EDUDORM ACADEMIC SERVICES

Treatment plan for adolescents with issues concerning mental health and substance abuse

Social work

Abstract

The adolescent years come with a lot of challenges for both the teenagers and their families. The phase is normally emotionally intense and thus requires special intervention. Just like the idea that it takes a village to raise a child, it takes the whole community to offer support for youth. It’s widely known that many teens encounter issues related to mental health, family affairs, friends, school work, drug abuse, sexuality and other hazardous behaviors. Such issues are usually worse for those youths who have no support from the community and they end up in juvenile corrective systems. Few of those get a chance to be treated considering the judgments based on state laws.

Introduction

There have been increasing rates of adolescent delinquency and thus involvement with juvenile justice system according to research done over the last 10 years. This increase in the art of adjudicated youth is a reflection of adult incarceration, but unlike adults this delicate and disadvantaged population has been neglect in the written law and the entire society. There is a need to allocate funds in the research on this issue in order to come up with ways of controlling the increased rates of juvenile crime and provide effective rehabilitation programs. Until such a time, it is very important that residential treatment improves services provided for the adjudicated youths. Due to the possibility that treatment provided is ineffective, the trend towards a more punitive approach in the juvenile justice can do more harm to the already disadvantaged population. It is dangerous to harbor the idea that nothing works, a notion that has no support of empirical evidence but is largely based on treatment literature reviews which do not document the changes associated with treatment. Within historical context a considerable gap exists in provision of appropriate services for youth. Past models of treating adolescents were focused on adult interventions and failed to deal with the distinctive developmental requirements of young people. However, today’s focus is slowly shifting towards developing more suitable treatment strategy that comprise of standardized, all inclusive bio-psycho-social evaluation to assist in the plan for treatment and clinical assignment (White, White,& Dennis, 2004). There is little literature and research on treatment outcomes. Furthermore, we need to ask if residential treatment is effective for treating teens with recurring substance misuse and diagnosing psychological health issues since about 50 to 80% of adolescents joining treatment have resurging psychiatric diagnosis (Evans &Sullivan, 2002).

It is possible for one to easily assume that young people with recurring SUD and psychiatric health are the clients who are mainly underserved. According to Falcon (2003) ofthe2million adolescents in U.S. needing SUD treatment each year, only200, 000 obtain treatment and less than100, 000 are getting treatment interventions suitable for their health requirements. This portrays a rather discouraging view on the effectiveness of treatment programs, mainly for adjudicated youth diagnosed with co-occurring conditions. Without doubt major changes in residential treatment are needed to increase effectiveness but without empirical evidence on best practice many programs, including my field placement, place strong emphasis on standardized cognitive and adaptive measures, applying punishment as behavioral management dismissing the rewarding part.

The regular application of principals of behavioral management underlying reward and punishment can aid in individuals reduction of drug abuse and criminal conduct. There is more likelihood for sanctions and rewards to change ones behavior when they are sure of following the targeted behavior, more so when followed swiftly, and when they are viewed as being fair (National Institute on Drug Abuse, 2014). It is more effective to realize long-term change that is positive while rewarding positive conduct than punishing negative behavior. In fact, punishment alone is not an effective intervention for public health and safety needs for those offenders with criminal behavior directly associated with drug abuse. Hence, both rewards and sanctions are needed to facilitate change but sanctions are mostly applied in treatment settings with the general assumption that the reward is the actual completion of program. And it might be good for the adults who voluntarily enroll in treatment but it fails to address developmental needs unique for young people with co-occurring conditions. Their developmental stage requires short term rewards, awarded more often as well as positive reinforcement. This study intervention will address the need of incorporating more objective rewards into the programs as a way of facilitating change. Based on existing literature related to rewarding positive behavior as being effective for treatment and personal experience in the field, it is believed that study intervention will prove to be effective in treatment programs.

