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ACCESSING THE KNOWLEDGE AND METHODS
OF THE TREATMENT INDUSTRY
(”TREATMENT PROGRAMS” & “THERAPEUTIC COMMUNITIES”)
TO FACILI...
I N T R O D U C T I O N
Part I: Focus on background, history, case studies, outcomes
Part II: Techniques, methods, challen...
P a r t I
FOCUS ON BACKGROUND,
HISTORY, CASE STUDIES, OUTCOMES
W E FA C E
G R O W I N G G L O B A L
C O N C E R N S …
Gilberto Gerra,
Chief, Drug
Prevention and
Health Branch,
UNODC
© 1999 - 2019 Linking Human, LLC
M A S S T R A U M A
E c o n o m y n e x t . c o m
• Earth’s climate is changing at an unprecedented rate
• The United Nations estimates that there will be 200
million peopl...
© 1999 - 2018 Linking Human Systems, LLC
Every refugee and
forced immigrant
population has an
average of 30%
increase in a...
© 1999 - 2018 Linking Human Systems, LLC
E P I D E M I C S & PA N D E M I C S
YELLOW FEVER
At least 51 people
died in Ango...
R A N D O M T R A U M AT I C E V E N T S
Random, unpredictable acts of violence are more terrifying, and
have greater imme...
P H Y S I C A L O R E M O T I O N A L
A B U S E / N E G L E C T
I S A P R E C U R S O R
O F S E L F - I N J U RY A N D S U...
PA R E N T S ’ C H I L D H O O D T R A U M A C A N
I N F L U E N C E T H E I R C H I L D R E N ’ S B E H AV I O R
A S C A ...
C H A N G I N G
T E C H N O L O G Y
Fear of Missing out FOMO
Fear of Being Ignored FOBI
Peer pressure
Belief that all important information is on their digita...
BRAINS & BODIES DO NOT FULLY
MATURE UNTIL 22 - 26 YEARS OF AGE
• Substances and behavioral compulsions can have a life-lon...
Y O U N G P E O P L E A R E V U L N E R A B L E
D U R I N G T R A N S I T I O N
TRAUMATIC
TRANSITIONS
RESULT IN
INCREASED
RATES OF… RELAPSE
STRESS
DEPRESSION &
SUICIDE
“Suicide is the second leading cau...
“ S U I C I D E I S T H E S E C O N D L E A D I N G C A U S E
O F D E AT H F O R P E O P L E A G E D 1 0 - 2 4 ”
T H E M A...
G E N D E R D Y S P H O R I A
GAMBLING/GAMING
LOVE & SEX
COMPULSION
? ? ? ? ? ? ? ? ?
EATING DISORDERS
• All of these factors threaten the fabric of families
• If families are at risk, youth and communities are at
risk
T H E ...
By:
• Expanding the capacity to recognize early warning signs
• Finding hope in the face of despair
• Preventing the inter...
.
BECAUSE:
• Children were treated as small adults in all aspects of life
• Awareness of their separate developmental need...
the first facility
specifically for
mental health is
established in
Spain
5th century BC
Ancient civilizations like the
Ro...
Temperance
Societies
developed in
the UK,
Europe and
the US
1774
Dr. Benjamin
Rush’s “Effects of
Ardent Spirits on
the Hum...
© 2015 International Recovery Institute, LLC
T H E C O M M O N V I E W
O F M E N T A L I L L N E S S
THE JOINT
COUNTIES’
LUNATIC ASYLUM
In the late 1880s, Nelly Bly posed as a mentally
ill woman, and documented everything that
happened to her in a series of ...
THE KEY ROOTS
OF OUR CURRENT MODELS
Peer Recovery
Model (1920’s)
Maxwell Jones Model 1940’s
Psychiatric Therapeutic Commun...
Synanon,
1958, Santa
Monica, US,
first addiction
focused
therapeutic
community
1935
Maxwell Jones, GB,
with Sanctuary
mode...
Our clients may be best
served by our humility and
readiness to integrate that
which is tried and true and
proven to work ...
WHAT HAVE WE LEARNED?
A quick trip around the world to look at current models used independently or in
combination
Modern ...
