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2018 DHCS Substance Use Disorder Conference
Making the Connection: Approaches for Adolescents & Young Adults
Carrie Mounier, LCSW
Christina Esquibel, CATC-II
Irene Lim, LCSW
Disclaimer
The Substance Abuse and Prevention and Treatment
Program has no relevant financial relationships with the
manufacturer(s) or any commercial product(s) and/or
provider of commercial products or services discussed in
this CME/CE activity.
We do not intend to discuss unapproved/investigative use
of commercial product(s)/device(s) in this presentation.
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Learning Objectives
1. Describe how youth substance use is different from adult
substance use.
2. Identify barriers to youths’ access to care with marginalized
groups such as immigrants, houseless, and LGBTQI youth.
3. Identify how personal biases affect our ability to engage
with youth.
4. Identify effective treatment strategies to impact change
among youth, including Harm Reduction techniques.
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Substance Use Prevention
& Treatment Program
• At the Division of Adolescent and Young Adult Medicine
(DAYAM)
• Funded by LA County Department of Public Health,
Substance Abuse Prevention and Control Department (SAPC)
• At-Risk and SUD Treatment services for youth and young
adults age 12-24.
• Walk-in clinic on Tuesdays, 8:30am – 11:00am
• 5000 Sunset Blvd. 7th Floor, Suite 701, LA, CA 90027
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Programs at DAYAM
• Teenage and Young Adult Health Center
• Substance Use Prevention and Treatment
• Strengthening Youth Paradigms Program – capacity building
• Research and Evaluation
• Project NATEEN – for expectant and parenting teens
• Homeless Adolescent Wellness Clinic
• HIV Prevention and Treatment Program
• Center for Transyouth Health and Development
• Behavioral Health Program
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Objective 1
Describe how youth substance use is different from
adult substance use.
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Tell me about your use?
• Myth that “MJ is natural”
• Curiosity
• Availability
• Identity/Connection
• Peer/Media Influence
• Relationships: family, friends, romantic
• Legal situation: probation, DCFS
• Trauma, poverty, physical violence, Mental Health issues, PTSD,
community violence, all the “isms” (marginalized groups in
particular)
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“I don’t use to feel good...I use to feel less bad”
What’s the difference?
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ADULT YOUTH
More experience with substances Beginning of a potential problem
Access to own resources Dependent minor
Able to make own plans Needs to check with others
Brain developed Brain developing – moved by emotions, testing boundaries
Less impacted by peers Peer acceptance and influence are important
And more…
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https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introduction
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https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introduction
ESSENCE of Adolescence
• ES – emotional spark, a powerful passion to live life fully
• SE – social engagement, central importance of supportive
relationships in our lives
• N – novelty, having the courage to leave the familiar, certain, and
safe home nest
• CE – creative exploration, imagining how things could be, not
simply accepting them for what they are
http://www.drdansiegel.com/blog/2014/02/07/the-essence-of-adolescence/
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Considerations for the Youth
o Acknowledgment of a problem
o Consent and Confidentiality
o Self Determination
o Stages of Change
o Consistency
o Ability to make each session
o Judgement
o Accountability/Responsibility
o SUD diagnosis
o Incentives for youth may be different
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Considerations for the program
• Providers need to LIKE youth to work well with youth
• Caregiver buy-in required – youth’s own is not enough
• Barriers to accessing services as youth may cause the development
of Adult SUD
• Programs need to adapt to youth needs not push them into adult
tailored programming.
– Individual and/or group services
– Programming must be appealing to youth – can’t be boring, dry
– Up-to-date with youth trends
– Reasonable structure, be flexible with active problem solving with the
youth and family
– Restorative justice practices - Gender Affirming/Inclusive
– Harm Reduction approaches - Resources for providers
– Trauma informed - Cultural humility
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Objective 2
Identify barriers to youths’ access to care,
especially marginalized groups such as immigrant,
houseless, and LGBTQI youth.
