Facilitator’s Guide Module 9 - Department of Health · Facilitator’s Guide – Section A 3 Training Frontline Workers: Young People, Alcohol and Other Drugs Background The project

Facilitator’s Guide Module 9

(c) Commonwealth of Australia 2004

ISBN 0 642 82458 4

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Project Outline

This project, an initiative of the National Illicit Drug Strategy, has developedteaching and learning resources to assist frontline workers address the needof young people on issues relating to illicit drugs. They will support a trainingorganisation in the delivery of training. The modules explore work with youngpeople, drug use and suitable intervention approaches.

Project Management

The development of the resources has been managed by:

� New South Wales Technical and Further Education Commission (TAFENSW) through the Community Services, Health, Tourism and HospitalityEducational Services Division

� Drug and Alcohol Office (Western Australia)� The Northern Territory Health Service.

Acknowledgements

The original consultations, writing, practitioner review and revision of thematerials has involved a large number of services including:

Alison Bell ConsultancyCentre for Community Work Training, Association of Children’s WelfareAgencies (NSW)Community and Health Services (Tas)Community Education and Training (ACT)Curtin UniversityDepartment of Community Services (NSW)Department of Juvenile Justice (NSW)Drug and Alcohol Office (WA)Health Department of NSWNational Centre for Education and Training in AddictionsNew England Institute of TAFE, Tamworth CampusNorthern Territory Health ServiceNSW Association for Adolescent HealthTed Noff’s Foundation (NSW)The Gap Youth Centre (NT)Turning Point (Vic)Youth Substance Abuse ServiceYouth Action Policy Association (Vic)

This project was funded and supported by the National Illicit DrugsStrategy through the Australian Government Department of Health andAgeing.

The Materials

The final product, provided for distribution on CD-Rom, consists of:

� a facilitator and learner guide for 12 modules,� a support text for workplace learning.� Overhead transparencies using Microsoft PowerPoint for each module to

support facilitators who choose face-to-face delivery.

Each document has been provided in

� Acrobat (pdf) format to ensure stability� A Microsoft Word version to enable organisations to amend, add and

customise for local needs

The primary user would be a facilitator/trainer/training organisation thatwould distribute the learning materials to the learners. They can be used intraditional face to face or through a supported distance mode.

Materials have been prepared to allow direct colour laser printing orphotocopying depending on the size and resources of the organisation. It isnot envisaged that learners would be asked to print materials.

Assessment

Where assessment of competence is implemented training organisations arereminded of the basis principles upon which assessment should be based:

Assessment is an integral part of learning. Participants, throughassessment, learn what constitutes effective practice.

Assessment must be reliable, flexible, fair and valid.

� To be reliable, the assessment methods and procedures must ensurethat the units of competence are applied consistently.

� To be flexible, assessment should be able to take place on-the-job, off-the-job or in a combination of both. They should be suitable for a varietyof learning pathways including work-based learning and classroombased learning.

� To be fair, the assessment must not disadvantage particular learners� To be valid, the assessment has to assess what it claims to assess.

2Facilitator’s Guide – Section A

Contents

Project Outline.................................................................................. 2

Project Management.......................................................................... 2

Acknowledgements ........................................................................... 2

The Materials ................................................................................... 3

Assessment ..................................................................................... 3

Background ..................................................................................... 3

Target occupational groups ................................................................. 3

Approaches to service delivery............................................................. 4

Project resources .............................................................................. 7

Using the Facilitator Guide ................................................................ 10

Supporting distance learners ............................................................. 11

Developing a learning plan ................................................................ 12

Assessment ................................................................................... 17

Resource requirements .................................................................... 18


Training Frontline Workers:Young People, Alcohol

and Other Drugs

Background

The project Training Frontline Workers – Young People,Alcohol and Other Drugs is part of a broad strategy tosupport the educational and training needs of frontlineworkers. The training and support needs of frontline workersnot designated as alcohol and other drug workers to enablethem to work confidently with young people on illicit drugs iswell recognised. This project attempts to meet this need. Itwas funded by the Commonwealth Department of Health andAgeing under the National Illicit Drug Strategy (NIDS).

Target occupational groups

This training resource has been developed specifically for thefollowing groups of frontline workers:

� Youth workers� Accommodation and crisis workers� Counsellors (including school-based)� Primary and community health and welfare workers� Juvenile justice workers� Teachers� Police


Approaches to service delivery

The development of the resources brings together twoapproaches to service delivery:

� work with young people� alcohol and other drug work

The two approaches which underpin these resources aresummarised as follows:

Working with young people

A systems approach is the most appropriate model tounderstand and work with young people. A systems approachassumes that no aspect of behaviour occurs in isolation,rather it occurs within a wider context. In other words, tounderstand young people we need to consider the individual,their family, the wider community and society as a whole aswell as how they interact with each other.

The systemic youth-focused approach assumes that:

� Young people deal with challenges in ways similar to otherpeople in society (some well, others not so well). Youngpeople develop their coping strategies and skills bylearning from others around them, through their ownpersonalities and through trial and error.

� The term ‘youth’ is a social construction. Societal valuesand beliefs about young people determine the way inwhich they are treated within society (for example, youngpeople are viewed differently in different cultures).

� Young people are not an homogenous group. Althoughyoung people share some common developmental issues,their backgrounds, experiences and cultures are asdiverse as the rest of the population.

� Young people participate actively in their lives, makechoices, interact with others, initiate changes andparticipate in our society. They are not passive victims ofa dysfunctional society, family or peer group.


The following social justice principles guide work withyoung people:

� Access - equality of access to goods and services

� Equity - overcoming unfairness caused by unequalaccess to economic resources and power

� Rights - equal effective legal, industrial and politicalrights

� Participation - expanded opportunities for realparticipation in the decisions which governtheir lives.


Alcohol and other drug work

Harm minimisation is the most appropriate approach forworking with alcohol and illicit drug issues. The goal of harmminimisation is to reduce the harmful effects of drugs onindividuals and on society. Harm minimisation assumes thatwhile we cannot stop drug use in society, we can aim toreduce the harm related to using drugs. Harm minimisationhas three components: harm reduction, supply reduction anddemand reduction.

A variety of drugs, both legal and illegal, are used in society.There are different patterns of use for drugs and not all druguse is problematical.

Large proportions of young people try alcohol or other drugs,including illicit drugs, without becoming regular or problemdrug users.

Drug use is a complex behaviour. Interventions that try to dealwith single-risk factors or single-risk behaviours are ineffective.

Drug use represents functional behaviour for both youngpeople and adults. This means that drug use can best beunderstood in the broader context of the lives of the youngpeople using them. Any interventions need to take the broadercontext into account.

Training approach

These training resources are based on the following principles:

� Training is consistent, supports a national qualification andprovides a pathway to a qualification.

� Training is based on adult learning principles. It should:− build on learners’ existing knowledge, skills and

experience− utilise problem-based learning and skills practice, and− develop critical thinking and reflection.

� Training is to be flexible and available through a variety ofmethods. Examples include workshops, self-directedlearning, distance learning supported by a mentor/facilitator and work-based learning.


� Work-based learning provides participants with theopportunity to reflect on current work practices, apply theirlearning to the work situation and to identify opportunities fororganisational change and development in their workplaces.

� A key learning strategy of the resources, supported byindividual, group and work-based activities, is reflection:alone and with peers and supervision. To reflect upon andevaluate one’s own work, the types of intervention used andthe assumptions they are based on is crucial to workingmore effectively.

Project resources

The Young People, Alcohol and Other Drugs program aimsto provide the core skills and knowledge that frontline workersneed to respond to the needs of young people with alcoholand drug issues, particularly illicit drugs.

This training resource, which comprises 12 modules, hasbeen developed to provide a qualification and/or specific unitsof competence. The resource can also be used as a test orreference document to support the development of a specificknowledge or skill.

Each module (except Module 1) comprises a LearnerWorkbook and a Facilitator Guide. Each Learner Workbook isa self-contained resource that can be used for both distanceand work-based learning or to support face-to-face learning(including workshops).

Relationship to the Community Services TrainingPackage (CHC02)

The training modules were initially developed to support fourunits of competence from the Community Services TrainingPackage (CHC99). These were:

CHCYTHA Work effectively with young people

CHCAOD2A Orientation to the alcohol and otherdrugs sector

CHCAOD5A Provide support services to clientswith alcohol and other drugs issues

CHCAOD6A Work with clients who areintoxicated.


Following the release of the revised Community ServicesTraining Package (CHC02) in April 2003, the modules wererevised to support the following units of competence from therevised Training Package:

Unit ofCompetence Module

CHCYTH1CWork effectively withyoung people

• Perspectives on Working withYoung People

• Young People, Risk and Resilience• Working with Young People

CHCAOD2BOrientation to thealcohol and otherdrugs sector

• Young People, Society and AOD• How Drugs Work• Frameworks for AOD Work

CHCCS9AProvide supportservices to clients

• Helping Young People Identify theirNeeds

• Working with Young People onAOD Issues

• Working with Families, Peers andCommunities

• Young People and Drugs – Issuesfor Workers

CHCAOD6BWork with clientswho are intoxicated

• Working with Intoxicated YoungPeople

The twelfth module Planning for Learning at Work is designedto support participants in their learning.

The four units of competence listed above contribute to nationalqualifications in both Youth Work and Alcohol and Other DrugWork and are electives in a range of other qualifications. Sincethese units by themselves will not deliver a qualification, theadditional units listed in the Community Services TrainingPackage Qualification Framework would need to be completed.

To achieve any of the above units a learner must complete allthe modules comprising that unit and be assessed by a qualifiedassessor from a registered Training Organisation. While it ispossible to complete individual modules, this will not enable youto achieve a unit of competence. Individual modules willcontribute towards gaining the unit of competence and over aperiod of time all modules needed for the unit could becompleted.


Each of the units of competence has a different focus and hasbeen customised within national guidelines to meet the needsof frontline workers in working with young people with illicitdrug issues. The modules each provide a learning pathwaywith stated learning outcomes to help achieve each particularunit of competence.

Since the modules associated with each unit of competenceprogressively build on each other, they can be delivered andassessed in an integrated manner. This provides learners witha ‘total view’ of the essential theory and required skills for theirwork roles.


Using the Facilitator Guide

Each Facilitator Guide is a comprehensive teaching tool thatcontains the information, resources and activities required tomeet the learning outcomes of a particular module. It isdesigned to be used in conjunction with the LearnerWorkbook for that module which contains detailed informationthat facilitators may wish to refer to. The Facilitator Guide andthe Learner Workbook are suitable for a variety of deliverymodes, including face-to-face learning, distance and work-based learning.

The Facilitator Guide is divided into two sections.

Section A provides general information about the trainingresources and guidelines on how to supportlearners and assist them in developing a learningpathway and plan.

Section B provides the facilitator instructions for the module.

The Facilitator Guide provides an overview of the module, thelearning outcomes and any links to other modules. It providesa summary of the Learner Workbook content topic by topicand suggested facilitator-led discussions and learningexercises. While an approximate timing of activities issuggested, facilitators are encouraged to use their judgement,taking into account the knowledge and skill level of thelearners. Each Guide contains overheads, a glossary and alist of references and resources. Icons are used in both theFacilitator Guide and the Learner Workbook to highlightinstructions and activities suitable for work-based learning,application and reflection.

It is recommended that facilitators read both the FacilitatorGuide, the Learner Workbook and key references.

Prior to commencing the module with learners, facilitatorsshould be familiar with the:

� Learning outcomes� Module content by topic area� Learning activities within each topic� Structure and flow of the module� Learner workbook� References and resources listed


Supporting distance learners

These training resources have been developed with theunderstanding that learners should not undertake thesemodules without the support of an appropriately qualifiedfacilitator. This is especially the case for distance learnerswho undertake their learning outside of a classroom orworkshop setting.

Distance learners have specific needs in relation to:

� Isolation� Conflicting priorities and time pressures.

A variety of strategies may be used to accommodate learnerneeds and support learning. These include:

� providing alternative activities or additional tasks toachieve the learning outcomes. Some activities may beunrealistic in some locations (e.g. asking learners to visitother agencies when they are in a remote location)

� developing a learning plan to clarify what topics are to becompleted, by when and how

� maintaining contact with learners to monitor their progressand assist with learning

� establishing a learning community through groupteleconferences, e-mail or list servers to help learnersprocess issues through discussions and ideas/feedbackfrom other learners.


Contact with distance learners

It is important for facilitators to establish and maintain contactwith distance learners.

The amount of contact will depend on:

� nature of the topic being undertaken

� learner’s available resources including availability of otherlearners, mentors or colleagues

� learner’s desire for interactivity

� learner’s motivation and other learning needs.

Developing a learning plan

In order to develop a learning plan with a learner you will firstneed to identify their learning needs. From these needs you willbe able to formulate learning goals and develop a plan to meetthese goals. The learning plan should contain details on whatwill be learned, how it will be learned, by when, what criteria willbe used to evaluate the learning and how the learning will bevalidated. A learning plan is best prepared by the learner withthe guidance and support of a mentor or facilitator. Topic 4 inthe module Planning for Learning at Work contains detailedinformation on preparing a learning plan.

Once learner needs have been identified they can bematched up with the units of competence and the resourcesavailable.

The following steps will assist you to develop a learning planwith a learner:

3. Assessment of learning needs

This may include analysis of:

� learner’s values� skills� strengths and weaknesses� preferred learning style� suitability of learner’s work situation as a work-based

learning environment (Is there a quiet place to read/write/consider? Are study leave provisions available? Ismanagement supportive of work-based learning?).


4. Identification of learning goals

It is important to identify learning objectives both from alearner’s perspective and from an organisationalperspective. Those learners who are undertaking learningas part of a process initiated by their organisation may wellhave different needs and motivations to those learners whohave elected or volunteered to undertake further learning.Once established, learning goals can be reviewed againstthe learning outcomes of the module/s in this resource.This will assist the selection of appropriate modules.

3. Identify learning resources, supports and strategies.Evaluate the availability of the following resources andthe learner’s confidence in accessing them.

