1. 1
A Proposal for Integrated Treatment
for
(Aboriginal) Youth with Concurrent
Disorders in the NWT
Site Location: Behchoko
Residential Dorms Area at Chief
Jimmy Bruneau Regional High
School
December 2005
Raymond Pidzamecky M.S.W. RSW
raypidzamecky@gmail.com
2. 2
Table ofContents
Introduction ........................................................................................................Page 3
Background ........................................................................................................Page 4
Service Availability
Summary of Limitations of Current Service Options ............ Page 8
Proposed System Improvements......................................................................Page 11
Service Delivery Component ............................................... Page 11
Linkage Component.............................................................Page 12
System Level Component ....................................................Page 12
Service Structure .................................................................Page 13
Staffing................................................................................. Page 17
Budget................................................................................................................. Page 19
3. 3
Appendices
Appendix 1 – Definition of Terms........................................................................ Page 21
Appendix 2 – Logic Model ..................................................................................Page 22
Appendix 3 – Excerpt from Provincial Rationalization Project ............................Page 23
Appendix 4 – Elements of a Day Treatment Program.........................................Page 25
Appendix 5 – Community Advisory Committee Flowchart ..................................Page 26
4. 4
A Proposal for Integrated Treatment for
Aboriginal Youth with Concurrent Disorders in the NWT
Introduction
There is a need for Day Treatment and service integration/co-ordination for Aboriginal
youth with concurrent disorders (see definitions Appendix 1) and their families.
Aboriginal youth and their families require an integrated, broad system of supports that
will work with families and youth who have mental illness, addictions and behaviour
problems or combinations thereof. The current system of service delivery is not
meeting the needs of all Aboriginal families and youth in the NWT. Co-ordination and
communication within the system that exists is problematic because of the territorial
structure related to screening children and youth with addictions and mental health
issues. At present all referrals to out of territory placement must go through a
committee at the Department of Health and Social Services in Yellowknife. That
committee does not include an Aboriginal representative. In addition, the committee
only accepts referrals through the mechanism associated with protection services.
Unfortunately the GNWT process put in place to ensure efficiency and accessibility of
services has no relationship to Aboriginal treatment/healing philosophy or needs. This
proposal describes a plan with three elements (see Appendix 2 for logic model):
Service delivery component that provides intensive family- and culturally relevant
community-based treatment that addresses the multiple determinants of substance
abuse, mental illness and serious antisocial behaviour in young people, the family
and extra-familial (peer, school and neighbourhood) contacts/supports
Linkage components that ensure common goals, objectives, training and service co-
ordination
System level components that ensure communication, co-ordination and integration
of services
5. 5
Background
In August 1998, because of growing concerns about addictions in Tlicho communities the
Treaty 11 Chiefs asked the Dogrib Community Services Board to develop an addictions
strategy. This strategy was presented to the Tlicho leaders and people at the general
Assembly in Gameti in August 1999. A Steering Committee was appointed a few weeks
later.
Over the next six months, all the communities were visited to consult with the people. This
resulted in a report entitled, “For the sake of Our Children…The Dogrib Addictions
Strategy” 1999. The publication was the outcome of responses from students from Chief
Jimmy Bruneau Regional High School in Edzo, the Elizabeth Mackenzie Elementary
School in Rae, the Mezi Community School in Wha Ti, the Alexis Arrowmaker School in
Wekweti and the Jean Wetrade Gameti School in Gameti.
Their responses were candid and spoke to the heart of the matter.
The youth identified a number of key issues including: 1) alcohol and drug abuse which
lead to the breakdown of the family support system including both discipline and
parental guidance and support; 2) a loss in the Tlicho traditions of language, cultural
beliefs and life skills 3) a lack of social supports for the youth 3) some youth feel
unimportant, unhappy, alone and 4) a need for youth to have a voice in their
communities
Recommendations from the youth included: 1) support to encourage peers to stop the abuse
of tobacco, alcohol and drugs; 2) the need for safe meeting places where social activities
could take place, to encourage a positive lifestyle free from tobacco, alcohol and drugs; 3)
the range of community activities should go beyond sports (such as arts, music and drama)
to entice those who were non-athletic; 4) supports needed to combat suicidal tendencies; 5)
the use of cultural events to help them better understand their culture and history were
warranted. Most of the youth respondents were willing to volunteer and become involved in
creating solutions.
