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Effective Use of Revised Child COD Supplemental Forms: MH 552, MH 553, MH 554

Effective Use of Revised Child COD Supplemental Forms: MH 552, MH 553, MH 554. Your Trainers. Joy Chudzynski, Psy.D. UCLA Integrated Substance Abuse Programs Thomas E. Freese, Ph.D. UCLA Integrated Substance Abuse Programs. Introduction: What we will cover.

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Effective Use of Revised Child COD Supplemental Forms: MH 552, MH 553, MH 554

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  1. Effective Use of Revised Child COD Supplemental Forms: MH 552, MH 553, MH 554

  2. Your Trainers Joy Chudzynski, Psy.D. UCLA Integrated Substance Abuse Programs Thomas E. Freese, Ph.D. UCLA Integrated Substance Abuse Programs

  3. Introduction:What we will cover Review of substance use in children and adolescents Review screening and assessment in developing appropriate interventions for those who are using or are at-risk for using alcohol / drugs. Review Revised Forms MH 552, 553, 554 Practice New Forms Wrap-Up, Q & A

  4. Substance Use Patterns of Children and Adolescents

  5. Prevalence .… • In 2012, 60% of Students age 12-17 report that drugs are used, kept or sold on their school grounds.1 • 52% say there is a place on or near school grounds where students go to drink, smoke, or use drugs during school. 1 • Before the age 13, 21% of high school students reported that they tried alcohol; 8% reported that they tried marijuana before the age of 13. 2 1 National Center on Addiction and Substance Use, 2012 2 Centers for Disease Control and Prevention, 2012

  6. Children & Adolescents with Substance Use Disorders... • Are largely undiagnosed; • Are distributed across diverse health and social service systems; • Are more likely to be involved in the juvenile justice system; • Have higher rates of child abuse(neglect, physical and sexual abuse); • Have high co-morbidity with psychiatric conditions.

  7. More than half of new illicit drug users begin with marijuana National Survey on Drug Use and Health (NSDUH), 2010

  8. Drug use is highest among those in their late teens and twenties National Survey on Drug Use and Health (NSDUH), 2010

  9. National Survey Data: Substance Abuse/Dependence among Youth (12-17) National Survey on Drug Use and Health, 2002–2011

  10. Adolescents Receiving Substance Abuse Tx. in County Programs, Los Angeles (N=1,591) FY 07/1/11-06/30/12

  11. Adolescents Receiving Substance Abuse Tx. in County Programs, Los Angeles (N=1,591) FY 07/1/11-06/30/12

  12. Total Open Children and TAY in 457 DMH Directly Operated/Contracted Programs(July, 2012 – Dec, 2012)

  13. Children and TAY Clients with Dual Codes Completed(July, 2012 – Dec, 2012)

  14. COD in Children and Adolescents

  15. Facts About Adolescent COD • In 2011, 2.0 million youth (8.2% of the population aged 12-17) reported at least one major depressive episode (MDE) in the past year. • Among 12-17 year olds who had past year MDE, 36% had used illicit drugs during the same period. SOURCE: 2011 National Survey on Drug Use and Health, SAMHSA.

  16. Substance Use among Youth*, by MDE in Past Year (2011) SOURCE: 2011 National Survey on Drug Use and Health, SAMHSA.

  17. COD and Juvenile Justice • Nearly two-thirdsof incarcerated youth with substance use disorders have at least one other mental health disorder; • As many as 50% of substance abusing juvenile offenders have ADHD; • About 30% of incarcerated youth with substance use disorders have a mood or anxiety disorder; • Those exposed to high levels of traumatic violence might experience symptoms of posttraumatic stress as well as increased rates of substance abuse

  18. Trauma among Adolescents Presenting for Treatment for SUD • 40-90% have been victimized • 20-25% report in past 90 days, concerns about reoccurrence • Associated with higher rates of - Substance use - HIV-risk behaviors - Co-occurring disorders

  19. Substance Use among those with Developmental Disabilities (DD) • Prevalence of use among those with DD may be twice as high • Exposure and experimentation among those with a DD may be delayed, but problems arise sooner after initial use • Social, academic, economic, and mental health issues may cause stresses that contribute to use. • Parents/teachers/providers often “protect” such individuals from information or education, and delay identifying and addressing experimentation, use, abuse. Westermeyer et al., 1996; National AIA Resource Center , 2005

  20. Conceptualizing COD in Children and Adolescents

  21. Screening and Assessing Children and Adolescents for Substance Use Risk

  22. What is the Difference between… What’s Going On in These Pictures?

  23. Screening Conducted with large numbersof people to identify the potentialthat a problem exists Screening is intended to be broad scale and produce false positives Screening leads to more in-depth assessment and intervention for people identified with a potential problem

  24. Assessment Assessment is individualized andspecific. Assessment is designed to identify particular needs and rule-out false positives Assessment leads to more individualized intervention for those identified with a problem

  25. What can be determined through the screening and assessment process? The interplay between the substance use and the mental health problem, and the degree to which substance use affects mental health functioning The frequency, duration and quantity of use and resulting diagnosis (i.e., substance abuse or dependence) Use of Screening (MH554), Parent (MH552), and Supplemental COD Assessment (MH 553) forms ensures that the topic will be raised and those who need additional assessment and intervention are appropriately identified. This will better inform the Treatment Plan and help identify substance use interventions that support Mental Health Goals.