� people (facilitator, other learners, mentors, supervisorsetc)

� resources (e.g. texts/libraries)� technology (e.g. phones, Internet/e-mail, video-

conferencing)

4. Specify what constitutes evidence of learning

How will you and the learner know that learning hasoccurred? Assessment of learning could include a portfolio,case notes, role plays and/or case studies.

5. Specify target dates

Specify dates for progress reviews and for module/taskcompletion. Agree on how this will occur

Target dates for contact with facilitators should specify:

� Informal query or concerns (How can a learner accessyou if they have a query or concern? For example, e-mail, telephone etc)

� Progress review dates (When will formal contact beinitiated to check on progress and how will this be done?For example, by telephone, face-to-face meeting etc.)

� Assessment event due dates (When are assessmentevents due and how will they be submitted? (Forexample, by post, e-mail etc)

� Feedback. When will feedback be available onassessment performance and how will that bedelivered?


Many learners will want to develop knowledge and skills in anumber of areas. Overlapping content across the units hasbeen identified in the individual modules.

NOTE: CHCAOD2B provides key underpinning knowledge onAOD work and reflection on personal values and attitudes toalcohol and other drugs. It is recommended that this unit becompleted before undertaking the other units in alcohol andother drug work. In particular, the module How Drugs Workprovides underpinning knowledge about the action of a drugon the individual. It is recommended that learners completingCHCCS9A and CHCAOD6B also complete this module.

Facilitator’s Guide – Section A

DEVELOPING A LEARNING PATHWAYWhen you have worked with your learners to identify their skill/knowledge gaps, the following guide may assist you in developing a learning pathway

for each learner or group of learners. Learners’ may choose to do one, several or all of the units, depending on their needs.

If learners want information aboutyoung people and ways of working

with young people.

UNIT CHCYTH1C

If learners want informationabout the alcohol and other drug

sector and a greaterunderstanding of drug use in

society.

UNIT CHCAOD2B

If learners want skills in identifyingAOD drug impacts on young people to

develop responses to alcohol anddrug issues for the young people.

UNIT CHCCS9A

If learners want skills andinformation to work withyoung people who are

intoxicated.

UNIT CHCAOD6BWorking with IntoxicatedYoung PeopleProvides information and skills inworking with intoxicated youngpeople.

If learners want advice aboutplanning learning and how tolearn

Perspectives on Working withYoung PeopleExplores the stage of adolescence and arange of factors that impact on thedevelopment of young people

Young People, Risk and ResilienceProvides a framework for understandingand working with young people

Working with Young PeopleProvides a broad framework forunderstanding and working with youngpeople, explores goals of working withyoung people and the development ofspecific skills.

Young People, Society and AODLooks at ways of understanding druguse in society and by young people inparticular and presents an overview ofpatterns and trends of AOD use byyoung people. Broad societal factorsthat influence work on AOD issues arealso explored.

How Drugs WorkProvides information about drugs andhow they act on the body.

Frameworks for AOD WorkProvides an overview of the range ofAOD interventions, from preventionthrough to treatment and explores theirrelevance to work with young peopleon AOD issues.

Helping Young People Identify theirNeedsDevelops skills in identifying alcohol andother drug issues for young people at anindividual, group and community level.

Working with Young People on AODIssuesProvides skills in working with young peoplewith AOD issues on a one-to-one basis. Theemphasis is on young people who areexperiencing problems because of their AODuse.

Working with Families, Peers andCommunitiesProvides a framework and skills for workingwith young people on AOD issues at acommunity and family level.

Young People and Drugs - Issues forWorkersExplores a range of issues that workers mayencounter when working with young peopleon AOD issues. These include personalvalues, ethical issues and issues surroundingconfidentiality and accountability.

Planning for Learning atWork

Facilitator’s Guide – Section A

Supporting Distance Learners in Developing a Learning Plan

1. Assessment oflearning needs

Learners should be assisted to assesstheir:• Values• Skills• Strengths and weaknesses• Learning style• Learning environment• Reason for attending• (e.g. compulsory - organisation

initiated or voluntary – individuallyinitiated)

2. Identification oflearning goals

• Learners goals (SMART)• Organisational goals (if applicable)• Module learning outcomes

3. Identification oflearning resources,supports and strategies4. Identification of

forms of evidence oflearning

5. Specify timeframesand mode of contact

Includes time frames for:• Informal contact (e.g. if the learner has a query)• Review of progress• Assessment events• Finalising module requirements

Mode of contact could include:• Telephone call• E-mail• Group teleconference (e.g. with other learners)• Face-to-face meetings

NOTE:Remember that learning is part of a cyclical process and the development andimplementation of the learning plan will form the basis of analysis, reflection andfurther planning.

Includes availability and confidence to access:• People (facilitator, other learners, mentors,

supervisors, colleagues, other professionaland services etc)

• Resources (texts/references, libraries etc)• Technology (Internet/websites, e-mail, video-

conferencing etc)


Assessment

Example assessments are provided for these resources.However, individual Registered Training Organisations(RTOs) will determine assessments for the modules/unitsoffered. Assessments will be responsive to learner needs andresources available and comply with Australian QualityTraining Framework (AQTF) 2001 requirements.

Assessment Principles

Principles upon which assessment should be based include:

� Assessment is an integral part of learning and developingan understanding of what constitutes effective practice

� Assessment must be reliable, flexible, fair and valid

− To be reliable, the assessment methods andprocedures must ensure that the units of competenceare applied consistently.

− To be flexible, assessment should be able to takeplace on-the-job, off-the-job or a combination of both.It should be suitable for a variety of learning pathwaysincluding work-based learning and classroom-basedlearning.

− To be fair, assessment must not disadvantageparticular learners

− To be valid, assessment has to assess what it claimsto assess.

Facilitator qualifications and knowledge

It is recommended that the facilitator possesses at least:

� the unit of competence or a qualification containing thetopic area being taught

� Certificate IV in Workplace Assessment and Training� experience in the delivery of services to young people

Ideally, a facilitator should also have tertiary qualificationsrelating to the module being taught.

Under the AQTF (2001) Registered Training Organisationsare required to provide appropriately qualified facilitators/trainers.


Resource requirements

Minimum resources required for the different modes ofdelivery are outlined below. Details of specific resources arecontained in each topic.

Face-to-face training requirements

One large room (preferably with break out rooms for smallgroup work) with the following resources:

� Whiteboard and markers� Overhead projector and screen� Butchers paper and markers� Learner Workbook� Blu tak

Distance learning requirements

� Learner Workbook

Mixed mode delivery requirements

One large room (preferably with break-out rooms for groupwork) with the following resources:

� Whiteboard and markers� Overhead projector and screen� Butchers paper and markers� Learner Workbook� Blu tak


Icons

The following icons are used in the Learner Workbook andFacilitator Guide to assist you in using the resources.

Facilitator direction

Workplace learning activity

Case study

Task

Writing exercise

Group activity

Links to other modules

Web resources

Video

Question

Answer

A good point for student to contact facilitator

Brainstorm

Suggested time

Overhead transparency

2

Contents

Topic 1 Introduction ...........................................................3

Topic 2 Introduction to AOD interventions .........................6

Topic 3 Understanding change........................................18

Topic 4 Motivational Interviewing.....................................42

Topic 5 Some motivational interviewing techniquesfor working with young people.............................53

Topic 6 Brief interventions ...............................................69

Topic 7 Working with young people to determine aplan of action.......................................................85

Topic 8 Relapse prevention/management .......................98

Topic 9 Summary and conclusion..................................102

Assessments ....................................................................107

References .......................................................................112

Key terms .........................................................................115

3

Topic 1

Introduction

Overview

In this module learners will explore principles and developtechniques for working effectively with young people withalcohol and/or other drug problems. The emphasis of thismodule is on working with young people on an individualbasis. Approaches that target peers, groups andcommunities are covered in the module Working withFamilies, Peers and Communities.

This module focuses on young people who areexperiencing problems related to their AOD use. Aslearners work through it, they will have the opportunity toreflect on their own work with clients and apply theirlearning within their own work context.

20 mins

4

1.2 Learning outcomes

� When learners have completed this module they willbe able to:

Identify AOD interventions suitable for workingwith young people

Apply the ‘Stages-of-Change’ model andmotivational interviewing to work with youngpeople

Implement strategies for working with resistanceand ambivalence with young people

Demonstrate skills in harm minimisation andbrief and early interventions with young people.

Apply relapse prevention and managementstrategies.

5

1.3 Assessment events

� Provide all learners with information on any assessmentactivities they might be required to undertake. Ensurethat contact is made with distance learners as soon aspossible.

� Discuss these with learners and provide time forquestions, feedback and examples.

� Reflect on assessment events throughout trainingsessions to enhance learners’ understanding andconceptualisation of what is required. All assessmentsmatch Learning Outcomes competencies.

� Suggested assessment events are provided afterTopic 8.

6

Topic 2

Introduction toAOD interventions

Overview

� This topic presents a framework for understandingindividually-focused AOD interventions for youngpeople who are experiencing problems due to theiruse of alcohol and/or other drugs.

� A number of approaches underpin alcohol and otherdrug work, many of which have been covered inother modules. We will briefly review them here toidentify how they can help us to understand andimplement AOD interventions. The youth-focusedsystems approach will also be presented as itprovides a framework for understanding youngpeople and their behaviour.

Note: To all learners and facilitators

If learners have completed the module Helping YoungPeople Identify their Needs they will have alreadycovered harm minimisation, Schaeffer’s model and theyouth-focused systems approach. Review them beforeyou proceed to Topic 3.

Young People, Society and AODFrameworks for AOD Work

1½ hours

Harm minimisation

Schaeffer’s model

Youth-focusedsystems model

Interaction model

7

2.1 Harm minimisation

� Harm minimisation is a useful approach because ithelps you to focus your assessment on the range offactors that are contributing to the harms associatedwith young people’s AOD use (and not just on theAOD use alone). You can then design interventionsto prevent or reduce those harms directly not just bytrying to reduce or eliminate AOD use.

� Harm minimisation is the current drug-related policyin Australia governing all drug-related laws andresponses. Harm minimisation considers the health,social and economic consequences of AOD use inrelation to the individual and the community. It hasbeen a key policy of Australian state and federalgovernments since the National Campaign AgainstDrug Abuse was launched in 1985.

Three key areas

� Harm minimisation strategies can be categorised intothree areas:

� Harm reduction – These strategies are aimed atreducing the harm from drugs for both individualsand communities and do not necessarily aim tostop drug use. Examples include needle syringeservices, methadone maintenance, briefinterventions and peer education.

� Supply reduction – These strategies are aimedat reducing the production and supply of illicitdrugs. Examples include legislation and lawenforcement.

� Demand reduction – These strategies are aimedat preventing the uptake of harmful drug use.Examples include community developmentprojects and media campaigns.

8

� The harm minimisation approach is based on thefollowing premises:

� Drug use, both licit and illicit, is an inevitable partof society

� Drug use occurs across a continuum, rangingfrom occasional use to dependent use

� A range of harms are associated with differenttypes and patterns of AOD use

� A range of approaches can be used to respond tothese harms.

� Harm minimisation includes those strategiesdesigned to reduce the harm associated with use,without necessarily reducing use. It involves thosestrategies (policies and programs) specificallytargeted at reducing the harm directly resulting fromdrug use.

� The concept of harm minimisation is not wellunderstood or accepted in the wider community asmany people believe that in attempting to reduce theharm associated with drugs, we are condoning druguse. These strategies aim to educate young peopleso that they are able to make informed decisions andchoices and try to keep people safe or as safe aspossible.

‘Harm minimisation in my service’

What are three ways in which yourorganisation attempts to reduce the harmassociated with AODs?

1.

2.

3.

9

� Learners to discuss the following questions in groupsof three or four.

What ways could your organisation furthercontribute to harm minimisation amongyoung people who use AODs?

Optional take away exercise/essay

Identify two harm minimisation strategies?

How are they implemented?

Photocopy relevant policy and procedures that outlinethese particular harm strategies in your organisation.

� Learners are to present their responses in essayformat in no more than 400-500 words.

10

2.2 Schaeffer’s model

� In the context of identifying a young person’s needs itmay be useful to reflect on Schaeffer’s model whichreminds us that not all young people’s AOD use isinherently problematic. In our assessments withyoung people we need to be able to distinguishbetween different patterns of AOD use and interveneappropriately depending on the type of use identified.

� Experimental use – Drug use is motivated bycuriosity or desire to experience new feelings ormoods. This may occur alone or in the company ofone or more friends who are also experimenting. Itnormally involves single or short-term use.

� Social/recreational use – Drugs are used onspecific social occasions by experienced userswho know what drug suits them and in whatcircumstances (e.g. ecstasy use by experiencedusers at dance parties, or alcohol with a meal).

� Circumstantial/situational use – Drugs are usedwhen specific tasks have to be performed andspecial degrees of alertness, calm, endurance orfreedom from pain are sought. (e.g. truck driving,shift work or studying for exams).

� Intensive use – This drug use is similar to theprevious category, but more intensive. It is oftenrelated to an individual’s need to achieve relief orto achieve a high level of performance. It can alsoinvolve binge AOD use, where there is excessiveuse of a substance at one time. The pattern ofbinge use may be occasional, or may relate tospecific situations.

� Compulsive/dependent use – Drug use leads topsychological and physiological dependencewhere the user cannot at will discontinue usewithout experiencing significant mental or physicaldistress. Drug use is central to the user’s day-to-day life.

11

� When a person is physically dependent they developwithdrawal symptoms when the drug is not taken.Psychological dependence occurs when the drug iscentral to a person’s thoughts, emotions andactivities. Drug users in this category have a strongurge to use despite being aware of the harmfuleffects.

� Even though not all use is problematic, there may stillbe harms and consequences associated with anypattern of AOD use.

12

Potential harms associated with Schaeffer’s list

Under each of the five patterns of useidentified by Schaeffer, list three potentialharms associated with that use. (There maybe some overlap between the types of use andassociated harms.)

