Opioids and Youth

1. Opioids and Youth Youth Substance Use Program “Partnering to Address Youth Substance Use with an Innovative Triage and Support Program”

2. Good Shepherd Youth Services

3. Notre Dame House

4. Notre Dame House and Community Resource Centre is the only Youth Shelter in Hamilton and provides Emergency Housing and Outreach Services for Street Involved and Homeless youth Aged 16-21 years

5. Community Resource Centre and Outreach Initiatives • Last year Notre Dame/CRC supported 657 unique individual youth • Accessible 7 days a week • Youth between 16-21 years living within the community can access supports which include • Section 23 School Program • Case Management and Advocacy • Youth Housing Support Project - Early Diversion, Prevention and Intensive Case Management • Shelter Health Network – Nurse Practitioner, Family Doctor, Hep C Team • Public Health – Sexual Health Clinic , Rapid HIV testing • Mental Health Concurrent Program, including access to Adolescent Psychiatrists and Psychologists

6. Community Resource Centre and Outreach Initiatives • Supports continued… • DBT informed Skills for Life • Alternatives for Youth • Hamilton Regional Indian Centre • Legal Clinic • Youth Trustee • Job Connect through YWCA • Therapeutic recreation • Life Skills • The Dope Group • Meal program • Access to donations, free laundry facilities • Street Youth Planning Collaborative

7. Access • Family Homes • Family Prescriptions provide access • Not a sustainable source • Streets are the next step

8. How are Youth Using? • Most youth using pills • Difficult to know how much they are using • Many youth unaware of what they are taking

9. Injection Use • Once tolerance has increased youth will change the route to increase the high • Many youth fearful of needles • As a result many youth will get others to shoot them up at the beginning • This means that many youth do not learn how to inject properly • We see many injuries that are a result of improper injection • There are increased health risks when youth do not learn to use safely

10. Why are Youth at Risk? • Overall, youth use at a lower rate than the adult population HOWEVER are often at higher risk. Why? • Many first time users are youth • Youth can be naïve • Youth have lower tolerances • Youth are less organized (adults will often put safety measures in place that youth) • Youth compete! • Lack of planning • It wont happen to me

11. Youth and Naloxone • Youth are resistant to carrying • Youth forget • Can create a false sense of security • Increased overdose risk after use

12. Concurrent Disorders • Correlation between MH and SU • Difficulty in getting help for a concurrent disorder • Hesitancy from the medical community to address MH due to SU concerns

13. What Works? • Follow up plans after treatment • Reduce the stigma • “Normalize” the conversation • Treat the family • Use a concurrent approach • Natural Communities of Support • Harm Reduction • Being Creative!

14. The YSUP Program: Who We Are 2 Organizations – in a partnership • Good Shepherd Youth Services -Notre Dame House • St. Joseph’s Healthcare Hamilton - 2 Withdrawal Management Services

15. Withdrawal Management Assistance with: • Acute intoxication and withdrawal needs • Crisis directly related to these substances • Early recovery education is provided • Barriers and resources • Settings - community or residential • Service will vary according to levels of complexity

16. Development of the YSUP Program • History of youth using substances staying in shelter (ER responses) • Being loud about the need • Community Response • Partnerships • Unique approach within existing shelter beds • Funder response • Development of the support team / ongoing consulting approach

17. YSUP Triage and Assessment • Screening • Assessment • Monitoring • Care Plan … YSUP • Initial Contact (ND/WDM) • Screening and Assessment for • Care Plan (WDM) • Assessing and Determining Risk Refusal of Service Detox / Withdrawal Management Hospital

18. YSUP Principles • Harm Reduction Approaches • Nonjudgmental Trauma Informed practices • Voluntary

19. YSUP Team Staffing • 9 pm-5 am • 7 days a week, all year • 1 Youth Substance Intervention Worker on site 9pm until 5am1 Withdrawal Management Worker onsite 9pm until 2am (with flexibility)