My experience with treatment plan for adolescents with issues concerning mental health and substance abuse (Adjudicated Youth in briefly held in the custody of Oregon Youth Authority) is based on providing frontline (direct) services to a group of 14 clients, assisting as back-up support, facilitating and co-facilitate approximately 5 hours of group counseling each day, evaluating and documenting clients progress, etc. Treatment program through fundamentals of Positive Peer Culture incorporates (BSB) basic social behaviors in order to provide a safe environment for all members to develop strength that will lead to recovery. This is accomplished by clients following Basic Social Behaviors. The concept is to allow peers to help each other and only involve staff when the group is struggling to collectively follow the PPC model. This is how the program works: when a youth is having difficulty following the BSB, peers may give him friendly reminder. Upon receiving his 3^rd reminder in day, staff intervention is necessary and youth is offered a VTO (voluntary timeout).This process issued to provide youth a few minutes to settle down and regain composure. Engaging in disruptive behavior during the VTO may result in MRV (major rule violation) Safety. MRV safety protocol places the youth in safety room supervised byback-upstaff.MRV safeties may last no longer than one hour and no shorter than 30 minutes. Failure to comply with safety protocols may cause a client to go off-program. This was indeed my biggest concern. At risk youth needs treatment not incarceration. But treatment needed to be improved in order to be efficient.

Improving youth behavior, engagement in school and treatment services

A one hour a week, one on one counseling and incorporating contingency management strategies in the program will improve the youth behavior; increase their school engagement and the relevant treatment services.

Empirical evidence

Strategies for Contingency management, known to be efficient in community settings, utilize voucher-based incentive rewards, like bus tokens, for imparting abstinence (measured by drug tests that are negative) or for directing improvement towards other treatment objectives, like attending program session or complying with medication treatment regimens. The application of Contingency management is mainly useful when the behavior being observed is followed by contingent reward. An intervention tested by CJ- DATS researchers, called “Step’n Out,” which is an intervention that has been put under test by CJ-DATS(researchers) utilized a contingency management strategy where the criminal justice personnel monitored particular behaviors such as employment searches and counseling attendance. They then offered rewards to individuals who met socially acknowledgement goals that had been agreed upon such as congratulatory letter and small material incentives like partial payment for job interviews’ clothes .This tactic improved attendance of parolees at integrated community instituions and sessions for addiction treatment , as well as better usage of treatment and personal counsel in services (National Institute on Drug Abuse ,2014) .To implement contingency management strategies , there is need to adopt programs that are skills-oriented so that to reduce any gateway for substance use and other negative behavior. The programs would have major components that include social skills and self- management skills that encourage feedback and evaluation of the strategy. The strategy would also be implemented by use of programs for behavior management that target the enhancement of positive behavior through monitoring and enhancement.

Customize Treatment-One hour a week individual counseling

NIH principles on treatment on drug addiction connotes that addiction is a complicated disease but which is treatable that affects functioning of brain and behavior. There is no common treatment that is good for everyone. The treatment varies according to the type of drug and the patient’s characteristics. A Match between interventions, settings of treatment and services to an ones ’s particular problems and needs is vital to their ultimate success. Effective treatment serves multiple needs of the person, together with their drug abuse needs. It is also essential that treatment be suitable to the one’s age, sex, ethnicity or culture (National Institute on Drug Abuse, 2012).A large number of clinical trials have supported the efficacy of individual counseling as an intervention for substance use.

Rationale

Punishment alone is an ineffective approach to treatment. To better understand the need for intervention, I will briefly discuss why the current BSB model doesn’t works. Clients admitted into treatment have been through many other programs that failed them before. Many are well aquatinted with curriculum considering the model to be ineffective and boring. This lack of motivation and hopeless attitude is contagious further hindering the recovery progress.

Furthermore, falling asleep during group counseling, refusing to engage in discussions, incomplete assignments, and lack of interest in educational process is really considered unacceptable behaviors which are sanction accordingly. For not complying with BSB youth would easily get 3reminders in a day, followed by VTO’s with many ending up in MRV (major rule violation) Safety. Once in MRV Safety, their behavior would decline even more placing them at risk for going off the program. In this way sanctions implemented due to lack of interest in the program cannot be effective strategies for behavioral improvement and personal engagement in treatment program.

