TIP 31 and 32 edited

TIPs 31 and 32 Adolescents: 

TIPs 31 and 32 Adolescents Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright AllCEUs.com 2011 Unlimited CEUs $99/year

Not Little Adults: 

Adolescent treatment requires an awareness of: Developmental stages Adolescent culture Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Not Little Adults

Adolescent Development: 

Cognitive Early Adolescence Emphasizes immediate reactions to behavior May not be fully aware of later consequences Late Adolescence Greater use of inductive/deductive reasoning More introspective and more sensitive to later consequences Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Adolescent Development

Developmental Tasks: 

Family Independence Beginning rejection of parental guidelines Ambivalence about wishes Insistence on independence, privacy May have overt rebellion, limit testing, withdrawal Peers Early: Most often "best" friend is same sex Late: Dating, risk taking, need to please peers Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Developmental Tasks

Developmental Tasks cont…: 

School and Vocation Beginning to identify skills, interests Starting part-time job Self Identity and Esteem Am I normal? Conformity--behavior that meets peer group values Some continue to pursue group/peer acceptance Some are able to reject group pressure if not in self-interest Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Developmental Tasks cont…

Professional Approach: 

Early Adolescents Provide firm, direct support Convey limits--simple concrete choices Do not align with parents, be an objective caring adult Encourage transference (hero-worship) Sexual decisions--directly encourage to wait Encourage parental presence in clinic, but interview teen alone Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Professional Approach

Professional Approach cont…: 

Late Adolescence Be an objective sounding board (but let adolescents solve own problems) Negotiate choices Be role model Don't get too much history ("grandiose stories") Confront gently--about consequences, responsibilities Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Professional Approach cont…

Professional Approach cont…: 

Consider "What gives them status in the eyes of peers?" Use peer group sessions Adapt systems to crises, walk-ins, impulsiveness, testing Ensure confidentiality Allow teens to seek care independently Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Professional Approach cont…

Screening and Assessment: 

Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Screening and Assessment

Screening and Assessment: 

Selection of instruments is guided by: Reliability and validity of the tool Its appropriateness to an adolescent population Type of settings in which the instrument was developed Intended purpose of the instrument Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Screening and Assessment

Features of Instruments: 

Short in duration High test-retest reliability Evidence of convergent validity (i.e., the instrument is strongly correlated with other instruments that purport to measure similar constructs) Predictive validity (i.e. school performance, relapse) Normed on adolescents Ability to measure meaningful behavioral and attitude changes over time Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Features of Instruments

Family Assessment: 

Adolescents may define family in nontraditional ways. The law and society may define family in ways that differ from the actual experiences of youth. Cultural and ethnic differences in family structures should be respected. The core problem may reside outside the adolescent and the substance use is a symptom. Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Family Assessment

Screening Indicators: 

Use during childhood or early adolescence Use before or during school Peer involvement in use Daily use of one or more substances Parental substance abuse Sudden change in school performance Marked change in physical or mental health Risky activities Truancy or running away Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Screening Indicators

Goals of Screening: 

Determine severity of disorder Examine associated factors Make appropriate referrals Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Goals of Screening

Assessment: 

More in-depth than screening Document disorders and interactions across all domains Identifies information to guide treatment planning Strengths Social supports Motivation Provides an opportunity for engagement and motivational enhancement Is an ongoing process Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Assessment

Areas for Assessment: 

Substance use history Age of first use for each drug Frequency, intensity, duration Concurrent use Immediate and remote consequences of use Family history of use Peer and family attitudes toward drug use Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Areas for Assessment

Areas for Assessment cont…: 

Mental health Family history Client’s history Present symptoms Past and present medication and/or treatment and effects Coping skills and strengths Trauma Self-esteem Eating disorders Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Areas for Assessment cont…

Areas for Assessment cont…: 

Physical health Current/past Current medications Family health history Housing School experience Performance Attendance Enjoyment Learning disabilities Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Areas for Assessment cont…

Areas for Assessment cont…: 

Social Peer relationships Changes in peer groups Interpersonal skills Neighborhood environment Gang involvement Pro-social activities Mentors/social supports Sexual history Activity Orientation STDs/pregnancies Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Areas for Assessment cont…

Areas for Assessment cont…: 

Juvenile justice involvement Developmental milestones and events Family history Parental relationships Involvement with DCF Home environment Other strengths Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Areas for Assessment cont…

Integrated Summary: 

Identifies the severity of all disorders Identifies (mitigating and exacerbating) factors Identifies a corrective plan of action to address these problem areas Details a plan to ensure that the treatment plan is individualized, implemented and monitored Makes recommendations for referral Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Integrated Summary

Integrated Summary cont…: 

Identifies a SPOC Describes how resources and services of multiple agencies can best be coordinated and integrated Recommend post-treatment services Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Integrated Summary cont…

Assessors: 

Trained in: Psych assessment SA assessment Developmental psychology Use of standardized tools Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Assessors

Legal Issues: 

Federal confidentiality regulations (42 C.F.R. 2.12(e)) Disclosure without the adolescent's consent in situations such as: medical emergencies child abuse reports program evaluations communications among staff Programs may not communicate with the parents of an adolescent unless they get the adolescent's written consent. Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Legal Issues

