SUBSTANCE MISUSE TREATMENT PROGRAM
Manual revised 09/2000
Introduction:
Youth Support
is a program serving adolescents ranging in age from 13 to 19. The program is
delivered to the target population within the school setting and for those out
of school, in the home community. The primary aim is to provide treatment
services in an environment in which adolescents can experience an orderly
goal-directed pattern of living and to begin to think about what is important
to them.
Being school based, the program has an
educational component, which is presented, in the classroom from primary
through secondary grades. Educational material is offered in a manner, which
focuses upon recovering adolescents and their experience.
Youth Support
is based upon a biopsychosocial model. Therefore, all aspects of an
adolescent’s life are impacted in the treatment process. Recovery from the
effects of substance abuse is achieved though counseling/therapy, peer support,
information, recreation and the provision of opportunities for emotional and
spiritual growth.
Adolescence Defined
The unfolding of human potential
in people of any age is one of the remarkable processes of life and living. It
is especially vivid during adolescence. Often adolescence is described as a
‘time of transition’, but it is also an important developmental stage in its
own right. For most young people, it is a time of rapid change and exuberant
exploration; a time to build upon early childhood experience and forge a mature
identity.
The majority deals with the challenges of
adolescence very well, but it is a period of extreme vulnerability. Not all
children are fully equipped to cope. They may carry scars from childhood. They
may have inadequate supports at home or in the world at large. They may face
barriers of class, race or gender - and so, a limited future.
Society has lavished a
great deal of attention upon adolescents, but provides them with few guidelines
to mark the way to a successful maturity. Role models are unclear and few rites
of passage remain.
Adults often cannot or
are unwilling to answer the searching questions of adolescents, sometimes
expecting in them wisdom beyond their years. We expect them to resist the
allure of mood-altering substances, although our culture promotes pleasure and
self-gratification as primary life goals without providing them.
The Youth Support Program
encourages adolescent clients to recognize and celebrate each step toward
maturity, being always aware of the stresses, which they face.
Treatment
is composed of those activities, which must be undertaken to deal with an
adolescent manifesting a substance abuse problem. A comprehensive continuum of
intervention is required to cope with the expanding range of experience an
adolescent is faced with.
In
defining the elements of this continuum, the treatment framework must include
the philosophy of the providers, the setting in which treatment takes place,
and the specific modalities used in each of the stages in treatment - acute
intervention, rehabilitation and maintenance.
Treatment
Philosophy
The Youth
Support Program is based on the concept that when treating substance abuse,
a program must address the physical, mental, social, emotional and spiritual
segments of an adolescent’s life and that recovery is an ongoing process, not
an event. Initial involvement in Youth Support is seen as a beginning
point in the process. Recovery involves renewal and healing of the whole
person, rather than dealing with just a bad habit.
The
treatment philosophy is based on the following beliefs:
·
Substance
abuse in adolescents, for the purpose of the Youth Support Program,
means the non-medical use of mood-altering substances to the extent that there
is evidence of a measure of psychological, social or physical dependence
resulting in a delay or impairment of normal adolescent development in one or
more major areas of life, (social, emotional, family, education, vocation or
health).
·
Youth
Support is based
on a belief that adolescents who do not abuse chemical substance, but come from
homes where substance abuse exists, must also be involved in the treatment
process.
·
Such
young persons are affected by the ‘family syndrome’, which is a cluster
of symptoms related to the excessive abuse of mood-altering substances by one
or more family members to the extent that non-using members deny feelings,
problems, and the severity of effect of the chemically dependent member’s
decisions, actions, and behaviors.
·
The program is based on
adolescents helping their peers in recovery, thus bridging the gap between youth
and parental/authority figures which so often interfere with the recovery
process.
·
Adolescents
must be directed toward self-discovery of their problems and an ownership of
the solutions to them.
·
Youth
Support is based
on a belief that the adolescent addictive process is adaptive and develops on a
continuum with varied causes and an interdependent relationship between
physical, spiritual, emotional and environmental factors (biopsychosocial).
·
The most effective way to
treat most adolescents who misuse substances is to deliver treatment services
in their own community and environment, hence a school-based program is
generally followed.
·
The misuse of mood altering
chemical substances is inappropriate for adolescents and can lead to many serious
biopsychosocial problems.
·
In any treatment program
for adolescents, a trust relationship is of critical importance between the
clinician and the young person before any meaningful therapy can take place.
·
In planning adolescent
programs, it is necessary that there be flexibility in the pursuit of the least
restrictive and most normalized course of action consistent with the person’s
needs and resources.
·
Adolescent treatment plans must be based
on a multi-disciplinary team approach, hence the need for close contact with
the school system, other drug treatment programs, and local agencies impacting
upon the young person.
·
The challenge faced by the Youth
Support Program is to normalize young people’s experiences, not to
marginalize them.
Referral Process
Youth Support
is a school-based program and referrals usually are made through the school
system. However, the adolescent, peers, parent, legal system, or any person or
agency impacting upon the young person may make them.
All referrals must meet admission criteria and
not indicate any of the exclusionary factors.
Referrals may be made to any staff person in the Youth
Support Program.