Whatever our individual
practice, most of us
consider the multifactorial
nature of challenges facing
our youth, and explor...
Y O U T H D I F F E R F R O M A D U L T S
I N T H E I R R E S P O N S E T O
T R A N S I T I O N S & S T R E S S
ALL YOUTHS AND FAMILIES ARE IN TRANSITION,
AND DEPENDING ON CULTURAL INFLUENCES ARE
IN OR OUT OF SYNC.
FAMILY LIFE
SPIRAL 1985
1985
FAMILIES
CAN
INFLUENCE
OUTCOMES
C O N N E C T E D N E S S S T U D I E S
MEASURES
1. Sexual risk-taking
2. Frequency of contact with extended family
3. Kno...
Draw on the family’s inherent resilience
rather than labeling behavior and
communication patterns as dysfunctional,
which ...
• Connectedness is interpreted as a
reward by the brain and is associated
with the release of dopamine
• Conversely, brain...
P O S I T I V E Y O U T H D E V E L O P M E N T
Focus on:
• Strengths and development potential rather than
deficits
• Rej...
Keys to ARISE® for adolescents and young adults
Respect
• Young people are full members of the family
Transparency
• Invit...
WHAT CAN TREATMENT PROGRAMS DO?
• A sense of social connection is a fundamental human need
• Number of close confidantes i...
SHIFTING
THE FAMILY
PERSPECTIV
E © 1999 - 2019 Linking Human, LLC
P H I L O S O P H Y
• Families are intrinsically healthy with both
strengths and vulnerabilities
• In constant transition
...
THE FIVE
KEYS
PRINCIPLES
• Empower family, community, and natural support system
• Reinforce connection to family- and cul...
W H A T C A N F A M I L I E S D O ?
• Share family meals
• Talk to one another regularly
• Take care of one another during...
WHAT CAN
FIRST
RESPONDERS
DO?
• Observe safety precautions at all times, for
self and others
• Always work with a team
• D...
W H A T C A N E D U C A T O R S &
C O N S U L T A N T S D O ?
• Understand the family life cycle
• Recognize learning styl...
W H AT C A N T H E R A P I S T S , C O U N S E L O R S
& T R E AT M E N T P R O G R A M S D O ?
• Communicate, connect and...
W H AT C A N T H E R A P I S T S , C O U N S E L O R S &
T R E AT M E N T P R O G R A M S D O ? ( C O N T D )
• Respect th...
R E S E A R C H VA L I D AT I O N
O F
I N T E G R AT I V E A P P R O A C H E S
• “Few substance abusers enter treatment without pressure from
family and friends” (Marlatt, et al., 1997)
• Narratives of...
• Transitional FamilyTherapy protocol for adolescent
outpatient services, 16 sessions (NIAAA)
• Compared with treatment as...
Improving Life
Outcomes For
Children With
History Of Mental
Health Challenges
And Trauma
SAMHSA’s CMHI National Evaluation...
• 2010 (52 countries)– repeated 2016 (26 countries)
• Effective for individual and social outcomes and cost
effectiveness....
LINC® EXAMPLE 1:
COMMUNITY & FAMILY
COMMUNITY RESILIENCE: 10,000 LIDERES PARA EL CAMBIO (BUENOS
AIRES PROVINCE, ARGENTINA ...
LINC® EXAMPLE 2:
COMMUNITY & FAMILY
COMMUNITY RESILIENCE: POST-WAR KOSOVO
• FOCUS: improving services and treatment compli...
LINC COMMUNITY RESILIENCE (1990): 10,000 Lideres
para el cambio (Buenos Aires Province, Argentina - pop.
12 million)
• FOC...
TOGETHER WE CAN WORK TO INTEGRATE THE MEDICAL,
SCIENTIFIC AND PEER RECOVERY METHODS TO BENEFIT
AND BRING HOPE AND HEALING ...
Y O U T H A T R I S K :
W H Y F A M I L I E S M A T T E R
Lee Fitzgerald’s London Conference
London – Nov 16 – 17, 2018
Ju...
London iCAAD 2019 - Dr Judith Landau and Gale Saler - Part 1 - ACCESSING THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY ...
