W HO S I N T HE R OOM T ODAY ? Please share your Name. How are you - - PowerPoint PPT Presentation

LIFE’S TRANSITIONS: ADDRESSING TREATMENT AND RECOVERY

WITH A TEAM APPROACH...

FROM ADOLESCENCE TO YOUNG ADULTHOOD

Presenters: Kellie Gage, MS , CAADC IDHS/DASA Aireal Weber, MA, LCPC Centerstone of Illinois

OUR GOALS FOR TODAY

Identify ways adolescent development impacts substance

use and recovery.

Discuss transitions in life that can cause stress in the life

• f developing youth and young adults.

Identify holistic support systems for young adults Discuss tools for working with adolescents, young adults,

their families and other support systems

WHO’S IN THE ROOM TODAY?

 Please share your Name….  How are you connected to the Behavioral Health Field?  Do you currently work with Adolescents and/or Young

Adults?

 What positive comment/thought would you share with

a Young Adult in Recovery?

DON’T BE LIKE TIMMY!!!! LIFE IS FILLED WITH SWIFT TRANSITIONS

https://youtu.be/5wBnBC-b540

WHAT WORDS COME TO MIND

When you hear the word Adolescent, what words come to mind?

ADOLESCENT WORD CLOUD

ADOLESCENCE IS….

Adolescence is a period of life with specific health and

developmental needs and rights.

All societies recognize that there is a difference between

being a child and becoming an adult.

How this transition from childhood to adulthood is

defined and recognized differs between cultures and over time.

Age is a convenient way to define adolescence. But it is

• nly one characteristic that delineates this period of

development.

ADOLESCENT DEVELOPMENT

“Adolescence is like having only enough light to see the step directly in front of you.” ― Sarah Addison Allen, The Girl Who Chased the Moon

EARLY ADOLESCENCE (12 & 13)

Physical Development

• Puberty
• Physical growth

Cognitive Development

• Growing capacity for abstract thought
• More interest in present versus future

Social-Emotional Development

• Struggle with sense of identity
• Desire for independence

Adapted from the American Academy of Child and Adolescent’s Facts for Families. 2008.

MIDDLE ADOLESCENCE (14-17)

Physical Development

• Puberty is completed
• Physical slow for girls, continues for boys

Cognitive Development

• Greater capacity for setting goals
• Interest in moral reasoning

Social-Emotional Development

• Intense self-improvement
• Driven to make friends and tendency to distance

selves from parents

Adapted from the American Academy of Child and Adolescent’s Facts for Families. 2008.

LATE ADOLESCENCE (18-25)

Physical Development

• Young women, typically, are fully developed
• Young men continue to gain height, weight,

muscle mass, and body hair

Cognitive Development

• Ability to think ideas through
• Examination of inner experiences

Social-Emotional Development

• Firmer sense of identity
• Increased concern for others
• Social and cultural traditions regain some of their importance

Adapted from the American Academy of Child and Adolescent’s Facts for Families. 2008.

STAGES OF ADOLESCENT TO EARLY ADULTHOOD DEVELOPMENT

Erik Erikson’s Stages of Development

• Adolescence is a period of

profound brain maturation.

• It was believed that brain

development was complete during childhood.

• The maturation process is

not complete until about age 25 (mid -twenties)

AHEAD

Motivation

Emotion Judgment

Cerebellum

Amygdala

Nucleus Accumbens

Maturation starts at the back of the brain..and moves to the front

Prefrontal Cortex Physical coordination Sensory processing

Notice: Judgment is last to develop!

ADOLESCENT BRAIN DEVELOPMENT

 Research indicates that the human brain is still maturing during

the adolescent years, with significant changes continuing into the early 20s.

 Brain maturation tends to occur from the back of the brain to the

front, so the front region of the brain known as the prefrontal cortex is responsible for high-level reasoning and decision-making, does not become fully mature until around the early to mid 20s.

Ken C. Winters, Ph.D. Adolescent Brain Development and Drug Abuse

ADOLESCENT BRAIN DEVELOPMENT

 The developing brain of the teenage years may help explain why

adolescents sometimes make decisions that seem to be quite risky and may lead to safety or health concerns.

 Psychologist Laurence Steinberg sees it this way, “a teenager’s

brain has a well-developed accelerator but only a partly developed brake.”

