Training Frontline Workers - Young People Alcohol and ... · Mod 9 - Working with Young People on AOD Issues 23 Working with ambivalence No such thing as ‘unmotivated’ behaviour

Mod 9 - Working with Young People on AOD Issues 1

Module 9

Working with YoungPeople on AOD Issues


Working with youngpeople on AOD issues

Topic 1

Introduction


Learning outcomes

When you have completed this moduleyou will be able to:

� Identify AOD interventions suitable forworking with young people

� Apply Stages-of-Change model and motivationalinterviewing to work with young people

� 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.



Topic 2

Introduction to AODinterventions


Harm minimisation

Harm reduction

Demand reduction

Supply reduction


Harm minimisationapproach

Drug use, both licit and illicit, is aninevitable part of society

Drug use occurs across a continuum.Patterns range from occasional use todependent use

A range of harms are associated withdifferent types and patterns of use

A range of approaches can be used torespond to these harms


Schaeffer’s model


Risk and protectivefactors


Overview

Harm minimisation focuses on reducingharms from AOD use, not the use itself

Not all young people experienceproblems from their drug use

The context of the young person mustbe considered

The context of drug use must beconsidered



Topic 3

Understanding change


Natural change

Finding a new reference

Finding (or rediscovering) a newpurpose in life

Dramatic and humiliating eventsassociated with their drug use

‘Maturing out’ from heavy use

Pregnancy


Natural change Cont ...

Developing new personalrelationships that are notcompatible with heavy AOD use

Financial and/or legal problems

Health concerns

Work problems

Advice from friends and family


Roadblocks tocommunication

� Ordering

� Over-sympathising

� Warning/threatening

� Lecturing

� Diagnosing

� Judging

� Interrogating


Stages of change

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse-Lapse-Change


Stages of change

Precontemplation

Precontemplation

Precontemplation

Contemplation

Contemplation

Contemplation

Preparation

Preparation

Preparation

Action

Action

Action

Maintenance

Maintenance

Maintenance

LastingExit


Five stages of change

Precontemplation

Contemplation

Preparation

Action

Maintenance


_____________________0 1 2 3 4 5 6 7 8 9 10

Notconsideringchange

Alreadychanging

Readiness to change



Topic 4

Motivationalinterviewing


Understanding change

Change is a process, not a single event

People may go around the cycle ofchange many times before achievingcontrol

Client resistance may be a sign that theworker has overestimated readiness forchange

10-point change scale useful tool forstarting conversations on how a youngperson feels about changing AOD usingbehaviours


Working with YoungPeople on AOD issues

Topic 5

Some motivationalinterviewing techniquesfor working with young

people


Motivational interviewing

Therapeutic approach developed byWilliam Miller and Stephen Rollnick

Main idea is to purposefully create aconversation around change withoutattempting to convince the person ofthe need to change or instructingthem about how to change


Key principles ofmotivational interviewing

Express empathy

Develop discrepancy

Avoid argument

Roll with resistance

Provide support

Encourage self-efficacy


Working withambivalence

� No such thing as ‘unmotivated’ behaviour

� The more involved a young person is withdrug use and associated lifestyle issues,the greater the chance they will feel someconflict or ambivalence about changingtheir pattern of use

� Ambivalence is a normal, human condition,central to decision-making

� Working with ambivalence is a key toassisting a young person move through thechange process


Working with resistance

Worker’s style is a powerfuldeterminant of resistance

Argument tends to evoke resistance

Young people may respond toconfrontation by presenting reasonsagainst change

When resistance is evoked, young peopletend not to change


Working with resistanceCont ...

Resistance may be a message from theyoung person that you do notunderstand them or their situation

Motivation emerges from theinteraction between the young personand the worker

Motivation can be increased by using avariety of strategies



Intervention technique thatpurposefully creates a conversationaround change without attempting toconvince the person of the need tochange, or instructing them about howto change

Working with ambivalence is central

Reflection can be a useful technique towork with resistance



Topic 6

Brief interventions


Some techniques

Decisional balancing– pros and cons for making change or

staying the same

Looking forward/future directions

Worst case scenario/best case scenario


Good things/less goodthings

Essential strategy, ‘heart and soul’of MI

Builds and explores ambivalence– current drug use– possibility of changing drug use

Builds rapport

Assesses readiness for change

Assesses other factors such as triggersfor relapse, if change were to occur


Decisional balancing

Good things Not so goodthings

Continue druguse

Reduce/stopdrug use


Looking forward/future directions

Helping clients to imagine a differentfuture

Some useful questions:

– ‘How do you think things might bedifferent for you once you turn 18?’

