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Department of Juvenile Justice Substance Abuse Treatment Programs: An Overview for the Substance Abuse Services Counsel Presented by Art Mayer LCSW CSOTP Sex Offender / Substance Abuse Program Supervisor Behavioral Services Unit June 21 st 2011

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  • Department of Juvenile Justice Substance Abuse Treatment Programs:

    An Overview for the Substance Abuse Services Counsel

    Presented byArt Mayer LCSW CSOTP

    Sex Offender / Substance Abuse Program Supervisor

    Behavioral Services UnitJune 21st 2011

    PresenterPresentation Notes

  • What are DJJ youth using?

  • 63.5% 63.0%

    51.8%

    8.8%

    3.4% 2.6%1.4%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    Cigarettes Marijuana Alcohol Cocaine Inhalants Crack Heroin

    Perc

    ent o

    f You

    th

    Type of Substance

    Percentage of Youth Substance Use* FY 2009

    * All substance use information on juveniles is collected using the Juvenile Profile (JP) forms completed at the Reception and Diagnostic Center.

    PresenterPresentation NotesALCOHOL-65%MARIJUANA-67%CIGARETTES-70%COCAINE-14%CRACK-6%HEROIN-5%

    Data from the Profiles of Incarcerated Adolescents in Virginia’s Juvenile Correctional Centers Fiscal Years 1999-2003

  • Cigarette Use by Sex

    66.4%

    61.8%63.5% 63.3%

    63.6%62.6%

    59.5%62.3%

    57.4%62.5%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    MaleFemale

    • In FY 2009, 64% of juveniles at admission to RDC reported cigarette use.

  • Cigarette Use by Race

    73.9%76.7% 75.6% 75.8% 74.5%

    63.0%

    55.8%58.4%

    56.6%58.7%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    WhiteBlack

    • In FY 2009, 64% of juveniles at admission to RDC reported cigarette use.

  • Marijuana Use by Sex

    64.6%

    60.1%64.0% 65.4% 63.2%60.4%

    55.7%

    44.2% 44.3%

    60.7%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    MaleFemale

    • In FY 2009,63% of juveniles at admission to RDC reported marijuana use.

  • Marijuana Use by Race

    68.3%

    65.0% 62.7%

    68.2%66.3%

    62.2%57.1%

    61.1%62.1% 62.2%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    WhiteBlack

    • In FY 2009, 63% of juveniles at admission to RDC reported marijuana use.

  • Alcohol Use by Sex

    51.3%

    46.3%

    51.7% 52.0%52.4%

    49.5%

    39.2%41.6%

    39.3%

    44.6%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    MaleFemale

    • In FY 2009, 52% of juveniles at admission to RDC reported use of alcohol.

  • Alcohol Use by Race

    63.1%

    56.1%

    63.6% 63.1%66.3%

    45.4%

    40.0%43.5% 44.4% 45.1%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    WhiteBlack

    • In FY 2009, 52% of juveniles at admission to RDC reported use of alcohol.

  • Cocaine Use by Sex

    10.6% 9.2% 9.5% 7.9% 7.9%

    16.5%13.9% 13.0%

    8.2%

    19.6%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f Yo

    uth

    Fiscal Year

    MaleFemale

    • In FY 2009, 9% of juveniles at admission to RDC reported cocaine use.

  • Cocaine Use by Race

    24.9%21.5% 23.6%

    25.8% 24.0%

    4.6% 4.6% 3.1% 2.9% 2.0%0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    WhiteBlack

    • In FY 2009, 9% of juveniles at admission to RDC reported cocaine use.

  • Inhalants Use by Sex

    3.4% 2.5% 2.5% 3.1% 3.2%5.5%

    1.3%3.9% 3.3% 4.9%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    MaleFemale

    • In FY 2009, 3% of juveniles at admission to RDC reported inhalant use.

  • Inhalants Use by Race

    11.2%

    6.3%8.0% 7.6%

    10.7%

    0.8% 1.0% 0.7% 0.8% 0.8%0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    WhBla

    • In FY 2009, 3% of juveniles at admission to RDC reported inhalant use.

  • Crack Use by Sex

    3.5% 3.2% 2.1% 2.3% 2.4%

    8.8%

    2.5%

    7.8%

    1.6%5.4%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    MaleFemale

    • In FY 2009, 3% of juveniles at admission to RDC reported use of crack cocaine.