As a result of that report and continuing lack of treatment for aboriginal youth in their
own communities this proposal for Day Treatment was offered. Leading up to this
proposal, the following was reviewed:
a scan of current programs for youth with concurrent disorders in NWT
a scan of adolescent mental health and addiction treatment centres in the vicinity of
NWT
reviewed the following documents/references:
6. 6
1 Working Together Because We Care (Suicide Prevention Regional Forums,
1992)
o Community participation in regional forums to come up with
recommendations to address high NWT suicide rates
o Forums held in Rankin Inlet, Baker Lake, Coppermine, Iqaluit, Fort
Simpson, Inuvik, Fort Smith & Yellowknife
o Recommended:
Training for community caregivers (lay and professional)
Promotion of healthy lifestyles;
Focus on the problems youth face; and,
Better referral, treatment and follow-up for suicidal clients
2 Working Together for Community Wellness: A Directions Document (1995)
o Collaboration between GNWT Departments of Education, Culture &
Employment; Health and Social Services; Municipal and Community
Affairs; NWT Housing Corporation; Justice; and Intergovernmental and
Aboriginal Affairs
o Recommended four areas of change:
Prevention, Healing and Treatment
Education and Training
Interagency Collaboration
Community Empowerment
3 Our Communities, Our Decisions: Final Report of the Minister’s Forum on
Health and Social Services (1999)
4 Mental Health Services in the NWT: A Discussion Document (1999)
o Consultation with Health & Social Services Boards (CEO’s & clinical staff
comprised territorial steering committee) recommended increased
integration between MH, addictions & family violence
o Document described a continuum of mental health services for all
populations/age groups.
5 Alternative Programming Initiative (1999-2000)
o Consultation on challenges and alternatives for addictions programming &
re-profiling existing buildings/programs
o Changes with Northern Addictions Services (board moved toward contract
with Corrections Canada)
Recommendations to address needs of children & youth, women & children, men
Women & Children’s Healing & Recovery Program initiated
(women’s trauma treatment, join project with YWCA of Yellowknife
& Yellowknife Women’s Centre/Centre for Northern Families)
7. 7
Children’s Assessment Centre proposed (not completed)
Mobile Addictions Treatment (women, youth) pilot projects
completed 2000/01
Men’s healing (not completed)
1 Toward a Better Tomorrow (2000)
o Cabinet released their vision document
o One of the stated priorities was to build healthy people and communities
who could benefit from economic opportunities
7 Children and Youth Strategy (Draft document) (2000)
o Drafted by Children & Family Services, with statistical support from Health
Analyst
8 Mental Health Needs Assessment (2001)
o Mental health had been neglected from the Disability Needs Assessment,
so a separate contract was established to assess MH needs
o Focus groups were held in Fort Simpson, Rae-Edzo, Fort Smith, Hay
River, Jean Marie River, Inuvik, Deline, and Yellowknife.
o Results: people saw mental health interconnected with addictions,
violence, physical and population health. People requested improved
integration and increased range of services.
9 Working Together for Community Wellness: A Draft Strategy for
Addictions, Mental Health and Family Violence (2001)
o Adapted from the 1999 Mental Health Discussion Document
o Used Community Wellness Document as integrated framework
o Extensive public consultation (plain language document mailed out, focus
groups and fax-in feedback)
o Feedback supported the proposed directions and priorities:
Prevention;
Services for families and children;
Education, training and support for workers;
Building community capacity to deal with problems; and,
A better integrated system.
