“Growing up is trying to find the right

substitute for your thumb”

Milkman H. (1990)

• They don’t operate out of the same rules as we do.

• They have great sense of justice no sense of law.

• There only crime is getting caught.

• They’re always on alert and in full battle mode.

• They’re tough, loyal to their gang, streetwise, well known to the Gardaí, extremely anti-authority.

• They give us a hard time just to get a rise out of us.

• They manipulate, run scams, tell fibs and sometimes bold faced outrageous lies.

• They came from poor neighbourhoods and early school leavers.

• They shared everything, lived in the now, very loyal to their friends, have a great sense of humour and great sense of fair play.

Matt Talbot Services is a voluntary organisation providing drug and alcohol treatment services to young people and

their families.

Service Design• Designing treatment programmes that attract, engage and hold

hard to reach young people.(96% retention rate 2010)• Therapeutic Relationship is key dynamic.• The building blocks to programmes based on rights and needs.• Young people/families have a voice in all matters that effect

them and they are actively involved in our developments- service user’s forums.

• Authority is democratic. A bottom up approach to everything.• A fresh start for all young people recognising wild loose

qualities as providing added value.• Social justice and a strong advocacy role.• Our effective and meaningful integration at local level is central

to service development.

Day Treatment ServicesCork City

Supported by

H.S.E. South, Drug/Alcohol Services. Probation Services, Y.P.F.S.F., S.R.D.T.F, Dormant

Accounts, Irish Red Cross

Cara Lodge ResidentialTreatment Centre West Cork

Supported by:Interdepartmentally Funded, Dept. of Health,

Dept. of Justice, Dept. of Education, The SRDRTF, Mercy Solidarity Fund

Day ProgrammeYouth Enterprise.

Training/Activity

Supported byProbation Services, FÁS.VEC

.

What we provide

THE PEOPLE WE SERVE: Young People and Families

Multi Disciplinary Teams

Manager Trabeg

Services

Manager Cara

Lodge

Manager YESDay

Programme

Chairperson Research and Development

Director of Services

Executive Committee

Chief Executive Officer Financial

Board of Directors

MULTI-DISCIPLINARY TEAM

Social Care Team

Psychotherapist

Cognitive Behavioural

Therapist

Addiction Counsellors

Practical

Instructors

Art Therapist

MA Student

FamilyCounsellors

Consultant Psychiatrist

Forensic

Psychologist

TeachersComputers

Arts/ Crafts

Horticulture

Policy Context

National Drugs Strategy 2010- 2016

• Action 49 – The need to develop a protocol for working with U18s with serious drug problems.

• Action 59 - The need for easy access to Counselling Services for U18s

• Action 60 – Treatment Services for young people to include family involvement and community integration.

The Report on the Working Group for Treatment of U18s presenting to treatment services with serious drug problems. 2005

“a need for a Service design that attracts, encourages and

retains hard to reach young people in treatment services”. (pg 51)

“A four-tier model of Service Delivery was recommended”

• 2010 National Rehabilitation Framework.

• Alcohol to be included in a new Substance Misuse Strategy. 2011

• MTS Services are guided by :- The UN Convention on the Rights of the Child; The

Child Care Act, 1991and 2001;The National Children’s Strategy Our child, their lives; The Health Strategy Quality and Fairness – A Health System for You

Numbers young people referred in last 3 years

257

278284

240

250

260

270

280

290

2008

2009

2010

2008 2009 2010

Sources of Referral 2010

21%

21%

13%

7%

7%

7%

2%

7%

3%

12%

Family

JLO

Probation

Self

Social Worker

Youth Initiative

Other

LDTF

Youth reach

CAMHS

.