20. YSUP Process 8:45 pm: YSUP Shift Change • Information on youth with potential substance use and/or active withdrawal • Follow ups • Self disclosures of use past , present, future plans • Any out of character behaviors, incidents or conflicts • Medication updates Considerations During Assessment • Looking for signs and symptoms of Intoxication or Withdrawal such as, alertness, signs of confusion, labored breathing, flushed skin, sweating, tremors, pinned/dilated pupils, agitation, restlessness, any mental health concerns, self harm and suicidal ideations. • Follow ups • Self disclosures of use past , present, future use and use plans • WDM has casual conversations with youth • Youth Support worker conducts searches • Connections and rapport are built

21. 3 possible outcomes 3 Possible Outcomes Care Plan Decision Tree Based on the assessments of the youth, information provided and presenting factors, YSUP staff will use a decision tree to determine what interventions the youth may require. Intervention Number One • Hospital Transfer • Youth in need of immediate medical intervention • Ambulance is called • Social Worker in ER notified of concerns Intervention Number Two • MASH/WKAS/Hospital Referral • Only if youth seeking this type of support • Partnership with MASH and Womankind • Warm Transfer • Barriers for youth accessing adult detox services Intervention Number Three • Youth Placed in YSUP Observation Rooms

22. Onsite Programming The Dope Group • An informative, educational group on substance use, harm reduction, and coping strategies. • Safe space for youth between the ages of 16-21 to come out, learn ways to reduce risks associated with substances use. • Discussions supported by interactive activities. • 14 Week program. • Youth have the opportunity to join in at any point through the 14 weeks. • Small group format: Average of 5-10 youth per session.

23. Internal Supports Good Shepherd concurrent disorders team: • Mental Health Clinical Lead • Mental health clinician • Mental health clinician (early intervention) • Concurrent disorders worker • Alternatives for youth • Community based concurrent disorders worker for the LGBTQ+ population

24. “ At first I didn’t like going into the YSUP program, but it was way better than sitting at the hospital where no one really cared if I was there or not. Most people just looked down at me because I was high and homeless” Codi – Age 19

26. “I have always felt like I couldn’t talk honestly about what I was doing or what was going on in my life, but now I have a chance to work through things without being ashamed or feel judged” Jessica – 17yrs

27. YSUP and Medication Medication interference • There are times when a youth is on medication and they have used substances which may have an interaction or higher overdose risk • WDM and YSIW use a medication decision tree to recommend if a youth should access their medication or if they should not NOTRE DAME YSUP MEDICATION DECISION TREE

28. Rapport Rapport • Non threatening and non judgemental • Explaining Role • Educating the youth on their substance use and the effects they are having on their body, mind and lives • Strong youth engagement skills • Being accountable for the work we do with the youth builds trust , which opens up communication and youth feel comfortable talking about their substance use • When rapport and communication are established it makes it helps us better support the youths and their needs

29. Decreasing Stigma • Harm Reduction philosophies • Non-judgemental practice • Open door policy • I respect you messages • Meeting the youth where they are at • Being supportive vs being authoritative

30. Growing Pains • No Existing Models • Youth Buy in • Combining Union/Non-Union Staff • Facility Limitations • Identifying Roles • Consultation Relationship • Transfer of Information/Confidentiality

31. Next Steps For The Future • Research • Evaluation • Community Engagement • Education • Enhanced partnership with ongoing knowledge exchange • Facility improvement • Dream to enhance this program 24/7

33. What Have We Seen 2016/2017 Targets • # Youth Served – 319 • # Service Bed days Provided – 897 • Actual • # Youth Served –432 • # Service Bed Days provided –1190 • # Youth Diverted from Emergency Department –430 • # Youth Sent to Emergency Department – 2 • # Youth Refused Service - 0

34. How does that Equate?? 432 X $645.00 (Current cost for Emergency Room Services) = $278 640.00 YSUP Budget: $164, 450

35. Questions and Wrap Up