10 Social Agenda: A Draft for the People of the NWT (2002)
o Territorial working group established to implement recommendations from
Social Agenda Conference
o Ten high-level, system recommendations to GNWT social envelope
departments
8. 8
11 State of Emergency: Evaluation of Addictions Services in theNWT (2002)
Community addictions programs & mobile treatment programs received failing
grade.
o Recommendations to begin with building a community based counseling
program. Also called for improvements in system coordination, staff
training and support
12 DHSS Integrated Service Delivery Model (2002)
o Need for updated and inter-connected core services.
o Chapter 6, ISDM = Mental Health and Addictions Core Services drafted.
o Community Counselling Program implemented (begin 2003)
o Key components of mental health/addictions to be added (children/youth,
withdrawal management, crisis services)
Summary of Limitations of Current Service Options
Several issues have been identified as needed in Tlicho to service youth with
concurrent disorders and their families. The following shortfalls should be noted:
Services generally will work with the young person only and only minimally with the
family and not at all with any peer or support systems in the young person’s life
Many service providers have specialized skills in either mental health counselling or
addictions, rarely both
Most services target specific populations e.g. only women, only men, over 18 years.
In particular, many of the addictions services targetindividuals over the age of 18
but the bulk of those admitted to treatment are adults with very different issues and
experiences to the young person aged under 18.
Follow-up or aftercare that ensures the young person can integrate back into school
and home are limited or not available for those who have had intensive treatment
outside of their home community. In addition, there may be differing treatment
philosophies between the intensive treatment centre and the follow-up or aftercare
facility that can impact on the young person’s ability to practice the skills they have
learned in treatment
For a young person to be able to successfully complete a day treatment program
(usually lasting one school semester) they need to be able to easily access the
service. Day treatment greater than a one hour commute from the young persons
9. 9
home will increase the likelihood they will not complete the course of
treatment and or have difficulty re-integrating back into their community
It is quite clear that the GNWT has limited resources for adolescents who are
experiencing mental illness/behaviour and substance abuse problems. Current
services are limited and on an outpatient basis related to either the young person’s
mental health/behavioural problem. One of the few options available to adolescents
who require a more intensive form of treatment is limited to residential treatment
outside of their community and the NWT. Unfortunately for adolescents in the NWT,
there is no middle ground in terms of offering treatment for those who fit the middle of
the continuum, i.e. adolescents whose substance abuse is too serious for outpatient
counselling, but do not require inpatient treatment. In addition, those adolescents who
return to NWT following a stay in an out of area residential facility do not have
programs available to support their transition back into their community.
Substance abuse frequently co-exists with mental health difficulties (depression, low
self-esteem, anxiety, behavioural problems etc.) In addition, many adolescents who
have been diagnosed with a psychiatric disorder also have substance abuse
difficulties. This has become a treatment dilemma for those particular young people
because of the two separate service systems (addictions and mental health) and the
territorial mandates and funding requirements that govern them. Unfortunately for
these adolescents, it is difficult for them to receive service with one service provider
due to the complex relationship between mental health difficulties and substance use.
Many of these adolescents spend a great deal of time being referred back and forth
between addictions and mental health centres, eventually being sent to inpatient
treatment outside NWT only to return to the same confusion.
Providing a day-treatment program in Tlicho would allow all service providers
(addictions, mental health, child welfare, education, probation, corrections and families)
the opportunity to work together and allow these particular adolescents to receive
treatment under “one roof”. The program would incorporate both addictions and mental
health theory and practice to ensure treatment needs of concurrent disorders are met.
Adolescents would remain in their community (NWT) and work intensively with their
10. 10
families and significant others to attain their goals, ensuring a better outcome for all
concerned.
A day-treatment program would target adolescents who have “dropped out” or have
begun to drop out of school or who may have displayed delinquent behaviour, their
families and the community they interact with. These particular adolescents require
daily structure that would focus on regaining their self-confidence and reconnecting
them with their family and community. The program would focus on substance use
reduction, education remediation, vocational planning and re-introduction of social,
life and leisure skills. In addition, the program would work with families to empower
them to build an environment that promotes the health of the family unit.
The systems improvements inherent in the model would provide a transition back into
aboriginal communities for those adolescents who may require inpatient treatment out
of the area. This would allow adolescents to begin to put in place many of the changes
they made while they were away.
Quite clearly, NWT has many aboriginal adolescents that fit the above description and
who do not, at the present time, fit into the regular school environment. Unfortunately,
without appropriate day treatment, these particular adolescents will most likely make
their way into the correctional system where treatment, as we know, is minimal.