Profile of Young Poly Drug User 2010

72 % presented with mental health issues

93% Involved in the Juvenile Justice

System

60% From socially excluded designated

areas of disadvantage

70% using substances by age 11

68% of young people

experienced trauma

54% Early school leavers no formal qualification

58% Combination of

alcohol and benzodiazepine

s

4% In Care

35% Violent Crime

73% From one parent families

38% Involved with Youth Homeless Services

Poly Drug Profile 2010

94 93

20 20

82

34

2

34

94

10

10

20

30

40

50

60

70

80

90

100

Percentage of young people usingspecific drug

Alcohol

Cannabis

Cocaine

Ecstacy

Benzodiazepines

Amphetamines

Heroin

Aerosols/ Solvents

Mephadrone (headshopproducts)

Crystal meth.

% %

%

%

%

%

%

%

%

%

Profile of Crimes Committed by Young People 2010

35

73

6

65

2.3

44

75

0

10

20

30

40

50

60

70

80

Percentage of young people committingspecific crimes

Assault

Possession of aWeapon

Arson

Disorderly Conduct

Attempted Homicide

Auto Theft

Possession ofSubstances

%

%

%

%

%

%

%

Working with adolescent

Is it Science with Art?Listen!!

These are interventions for which there is consistent scientific evidence showing young

people’s treatment outcomes.

Evidence Based Practices

Our interventions have a strong basis of scientific evidence:-

• Cognitive Behavioural Therapy

• Motivational Interviewing

• Brief Intervention

• Relapse Prevention

• Family Systems Approach- Strengthening Families Programme.

Clearly Measured Outcomes

Our Treatment programmes rely on

outcome data to determine treatment

efficacy.

Our treatment practice is supported

from both a theoretical and

outcomes based position.

Care Co-ordination is an evolving partnership between stake holders and treatment providers that results in better outcomes and more efficient use of Treatment resources.

Young People need Case Managerswho can advocate for themacross the entire treatment

continuum.

Harm Reduction Approach• We offer services regardless of the level of motivation. • It is an approach of pragmatism rather than purism –

an acceptance that it may sometimes be better to go for a probable silver than a possible gold.

• Empowers some young drug users to develop healthier live styles even when they are ambivalent regarding stopping their drug use.

• HR recognises that drug use is multi-faced and sits on a wide continuum from severe use to total abstinence.

• It engages drug users in a way that reduces the negative consequences and meets the young person earlier in the dependency continuum.

Developments 2010 – Enhancing Best Practice

Bio Psycho Socio-legal

-Dept. of PharmacologyUniversity College Cork

-3yr PhD Benzodiazepine abuse among young people-Educational Seminar with GP’s-Health Literacy Study-Staff Training

-Dept. of PsychologyUniversity College Cork

-Ma in Applied PsychologyMapping life paths

- Ongoing research and support

Dept of LawUniversity College Cork

- Law Lectures-Ma Students research in Sept.-Law Clinics

Other developments….Accreditation Forensic

PsychologistFamily Therapist

Networks & Partnerships

Networks & Partnerships

Quads and CHKS(Caspe Healthcare Knowledge Systems-UK Accreditation Body)

Interventions with young people and staff training

Evaluation of family programmesFamily therapy

1. University College Cork: Law. Psychology, Pharmacy, Social Work, Art Therapy

2. Youth Justice Service Northern Ireland.

3. Rutgers University, USA Centre for Drug and Alcohol Research

• Towards engagement, relationships

and connection

• It isn’t what you do that counts, it’s what you are!

• You gotta have a heart being present to pain.

Why are young people difficult to work with?

Normal Adolescent Development.

Drug Abuse.

Multiple Diagnosis

Difficult Family situations/living situations.

Normal adolescent development.

• Individuation• Separation• Autonomy• Co-operation

Individuation

“Who am I”

Separation

“I have to separate from my family to develop independent thought and action”

Autonomy

They don’t accept everything their parents say just because they say it.

Co-operation

They begin to master the skills of successful integration with peers and

a wider community.

To Sum Up

Mastering the developmental tasks of adolescents is a very frustrating process….

for adults.

We need pre-treatment programmes for pre-contemplative Young People!

Two things in common

1.They had no choice about coming to our service.