London iCAAD 2019 - Dr Judith Landau and Gale Saler - Part 1 - ACCESSING THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY ...
London iCAAD 2019 - Dr Judith Landau and Gale Saler - Part 1 - ACCESSING THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY ...
London iCAAD 2019 - Dr Judith Landau and Gale Saler - Part 1 - ACCESSING THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY ...
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London iCAAD 2019 - Dr Judith Landau and Gale Saler - Part 1 - ACCESSING THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY AND THERAPEUTIC COMMUNITY TO HELP CHILDREN, FAMILIES AND COMMUNITIES WORK TOGETHER TO FACILITATE RESILIENCE AND IMPROVE OUTCOMES

Presentation #1: Bridging the knowledge of the treatment industry and Therapeutic Community.

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London iCAAD 2019 - Dr Judith Landau and Gale Saler - Part 1 - ACCESSING THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY AND THERAPEUTIC COMMUNITY TO HELP CHILDREN, FAMILIES AND COMMUNITIES WORK TOGETHER TO FACILITATE RESILIENCE AND IMPROVE OUTCOMES

  1. 1. ACCESSING THE KNOWLEDGE AND METHODS OF THE TREATMENT INDUSTRY (”TREATMENT PROGRAMS” & “THERAPEUTIC COMMUNITIES”) TO FACILITE RESILIENCE AND IMPROVE OUTCOMES ICAAD 2019 London, UK Judith Landau, MD, DPM, LMFT, CFLE, CIP, CA Gale Saler, LCPC, CRC-MAC CAI, CIP ARISE® Network www.ARISE-Network.com 1 (877) 229-5462
  2. 2. I N T R O D U C T I O N Part I: Focus on background, history, case studies, outcomes Part II: Techniques, methods, challenges and solutions Part III: Goals, tasks and actions for your own program/practice and community
  3. 3. P a r t I FOCUS ON BACKGROUND, HISTORY, CASE STUDIES, OUTCOMES
  4. 4. W E FA C E G R O W I N G G L O B A L C O N C E R N S …
  5. 5. Gilberto Gerra, Chief, Drug Prevention and Health Branch, UNODC
  6. 6. © 1999 - 2019 Linking Human, LLC
  7. 7. M A S S T R A U M A
  8. 8. E c o n o m y n e x t . c o m
  9. 9. • Earth’s climate is changing at an unprecedented rate • The United Nations estimates that there will be 200 million people displaced by climate change by the year 2050 • Climate change could create the world biggest refugee crisis C L I M AT E R E F U G E E S
  10. 10. © 1999 - 2018 Linking Human Systems, LLC Every refugee and forced immigrant population has an average of 30% increase in addiction, mental health, heart and lung issues UNHCR (2017)
  11. 11. © 1999 - 2018 Linking Human Systems, LLC E P I D E M I C S & PA N D E M I C S YELLOW FEVER At least 51 people died in Angola after a yellow fever outbreak in February 2016
  12. 12. R A N D O M T R A U M AT I C E V E N T S Random, unpredictable acts of violence are more terrifying, and have greater immediate and long term impact than violence in a community that is organized and at a constant level of preparedness, e.g., Israelis and Palestinians Danieli, et al., 2010 © 1999 - 2018 Linking Human Systems, LLC
  13. 13. P H Y S I C A L O R E M O T I O N A L A B U S E / N E G L E C T I S A P R E C U R S O R O F S E L F - I N J U RY A N D S U I C I D E © 1999 - 2019 Linking Human, LLC R i c h a r d L . L i u , P h D ( 2 0 1 7 )
  14. 14. PA R E N T S ’ C H I L D H O O D T R A U M A C A N I N F L U E N C E T H E I R C H I L D R E N ’ S B E H AV I O R A S C A N T H E I R S U B S TA N C E U S E , D I V O R C E , D E P R E S S I O N Rapaport (2018) © 1999 - 2019 Linking Human, LLC
  15. 15. C H A N G I N G T E C H N O L O G Y
  16. 16. Fear of Missing out FOMO Fear of Being Ignored FOBI Peer pressure Belief that all important information is on their digital media Detaching from the Real World Conditioned to instant response to the “ting” WHY OVERUSE? It’s estimated that kids and youth between the ages of 8 to 28 spend about 44.5 hours each week in front of digital screens. (NIH) You are fat and ugly: you are a freak” Cyberbullying Sexting: 1 out of 7 youth has sent explicit picture; 1 out of 6 has received picture: Increases the risk of being trafficked GAMING GAMBLING 50 percent of youth say they feel addicted to their mobile devices. © 1999 - 2019 Linking Human, LLC
  17. 17. BRAINS & BODIES DO NOT FULLY MATURE UNTIL 22 - 26 YEARS OF AGE • Substances and behavioral compulsions can have a life-long impact on brain and body • Substances and compulsive behavior before maturity can cause permanent abnormalities • The later the use/behaviors start, the less damage is caused • The sooner the use/behavior stops, the more opportunity for healing © 1999 - 2019 Linking Human, LLC