Drug use Potential harms

• Experimental

• Recreational/social

• Situational/circumstantial

• Intensive

• Compulsive dependency

Experimental – Lack of knowledge, experience and lowtolerance could lead to accidental overdose or risk-takingbehaviours.

Recreational/social – Peer influences, tendency to getlost in the moment, excitement, using too much oruncertainty about the concentration of the drug couldlead to accidental overdose or risk-taking behaviours)

Situational/circumstantial – Not coping or using tocope could lead to risk behaviours, accidents etc.)

Intensive – Accidents, overdose, legal/financial issues

Compulsive/dependency – Health problems,relationship issues, legal/financial issues,accidents/overdose

� Discuss the suggested harms with learners.Brainstorm any other responses.

13

Optional exercise

Provide two examples of patterns of druguse evident among the young people youwork with. (Ensure confidentiality of youngpeople is maintained and false names areprovided.)

� Ask learners to share these experiences with thegroup and identify and discuss the differences inthese groups.

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2.3 Youth-focusedsystems model

� In applying a broader perspective on drug use andharm minimisation a young person’s drug use can beviewed within a holistic context. The youth-focusedsystems approach is a useful framework as it helpsyou to take into account a broad range of factors thatimpact on young people and their AOD use.Sometimes our tendency is to focus solely on theAOD use, without taking into account the context ofthat use (e.g. family, peer and/or community factors)which can be very important influences on a youngperson’s pattern of AOD use.

� This module will deal largely with interventions aimedat individual factors. However, it is important to beaware of the other aspects of the system, even whendealing with the young person in a one-on-onecontext, because those factors may influence theoutcomes that you are trying to achieve with theyoung person. No-one exists in isolation.

� The following diagram illustrates the factors thatinfluence a young person’s life. Each of the factorsinvolves a complex array of influences and situationswhich can serve as protective or risk factors. Thesefactors can influence the health and wellbeingoutcomes for that individual.

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Identifying possible outcomes for young people

What are some of the possible influences ona young person and their AOD use? Consideryour responses in accordance with thecategories in the above model (e.g. individualcharacteristics – physical health, values beliefs,family factors, abuse and neglect, etc).

Review the youth-focused systems model onthe next page. Were your suggestedoutcomes similar to those listed in themodel?

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YOUTH-FOCUSED SYSTEMS APPROACH

• Laws of society• Socio-economic climate• Availability of services• Social values and norms• Social/cultural practices and traditions• Popular culture (e.g. movies and music)• Government ideology and policies• Role of media and advertising

• Family harmony• Abuse and neglect• Family dysfunction• Patterns of communication• Family income/employment• Parents’ mental and physical health• Consistency of connection• Family values, beliefs and role models• Family discipline and structure• Extended/nuclear family• Family size

• Population density• Housing conditions• Urban/rural area• Neighbourhood violence and crime• Cultural norms, identity and ethnic pride• Opportunities for social development• Recreational and support services• Demographic and economic factors• Connectedness or isolation

• Nature of relationships• Health and wellbeing• Life opportunities

(e.g. education and work)• Criminal and legal consequences• AOD use and related harm• Social inclusion or

marginalisation

• Peer connectedness• School climate and culture• School attendance• Opportunities for social connection• Norms and values of peers and school• Friendships and interests• Educational approach/methods• School discipline and structure

• Personality and intelligence• Gender• Cultural background• Physical and mental health• Social skills and self esteem• Sexual behaviour/sexuality• Alcohol and drug use• Criminal involvement• Living situation/homelessness• Values and beliefs

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2.4 Interaction model

� Zinberg’s (1984) Interaction model provides a simplerversion of the youth-focused system approach. It isalso useful when trying to understand the relationshipbetween different factors that impact on the drug-using experience. The model identifies three factors:

� The drug (i.e. the properties of drug(s) consumed)

� The set (the individual characteristics of the user)

� The setting (the environment in which theintoxication is occurring).

� In recent times the model has been adapted and theabove factors are often referred to as drug, individualand environment.

• Harm minimisation focuses on reducing harms fromAOD use, not the use itself.

• Not all young people experience problems fromtheir drug use.

• The context of the young person must beconsidered.

• The context of drug use must be considered.

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Topic 3

Understandingchange

Overview

� This topic pinpoints various ‘stages of change’ thatoccur for young people and emphasises how important it isfor a worker to be able to determine which stage a youngperson is at in their AOD use.

� This topic explores the idea of change and presentsthe Stages-of-Change model. Learners will develop skills inidentifying and responding to a young person’s readiness tochange.

Understanding change

Communication‘roadblocks’

The Stages-of-Changemodel

Applying the Stages-of-Change model toworking with youngpeople

Identifying andresponding to a youngperson’s readiness tochange

2½ hours

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3.1 Understandingchange

The change process

� Change can be easy or difficult depending on what itis that we want to change and what that changemight mean in the broader context of our lives.Personal or lifestyle-related changes such as givingup smoking, leaving a relationship or deciding to getup early in the morning to exercise can be far moredifficult both to achieve and sustain.

� We know that smoking is linked to lung cancer or thatwe should exercise more in the interest of goodhealth but knowledge alone is not enough to achievebehaviour change, especially when it comes tolifestyle changes. We can be ambivalent aboutchange, that is, we can have strong reasons formaking change and strong reasons against makingchange. It is important to note that ambivalence is anormal human condition and it is central to decision-making in relation to change.

Natural and assisted change

� Having acknowledged that many changes require asignificant effort, it is also true that change canhappen naturally. In fact it is possible that mostchange in drug-using behaviour, for example, hasalways occurred outside of formal treatment. Thistype of change seldom happens overnight, but ratherinvolves the slow process of change that also appliesto those who receive treatment (Prochaska,DiClemente & Norcross, 1997). Many of those whonaturally recover also experience lapses back to druguse, as do those who receive treatment.

� Remember that most young people do not haveestablished patterns of use. However, natural changeoccurs often in young people and as workers weshould assist them with this process.

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Key features of natural change

� The common ingredients of natural change are:

Optional exercise – Self reflection journal

� Ask learners to recall ‘one thing’ that they havechanged in their life. It could be related to health,exercise, relationships, employment, etc. Learnersshould reflect on the whole process – from start tofinish – and describe their reasons for implementingthe change and how the change was achieved.

� They may wish to share the major steps in smallgroups, or as a whole group.

• finding a new reference group to identifywith and belong to that does not have an AODfocus

• finding (or rediscovering) a purpose in lifeand activities that are not compatible with heavyAOD use (which is often related to the previousaction)

• dramatic and humiliating events associatedwith AOD use

• ‘maturing out’ from heavy use in which heavydrug use has gradually been replaced by otherpriorities, commitments and obligations

• developing new personal relationships thatare not compatible with heavy AOD use ortrying to salvage existing relationships(responding to pressure from family and friendsto give up)

• financial and/or legal problems• health concerns• work problems• advice from friends and families• pregnancy.

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3.2 Communication‘roadblocks’

� People can be ambivalent about change. Too muchfocus by someone (e.g. counsellor, GP, familymember) on the negatives of using drugs or possiblepositives associated with change can often lead to‘yes but’ arguments and a reinforcement of theopposite side.

� There are times when workers may find themselvesusing less effective communication responses,particularly if there is perceived resistance from ayoung person. This in turn can lead to high levels offrustration in workers.

� Following are 12 common examples of less-than-ideal approaches to communication which arereferred to as roadblocks. They were originallyproposed by Thomas Gordon, the developer of‘Parent Effectiveness Training’ (PET) but they arejust as applicable to the worker-young personrelationship. None of the 12 roadblocks listed are‘right’ or ‘wrong’. They are responses that may beless effective when talking to a young person abouttheir drug use.

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Twelve communication roadblocks

Roadblock Examples

1. Ordering, directing,commanding

‘Don’t say that.’‘You’ve got to face up to reality!’‘You have to do something about yourdrug use!’

2. Warning orthreatening

‘You’re really asking for trouble!’‘If you go down that road you’ll be sorry!’

3. Giving advice,making suggestions,providing solutions

‘Have you thought about…?’‘What I would do is…’ ‘Why don’tyou…?’

4. Persuading withlogic, lecturing,arguing

‘The facts are…’‘Statistics show…’‘Yes, but…’

5. Moralising,preaching or tellingsomeone what to do

‘You should go to rehab.’‘The best thing you could do is get a job.’‘You really ought to…’

6. Disagreeing, judging,criticising or blaming

‘It’s your own fault.’‘Don’t you think you ought to think ofothers?’ ‘Surely there’s more to do thansmoke dope.’

7. Agreeing, approving,praising

‘I think you’re absolutely right.’‘That’s how I would feel if I were you.’

8. Shaming, ridiculingor labelling

‘That’s a silly way to think.’‘You really ought to be ashamed ofyourself.’‘How could you do such a thing?’

9. Interpreting oranalysing

‘Do you know what the real problem is?’‘You don’t really mean that.’

10. Over questioning orprobing

‘What makes you feel that way?’‘Why?’

11. Reassuring,sympathising,consoling

‘Things aren’t really that bad.’‘Don’t worry – you’ll look back on this ina year and laugh.’‘Things will turn out OK, you’ll see.’

12. Withdrawing,distracting,humouring, changingthe subject

‘Let’s talk about that some other time.’‘Oh, don’t be so gloomy! Look on thebright side.’‘You think you’ve got problems! Let metell you about …’

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� Often the above responses are made by well-meaning workers and although there are no hard andfast right or wrong answers, they can be roadblocksto effective communication with young people.

Recognising the roadblocks

� Ask learners to look through the list of‘Communication roadblocks’. Choosing at leastTWO of the ‘roadblocks’, write down or discuss insmall groups two professional situations wherethey have used a communication blocker.

Describe the circumstances surrounding thesituations that may have led to a ‘roadblock’.Record or discuss the factors that may havecontributed to the situation. (They may havebeen factors within yourself, your client, otherstaff member or within the environment.)

Devise two examples of alternative skills orstatements that you could have employed inthis communication situation.

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3.3 The Stages-of-Change model

� Traditionally, changing AOD use was viewed as asingle event rather than a process. This ofteninvolved only one possible outcome: total cessationor abstinence. This view does not take into accountthe small steps towards cessation that a personmight make and the achievement that those smallersteps might represent (such as reducing the numberof cigarettes smoked in a week). Young people whodid not change their substance use in this way wereviewed as being resistant and unmotivated.

� In the early 1980s, James Prochaska and CarloDiClemente (among others) developed a model toexplain the process of change in the context ofsubstance use and dependence. Based on theirresearch of ‘self-changers’, the Stages-of-Changemodel forms part of a broader conceptual frameworkknown as the Transtheoretical Model (Prochaska &DiClemente, 1982; 1986).

� This model recognises that different people are indifferent stages of readiness for change. It isimportant not to assume that people are ready for orwant to make an immediate or permanent behaviourchange. By identifying a person’s position in thechange process, a worker can more appropriatelymatch the intervention to the client’s stage ofreadiness for change.

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STAGES-OF-CHANGE MODEL

Precontemplation

Precontemplation

Precontemplation

Contemplation

Contemplation

Contemplation

Preparation

Preparation

Preparation

Action

Action

Action

Maintenance

Maintenance

Maintenance

LastingExit

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The five stages of change:

People in this stage

1. Precontemplation Not thinking seriously about changingand tend to defend their current AODuse patterns. May not see their useas a problem. The positives orbenefits, of the behaviour outweighany costs or adverse consequencesso they are happy to continue using.

2. Contemplation Able to consider the possibility ofquitting or reducing AOD use but feelambivalent about taking the nextstep. On the one hand AOD use isenjoyable, exciting and a pleasurableactivity. On the other hand, they arestarting to experience some adverseconsequences (which may includepersonal, psychological, physical,legal, social or family problems).

3. Preparation Have usually made a recent attemptto change using behaviour in the lastyear. Sees the ‘cons’ of continuing asoutweighing the ‘pros’ and they areless ambivalent about taking the nextstep. They are usually taking somesmall steps towards changingbehaviour. They believe that changeis necessary and that the time forchange is imminent. Equally, somepeople at this stage decide not to doanything about their behaviour

4. Action Actively involved in taking steps tochange their using behaviour andmaking great steps towardssignificant change. Ambivalence isstill very likely at this stage. May tryseveral different techniques and arealso at greatest risk of relapse.

5. Maintenance Able to successfully avoid anytemptations to return to usingbehaviour. Have learned to anticipateand handle temptations to use andare able to employ new ways ofcoping. Can have a temporary slip,but don’t tend to see this as failure.

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Optional exercise – ‘Which stage?’

� Make up some A4 cards and write each stage ofchange on the card. Then place the cards around theroom.

� Ask the learners to think about a habit or somethingthey are dependent upon and get them to identifywhich ‘stage’ of change they are at. Each learner tostand by that particular ‘stage-of-change’ card.Learners can then discuss their reasons for choosingthis stage with other group members who have alsonominated that stage. In the large group compareand discuss the characteristics of the differentstages. The habit can be anything from watching daytime soaps to hang gliding, dieting, eating chocolate,smoking or exercising.

� Encourage learners to pick something they feelcomfortable to share with the rest of the group.

The five stages of change:

1. precontemplation2. contemplation3. preparation4. action5. maintenance

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Relapse

� During this change process, most people willexperience relapse. Relapses can be important forlearning and helping the person to become stronger intheir resolve to change. Alternatively relapses can be atrigger for giving up in the quest for change. The key torecovering from a relapse is to review the quit attemptup to that point, identify personal strengths andweaknesses, and develop a plan to resolve thoseweaknesses to solve similar problems the next timethey occur.

� Relapse is a factor in the action or maintenancestages. Many people who change their behaviourdecide for a number of reasons to resume their druguse or return to old patterns of behaviour. Researchclearly shows that relapse is the rule rather than theexception.

� A note about lapse versus relapse: A lapse is a slipup with a quick return to action or maintenancewhereas a relapse is a full-blown return to the originalproblem behaviour.