We know that treating these young people in separate systems is not ideal. The
additional advantage of integrating the expertise is a cross learning that can occur
when professionals from the mental health and addictions sectors form one treatment
team (multisystemic). The exchange of knowledge and expertise is synergistic
because these professionals will have an increased understanding of how to treat
concurrent disorders. Recognition of the inter-relatedness of addictions and mental
illness is reflected in the recent integration of Mental Health and Addictions Core
Services (Department of Health and Social Services, GNWT).
Proposed System Improvements
Loosely based on Multi Systemic Therapy, the proposed model for Behchoko will
incorporate a Day Treatment component and provide a practical, goal-oriented
11. 11
treatment that specifically targets those factors in the young person’s social network
that are contributing to his/her behaviour. In addition, services will work with
families/caregivers to support discipline practices, enhance family relations, decrease
youth association with deviant peers, increase youth association with pro-social peers,
improve youth school or vocational performance, engage youth in pro-social
recreational outlets, and develop support network of extended family, neighbours, and
friends to help all involved achieve and maintain change.
To address the needs of Aboriginal youth with concurrent disorders and to rectify the
above barriers, there needs to be a service model with three main components:
service delivery, service/systems links and systems integration is needed to address
the following long and short term goals (see Logic Model Appendix 2).
Service Delivery Component
Goal: To ensure that youth with or at risk (of concurrent disorders) and their
families have access to an integrated, accessible and comprehensive system of
services
Long Tern Objectives:
- Improved healthy adolescent development
- Removal of psychosocial barriers that inhibit the ability of youth to learn
- Improved parenting capacity and problem solving
- Short Term Objectives
- Increased access to appropriate services for youth and their families
- Increased identification of youth at risk
- Increased referral to appropriate community resources, including Day
Treatment, for youth identified at risk
- Increased parenting confidence, knowledge and skills
- Increased linkages between agencies of other providers (wrap around)
- Increased accessibility tom discharge planning and appropriate ongoing
care/support
12. 12
Linkage Component
Goal: As for Service Delivery Component
Long Term Objectives
- Increased knowledge of services that exist in the system
- Increased appropriate service utilization in NWT
Short Term Objectives
- Increased awareness of community at large of the impact of mental illness
and addiction on youth
- Increased consultation between the mental health and addictions providers
- Increased awareness of a variety of service providers regarding potential risk
in youth
- Increased collaboration between agencies and organizations
- Increased awareness of the community at large re the influence and
challenges to parenting
System Level Component:
Goal: To ensure communication, co-ordination and integration of effective
services funded through Health, Education and Justice thereby reducing costs
related to family breakdown and youth criminality
Long term Objectives:
- Increased co-ordination of services within the community
- Decreased percentage of youth who prematurely leave school and are at risk
of developing criminal behaviour
Short Term Objectives:
- Increased integration between interagency groups
- Decreased duplication of service
- Increased number of common policies and procedures within the interagency
group(s)
- Increased knowledge and understanding of roles by service providers within
the interagency group(s)
13. 13
Service Structure
1. Community Advisory Committee (See structure model in Appendix 5)
Overseeing, administering and providing direction to the program would be a
Community Advisory Committee. The committee would be made up of organizations
providing services to the target population as well as parents and youth. The role of the
Community Advisory Committee would be ensure that the appropriate processes and
procedures are in place to meet the mandate of the program - the provision of a
comprehensive system of services for youth with concurrent disorders and their families
and, specifically, the management of the day treatment service.
Funding for the program would be flowed to a lead administrating agency (or agencies).
This organization would be responsible for:
Budget
implementing program set by the CAC
day to day interactions with the program managers
A community partnership model would be considered for this project. This model would
pull the stakeholders together into a structure that would oversee the implementation of
the program and give the implementation to the lead agencies. The community
partners come together out of interest in or an ability to commit resources to the
program. A common ground or shared vision keeps these partners working together.
The model for day-treatment being proposed incorporates three major functions:
(1) traditional intervention that includes: education, life skills training and therapy
(individual and group)
(2) working with extended family, neighbours and friends to help achieve and
maintain change and
(3) case co-ordination by a continuity team undertaken before, during and following
the intervention.
