A Risks to Resilience for Youth in Transition to Adulthood
Vincent Giordano, Ph.D., Program Director
Peter Gamache, Ph.D. candidate, MBA/MPH
Research & Evaluation Specialist
Learning Objectives
1. Gain a comprehensive overview of the program
2. Gain information on an assets‐based approach that inverts a problem and risk‐
based orientation toward resilience 3. Gain strategies for building and sustaining a network of social support to ensure cultural competency 4. Gain program design examples for youth leadership and mentoring
Operation PAR, Inc.
Mission: To strengthen our communities by caring for families and individuals impacted by substance abuse and mental illness.
Vision:
Operation PAR, a beacon of hope in our communities ‐
helping people be aware, be responsible, be healthy and be happy.
Family Resources, Inc.
Mission: To strengthen families and build better communities by providing prevention, support and counseling services to children, teens and families. Vision:
We at Family Resources believe that every child should be safe, that every troubled teen deserves help, and that every family torn apart in crisis be given the opportunity to mend. Purpose of the Program
U‐Turn‐New Directions Toward Recovery and Independent Living
provides outpatient substance abuse treatment to homeless youth residing at three Transitional Living Programs operated by project partner Family Resources, Inc. in Pinellas County, Florida.
Treatment Services
Motivational Enhancement Therapy (MET)
Cognitive Behavioral Therapy (CBT)
RESPECT
Motivational Enhancement Therapy
Motivational Enhancement Therapy Based on motivational principles, MET is designed to be an individual approach in which the therapist works with the client regarding the client’s own specific reasons for considering change. MET
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy CBT is a group treatment approach that focuses on training interpersonal and self‐management skills. CBT
RESPECT
RESPECT
The RESPECT intervention is designed to support risk reduction behaviors by increasing the client’s perception of his/her personal risks and by emphasizing incremental risk‐reduction strategies. RESPECT
Goals of U‐Turn
To expand and enhance outpatient treatment to homeless runaway youth
Reduce the amount of risky behaviors
Provide participants educational and/or vocational opportunities to prepare them for independent living
To establish case management and other linkage strategies to connect participants with housing and other necessary services
Form a Youth Led Community Advisory Panel
Screening & Assessment
Global Appraisal of Individual Needs (GAIN)
Chestnut Health Systems, Inc.
Assessment Instrument
Data collected using the Global Appraisal of Individual Needs (GAIN) developed by Dr. Michael Dennis and Chestnut Health Systems
GAIN‐Initial Full Baseline Assessment
Average Time=88.47 minutes (1 hr, 29 min)
GAIN‐Monitoring 90 Days (M90) Full Follow‐up Assessment
Average Time=42.81 minutes GAIN
Global Appraisal of Individual Needs
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Background
Substance Use Physical Health
Risk Behaviors
Mental Health
Environment
Legal
Vocational
GAIN
Telling our story with data
Baseline Demographics & Clinical Characteristics
Gender & Race Demographics
Mean Age 16.1
Institutional & Treatment Involvement
Substance Use & Co‐occurring Disorders
61.1%
Any Co‐
occurring Disorder
33.3%
Dual Diagnosis
Mental Health Diagnoses
42.2%
50.0%
Internalizing Disorders (MDD, TSD, GAD)
Externalizing Disorders (ADHD, CD)
Juvenile Justice System Involvement
23.3%
17.8%
Arrested in Past 90 Days
On Probation in Past 90 Days
Case Studies
Stories from the front lines
His Story: Case Study #1 “Wayne” is a 16 year old adolescent male who was referred to U‐Turn by the transitional living program.
The intake assessment showed that “Wayne” meets criteria for ADHD and Conduct Disorder. While he did not self‐report enough symptoms to meet criteria for abuse or dependence, he did report use of alcohol , marijuana and some prescription medication within the past year.
He is unemployed, but actively pursuing work while completing a GED program. Treatment Experience & Outcomes
“Wayne” was one of the only male participants to date to complete the full treatment program, which meant he attended all 12 MET/CBT sessions and both RESPECT sessions.
During his 6‐month follow‐up interview, “Wayne” told the research staff that he had not used alcohol or any other drugs since starting the program. He was stable in the community, which means he was not using, was not incarcerated or in a controlled environment and was not experiencing substance‐related problems. Her Story: Case Study #2 “Jasmine” is a 16 year old adolescent female who was referred to U‐Turn by the transitional living program. The intake assessment showed that “Jasmine” meets criteria for several co‐occurring disorders (including depression, traumatic stress, conduct disorder and ADHD). “Jasmine” also reported a history of abuse or victimization in her lifetime.
