THPPlus/THP+FCTrainingSeries

PartI:SubstanceUse
FRAMEWORKSFORWORKINGWITHYOUTHUSINGALCOHOLANDDRUGS
OCTOBER9,2014

InformationtoParticipate
Callinnumberis+1(415)6550062and
accesscodeis839671559.
Presentationmaterialsandaudiowillbe
postedatwww.thppplus.org underpast
trainings.
Tosubmitlivequestions,clickonthe
Questionspanel,typeyourquestion,and
clickSend
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TodaysPresenters:
CeciliaTran,PolicyAssociateattheJohnBurtonFoundation
JeannieLittle,ExecutiveDirectoroftheCenterforHarmReduction
Therapy
SamanthaLaGrasse,Aspiranet (THPPlusandTHP+FCProvider)
SteveDuran,PeacockAcres(THPP,THPPlusandTHP+FCProvider)

Fosteryouthoftenhaveacomplex
relationshipwithdrugsandalcohol:
35%oftheprimarycaregiversinthehomesthatfosteryouthwereremoved
fromdealtwithalcoholabuse
43%offosteryouthreportedthattheprimarycaregiverinthehomethey
wereremovedfromhadadrugabuseissue.
Drugandalcoholabusewereamongthetopthreeproblemtraitsthatfoster
youthidentifiedabouttheirprimarycaregiverspriortoenteringfostercare
MidwestEvaluationoftheAdultFunctioningofFormerFosterYouth: ConditionsofYouthPreparingtoLeaveStateCare
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FosterYouthandDrug/AlcoholUse:
Fosteryoutharemoreliketo
engageinriskybehaviorsthan
theirpeers.
Multiplestudiesconfirmthat
drugandalcoholusebeginata
youngerageandhappenat
higherratesforfosteryouth
thantheirpeers.

Escapingfrom
stressors
Experimenting
asayoung
adult

Copingwith
trauma

Drugand
Alcohol
Use

WhatisHarmReduction?
Anystrategyaimedatreducingtheharm causedbytheuse
ofalcoholandotherdrugswithoutnecessarilyreducingor
eliminatingsubstanceuse.
Harmsmayinclude:
Autoaccidents
Overdose
Jailandprison
Disruptededucationoremployment

ExamplesofHarmReduction:
Drinkinganddrivinglaws
Accuratedrugeducation(notJustSayNo)
OverdosepreventionkitsandGoodSamaritan
laws
Decriminalization(ordefelonization)of
nonviolentdrugoffenses

Theharms causedbydruguse,notthedruguseitself,arethefocus
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HarmReductionEmbracesCertainRealities:
Peopleusedrugs,alwayshave,andalwayswill theWaronDrugshasmadeno
impactontheuseofsubstances
DrugUSE isanormalandexpectedpartofhumanexistence someisfun,someis
medicine,someishabit
DrugABUSE isahealth,notalegaloramoralconcern itshouldbeinthehands
oftreatmentprofessionals,notthecriminaljusticesystem
Housingisahumanright homelessnessisnotacureforaddiction

EvidenceConsistentwithHarmReduction:
ResearchersattheUniversityofWashington(Holltum andCollins,2014)
Comprehensiveliteraturereviewofharmreductioninterventionsfoundacrossallstudies:

Reducedlevelsofsubstanceuse
Lowereddepressionandanxiety
Improvedrelationships
Increasedstabilityatwork
Improvedselfesteem

StageModelofChange:
Prochaska,DiClementi,andNorcross(1992)
30yearsofresearchshowshowpeoplechangeinsteps,orstages,andthatrespectingthis
journey,aswellasplanningtreatmentbasedonthesestages,promoteslastingimprovements.

EvidenceConsistentwithHarmReduction:
Whenthegoalsofcounselorsarecompleteabstinenceandthegoalsofthe
patient/clientaresomethingelse,thetherapeuticrelationshipislikelytobe
confrontational,therebyleadingtodishonestyandtreatmentrefusal
Miller&Carroll(2006)page210.

Ontheotherhand,whenpeoplearegiventheopportunityto
choosetheirowngoals,theyaremorelikelytomeetthosegoals,
tostayintreatment,andtosetfurthergoalsforthemselves.
Tucker&Simpson(2011)

HarmReductionTreatment:
Traumainformed(upto90%ofsubstanceabusers)
Honorseachpersonsrighttoselfdetermination
HarmReduction
Counseling/Therapy

Utilizesmotivationalinterviewing
Ispractical
BasesinterventionsontheStagesofChange

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HarmReductioninHousingRequires:
Balancingclientcenteredsupportserviceswithlandlordcentered
rules
Balancingtheneedsoftheindividualwiththeneedsofthecommunity
Elicitingcooperationfromclients
Focusingonbehaviors,notonthemerefactthatsomeonemightbea
substanceuser

