1 Jacqui de la RUE, MAPS, Health Psychologist (Registrar)Young people and dual diagnosis: Seeing the recovery model in action, and the impact for health behaviour change research, and practice. Jacqui de la RUE, MAPS, Health Psychologist (Registrar)
2 Dual diagnosis counselling program:Who comes to BYS and what are their stories Referral trends, demographics, DASS-21, K-10, and MSC (self-report measure) Health Behaviour Change: How change happens Change: BOTH as individual AND dependent of SDoH “What’s my take home point” Practitioners – if you’ve only got 10 sessions, what can you do… Toolkit and Measures -- websites, scales, resources , and toolkit options Researchers – why isn’t health psychology doing more with the Recovery model? Top tips -- participation, involvement, visually based resources, focused on skills
3 Social justice, strengths-based, harm minimisation, person-centredMultidisciplinary youth service supporting homeless and disadvantaged young people aged years, and their children. Holistic support programs emergency support, case management, activities, groups, intensive support, and research and evaluation. Social justice, strengths-based, harm minimisation, person-centred Housing support Crisis, transitional and supported housing Sustaining young tenancies pilot program Health Services AOD services Health clinic (nurse and GP support) On-site counselling program Day to day living program (NDIS, 2018 onwards) Women’s Team Transitional Housing Women’s safe space – groups Intensive Case Management Families Team Positive parenting and communication style Attachment and circle of security groups Intensive case management
4 Who comes to BYS? 2015-2017 n=1200,12-25 years24% Aboriginal and/or Torres Strait Islander (ATSI) 14% Migrant or refugee, and CALD 29% - Parents 16% - LGBTIQ AND…34% are experiencing current violence, 29% have current legal issues, 54% have poor or no family support, 36% are unemployed , 17% have no current income 39% current debts
5 Key reason: 47% mental health diagnosis: 20% current AOD issues:56% housing support is their primary reason for contact, followed by: financial assistance, support with mental health, and substance use issues. 47% mental health diagnosis: 21% self harm and 29% report suicide risks 20% current AOD issues: 49% past issue 42% currently using illicit drugs 53% Cannabis 19% Meth/amphetamines.
6 Supporting the findings of Cost of Youth Homelessness in Australia Study (2015): - Higher rates of interacting issues for homeless young people
7 How did it all begin…. 2011. No counselling program on site.Health Onion approach: How do young people use this service THEME = Accessible not just available How is information communicated to young people THEME = I trust my worker, not a brochure What barriers are there (real or perceived) THEME = I don’t volunteer information easily
8 The concept of Recovery:The value of the lived experience + the expertise, knowledge and skill of the practitioner There is no single definition of recovery. Personal recovery “definition”: As an ongoing process or journey recovery is not concerned with ‘achieving’ a state of being ‘recovered’. Reference: The national framework for recovery-orientated mental health services: A guide for practitioners and providers, 2013. ”
9 Recovery concepts in practiceOutcomes that are unique to the person (they decide) Real choices (what strengths are already there) Attitudes and rights (What is important to the YP) Respectful engagement (taking their concerns seriously) Partnership (YP – life expert Psych – skilled practitioner ) Evaluating Change (Recovery does not mean no evaluation)
10 The on-site counselling serviceFLEXIBLE COUNSELLING OPTIONS - Crisis intervention (unplanned support) Brief counselling (2-3 sessions) Short term counselling (6 sessions) Longer term counselling (8-12 weeks) Handover (4 months or longer) INTERVENTION STRATEGIES –ACT, DBT, CBT, and SFBT. HEALTH BEHAVIOUR CHANGE: AOD Measures, Outcomes Star, SCID I & II, Relapse Prevention, M.I. Change talk, T1/T2 specific measures Measuring CHANGE: Young people coming to short term and longer term counselling, completed the following measures: K-10 (on referral, and at 4 weeks) DASS – 21 (at 8 weeks, at exit) T1, T2 – AOD measures
11 Referral trends (n=458, 2012-2017) Reason for referralsKey referral combinations (by gender) Alcohol and drugs (35%) Dealing with anger (60%,) Feeling better about myself (30%) Goal setting for the future (70%) Relationships (70%) Depression and anxiety (75%) Ways of coping better (85%) How many options did YP select: one option: <5% 2-4 options: 20% 5-7 or more: 75% Females: Relationships, Goal setting, depression and anxiety; ways of coping better, feeling better about myself Males: Dealing with anger, feeling better about myself, ways of coping better, goal setting. Transgender: Ways of coping better, dealing with anger, feeling better about myself, relationships, goal setting.