ADOLESCENT BRAIN DEVELOPMENT

“As the prefrontal cortex matures, teenagers can reason better, develop more control over impulses and make judgments better. In fact, this part of the brain has been dubbed ‘the area of sober second thought.’” –Frontline/Dr. Jay Giedd at NIMH

https://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/work/adolescent.html

RISKY BEHAVIORS

 It is useful to consider substance use during adolescence within the

context of the more general spectrum of risk behaviors that mark this developmental period.

 Problem behavior theory defines risk behavior as behavior that can

interfere with successful psychosocial development (i.e. having deviant peers) whereas problem behaviors are risk behaviors that lead to either formal or informal social responses designed to control them (i.e. substance use).

RISKY BEHAVIORS

 Risk behaviors increase the adolescent’s vulnerability to a problem.  What are some common risky behaviors seen by adolescents in that

you serve?

SUBSTANCE USE AND CO-OCCURRING CONCERNS

 ACE’s Study: Health Findings (CDC)

NUMBER OF ADOLESCENTS AGED 12 TO 17 WHO USED CIGARETTES, ALCOHOL, OR ILLICIT DRUGS FOR THE FIRST TIME ON AN AVERAGE DAY

(NSDUH, 2013)

AGE OF FIRST USE OF PRIMARY SUBSTANCE (TREATMENT ADMISSIONS DATA: 2009)

PAST MONTH ILLICIT DRUG USE AMONG PERSONS AGED 12 OR OLDER, BY AGE (SAMHSA, 2012)

PAST YEAR SUBSTANCE USE (2012) (GRADES 9 – 12)

• CEASAR. April 29, 2013, 22 (17).

PRIMARY SUBSTANCE OF ABUSE RURAL AND URBAN ADMISSIONS (AGES 12+) (SAMHSA, 2009)

A SNAPSHOT OF ILLINOIS YOUTH

 Every two years, the Illinois Youth Survey provides current data on

substance usage rates of youth in grades 6, 8, 10, and 12.

 “Gateway” drug findings from the most recent survey were:  Alcohol is the number one drug for Illinois youth, with usage rates higher

than the national average.

 Marijuana use is higher than the national average.  Cigarette use is similar to the national average.  Students using drugs or alcohol are up to five times more likely to drop

• ut of school.

 Nearly 10,000 Illinois residents die annually from accidental injuries,

and 40% of those are related to use of alcohol!

WHAT WORDS COME TO MIND

When you hear the word Emerging Adult/Transitional Aged Youth, what words come to mind?

WHAT WORDS COME TO MIND WHEN YOU THINK ABOUT YOUNG ADULTS

CROSSING OVER

A LONGER ROAD TO ADULTHOOD

For the young Americans of the 21st Century, the road to

adult-hood is a long one.

From their late teens to their late twenties, they explore

the many possibilities available to them (love, work, etc.)

Exciting to explore the different options they have Also a time of Anxiety, because of unsettledness

DOES IT GET BETTER?

https://youtu.be/1-g9hpU_RtM

“There are an estimated 10.5 millions emerging adults ages 18-25 in the US with an SUD, but research on treatments for emerging adults lags behind that for adolescents and older adults.”

Douglas C. Smith, PhD, LCSW Emerging Adults and Substance Use Disorder Treatment

BUILDING HEALTHY SUPPORT SYSTEMS

 Best Practices  Evidence Based Models (ACRA/ACC)  12-14 weeks outpatient treatment  Skills building focus (i.e.: communication, problem solving, job seeking,

drink and drug refusal, etc.)

 Transition to meeting in the community at discharge from ACRA –

whether or not the discharge is “successful”

 Emphasizes community interaction, family support, and linkage

• Formal Support: Alcoholics Anonymous, Narcotics Anonymous,

Celebrate Recovery, Refuge Recovery, SMART Recovery, etc.

• Goal Aligned/Holistic Supports: Gym Membership, Religious

Involvement, Exercise Groups, College Classes, Work Colleagues, etc.

MISSION: Leadership team creates and cultivates local community-led chapters through grassroots organizing and training. Chapters support young people in or seeking recovery by empowering them to obtain stable employment, secure suitable housing, and continue and complete their

• educations. Chapters also advocate on the local and state levels for better

accessibility of these services and other effective recovery resources. VISION: YPR envisions a world where all young people in or seeking recovery will be provided with the tools and support that allows them to successfully take charge of their futures.

