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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
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)
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).
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).
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
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
• 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).
What are the Personality-targeted Interventions
(i.e., Preventure Program)?
Dr. Patricia Conrod
Department of Psychiatry
University of Montréal
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
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)
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
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.
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. Christine Wekerle
McMaster University
Dr. Sherry Stewart
Dalhousie University
Dr. Christopher Mushquash
Lakehead University
Dr. Hanie Edalati
University of Montréal
Well-Venture Project
Ethics approval
Pilot Trial
• Content of interventions
• Assessments
• Procedure
• Starting date
First working group
meeting
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.
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
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
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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ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System

  • 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. 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. 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. 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. Less than 10% of adolescents and young adults in need receiving such interventions (SAMHSA, 2009).
  • 6. Personality Risk Profiles as Targets for Reducing Substance Use Problems in Adolescents Involved in Child-welfare System
  • 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. • 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.
  • 10.
  • 11. What are the Personality-targeted Interventions (i.e., Preventure Program)? Dr. Patricia Conrod Department of Psychiatry University of Montréal
  • 12. 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
  • 13. Validated Prevention Program through 8 Randomised Trials
  • 14. 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
  • 15. 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.
  • 16. Well-Venture Project • Content of interventions • Assessments • Procedure • Starting date First working group meeting
  • 17. 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
  • 18. Well-Venture Project Ethics approval Pilot Trial • Content of interventions • Assessments • Procedure • Starting date First working group meeting
  • 19. 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.
  • 20. 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
  • 21. 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
  • 22. 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