DCF Hartford Youth Project

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The Hartford Youth Project
A Model for Accessing, Engaging, and Retaining
Adolescents into Evidence-Based Substance Abuse
Treatment
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Presenters

• Peter Panzarella, M.A., M.S.
• Director of The Division of Substance Abuse, CT
  Department of Children and Families
• Reginald Simmons, Ph.D.
• Treatment Coordinator, Hartford Youth Project,
  Connecticut Department of Children and Families
• Catherine Corto-Mergins, MSW, LCSW
• MDFT supervisor, Village for Families and
  Children
• David Cohen, MSW
• MDFT Therapist, Village for Families and Children
• Celia Alamo, BSW
• MDFT therapist Assistant, Village for Families
  and Children

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What is the Department of Children and Families
(DCF) ?

• A Consolidated State Childrens Agency (child
  welfare, juvenile justice, adolescent substance
  abuse treatment, childrens mental health).
• DCF administers, plans, funds and operates
  programs.
• DCF contracts for adolescent substance abuse
  treatment services for 8 million dollars
• SFY 2003 DCF State Budget is 569,000,000

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DCF Connecticut Adolescent Substance Abuse
Treatment

• Target Population
• Approximately 15, 000 youth in Connecticut in
  need of substance abuse treatment
• In 1999, 1045 youth received services
• 70 were admitted to outpatient level of care
• 87 were 14-17 years of age
• 68 were male

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Hartford Youth Project

• Purpose
• To strengthen community-based substance abuse
  treatment for Hartford youth ages 10 to 17 by
  developing a comprehensive, culturally competent,
  gender-specific model
• To use the Hartford Youth Project as a model for
  other regions in Connecticut

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Why Hartford?

• One of the poorest cities in the country
• More youth from Hartford committed to juvenile
  training school than any other Connecticut city
• Significant rate of school failure and report of
  SA use
• Active community mobilization
• Influential Parent/Family advocacy organizations
• Strong Latino and African-American advocacy and
  service organizations
• Community collaboratives
• Pre-existing support and implementation of
  Evidence-Based Treatments

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Hartford Youth ProjectObjectives

• Increase treatment capacity
• Implement cost-effective treatments modeled after
  the following evidenced-based treatments for
  adolescents
• MST
• MDFT
• MET/CBT
• Family Support Network

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Hartford Youth Project Objectives

• Provide a continuum of treatment services to
  include
• Screening
• Early intervention
• Referral
• Assessment
• Case management
• Continued care

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• Hartford Youth Project

Hartford Schools, Community Agencies, Primary
Care Clinics, and Homeless Youth
Outreach,Identification, Engagement, Referral -
Urban League
Outreach, Identification, Engagement, Referral -
Hispanic Health Council
Juvenile Justice Probation, Committed Delinquents
DCF Referrals Committed Youth, Voluntary and
Behavioral Health Systems
Network and Linkages to Provider Network
ADRC
NAFI
The Village
CSI
Wheeler
HBH
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What is The Hartford Youth Project?
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Key Components

• Community Collaboration
• Adolescent Outreach and Engagement
• Standardized, Ecologically-Oriented Assessment
• Assessment-Driven Treatment Matching
• Evidence-Based Treatments
• Continuum of Care
• Family Involvement
• State of the Art MIS

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Family Involvement

• Families are involved in development and
  evolution of the project
• Advertising informed by youth focus groups
• Youth representation on HYP steering committee
• Choice of evaluation incentives
• Informed cultural relevance of assessment tools

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Family Involvement

• Family-Centered Service Planning
• Family-Driven Case Management

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How is HYP Culturally-Competent?

• Bi-lingual, Bi-cultural engagement specialists
  and assessment staff
• Ecologically-oriented assessment and treatment
  matching
• Family-Driven, multi-domain Service-Planning
• Multi-systemic treatments

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HYP Outcome Evaluation

• Purpose
• Assess the effect of treatment on
  substance-abusing youth served by the HYP
  treatment system
• Evaluate whether changes in the treatment system
  are reflected in more positive outcomes for youth
  
• Approach
• Conduct pre- and post-treatment (3, 6 and
  12-month) assessments with youth served (n 180)
  using site-specific versions of the GAIN 5.3,
  GAIN M90, and ecological measures
• Compare youth served in the early and latter
  stages of the project
• Compare youth entering through community-based
  referrals vs. juvenile justice referrals

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MDFT

• Multidimensional Family Therapy

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Theory of Change

• Adolescent substance abuse is influenced by a
  combination of individual and environmental
  factors.
• MDFT is designed to work intensively with the
  family to reduce the influence of the factors
  that place an adolescent at-risk of substance
  abuse (such as school failure, family conflict,
  environmental stress), while also strengthening
  the presence of protective factors (such as
  positive parental relationship, pro-social
  involvement, parental monitoring).

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What is MDFT?

• Treatment is mainly in-home 3-5 times per week
  for 3-6 months.
• Therapist Assistant has daily contact with family
  and/or system entity (school, social-service
  agency, etc.)
• Interventions are multidimensional and target
• 1) adolescent, 2) parent,3) parent-adolescent
  interaction,4) family members, and 5) systems
  external to the family (education, juvenile
  justice, peers, social-services, etc..).
• Therapy itself is based on tenets of structural
  and strategic family therapy

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MDFT Target Population

• 11 to 17.5 years old
• Living at home with or returning to a primary
  caregiver
• Substance abusing or at risk for substance abuse
  (co-occurring acting out behaviors and/or other
  psychiatric issues)

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Treatment Team

• Two Therapists who conduct family, parent, and
  individual therapy with the adolescent
• One Therapist Assistant who provides
  case-management
• Supervisor who meets weekly with the therapist
• MDFT Consultant

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Staff Qualifications

• Therapists and supervisors must have a minimum of
  a Masters degree in a counseling-related field.
  Training in Structural and/or Strategic Family
  Therapy is recommended
• Therapist Assistant needs case-management
  experience in the area served by provider and
  knowledge of formal and informal community
  resources
• Associate or Bachelors degree in a Social-Service
  field preferred.