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StructuralToolsinHRHousing
PreMoveInInterviews:
Buildapositiverelationshipbyasking questionstounderstandtheirhistoryof
homeandtheirexpectationsforthisplacement.
Buildinvestmentbysharing thehistoryandcultureoftheprogramandasking
howtheymightenvisionthemselvescontributingtothecommunity.
PostMoveInAgreements:
Strengthenautonomybydiscussing andagreeing howtheparticipantprefersto
beapproachedifastaffpersonisconcerned;howtheywouldliketoseekout
helpshouldtheyneedit;andhowtodealwithconflict.
CreateaCommunitywithaCultureofEmpathy:
Creatediverse groupactivitiestoreinforcetheconceptoflivingwith others.
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CounselingToolsandPracticalSolutions:
PracticeMotivationalInterviewing

Empathiccounselingapproachtoestablishtrust,increasemotivationanddecrease
resistance

Collaborate

Sharewithclientsresponsibilityforthelifeandhealthofthecommunity
Modeldifficultdecisionsbybeingactivelyinvolvedincommunitydilemmas

SubstanceUseManagement

Pragmaticapproachtohelpingsomeonefigureouthowmuch,when,where,andhow
oneuses
Provideaccurateinformation requiresstafftohaveknowledgeaboutalcoholand
otherdrugsandcomfortdiscussingthemwithclients
Suggestalternativestousingillegaldrugsonsite requiresstafftolearnagreat
dealaboutclientsdrugusingbehavior
Practicedecisionmaking(muchlikedrinkrefusal) requiresstafftoroleplaywith
clients
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ProvidersInsights
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Aspiranets Vision:
Ourvisionistotakecollectiveactiontosupportcommunitiesand
familiesastheyloveandcareforchildren.Ourfocusisonbringingthe
spiritofinnovationtothosewhoneedourservices,notonlytosupport
ourvisionofsuccess,buttoraisehopeandempowerthecommunitieswe
cherish.
Aspiranet currentlyserves115youthinTHPPlusand142youththeirTHP+FC
Program.TheycurrentlyhaveTHPPlussitesin10countiesandTHP+FCsitesin
13counties.
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Aspiranets ApproachtoAddressing
SubstanceUse:
DevelopmentalFramework:
Itisnormalandexpectedthatallyouthexperiencingtheindependencethatcomes
withyoungadulthoodwillexperimentwithmanybehaviors,includingthepossibility
oftryingorusingdrugsandalcohol.

TraumaInformed:
Youthincarehaveexperiencesthatmayleadtomaladaptivewaysofcopingor
responding
Theprovidersroleistopromotesafety,connections,andattendingtoemotions

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Aspiranets ApproachtoAddressing
SubstanceUse
TransitionFramework:
Identifywhereyouthareatintransition
YouthFocused:Startwheretheyouthisatinrelationtothistransition
Usestrategiesthatworkwellforwhereyouthisatinrelationtothe
changeathand

EducationandMentoring
Lifecoachesandexperiencecoaches
Participantagreements,weeklymeetings,TILPs,CAPs
Individual,group,peers,referrals
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TensionsbetweenPolicy&YouthNeeds
POLICY
ProgramPolicy:DrugFree
CCLregulations
Setclearexpectations&
consequencesforyouth
aboutcompliancewith
programrules,
engagementinprogram
activities,andTILPgoals

YOUTHNEEDS
Understandingthatchange
occursincrementally
Requirestime,
communicationandsupport
notazerotoleranceresponse

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SupportingaYouthUsingDrugsorAlcohol
Assesstheyouthsneedinrelationto
experimentation,useorabuse
Assessyouthengagement,functioning,and
progress
TeamApproach:ILP,HostParents,Youth,
ProbationOfficers,othertreatingagencies

Ifinterventionsare
unsuccessful,then
considerthe
appropriatenessof
placementtype
(Ex.Apartmentvs.
singlesitewithdrug
treatmentprogram)

Linktoresources,provideinterventions,
createcorrectiveplans

Createaformalsafetyplan
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Scenario1:
IhaveanewTHP+FCparticipantwhohasbeenmissingmeetings
withhercasemanagerandhasskippedworkrepeatedly.Her
roommatehascomplainedaboutsmellingmarijuanasmokein
theirapartmentrecently.HowdoIapproachheraboutthisand
providesupport?

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PeacockAcresMission:
PeacockAcresprovidessupportivehousing,intensecasemanagement,
andlifecoachingforfosterchildrenthathavebeenseparatedfromtheir
families.Withunendingresolve,westeerthemtowardsopportunitiesfor
growthastheycontinuetheirjourneytowardahappy,productivelife.
PeacockAcrescurrentlyserves12youthinTHPP,10youthinTHPPlusand20
youthinTHP+FC.TheycurrentlyhaveoperatesitesoutofMontereyCounty.