WE NEED THEIR VOICES AT THE TABLE!

Involving Young Adults in SYT-I Preparing the Interagency Council Adultism Preparing the Young Adults Finally….We Meet!

MAINE TOWNSHIP: RECOVERY CONNECTION

www.mainetownship.com/services/recovery/

http://illinoisfamilyresourcecenter.org/

COMING SOON

www.serenityacademychicago.org/about/

WHAT IS SAMSHA’S DEFINITION OF COMMUNITY?

a) Meaningful daily activities, such as a job, school, volunteerism, family caretaking,

• r creative endeavors, and the independence,

income and resources to participate in society b) Relationships and social networks that provide support, friendship, love, and hope c) A stable and safe place to live d) Overcoming or managing one’s disease(s)

• r symptoms—for example, abstaining from

use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem— and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.

THE ROSC ENVIRONMENT

RECOVERY-ORIENTED SYSTEMS OF CARE

ROSC are networks of formal and informal services developed and mobilized to promote community health and wellness for all and to sustain long-term recovery for individuals and families impacted by severe substance use disorders. The system in ROSC is not a treatment agency but a macro level

• rganization of a community, a state or a nation.

VALUES AND PRINCIPLES ARE THE FOUNDATION

For

 Accessible services  A continuum of services  Care that is age- and gender appropriate

and culturally competent

 Care in the person’s community and home

using natural supports, when possible

RECOVERY ORIENTED SYSTEMS OF CARE (ROSC) 101 VALUES

Person-centered Self-directed Strength-based Participation of family members, caregivers,

significant others, friends, community

Individualized, comprehensive services and

supports

Community-based services and supports

RECOVERY ORIENTED SYSTEMS OF CARE (ROSC)101- OPERATIONAL ELEMENTS

Collaborative decision-making Continuity of services and supports Service quality and responsiveness Multiple stakeholder involvement Recovery community/peer involvement Outcomes-driven for the individual and system Adequately and flexibly funded

OPERATIONAL CHARACTERISTICS

Integration of evidence-based and promising

practices

Home and community-based alternatives Broad, flexible array of services and supports Individualized services and supports “wrapped”

around children, youth and families

Pires, S. A. (2010).

OPERATIONAL CHARACTERISTICS

 Collaboration across agencies  Cross-agency service coordination and care management  Integration of formal services and natural supports and linkage to

community resources

 Single plan of services and supports  One accountable care manager

Pires, S. A. (2010).

OPERATIONAL CHARACTERISTICS

 Partnerships with families and youth  Staff, supervisors, providers, and families trained and

mentored

 Cultural and linguistic competence  Child and family service-planning and service-monitoring

teams across agencies

Pires, S. A. (2010).

OPERATIONAL CHARACTERISTICS

 Blended, braided, or coordinated funding  Data-driven systems supported by cross-system management information

systems and focused on continuous quality improvement

 Shared governance (and liability) across systems  Shared outcomes across systems  Organized pathways to services and supports

Pires, S. A. (2010).

FAMILY DRIVEN AND YOUTH GUIDED

Families have a primary decision-making role in the care of their children, as well as the policies and procedures governing care for children. This includes:

• Choosing supports, services, providers
• Setting goals
• Designing and implementing programs
• Monitoring outcomes
• Partnering in funding decisions
• Determining effectiveness

Pires, S. A. (2010).

RECOVERY SUPPORT SERVICES

Non-clinical services that

• assist individuals and families working towards

recovery

• incorporate a full range of social, legal, and other

resources that facilitate recovery and wellness to reduce

• r eliminate environmental or personal barriers to

recovery

• include social supports, linkage to and coordination

among allied service providers, etc.

SAMHSA, 2010.

EXAMPLES OF ROSC ACTIVITIES

 Early screening before onset (Prevention-SBIRT)  Recovery support services (Intervention)  Menu of treatment services (Treatment)  Alternative services and therapies (Treatment)  Recovery support services (Post-treatment)  Check-ups (Post-treatment)

SAMHSA, 2010.