� We will return to relapse management in Topic 8.

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Reflecting on change using the Stages-of-Changemodel

� Ask learners to refer to their Learner’s Workbook tocomplete this exercise.

Choose a behaviour from your own life thatyou have changed or attempted to change(related to smoking, exercise, diet, caffeineintake, career direction, etc.) Note down theprocess you went through using the stage-of-change model and record relapses andslip-ups.

What strategies did you use in making thatchange? For example, did you set yourselfshort-term and longer-term goals?

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Identifying the stage of change

� Divide the group into four small groups. Assign eachgroup a case study. The following four case studiesare in their Learner’s Workbook.

� Ask each group to identify the stage of change thatseems to fit the young person in their case study.

SARAH, JAMES, SAMMIE AND GRACIE

Sarah is a 16-year-old girl who has been using speedfor about two years. She uses speed intravenously,having originally snorted it for the first 12 months. Onassessment, Sarah tells you that she has been trying tocut down on her speed use and has even had a periodof two weeks where she didn’t use it. She appears to be‘speeding’ when you meet with her.

James is a 14-year-old boy who smokes cannabis andtobacco. On assessment of his cannabis use, he statesthat he can ‘take it or leave it’. He tends to smoke withfriends on the weekend. James smokes cigaretteswhenever he can afford them. He also drinks alcohol tothe point where he ‘blacks-out’ about once a month.

Sammie is an 18-year-old male who has been usingheroin for about three years. He smokes heroin on adaily basis and also takes Valium or Normison if hecan’t get any heroin. Sammie has been caught breakingand entering on a number of occasions. His family arevery worried about his drug use and the trouble he isin. Sammie has no desire to detox from heroin use.He states ‘It’s a hassle sometimes, but at least I don’tinject it’.

Gracie is a 17-year-old female who is involved in a DrugCourt program. She has a history of poly-drug use andhas worked as a sex worker. Gracie has been trying tostay off cocaine and speed. She continues to drinkheavily a couple of times a week and also takes streetbenzos as she says this helps her to sleep. Gracie’slatest urinalysis reveals cannabis, benzodiazepines andamphetamines. She is pretty worried that she will betaken off the Drug Court Program and she states shereally wants to stay out of trouble.

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Sarah - PreparationJames - PrecontemplationSammie - PrecontemplationGracie - Action

� Discuss the answers in the large group. Provide timefor feedback and questions.

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3.4 Applying theStages-of-Changemodel to working

with young people

� Adolescence is a time of great change and risk-taking behaviour that can include someexperimentation with drugs. Remember that there aredifferent patterns of drug use (Schaeffer’s model) andthat young people for the most part fit within theexperimental/ recreational patterns of use. Althoughthe Stages-of-Change model was developed usingadult experiences, it is useful for understandingchange in general. It is probably most relevant forwork with young people with established patterns ofAOD use.

� The youth-focused systems model indicates that ayoung person’s readiness to change may beinfluenced by other factors in the system. Forexample, peers may be pressuring a young person tokeep using or a young person’s family may haveexpressed their lack of confidence in a youngperson’s ability to change. Keep this in mind whenassessing readiness for change.

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3.5 Identifying andresponding to a young

person’s readinessto change

� The Stages-of-Change model is primarily of usewhen dealing with people with established patterns ofAOD use.

� There are a number of ways of determining a youngperson’s stage of change and readiness for action. Itis important to use basic counselling skills includingthe use of open-ended questions, reflective listening,summarising and confirming the young person’sviews. One of the simplest tools for assessingreadiness for change is to ask someone to indicatetheir response on a 10-point scale. (See Tool 1, TheTen Point Change Scale. (Ask learners to refer to thisscale in their Learner’s Workbook.)

� Ask the young person to mark on the scale how theycurrently feel about changing their AOD use. It islikely that the young person will feel differently aboutdifferent drugs so it may be worth using the tool witheach of the drugs they use.

� This approach provides a framework for having astructured conversation with a young person abouttheir drug use.

� Discuss the examples of questions you could use inresponse to the young person’s position on the scalewith the learners. The focus of the conversation is notto convince the young person to change behaviour,but to help them consider the possibility of changeand perhaps move along the stages of change.

� We will explore the use of this tool further in the nexttopic.

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TOOL ONE - THE TEN POINT CHANGE SCALENot Considering Change Thinking About Changing Already Changing

0 1 2 3 4 5 6 7 8 9 10If their mark is

on the left end of the line

Goal for conversation:To encourage the young person to thinkabout the possibility of changingbehaviour. Young people at this end of thescale can appear argumentative or in‘denial’ and the natural tendency is to try to‘convince’ them which usually provokesresistance and can be a roadblock tocommunication.

Some useful questions might be:‘What would have to happen for you todecide that your AOD use is a problem?’‘What warning signs might tell you to startthinking about changing?‘What things may happen if you continueto use …?’‘What have other people said about yourdrug use?’‘How might your use of … have stoppedyou from doing other things you want todo?’‘What are some of the hassles that your…. use may have caused?’

If their mark issomewhere in the middle

Goal for conversation:To encourage the young person toexamine the ‘pros’ and ‘cons’ ofchanging

Some useful questions might be:‘What are some of the reasons you mightlike to make a change to your….. use?’

‘What might be some of the advantages innot using …?’

‘If we were to bump into each other on thestreet in six months time, what do youthink you would you like to tell me aboutyour life at that point?’

If your mark ison the right end of the line

Goal for conversation:To encourage the young people to explorefactors that can support their decision tochange.

Some useful questions will be:‘Pick one of the barriers to change and list somethings that could help you overcome this barrier.’‘Pick one of those things that could help anddecide to do it by …… (write in a specific date).’‘If you’ve taken a serious step in making achange:-‘What made you decide on that particular step?’-‘What has worked in taking this step?’-‘What helped it work?’-‘What could help it work even better?’-‘What else would help?’-‘Can you break that helpful step down intosmaller steps?’‘Pick one of those steps and decide to do it by……. (write in a specific date).’

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Optional exercise – Stage of change

� Recall previous optional exercise where learnersidentified a ‘habit’ and their stage of change.

� For this exercise ask learners to choose where theymight sit on the 0-10 scale. Then in pairs take turnsin asking some useful questions regarding this ‘habit’and consider some appropriate interventions andgoals. Learners should refer to the 1-10 scale forquestions.

� Learners may need to modify their line of questioningaccordingly. For example, if the learner does notexercise at all, some useful questions might be:

‘What things about your life may change if youcontinue not to exercise?’

‘What negative effects on your health has lack ofexercise caused you or could cause you in thefuture?’

‘What are some of the reasons you might want tostart exercising?’

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Starting a conversation about change using theten-point change scale

� The following role-play activity will provide a safeopportunity to practise using the ten-point changescale as a tool for facilitating a conversation aboutthe possibility of change. Remember that this isintended to be a constructive learning opportunityand its success will depend on the way you provide,and take on, feedback.

� Working in groups of three, each participanttakes a turn in the following roles:

� the school counsellor� the young person� the observer

Read the following:

� Role play scenario� Debriefing Sheet� Observer Worksheet� Reflection Sheet

� Allow approx. 10−15 minutes for the role play anda minimum of five minutes for debriefing. Theobserver will manage time and the debriefingprocess.

� If learners are undertaking this task via distancelearning advise them to complete the role play withtheir co-workers. Advise distance learners tocomplete the Debriefing Sheet and the ReflectionSheet and to use the Observation Worksheet as aself-evaluation task if they are unable to find anobserver for the role play.

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Role play scenario

Troy is a 14-year-old male who was recently founddrinking alcohol on school grounds. When confrontedabout it by a teacher, he became extremely argumentativeand aggressive and was suspended as a result. Troy hasa history of getting into trouble at school for missingclasses, failing to complete homework and generalrudeness to teachers. A number of teachers have reportedbeing concerned about Troy’s health and wellbeing, andhave stated that they were sure that they had smelt alcoholon his breath on several different occasions. They havealso noticed a deterioration in his school work as well ashis general demeanour.

Troy has admitted that he has been drinking ‘quite a lot’and sometimes by himself to get away from things.However, he doesn’t see that there is a problem with hisdrinking, and believes that the teachers should mindtheir own business. He doesn’t really see the point inschool because he isn’t doing well anyway although hedid want to at least finish high school.

The school counsellor has been asked to speak withTroy about his alcohol use and the other problemsthat have been arising at school.

The counsellor’s aim is to:

• start a conversation about how Troy feels aboutthe possibility of changing his alcohol use usingthe ten-point change scale as a tool

• determine what stage of change might beconsistent with Troy’s current state

• respond appropriately to Troy’s elected position.

38

Role Play Debriefing Sheet

Those taking the observer role are responsible forfacilitating the debriefing.

1. Ask the person who played ‘the worker’ to state theirresponse to the role play − what they think they didwell and what could be done differently next time.

2. Ask the ‘young person’ to give constructive feedbackto the worker stating how they responded to theirapproach. (What was helpful, and not so helpful,including verbal and non-verbal aspects of worker'sapproach.)

3. Give the worker an opportunity to comment or seekany further feedback (e.g. ‘How was it for you when I……. ?’)

4. Ask the young person and worker role players tostand physically move away from their seatingposition and shake off the role. State their real nameand two qualities about them which are different fromthe role they played.

5. Observers then give constructive feedback to theworker. Finish by restating what strengths the workerdemonstrated.

All group members then identify the key learning pointsof the role play.

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Role Play Observer Worksheet

Starting a conversation about the possibility of changeusing the ten point change scale

Feedback on worker’sresponse to the situation

Yes No Comment

Approached the young person inan appropriate way (e.g.introduced themselves, non-threatening and non-judgemental)

Raised the issue of concern:episodes of being alcohol affected.

(This should be factual focusing onincidents at the school.)

Introduced the ten-point scale ofchange and clearly explained toTroy what was required of him.

Responded appropriately to Troy’selected position on the scale usingat least one open-ended questionto explore why he positionedhimself at that point on the scale.

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Reflection Sheet

Reflect on what you have just learnt and write downyour thoughts to the following questions:

What went well in the role play and whatdidn’t go so well?

What constraints might you come across inthis type of situation at work?

What steps could you take in your workplaceto apply what you have learnt in this topic?

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Distance learners have been advised to make contactwith you, the facilitator, to check their learningprogress.

Lifestyle change is a difficult task. The Stages-of-Change model provides a framework for assessingand working effectively with young people.

Key points about the Stages-of-Change model:

• Change is a process, not a single event

• People may go around the cycle of changemany times before achieving control

• A young person’s resistance may be a signthat the worker has overestimated theirreadiness for change.

The ten-point change scale can be a useful tool forstarting a conversation focusing on how the youngperson feels about the possibility of changing theirAOD using behaviours.

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Topic 4

Motivationalinterviewing

Overview

� In this topic we will be discussing some of thefundamental aspects of motivational interviewing andsome techniques that may be helpful for you in yourwork with young people. It is not, however, acomprehensive course in motivational interviewing asthis requires far more information and skills which arebeyond the scope of this module.

Introduction tomotivationalinterviewing

Working withambivalence in youngpeople

Working withresistance in youngpeople

2 hours

Article “What is motivational interviewing”, (Rollnick & Miller, 1995)

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4.1 Introductionto motivational

interviewing

Issue of motivation

� The issue of motivation is often raised in discussionsabout young people and also in relation to AOD use.

� The main idea of motivational interviewing is topurposefully create a conversation around change,without attempting to convince the person of theneed to change or instructing them about how tochange.

� Motivational interviewing is a therapeutic approachthat was originally developed in the alcohol and otherdrug field by William Miller and Stephen Rollnick(Miller, 1983; Miller & Rollnick, 1991).

� This approach utilises the principles and practices ofclient-centred counselling to encourage the client tomove through the stages of change and to makepersonal choices along the way. Client resistance isviewed as evidence of conflict or ambivalence and ismet with reflection rather than a confrontational style(Rollnick & Miller, 1995).

44

� Ask learners to read the article ‘What is motivationalinterviewing?’ (Rollnick & Miller, 1995) beforeanswering the following questions in their Learner’sWorkbook.

What is motivational interviewing?

Reflect on the points made in the articleunder the subheading ‘The Spirit ofMotivational Interviewing’. How do theseideas compare with your current work withyoung people?

How might motivational interviewing beused in your work with young people?

� Learners to discuss their responses in groups,considering the positives and negatives ofmotivational interviewing in various types oftreatment settings.

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The key principles of motivational interviewing

� The following are the key principles of motivationalinterviewing.

Express empathy� Acceptance facilitates change� Skilful reflection is fundamental� Ambivalence is normal.

Develop discrepancy� Awareness of consequences is important� A discrepancy between present behaviour and

important goals will motivate change.

Avoid argument� Arguments are counterproductive� Defending breeds defensiveness� Resistance is a signal to change strategies� Labelling is unnecessary for change.

Roll with resistance � Momentum can be used to good advantage� Perceptions can be shifted� New perspectives are invited but not imposed.

Support self-efficacy� The belief in the possibility of change is an

important motivator

� The client is responsible for choosing andcarrying out personal change

� Client should present arguments for change.

46

Key principles of motivational interviewing

� Express empathy

� Develop discrepancy

� Avoid argument

� Roll with resistance

� Support self-efficacy.

47

4.2 Working withambivalence

in young people

� One of the underlying premises of motivationalinterviewing is that all behaviour is motivated. Thereis no such thing as ‘unmotivated’ behaviour. Ittherefore assumes that people may be motivated tochange and at the same time have strong motivatorsto stay the same. The more a young person isinvolved with drug use and the associated lifestyleissues the greater the chance they will feel someconflict about making a significant change to theirdrug use and avoid making that change. That is,they may be ambivalent about changing theirpatterns of use. Understanding and working with ayoung person’s ambivalence is a central element ofmotivational interviewing.

� As mentioned earlier, ambivalence is a normal,human condition central to decision-making.

� Provide learners with a comparison (i.e. relationships).

