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YOUTH SUPPORT

SUBSTANCE MISUSE TREATMENT PROGRAM

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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 adolescentís 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 Ďtime of transitioní, 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 Defined

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

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.

 

 

PHILOSOPHY AND BELIEFS

 

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 adolescentís 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 Ďfamily syndromeí, 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 memberís 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 personís 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 peopleís 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 meetcriteria 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.

 

 

 

 

 

 

STAFF GUIDELINES FOR ETHICAL BEHAVIOUR

 

 

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 participantsí disclosures.

 

4.)†††††††††† When the adolescentís 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 adolescentís 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.

 

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REFERENCES

For

STAFF GUIDELINES FOR ETHICAL BEHAVIOUR

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOCUMENTATION

 

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 clinicianís 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.

 

Parental Consent

 

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:

 

 

≠≠≠≠≠≠

 

 

 

 

 

ASSESSMENT

 

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 Ďa normal part of growing upí.

 

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 Ďlabelí 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 adolescentís 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 adolescentís substance abuse?

 

 

 
School

 

 

          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 adolescentís 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

 

 

 

 

 

 

 

 

 
Health

 

 

 

 

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 theyíre angry?

d)††††††††††† Who are the most frequent targets of the adolescentís 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 adolescentís 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)

 

Part two

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