  18. 18. Y O U N G P E O P L E A R E V U L N E R A B L E D U R I N G T R A N S I T I O N
  19. 19. TRAUMATIC TRANSITIONS RESULT IN INCREASED RATES OF… RELAPSE STRESS DEPRESSION & SUICIDE “Suicide is the second leading cause of death for people aged 10-24” Alongi, 2017
  20. 20. “ S U I C I D E I S T H E S E C O N D L E A D I N G C A U S E O F D E AT H F O R P E O P L E A G E D 1 0 - 2 4 ” T H E M A J O R I T Y A R E W O M E N April 22, 2017. Phyllis Alongi, Clinical Director of the Society for the Prevention of Teen Suicide
  21. 21. G E N D E R D Y S P H O R I A GAMBLING/GAMING LOVE & SEX COMPULSION ? ? ? ? ? ? ? ? ? EATING DISORDERS
  22. 22. • All of these factors threaten the fabric of families • If families are at risk, youth and communities are at risk T H E P E R F E C T S TO R M
  23. 23. By: • Expanding the capacity to recognize early warning signs • Finding hope in the face of despair • Preventing the intergenerational legacy of disconnection and trauma resulting in mental health, physical health and addiction issues • Dealing with global challenges WE NEED TO EMBRACE OUR HI STORY TO BE EFFECTI VE
  24. 24. . BECAUSE: • Children were treated as small adults in all aspects of life • Awareness of their separate developmental needs only started between WWI and WWII • Child guidance movement started in Britain from the end of the First World War • Children’s problems were attributed to maladjustment. This view still prevails in some communities ADOLESCENTS AND YOUNG ADULTS WERE EVEN MORE AT RISK UNTIL THE MID-1900’S
  25. 25. the first facility specifically for mental health is established in Spain 5th century BC Ancient civilizations like the Romans & Egyptians considered mental health problems to be a religious nature. Some thought a person with a mental disorder may be possessed by demons, thus prescribing exorcism as a form of treatment Pre 1400 CE 1407 CE John Locke believed all or almost behavioral traits come from "nurture" termed tabula rasa ("blank slate") 1690 Sir Francis Galton's English Men of Science: Their Nature and Nurture, argued that intelligence and character traits came from hereditary factors (this was well before the modern science of genetics). We still argue the genetics versus environment issue 1874 Hippocrates believed that mental illness and alcoholism were physiologically affiliated. As a result, his methods involved a change in environment, living conditions, or occupations Phillipe Pinel (France)l: First advocacy to improve living conditions for mentally ill persons occurred in France 1700s Native American Alcoholic mutual aid societies (sobriety "Circles") 1750 to Early 1800s
  26. 26. Temperance Societies developed in the UK, Europe and the US 1774 Dr. Benjamin Rush’s “Effects of Ardent Spirits on the Human Mind and Body” defined alcoholism as a disease 1784 1805 Rev. Lyman Beecher's Six Sermons on Intemperance "addicted to sin" 1825 Dr. Samuel Woodward called for creation of inebriate asylums and 1840: The Washingtonian Society was organized 1830-1840 1774: Anthony Benezet's “Mighty Destroyer Displayed” published. Procedures in mental health facilities were unspeakably cruel—unfortunately in some countries these conditions still prevail: Insulin-induced comas; Lobotomies; Malarial infections; Ice cold baths and showers (sometimes with the ice); Electroshock (Electroconvulsive) therapy (ECT); Chemical Interventions 1700’s- 1870’s Dorothea Dix fought for better living conditions and compassionate care for mentally ill and got government to build of 32 state psychiatric facilities. 1840s-1870’s Frederick Douglass issued a call for abstinence as a foundation of the drive to abolish slavery 1840’s 1870 The American Association for the Cure of Inebriety was founded under the principle "Inebriety is a disease." German psychiatrist Emil Kraepelin studies mental illness and began to draw distinctions between different disorders. 1883 Sigmund Freud recommends Cocaine for treatment of alcoholism and morphine addiction. 1880s Bottled home cures contained alcohol, opium, morphine, cocaine and cannabis 1890’s
