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Working
With Young People
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The information below was originally developed for the NSW Government and was designed to be read in the context of their Youth Policy and the Department of Community Services Youth Policy. Providing services to adolescents who are using legal and/or illegal drugs raises a range of specific issues. The developmental challenges of adolescence requires those engaged in their care to apply age appropriate strategies rather than simply thinking of this diverse group as mini-adults. Young people
who come to the attention of health and welfare professionals often use drugs as a means
of coping with situational and emotional distress. While
this drug use may also exacerbate problems, practical assistance in areas such as
accommodation, family, recreation, financial, vocation and educational support will most
often need to precede or coincide with any drug use management. Linking drug-related effects and interventions to goals identified by the client will enhance the possibility of change. The points below are provided as a guide only. Some young people will require very few of these interventions while others will require more than is available here. |
| Contents Consider using
this table of contents as checklist for adolescent drug management. 2. Assessmentb. Screen all young people for Alcohol and Other Drug (AOD) use issues c. Assessment drug frameworks and models i) Pattern of use (experimental, social, intensive, dependent) ii) Functions of drug use (Social Learning) iii) Problems of drug use (Thorley & 4Ls) iv) Stage of change v) Client goals vi) Interaction Model (D.I.E.) 3. Interventionsa. Solution Focused Brief Therapy b. Social context of the young person c. Provide practical assistance d. Manage the functional aspects of drug use e. Manage actual and potential problem areas f. Identify goals and assess motivation h. Relapse prevention and management j. Intoxication k. Withdrawal 4. Supervision5. Agency and systems issues
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· Few young people voluntarily seek 'drug counselling'. Most drug management is delivered by generalist workers in the context of general service provision. · Practical assistance rather than 'counselling' in the first instance is likely to be more meaningful for the young person. · Be honest, open and be respectful in your interactions · Clarity in explaining role and boundaries of your assistance/intervention and why you are involved with them · Be specific about the boundaries of confidentiality - Depending on age, may be required to advise parent - Statutory requirements if harm to self or others - Reporting conditions if on statutory orders ( eg juvenile justice) · Always ask for clarification of any jargon that a young person may use. This elevates the young person to the role of teacher · Don’t attempt to use jargon with youth – you are not a teenager and you are likely to lose credibility · Clearly state what you can and cannot offer and what you expect of the young person · Ask the young person to articulate what they expect and what they are prepared to do · Acknowledge the importance and the role of peers and social group of young person · If a young person asks you about your own drug use you need to consider the benefits versus the cost of self-disclosure. Generally speaking, self disclosure of drug use by a worker to a client is a high risk behaviour. It may also divert attention away from the client’s issues. Some ways of managing this might be to : - Ask the client how such information would help them - Tell the client that your drug use history is not really relevant to their situation - Tell the client it is not agency policy for staff to disclose information about their own drug use
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2. Assessment · Drug frameworks may not only assist staff in developing methodical drug assessments, they may also help young people find order in what may otherwise be confusing and chaotic behaviour. · Assessment should not be an interrogation but rather an ongoing gathering of information. This information not only comes from interview, it is derived from observation, existing documentation and other sources. · Assessment should be both planned, opportunistic and ongoing. The order presented below is not necessarily the order you should use. · Identifying and differentiating those aspects which are fixed and those which are changeable is helpful. · Strengths as well as weaknesses (individual, interpersonal and environmental) should be identified. · Assessment is an intervention in its own right. b. Screen all young people for Alcohol and Other Drug Use (AOD) issues
i) Routine questions; “Do you smoke cigarettes? Drink alcohol? Other drugs? How do they help? Have they ever been a problem? Do others see them as a problem?” ii) If there is a relationship of trust, an alternative question could be; “how many joints or cones do you have a day – what about other drugs and alcohol?” iii) Bridging statements can be helpful in providing a context and reference for questions; “… Many young people find alcohol or other drugs helpful in coping as well as for having fun – can you tell me about your alcohol and other drug use?” This question presumes drug use allowing for a more honest answer. c.
Assessment
frameworks and models
i) Schafer: ii) Social Learning iii) 4L’s & Thorley iv)
Stage of change
Motivation may be different for different drugs May be willing to take action on problems but not on drug use per se May be motivated but lacks confidence and too many barriers Use Motivational Interviewing to help weigh positives and negatives of drug use against life goals. v)
Client goals vi)
Interaction model vii) Drug
treatment history
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a. Solution Focused Brief
Therapy (SFBT) b.