  • Crack Use by Race

    10.8% 9.9%8.4%

    5.6%9.2%

    1.0% 0.5% 0.2% 0.4% 0.4%0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    WhiteBlack

    • In FY 2009, 3% of juveniles at admission to RDC reported use of crack cocaine.

  • Heroin Use by Sex

    1.0% 1.6% 1.2% 1.1% 1.3%2.2% 1.3%3.9%

    1.6% 3.3%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f You

    th

    Fiscal Year

    MaleFemale

    • In FY 2009, 1% of juveniles at admission to RDC reported heroin use.

  • Heroin Use by Race

    3.2%4.9% 5.3%

    2.0%4.6%

    0.3% 0.5% 0.0% 0.2% 0.4%0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2005 2006 2007 2008 2009

    Perc

    ent o

    f Yo

    uth

    Fiscal Year

    WhiteBlack

    • In FY 2009, 1% of juveniles at admission to RDC reported heroin use.

  • 52.5% 54.8%

    45.9%

    59.0%

    64.2%59.7%

    62.2%63.8% 63.0%

    1.6% 2.2% 2.0% 2.6% 1.1% 1.6% 1.4% 1.2% 1.4%0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    2001 2002 2003 2004 2005 2006 2007 2008 2009

    Perc

    ent o

    f You

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    Fiscal Year

    Marijuana

    Heroin

    Marijuana & Heroin Use Trends

  • A Quick Snap Shot in FY 2010

    • Substance Abuse Treatment Needs– 88.0% had either mandatory or

    recommended substance abuse treatment need

    • 88.9% of males had either mandatory or recommended substance abuse treatment need

    • 71.9% of females had either mandatory or recommended substance abuse treatment need

    PresenterPresentation NotesApproximately 1200 youth are committed

    70% 0f 1200 is 840 youth per year needing SA tx

  • Mandatory Substance Abuse Services if:

    • One or more substances were being used at the time of the offense.

    • The offense constituted a substance-related charge, i.e., possession, with an additional requirement of substance use, or substance dependence.

    • The offense was a violation of probation or violation of court order related to failing a drug screen or failure to complete a substance abuse program.

    • The offense involved trying to obtain drugs for personal use, i.e., B&E, robbery, when the intent was to steal drugs, or rob someone of drugs, or their property to be sold or traded for drugs.

  • Recommended Substance Abuse Services if:

    • There is a prior offense related to substance abuse, but the former criteria are not met.

    • The resident admits to substance abuse or dependence, but the former criteria are not met.

    • If a committing charge was substance-related but did not involve personal substance use. For example, possession of drugs for purposes of dealing, or B&E, Robbery, etc., to obtain drugs for dealing only. Not personal use.

  • Need For Substance Abuse Treatment

    • Substance Abuse Treatment needs are evaluated while the juvenile is at RDC and recorded on the Juvenile Profile form.

  • Historically Speaking…

    • Education programs– Designed to be completed within a 16

    session time frame in approximately 8 weeks.

    • Therapy Programs– Based on progress toward completion of

    standardized treatment objectives (personal history, defense mechanisms, feelings, relapse prevention, family issues). Duration 3-6 months.

    PresenterPresentation NotesPsycho Ed-In general population situations, groups usually occur twice a week so that group is completed within two weeks. In specialized units, especially sex offender, groups generally meet once a week due to the high volume of groups already in that unit

    1 MONTH PER OBJECTIVE=4 MONTHS TO COMPLETE THE PROGRAM

    Therapy group generally meets twice a week.

  • New Treatment Direction

    • November 2006 – Received Grant from Project TREAT (Training and Resources for Effective Adolescent Treatment) to implement an Evidenced Based Substance Abuse Treatment Program.

    • March 2007 – Trained 30 staff in motivational Interviewing.

    • April 2007 – Trained 30 staff in Cannabis Youth Treatment (CYT).

    • Summer 2007 - began new programming.• 2007 and beyond - Yearly MI booster training.

  • Current Boy’s Programming• Facilities discarded exclusive substance

    abuse educational programs. • Facilities are administering MET/CBT CYT 5

    & 7 as its foundation. • Residents w/ co-occurring disorder receive:

    – individualized treatment plan– additional ind. and/or group treatment

    • SA units are paired w/Aggression Management programming (AMSA).