STATE YOUTH TREATMENT-IMPLEMENTATION (SYT-I)

The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) Collaborative Agreements for State Adolescent and Transitional Aged Youth Treatment Enhancement and Dissemination Implementation SYT-I: #TI025993

COMMON ACRONYMS

 A-CRA: Adolescent Community Reinforcement Approach  ACC: Assertive Continuing Care  ATTC: Addiction Technology Transfer Center  CSAT: Center for Substance Abuse Treatment  MHD: Mental Health Disorder  SAMHSA: Substance Abuse and Mental Health Services

Administration

 SUD: Substance Use Disorder  SYT-I: State Youth Treatment-Implementation  TAY: Transitional Age Youth

INTRODUCTION

 Spring of 2015, SAMHSA/CSAT released the FY2015 Cooperative

Agreements for State Adolescent and Transitional Aged Youth Treatment Enhancement and Dissemination Implementation (Short Title: State Youth Treatment-Implementation) Request for Applications.

 Illinois Responded and Awarded: Illinois is one of Eleven (11) states to

awarded the SYT-I. Illinois to receive $800,000, for 3-years.

 Other SYT-I States: Arizona, Iowa, Louisiana, Massachusetts, Maine,

Montana, New York, Oklahoma, South Carolina, and Washington State

FEDERAL: PURPOSE FOR SYT-I

 The purpose of this program is to provide funding to states to improve

treatment for adolescents and/or transitional aged youth with substance use disorders SUD) and/or co-occurring substance use and mental disorders by assuring youth state-wide access to evidence-based assessments, treatment models, and recovery services supported by the strengthening of the existing infrastructure system.

 SYT-I is a combination of infrastructure improvement and direct

treatment service delivery.

ILLINOIS’ SYT-I FOCUS

 The SYT-I Award for the State of Illinois has two primary purposes  SYT-I funds will support an enhancement and expansion of the Illinois

statewide adolescent substance use disorder (SUD) infrastructure and evidence-based treatment implementation services and activities to include a focus on youth between 18 and 25 years of age in Illinois.

 The Adolescent Community Reinforcement Approach (ACRA) coupled

with Assertive Community Care (ACC) will comprise the clinical services provided to transitional aged youth (TAY) and their family members

 At least 400 unduplicated male and female youth between 18 and 25

years of age will be admitted to the enhanced treatment services over the three years of SAMHSA/CSAT funding.

IL SYT-I GOALS:

Project Goal 1. Enhance and expand the existing Illinois

Statewide Adolescent Treatment and Enhancement Dissemination (SAT-ED) infrastructure to include support of a continuum of services for transitional aged youth (TAY) with SUDs.

IL SYT-I GOALS:

 Project Goal 2. Enhance the SUD treatment and recovery support

services that are available to TAY with SUDs and/or co-occurring SUDs and MHDs in Illinois through the statewide implementation of evidence- based treatment, and recovery support practices.

 Project Goal 3. Document the results of Illinois SYT-I infrastructure and

clinical service enhancements, and obtain evidence of positive outcomes among the TAY who are admitted to the clinical treatment services supported through this cooperative agreement.

ANTICIPATED RESULTS OF GOAL ACHIEVEMENTS

The Illinois SYT-I initiative will serve as a learning laboratory

through which Illinois can strategize improving TAY access to a full continuum of services during and beyond this award grant.

A strengthened voice of TAY and their family members in the

implementation of these services, that are shown to improve the quality of care and sustainability of changes made.

An expanded Illinois Adolescent/TAY Interagency Council that

will have oversight and help ensure that results are meaningful and relevant.

ACHIEVEMENT OF OUR SYT-I COOPERATIVE AGREEMENT GOALS

WILL RESULT IN:

 Improved long-term recovery and post-treatment outcomes among

TAY with SUDs in Illinois.

 The implementation of A-CRA and ACC can allow TAY to view

treatment as a continuum of care that focuses on sustaining recovery and allowing these youth to practice skills and build a drug-free lifestyle in their natural environment.

 The implementation of the A-CRA coupled with ACC will ensure that

an increased number of Illinois providers will be using approaches that are developmentally appropriate and that TAY have access to these evidence-based treatment and recovery support practices.