  27. 27. © 2015 International Recovery Institute, LLC T H E C O M M O N V I E W O F M E N T A L I L L N E S S
  28. 28. THE JOINT COUNTIES’ LUNATIC ASYLUM
  29. 29. In the late 1880s, Nelly Bly posed as a mentally ill woman, and documented everything that happened to her in a series of articles and a book. 1879 Placing the mentally ill in facilities allowed members of the general public to ignore the problem. They didn’t see anyone who had a mental illness and if they placed a person in an institution or prison they just disappeared 1880s late 1800s Wundt founded the first formal laboratory for psychological research at the University of Leipzig. Using psychoanalytical theories, Sigmund Freud and Carl Jung treated their patients for mental illness. Many of the theories they employed are still discussed today and used as a basis for the study of psychology along with all the leaders of modern thought, psychology and psychiatry Early 1900s
  30. 30. THE KEY ROOTS OF OUR CURRENT MODELS Peer Recovery Model (1920’s) Maxwell Jones Model 1940’s Psychiatric Therapeutic Community basis of both medical and peer systems I n t e g r a t i v e M o d e l Addiction Treatment Center Model (1950’s) © 1999 - 2019 Linking Human, LLC
  31. 31. Synanon, 1958, Santa Monica, US, first addiction focused therapeutic community 1935 Maxwell Jones, GB, with Sanctuary model therapeutic community originally in psychiatric facilities 1940’s-1960’s 1805 The establishment of drug-free TCs in Europe for heroin problems TCs now in more than 65 countries 1960’s-1970’s marked a movement in advocacy and care for mental health and addiction with development of psychiatric facilities marking a split in treatment models with both using variations on the therapeutic community Early 20th century Alcoholics Anonymous (AA) was founded in 1935 by Bill Wilson (known as Bill W.) and Dr. Robert Smith (known as Dr. Bob). Beginning of peer recovery movement followed by publication of the “Big Book” Methadone approved for pain management 1947 A wave of deinstitutionalization began 1950s to 1960s beginning of psychiatric medication with lithium then antipsychotics then anti-depressants and anxiolytics 1948-1950’s 1940’s – 1960’s emergence of family therapy and integration of the family into treatment for both psychiatric and addiction issues A new generation of prescription antipsychotic drugs emerged 1990’s A new generation of prescription drugs for treatment and withdrawal from opiates and other drugs 2000’s
  32. 32. Our clients may be best served by our humility and readiness to integrate that which is tried and true and proven to work across time as we develop and grow to address current challenges “The thing that hath been, is that which be: and that which is done is that which shall be done: and there is no thing new under the sun” Book of Ecclesiastes 1:9 © 1999 - 2019 Linking Human, LLC
  33. 33. WHAT HAVE WE LEARNED? A quick trip around the world to look at current models used independently or in combination Modern Therapies include medication, various forms of psychotherapy, neurological interventions PEER RECOVERY PSYCHOTHERAPY Individual, couples, family, group PSYCHOANALYSIS PSYCHIATRY & NEUROLOGY ADJUNCTIVE THERAPIES SCIENTIFIC MEDICINE & MEDICATION TRADITIONAL MEDICINESPIRITUALITY & SPIRITUAL HEALING
  34. 34. Whatever our individual practice, most of us consider the multifactorial nature of challenges facing our youth, and explore each level of bio-psycho- social-spiritual-cultural environmental factors • Developmental history and life cycle • Family and intergenerational developmental history including previous trauma and unresolved losses • Individual, family and intergenerational health and mental health history • Relational history including attachment • Family and community resources including nutrition, education, housing, safety, etc. • Family spiritual history and current beliefs • Culture of the youth, family and environment • Influence of transitions including displacement, loss and trauma • Family and community attitudes towards youth: positive or negative predictors © 2015 International Recovery Institute, LLC
  35. 35. Y O U T H D I F F E R F R O M A D U L T S I N T H E I R R E S P O N S E T O T R A N S I T I O N S & S T R E S S
  36. 36. ALL YOUTHS AND FAMILIES ARE IN TRANSITION, AND DEPENDING ON CULTURAL INFLUENCES ARE IN OR OUT OF SYNC.
