Presented by Allan Farkas, Director of Portage's residential drug addiction rehabiliation centre for adolescents in Beaconsfield, Québec at the International Council on Alcoholism and Addictions Conference October 11 to 16, 2009 www.portage.ca

1. The Portage Therapeutic Community François BourdonAllan Farkas 1

2. The Therapeutic community Today we will present you the therapeutic community We will show you the tools we use to help our residents acquire skills and competencies that will support them in their reinsertion in the community. Phases &Workshops Competencies PASS Evaluation Education Outreach Research Results 2

3. Portage phases Portage Program works with different phases based on acquisition of competencies Phase 1 through 6 In each of those phases the expectations and responsibilities increase with the status of the resident in the community 3

4. Expectations The residents are expected to acquire skills and competencies. These expectations grow at each phase change. Phase 1 Get to know your environment Get to know the people in the community Get use to the schedule 4

5. Phase 2 Phase 2 Learn basic expectations Integrate in the community Understand the basic tools of therapy Follow the structure of the program Participate in groups and meetings Put the tools of therapy in practice Participate in all workshop 5

6. Phase 3 Be responsible and a model in the community Accomplish the tasks for witch you are responsible Show leadership Follow treatment plan Transfer competencies Maintain a balance between your recovery and your role in the community 6

7. Phase 4 Be a leader in the community Prepare your exit plan Be a role model Help new members integrate in the community Work on positive networking during outings 7

8. Phase 5 Reintegrate in the community and your family Be a support to the community and your peers Be a role model Attend aftercare groups Reinforce your positive network 8

9. Phase 6 Practice a positive lifestyle Go back to school or work Attend aftercare meetings Have a personal inventory of your own progress Reintegrate with family and community 9

11. Ability to take initiatives

12. Demonstrate empathy

13. Express self in an appropriate manner

14. Active participation in treatment

15. Encourages others

16. Planned and orderly

17. Shows consistency

18. Demonstrates reliability and is trustworthy

19. Energetic and enthusiasm

20. Demonstrates good problem solving and decision making abilities10

22. Ability to prepare structured activities

23. Ability to conduct structured activities

24. Assist well in conflict resolution

25. Ability to ask for help

26. Demonstrates accurate self-awareness

27. Transfer of learning

28. Accepting of supervision

29. Ability to communicate effectively

30. Has developed realistic goals and objectives for post treatment

31. Demonstrates social adjustment11

34. Safe community

35. Coaching and coaching board

36. Importance of belonging/only as strong as the community12

38. Relationships

40. Relationship between school and therapy

41. Competencies

42. Belief system: Philosophy 13

44. The purpose is:

45. to measure the progress made by the resident from the beginning of therapy to its conclusion, including the aftercare phase.

46. to help clinical staff members measure the acquisition of the 21 competencies/skills.

47. to assess the clients’ progress.

48. The PASS must not be used to compare residents.

49. The results of the pass must be used as part of the monthly treatment plans of the resident14

50. The PASS Using the following scale, which ranges from Strongly Disagree (1) to Strongly Agree (7), please circle the number closest to the way you rate the client now for all statements. Please provide a fair and honest evaluation of the client. 1 The client is organized and orderly. 1 2 3 4 5 6 7 2The client behaves in a consistent way. 1 2 3 4 5 6 7 3The client is reliable. 1 2 3 4 5 6 7 4 The client participates actively in his/her recovery. 1 2 3 4 5 6 7 5 The client demonstrates the ability to plan structured activities. 1 2 3 4 5 6 7 6 The client demonstrates the ability to lead structured activities. 1 2 3 4 5 6 7 7 The client uses his/her acquired skills in different situations (transfer of learning). 1 2 3 4 5 6 7 8 The client takes initiative. 1 2 3 4 5 6 7 9The client expresses himself/herself appropriately. 1 2 3 4 5 6 7 10 The client encourages others. 1 2 3 4 5 6 7 Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree Please circle only one number per statement. 11 The client accepts to be supervised. 1 2 3 4 5 6 7 12 The client demonstrates the ability to work within a team. 1 2 3 4 5 6 7 13 The client communicates effectively. 1 2 3 4 5 6 7 14 The client demonstrates the ability to integrate socially. 1 2 3 4 5 6 7 15 The client demonstrates the ability to be objective. 1 2 3 4 5 6 7 16 The client demonstrates the ability to be empathetic. 1 2 3 4 5 6 7 17 The client demonstrates the ability to make decisions. 1 2 3 4 5 6 7 18 The client demonstrates the ability to solve problems. 1 2 3 4 5 6 7 19 The client demonstrates the ability to ask for help. 1 2 3 4 5 6 7 20 The client demonstrates the ability to resolve conflicts. 1 2 3 4 5 6 7 21 The client knows who he/she is and where he/she is at. 1 2 3 4 5 6 7 15

