TIP 31 & 31 Adolescent ddictions Treatment

1,204 views

Published on

Mental Health continuing education and addictions counselor training series. Narrated versions available at http://www.allceus.com

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,204
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
27
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

TIP 31 & 31 Adolescent ddictions Treatment

  1. 1. TIPs 31 and 32 Adolescents Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  2. 2. Adolescent Development Cognitive  ◦ Early Adolescence  Emphasizes immediate reactions to behavior  May not be fully aware of later consequences ◦ Late Adolescence  Greater use of inductive/deductive reasoning  More introspective and more sensitive to later consequences Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  3. 3. Developmental Tasks Family Independence  ◦ Beginning rejection of parental guidelines ◦ Ambivalence about wishes ◦ Insistence on independence, privacy ◦ May have overt rebellion, limit testing, withdrawal Peers  ◦ Early: Most often quot;bestquot; friend is same sex ◦ Late: Dating, risk taking, need to please peers Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  4. 4. Developmental Tasks cont… School and Vocation  ◦ Beginning to identify skills, interests ◦ Starting part-time job Self Identity and Esteem  ◦ Am I normal? ◦ Conformity--behavior that meets peer group values ◦ Some continue to pursue group/peer acceptance ◦ Some are able to reject group pressure if not in self-interest Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  5. 5. Professional Approach Early Adolescents  ◦ Provide firm, direct support ◦ Convey limits--simple concrete choices ◦ Do not align with parents, be an objective caring adult ◦ Encourage transference (hero-worship) ◦ Sexual decisions--directly encourage to wait ◦ Encourage parental presence in clinic, but interview teen alone Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  6. 6. Professional Approach cont… Late Adolescence  ◦ Be an objective sounding board (but let adolescents solve own problems) ◦ Negotiate choices ◦ Be role model ◦ Don't get too much history (quot;grandiose storiesquot;) ◦ Confront gently--about consequences, responsibilities Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  7. 7. Professional Approach cont… ◦ Consider quot;What gives them status in the eyes of peers?quot; ◦ Use peer group sessions ◦ Adapt systems to crises, walk- ins, impulsiveness, testing ◦ Ensure confidentiality ◦ Allow teens to seek care independently Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  8. 8. Screening and Assessment Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  9. 9. Screening and Assessment Selection of instruments is guided by:  1. Reliability and validity of the tool 2. Its appropriateness to an adolescent population 3. Type of settings in which the instrument was developed 4. Intended purpose of the instrument Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  10. 10. Features of Instruments Short in duration  High test-retest reliability  Evidence of convergent validity (i.e., the  instrument is strongly correlated with other instruments that purport to measure similar constructs)  Predictive validity (i.e. school performance, relapse)  Normed on adolescents  Ability to measure meaningful behavioral and attitude changes over time Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  11. 11. Family Assessment Adolescents may define family in  nontraditional ways.  The law and society may define family in ways that differ from the actual experiences of youth.  Cultural and ethnic differences in family structures should be respected.  The core problem may reside outside the adolescent and the substance use is a symptom. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  12. 12. Screening Indicators Use during childhood or early  adolescence Use before or during school  Peer involvement in use  Daily use of one or more substances  Parental substance abuse  Sudden change in school performance  Marked change in physical or mental  health Risky activities  Truancy or running away  Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  13. 13. Goals of Screening Determine severity of disorder   Examine associated factors  Make appropriate referrals Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  14. 14. Assessment More in-depth than screening  Document disorders and interactions  across all domains  Identifies information to guide treatment planning ◦ Strengths ◦ Social supports ◦ Motivation Provides an opportunity for engagement  and motivational enhancement  Is an ongoing process Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  15. 15. Areas for Assessment Substance use history  ◦ Age of first use for each drug ◦ Frequency, intensity, duration ◦ Concurrent use ◦ Immediate and remote consequences of use ◦ Family history of use ◦ Peer and family attitudes toward drug use Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  16. 16. Areas for Assessment cont… Mental health  ◦ Family history ◦ Client’s history ◦ Present symptoms ◦ Past and present medication and/or treatment and effects ◦ Coping skills and strengths ◦ Trauma ◦ Self-esteem ◦ Eating disorders Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  17. 17. Areas for Assessment cont… Physical health  ◦ Current/past ◦ Current medications ◦ Family health history ◦ Housing School experience  ◦ Performance ◦ Attendance ◦ Enjoyment ◦ Learning disabilities Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  18. 18. Areas for Assessment cont… Social  ◦ Peer relationships ◦ Changes in peer groups ◦ Interpersonal skills ◦ Neighborhood environment ◦ Gang involvement ◦ Pro-social activities ◦ Mentors/social supports Sexual history  ◦ Activity ◦ Orientation ◦ STDs/pregnancies Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  19. 19. Areas for Assessment cont… Juvenile justice involvement   Developmental milestones and events  Family history ◦ Parental relationships ◦ Involvement with DCF ◦ Home environment Other strengths  Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  20. 20. Integrated Summary Identifies the severity of all disorders   Identifies (mitigating and exacerbating) factors  Identifies a corrective plan of action to address these problem areas  Details a plan to ensure that the treatment plan is individualized, implemented and monitored  Makes recommendations for referral Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  21. 21. Integrated Summary cont… Identifies a SPOC   Describes how resources and services of multiple agencies can best be coordinated and integrated  Recommend post-treatment services Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  22. 22. Assessors Trained in:  ◦ Psych assessment ◦ SA assessment ◦ Developmental psychology ◦ Use of standardized tools Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  23. 