The following describes the intensive intervention portion of the model.
2. Referral & Intake
anyone can refer a youth for concerns related to mental health and addictions
identified need including but not limited to:
14. 14
weak interpersonal relationship skills such as initiating conversation,
joining a group, or acquiring attention
weak in communication skills such as asking questions, self-disclosure,
advice giving
weak sharing and co-operation skills like co-operation, sharing, give-and-
take, reciprocal interactions, fair play
weak problem-solving and conflict resolution skills for example
considering and appraising alternative courses of action when presented with
interpersonal problem situations.
problem behaviour associated with substance use
age - 14-18 (high school aged) male & female
geographic area – NWT
program plan (content) - mental health & addictions
administration/accountability - one agency/organizational structure
build on existing resources, specifically Tlicho healing Path-Wellness Centre
family willingness to be involved with treatment
3. Assessment
data gathering from:
other agencies who have a history with the client
the family
the individual
Assessment measures will include
Intellectual and academic abilities:
Mental health and psychosocial functioning:
Family functioning:
The learning environment:
Family-school linkage:
4. Treatment
Components
academics (including credit courses)
life skills (cooking, budgeting, etc.)
counselling – individual, family and group
duration: available 11 months of the year - closed August for day treatment
but open for intake, follow-up and staff training
approximately 60 young people would be seen annually
15. 15
5. Discharge planning (Follow-up)
adolescent readiness
community (including school) readiness (systems issues)
family readiness (systems issues)
6. The Continuity Team (Case Co-ordination)
The uniqueness of the model being proposed is the concept of a Continuity Team.
Experience has shown that young people with concurrent disorders are very
challenging to manage and treat. The challenges include but are not limited to:
the nature of the concurrent mental health, substance abuse and behavioural
problems
the different mandates of service providers
funding from three separate departments (Education, Health and Justice)
adolescent and family relationships
limitations within the school system to deal with adolescents with psycho-social
problems
As indicated earlier in this document, young people with concurrent disorders receiving
services are seen by multiple care givers and many sites. While attempts are made to
communicate between service providers, there is currently no co-ordinated system in
place to facilitate this process. The purpose of the Continuity Team would be to
provide one stop shopping for the individual, the family as well as service providers to
ensure that a young person with a concurrent disorder receives the most appropriate
care, in NWT and in a timely manner. That care (treatment) could include outpatient
counselling, day treatment or residential treatment or any combination thereof.
The continuity team would serve approximately 200 young people and their families
annually and fulfil several functions.
16. 16
ensure education to the community at large about youth with concurrent
disorders
receive enquiries regarding admission to the Day Treatment component of the
program
facilitate referral to, and that linkages are made with, appropriate community
resources if Day Treatment is not the most appropriate service
consultation (out reach) to other organizations in the community (system) working
with youth with mental health and addictions
education of staff from community organizations
treatment planning with other organizations
opportunities for groups for youth
ensure a supportive environment for the individual and family following discharge.
This could include working with families, schools, workplaces, sport and social
networks the youth is connected to prior to discharge.
case management & co-ordination including setting up planning meetings with the
individual, family and identified service providers
ensuring that appropriate aftercare is in place and working following discharge
Program evaluation would be the responsibility of the Manager. Components being
evaluated based on the short term objectives of the Logic Model (see Appendix 2)
17. 17
Staffing (See attached staffing schematic)
Title Qualifications FTE/cost
Program Manager Mental Health
Professional*
1 FTE @$130,000
Co-ordinator/Team Leader
(Intake/Discharge Follow-
up)
Mental Health
Professional*
1 FTE @ $ ?
Co-ordinator/Team Leader
(Day Treatment)
Mental Health
Professional*
1 FTE @$ ?
Nurse/Social Worker Mental Health
Professional*
2 FTE @$ ?
Child & Youth Worker Community College 6 FTE @$ ?
Administrative Support Community College 1 FTE @$ ?
Psychologist Sessionals $ ?
Psychiatrist Sessionals $ ?
Teacher Education 1 FTE $ ?