The goal of this study is to prevent youth from losing their treatment opportunity by going off the program back to juvenile detention. History of treatment failure contributed towards their resistant attitude therefore in order for any change to occur, effective communication had to be present as well as reinforcement of positive behavior through rewards.

Study hypothesis

One hour a week, a face to face counseling as well as incorporating contingency management strategies in the program will improve youth behavior, increase their school engagement and treatment services for negative behavior and increasing self-esteem.

Independent variable

These are the intervention strategies which include one on one counseling and contingency management that are aimed at positive outcomes.

Dependent variables

These include participant’s engagement, attitude towards treatment, behavior and self-esteem.

Significance

It is important to prevent youth from going off the program for 2 reasons. First if they do go back to jail, they will spend their time there until theyturns18.Then they will be released and without proper treatment they will end up living homeless on streets. Second reason is discouragement. If treatments continue to fail youth, they will never seek help or believe in their own recovery. Therefore time is of essence in this case.

Youth voice

They don’t want to goof program and spend their remaining time in juvenile because compare to incarceration environment treatment centers are better. Many are also talking about their own fears and anxiety related to living homeless on the streets since foster care is no longer an option after they turn18.

Study setting

This study will be conducted at the residential treatment program since the youth is restrained. The center will be used to hold the meetings as well as to facilitate the intervention. As part of the prevention intervention, each participant will meet their counselor once a week for 1 hour. The assigned therapist will remain the same throughout the study and the participants are expected to remain the same.

Study Design

14 male adolescents who were diagnosed with recurring substance abuse and psychiatric disorder, who were already admitted to residential treatment were incorporated in the study; age 16.5 to 18years,and the length of the treatment program is 9months.This is a A-B design-a baseline and one intervention. Client’s daily basic social behavior according to agency policy was recorded from first day of enrollment. Assessment and case foundation were available and having access to these records it was easy to obtain retrospective baseline of pretreatment trends. The retrospective baseline will serve as a basis for comparison with the subsequently acquired data.

The AB design would be implemented with an evaluation option. In this case the, the condition for treatment is introduced and then withdrawn after a given period. If there is systematic change in behavior, confidence for the treatment will be known to be the reason for the change in behavior. Each participant will be taken through the above procedure and the counselors or therapist will take details. The case will then be presented to assess the extent to which the participants responded to the intervention strategies. Two observers, who are independent from the counselors or other staff, will supervise each case to ensure reliability of data collected.

Measures

Measure1

Source Available Records-participants records will be used to collect data related to his BSB sanctions-how many reminder hey received daily, how many VTO’s and how many MRV (major rule violation which may cause off-program or loss of treatment benefit) Recorded data from 2weeks,14 day prior to intervention will be used for retrospective baseline.

The recorded data will continue to be collected following the intervention to compare participant improvement according to program Basic Social Behavior expectations. There is no information available about the reliability and validity of these measures. But there is some built-invalidity because these are the actual measures of problems that are used in the program.

Measure 2

Researcher will rate participants’ behavior based on personal observation of client participation, sharing and overall engagement in group discussions. Then at the end of each group counseling assigned paperwork will be collected, rate accordingly and finding documented. This will measure youth participation and engagement in their recovery.

Measure 3

Self-Report-Scale-will is used to measure client’s overall well being and recovery progress overtime. For this, Rosenberg Self-Esteem Standardized Scale will be used and a couple of qualitative questions. Psychologists and sociologists are common users for Rosenberg Self-Esteem so this tool is a vital part in social science study and is commonly used for teenagers. The Rosenberg Scale for Self-Esteem is given high ratings in dependability areas; internal uniformity was 0.77, least Coefficient of Reproducibility was at minimum of 0.90 (M.Rosenberg, 1965).

Measure 4

A survey that is purposely designed to measure the participants’ satisfaction with the treatment programs is done. The participants’ recruitment is done at the time of admission or the last days of treatment periods. The questions design was purposely done to fit the specific participant. These measures can then be compared to others in order to define the relation.