Admission Criteria
·
Must be between the ages of 13 and 19. However,
younger persons may be assessed for partial involvement in program services.
·
Show signs of substance abuse, or
indicates that there is substance misuse by a family member or peer.
·
To be willing to abide by such treatment
program as may be recommended by the staff.
·
N.B.Admission to a Detoxification Unit
requires that the adolescent meet
criteria as applicable to that facility.
Exclusion Criteria
·
If the adolescent has a psychiatric
condition or personality disorder which would prevent
them or others from benefiting from the program, they may be excluded and be
referred to an appropriate agency.
·
If an adolescent is violent or disruptive
in the group setting, they may be asked to withdraw.
·
If it is in the opinion of staff that the
adolescent is attempting to manipulate the school or the legal system, they may
be excluded from the program.
1.) Staff have a primary obligation to respect
the integrity and to promote the welfare of the adolescent, whether they are to
be assisted individually, or in groups.
2.) In the group setting, staff is
responsible for protecting adolescents from physical and /or psychological
trauma resulting from interaction within the group.
3.) In the counselling/therapeutic
relationship, information resulting from within must be kept confidential in a
manner consistent with the obligation of all staff members in the
program. In a group setting, staff is expected to set and encourage the norm
of confidentiality regarding all group participants’ disclosures.
4.) When the adolescent’s condition
indicates that there is clear and imminent danger to the adolescent or
others, staff must take
reasonable personal action, or inform responsible authorities. Staff should
consult with other professionals and should only assume responsibility for the
adolescent’s action after careful deliberation.
5.) Any records of the
counselling/therapeutic relationship, including interview notes, test data,
correspondence, tape recordings and other documents, are not part of
official records of the Youth Support Program or any other agency in
which the counselor or therapist is employed. Revelation to others of
counseling material should only occur upon the informed consent of the
adolescent.
6.) The adolescent must be
informed of the conditions of the therapeutic/therapeutic relationship at or
before the time the adolescent enters such a relationship. In individual or
group situations, the staff/leader must make clear the purposes, goals,
techniques, rules of procedure, and any limitation which may affect the
continuance of the relationship.
7.) Staff
may consult with any other professionally competent person about the
adolescent.
8.) Staff must decline to initiate, or
shall terminate the therapeutic/therapeutic relationship when staff cannot be
of professional assistance to the adolescent, either because of lack of
competence or personal limitation. In such instances, the adolescent will be
referred to an appropriate professional.
9.) Staff will avoid any
type of sexual intimacies with the adolescent. Dismissal will result from any
such situations.
10.) Staff have the responsibility to screen
prospective group members, since group goals focus on self-understanding and
growth through self-disclosure.
If the adolescent declines the suggested
referral, staff is not obligated to continue the relationship.
11.) If, in the process of a therapeutic/therapeutic
relationship with an adolescent, that staff becomes aware of any criminal
activity, sexual or physical abuse, the appropriate authorities must be
advised and informed of the situation at once. Staff must explain to the
adolescent the reason for such action and provide support, if appropriate.
American
Association for Counseling and Development (1988)
Ethical
Standards,
Alexandria V.: Author
Canadian
Guidance and Counseling Associates (1981)
Guidelines
for Ethical Behaviour, Ottawa: Author
Howden,
Lee (Ed.) (1980)
An
Ethical and Legal Handbook for School Counsellors,
Mississauga,
Ontario: Ontario School Counsellors Association
Kelly,
Margaret (Ed.) (1988)
An
Ethical Standards Casebook, Scarborough, Ontario: Nelson Canada
Adolescents in the school system should
not be registered clients with full case recording. Consequently, a diary is
kept by the clinician, which notes the names, date, and a short summary of each
meeting.
Procedure for Youth Support Diaries
a) Name,
date, and note to be recorded only on form provided.
b) Each
school will have a separate diary.
c) Notes
will be short and are intended as guides for the clinician and do not
constitute a full case note on any meeting with the client.
d) At the end of each week, notes will
be transferred from the clinician’s file to a master binder kept in a secure
location.
e) A
monthly report (on form provided) will list names, times contacted and group
contact.
Exceptions
Adolescent clients who
are seen by staff other than those in the school system will be registered
clients with full case documentation. This situation also applies to any such
client treated in a Detoxification Unit.
The Youth Support
Program in the school system must be considered an extension of the
Guidance Program, and therefore parental consent is not necessary for contact
within
the school system.
Parental consent is required for those persons under eighteen (18) years of age
for recreation programs involving overnight accommodation, trips,
detoxification, and any residential rehabilitation program.
Exception may be made
in the case of an emancipated adolescent.
YOUTH SUPPORT PROGRAM
Weekly
Diary Week of: ___________________
School:______________________________________________________________
Attended Group:
[ ] Name:__________________________________________________________
_________________________________________________________
_________________________________________________________
[ ] Name:__________________________________________________________
_________________________________________________________
_________________________________________________________
[ ] Name:__________________________________________________________
_________________________________________________________
_________________________________________________________
[ ] Name:__________________________________________________________
_________________________________________________________
_________________________________________________________
[ ] Name:__________________________________________________________
________________________________________________________
________________________________________________________
[ ] Name: __________________________________________________________
_________________________________________________________
_________________________________________________________
PARENTAL CONSENT FORM
This is to confirm that ________________________________________
has my
Permission to attend: _________________________________________________
_________________________________________________
_________________________________________________
Located at:
_________________________________________________
Sponsored by The Youth Support Program on: ____________________
I fully
understand the nature and intent of this event.
