Effective and Innovative Young Adult Treatment In Drug Court

1. Ninth Annual Treatmet Court Training Conference, November 17-19,2004 Effective and Innovative Young Adult TreatmentIn Drug Court National Development & Research Institutes, Inc - The Training Institute – Andrew Osborne, Director

2. The Ideal Program: Treatment Components • Initial Assessment • Treatment Planning • Treatment Approaches • The Treatment Team • Program Design • Program Evaluation

3. Why Implement Best Practices Now? • Prevalence of use at earlier ages Ages 12-20 – Rates of “past-month use” more than doubled Alcohol from 20% to 75% Marijuana from 8% to 27% • Lowered ages at first use 63% report marijuana use before age 15 71% have used other drugs

4. Why Implement Best Practices Now? • Emerging trends in drugs of choice Xtasy, Sextasy, Rolls New breed of amphetamines Cotton and Scramble New breed of opiates, low grade heroin A & E New breed of hallucinogens Fry Sticks New takes on old favorites

5. Why Implement Best Practices Now? • Increased co-morbid disorders - Combined marijuana and alcohol users are 4 to 47 times more likely to have wide range of problems - 70-90% of youth with substance use disorders had 3 or more diagnoses for disruptive behavior, mood disorder, anxiety disorder

6. Why Implement Best Practices Now? • Increased admission rates to treatment, decreased engagement rates - Under 50% stay 6 weeks - 75% stay less than the 3 months recommended by NIDA

7. Why Implement Best Practices Now? • Unsustained recovery patterns after graduation 40% of treatment graduates have continuous substance abuse problems 29% have intermittent problems Only 15% sustain recovery for 12 months or more

8. Interventions Associated with No or Minimal Change • Passive Referrals • Educational Units Alone • Probation Services As Usual • Unstandardized Outpatient As Usual

9. Interventions Associated with Deterioration • Treatment in groups including one or more highly deviant individuals • Treatment of adolescents in adult units and/or with adult models/materials (particularly outpatient)

10. NADCP’s 10th Annual Drug Court Training Conference Initial Assessment

11. Performance Objectives • Identify the goals and principles of assessment • Identify characteristics of a strength-based assessment • Compare the GAIN assessment instrument with current JDC practices

12. Instrument Selection The instruments for use with adolescents should be: (1) reliable and valid; (2) developmentally appropriate; (3) considered by the type of setting in which the instrument was developed; (4) chosen based on the purpose of the instrument.

13. Assessor Characteristics • Outcome influenced by assessor skill and ability • Capacity to establish trust • Integrity • Active listening

14. Purposes of the Assessment • Accurately identify who needs treatment • Determine severity • Learn about the nature, correlates and consequences of the substance-using behavior • Flag other related problems

15. Purposes of the Assessment • Examine how the family can be involved in the assessment and in subsequent interventions • Identify the youth’s strengths and how they can be used in the treatment plan • Develop an appropriate written report that can help frame the planning process

16. On Going Assessment • More frequent – changing drugs • 30 days • Phase movement • Move to higher level of care

17. Assessment Domains • Strengths • History of substance use • Medical health • Developmental issues • Mental health • Family history

18. Assessment Domains • School history • Vocational history • Peer relationships • Juvenile justice involvement • Social service agency involvement • Leisure activities

19. NADCP’s 10th Annual Drug Court Training Conference Models and Approaches to Treatment

20. Knowledge Base of Current Studies: Lessons Learned • Improvements generally came during active treatment and were sustained for 12 or more months • Family therapies were associated with less initial change but more change post active treatment (and the same in long-term results)

21. Knowledge Base of Current Studies: Lessons Learned • Effectiveness was associated with therapies that were: • manual guided, • developmentally appropriate, • clinically focused and supervision/quality assurance • achieved therapeutic alliance, early positive outcomes • successful in engaging adolescents in aftercare, support groups, positive peer reference groups and more supportive recovery environments.

22. The Response to Findings • Developing manualized treatment models • Creating systems of care • Building partnerships and strategic alliances • Continuing research to obtain longer term results.