  26. Rationale for Revising COD Child Forms • Health Reform = new expectations / requirements for the delivery of more integrated and evidence-based care, and better documentation of service. • Substance use/abuse cannot be the principal mental health diagnosis of a DMH consumer, yet many are severely impacted by substance use which compounds mental health symptoms. • There have been system-wide challenges aligning substance use issues and mental health diagnoses when screening and assessing COD among Child and Adolescent consumers. • DMH designed new forms (with the help of UCLA and others) to help clinician engage, and gather appropriate information to assist in development of COD interventions that will improve mental health functioning. • Implementation of IBHIS allowed for revisions and streamlining.

  27. COD Child Screening (MH 554) Revisions

  28. MH 554 RevisionsCOD Substance Abuse Screener • Must be interviewer-administered to all children 11 and older (clinical judgment if <11) • # of Screener Questions Streamlined: 15 Qs 10 Qs • Less formal language (styled after CRAFFT and other EB screeners for adolescent SU) • Several Qs removed about specific consequences • 2 Qs added about general consequences and family member substance use • Qs (e.g., tolerance, loss of control) that support Diagnosis moved to Child Assessment to be completed by AMHD/Clinical staff • Any YES leads to Administration of the COD Assessment Form (MH 553)

  29. Risk Factors for Children Age 11 and Under • Parental/caregiver substance abuse • Substance use endemic in school/neighborhood • School performance slipping (grades, detention) • Shift in friends • Moodiness • Unexplained burns/sores/injuries • What else?

  30. COD Child Parent / Caregiver Questionnaire(MH 552) Revisions

  31. MH 552 Revisions(COD Parent/Caregiver Screener) • Must be interviewer-administered for all children 11 and older (clinical judgment if <11); explore family and consumer risk. • # of Screener Questions Streamlined: 16 Qs 8 Qs • Less formal language (styled after CRAFFT and other EB screeners for adolescent SU) • Some Qs retained or collapsed • Some Qs about specific use behaviors removed • Any YES; use clinical judgment regarding administration of COD Assessment Form (MH 553)

  32. COD Child Assessment (MH 553) Revisions

  33. MH 553 Revisions(Supplemental COD Assessment) • AUDIT C (EB Alcohol screener) – 3 Questions Added • Drug categories added and specified to reflect current adolescent drug use trends • Quantity and frequency of use combined, Route of Administration added • Positives/Negatives of use delineated to help support impact of SU on MH functioning improved documentation of MH as Primary with SU exacerbating MH symptoms. • Qs (e.g., tolerance, loss of control) that support Diagnosis moved to Child Assessment to be completed by AMHD/Clinical staff • Administer if any YES on 554, use clinical judgment if YES on 552

  34. Practice with the Revised Forms • Form pairs. • One person will play the clinician and the other will play “Marco.” • Practice using the Revised Child Screener (MH554) and COD Assessment Forms (MH553). • Experience with new forms? • Thoughts / Feedback?

  35. Practice: “Marco” 15-year old freshman in high school, has been referred to DMH by school following a series of physical fights on campus, one with a teacher. Threatened suicide on two occasions in the past 2 years, both following a brief reunion with his father who is in jail on gang-related crimes. Spends free time with older cousin who attended his high school until recently when he was kicked out for getting caught with marijuana and pills in his backpack. Continues to get mostly C’s and B’s in school. Reports feeling “bummed out” about life, isolated, angry at his mother and her new boyfriend who recently moved into the house with his mom and Marco’s younger brother.

  36. 1. Precontemplation Definition: Not yet considering change or is unwilling or unable to change. Primary Task: Raising Awareness—Connect SU and MH Sxs 6. Recurrence Definition: Experienced a recurrence of the symptoms. Primary Task: Cope with consequences , relate toMH functioning as precursorand outcome 2. Contemplation Definition: Sees the possibility of change but is ambivalent and uncertain. Primary Task: Resolving ambivalence/ Helping to choose change Stages of Change:Primary Tasks in Linking MH and SU 5. Maintenance Definition: Has achieved the goals and is working to maintain change. Primary Task: Develop new skills to maintainimprovements in MH and SU 3. Determination Definition: Committed to changing. Still considering what to do. Primary Task: Help identify appropriate strategies to improve MH/reduce SU 4. Action Definition: Taking steps toward change but hasn’t stabilized in the process. Primary Task: Help implement change strategies to decrease MH Sxs and SU

  37. 1. Pre-contemplation 2. Contemplation 3. Determination 4. Action 5. Maintenance 6. Recurrence

  38. Practice with the Revised Forms • Working in pairs, determine what stage of change Marco is in. • Identify one MH goal appropriate for Marco • Identify one or more SU interventions that would help move Marco toward this MH goal.

  39. Thank you!! joychud@ucla.edu www.uclaisap.org www.psattc.org http://sbirt.samhsa.gov/about.htm http://www.motivationalinterview.org http://www.niaaa.nih.gov/ http://www.drugabuse.gov/

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