Sub Total 11 FTE $ ?
Benefits @ 15% $ ?
Sub- Total 7.5 FTE $ ?
* Note: A Mental Health Professional includes but is not limited to Nurses, Social
Workers and other Health Care practitioners with a minimum of an under graduate
degree and experience in the mental health and/or addictions field.
18. 18
} {
COMMUNITY ADVISORY COMMITTEE
Lead Administrative Agency:
Wellness Centre
Program Manager
Continuity Team
Leader
Treatment
Team Leader
Nurse/Social Worker 6 Child & Youth
Workers
Psychiatry Sessionals
Psychology
Psychiatry
Psychology
Administrative
Support
Teacher
(Employed by
Education)
19. 19
Budget
Rent ?
Salaries ?
Travel ?
Training & development ?
Program Expenses ?
Office Administration
(Supplies, audit, legal, evaluation)
Promotion & public education
?
?
Total ?
Conclusion
Over the past several years organizations that provide youth mental health and
addictions services have been located out of territory. Better co-ordination of services
for Aboriginal youth with concurrent disorders in the NWT and their families is required.
While there have been some improvements because of increased co-operation, there
are still no resources dedicated to this target population. Specifically, added resources
are needed to work intensively with aboriginal youth with concurrent disorders and their
families to empower the young person and his/her parents with resources and skills.
The long term cost savings in future productivity for the young person and the
prevention of the development of deviant behaviours and their resulting costs will more
than pay for the investment now in this initiative.
20. 20
Appendices
Appendix 1 – Definition of Terms........................................................................ Page 21
Appendix 2 – Logic Model ..................................................................................Page 22
Appendix 3 – Excerpt from Provincial Rationalization Project ............................Page 23
Appendix 4 – Elements of a Day Treatment Program.........................................Page 25
Appendix 5 – Community Advisory Committee Flowchart ..................................Page 26
21. 21
Appendix 1
Definition of Terms
Definitions
Concurrent Disorders:
Individuals having both mental health and substance abuse problems.
Dual Diagnosis:
Individuals having both mental illness and a developmental handicap.
Mental Disorder (Illness):
A mental disorder is a recognized medically diagnosable illness that results in the
significant impairment of individuals cognitive, affective or relational abilities. Mental
disorders result from biological, developmental and/or psycho-social factors and can, in
principle, be managed using approaches comparable to those applied to physical
disease,that is: prevention, diagnosis, treatment and rehabilitation.
Addictions
Physiologic or psychologic dependence on some agent (e.g. alcohol, drug, work, sex,
food etc) with a tendency to increase its use
Behavioural Patterns
The dependent adolescent displays behaviour significantly different from behaviour
that predated his use. The adolescent frequently displays aggressive behaviour under
the influence that includes threats toward or physical altercations with family or peers,
burglary vandalism or thefts. Behaviours displayed when the adolescents are not under
the influence include irritability, hostility and anger towards authority figures,
stealing from friends and friends lying to cover up use and dealing drugs to support a
drug habit
Multiple Diagnosis
Any combination of the above
Mental Health
Mental health is the capacity of the individual, the group and the environment to interact
with one another in ways that promote subjective well-being, the optimal development
and use of mental abilities (cognitive, affective and relational), the achievement of
individual and collective goals consistent with justice and the attainment and
preservation of conditions of fundamental equity
Youth
For the purpose of this initiative, youth is defined as individuals between the age of 12
and 21
22. 22
Appendix 2
Behchoko Concurrent Disorders
Proposal
Program
Components:
Responsibility:
Activities:
Service CoordinationTeams
Case management
ContinuityTeam
INTAKE &
ASSESSMENT
Telephone
Access 1-
800
Universal
Intake
- all systems
Education
Referral to
community
resources if
REFERRAL &
LINKAGE
Referral &
Linkage to
needs based
programs and
services
Ongoing
support to youth
and parents
until linkage is
complete
DAY TREATMENT
Education mediation
- academics
Skills development
- Social skills
- Life skills
Therapy
- Individual
- Group
DISCHARGE PLANNING
Coordinated planning
with all who support
youth and family
- formal and
informal
- community
organizations
- youth