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Training

• Trainees undergo intensive six-month training
  process facilitated by model experts from Center
  for Treatment Research of University of Miami
• -Bi-Monthly On-site training (3-5 days each)
• -Monthly Review of therapists video-taped
  sessions and case-conceptualizations
• -Assessment of supervisor competency via
  video-tape review of supervision sessions
• -Weekly phone consultation by MDFT during 6 month
  training
• Competence assessed by written mastery exam and
  rating of last video-tape submission

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Why will this Work?

• Randomized clinical trials have demonstrated
  long-term reductions in substance use and
  improvement in the functioning of highly at-risk
  adolescents from ethnically-diverse (White,
  African-American, and Hispanic) backgrounds and
  needing varying levels of care.
• Substance use continues to decrease and
  emotional/behavioral functioning continues to
  improve after treatment discharge .
• MDFT more effective and cost-efficient than
  standard outpatient and residential substance
  abuse treatment

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MDFT Case Presentation

• Catherine Corto-Mergins
• David Cohen
• Celia Alamo

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Hartford Youth Project (HYP)Referral Process
HYP Presentation to school about MDFT
School social worker makes call to HYP ES
ES gives client quick GAIN
Client receives comprehensive assessment Full
GAIN
Referral made from ES to agencys MDFT program
Service planning meeting
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Demographics

• Family make-up
• Living in home
• Bio-mother (45) Bio-father (38) IP-female (15)
  brother (13)
• Living outside of home
• Extensive extended family including other
  siblings living in Puerto Rico
• First generation, monolingual, Puerto Rican
  Family
• Acculturation process and need for culturally
  competent treatment approach
• Low socio-economic status
• Reside in high risk urban neighborhood

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Presenting Problems

• Marijuana use
• Communication between mother and IP
• School truancy
• Depression
• History of suicidal ideation

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MDFT Phase 1- Build Foundation/ Engagement

• 1-2 months of building rapport
• Adolescent
• Motivating the adolescent to engage in
  therapeutic process
• Adolescent Engagement Intervention (AEI)
• Encouraging a collaborative process to formulate
  goals
• Allow IP to voice their concerns and express
  their hopes
• Assess for co-morbidity, refer for psych
  evaluation for depressive/suicidal symptoms
• Parent
• Assess current and past stress and burden
• Assess current and past parenting styles
• Parental Reconnection Intervention (PRI)
• Enhance and strengthen feelings of love and
  commitment
• Motivate parents you are the medicine, no
  regrets
• Family
• Assess family interactions
• Understand family journey and history
• Develop family response to crisis (suicidal
  attempt)
• Interaction with psychiatrist

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Phase II Work Themes/Request Change

• Work with family communication
• Adolescent
• Adolescent explained that her mother was too
  restrictive
• Had conversation about adjustment to Hartford
• Discussion on her cutting
• Helped form new communication techniques
• Parent
• Instill hope about change
• Build sense of team between parents
• Address parental conflict
• Parent explained adolescent showed extreme
  disrespect towards authority
• Shifted content from focus on behavior to focus
  on emotion with parent
• Discipline differences ( Mothers system of
  discipline)
• Parents trying different parenting approaches and
  IP reacting
• Psycho education on adolescent development
  moving from power and control to influence
• Increase father involvement
• Family
• Maintaining working alliance with both adolescent
  and parent
• Age appropriate negotiation

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Phase III- Seal changes and Exit

• Acknowledge progress and changes
• Review parenting style and safety plan
• Became less content-directive and focused more on
  coaching the process of the conversation
• Referral to Outpatient
• Transition from MDFT to new clinician
• Securing Pro-social Activities
• Progress of Treatment
• Communication between parents and IP became more
  frequent and substantive, no physical
  altercations
• Decrease in marijuana use
• IP was talking about more openly about her
  thoughts and feelings
• School truancy was not an issue
• No suicidal ideation at present time
• Parents were able to work extra-familial domain
  on their own

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MDFT SUPERVISION MODEL

• WEEKLY INDIVIDUAL SUPERVISION (2 hr.)
• Role of case-conceptualization
• Session Planning Sheets
• LIVE SUPERVISION (2 x per month)
• VIDEOTAPE REVIEW (2 x per month)
• WEEKLY TEAM SUPERVISION (includes phone consult
  with University of Miami)
• 24 / 7 AVAILABILITY

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KEY COMPONENTS OF MDFT SUPERVISION

• Parallel process between treatment and
  supervision
• Request change
• Model direct communication
• Assist with creativity in problem solving
• Instill sense of hope when clinician and family
  feel stuck
• Provide ongoing support

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KEY SUPERVISION COMPONENTS (CONT.)

• Assist in the connection between the big and
  small picture / the generic and idiosyncratic
• Apply overarching principles of MDFT
• Assist in crafting goals / themes for the work
• Integrate cultural component of the family
• Work the team approach
• Insure quality of treatment

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Take-Home Points

• Seek understanding of clients cultural
  background
• Intervention should adapt to changing needs of
  family
• Support family(and therapist)when difficulties
  arise
• Extra-familial work is crucial

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Thank You!

• For additional info. contact
• Reginald Simmons, Ph.D.
• CT Department of Children and Families
• Phone [phone]
• Email reginald.simmons_at_po.state.ct.us