23. Legal Issues Federal confidentiality regulations (42  C.F.R. 2.12(e))  Disclosure without the adolescent's consent in situations such as: ◦ medical emergencies ◦ child abuse reports ◦ program evaluations ◦ communications among staff Programs may not communicate with the  parents of an adolescent unless they get the adolescent's written consent. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  24. 24. Legal Issues cont… The Federal regulations contain an  exception permitting a program director to communicate with an adolescent's parents without her consent when: ◦ The adolescent is applying for services ◦ The program director believes that the adolescent does not have the capacity to decide ◦ The program director believes the disclosure is necessary due to a substantial threat to the life or well-being of the adolescent or someone else Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  25. 25. Legal Issues cont… Other exceptions:  ◦ Information that does not reveal the client as having a substance use disorder ◦ Information ordered by the court after a hearing ◦ Medical emergencies ◦ Information regarding crimes on program premises or against program personnel ◦ Information shared with an outside agency that provides service Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  26. 26. Legal Issues cont… Other exceptions cont…  Information discussed among people within o the program Information disclosed to o researchers, auditors, and evaluators with appropriate Institutional Review Board review and approval to ensure the protection of program participants Note: Always check with your legal counsel  in your state to ensure conformance with state as well as federal laws Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  27. 27. Issues in DJJ Concurrent issues  ◦ Physical or sexual abuse ◦ Psychological and emotional problems ◦ Poor performance in school ◦ Family difficulties ◦ Gang-related violence and involvement ◦ Living in neighborhoods where poverty and low income have led to communitywide despair and hopelessness Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  28. 28. Treating Adolescents Adolescents are not little adults   Drug and alcohol use often stems from different causes  They have trouble anticipating the consequences of their use  Must address cognitive, emotional, physical, social and moral development Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  29. 29. Treating Adolescents cont… Take into account  gender, ethnicity, disability status, stage of readiness to change and cultural background  Identify and treat delays in normal cognitive and social-emotional development associated with substance use during adolescence  Involve the adolescent's family because of: ◦ its possible role in the origins of the problem ◦ its ability to change the youth's environment Be sensitive to motivational barriers  Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  30. 30. Treatment Planning Identify biopsychosocial problems   Identify attainable goals for those issues  Enhance strengths and resources to meet those goals  Specify objectives that are realistic and measurable for each goal  Describe interventions needed to achieve objectives Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  31. 31. Program Components Orientation   Daily scheduled on-site and off-site activities  Peer monitoring  Conflict resolution  Vocational Training Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  32. 32. Program Levels Detoxification   Outpatient  Intensive Outpatient  Group Home/Residential  Inpatient/Hospital Based  Continuing Care Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  33. 33. 12 Steps for Adolescents Providers treating adolescents in a 12-  Step-based program should bear the following in mind: ◦ CoD are primary, multifaceted illnesses that exist in people of all ages, including adolescents ◦ Persons with CoD share a common problem but have unique and separate needs ◦ Once adolescents are informed in an understandable way, they are capable of helping others with guidance Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  34. 34. 12 Steps for Adolescents cont… ◦ Use of group therapy is well suited to adolescents, who tend to rely heavily on peer examples and approval ◦ The principles of recovery outlined by AA/NA provide effective and proactive tools for continuing recovery ◦ Once a person has lost control over his use of substances as an adolescent, returning to responsible and legal use as an adult may require additional help and support Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  35. 35. Adolescents and the First 5 Steps Focus on the first 5 steps during  treatment ◦ Step 1: We admitted we were powerless over alcohol--that our lives had become unmanageable.  Assist adolescents in reviewing their SA history and associate it with harmful consequences. ◦ Step 2: We came to believe that a Power greater than ourselves could restore us to sanity.  Help adolescents with CoD to understand that Step 2 refers to obtaining help to stop drug seeking and use behavior. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  36. 36. Adolescents and the First 5 Steps cont… ◦ Step 3: We made a decision to turn our will and our lives over to the care of God as we understood Him.  Using the phrase quot;Helping Powerquot; instead of quot;Higher Powerquot; or “Good Orderly Direction” can benefit some. ◦ Step 4: We made a searching and fearless moral inventory of ourselves; Step 5: We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.  Steps 4 and 5 provide an opportunity to be accepted by another person in spite of one's past behaviors and to take a quot;personal inventoryquot; of those past behaviors. Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  37. 37. Staff Training Treatment approaches specific to  adolescents and their families  Family dynamics and family therapy  Adolescent growth and development  Sexual and physical abuse  Gender issues  Mental health problems  Different cultural and ethnic values Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  38. 38. Staff Training cont… Psychopharmacology  Referral and community resources  Cognitive impairments  Legal matters Recreational and pro-  social activities Group dynamics and group therapy  Suicidal behavior  Grief and loss  Management of oppositional and violent  behaviors Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  39. 39. Staff Training cont… Legal matters (custody and juvenile  justice concerns, child abuse and neglect reporting requirements, duty-to-warn issues) Treatment planning and documentation  HIV/AIDS  Other health matters  (STDs, tuberculosis, hepatitis, nutrition) Gangs  Drug dealing  Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
  40. 40. Summary Treating adolescents requires special  skills and training Most adolescents begin use to cope or  receive external validation Adolescents’ development is often  thwarted at the point of SA initiation A strengths-based motivational approach  works well with older adolescents Adolescents can be helped to develop  into healthy adults Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

×