0.88 to 1.16)* 0.06c--0.0610 0.18f 0.4 7 029 to 0.65)* 0.65 (0.46 to 0.84)* 0.54 (OJ S to 0.72)* ot reported ot reported 0.64 0.48
  13. 13. Well-Venture Project ❖ This project aims to adapt personality-targeted interventions for youth in child welfare system. • To offer targeted interventions for at-risk adolescents in child welfare system; • To integrate a trauma-informed approach into personality- targeted interventions using a developmental perspective; • To reduce the risk of substance use disorders and related problems in adolescents with histories of adverse childhood experiences and trauma.
  14. 14. Well-Venture Project • Content of interventions • Assessments • Procedure • Starting date First working group meeting
  15. 15. Well-Venture Working Group Dr. Patricia Conrod University of Montréal Dr. Delphine Collin-vézina McGill University Dr. Christine Wekerle McMaster University Dr. Sherry Stewart Dalhousie University Dr. Christopher Mushquash Lakehead University Dr. Hanie Edalati University of Montréal
  16. 16. Well-Venture Project Ethics approval Pilot Trial • Content of interventions • Assessments • Procedure • Starting date First working group meeting
  17. 17. 200 invited to participate ~ 160 meet personality risk criteria Randomized ~ 80 Control - treatment as usual ~ 80 Intervention - four 45-minutes group sessions • Study will be conducted at Batshaw Youth and Family Centres. Girls & Boys Age: 12-17 Follow up for 3 months on cognitive, mental health, and substance use variables Well-Venture pilot trial • 13-15 facilitators (educators and counsellors) from Batshaw Centres will be trained.
  18. 18. Well-Venture Project Ethics approval Pilot Trial Focus group with participating youth Second working group meeting • Content of interventions • Assessments • Procedure • Starting date First working group meeting • Qualitative • Quantitative Data analysis
  19. 19. Conclusions • Help reducing existing barriers in delivering effective substance use and mental health services to adolescents involved in child welfare system and those living in vulnerable context or exposed to maltreatment/trauma, but are not known to the child welfare system. • Efficacious and efficient approach: ▪ Peer involvement, group sessions ▪ Critical period in development ▪ Prospective risk factors rather than early signs of problems ▪ CBT and motivational techniques: target individual risk factors, personally- relevant, focused, and easy for adolescents to engage ▪ Sensitivity to the developmental needs, cultural values, and attitudes of the target group ▪ Reduces a range of concurrent psychiatric symptoms and disorders
  20. 20. Thank You! Hanie Edalati, PhD Postdoctoral Research Fellow Centre de recherche du CHU Sainte-Justine Département de psychiatrie Université de Montréal Hanie.edalati@umontreal.ca www.conrodventurelab.com

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