- family
- school
- service providers
AFTER CARE
Individual
Group
PARENTAL
SUPPORT
Parenting
Education
EDUCATION
Awareness
campaign to
all re: normal
youth
development
and concurrent
disorders
CONSULTATION
Access to consultation and
professional bycommunity
organizations whoservice
youth and their families
- education to staff of
organizations
- planning appropriate
interventions
no
intervention
required
Target
Group:
Short Term
Outcome
Objectives:
Long Term
Outcome
Objectives:
Goals:
A variety of community agencies
Organizations who work with youth (wrap around)
Community at large
Increase access to appropriate services for youth and their families
Increase identification of youth at risk (of concurrent disorders)
Increase referral to appropriate community resources, including to Day Treatment, for youth identified at risk
Increase parenting confidence, knowledge and skills
Increase linkages between agencies of other providers (wraparound)
Increase accessibility to discharge planning and ongoing care/support
Improved healthy adolescent development
Removal of psycho-social barriers that inhibit the ability of youth to learn
Improved parenting capacity
Improved service linkages
Increase awareness of community at large of the impact
of Mental Illness and Addiction on Youth
Increase consultation/substance abuse and awareness to
a variety of services regarding potential risk in youth
Increase collaboration between agencies and
organizations
Increased knowledge of services that exist in the system
Increased appropriate service utilization in NWT
Continuity Team
Community Advisory Committee
LOCAL VISION PROMOTION OF INTEGRATION
OF SERVICES PROVIDED BY:
TRAINING/EDUCATION
TO SERVICE PROVIDERS
WITHIN ALL SYSTEMS
For services for youth and their
families
- common processes
- policies and procedures
developed
Health & Social Services
ECE
Justice
Police
Common tools
Assessment
processes
Organizations and Agencies funded through
- GNWT
- Health
- Education
Increase integration within human service system
Decrease duplication of service
Increase number of common policies and procedures within Human Service System
Increase knowledge and understanding of roles by service providers within the Human Service System
Increased coordination of services within community
Decreased % of youth who prematurely leave school and are at risk of developing criminal behaviour
Service Delivery
Components
Services to Youth and
Families
Links System Level
Components
Individuals
Youth
Family
Parents
Caregivers
23. To ensure communication, coordination and integration of effective services funded through:
- GNWT
- Health and Social Services
- ECE
- Justice & RCMP
Thereby reducing costs related to family breakdown and criminality.
To ensure that youth with or at risk (of concurrent disorders) and their families have access to an integrated, accessible and comprehensive system of services
24. 23
23
Appendix 3
Youth
Introduction
“Youth” (usually understood to be under 21 years of age), are themselves a
heterogeneous group that can be subdivided according to a number of characteristics.
An important one is developmental stage, which includes latency, adolescence and
young adult stages. Agencies offering services to youth should be multifunctional and
multidimensional in recognizing and offering specialized services to these three major
age categories. This does not necessarily mean that each youth treatment agency
should have a full continuum of services for all age groups, but they should be linked to
other services so that the full continuum of services is readily accessible.
Issues Regarding Appropriateness and Accessibility of the Treatment System
Recently, there has been an increasing emphasis on developing services for under 19
year olds. Programs for this population should demonstrate their commitment to
developing age-appropriate programming linkages with other children’s and family
services in the community and procedures for involving the family in the treatment
process.
In the addictions treatment field, it is essential that services for youth are seen as
discreet and specialized from the more generic adult-oriented services. This is
not meant to imply that every youth service must be a stand-alone entity, but does
mean that there should be special programs and staff dedicated to youth.
Other issues in treating youth who require special attention are ethnicity, sexual
orientation, homelessness, concurrent mental health problems such as eating disorders
and depression, family violence and sexual abuse. Programs must address these
special needs by either offering issue-specific responses within their own services or by
linking with other appropriate resources in the community.