12 DASS-21 scores (n=367, 2012-2017) Provisional Psych (interns)Individual Measurement how many YP worked with… DASS collected at 6 and 12 weeks 1 intern (4 months) = 20% D-scale, significant, p=0.03* A-scale, significant, p=0.05* 2 interns (8 months) = 30% D-scale, significant, p=0.01* 3-4 interns (12 – 18 months) = 50% (n=221) DASS Stress scale: No significant change across all groups, p=0.07
13 Why is that? BUT the social determinants of health had greater impact:Individual skills have improved (thinking, feeling, problem solving, decision making). BUT the social determinants of health had greater impact: “I’m still homeless” “I’m still in that domestic violence relationship” “I still don’t have a job” “I’m still sorting out those legal issues”
14 The lived experience of how change happensCHANGE ITEMS (N=221) Change Story Title (MSC) Did not make the change 20% “I thought change would be easier” Changed for a few weeks/months 15% “I’ve tried this before, it didn’t work then, and it didn’t work now” “My friend kicked his/her habit, why didn’t I?” Made the change, but I don’t always stick to it 40% “I have some relapses, I’m still learning all this new stuff.” Made the change, <6 months ago, sticking to it “I tired it out, I didn’t get it all right, and I learnt as I went on” Made the change, >6 months ago, sticking to it 5% “I kept it up, I gave myself permission to fail and then keep going.”
15 20% did not make the change (n=44):“It might be bad for me, but it helps me cope” “I like taking drugs – it does take away the pain” “When I’ve sorted out [insert here] I will deal with the drugs” Made the change
16 What did the young people say…“Helped me with my problems and provided me with someone I could talk to. They took what I said seriously. I felt heard. “ (F, 16) “I could come in, I could make an appointment. No fuss, no drama. If I missed one, they did not get all stupid about it. I was just able to make another one. They understood me.” (M, 20) “Well, I was nervous about this, but my worker said I could meet with the head woman and ask some questions before coming along. I thought maybe it would be ok. Jacqui introduced me to the intern psych’s and I saw her for 5 months. It helped me a lot. So I asked to be handed over to the next one. ” (F, ATSI, 25) “I’ll be honest, I did not want to come to see the Psych’s here. But then I noticed some of my mates, and the changes they made. So I said I’ll only go once. That was a year ago. I’m still coming along. It wasn’t as bad as I thought it would be.” (M, ATSI, 22)
17 What did the Interns say…“I learnt so much about young people, and about working in an NGO. It was an invaluable experience.” (2012) “It was great to work with clients that often fall through the cracks.” (2015) “I had heard about the recovery model, but I had not seen in practice. This placement showed me how to use it [in counselling], and it challenged what I previously though about the causes of drug use and misuse.” (2013) “I really feel more confident about dual diagnosis now, and about what to look for, and how to devise a case formulation with young people. Thank you, BYS.” (2014) “The young people impressed me the most. They came for counselling, I had very few missed appointments.” (2016) “This has changed me professionally. I think everyone should do a placement with young people.” (2017)
18 What’s my take home point: 10 sessions and no more…“Teenage Mental Health: What helps and what hurts?” 2009, n= 227,12-20 yrs, 18 months UK study Four key principles working with YP: Participation and involvement Visual (over talk-based) resources Focus on skill development Support: Expect to have to encourage the YP to talk
19 Outcomes Star http://www.outcomesstar.org.uk/ 1-2 Stuck stage –“I’m not ready to change” 3-4 Accepting help stage – “I want someone else to sort things out “ 5-6 Believing stage – “I can make this change” 7-8 Learning Stage – “I’m learning how “ 9-10 Self Reliant Stage – “I can manage without help”
20 What’s my take home point: ResourcesAOD Measures (include the context) Adolescent Relapse Coping Questionnaire (ARCQ) – 2004 SOCRATES (Stages of Change Readiness Treatment Eagerness Scale) – 1990 Alcohol version – “Sometimes I wonder if my drinking is hurting other people” (Q6) Drug version – “I’ve already started to make changes to my drug taking”(Q4) Time 1, Time 2 (test- retest) Australian Treatment Outcomes Profile (Module 3: Review, Turning Point) Resources (websites) Turning Point, Talk to Frank, Reach Out, headspace (fact sheets)
21 What’s my take home point: Supervision and CollaboratingMulti-disciplinary case conferencing: Change is a function of both individual factors, and SDoH, so working with other providers will be essential; In my role: 40% of my time is in case conferencing
22 What’s my take home point: ResearchersIf “recovery” is all about an individual journey… Health Psychology is all about QoL, hopefulness, community connectedness, health attitudes, health beliefs, behaviour change, THEN…. Is there more than HP to do more with the Recovery model? Recovery model and.. HIV? Diabetes? MS? Chronic fatigue? Pain management?
23 Let me finish with some good news…I started this presentation talking about the wide range of complex issues that young people face… Results from our BYS Annual survey (2017) reveal….positive changes
24 Young people say: They feel more capable They are saferThey have more stable housing and material basics They are more connected with support Their physical and emotional/ mental wellbeing has improved They are participating more They have more voice in their life And all of those are Recovery-based markers.
25 Jacqui de la RUE, MAPS, Health Psychologist (Registrar) Ph: BYS Website: BYS Facebook: https://www.facebook.com/brisyouth