  • ASSESSMENT• Substance Abuse Subtle Screening Inventory –

    Adolescent Version (SASSI-A2).• Self reported history from both medical and

    psychological interviews.• DSM-IV TR diagnostic criteria from psychological

    interview. • Information provided by the community.*

    – Prior treatment records– Family accounts – Prior arrests, charges, etc.

    *when available

    PresenterPresentation NotesSASSIDepartment has been using this for many, many yearsSelf reporting instrumentThis is a screening tool only, not a diagnostic tool. It gives us a sense of whether or not we should send a client on for further assessment.Client’s can be found “at high risk” for dependence or abuse or “not at high risk”.All youth coming through RDC receive a SASSI which is administered by the case managers.

    APSIThe entire Index looks at 7 areas of life functioning, but DJJ only uses the alcohol and drug questionnaire pieceGives a qualitative and quantitative measure of substance use historyHas DSM IV TR criteria for substance abuse and dependence so that the clinician can make a diagnostic impressionSelf reporting instrument administered by BSU psychologist

    ASSESSMENT PROCESSAdministered the SASSIAdministered the APSIMedical evalPsychological evalStaffing team decision on treatment need

  • Lower Intensive Treatment Services(CYT-5)

    • Targets residents who are experimental versus abusive / dependent.– General population groups.– Individual therapy.

  • Intensive Treatment Services(CYT-12 & ITP Groups)

    • Targets residents with abusive / dependent / dependent traits. – Self-contained unit– General population groups– Individual therapy– Family therapy

  • Sorting Criteria for CYT 5• SASSI-A2 indicates no probability of

    dependence.• Experimental experience vs. abuse. • Family History / Peer history.

  • Sorting Criteria for CYT 12• SASSI-A2 indicates probability of

    dependence: OR• There is a pattern or developing pattern of

    use / abuse (any drug and/or alcohol)– Weekends, after school, parties, social

    gatherings, etc.– Some duration (use common sense)

    • Poly Substance use.• Co-occurring disorder present.

    – (ADHD, PTSD, Depression, anxiety, etc.)• Failed prior treatment attempts.

  • Beaumont• Treat Boys 16-18.• 24 bed - Self Contained Substance

    Abuse Unit.• Combined w/ Aggression Management

    – AMSA.• Satellite Services.

  • Hanover• Treat Middle School Age Boys & Up.• Self Contained Substance Abuse Unit.• Combined w/ Aggression Management.

    – AMSA• Satellite Services.• JROTC.

  • Culpeper• Treat Boys 18 & Up. • Self Contained Substance Abuse Unit.• Creative use of school scheduling.• Satellite Services.

  • Oak Ridge• Treat Boys w/ Intellectual and/or

    Developmental Disabilities.• Boy’s Outpatient “General Pop”

    Groups.

  • Bon Air

    • Treat Boys 15-17. • Self Contained Substance Abuse Unit.• Combined w/ Aggression Management.

    – AMSA• Satellite Services

  • Bon Air for Girls• All girl’s needing substance abuse

    services receive residential services.• Treatment includes individual, group &

    family therapy.• Treatment addresses:

    • Psycho-education• Relapse prevention• Skills building• Trauma / emotional, physical, sexual abuse• Gender specific issues

  • What is CYT all about?– Evidenced Based Practice– Based on the Stages of Change– Based on Motivational Interviewing /

    Enhancement Techniques– Skills Based

  • Stages of Change (Prochaska & DiClemente)

    • Pre-Contemplative• Contemplative• Preparation / Planning• Action• Maintenance• Relapse

  • Motivation Enhancement Therapy

    • MET is a therapeutic approach based on the premise that clients will best be able to achieve change when motivation comes from within themselves, rather than being imposed by the therapist (Miller & Rollnick 1991).