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PeacockAcresApproachtoAddressing
SubstanceUse:
Strongrapportandrelationshipbuilding:
Establishthatdischargefromtheprogramisnotthegotoresponseforcase
managers/provider
Createanenvironmentoftrustthatallowsforopendiscussionofsubstanceabuseissues
TeaminvolvementinworkingwithallTAYresidents,regardlessoftheprogramayouthis
enrolledin
Contractsforselfbettermentindividuallytailoredplancollaborativelycreatedbytheparticipant
andstaffonmeetinggoalstoreducealcoholanddruguse
Periodiccheckins:Drugtestingisnotusedinapunitiveway
Outreachtoappropriatedrugandalcoholtreatmentoptionsandcontinuedsupportand
relationshipbuildingwhileyouthisintreatment
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Scenario2:
Thereisa20yearoldparticipantwhohasahistoryofalcoholabuse.He
hasdisclosedthathehasbeendrinkingsincetheageoften.Hewasclean
forayearbutrecentlyhasbeguntoshowinguptomeetingsdrunkand
totaledhiscarduringadrinkingbinge.HowcanIbestsupporthim?

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SeriousAlcoholAbuseandYouth
Facilitateaconversationabouttheharmscausedbyhisdrinkingtohas
academicgoalsandlifegoals
Assesshiswillingnesstoseektreatmentandreaffirmedtheprograms
commitmenttosupportinghim
Findoutwhatkindoftreatmenthewascomfortablewithandconnect
himwithservices
Understandthatreductionissuccessandthattheprocessisalongterm
onethatmayincluderelapses
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WhataboutMedicalMarijuanaCards?
RegardingNMDlivinginaTHP+FCsite,wherebytheNMDhasamedicalmarijuanacard
statingthatheorshemustsmokeitwithintheirownhome,whiletheproviderdoesnot
wanttoallowit:
InaccordancewithTitle22,CaliforniaCodeofRegulations,section
86087(f),theprovidermustforbidsmokingattheTHP+FCsite.
However,thisdoesnotprohibittheNMDfromtakingthemarijuana
byothermeans(e.g.,orally).Accordingly,thecountymustcomply
withanyprotectionstopreventthosewithoutamedicalmarijuana
cardfromalsoconsumingthesubstance.Suchprecautionsmay
include,butarenotlimitedto,keepingthemarijuanainlocked
storageandhavingonhandonlywhatwillbeusedimmediately.

RickPimentel,ILPPolicyUnit,CDSS
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MedicalMarijuanaandYouth
Assessdocumentationtolegallyuse
Explorereasonforuse
Workwithyouthtoexplorealternatives
Painassessment&medicalneeds
Discussprogramexpectations,apartmentrules
Education&Referrals
Consultwithreferringagency
ConsideryouthabilitytoparticipateinTHP+FC
Assesssafetyforindividualand/orroommate

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Questions
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Formoreinformation:
TheCenterforHarmReductionTherapy
ContactforTrainingInquiries:Dr.PattDenning
Phone:4152520669
Email: pattdenning@harmreductiontherapy.org
Website:http://www.harmreductiontherapy.org
SamanthaLaGrasse,Aspiranet:
Email:slagrasse@aspiranet.org
Phone:5593265696
SteveDuran,PeacockAcres:
Email:steve@peacockacres.org
Phone:8317543635

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THPPlus/THP+FC
ThreePartTrainingSeries:
October9th

November13th

Addressing
drugs&
alcoholin
housing

Serving
youthwith
mental
illness

December11th

Property
recruitment
and
management

Fordetailsonthesetrainings,pleasevisit:http://thpplus.org/wp2/wpcontent/uploads/2014/09/JBFTrainingSeries.pdf
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Thankyouforyour
participation!
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References
Courtney,Mark,S.Terao andN.Bost.(2004).MidwestEvaluationoftheAdultFunctioningofFormerFosterYouth:
ConditionsofYouthPreparingtoLeaveStateCare.
Denning,P.andLittle,J.(2012).Practicingharmreductionpsychotherapy:Analternativeapproachtoaddictions. NY:
Guilford.
Denning,P.,Little,J.,andGlickman,A.(2004).Overtheinfluence:Theharmreductionguideformanagingdrugsand
alcohol. NY:Guilford.
Holltum,J.&Collins,S.E.(2014).Harmreductionliteraturesearch:Afocusonkeyinterventionandtreatment
components.UnpublishedManuscript.HarmReductionResearchandTreatmentLab,UniversityofWashington
HarborviewMedicalCenter.
Miller,W.R.,andRollnick,S.(2013).Motivationalinterviewing:Helpingpeoplechange,3rdEdition. NY:Guilford.
Miller,W.R.,andCarroll(2006).SubstanceAbuse:WhattheScienceSaysandWhatWeShouldDoAboutIt.NY:Guilford.
Prochaska,J.O.,DiClemente,C.C.,andNorcross,J.C.(1992).Insearchofhowpeoplechange:Applicationstoaddictive
behaviors.AmericanPsychologist,47:11021114.
Tucker,J.A.,andSimpson,C.A.(2011).Therecoveryspectrum:Fromselfchangetoseekingtreatment.AlcoholResearch&
Health,Volume33,IssueNumber4

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