Social Context of the young
person i) Parents/legal guardian The following issues should be considered when involving parents/guardians. Parental rights have to be weighed against client rights along with the clinical utility of involving parents. Parents/legal guardians must be informed of significant issues if the young person is under 13 years. From 13 to 16 years, young people may choose to withhold information from their parents only if they are deemed to have the cognitive and emotional maturity to make informed decisions. At 16 years and above, consent from the young person is required to inform parents. However, where possible, parents/legal guardians should be involved in decision making and planning. Discuss parental involvement with the young person Encourage the
young person to raise the issue with their parents if they have not done so already.
Resource material is available on-line to assist: Provide
parents/care-givers with support and resource material: If the young person is at risk of physical abuse from parents when drug use is disclosed, it may be better to confront them yourself (if the young person consents) or together with the young person. The alcohol and
other drug use of parents is influential in several ways: ii) Peers With permission of the young person, involve as much as possible Aim to maximise positive influence and minimise negative influences. Utilise/develop peer influence and peer support (help a mate) and buddy programs. Provide assertion training and refusal skills to help manage negative peer influence. Teach first-aid to peers. iii) Partner
Sexuality,
adolescence and the role of drugs Provide relationship support and where appropriate, couples counselling if young person has a partner. Discuss use of protective strategies regarding transmissible diseases and contraception. Additional support may be required if ambivalent about sexual orientation. iv)
Professionals (Inter-agency case management) What other agencies are/have been involved (eg school psychologist, juvenile justice, etc)? How successful or otherwise is/was this? How long ago were they last involved and what are their future plans about any other agency involvement. Seek permission to contact these agencies to coordinate care. Decide which agency will be responsible for primary case management.
Maintain
confidentiality and client's right to privacy. Click here for more on agency and systems issues c. Provide
practical assistance Support areas of accommodation, family relationships, recreation, education, vocation, financial, peer and partner supports. Identify and manage where drug use interferes with provision of practical assistance. While it may be possible to utilise practical assistance as a leaver to encourage the reduction of drug use/drug problems, basic rights such as accommodation should not be withheld on the basis of drug use. d. Manage
the functional aspects of drug use Identify and provide alternatives (such as recreational and vocational opportunities) to factors which positively reinforce drug use (e.g. fun/recreation, socialization, adventure, sexual enhancement, dutch courage, feelings of power and freedom ) Identify and provide alternatives (such as stress management, accommodation) to negative reinforcements of drug use (e.g. coping with negative emotional states, avoidance of withdrawal symptoms, pain relief) e.
Manage actual and potential problem areas (harm reduction) In particular, pay attention to overdose, transmissible diseases, regrettable sexual behaviour when intoxicated on alcohol or other drugs, driving when intoxicated, legal consequences, and violence. General approach If any suicidal ideation and/or behaviour, manage as a first priority. Note that risk reduction messages may back-fire if client does not care about their life or is actively seeking high risk situations. Discuss issue
of risk-taking. Separate risks into categories of Ask them how they have, and are going to maintain their safety – elevates them to position of responsibility. Teach first-aid. May be useful for themselves and/or drug using peers. Specific issues Discuss safer injecting practices if injecting. Discuss overdose risks, particularly if mixing drugs, recent detoxification or a forced period of abstinence such as following release from a detention center (danger of reduced tolerance, using on own, big celebration and unknown purity). f. Identify goals and assess motivation, particularly in relation to drug use. Use motivational interviewing techniques. Steps are: - Ask about the positives of drug use. - Ask about the negatives. - Summarise - Ask about life goals and compare to drug use. - Ask for a decision (e.g. continue to use, cut down or stop). - Make a short-term goal and plan. Teach S.M.A.R.T. (Specific, Meaningful, Assessable, Realistic, Time-bound) goal setting g. Develop general skills as appropriate Rather than rehabilitation young people with drug problems often require habilitation (development of life skills). Consider enhancing the following: - Decision making, goal setting, problem solving skills. - Other life skills such as cooking, budgeting, study, social, recreational skills. - Skills to help recognise and deal with negative emotional states (e.g. stress management, anger management, coping with depression) - Communication skills and social living skills.