51. TREATMENT PLAN 16

53. In effect our residents become mentors with peer students working hand and hand to mentor high school students at risk17

56. PORTAGE EDUCATIONAL MODEL IN THE TC AND OUTSIDE A very important way this is accomplished is by putting these adolescents in contexts with their peers outside of the facility, while they remain part of the program and continue their therapy. This process enhances the acquisition of competencies Putting the problem out on the table relieves some of the shame and stigma attached to admitting to a sense of loss, (a break up with a girl friend or boy friend, a sense of sadness (not meeting their parent’s academic expectations or - an addiction).

57. Education At Portage peer-on-peer accountability is paramount, and each resident is held responsible for their personal contribution within the community. The Portage adolescent programs believe that academic education is an integral part of the recovery process for teenagers with drug and alcohol addictions and behavioral disorders.

58. Statistics All youth admitted at Lac Écho between January 2003 and March 2008 and having received at least 15 days of treatment have been invited to participate in a research project (77.9% have been contacted). Questionnaires were filled up to October 2008. Boys represent 60.2% (n=127) while girls represent 39.8% (n=84). The average age at admission of those who answered was 16.0 years old. Description of youth: _______________________________________________________________________________________________________________Polydrug users: 75.6% Committed a delinquent act criminally punishable: 91.6% Cannabis use: 89.5% Arrested or charged with an offence: 58.1% Amphetamines, speed or Ritalin use: 55.8% Suspended or expulsed from school: 87.4% Hallucinogenic use: 53.6% Five or more psychological problems: 86.5% Cocaine use: 43.2% Reported to LPJ: 62.6% Previous treatments for alcohol or drug use: 53.9% ________________________________________________________________________________________________ 22

59. Study results: Number of days of use of illegal drugs in a month ________________________________________________________________________________________________________________________ Number of days in treatment Before treatment 7.5 months after treatment 14.5 months after treatment ________________________________________________________________________________________________________________________ 15 to 60 days 20,1 days 10,5 days 13,2 days (n=61) 61 to 180 days 21,8 days 7,8 days 8,7 days (n=69) 181 days and more 22,2 days 3,1 days 5,0 days (n=79) 23

60. Study results: 24

61. Study results: Percentage of youth abstinent of illegal drugs in last 30 days ____________________________________________________ Number of days 7.5 months after 14.5 months after In treatment treatment treatment ___________________________________________________________________________________________________________________________________________________________________ 15 to 60 days 37.7% 32.8% (n=61) 61 to 180 days 58.0% 44.9% (n=69) 181 days and more 79.7% 65.8% (n=79) __________________________________________________________________________________ 25

62. Study results: 26

63. Study results: If youth use drugs for between 20.1 and 22.2 days in a month before entering treatment, they use drugs for between 3.1 to 13.2 days a month after treatment depending on time spend in treatment. Those who use the least are those who stay longer in treatment. Abstinent rates of all illegal drugs after treatment range from 37.7% to 79.7% depending on time spend in treatment. Those who are the most abstinent are those who stay longer in treatment. 27