� Working with this ambivalence (rather than ignoring itor denying it) can be one of the keys to assistingyoung people in moving through the change process.

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4.3 Working withresistance in young

peopleResistance in young people

� Resistance in young people can be one of the mostchallenging and frustrating issues to deal with andoften occurs when freedom of choice is beingthreatened. In the Juvenile Justice context, forexample, coercion into treatment can be a clearsource of resistance! Where possible, encourage theyoung person to reflect on the choices they have andinvolve them as much as possible in the decision-making process. Reflection and expression ofempathy can also help the young person to talkabout their loss of choice.

� Key issues in working with resistance:

� The worker’s style can be a powerful determinantof the young person’s resistance and motivationto change

� Argument tends to provoke resistance� Young people may respond to confrontation by

presenting the reasons against change� When resistance is provoked, young people tend

not to change� Resistance may be a message from the young

person that you do not understand them or theirsituation

� Motivation emerges from the interaction betweenthe young person and the worker

� Motivation can be increased by using a variety ofstrategies.

� One of the goals of motivational interviewing is toavoid reinforcing any resistance or reluctance aperson may express. This is known as ‘rolling withresistance’.

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� Reflection can be used to reduce resistance and canalso be employed as a way to work with, rather thanagainst, the energy of resistance.

� Some examples are:

� Simple acknowledgement of the client’sdisagreement, emotion or perception can permitfurther conversation rather than defensiveness.

� Reflecting back what the client has said,exaggerating the point but with a quiet,understated tone. If successful, the client mayback off a bit and might articulate the other side ofthe ambivalence.

� Acknowledge what the client has said and includethe other side of the issue, with the aim ofincreasing ambivalence.

� In relation to AOD issues, resistance is most likely tooccur when there is a mismatching between theclient’s stage of change and the approach beingtaken by the worker.

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Responding to resistance

� Divide the group into small groups. Ask learners toread the following statements from their Learner’sWorkbook and spend some time considering thepossible sources of resistance. Learners are to workin groups and brainstorm two responses to each ofthe following statements.

‘Who are you to tell me what to do? What do youknow about smack? You’ve probably never eventried dope!’

‘I don’t have to talk to you. I’m only here ‘cause Ihave to be!’

‘I couldn’t change even if I wanted to. My fatheralways said I’d be no good.’

‘I don’t use any more than my friends. They aren’tbeing hassled!’

‘The law sucks! Everyone knows that alcoholcauses far more problems than marijuana.Besides, they’re trying to legalise it now.’

‘Things are different now than when you were akid. There’s nothin’ else to do except smokecones!’

The person responds to any question with eithersilence or ‘I dunno’.

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Optional exercise: Presentation/role play

� Ask each group to pick any one of the abovestatements and develop it as a dialogue/casescenario illustrating the worker’s ability to deal withresistance. Allow time for each group to report backto the large group.

Sources of resistance in your work withyoung AOD users

� Ask learners to brainstorm the following exercise.

Why might you encounter resistance as aworker with young people who use AOD?

� Ask learners in groups of three to write down anddiscuss the following issues.

List three examples of resistance that hasarisen in your interactions with youngpeople who use AOD.

1.

2.

3.

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What aspects of your role and the wayyoung people may view it that maycontribute to resistance?

Are there any aspects of your ownwork style that may contribute to clientresistance?

� Each group is then asked to present their answers tothe large group.

• Motivational interviewing is an interventiontechnique that purposefully creates a conversationabout change without attempting to convince theperson of the need to change, or instructing themabout how to change.

• Working with ambivalence, rather than ignoring ordenying it, can assist young people in movingthrough the change process.

• Reflection can be a useful technique to work withresistance.

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Topic 5

Some motivationalinterviewing

techniques forworking withyoung people

Overview

� This topic discusses some relevant motivationaltechniques and looks at the strategy known as‘decisional balancing’. The strategy will help thelearner to explore ambivalence as well as building arapport with a young person. A role-play exercise isused to assist learners in developing these particularskills.

Introduction tomotivationalinterviewingtechniques

Good things/lessgood things

Looking forward/future directions

Worst-case scenario/best-case scenario

2-3 hours

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5.1 Introduction tosome motivational

techniques

� The strategies can be used alone in shortconversations with young people or in combinationwithin more lengthy or in-depth interactions,depending upon the setting in which the worker isplaced.

� The techniques include:

� Pros and cons for making change or stayingthe same (also known as decisional-balancing): a young person is asked to identifysome of the good and less good things aboutmaking change and staying the same

� Looking forward/future directions: a youngperson is asked to consider what life might be likefor them in the future

� Worst-case scenario/best-case scenario: ayoung person is asked to think of what the worstand best-case scenarios might be like for them.

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5.2 Good things/less good things

� This strategy, known as decisional-balancing(Saunders and Wilkinson, 1990) represents the ‘heartand soul’ of motivational interviewing. It is anessential strategy for building and exploringambivalence about current drug use and thepossibility of changing drug use.

� An exploration of the two sides of the young person’ssubstance use serves a number of purposes. Thestrategy:

� helps to build rapport

� helps assess how the young person feels

� assesses readiness for change

� assesses other dimensions (e.g. triggers forrelapse if change were to occur)

� when the good things and less good things arewritten down it provides a visual representation ofthe situation.

� Resistance is minimised when you start with thepositive things about a young person’s substanceuse and then talk about the ‘less good things’, ratherthan start with ‘problems’ or ‘concerns’. This allowsthe young person to identify areas of concern withoutfeeling that these are being labelled as a bigproblem.

� Begin by expressing empathy for the young person’sposition. Try to elicit from the young person thebenefits and costs of their alcohol or drug use. Thisstrategy is a useful way of assessing the stage ofchange and the degree of ambivalence.

� Be careful not to presume that the costs or ‘less goodthings’ related to substance use are a source of greatconcern to the young person.

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Good things and less good things about drug use

� A useful tool for recording the information gatheredduring a discussion of the good things and less goodthings about staying the same or changing(decisional-balancing) is shown below:

Using smoking marijuana as an example,answer the following questions, bycompleting the table.

� What might be some of the positives ofsmoking marijuana?

� What might be some of the negativesassociated with smoking marijuana?

� What might be some of the positives ofnot smoking marijuana?

� What might be some of the negativesassociated with changing marijuanasmoking?

Tool 2: ‘Good things/less good things’ table

Good things Not so good things

Continue druguse

Reduce/stopdrug use

Hint: Consider effect on finance, friendships, relationships,health, work, legal issues etc.

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Optional exercise – Self reflection

� Ask learners to revisit their own ‘habit’ they discussedearlier in Topic 4.

� Once again in pairs ask learners to draw up a‘decisional-balance sheet’ and consider the goodthings and less good things about their ‘habit’.Learners should take this in turn and discuss theirresponses.

� Depending on the group, they could discuss thistogether.

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Reflection

In terms of the Stages-of-Change model,which stage/s do you think this tool might beappropriately used with a young person?Why?

This tool may be useful at the beginning ofconversation with a young person as it can assistin developing rapport and avoids discussing druguse as a ‘problem’. The good/less good thingsstrategy can also be used when young peopleare thinking more about change (in thecontemplative/action phases). You may ask theyoung person to describe the good things abouttheir current (or past) efforts to change and someof the less good things. Remember the goal isalways to facilitate or lead movement to the nextstage of change without forcing the youngperson.

In terms of the ten-point change scale, atwhich end of the spectrum do you think thisstrategy might work best?

This strategy is probably most useful in thelower half of the scale where people are eithernot considering, are beginning to consider orhave tried to make small changes (0-5).

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� Ask learners to complete the following questions inclass or as a take away exercise. Refer them to theirLearner’s Workbook.

In your own work with young people, outlinesome situations in which this tool might beuseful.

What might be some barriers to using thistool with the young people you work with orin your workplace?

What are some strategies that might assistyou in overcoming those barriers?

Optional exercise – Short essay

� Ask learners to write a short 400-600 word essay thatconsiders each of the three questions outlined above.Learners are encouraged to reflect on their ownworkplace experiences and workplace practice.

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Good things/less good things (Decisional-balancing)

� Spend some time with a young person and askfor the following information.

‘What are/were some of the good thingsabout your use of alcohol/drugs?’

‘What are/were some of the not-so-goodthings about your use of alcohol/drug(s)?’

‘What are some of the good things aboutmaking a change to your drinking/drug use?’

‘What are some of the not-so-good thingsabout making a change to yourdrinking/drug use?’

Discuss with the young person what it is like to havethe opportunity to discuss the positives and negativesof using substances and changing substance use.

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5.3 Looking forward/future directions

� Helping a young person to imagine a different futureis another approach to discussing change.

� Some questions that you could use in this strategyare:

� ‘How do you think things might be different for youonce you turn 18?’

� ‘If you were to become a parent, how might yourdrug use fit in with that role?’

� ‘What would be the best possible result that youcould imagine, if you were to make a change?’

� ‘If we were to bump into each other on the streetin six months time, what do you think you wouldyou like to tell me about your life at that point?’

� ‘If you did make a change to your drug use, howwould you like things to turn out?’

Reflection

� Refer learners back to the stages of change model.

In terms of the Stages-of-Change model, inwhich stage/s do you think the looking forwardstrategy might be appropriately used with ayoung person? Why? (Remember the goal isalways to facilitate or lead movement to the nextstage of change if the young person is ready.)

In terms of the ten-point change scale, atwhat point on the scale do you think thisstrategy might work best?

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5.4 Worst-case scenario/best-case scenario

� It can be useful to ask young people to consider‘worst-case’ and ‘best-case’ scenarios in response tochange.

� Some questions that you could use in this strategyare:

� ‘If you were to stop using heroin, what do youimagine would be the worst things that couldpossibly happen?’

� ‘If you were to keep using heroin, what do youimagine would be the best things that couldpossibly happen?’

� These questions could be varied to include the‘worst-case’ and ‘best-case’ imaginings aroundchange and staying the same.

� Ask learners to again recall the stages of changemodel.

In terms of the Stages-of-Change model, inwhich stage/s do you think the best-casestrategies might be appropriately used witha young person? Why? (Remember the goalis always to facilitate or lead movement to thenext stage of change if the young person isready.)

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Continuing a conversation about change usingsome motivational interviewing techniques

� Refer learners to their Learner’s Workbook andparticipate in the following role play.

� The following role-play activity builds on the previousrole-play with Troy. It will provide you with anopportunity to practise using the three motivationalinterviewing techniques (good/less good things,looking forward/future directions and worst-casescenario/best-case scenario) for facilitating aconversation about the possibility of change.Remember, this is intended to be a constructivelearning opportunity and its success will depend onthe way you provide and take on feedback.



� Read the following:

� Role play scenario� Debriefing sheet� Observer worksheet� Reflection sheet.

� Allow approximately 15-20 minutes for each roleplay including the debriefing. Allow time for rolechangeover. The Observer will manage time andthe debriefing process.

� If learners are undertaking this task via distancelearning advise them to complete the role playwith their co-workers. Advise distance learners tocomplete the Debriefing Sheet and the ReflectionSheet and to use the Observation Worksheet as aself-evaluation task if they are unable to find anObserver for the role play.

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Role play scenario

Troy (the 14-year-old male from the previous scenario)has admitted that he has been drinking quite a lot,sometimes by himself, to ‘get away from things’.However, he doesn’t see that there is a problem with hisdrinking and believes that the teachers should mind theirown business. He doesn’t really see the point in schoolbecause he isn’t doing well anyway although he did wantto at least finish high school.

Troy says that he sometimes thinks about changing hisdrinking behaviour, but then things ‘get on top’ of himand he tends to have a strong urge to drink more oftenwhich he says makes him feel better. He also likeshaving a good time drinking with his mates. He rateshimself as being somewhere between 3 and 4 on thescale and seems to be ambivalent about change at thistime.

The school counsellor who has been speaking withTroy about his alcohol use and the other problemsthat have been arising at school.

The counsellor’s aim is to:

� determine what stage of change might beconsistent with Troy’s current state

� respond to Troy’s elected position on the scaleappropriately

� respond appropriately to ambivalence

� roll with any resistance from Troy (e.g. usingreflection)

� use one or more of the techniques outlined toprovide Troy with an opportunity to explore someof the pros and cons of changing.

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6. Ask the person who played ‘the worker’ to state theirresponse to the role play − what they think they didwell and what could be done differently next time.

7. Ask the ‘young person’ to give constructive feedbackto the worker stating how they responded to theirapproach. (What was helpful, and not so helpful,including verbal and non-verbal aspects of worker'sapproach.)

8. Give the worker an opportunity to comment or seekany further feedback (e.g. ‘How was it for you whenI ……. ?’)

9. Ask the young person and worker role players tostand physically move away from their seatingposition and shake off the role. State their real nameand two qualities about them which are different fromthe role they played.



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Starting a conversation about the possibilityof change using the ten point change scale

Provide feedback on worker’s response

to the situationComment

Communicated in a non-threatening and non-judgementalmanner

Dealt with any resistance fromTroy by responding empathicallyand using reflection wherenecessary

Approached Troy’s apparentambivalence appropriately

Used one or more of thetechniques described to continuethe conversation about thepossibility of change with Troy:� Good things/less good things� Looking forward/future

directions� Worst-case scenario/best-case

scenario

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Reflection Sheet

Reflect on what you have just learnt and write down yourthoughts to the following questions:

What went well in the role play and whatdidn’t go so well?

What would be some constraints that youmay come across in this type of situation atwork?

What steps might you take in yourworkplace to apply what you have learnt inthis topic?

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Distance learners have been advised to make contactwith you, the facilitator, to check their learningprogress.

Motivational interviewing:

• is one way to work with some people, some ofthe time, in some situations

• is an approach that aims to work with people attheir own pace, and addresses the need forchange

• uses a quiet, eliciting style rather than directiveapproach

• has application in both specialist AOD andother settings

• is useful in brief interventions.

Some useful motivational interviewing techniquesfor working with young people include:

• good/less good things

• looking forward/future directions

• worst-case/best-case scenarios.