  • MI / MET Spirit

    • Understand ambivalence• Express empathy• Develop discrepancy• Avoid argumentation• Roll w/ resistance• Support self-efficacy

  • CYT 5 structure • Two sessions of individual

    motivational enhancement therapy &• Three sessions of group cognitive

    behavioral therapy– Teach Marijuana refusal skills / Enhance social

    support networks / Increase pleasant activities / Cope w/ high risk situation & relapses

  • CYT 7 structure• Seven sessions of group cognitive

    behavioral therapy• Ultimate goal is abstinence w/ two objectives:

    – Teach broad spectrum of skills / coping activities to help deal with problems, interpersonal conflicts, negative mood states &

    – Teach how to anticipate & challenge thoughts, cravings & urges that drive AOD use

    PresenterPresentation NotesDecision making skills, anger management, coping and craving, dealing with depression

  • CYT Modules• Motivation to change• Refusal skills• Building Social Supports• Planning for emergencies (relapse Prev.)• Problem solving• Anger awareness / management• Communication• Coping with cravings• Depression management• Managing thoughts about drug use

  • Who Else Uses CYT?

  • CSAT GRANT• Arizona• Arkansas• California• Colorado• Connecticut• D.C.• Florida• Maryland• Massachusetts• Michigan

    • Missouri• North Carolina• New Jersey• New Mexico• Ohio• Oregon• Pennsylvania• Rhode Island• Texas • Vermont• Washington

  • ITP Groups & Other Services• Focuses on a variety of clinical issues.

    – Co-occurring disorders– Family dynamics– Process of addiction– Psycho education / Pharmacology– Life skills– Contemporary / Current events– Criminogenic Factors– Trauma – Or other clinical issue related to AOD abuse

    PresenterPresentation NotesITP groups Show The Corner… DeAndre’s Blues 2nd episode.Co-occurring – ADHD, Depression, PTSD, Abuse & other Psychological / problematic behavioral issuesActivities from a variety of sourcesVideos (the Corner) Movies (28 days, Clean and Sober, Antwan Fisher)GenogramLife historyEulogySource material Pathways to Self Discovery, Phoenix Curriculum, other CBT oriented publications)SAHMSA & NIDA materials / pamphlets

  • Logistical Challenges• Time constraints

    – Length of stay (providing services in a timely & qualitative fashion).

    – Competing entities e.g., educational, vocational, recreational & other treatment programs.

    • Treatment space / confidentiality• Security / safety procedures.• Staffing ratios / budget realities

  • Glossary of Terms• MI / MET

    – Motivational Interviewing / Enhancement *Miller & Rollnick

    • CBT– Cognitive Behavioral Therapy

    • EBP– Evidenced Based Program

  • Glossary of Terms

    • CYT– Cannabis Youth Treatment

    • Stages of Change– Six universal stages

    • ITP– Individualized Treatment Plan

    PresenterPresentation NotesStages of Change - (Prochaska & DiClemente)Pre-contemplative, contemplative, planning, action, maintenance, relapse

  • Art MayerCentral Office

    786-4335

    [email protected]

    mailto:[email protected]

    Department of Juvenile Justice Substance Abuse Treatment Programs:�An Overview for the Substance Abuse Services CounselWhat are DJJ youth using? Percentage of Youth Substance Use* �FY 2009Cigarette Use by SexCigarette Use by RaceMarijuana Use by SexMarijuana Use by RaceAlcohol Use by SexAlcohol Use by RaceCocaine Use by SexCocaine Use by RaceInhalants Use by SexInhalants Use by RaceCrack Use by SexCrack Use by RaceHeroin Use by SexHeroin Use by RaceMarijuana & Heroin Use TrendsA Quick Snap Shot in FY 2010Mandatory Substance Abuse Services if: Recommended Substance Abuse Services if:Need For Substance Abuse TreatmentHistorically Speaking…New Treatment DirectionCurrent Boy’s ProgrammingASSESSMENTLower Intensive Treatment Services�(CYT-5)��Intensive Treatment Services�(CYT-12 & ITP Groups)��Sorting Criteria for CYT 5Sorting Criteria for CYT 12BeaumontHanoverCulpeperOak RidgeBon Air Bon Air for GirlsWhat is CYT all about?Stages of Change (Prochaska & DiClemente)Motivation Enhancement TherapyMI / MET SpiritCYT 5 structure CYT 7 structureCYT ModulesWho Else Uses CYT?CSAT GRANTITP Groups & Other ServicesLogistical ChallengesGlossary of TermsGlossary of Terms�Art Mayer�Central Office��786-4335��