– ‘What would be the best possibleresult that you could imagine, if youwere to make a change?’

– ‘If you made a change to your druguse, how would you like things to turnout?’


Looking forward/future directions Cont ...

The goal is to facilitate movement tothe next stage of change if the youngperson is ready

Ten-point scale is a useful tool to usewith this technique


Worst case scenario/best case scenario

Some questions:– ‘If you were to stop using heroin,

what do you imagine would be theworst things that could possiblyhappen?’

– ‘If you were to stop using heroin,what do you imagine would be thebest things that could possiblyhappen?’

Vary to use worst and best caseimaginings around change and stayingthe same



In summary:

One way to work with some people, someof the time, in some situations

An approach that aims to work withpeople at their own pace, and addressthe need for change

Uses a quiet, eliciting rather than adirective style

Has application in specialist AOD andother settings and is useful in briefinterventions



Topic 7

Working with youngpeople to determine a

plan of action


Brief interventions

Engage with those clients not yet readyfor change

Increase the client’s perception of realand potential risks and problemsassociated with AOD use and practices

Encourage change by helping a youngperson to consider reasons for changeand risks of not changing


When not to usebrief interventions

When a person:

doesn't wish to engage in conversationand becomes visibly distressed or angrywhen questioned

is in a highly emotional state

is extremely intoxicated

is on medication that is mood/mindaltering


Counterproductiveassumptions

This person ought to make a change

This person wants to make a change

This person’s health/relationship/legalsituation is a prime motivating factor

If they decide not to change, theintervention has failed


Counterproductiveassumptions Cont ...

People are either motivated to changeor not

Now is the right time to considerchange

A tough approach is most effective

I’m the expert. The young person mustfollow my advice


Brief interventions

In summary:

Don’t require ongoing formal counsellingsessions

Make the most of small opportunities

Can occur at anytime in your work withyoung people

Can provide information quickly whenit’s most needed

Can increase a young person’sacceptance of information


Assisting withgoal-setting

To plan action, a goal must be pictured

Goal must be related to a youngperson’s values, beliefs and dreams(meaningful)

Goals can be short-term or long-term

Goals need to be negotiated

Setting small steps will empower ayoung person


Beginning the process

Useful questions:

– What sort of things are important to you?

– What is one of the most important things inyour life that you would miss the most?

– What sort of person would you like to be?

– If things worked out in the best possible wayfor you, what would you be doing one year fromnow?

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

– How does your drug use fit in with your plansfor the future?


SMART approach

Specific Meaningful Assessable Realistic Timed


SMART approachquestions

Make a list of goals for:– the day– this week– this month– the year– for 5 years

What will be your next (first)step now?


SMART approachquestions Cont ...

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

Have you ever done any of thesethings before to achieve this?What will you need to do torepeat these actions?

Who will be helping andsupporting you?


SMART approachquestions Cont ...

On a scale of 1 to 10, what arethe chances that you will carryout the next step?

Be hesitant about acceptinganything under a seven - theinitial goal or next step mayneed to be more achievable


Problem-solvingtraining

The goals of problem-solving training arefor the client to:

recognise when a problem exists

generate a range of possible solutions

decide on the most appropriate optionand determine a plan for enacting it

be able to evaluate the effectivenessof the selected option


Determining a plan ofaction

In summary:

Assisting a young person to setrealistic and reachable goals canbe an important step in theprocess of taking action forchange



Topic 8

Summary and conclusion


Determining a planof action

Once it is clear what a young personaims to achieve by making a change,concrete help with problem-solving anddecision-making can be necessary

Setting goals, solving problems andmaking decisions are all part of theprocess of change


Relapses

A lapse is normal and should not beviewed negativelyStrengthen motivation to changethroughout the change processIdentify high-risk situationsDevelop coping strategies and skills forhigh-risk situationsDevelop coping strategies and skills todeal with lapsesRecognising and implementing changesin the young person’s environment andlifestyle


Relapse strategies

Positive self-talk

Problem-solving skills

Relaxation skills

Anger and depressionmanagement

Coping with craving

Identify the build up to relapse


Long-termmaintenance of change

Establishing social contacts thatare not AOD-centred

Establishing new leisure activitiesand hobbies that are not AOD-centred

Living in a new place to avoid afamiliar group of heavy users

Working in a new location to avoidheavy drug-using scenes

Documents

Training Frontline Workers - Young People Alcohol and ... · Mod 9 - Working with Young People on AOD Issues 23 Working with ambivalence No such thing as ‘unmotivated’ behaviour