  37. 37. FAMILY LIFE SPIRAL 1985
  38. 38. 1985
  39. 39. FAMILIES CAN INFLUENCE OUTCOMES
  40. 40. C O N N E C T E D N E S S S T U D I E S MEASURES 1. Sexual risk-taking 2. Frequency of contact with extended family 3. Knowledge of family stories across time SUBJECTS STUDY 1 Women in a Sexually Transmitted Disease Clinic compared with women in Social Community Center STUDY 2 Troubled adolescent girls. RESULTS STUDY 1 Measures of frequency of contact and knowledge of family stories held up together and separately, and both correlated with reduced sexual risk-taking STUDY 2 Quantitative results were similar. Then analyzed stories for themes of resilience vs. vulnerability 1. Least risk-taking correlated to themes of resilience 2. Next lowest correlated with themes of vulnerability 3. Most risk-taking correlated with knowing no stories Interesting Finding: Content in stories of “resilience” and “vulnerability” were often identical – what varied was how the family perceived challenges they faced Landau, et al, 2000
  41. 41. Draw on the family’s inherent resilience rather than labeling behavior and communication patterns as dysfunctional, which leads to continued vulnerability and risk-taking, rather than increased self- esteem, competence and self-efficacy Landau, et al., 2000 E N H A N C I N G P O S I T I V E C O N N E C T E D N E S S
  42. 42. • Connectedness is interpreted as a reward by the brain and is associated with the release of dopamine • Conversely, brain imaging studies suggest that the same parts of the brain are activated during social rejection and physical pain Ethat Kross, University of Michigan THE BRAIN AND CONNECTEDNESS
  43. 43. P O S I T I V E Y O U T H D E V E L O P M E N T Focus on: • Strengths and development potential rather than deficits • Rejecting the portrayal of adolescents and young adults as “inevitable problems” that need to be fixed • Nurturing core internal strengths and abilities • Providing opportunities to believe in themselves and their ability to influence their lives and the world around them • Encouraging strength and positive development to ease a healthy transition into adulthood
  44. 44. Keys to ARISE® for adolescents and young adults Respect • Young people are full members of the family Transparency • Inviting young people to a family meeting Strength Based Establishing Boundaries Focus on the family system • When one member becomes symptomatic the health of all is impacted • Young person is part of the solution for the whole family K E Y S F O R A D O L E S C E N T S & Y O U N G A D U L T S
  45. 45. WHAT CAN TREATMENT PROGRAMS DO? • A sense of social connection is a fundamental human need • Number of close confidantes in the US decreased from 3 in 1985 to 1 in 2004: 25% of respondents said they have none • Increase in loneliness, isolation, and alienation may be the leading reason people seek psychological counseling • Lack of social connection leads to vulnerability to anxiety, depression, antisocial behavior and suicidal ideation • Building and maintaining social connections requires a level of self- confidence and self-efficacy that many young people lack S O C I A L C O N N E C T E D N E S S
  46. 46. SHIFTING THE FAMILY PERSPECTIV E © 1999 - 2019 Linking Human, LLC
  47. 47. P H I L O S O P H Y • Families are intrinsically healthy with both strengths and vulnerabilities • In constant transition • Typically cope well with transition unless there are 3 or more transitions in a short space of time (or transitions are traumatic) • Able to access and utilize their strength and resilience unless they are cut off from their natural support systems Landau, 1982; Landau & Griffiths, 1979, Landau, Griffiths & Mason, 1978 WE BELIEVE THAT INDIVIDUALS, FAMILIES AND COMMUNITIES ARE:
  48. 48. THE FIVE KEYS PRINCIPLES • Empower family, community, and natural support system • Reinforce connection to family- and culture-of-origin • Focus on individual, family, and community healing and recovery • Remove the “we/they” dichotomy • Mobilize and reconnect the extended natural support system