2. They had no level of acceptance that they had a drug/alcohol problem

Goal of the pre treatment process

• Engagement

• Perception shift

• Agree to enter appropriate treatment.

Drugs

• Young People who use drugs to dull their senses or avoid reality have something inside that hurts.

• The self hurts- the drugs work!

Serious Drug Use often reveals a complex interplay of biological, psychological and social

difficulties.

Gang

Neighbourhood

Family

Young people’s choices to use drugs are often made as a

result of their wider experience of society.

Young Person

Enhancing Outcomes through Client Driven Treatment

Matt Talbot Services

Quantum of Services

Engagement

Pre-Treatment Programme

•Initial/Comprehensive Assessment

•Day Treatment Programme

•Relapse Prevention

•Harm Reduction

•Individual Counselling

•Psycho/educational Groups•Fathers/Mothers Support Group

•Family Counselling

•Aftercare Support

•Aftercare Support

•Onward Referral

•Psychiatric Consultation

•Brief Interventions

•Crisis Intervention

•Community Support

•Multi-Agency Collaboration

•You Can Heal Your Life – Louise Hay

•Service Users Forums.

•Training and Activities

•Empowerment Life Skills •Educational Skills

•Personal Development

•Strength Focused Skill Groups

Cara Lodge

Residential Treatment Centre

National Winner of Children Act Advisory Board Awards for Services to Young People

CARA LODGE

• Is a drug free programme for boys 14 to 18 years who are enmeshed in a subculture of chaotic substance abuse with coexisting psycho/social challenging behaviour.

• Capacity for 6 young people• The length of stay is determined by a young

person’s presenting needs/treatment goals.• The programme is divided into 3 phases: settling

in, laying foundations and community re-integration.

“One size fits all” treatment onlyworks for the client who happens to fit that

modality – the rest aresquare pegs being forced to fit through

round holes.

Tailoring Treatment to Young People.

More is not necessarily betterand, in fact, can produce

diminishing returns.

Engaging the young personin Treatment

requires us to focus on theclient's strengths, resiliency,

and what motivates him.

The important treatmentquestion is

“What does the young person want?”

The challenge is to create anethical balance between whatthe client wants and what is

clinically determined

A Day at Cara Lodge… Hi

Counsellor

Weekend Activities include:

Fishing, hill walking, horse riding, cinema, outdoor adventure, pitch and putt, soccer and football.

Young People get a good kick start in Treatment but it is continuous work and

support of the family/ carers and strong community links that will make the real

difference.

0

5

10

15

20

PRE RESIDENTIAL TREATMENT 2008

Series1 20 2 3 20

Daily Use Education Employed Offending

0

5

10

15

20

POST TREATMENT OUTCOMES 2010

Series1 4 19 7 8

Daily Use In Education Employed Re Offending

0

5

10

15

20

25

ON ENTERING RESIDENTIAL TREATMENT 2010

Series1 24 7 2 22

Daily use In

Education Employed Offending

Cara Lodge Residential Treatment Service Outcomes 2010

3 16 6 6

After Care Discharge Graduation ceremony when treatment goals have been

completed.

Each Young Person has his Individual Relapse Prevention Programme. (Marlott got and Gordon’s).

• Services User Research in 2009 – • Young People not happy with After Care Service.• Looked for a full-time outreach worker.

Structured Training/Activity Day Programme

Youth Enterprise

Scheme

Low self esteem

Alcohol Misuse

Boys 16-18 years

Who have…….

Poor Health

Difficulties engaging

Ongoing involvement with Justice System

Drug Misuse

Difficulties in sustaining relationships

Lost opportunities of education

Ambition

Positive mental well being

Reduced offending

Increased positive relationships

Increased Self Esteem

Reduction in alcohol and drug misuse

Certification in education

Why? Outcomes

In Partnership with the Probation Service

Thank YouThank You

If you have the courage- love the young people If you have the courage- love the young people you work with, so they may learn to love you work with, so they may learn to love

themselves.themselves.