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Our Youth & Their Culture
• We serve very specific populations:
– LGBTQI youth
– Immigrant youth
– Youth of Color
– Court involved youth (DCFS/Probation)
– Expectant and Teen parents
– Houseless youth
• Thus, services need to be:
– Trauma-informed
– Mindful of different learning, processing, and communication
styles
– Welcoming of all
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Suggestions for Engagement
• Offer safety, consistency
• Do not confront or “break down” defenses.
• Emphasize youth’s control over self
• Provide tokens or taxi vouchers
• Offer flexibility in appointment setting.
• Offer food or other incentives
• Provide empathy and acknowledge youth’s experience of pain and injustices.
• Do not tell youth they “have” to do a specific thing.
• Make each session/appointment count
Risk Factors
• Lack of parental/caregiver
involvement
• Trauma, child abuse &
maltreatment (ongoing and/or
history of it)
• Inadequate supervision
• Neighborhood poverty &
violence
• Aggressive and/or violent
behaviors
• Poor or negative image of the
self
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• “Family” involvement (chosen or
by blood)
• Involvement in community
and/or afterschool programs
• Limited availability to AOD
• Environments that encourage
positive change to:
– Learn new coping skills
– Learn emotional regulation
– Encourages positive views of the self
•https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/risk-protective-factors
•http://youth.gov/youth-topics/substance-abuse/risk-and-protective-factors-substance-use-abuse-and-dependence
Protective Factors vs.
How can we understand youth behaviors in the
context of their trauma history?
Present focused
• Different types of trauma (NCTSN, 2017)
– Some examples: complex, community, DV, early childhood
• Can be seen years after event(s) occurred and affect how someone
interprets events (e.g. “it is what it is” vs. “why do bad things
always happen to me?” vs. no response)
• Having triggers they might not be aware of
– Desensitized or extreme reactions
• Adverse and unhealthy coping skills
– Using substances
– Avoiding topics, places, people, things
– Irritable or easily agitated
http://www.nctsn.org/trauma-types
http://corkpsychotherapyandtraumacentre.ie/wp-content/uploads/2015/05/recovering-from-trauma.jpg
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Trauma & Adolescence
What would you hope for?
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• Welcoming
• Positive Attitude
• Interest
• Action
• Verbal Language
• Body Language
• Tone of Voice
• Location
• Sanctuary
• Inclusive signage
• Community Representation
https://www.govloop.com/govt-customer-service-isnt-customer-experience/
Let’s go to the DPSS office!
• DMC provides more SUD services now
• Minor Consent DMC
– 12 – 17 yo
– Apply in person only
– Monthly renewals
– DPSS offices not easily accessible
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Objective 3
Identify how personal biases affect
our ability to engage with youth.
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How Your Personal Beliefs Can
Influence Your Work
• Why does it affect the way we treat youth?
• Kid vs. Youth; Addict vs. User; Illegal vs. Undocumented
• Are you the right provider?
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“They’re making a choice to keep
using…they can stop whenever they want
to”
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Differentiating Provider Preference
& Youth Needs
Understanding the whole person in front of you with
complex needs and reasons for use
oNot condoning use and understanding why they use.
oRole of Stigma
oPersonal history with recovery
oVicarious trauma
oExternal forces - probation
oProgram Guidelines
oMinor Consent Services, Self Sufficient Minor Status
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“Kurzgesagt – In a Nutshell”
https://youtu.be/ao8L-0nSYzg
Let’s Connect
• Make that connection!
• Build rapport
– Listen for change talk
– Affirm positive goals
– Listen to youth not to respond, but as a
medium of getting to know them
• Empathy
• Team work
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Enhancing Resilience and Focusing
on Relationships
Relationships matter
Youth have strengths
Youth are the expert on their own life experience
Objective 4
Identify effective treatment strategies to impact change
among youth, including Harm Reduction techniques.