  49. 49. W H A T C A N F A M I L I E S D O ? • Share family meals • Talk to one another regularly • Take care of one another during times of stress • Take of animals and garden together • Share activities • Worship, meditate, grieve together • Share intergenerational family stories • Get to know one another’s friends • Enjoy family celebration
  50. 50. WHAT CAN FIRST RESPONDERS DO? • Observe safety precautions at all times, for self and others • Always work with a team • Debrief with a colleague or therapist on a regular basis • Provide education about prescribing and taking opiates • Be certified in CPR and administering Naloxone
  51. 51. W H A T C A N E D U C A T O R S & C O N S U L T A N T S D O ? • Understand the family life cycle • Recognize learning styles and challenges • Avoid negative language • Support diversity and tolerance • Develop a robust referral network • Do motivational interviewing • Meet with young people in their homes • Collaborate with families • Know when to refer and when to delegate
  52. 52. W H AT C A N T H E R A P I S T S , C O U N S E L O R S & T R E AT M E N T P R O G R A M S D O ? • Communicate, connect and collaborate with families and other professionals ensuring a continuum of care • Support family communication and connection • Understand that symptomatic behavior in family members has its origins in love and protection • Life cycle transitions repeat themselves unless understood and resolved • Symptomatic behavior in family members has its origins in love and protection • Family, couples, group therapy and psycho-education • Multifamily activities therapy • Identify therapeutic modalities best suited to the client and family • Teach positive ways of self-soothing
  53. 53. W H AT C A N T H E R A P I S T S , C O U N S E L O R S & T R E AT M E N T P R O G R A M S D O ? ( C O N T D ) • Respect the natural hierarchy, identifying natural strengths and resources • Engage the entire system, being sensitive to issues of culture, gender and spirituality • Identify patterns across generations and expose and resolve secrets • Assure continuity of family and community values, mission and heritage Landau, 2018
  54. 54. R E S E A R C H VA L I D AT I O N O F I N T E G R AT I V E A P P R O A C H E S
  55. 55. • “Few substance abusers enter treatment without pressure from family and friends” (Marlatt, et al., 1997) • Narratives of Recovery from Mental Illness: the role of peer support. (Watts& Higgins, 2017) • Engaging the natural support system significantly improves the chances of treatment entry and completion, therefore improving likelihood of long-term recovery (Simpson, 1981) • There is substantial evidence of the effectiveness and longer- lasting results of family couples treatment (Stanton, 2013) • SAMHSA/CSAT No. 39 Treatment Improvement Protocol • Modified therapeutic community for co-occurring disorders: A summary of four studies. (Sacks, Banks, McKendrick & Sacks, 2008) • Modified therapeutic community for mentally ill chemical "abusers": Background; influences; program description; preliminary findings. (Sacks, Sacks, DeLeon, Bernhardt, & Staine, 1997) Jessa please pretty up these next slides FAMILY AND COMMUNITY SUPPORT SYSTEMS DRIVE RECOVERY
  56. 56. • Transitional FamilyTherapy protocol for adolescent outpatient services, 16 sessions (NIAAA) • Compared with treatment as usual at 3 years (NIAAA): • Both adolescent and family markers were significantly improved and continuing to improve at 3 years • Treatment as usual (TAU) both adolescent and family markers improved initially and then returned close to baseline after 3 years ADOLESCENT & FAMILY THERAPUETIC INTERVENTION National Institute of Alcohol Abuse and Alcoholism (NIAAA). Family and Group Therapies for Adolescent Alcohol Abuse. (1 RO1 AA 12178–01). P.I. M.D. Stanton.