System Issues and Program Models
With regard to the adolescent age group, there is increasing evidence that brief
outpatient treatments are appealing and appropriate alternatives to day and residential
treatments. At this time, there is a pressing need and ready market for brief outpatient
treatment protocols (e.g.: 4-8 sessions), that address not only substance use but also
other interconnected issues such as motivation to change, family relationships, peer
networks, physical and emotional health, education and leisure. The reality is that
some youth will require additional, highly focused, supplemental treatment and thus a
25. 24
24
stepped-care approach in which specialized treatments such as family therapy, group
therapy, day programs and residential support should be available to build on the brief
outpatient treatment, which can be seen as the cornerstone of a youth treatment
system.
There are several different theoretical approaches for working with youth (e.g.:
cognitive-behavioural, 12 step, solution-focused, psychodynamic). Ideally, a
community should have a variety of treatment approaches for youth to access
according to their capabilities and preferences. Generally speaking, youth seem to
prefer treatments that are brief, skill enhancing, self-affirming and focused on day-to-
day life events.
A community that is responsive to youth must also offer them a choice in terms of
substance use goals, ranging from abstinence, to reduced use, to harm reduction. It is
not necessary that this choice be available within each individual agency, but it should
be accessible within the treatment system. Goals of non-abstinence give rise to special
concerns when it comes to treating minors, and therefore agencies offering such goals
must have explicit policies and procedures to deal with this issue. Agencies must also
have in place policies and procedures that are sensitive to the frequently occurring
issues of confidentiality of information between parents/guardians and the youth.
Recommendations
There is a tremendous opportunity to broaden and enhance existing non-addiction-
specific youth services (e.g.: Health, Protection, Family Services) by embracing and
integrating the assessment and treatment of substance use within the context of their
overall treatment services. Such initiatives should be seen as a priority within each
community.
Involvement in the Planning and ConsultationProcess
“Youth” is a visible high-priority population whose unique needs and attributes
necessitate treatment approaches that are distinct from those for adults. The field has
relied too extensively on generalizing experiences drawn from treating adult
populations to plan and develop youth services. Instead, greater emphasis should be
placed on learning from youth themselves and from the experience of youth service
providers, both in the substance abuse and other treatment fields. It is our
recommendation that special youth-specific outreach, assessment procedures,
treatment protocols and evaluation methods be developed and disseminated to
enhance the quality of treatment services for youth.
References and other Resources
Tupker, E. (1994). Youth & Drug Abuse: A Planner’s Guide to Multi-Functional
Treatment. Toronto: Addiction Research Foundation.
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25
Appendix 4
Elements of a Day Treatment Program
Assessment including
collection of existing data,
screening for eligibility/priority,
admission decision,
alternative recommendations/redirection.
Therapeutic/behavioural interventions including;
Individual work including:
goal setting/review
discharge follow-up plans to support gains made.
Family work including:
psycho-education re: nature of mental health disorders*, treatment alternatives, how
parents can help improve outcomes, traditonal healing
family therapy,
Follow-up planning.
Group work including:
psycho-education re: the nature of mental health disorders*, treatment alternatives,
how the individual can help improve outcomes, traditonal healing
Life skills including communications, stress management, problem-solving
strategies, conflict resolution/anger management, building self-esteem, values
clarification, making the most of community resources, etc.
Education including:
individualized instruction,
linkage to school for continuity of content,
recommendations for follow-up by feeder school/board to support academic and
social reintegration in the school setting post-discharge.
Social/Recreational activities including:
physical exercise
culturally expressive arts (arts, crafts, drama, music, etc)
*Includes psychiatric behavioural, substance abuse, learning disorders and any combination thereof
27. 26
Community Advisory
Committee
(Treatment Sub-committee or something new)
Continuity
Team
Kids
Family &
Friends Hospital Schools Agencies Employers Recreation Police
Community
Education
(Awareness)
Assessment &
Treatment
Discharge &
Follow-up
Lead Administrative Agency
Intake &
Referral
Ongoing training in Mental Health & Addictions
(Staff & Community professionals)
Outreach to other organization
26
Appendix 5
Community Advisory Committee
AA MMooddeell ffoorr IInntteeggrraatteedd TTrreeaattmmeenntt ffoorr YYoouutthh
wwiitthh CCoonnccuurrrreenntt DDiissoorrddeerrss
DayTreatment
Integrated