During the initial assessment, “Jasmine” reported using alcohol, marijuana and some prescription medications within the past year.
Treatment Experience & Outcomes
“Jasmine” successfully completed the U‐Turn program, attending all 12 MET/CBT sessions and both RESPECT sessions.
During her 6‐month follow‐up interview, “Jasmine” reported that she had not used alcohol or any other drugs since starting the program. She was stable in the community, which means she was not using, was not incarcerated or in a controlled environment and was not experiencing substance‐
related problems.
Telling our story with data
Treatment Engagement &
Preliminary Outcomes
Treatment Engagement & Completion
Completion Definitions
No/Minimal=0‐1 sessions
Partial =2‐7 sessions
Completer=8‐12 sessions
Decreases in Illegal Activity
70.6%
63.7%
Decrease in any illegal activity
Decrease in reported drug crimes committed
Assets‐based Approach
• Biological Needs
• Psychological Needs
• Social Needs
Physical
Emotional
• Human Capital
• Social Capital
• Cultural Capital
Mental
Service System Interviews • Identify resources
• Reduce multi‐system barriers
– Communication & coordination
– Eligibility requirements
– Policies (referrals/data)
• Make connections
– On‐site visits
– Request speakers
– Identify mentors
Assets‐Based Approaches
Resiliency Development
Resilience supports an assets‐based approach by: (1) identifying qualities of individuals and support systems that explain or predict success (2) describing the process of coping with negative stressors (3) creating experiences that move individuals toward reintegration (Richardson, 2002; Masten & Powell, 2003) Assets‐Based Approaches
Resilience research has found: • Early and continuous attachment positively shapes relationship development in later years among all young children, adolescents, and adults (Rutter & Rutter, 1990) • Protective factors in one setting can compensate for risks in multiple settings (Bernard, 2004) Assets‐Based Approaches
• Community‐Focused Cultural Competency
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Ensure compatibility between an organization’s/system’s structures and processes and the community’s characteristics Engagement with youth includes an awareness of both their struggles and achievements to be effective Specific practices, such as those that employ messaging (e.g., risk awareness messages, health maintenance messages) also incorporates an understanding of labeling and self‐identification Assets‐Based Approaches
• Community‐Focused Cultural Competency
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The expected outcome of organizational cultural competence is reduced mental health disparities
This outcome is the product of joint organizational and community efforts Assets‐Based Approaches
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Joint organizational and community efforts contribute to cultural competence when they provide shared decision‐
making with youth along heightened levels of a ladder of participation (Hart, 2002)
Social Support
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Ensure inclusiveness
Review frontline practices (including screening, assessment and evaluation) Change negative, harmful climates; be strengths‐based and create safe environments Include role models Familiarize youth with local, state and national resources Develop comprehensive, individualized service plans
Youth Leadership
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Youth‐initiated, shared decision‐
making
Networking with professionals
Ensure service and support plan identifies strength‐based, creative, practical, culturally competent strategies to meet the needs identified by the youth
Youth‐led Community Advisory Panel
Youth Leadership
Needs
„ John needs to learn to get along with others
„ John needs to feel that he is OK and contributing to school, community.
„ John needs to feel safe at school;
„ John needs to attend all his classes for the next 3 months to graduate
„ John needs to develop a social support network; receive acceptance for who he is
„ Community needs help with project
Culture and Strengths
• John is a good artist
• John has strong spiritual beliefs
• The wrap-around service system
for John has strong community
connections
John’s Vision: To get along better; to graduate from high school and get a good job
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Strategies
John will work with other youth to design logos and posters for community events
„ Art teacher will introduce John to local artists „ John will attend family organization meetings
School will provide in‐service to school staff to provide strong support and intervention in the event of bullying
(Lazear, 2009)
Thank you for stopping by!
Operation PAR, Inc.
Mark Vargo, Ph.D.
Vice President of Research & Evaluation/U‐Turn Evaluator
mvargo@operpar.org
Jackie Griffin‐Doherty, MS
Vice President of Development/U‐Turn Program Coordinator
jdoherty@operpar.org
Vincent Giordano, Ph.D., CAP
U‐Turn Program Director
vgiordano@operpar.org
Tommi L. Leveille
Administrator of Research & Evaluation
tleveille@operpar.org
Peter Gamache, Ph.D. Candidate, MBA/MPH
Research & Evaluation Specialist