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Topic 6

Briefinterventions

Overview

� This topic considers a range of brief interventionsavailable to workers and young people. A cleardefinition of the term ‘brief intervention’ is providedand a close look at when, where and how a briefintervention can occur is discussed. Learners willhave the opportunity to practise a brief intervention inthe form of a role play and provide constructivefeedback.

Working with Intoxicated Young PeopleHelping Young People identify their needs

Brief interventions –a definition

Range of briefinterventions

How to carry outbrief interventions

Counterproductiveassumptions

Applyingbrief interventions

www.nt.gov.au/health

2 hours

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6.1 Brief interventions– a definition

� Most frontline workers will be familiar with ‘briefintervention’ as an approach for working with youngpeople. By ‘brief intervention’ we mean implementingan intervention that takes very little time. Briefinterventions are usually conducted in a one-on-onesituation and can be implemented anywhere on theintervention continuum.

� Brief interventions recognise that many people canbenefit from being given appropriate information atthe right time. This option can work particularly wellfor young people as they are less likely to engage inongoing counselling sessions.

� Brief interventions are therefore a much less‘traditional’ form of intervention option and can be auseful tool for working with young people, who maybe impulsive and erratic in their decision-making. Thefocus of many brief interventions is harm reductionand safer drug use.

� It involves making the most of an opportunity to raiseawareness, share knowledge and get a youngperson thinking about making changes to improvetheir health and behaviours. The intervention can bebrief and ‘opportunistic’, lasting as little as 30seconds, or extending over a few sessions lasting 5-60 minutes. Brief interventions often consist ofinformal counselling and information on certain typesof harms and risks associated with drug use and/orrisky behaviours.

� The aims of brief intervention are to:

� engage with those young people not yet ready forchange

� increase the young person’s perception of real andpotential risks and problems associated with AODuse and associated practices.

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� encourage change by helping the young person toconsider the reasons for change and the risks ofnot changing.

� Brief interventions utilise many of the skills alreadycovered in this module such as motivationalinterviewing, problem solving, decisional-balancingand goal setting and requires an understanding of theprocess of change.

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6.2 Range of briefinterventions

� Brief interventions can take many forms and canoccur in a variety of settings. Examples of briefinterventions include:

� Informal discussions around drug use in a youthdrop-in centre

� Telephone services such as Kids Helpline

� One-to-one counselling opportunities in the contextof a youth program (e.g. during assessment, orwhen a young person seeks advice about AODissues)

� Self-help manuals or workbooks provided by aschool counsellor or youth worker

� AOD education in a group setting in a JuvenileJustice centre.

� Computer-based or on-line quizzes andquestionnairesaround drugs and drug use

� School-based peer-intervention programs

� Provision of harm reduction information in generalpractice or hospital accident and emergencysettings.

� Ask learners to think of more brief interventionexamples, specific to their workplace.

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When to carry out brief interventions

Brief interventions can take place almost anywhere andanytime. Take some time to reflect on your own workpractice and think about when and where briefinterventions have occurred whilst working with youngpeople.

Are there times when it may not beappropriate to undertake a brief intervention?

� When the person does not wish to engage inconversation and becomes visibly distressedor angry by your questioning

� When a person is in a highly emotional state

� When a person is extremely intoxicated andwill gain little benefit from any conversationor intervention until they begin to sober up

� When a person is on medication that ismood/mind altering (i.e. methadone or someanti-psychotics).

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Optional exercise – Brief intervention example

� Ask learners in small groups to recall a workplacescenario where a brief intervention occurred.

Prepare a case study example recalling aworkplace scenario where a briefintervention occurred and include thefollowing information (ensuring all namesremain confidential.)

1. When did the brief intervention takeplace?

2. Where did it take place? Provide a briefoverview of the environment, location, ifany others were involved.

3. What was the goal of the intervention?

4. How was the brief interventionconducted? What strategies did you use?

� Were any harm minimisation strategiesdiscussed?

� Were any referrals made?� Was another time arranged to meet with

the young person to discuss issuesfurther?

� How long did the intervention take?

5. What would you do differently?

� Each group to present back to the large group.

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6.3 How to carry outbrief interventions

� Brief interventions require good communication skills.It is therefore important that you:

� Assess the situation first. Is the environment safeor hostile?

� Assess the young person’s level of intoxication orlevel of attention

� Listen to what a young person has to say� Notice what they haven’t said or what they do not

wish to talk about� Observe how they react� Empathise with them and their situation� Consider what you may already know about them� Talk in a non-threatening manner� Avoid lecturing.

� At the very least, brief interventions will ensure thatthe young person will go away with some information,advice and point of contact or referral for ongoingsupport and/or information.

� A worker must determine whether or not a briefintervention is appropriate at that particular time.

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� Refer learners to their Learner’s Workbook for thisrole play.

� This role play provides you with an opportunity topractise your skills in brief intervention. Rememberthat this is a constructive learning opportunity and itssuccess will depend on the way you provide, andtake on, the feedback.



� Read the following:

� Role play scenario� Debriefing Sheet� Observer Worksheet� Reflection Sheet

� Allow approximately 15-20 minutes for each roleplay including the debriefing. Allow time for rolechangeover. The observer will manage time andthe debriefing process.

� If learners are undertaking this task via distancelearning advise them to complete the role playwith their co-workers. Advise distance learners tocomplete the Debriefing Sheet and the ReflectionSheet and to use the Observation Worksheet as aself-evaluation task if they are unable to find anObserver for the role play.

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Role play scenario

Matt is a 16-year-old male in Year 11 at school. Hisparents have recently called the school counsellor,concerned because he is drinking large amounts ofalcohol on weekends with his friends. More recently hehas begun arriving home early on Sunday morning (aftera Saturday night out) extremely intoxicated, to the pointwhere he vomits and has difficulty speaking or evenwalking.

A few weeks ago, Matt arrived home later than usual(minus his eyebrows because they were shaved off byhis mates after he had ‘passed out’ after drinking toomuch), and talked about using marijuana. AlthoughMatt’s parents accept ‘heavy drinking’ as a relativelynormal part of growing up, they are concerned thatMatt’s drinking is becoming more frequent and he is nowusing an illicit drug. They also suspect that he may beusing other substances as well. Whenever they havetried to discuss their concerns with Matt, or impose limitson his going out, he becomes extremely agitated andtells his parents that they don’t understand and that theyare being over-protective. Matt believes that he is justdoing what his mates do, and that there is nothing wrongwith his behaviour.

The school has noticed no recent decline in his grades.Although Matt has never been a top student, he hasconsistently obtained B/C grades and has alwaysplanned on going to university to study business.Indeed, as long as his current grades are maintained, hemay achieve this goal (although in order to do so it isimportant that his grades do not fall).

The school counsellor undertakes a brief interventionwith Matt.

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1. Ask the person who role-played ‘the worker’ to statewhat they felt they did well and what could be donedifferently next time.

2. Ask the young person (role player) to giveconstructive feedback [to the worker stating what washelpful, and not so helpful, including verbal and non-verbal aspects of worker's approach.

3. Give the worker an opportunity to comment or seekany further feedback (e.g. ‘How was it for you whenI ……. ?’)

4. Ask the young person and worker role players tostand physically move away from the role's seatingposition and shake off the role. State their real nameand two qualities about them which are different fromthe role they played.



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Brief intervention

Feedback on school counsellor’sinitial response to young person Comment

Maintained communication with theyoung person in an appropriate way,(non-threatening and non-judgemental manner, used open-ended questioning)

Checked to see if it is an appropriatetime to conduct a brief intervention,bearing in mind confidentialityissues and ethical conduct?

Identified the young person’s stageof change and respondedappropriately

Provided relevant information toyoung person regarding drug useand/or harm reduction strategiesand information for referrals toappropriate agencies and/ortreatment services

Provided the young person withrelevant information regardinghealth risks of drug use

Communicated clearly and calmly atall times

Explained to the young person whattheir options are, and discussedtheir choices, needs, safety

Explored possible risk andprotective factors outlined in theyouth-focused systems model

Provided the young person withrelevant information regardinghealth risks of drug use

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Reflection Sheet

Reflect on what you have just learnt and write downyour thoughts to the following questions:

What went well in the role play?

What didn’t go so well?

What would you do differently next time?

What constraints might you come across inthis type of situation at work?

What steps might you take in yourworkplace to apply what you have learnt inthis topic?

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6.4 Counterproductiveassumptions

� Rollnick and Mason (1995) identified someassumptions that health, welfare and other workerscan make when working with people with alcoholand/or other drug problems, particularly in briefcontacts. These also apply to work with youngpeople. The following ‘dangerous’ assumptions areNOT wrong, but can negatively impact on briefinterventions.

� This person ought to make a change

� This person wants to make a change

� This person’s health is a prime motivating factorfor change

� If the person decides not to change, theintervention has failed

� People are either motivated to change or not

� Now is the right time to consider change

� A tough approach is most effective

� I’m the expert. He or she must follow my advice.

� The following could be a whiteboard exercise.

Describe some negative assumptions madein your workplace? How do these affect yourwork?

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6.5 Applyingbrief interventions

� Ask learners to reflect on any brief interventions thatthey currently use in their work with young peoplewho are using alcohol and/or other drugs. Refer themto their Learner’s Workbook for this exercise.

� They could answer these questions individually, insmall groups or as a whiteboard exercise.

Are there areas or skills you would like toimprove? If so, what are they?

If you are not currently using any briefinterventions, can you think of anyopportunities or situations where you mightbe able to introduce them in your work?

� Remind learners to identify a specific situation atwork where they can practise implementing briefinterventions. They should read over their notesagain before applying this learning.

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� Learners should reflect on the following after workingwith a young person on harm reduction. (This activitycan be done as a take away exercise.)

What worked well?

What didn’t work so well?

What would you do differently next time?

Brief interventions:

• Don’t require ongoing formal counsellingsessions

• make the most of small opportunities

• can occur at any time in your work with youngpeople

• can provide information quickly when it’s mostneeded

• can increase a young person’s acceptance ofinformation.

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Topic 7

Working withyoung people to

determine aplan of action

Overview

� Brief interventions and other opportunities andconversations can help you establish a rapport with ayoung person.

� Once you have established a rapport and gainedenough information about the young person, the nextstep often entails a plan of action and goal-setting.This topic provides a brief overview of some basicsteps towards negotiating a plan of action anddiscusses relevant problem-solving strategies.

� Each of these steps could entail the use of brief andopportunistic discussion.

Negotiating a planof action usingproblem-solving andgoal-setting skills

Problem-solving andsetting-goals

1½ hours

Jarvis, T., Tebbutt, J. & Mattick, R. (1995).

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7.1 Negotiatinga plan of action

using problem-solvingand goal-setting skills

� When working with young people through theprocess of change it is important to help set realisticand achievable goals.

Goal-setting skills

� Encouraging young people to set goals and to worktowards achieving them can be an important part ofthe process of changing AOD use. Workers mustremember that as young people are spontaneousand still going through major developmental changes,their goals can change dramatically from day to day.Do not assume that you know what is best for theyoung person. Allowing young people to explore theirown identities and goals is often a crucial part of theprocess in negotiating a plan of action.

� In order to plan ‘action’, a goal must be pictured. Ayoung person may be side-tracked very easily if thereis no clear vision, purpose and ownership of the planof action.

Beginning the process

� Goals are related to a person’s values, beliefs anddreams. For a young person to see a need to setgoals, it is important to elicit their current beliefs andvalues as well as their future hopes and plans.

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� Questions that may assist the process can include:

� The last question is helpful to possibly identifydiscrepancy and elicit self-motivational statements.

� It can also be useful to explain that goals can be short-term or long-term. Short-term goals are things that youcan achieve in a day, a week or a month. Encouraging ayoung person to start with small goals, such as gettingout of bed at a particular time, or joining a sports teamcan enhance the likelihood of success.

� Setting small steps will empower a young person. Thesteps can be as simple as attending a treatment session.If young people are achieving small goals they will bemore likely to aim for and achieve longer-term goals. It isimportant for them to be able to see progress. Youshould commend them for talking with you.

� If a young person is unsure of what they want toachieve, ask them to take some time to think about itand write down a list of goals on a piece of paper.Stipulate that these goals can be as wildly ambitiousor as modest as they like. When they have writtendown their goals it is a good idea to discuss with themwhich ones they believe they are most likely toachieve in the short term, then identify which goalsthey believe are most likely to be achieved in thelonger term.

� What sorts of things are important to you?

� What is the one most important thing in your life,that you would miss the most?

� What sort of person would you like to be?

� If things worked out in the best possible way foryou, what would you be doing in one year fromnow?

� What are some of the good things your friendsand family say about you?

How does your drug use (or you as a drug user)fit in with your plans for the future?

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Using the SMART approach

� Using the acronym SMART (Specific, Meaningful,Assessable, Realistic, Timed) can assist you to helpto set concrete and achievable goals.

� Ask learners to read the following definitions to theSMART acronym in their Learner’s Workbook. Oncethey have finished ask them for their feedback.

� Specific – Goals that are vague or unclear arehard to reach. Specific targets need to be reached,thus creating a greater sense of achievement.Examples of vague goals might be ‘I want to get fit’or ‘I want to smoke less dope’. While fitness canbe a desirable goal, this is often vague and difficultto assess when it is achieved. A more specific goalmight be ‘I want to go to a gym for one hour threetimes a week’ or ‘I want to stop smoking conesduring the week. I will only smoke cones on theweekend’.

� Meaningful – Since the young person is the onewho has to put in the hard work, change may takea great deal of personal effort. It is obviouslyimportant that goals are of personal relevance.While goals may involve other people, they needto fit closely with a young person’s values, beliefsand personal desires.

SMART

SpecificMeaningfulAssessableRealisticTimed

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� Assessable – In order for the young person tocontinue to change, it is important that they cansee when a set goal has been achieved. Making agoal assessable means that it is also flexible if it isnot reached. Stipulating a time frame forachievement as well as setting specific short-termgoals can make the goal more assessable.