h. Relapse prevention and management Relapse is a normal part of the change process and is the rule rather than the exception for most attempting to stop or reduce drug use. Use the analogy of a fire drill to help raise this issue. Also explain that it's common for people trying to change to have slips. This may reduce the possibility of the counsellor being accused of not believing in their resolve to change. Identify and develop strategies to manage high risk situations Manage cravings (‘urge surfing’ techniques) - Learn impulse control Teach refusal skills Develop alternative behaviours which compete with drug use. Learn to manage slips (lapse) before they turn into a total collapse (relapse) Reframe previous and current relapses as learning opportunities. Consider harm reduction (e.g. caution regarding reduced tolerance with overdose and other unsafe behaviour) i. Drug Testing (Urinalysis) Drug testing may be helpful in providing an external motivation to maintain change and provide accurate feedback on drug using. However, unless part of a statutory condition, informed client consent will be required. Drug testing should be reframed in the positive as giving an opportunity to demonstrate change (particularly useful to clients who are facing drug-related court charges) Consequences for both positive and negative urine results should be clear prior to testing. Random testing will help improve reliability. Urine testing may encourage more hazardous drug use as substances such as cannabis are detectable in urine for a long time while heroin and amphetamines are detectable for a much shorter period. j. Intoxication and Crisis Management
Know agency policy and procedures for dealing with intoxication and disruptive incidence.
Assume impaired
control – that is, make it clear intoxication is no excuse for inappropriate
behaviour. Call for assistance Separate from others where possible Use short, clear sentences and do not engage in therapy while intoxicated. Attempt to assess amount, type and time of drug(s) used. Provide frequent observations of conscious state. If overdose suspected, call an ambulance and apply first aid as required. Withdrawal symptoms can often be successfully managed on an outpatient basis. Residential withdrawal indicated if severe addiction, few supports and accommodation a problem. Utilise medical assessment and management through GP services. Provide enjoyable alternative activities to shift focus Suggest warm baths, massage and symptomatic treatment to provide comfort l) Pharmacological Treatments A range of drug treatments can be used to assist in treating drug addiction and related problems. These treatments are prescribed by a medical practitioner and often under the supervision of a drug specialist. Treatments include: Blocking: eg naltrexone blocks heroin (and alcohol) Replacement: eg methadone replaces heroin Symptom: eg clonidine reduces heroin withdrawal symptoms Drug treatments are often seen as attractive by drug users as they are often seen as a ‘quick fix’ by drug users. Pharmacological treatments are most successful when: - they are the choice of the client - there is a supportive partner and/or parent (who may administer the drug in some cases) - there is adjunctive counselling m) Exit planning - Link with ongoing supports - If injecting drug use suspected, provide information about access to clean equipment - eg needle exchange facilities, chemists - Provide follow-up evaluation and support - Provide informative, educational and self-help written material - If excluded or rejected from service due to drug use, provide names of other services as well as requirements to re-enter current service. - Consider duty of care issues including informing statutory agencies if required as well as parents if under 16 years of age.
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4. Supervision Utilise supervision including professional supervision, peer supervision and consultations with drug specialist agencies.
Possibly use
the Alcohol and Drug Information Service (ADIS): b. Enhance professional development Identify own areas of personal and professional growth and development regarding drug use issues. Review own attitudes and values on drug use and youth drug use. Discuss how these may impact on client treatment and develop strategies to manage. Review approach to youth in general (e.g. parental, buddy, mentor, facilitator, coach). Discuss underpinning theoretical approach and in particular use of frameworks and models. Review specific cases and determine where skills and knowledge well developed and areas for improvement c. Discuss within and between agency issues Discuss agency drug-related policy and procedures including the management of any problems associated with implementation of agency policy. Review inter-agency issues.
Click here for more on supervision
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5. Agency and systems issuesa. Agency policy- Given the high prevalence of drug use amongst those young people accessing welfare services, agencies should have policies regarding drug use which are known and applied by staff. - Inclusion and exclusion criteria around drug use should be considered in light of the need to provide services to young people who are drug users and the need for safety of others using the service. b. Inter-agency protocols- Develop inter-agency protocols regarding drug use. In particular, identify role boundaries, information sharing, referral and case management procedures. - Provide regular opportunities for staff to share information between agencies and to review inter-agency procedures. - Maintain
confidentiality and client's right to privacy. c. Click here for NSW drug agency information
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