THE SYT-I INTERAGENCY COUNCIL

Members Goals Our Progress

WORKING WITH EMERGING ADULTS WITH SUBSTANCE USE DISORDERS

TERMINOLOGY

 Emerging Adult  Transitional Aged Youth  Includes some Millennials Born (1982-1999) the full age range of

Millennial’s is (1982-2004)

 Differences in Age: 18-25; 16-26; 18-21;  What’s missing????

Jeffrey Jensen Arnett

EMERGING ADULTHOOD

Jeffrey Jensen Arnett: Pioneer on Emerging Adulthood Defined as: A new paradigm, a new way of thinking about

development from the late teens through the twenties, especially ages 18-25 (Arnett, 2015)

It’s a time of responsibilities related to a stable job,

marriage and parenthood (Munsey, 2006)

FIVE FEATURES OF EMERGING ADULTS

1.

Age of identity exploration: Deciding who they are and what they want out of work, school and love

2.

Age of Instability: Post-high school, repeated residence changes (college, living with friends, or a romantic partner)

3.

Age of self-focus: Decisions of where to go and with who

• ccur

FIVE FEATURES OF EMERGING ADULTS

4. Age of Feeling in Between: Many say they are taking

responsibility for themselves, but still not fully an adult

5. Age of Possibilities: Optimism reigns!! Many believe

they have a good chance of living “better than their parents.”

FOUNDATIONAL STRUCTURE

Many Emerging adults who face problems becoming

independent have faced past challenges meeting developmental tasks for one reason or another (Tanner, 2015).

The foundation laid in childhood and adolescence are key

elements in how well an adolescent makes the transition through young adulthood into adulthood.

911

 (Arnett) sees the need for greatly expanded societal efforts to help

Emerging Adults navigate the transition into careers and family.

 They have unique treatment needs with Substance Use.  At increased risk for co-occurring (MH/SU) disorders, suicidal

ideation, suicide, unemployment, homelessness, unplanned pregnancy, criminal justice involvement (SAMHSA, 2013)

TRANSITION AGED YOUTH (TAY)

Based on SFY14 DARTS Data (DASA’s administrative/funding database)

AGE OF TAY VS. OTHER POPULATIONS SERVED

OTHER DEMOGRAPHICS

PRIMARY SUBSTANCE

OTHER ATTRIBUTES

TREATMENT INFORMATION

NATIONAL OUTCOME MEASURES

REACHING THE EMERGING ADULT THROUGH SUBSTANCE USE SERVICES

 Substance Use Disorders Treatment for Emerging Adults (White

paper, Sanders 2016)

❑ Substance Use: Ability to delay the stages of development ❑ Special emphasis on helping them achieve the developmental tasks

COMPLETION OF THE DEVELOPMENTAL TASKS OF ADOLESCENCE

 Some of the tasks include:

▪ Greater Independence w/parental relationships ▪ Increased problem solving skills ▪ High School graduation ▪ Establishment of healthy relationships with peer group ▪ Selection of a career goal ▪ Become more socially responsible ▪ Acquire a set of values to guide behavior

(Sanders, 2016)

APPROACHES TO HELPING E.A.

 Harm Reduction: can be instrumental (Narcan, No needle sharing,

etc.)

 Evidence Based Practices: Recommended for therapist working

with E.A. (Motivational Interviewing, Motivational Incentives, A- CRA/ACC, Integrated Dual Disorders TX, etc.)

 Trauma Informed Care: Histories of Trauma that often precede the

SU (Nico’s case) (Sanders, 2016)

TREATMENT FOR EMERGING ADULTS

 Alternative Therapies: art, music, dance, drama can create a fun

• atmosphere. Audio/Visual materials

 Culturally specific services: services should be tailored to meet the

specific needs of the E.A.

 Family: One goal is to help the E.A. develop differentiation of self in

their family of origin. Establish healthy boundaries (Sanders, 2016)

RECOVERY COACHING & PEER SUPPORT

Provide support, outreach to those not ordinarily seeking

treatment

Coaches: connect E.A. to community, can help create a

seamless system of care between treatment and the community

Peers: Have lived experience and can identify with the

E.A. (YPR)

Guest Panel

Our Contact Information:

Kellie Gage Illinois Department of Human Services Division of Alcoholism and Substance Abuse Ph: 312-814-6415 Email: kellie.gage@illinois.gov Aireal Weber Centerstone-Carbondale South Ph: (618) 457-6703 ext: 7976 Aireal.Weber@Centerstone.org