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Treatment Approaches
Motivational Interviewing
Grounding
Talk Therapy
Seeking Safety
Harm Reduction
Creative Expression
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What YOU can do
• Screen – S2BI/CRAFFT
• Brief Intervention – positive reinforcement
or express concern
• Referral to Treatment – warm hand off
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Empathy
Stay in the “empathic window” in order to be most
useful and prevent burnout.
Being empathic still requires setting limits- expressed
kindly and respectfully.
Check your feelings –frustration can lead to being
judgmental, disconnected
Check with colleagues – “Am I being fair?”
Challenges Tuning in to Emotions
Goal for provider is attunement – paying attention, being
observant, exploring possible feelings and meanings,
seeing what is useful and remembering it, verbalizing it
•Restricted experience and expression of emotion
•Difficulty identifying their own feelings
•Difficulty expressing their real feelings and needs
•Guarded against expressing vulnerability
•Vague and indirect expression of need.
How can we respond to youth behaviors in ways that do
not re-traumatize, but instead provide opportunities
for growth?
Avoid punitive responses
Focus on respectful youth
engagement.
Recognize the realities of
homelessness, for example
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Focus on Safety
Trust and Safety!!
Emphasize confidentiality
Be transparent about mandatory reporting
requirements.
Allow the young person to define their experience
Allow their feelings however they express them
(safely)
Let the youth control the
pace of disclosure
Safety in life
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Collaborate with Youth to Develop
Treatment Goals
o Ask youth what brings them to your program and what do they know about that program
o Ask youth what they are concerned about and would like to focus on.
o What is presenting problem from youth’s perspective?
o Are any of the problems acutely life threatening? o Where are the opportunities for most immediate
movement? o Present a range of options, in a neutral, non-judgmental
manner
Why Harm Reduction?
• Harm Reduction vs. Abstinence
– Safer use
– Managed use
– Abstinence
• Youth is in control: “Meet them where they’re at”
– Youth defines the goals…not the provider
“Harm reduction is a developmentally congruent approach to
the primary and secondary prevention of risky behaviour in the
adolescent population” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528824/
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Understanding, Restoring, Reducing &
Repairing Harm
h
Who's harm? Recognizing
the big picture. We are
responsible for seeing our
youth as persons who have
been harmed rather than
seeing them as bad.
Focus on Advocacy
Be an advocate – lend your privilege to help young
people be heard
Challenge mis-gendering, stereotyping, and assuming
the worst about youth
Be the reminder for a trauma informed perspective
When conclusions are uncertain, interpret information
to benefit the youth
Be sensitive to power and control dynamics and
advocate for youth’s self determination
Vignette
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http://dailyfreepress.com/2016/03/31/marijuana-users-social-exclusion-study/
Creative Expression
• For female identified minors 14-17 yo
• Creative and safe place for expression
• Includes a continuum of topics
• Utilizing:
– Motivational Interviewing
– Grounding
– Affirmations
– Positive Self-Talk
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The Fellas’ High School Group
• Open treatment group for male identified minors 14-17
years old
• Conversation…not a lecture
• How specific substances effect THEIR brain and body
• Explores triggers, healthy coping, and motivators to
reduce/quit
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https://static.highsnobiety.com/wp-content/uploads/2018/04/12213631/sandlot-reunion-25th-anniversary-reboot-001-1200x720.jpg
Resources
• Los Angeles County Substance Abuse Service Helpline
SASH: (844) 804-7500 – Toll-free for both youth and adults
– Open 24/7/365
– Screening and referral services
• Crisis Text Line
– Text CONNECT to 741741
– Available 24/7
– Live, trained Crisis Counselor receives text
• California Youth Crisis Line – (800) 843-5200
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Thank you!
Substance Use
Prevention & Treatment Program
5000 Sunset Blvd. 7th Floor, Suite 701
Los Angeles, CA 90027
(323) 361-2463
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