Signed:
Parent/Guardian
_________________________
Date:
_________________________
Please note any medical conditions or allergies we should be aware
of:
The assessment of adolescents for alcohol and
drug misuse presents a unique set of problems. When compared with adults seeking
treatment, adolescents are often unpredictable in their substance use, and
experience a multiplicity of problems.
Adolescent substance misuse is of a shorter
duration and does not involve as many physical consequences. It has usually
involved loss experiences different from those of adults. These experiences
must be addressed in a caring and validating manner and they require special
attention. They must not be dismissed as merely ‘a normal part
of growing up’.
Although adolescents may be harmfully involved with alcohol and
drugs, they are less likely to be dependent than adults upon entering
treatment. As a result, many of the indicators used to determine the presence
of substance misuse problems in adults simply are not present in most adolescents.
However, caution should be exercised, since a significant minority may be fully
addicted.
Adolescence is a normal developmental phase of
life in which conflicts; uncertainty, risk-taking behavior, and change are known
to be notable features. These have to be differentiated from problems
associated with substance abuse.
The Youth Support Program presents a
situation, which differs from that found in most residential or out patient
programs. The duration of weekly counseling/therapy sessions is relatively
short, necessitating a longer period of assessment. However, combined with
weekly group therapy sessions, an opportunity exists to build a trust
relationship, which, in the long term, may well produce an assessment of a more
comprehensive nature.
The primary aim of assessment is to develop a
trust relationship while conducting a continuing assessment. It is not
desirable to ‘label’ young people, because most are at an early stage of
addiction.
The
following are the areas and issues to be investigated and need not be dealt
with in the order listed:
Drug Use and History
a) amount
b) frequency
c) duration
d) where,
and with whom
a) school
b) relationships
c) health
d) finances
e) other
Family Relationships
a)
If the parents are separated,
how long has it been?
b) If
the adolescent is not living with either parent, how long has it been?
c) If
the adolescent left home, what was the reason for leaving?
d) What
is the occupation and income of the parents?
e) Is
there a family history of psychological or mental problems?
f) What
is the level of support by the parents for treatment of the adolescent?
a)
How many siblings?
b) Where
do the siblings live?
c) What
is the quality of relationships with siblings?
d) What
is the birth order of siblings?
a)
How do the parents discipline?
b)
Are there firm consequences for unaccepted behaviour?
c)
Do the parents agree on how they discipline?
d)
Does it work? If not, why?
e) What
is the adolescent’s description of discipline?
f) How were the parents disciplined?
a) Do
any family members have a history of substance misuse?
b) How
does the adolescent describe this misuse?
c) How
has this affected the adolescent?
Peer Relationships
·
How many of their friends
are involved in substance misuse?
a)
If so, how long have they been friends?
b)
Is this person a substance abuser?
c) What is their role in the
adolescent’s substance abuse?
·
What is the academic history?
a) Have any grades
been repeated?
b) What
are their most recent marks?
c) Is
their academic performance better or worse over time?
d) If
there are any problems, when did they begin?
e) Has
the adolescent been in any special programs?
f) Ask school staff for a student
profile.
·
What is the adolescent’s behaviour in
school?
a) Have
there been any behavioural problems in school?
b) How
does the adolescent relate to teachers and staff?
Employment History
Legal/Police Background
Leisure Activities
Emotional History
·
History of depression (sadness, boredom)
a) How often?
b) How
long do their sad feelings last?
c) Is
this in relationship to substance abuse?
d) Is
there a history of suicidal ideation or suicide attempts?
e) Are there sleep difficulties?
f) Have
there been changes in appetite (i.e.. eating too much or too little)?
·
Fears and Worries
a) Does
the adolescent have specific fears?
b) Does the adolescent view himself or
herself as a worrier? If yes, what type of things does the adolescent worry
about?
·
Dealing With Anger
a) Does the adolescent view themselves
as having a bad temper?
b) How
often does the adolescent get angry?
c) What
does the adolescent do when they’re angry?
d) Who
are the most frequent targets of the adolescent’s anger?
e) Have
there been any incidents of harm to self or others?
f) Does the adolescent damage property
when angry?
·
Accessibility of Emotions
a) Is
it easy or hard for others to tell the mood of the adolescent?
b) If the adolescent is upset about
something, are they more likely to talk to someone, or keep it to themselves?
If they can talk to someone, then to whom?
·
History of Abuse
a) Physical
abuse
b) Sexual
abuse
c) Emotional
abuse
What have contacts been with other counsellors, therapists,
etc., and are they aware of the adolescent’s Youth Support involvement?
Attempt to determine if there is any information,
which the adolescent feels, is important, and which was not asked about. (i.e.,
sexuality, spirituality, the occult or religious activity)