� Realistic – People involved in the process ofmaking a significant change may have highexpectations of what they can achieve. Significantothers may also have high expectations of theoutcomes. Setting unachievable goals may set theyoung person up for a sense of failure with thepossibility that they may give up on the process.An example of an unrealistic goal might be ‘I’mgoing to buy a sports car for my next birthday’.This may be unrealistic if the young person doesnot have any savings or a job. While it is importantto have long-term desires and goals, settingsmaller milestones is more realistic and less proneto failure. A realistic goal might be ‘I am going togo to get a job by the end of the month. I plan tosave $20 a week’.

� Timed – Goals need to have a timeframe attachedto them. It is said that for younger people ‘Goalsare dreams with a deadline!’ In order to assessgoals, it is important to set a date for review, forexample their next birthday, the next holiday or bythe end of the year. Setting a timeframe for goalsalso increases the possibility of success andallows for revision.

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Questions that may assist with setting goalswithin the SMART framework can include:

Make a list of goals for the day.

Make a list of goals for this week.

Make a list of goals for this month.

Make a list of goals for your year.

Make a list of goals for five years.

What will be your next (first) step now?

What will you do in the next one or two days(week)?

Have you ever done any of these things beforeto achieve this? What will you need to do torepeat these things?

Who will be helping and supporting you?

On a scale of 1 to 10, what are the chances thatyou will achieve your next step? (Be hesitantabout accepting anything under a 7. The initialgoal or next step may need to be moreachievable).

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Practising goal-setting

� Ask learners to complete this exercise as a takeaway activity in their own time. Refer them to theLearner’s Workbook.

Select a young person to work with for this exercise.If necessary, choose a young person from yourfamily or your community.

Using the key ideas discussed above, spend 15minutes assisting the young person to set oneshort-term and one longer-term goal.

When you have finished, reflect on the usefulness ofthe process.

Did the young person find the exerciseuseful?

Do you think the young person will followthrough on the goals set? If so, why? If not,why not?

What particular factors might need to betaken into consideration when assistingyoung people with goal-setting?

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Optional exercise – Case Study (cont’d)

� Ask learners to go back to Topic 5.4 and re-read thecase study on Troy.

� In pairs discuss various ideas for setting short andlong-term goals for Troy. Write out a script thatdepicts how a worker would interact with Troy andhow Troy may respond to goal-setting. Ensure thatthe SMART approach is utilised throughout the script,together with any other appropriate assessmenttools.

� Learners can then role-play their scenario in front ofthe group.

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7.2 Problem-solvingand setting goals

� Problem-solving techniques are an essential part ofworking with young people with AOD-relatedconcerns. While such techniques may often be usedto assist a young person to take action with regard totheir drug use, problem-solving approaches can alsobe applied in the reduction of drug-related harm. Forproblem-solving techniques to be of value, the youngperson has to have some level of concern about theperceived problem. The stage of readiness for changewill have an impact on the timing and approach aworker might take in regard to using problem-solvingstrategies.

� Ask learners to discuss in groups the followingperspectives.

Problems – What problems?

Drawing on the information presented earlierin this module, what are some of the factorsthat workers need to be aware of when usinga problem-solving approach with youngpeople in the AOD context?

Problem-solving styles

� Young people vary in the manner in which theyapproach problems and make decisions. They mayhave good decision-making (coping mechanisms)styles that may sometimes be helpful, yet at othertimes be potentially harmful.

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� Problem-solving approaches can be influenced by arange of factors such as young person’sdevelopmental stage, the example set by parents orsignificant others and personal beliefs. AOD use canalso influence a person’s problem-solving ability. Forexample, if a young person is intoxicated, cleardecisions are less likely. As well, if a young person isdependent upon a substance, it is possible that theirdecision-making style will be more compulsive.

� Workers can assist young people with their problemsolving by helping them to identify their style ofdecision-making and by exploring their strengths anddeficits. Past experiences of problems faced,decisions made and the consequences can also beexplored.

Problem-solving training

� Assisting a young person to develop problem-solvingstrategies is central to working with them through theprocess of change. Problem-solving training is animportant part of the process.

Problem-solving training aims to help the youngperson to:

� recognise when a problem exists

� generate a range of possible solutions

� decide on the most appropriate option anddetermine a plan for enacting it

� evaluate the effectiveness of the selected option.

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Problem-solving worksheet

� A useful tool for working with clients through theprocess of problem solving and decision-making hasbeen developed by Jarvis, Tebbutt and Mattick. It canalso be used for young people to work through ontheir own.

Example 1: Problem-solving worksheet

Stage 1: My problem is:I smoke dope because it makes me feel good and I have moreconfidence when I socialise with my mates! Mum and Dad are reallygetting on my back lately because they think that I am not doing sowell at school and that I spend too much time in my room smokingand not enough time doing school work. It’s fun to hang out with mymates and smoke.

Stage 2: Brainstorm possible solutions:- Join a sports team or start a sports team with mates- See if your mates can come over and study with you- Hang out with your mates less during the week and see them on

the weekends- Get a tutor to help with your study- Cut down on your smoking during the week- Fail school- Get Mum or Dad to help you with your study- Study out in the kitchen- Try and smoke less on social occasions

Stage 3: Pros and cons of each solution:

Possible Solution Pros ConsStudy with mates Get work done together End up doing nothing

Fail at school Continue to smoke Get left behind

Join a sports team Hang out with mates Don’t get to smoke

…. And the choices are:Join a sports team and study with mates

Stage 4: What’s my plan?

How? Find out times and days of sports, organisestudy days

When? Start on Monday after the weekendWhere? At school and at homeWith whom? Friends from school

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Example 2: Problem-solving worksheet

Stage 1: My problem is:

When I smoke dope I end up doing nothing. But smoking dopehelps me to sleep. If I don’t smoke late at night I can’t get to sleepat all. Then I want to sleep all day.

Stage 2: Brainstorm possible solutions:

- Stay awake all night- Watch TV until I fall asleep- Have a hot bath- Drink Milo and hot milk- Force myself to stay awake all day- Read a boring book- Take sleeping tablets

Stage 3: Pros and cons of each solution:

Possible solution Pros ConsStay awake all night Will eventually Will give up

get tired and smokeWatch TV Something to do Could keep

me awakeHave a hot bath Relaxing Boring

…. And the choices are:

Have hot baths and drink Milo and hot milk

Stage 4: What’s my plan?How? Get mum to buy some stuff for the bath and some

MiloWhen? Start on Sunday night after the weekendWhere? At homeWith whom? Tell mum what I’m going to do

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Optional exercise – problem solving (habit)

� Ask learners to once again use their ‘habit’ as anexample for working through the ‘problem solvingworksheet’.

� In pairs ask learners to apply the worksheet to theirhabit, once again taking it in turns to problem-solve.

Applying problem-solving skills

Ask learners to use the example of ‘Joe’ to develop aproblem-solving worksheet. They should refer to theirLearner’s Workbook for the problem-solving worksheetexample and case study.

Write down key questions and statements used toget responses from Joe to get him involved in theprocess.

JOE

Joe is a 14-year-old boy who has been caught smokingmarijuana at school for the second time. He is beingthreatened with exclusion from school unless he agreesto see the AOD counsellor. Joe only smokes marijuanawhen he is with Peter and Fran as they are his goodfriends. Joe’s parents have demanded that he not seethose friends any more and have told him he will be sentto a boy’s-only boarding school if he is expelled from hiscurrent school.

• Assisting a young person to set realistic andreachable goals can be an important step in theprocess of taking action for change.

• Once it is clear what a young person aims toachieve by making a change, concrete help withproblem solving and decision-making can benecessary.

• Setting goals, solving problems and makingdecisions are all part of the process of change.

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Topic 8

Relapseprevention/

management

Overview

� The stages of change do not always progress in neatorder. For a range of reasons young people mayrevert to activities they previously decided to avoid.

� Relapse prevention and management can be anintegral part of working with young people and is afocus from the outset of intervention. To preventrelapse and modify drug use the young person canbe assisted to identify high risk situations, alternativeactivities, and develop skills to avoid and curtaillapses.

15 mins

Relapseprevention/management

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8.1 Relapse prevention/management

� Relapse is common in any attempt to changebehaviour, not just AOD-related behaviour (e.g.reducing coffee intake, quitting smoking or eventrying to start and maintain an exercise routine, etc).

� Relapse prevention/management should be anintegral part of an entire intervention and play a majorrole in working with young people.

� Learners should already be familiar with the Stages-of-Change model and the concept of relapse. Thefollowing exercise is intended to reinforce thatlearning.

� Ask learners to discuss in small groups what theythink relapse, relapse prevention and relapsemanagement mean. Clarify where necessary(Learner’s Workbook is a source of information forthis discussion). Learners to report to the largegroup.

� Outline the essential ingredients of relapse (lapse)prevention.

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Relapse (lapse) prevention and management

A work situation

� Ask learners to recall a young person they are workingwith and in point form jot down their issues andcharacteristics. They should choose a particular situationor issue that they may have raised and, from the rangeof strategies above, draw up a plan to deal with it.

� Then ask learners to ‘role play’ that young person,being interviewed by another learner. Ask them tochoose a particular situation faced by that youngperson and develop a strategy to deal with it byre-establishing their resolve, then aim to learn fromthe ‘lapse’.

The essential ingredients of relapse (lapse) preventionand management include:

� Acknowledging that a lapse is a normal experienceand not be viewed negatively

� Strengthening the motivation to change throughoutthe change process

� Identifying high-risk situations� Developing coping strategies and skills to avoid

high-risk situations and to deal with them whenthey are unavoidable

� Developing coping strategies and skills to deal withlapses

� Recognising and implementing changes to theclient's environment and lifestyle to minimise thefrequency of high-risk situations and to strengthencommitment to change.

� Positive self-talk: the young person can be helpedto develop a phrase or two to repeat to themselveswhen tempted to use (or go beyond their limit)

� Problem-solving skills� Relaxation skills� Anger and depression management� Coping with craving� Identifying the build-up to relapse.

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Motivational interviews and relapse drills

� Strategies that are helpful in the management ofrelapse can include relapse drills and motivationalinterviewing discussed in the Learner’s Workbook.

� When a young person continues to revert to drug-using behaviour it is advised that they be referred toa specialist alcohol and other drug worker.

� Ask learners to review the problem-solving worksheet in the previous topic and note how the youngperson is asked to identify a different situation, and toprepare in advance to deal with it.

Maintaining changeLong-term maintenance of change often requiressignificant changes to a young person’s' lifestyle,such as:� establishing social contacts that are not AOD

centred (new friendships/ peer group)� establishing new leisure activities and hobbies

that are not AOD centred� living in a new place if needing to avoid a

familiar group of heavy users� working in a new location to avoid heavy drug

using scenes.

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Topic 9

Summary and conclusion

� At this point you should reflect with the learners ontheir learning experience and together assesswhether the following learning outcomes have beenmet:

Identify AOD interventions suitable for workingwith young people

Apply the ‘Stages-of-Change’ model andmotivational interviewing to work with youngpeople

Implement strategies for working withresistance and ambivalence with young people

Demonstrate skills in harm minimisation, andbrief and early interventions with young people.

Apply relapse prevention and managementstrategies.

1 hour

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9.2 Summary ofcontents

� This module has focused on strategies for workingeffectively with young people with alcohol and otherdrug concerns. The usefulness of brief interventions,particularly in non-AOD settings was explored. Arange of brief intervention techniques was introducedwith a focus on when brief interventions may or maynot be appropriate.

� The Stages-of-Change model was introduced whichfocuses on matching the young person’s readiness forchange to different strategies. Methods for measuringreadiness were provided.

� The principles and practice of motivationalinterviewing were outlined as an approach that hasbeen proven to be effective for engaging youngpeople in the process of change. Strategies forworking with ambivalence and for encouragingchange conversation were introduced. As well,approaches for working with any resistance that mightarise when working with young people werediscussed.

� The place of goal-setting and problem-solving in thechange process was discussed. Questions for elicitinggoals were introduced as well as a framework forassisting young people to set achievable goals.Problem-solving and decision-making styles wereraised. Techniques for increasing problem-solvingskills in young people were addressed.

� Finally it was noted that young people do not progresssmoothly through change. The worker must assist theyoung person to learn from past lapses and to setgoals to manage future ones.

� Remember, continued relapses means you shouldrefer the young person to a specialist.

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� It is important to remember when working with youngpeople with AOD issues that some things work forsome people some of the time in some situations.Finally, it may also be useful to remember thatchange is a journey, not a single event. Assistingyoung people early in the journey increases theirchances of reaching their destination.

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9.3 Self-reflectionactivity

� Ask learners to take time to reflect on what they havegained from this module and complete the followingquestions. Allow time for feedback and discussion.

What aspect of this module do you feel ismost relevant and useful in your workpractice?

What kinds of issues has this module raisedfor you in your work?

Have you identified any further learningneeds as a result of completing thismodule?

If so, what are some ways you can achievethese learning needs?

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Assessments

Overview

� The suggested assessment events for this modulehave been mapped to the unit of competenceCHCYTH1A and correspond with the learningoutcomes listed at the beginning of this module,Working with Young People on AOD Issues. Overthe course of this program learners could be requiredto complete one of the following assessments:

Event 1: Client case study

Part A – Identifying needs

� Demonstrate your knowledge and skills in thefollowing key areas:

� Brief interventions

� Assisting young people to identify at which stageof change they are at

� Identifying and prioritising strategies to respond totheir identified needs

� Recognise how family goals and peer networkscan influence/assist drug use behaviours

� Harm minimisation strategies.

For this assessment you may use a young person thatyou have worked with or you may use the case scenarioprovided. If using a client you have worked withremember to respect and maintain their confidentiality.

Provide a brief case history of the young person. Includeinformation on their age, sex and drugs used. (If usingthe case scenario you may develop the case further, asnecessary to answer all the questions.)

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Complete the following questions. Answers to eachquestion will be approximately 50-100 words long.Alternatively, this material could be presented to agroup.