23. The Purpose of CYT • Learn more about the characteristics and needs of adolescent marijuana users • Adapt evidence-based, manual-guided therapies • Evaluate the relative effectiveness, cost and cost-effectiveness • Provide validated models to address the pressing demands for expanded and more effective services

24. The CYT Study • More than 600 teens and their families were treated • Preliminary findings showed that each therapy worked • Results so encouraging the protocol manuals have been replicated nationwide

25. The CYT Manuals The manuals include: • Rationale for each approach • Effective assessment tools to help plan effective treatment • Information on the staff requirements and training suggestions • Forms to track treatment delivery • Information on the CYT study

26. The CYT Manual How-To’s • Precise procedures for using the approaches • Detailed session guidelines • Examples of conversations between clients and counselors • How to do roleplays

27. The CYT Manual How-To’s • Suggested topics for group exercises • Information handouts such as skill guidelines, reminder sheets, and take-home exercises for teens and their parents or caregivers. • Posters for use in the session • “Talking points” for counselors

28. CYT : Study Group Topics • Motivational Enhancement Therapy and Cognitive Behavioral Therapy • Family Support Network • The Adolescent Community Reinforcement Approach • Multidimensional Family Therapy

29. NADCP’s 10th Annual Drug Court Training Conference Expressive and Experiential Therapies

30. Performance Objectives Identify a variety of expressive and experiential media and interventions in order to help drug court participants become motivated for, engage and be retained in a dynamic therapeutic environment Determine how to apply/integrate these approaches with current treatment practices

31. ExpressiveTherapies: Their Efficacy for Treating Adolescent Substance Abusers

32. Music Therapy: Using Music to Achieve Treatment Goals Integrating elements of music with specified therapeutic goals Using the sensory stimulation evoked by music to provoke responses due to familiarity, predictability and feelings of security associated with it

33. Music Therapy: Using Music to Achieve Treatment Goals Creating a sound mirror. Sound mirrors first reflect the client’s self-reported inner state or feelings and then reflects the desired mood or feeling the client is hoping to attain. Transforming the client’s rhythm orientation to a lyrical/process orientation. By so doing the client learns to experience the music, not merely listen to it.

34. Applying Music TherapyPrinciples Select the appropriate music Sequence the music Let the music fill the room Prepare the clients to listen

35. Applying Music TherapyPrinciples Listen to the entire musical selection first Allow time to process Create a safe place to dialogue Encourage clients to listen alone and journal Encourage parents to listen to the music

36. Dance/Movement Therapy When integrated into a substance abuse treatment regimen, dance/movement therapy can effect changes in: feelings cognition physical functioning behavior

37. Art Therapy “At the deepest level, the creative process and the healing process arise from a single source. When you are an artist, you are a healer, a wordless trust of the same mystery is the foundation of your work and its integrity.” Rachael Naomi Remen, MD

38. Art therapy can help adolescents: • Express feelings too difficult to talk about • Increase self-esteem and confidence • Develop healthy coping skills

39. Art therapy can help adolescents: • Identify feelings and blocks to emotional expression and growth • Provide an avenue for communication • Make verbal expression more accessible

40. Journaling Techniques • Dialoguing • List making • Dream documenting • Clustering

41. Bibliotherapy Goals To develop accuracy and understanding in perceiving self and others To develop creativity, self-expression and greater self- esteem;

42. Bibliotherapy Goals To vent overpowering emotions and release tension To find new meaning through the exploration and re-exploration of ideas and insights

43. Guidelines for Using Bibliotherapy Select a recognizable piece of written work Create a non-threatening atmosphere to share feelings Be willing to explore sensitive details Ensure connections are made and provide closure

44. Issues/Situations for Dramatization • Confrontation with peers • Rejection • Patterns of interpersonal interaction

45. Issues/Situations for Dramatization • Ways to establish credibility, trust and legitimacy • Sexual expression • Assumptions, prejudices, stereotypes and expectations of others

46. Wilderness Therapy:Phases of Treatment Cleansing Social and personal responsibility Transition and aftercare

47. Recreational Therapies • Team Building • Problem Solving (independent vs. group) • Accepting Loss

48. Process Questions • How do we utilize this information as well as the techniques and approaches to enhance our treatment services? • How do we ensure that this process or practices is continuously effective? Culturally, developmentally and gender appropriate? • How do we integrate the family? • How do we integrate the juvenile justice professionals in this process/practice?