  57. 57. Improving Life Outcomes For Children With History Of Mental Health Challenges And Trauma SAMHSA’s CMHI National Evaluation data show: • Children who experience trauma and receive treatment show: • Significant improvements in behavioral and emotional health • Improved school attendance • Fewer problems at school • Evaluation data after one year of treatment show: • Rates of suicidal thoughts reduced 68 percent • Suicide attempts reduced 78 percent • Displays of externalizing behaviors reduced 17 percent • Internalizing symptoms reduced 22 percent
  58. 58. • 2010 (52 countries)– repeated 2016 (26 countries) • Effective for individual and social outcomes and cost effectiveness. • Understands and responds to vulnerable populations and the complexity of other conditions accompanying drug abuse • Responsive also to their families, social environment and communities • Adapt Interventions to participants’ needs and their cultural, social and religious diversity. • Provide aftercare services focused on improving the social reintegration of the participants. GENOA & MALLORCA INTERNATIONAL MEETINGS TO REVIEW EFFECTIVENESS OF THE THERAPEUTIC COMMUNITY
  59. 59. LINC® EXAMPLE 1: COMMUNITY & FAMILY COMMUNITY RESILIENCE: 10,000 LIDERES PARA EL CAMBIO (BUENOS AIRES PROVINCE, ARGENTINA – POPULATION 12 MILLION) • FOCUS: Violence, HIV/AIDS and substance abuse prevention for the entire community • FAMILY/COMMUNITY LINKS: Concerned community members working in collaboration across all levels of the community • RESULT: 400% increase in young substance abusers being brought into treatment by their families within 2 years • Follow up 15 years later, in one city of two million people, 37 of 43 projects were still functioning Landau, 2004, 2007, 2011; Yaria, 2002
  60. 60. LINC® EXAMPLE 2: COMMUNITY & FAMILY COMMUNITY RESILIENCE: POST-WAR KOSOVO • FOCUS: improving services and treatment compliance of chronic mentally ill; reducing rates of addiction; developing health and mental health services • FAMILY/COMMUNITY LINKS: Professional and lay members of community • RESULTS: • Established regional decentralized home health houses and treatment clinics • Mobilized Family and Community Links to reach out to families in each region • Ensured collaboration between health, mental health and new addiction services • Compliance rate of individuals with schizophrenia and their families: 98% Agani, Landau, & Agani, 2010; Weine, et al., 2005
  61. 61. LINC COMMUNITY RESILIENCE (1990): 10,000 Lideres para el cambio (Buenos Aires Province, Argentina - pop. 12 million) • FOCUS: Violence, HIV/AIDS and substance abuse prevention for the entire community • FAMILY/COMMUNITY LINK: Concerned community members working in collaboration across all levels of the community • RESULT: 400% increase in young substance abusers being brought into treatment by their families within 2 years • Follow up 15 years later, in one city of two million people, 37 of 43 projects were still functioning Landau, 2004, 2007, 2011; Yaria, 2002 A R G E N T I N A
  62. 62. TOGETHER WE CAN WORK TO INTEGRATE THE MEDICAL, SCIENTIFIC AND PEER RECOVERY METHODS TO BENEFIT AND BRING HOPE AND HEALING TO ALL THE COMBINED KNOWLEDGE OF THE TREATMENT INDUSTRY AND THERAPEUTIC COMMUNITY CAN HELP CHILDREN, ADOLESCENTS, YOUNG ADULTS, FAMILIES AND COMMUNITIES FACILITATE RESILIENCE AND IMPROVE OUTCOMES © 1999 - 2019 Linking Human, LLC
  63. 63. Y O U T H A T R I S K : W H Y F A M I L I E S M A T T E R Lee Fitzgerald’s London Conference London – Nov 16 – 17, 2018 Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI ARISE® Network www.ARISE-Network.com Hotline: 1-877-229-5462 Office: 303-44-3755

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