1. Describe how, when and where you could conducta brief intervention with a young person. Provide acouple of examples

2. Identify the young person’s stage of ‘readiness tochange’. How did you determine this stage? Whichmethod did you use?

3. Outline the general areas of the young person’ssituation that you collected information on. Brieflydescribe why these areas are important in yourwork with the young person

4. Describe how you introduced the topic of alcoholand/or other drug use with the young person. Whatspecific questions did you ask to get an accuratepicture of their alcohol and/or other drug use? Didyou meet with any resistance? How did you dealwith these roadblocks?

5. Describe the process you used to set and negotiategoals. Give your reasons for establishing thesegoals.

Part B – Responding to needs

Demonstrate your knowledge and skills in the followingareas:

� Responding to the needs of young people

� Implementing harm reduction

� Referring clients.

Refer to the same young person used for Part A.Remember to respect and maintain their confidentiality.If using the case scenario you may develop the casefurther, as necessary, to answer all the questions.

Complete the following questions. Answers to eachquestion will be approximately 50-100 words long.

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Alternatively, the learner may present the answers to asmall group.

1. Describe the family and friendship networks for theyoung person. In what ways could these networkshelp or influence the young person cut down theirdrug use?

2. What harm minimisation strategies are useful for thisperson and why? Outline how you negotiated and/oreducated the young person about harm reduction.Provide example examples where possible.

Case scenario

Jessie is a 15-year-old female who has a history ofbinge drinking. She also uses ecstasy andbenzodiazepines occasionally. She is still at schoolalthough she increasingly does not attend and as aresult she is having a lot of difficulties with her schoolwork. She is part of a group of girls at school who usealcohol and drugs in similar ways. As these girls are heronly friends at school it is important for her to remainpart of this group.

Jessie lives at home with her mother and stepfather andher two half sisters aged 2 and 4 years. She argues a lotwith her mother and feels that her mother has no time forher. She has a distant relationship with her stepfatherand feels that he prefers her not be around. She has nocontact with her father. Jesse is unhappy with her familyand school life but does not see her drug use as aproblem.

Assessment criteria

The following key areas are to assist you and thelearners in providing a guide for marking the assessmentfor this particular unit:

� Demonstrates ability to apply relevant assessmenttechniques with regard to the case study andaddresses key areas outlined in parts A and B

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� Demonstrates knowledge of relevant assessmenttechniques that assist young people in recognisingAOD issues and problematic behaviours andknowledge of current harm minimisation practices ina workplace context

� Demonstrates ability to identify appropriate methodsand techniques for problem solving and goal settingwith young people on AOD issues in a theoreticalcontext

OR

Event 2: Interventions - Audio Tape

Demonstrate a brief intervention either by focusing on‘good things/less good things’ about drug use or byproviding information about drug use.

� For this assessment select one of the case scenariosbelow OR write a case scenario related to yourworkplace.

� Find a colleague or friend who is willing to play the‘client’ for the role-play. It is preferable that you don’tuse a ‘real’ client for the purposes of thisassessment.

� Write a script for the scenario and ask the ‘client’ toanswer your questions in response to the ‘goodthings/less good things’ strategy. Record the sessionon audio tape. The session should be no longer than10 to 15 minutes in length.

� Review the recording of the brief intervention. Write a300-word critique of the session, focussing on thetechniques and skills you used. What do you thinkworked well? What do you feel you could improveon? Ask the person who played the ‘client’ to provideyou with some feedback to assist you in writing yourown critique.

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SCENARIO 1: PETER

Peter is a Year 10 student who has been caughtsmoking marijuana for the second time. Following a one-week suspension, Peter has been allowed to come backto school on the proviso that he attends counselling withthe school counsellor once a week.

Peter knows that if he is caught smoking marijuanaagain he will probably be expelled. In fact, he wasthreatened with exclusion after the most recent incidentbut pleaded with the school principal to be given anotherchance. He really wants to at least pass the schoolcertificate.

At the same time, Peter has formed close friendshipswith a group of boys who smoke dope. A couple of olderboys have already left school and are on the dole. Peterreally values the mateship he has with these guys as hehas never really had such close friends before.

During the week, Peter lives with his Mum and his twoyounger brothers. They spend every second week withtheir Dad. Peter’s Mum is really upset about themarijuana smoking incident and has threatened to kickhim out it happens again. Peter’s Dad is not too worriedabout it. In fact, he remembers smoking dope when hewas Peters’s age and thinks he will grow out of it in time.

SCENARIO 2: KYLIE

Kylie is a 16-year-old female who has recently beenreleased from a custodial centre after a six-monthsentence for various drug-related offences, includingbreak and enter, credit card theft, fraud and possessionof illicit substances.

Kylie began using substances at the age of 12, whenshe first smoked cannabis. At the age of 14, Kylie begansmoking and soon after injecting heroin. Kylie’s heroinuse increased to daily use at the age of 15 when shemet Carl, a 24-year-old man who was dealing heroin andother drugs. Carl is currently serving a six-year sentencefor dealing in illicit substances.

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Until she entered custody, Kylie had never been throughheroin withdrawal. Kylie underwent detoxification andcounselling for her heroin dependence whilst in custodyand managed to abstain from any drug use. She haddecided to try to finish year 10 through TAFE uponrelease from custody so that she could become anapprentice hairdresser.

Kylie lives with her mother, stepfather and 14-year-oldsister. Her stepfather is a heavy drinker and is oftendrunk and abusive towards her mother. Kylie’s sistersmokes cannabis on occasions but is not yet usinganything else. There are often fights at home. Kylie doesnot have anything to do with her father because of pastconflicts and abuse.

Most of Kylie’s friends use drugs of some description.She finds it hard to be around them at the moment butshe feels very lonely and bored without her friends.

Kylie is not interested in seeking further counselling fromAOD services as she feels she has it ‘under control’.

Assessment criteria

� The following key areas are to assist you and thelearners in providing a guide for marking theassessment for this particular unit:

� Demonstrates ability to identify, conduct andperform an appropriate role-play scenario thataddresses the key assessment areas of thatparticular case study

� Ability to write a script for the role-play thatdemonstrates a ‘brief intervention’ andimplements relevant assessment techniquesthroughout the duration of the audio-tape

� Demonstrates ability to conduct the role-play in atimely, clear, concise manner and write a critiquethat explores the process and considers theinteractions of the interviewer and the client.

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ReferencesHando, J., Howard, J. & Zibert, E. (1997). Risky drugpractices and treatment needs of youth detained in NewSouth Wales Juvenile Justice Centres. Drug and AlcoholReview 16 (2), 137-145.

Jarvis, T., Tebbutt, J. & Mattick, R. (1995). TreatmentApproaches for Alcohol and Drug Dependence: AnIntroductory Guide. Sydney: Wiley.

Miller, W.R. & Rollnick, S. (1991). MotivationalInterviewing: Preparing people to change addictivebehaviour. New York: Guilford Press.

Spooner, C., Mattick, R. & Howard, J. (1996). The natureand treatment of adolescent substance abuse.Monograph No.26. National Drug and Alcohol ResearchCentre, Sydney.

Toumbourou, J.W. (2002). Drug Prevention Strategies; adevelopmental setting approach. Prevention ResearchEvaluation No 2, Sept 2002 (available from Drug InfoClearinghouse – druginfo.adf.org.au).

Bien, T.H., Miller, W.R. & Tonigan, J.S. (1993). Briefinterventions for alcohol problems: A review. Addiction,88, 315-336.

Miller, W.R. (1998). Why do people change addictivebehaviour? Addiction, 93, 163-172.

Miller, W.R. & Heather, N. (1998). (Eds.) Treatingaddictive behaviours: Processes of change (2nd ed).New York: Plenum Press.

Monti, M., Colby, S.M., Barnett, N. P., Spirito, A.,Rohsenow, D. J., Myers, M., Woolard, R., & Lewander,W. (1999). Brief intervention for harm reduction withalcohol-positive older adolescents in a hospitalemergency department. Journal of Consulting andClinical Psychology, 67, 989-994.

Monti, P.M, Colby, S.M., & O'Leary, T.A. (eds.)(2001).Adolescents, alcohol, and substance abuse: Reachingteens through brief interventions, New York, Guilford.

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Nelson-Jones, R. (1997). Practical Counselling andHelping Skills. (4th ed). London: Cassell.

Noonan, W.C. & Moyers, T.B. (1997). MotivationalInterviewing. Journal of Substance Misuse, 2, 8-16.

Prochaska, J.O., DiClemente, C.C & Norcross, J.C. (1997).In search of how people change: applications to addictivebehaviours. In Marlatt, G.A. & VandenBos, G.R. (eds)Addictive Behaviours. (pp.671-696). Washington DC:American Psychological Association.

Rollnick, S., Mason, P. & Butler, C. (1999). Healthbehaviour change: A guide for practitioners. New York:Churchill Livingstone.

Rollnick, S. and Miller, W.R. (1995). What is motivationalinterviewing? Behavioural and Cognitive Psychotherapy,23, 325-334.

Stephens, R. S., Roffman, R. A., & Curtin, L. (2000).Comparison of extended versus brief treatments formarijuana use. Journal of Consulting and ClinicalPsychology, 68, 898-908.

Websites

The Motivational interviewing website is very useful forlatest research and articles:www.motivationalinterview.org/index.shtml

The Australian Drug Foundation (ADF):www.adf.org.au/index.htm

Centre for Youth Drug Studies is within the ADF:www.adf.org.au/cyds/index.html

The National Drug and Alcohol Research Centre(NDARC):www.med.unsw.edu.au/ndarc/

The Centre for Education and Information on Drugs andAlcohol (CEIDA): www.ceida.net.au/

Drug Arm (This site is particularly focused on youth issues):www.drugarm.org.au

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A practical guide to the stages of change and workingwith ambivalence:www.habitsmart.com/tip2.htm

The National Institute on Drug Abuse (NIDA), USA:www.nida.nih.gov/

The National Institute of Alcohol and Alcohol Abuse(NIAAA), USA: www.niaaa.nih.gov/

Drug Info Clearinghouse – The drug prevention networkhttp://druginfo.adf.org.au

The Alcohol and Other Drug Council of Australia (ADCA):www.adca.org.au/

The Network of Alcohol and Drug Agencies (NADA):www.nada.org.au

The Australian Drug Information Network:www.adin.com.au

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Key termsAbstinence Refraining from drug use.

Ambivalence Conflicted feelings towards someone or something.Understanding and working with a young person’sambivalence is a key component of the motivationalinterviewing model.

AOD Alcohol and/or other drugs

Brainstorming A technique that can be used when assisting a youngperson with problem-solving. A range of ideas aregenerated by the a young person and the worker which arethen more fully explored.

Brief intervention An intervention that takes very little time. Brief interventionsare usually conducted in a one-on-one situation.

Central nervoussystem (CNS)

Brain and spinal cord.

Depressants Drugs that slow down the brain and central nervoussystem.

Drug Within the context of this course, a drug is a substance thatproduces a psycho-active effect.

Drug dependence Anyone who relies on and regularly seeks out the effects ofa drug can be considered to be dependent on that drug tosome degree. Drug dependence occurs when a drugbecomes central to a person’s thoughts, emotions andactivities. A dependent person finds it difficult to stop usingthe drug or even to cut down on the amount used.Dependence has physiological and psychologicalelements.

FRAMES An acronym standing for Feedback, Responsibility, Advice,Menu, Empathy and Self-efficacy. This frameworkhighlights the key elements of a particular style of briefintervention.

Hallucinogens Drugs that act on the brain to distort perception (i.e. sight,taste, touch, sound, smell).

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Key terms (continued)

Harm minimisation Harm minimisation is the primary principle underpinning theNational Drug Strategy and refers to policies and programsaimed at reducing drug-related harm. It encompasses awide range of approaches including abstinence-orientedstrategies. Both legal and illegal drugs are the focus ofAustralia’s harm minimisation strategy. Harm minimisationincludes preventing anticipated harm and reducing actualharm.

Harm reduction Harm reduction aims to reduce the impact of drug-relatedharm on individuals and communities. It includes thosestrategies designed to reduce the harm associated withdrug use without necessarily reducing or stopping use.

Intervention A purposeful activity designed to prevent, reduce oreliminate AOD use at an individual, family or communitylevel.

Motivationalinterviewing

A therapeutic style developed in the AOD field in the early1980s as an alternative to the more confrontationalapproach used in some sectors of the treatment field. Theaim of motivational interviewing is to build on a youngperson’s own motivation and encourage choices forchange.

Poly-drug use The use of more than one psycho-active drug,simultaneously or at different times. The term ‘poly-druguser’ is often used to distinguish a person with a variedpattern of drug use from someone who uses one kind ofdrug exclusively.

Relapse A return to drug use after a period of deliberate abstinenceor controlled use.

Relapseprevention/management

A variety of strategies used in intervention to increasemotivation for maintenance of change, to identify high-risksituations for relapse, and develop skills to both avoid andmanage relapses.

Resistance Inter or intrapersonal conflict that can manifest within orbetween a young person and a worker.

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Key terms (continued)

Risk-taking Refers to risks that could be associated with AOD use,apart from the drug use itself. In an assessment, involvesidentifying factors such as sharing injecting equipment,being intoxicated in dangerous places (e.g. near a railwaytrack), or having unprotected sex while intoxicated.

Rolling withresistance

One of the principles of motivational interviewing. Rollingwith resistance refers to the idea of going with, rather thanagainst any resistance that may arise when working withyoung people.

Self-efficacy Refers to a person’s sense of self-mastery, that is, theextent to which a person believes he or she has the abilityto carry out and achieve a given task and reach the desiredgoal.

Self-motivationalstatements

One of the key strategies used in motivational interviewing.Key questions are asked with the aim of encouragingchange conversation.

Stages-of-Changemodel

A model of change developed within the AOD field in theearly 1980s. The model proposes that change is a processand not a one off event.

Documents

Facilitator’s Guide Module 9 - Department of Health · Facilitator’s Guide – Section A 3 Training Frontline Workers: Young People, Alcohol and Other Drugs Background The project