Qualitative component

At risk youth are extremely intelligent but hopeless when it comes to their recovery. Every time they have a chance to discuss their progress in treatment it would be evaluated based on previous failure or high dropout rates or program incompletion currently recorded. They would argue that out of 14clients currently in the program only half will get to the completion and no one is safe from relapsing. Resistant attitude is very common among troubled youth. After working with this population for some time, mostly listening, I learned their strengths and weaknesses and discovered that giving them” points rewards” for following The BSB model improved overall behavior, engagement in treatment as well as self-esteem. Points were used to purchase needed items, such as a belt, candy bars, books, etc.(which I provided in the beginning from my sons but with time the support team have gathered many more items and we created a mini store in a vacant cubicle).It is believe by many that development is affirmed and promoted by person-centered contexts and interactions therefore the qualitative component data in the questionnaire was addressed accordingly. Wanted to know what are the participant’s biggest success and greatest challenges every week. So, I followed through with 2 qualitative questions which clients would have to answer weekly.

Method of data collection and analysis:

Data will be collected from available records, using agency software such as Basic Social Behavior reports which will clearly show all implemented sanctions such as reminders, VTO’s and MRI before the intervention as well as during and after. Available records are very useful in for this time sensitive case study when intervention cannot be delayed.

It will also be collected from direct behavioral observation. Participants’ behavior during group counseling, participation and engagement in group discussions as well as paperwork completion will be documented. This method of data collection is the most practical and popular in this field practice. Moreover Self-Report-Scale-findings will be recorded and data analyzed accordingly.

The collected data will be recorded in a table which will be presented in graph to show the conditions before and after the behavioral improvement.

Discussion

This Single case study is easy to use and understand, even with limited understanding of research methodology. It provides practitioners and social workers immediate, inexpensive and practical feedback on whether their clients are improving or not. Relating to this intervention for difficult youth it is very beneficial to build on the simple case study model by constructing a baseline and observing targeted behaviors. This single case study also provides the practitioners opportunity for more direct engagement with client. Ultimately, the single case study is capable of providing us with objective evidence that our intervention did or did not benefit the client. In these times of scare resources in the social welfare arena practitioners should strive to implement single case design whenever they can.

Weaknesses

As with all single-case design study one of the major weakness is the limited external validity clearly stated in our textbook- we may not be able to generalize the study to different settings and populations (Rubin&Babbie,2007).Another weakness related to this study has to do with data collecting: for Self-Report scales, participants might lose interest in completing the qualitative questioner once a week and Rosenberg Self-Esteem Scale once a month and for agency available records there is no information available about their liability and validity of the discussed measures.

Reference

National Institute on Drug Abuse (2014). How can rewards and sanctions be used effectively with drug-involved offenders in treatment? Principles of Drug Abuse Treatment for Criminal Justice Populations - A Research-Based Guide.

National Institute on Drug Abuse (2012). Principles of Drug Addiction Treatment. Retrieved from: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment

Evans,K.,& Sullivan,J.M.(2002).Dualdiagnosis:Counselingthementallyillsub-stanceabuser.NewYork:TheGuilfordPress.2 Ed.

Falco,M.(2003).Finding treatment for adolescent substance abusers. Counselor: The Magazine for Addiction Professionals,4(1),56–57.

Muck,R.D.,&Butler,J.(2004).Adolescenttreatmentexcellence:Connecttoagrowingmovement.Counselor:TheMagazineforAddictionProfessionals,5(2),12–17.

Morris, R., (1965). Society and the Adolescent Self-Image. Princeton:PrincetonUP,.Print.

Rubin,A.&Babbie,E.(2011).Research methods for social work. Belmont, CA:Brooks/ Cole, Cenegage Learning. 7 Ed.

White,M.,White,W.,&Dennis,M.(2004).Emerging models of effective adolescent substance abuse treatment.Counselor:The Magazine for Addiction Professionals,5(2),24–28.

Appendix#1-Rosenberg'sSelf-EsteemScale

STATEMENT

Strongly Agree Agree Disagree Strongly Disagree