Legal Issues cont…: 

The Federal regulations contain an exception permitting a program director to communicate with an adolescent's parents without her consent when: The adolescent is applying for services The program director believes that the adolescent does not have the capacity to decide The program director believes the disclosure is necessary due to a substantial threat to the life or well-being of the adolescent or someone else Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Legal Issues cont…

Legal Issues cont…: 

Other exceptions: Information that does not reveal the client as having a substance use disorder Information ordered by the court after a hearing Medical emergencies Information regarding crimes on program premises or against program personnel Information shared with an outside agency that provides service Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Legal Issues cont…

Legal Issues cont…: 

Other exceptions cont… Information discussed among people within the program Information disclosed to researchers, auditors, and evaluators with appropriate Institutional Review Board review and approval to ensure the protection of program participants Note: Always check with your legal counsel in your state to ensure conformance with state as well as federal laws Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Legal Issues cont…

Issues in DJJ: 

Concurrent issues Physical or sexual abuse Psychological and emotional problems Poor performance in school Family difficulties Gang-related violence and involvement Living in neighborhoods where poverty and low income have led to communitywide despair and hopelessness Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Issues in DJJ

Treating Adolescents: 

Adolescents are not little adults Drug and alcohol use often stems from different causes They have trouble anticipating the consequences of their use Must address cognitive, emotional, physical, social and moral development Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Treating Adolescents

Treating Adolescents cont…: 

Take into account gender, ethnicity, disability status, stage of readiness to change and cultural background Identify and treat delays in normal cognitive and social-emotional development associated with substance use during adolescence Involve the adolescent's family because of: its possible role in the origins of the problem its ability to change the youth's environment Be sensitive to motivational barriers Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Treating Adolescents cont…

Treatment Planning: 

Identify biopsychosocial problems Identify attainable goals for those issues Enhance strengths and resources to meet those goals Specify objectives that are realistic and measurable for each goal Describe interventions needed to achieve objectives Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Treatment Planning

Program Components: 

Orientation Daily scheduled on-site and off-site activities Peer monitoring Conflict resolution Vocational Training Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Program Components

Program Levels: 

Detoxification Outpatient Intensive Outpatient Group Home/Residential Inpatient/Hospital Based Continuing Care Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Program Levels

12 Steps for Adolescents: 

Providers treating adolescents in a 12-Step-based program should bear the following in mind: CoD are primary, multifaceted illnesses that exist in people of all ages, including adolescents Persons with CoD share a common problem but have unique and separate needs Once adolescents are informed in an understandable way, they are capable of helping others with guidance Copyright AllCEUs.com 2011 Unlimited CEUs $99/year 12 Steps for Adolescents

12 Steps for Adolescents cont…: 

Use of group therapy is well suited to adolescents, who tend to rely heavily on peer examples and approval The principles of recovery outlined by AA/NA provide effective and proactive tools for continuing recovery Once a person has lost control over his use of substances as an adolescent, returning to responsible and legal use as an adult may require additional help and support Copyright AllCEUs.com 2011 Unlimited CEUs $99/year 12 Steps for Adolescents cont…

Adolescents and the First 5 Steps: 

Focus on the first 5 steps during treatment Step 1: We admitted we were powerless over alcohol--that our lives had become unmanageable. Assist adolescents in reviewing their SA history and associate it with harmful consequences. Step 2: We came to believe that a Power greater than ourselves could restore us to sanity. Help adolescents with CoD to understand that Step 2 refers to obtaining help to stop drug seeking and use behavior. Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Adolescents and the First 5 Steps

Adolescents and the First 5 Steps cont…: 

Step 3: We made a decision to turn our will and our lives over to the care of God as we understood Him. Using the phrase "Helping Power" instead of "Higher Power" or “Good Orderly Direction” can benefit some. Step 4: We made a searching and fearless moral inventory of ourselves; Step 5: We admitted to God, to ourselves, and to another human being the exact nature of our wrongs. Steps 4 and 5 provide an opportunity to be accepted by another person in spite of one's past behaviors and to take a "personal inventory" of those past behaviors. Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Adolescents and the First 5 Steps cont…

Staff Training: 

Treatment approaches specific to adolescents and their families Family dynamics and family therapy Adolescent growth and development Sexual and physical abuse Gender issues Mental health problems Different cultural and ethnic values Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Staff Training

Staff Training cont…: 

Psychopharmacology Referral and community resources Cognitive impairments Legal matters Recreational and pro-social activities Group dynamics and group therapy Suicidal behavior Grief and loss Management of oppositional and violent behaviors Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Staff Training cont…

Staff Training cont…: 

Legal matters (custody and juvenile justice concerns, child abuse and neglect reporting requirements, duty-to-warn issues) Treatment planning and documentation HIV/AIDS Other health matters (STDs, tuberculosis, hepatitis, nutrition) Gangs Drug dealing Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Staff Training cont…

Summary: 

Treating adolescents requires special skills and training Most adolescents begin use to cope or receive external validation Adolescents’ development is often thwarted at the point of SA initiation A strengths-based motivational approach works well with older adolescents Adolescents can be helped to develop into healthy adults Copyright AllCEUs.com 2011 Unlimited CEUs $99/year Summary