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Introduction to Washington State’s Recommended Process for the Screening and Assessment of Persons with Co-Occurring Disorders

This training designed to meet Washington State RCW Washington State RCW TIP 42: Substance Abuse Treatment for Adolescents with Co-Occurring Disorders TIP 42: Substance Abuse Treatment for Adolescents with Co-Occurring Disorders National trends National trends Facts on the ground Facts on the ground

Effectiveness of Drug and Alcohol Treatment for Youth: Results from DATOS-A  Youth with co-occurring mental health disorders had lower treatment retention  Treatment retention was negatively associated with having mental health, health and family service needs  Youth with co-occurring mental health disorders were more likely to use all classes of drugs at follow-up

Training Module Design Take out your Tip 42 and turn to page 65

But enough about me, what about you? Expectation? Expectation? What do you want to come away with? What do you want to come away with? Beliefs about: Beliefs about: –Need for this training? –Evidenced-based treatment? –Manualized treatment?

To what extent do you agree with the following statements from 1 (strongly disagree) to 5 (strongly agree) I believe that the assessments that I provide are very effective; it’s just that how I assess has not been studied I believe that the assessments that I provide are very effective; it’s just that how I assess has not been studied I am in favor of making changes in the way we provide assessments but I am concerned that it will mean more paperwork I am in favor of making changes in the way we provide assessments but I am concerned that it will mean more paperwork

I don’t believe we need to change the way we are providing assessments. I don’t believe we need to change the way we are providing assessments. I look forward to the proposed changes in the assessment process but am concerned that I won’t be consulted about how these changes impact me. I look forward to the proposed changes in the assessment process but am concerned that I won’t be consulted about how these changes impact me.

I have been through these trainings before and I am not sure that they do any good I have been through these trainings before and I am not sure that they do any good It is important that assessments be provided consistently regardless of which agency is providing them It is important that assessments be provided consistently regardless of which agency is providing them

Tony is a 10-year-old boy in the 4th grade. He has been brought to a mental health clinic by his mother after his second school suspension for fighting. Tony was involved in a fight in the cafeteria where he hit another boy for no apparent reason. When taken to the office by a teacher and counselor, Tony cursed at them and refused to discuss the incident further. Tony's mother brought him to the clinic hoping for some advice (or medication) to help Tony calm down and behave himself. Tony as a good baby and a sweet tempered youngster. She was drinking until Tony was 4 years old and admits that he was neglected until age 4. He was removed from her care twice, at age 5 months and two years. He lived with his maternal grandmother both times. Tony is an only child. His current relationship with his mother is described as "close." Christine has been recovering from alcoholism for 5 years. She is currently employed and recently broke off a long- term relationship with a man who had a lot of conflict with Tony. Christine denies that Tony has been physically or sexually abused.

Tony has always been behind academically and teachers described him as having attention problems. His strengths include arts and crafts he also enjoys sports and music. Tony's aggressiveness was first noted when he was two and a-half. He has always lashed-out physically and verbally at his peers and adults who tried to calm him. As a result Tony hasn't had many friends; although this year he has developed a “reputation” and begun to hang around older boys who also get in fights. Tony hasn't been in any trouble outside of school, but his mother is worried that he will. In the mental health interview, Tony is withdrawn and sullen. He warms up a bit when allowed to choose an activity and talks a little while shooting baskets. Tony complains that other kids pick on him and that he gets in fights when he tries to stop them. Tony says he "hates" school. He says he likes basketball and video games and he does both of these activities alone.

Questions 1. What are the risk factors in Tony’s history? 2. Is Tony more or less at risk for mental health disorder, substance use disorder or criminal involvement? How can you tell?

Questions 3. What are protective factors now present? 4. What are potential protective factors?

Risk Factors Family History of Substance Abuse or Family History of Substance Abuse or Mental Health Disorder Mental Health Disorder Early Dysregulation (affect, cognitive, behavioral) Early Dysregulation (affect, cognitive, behavioral) Environmental Problems Environmental Problems –Family –School –Peers –Neighborhood

Protective Factors Positive Parenting Positive Parenting –High Monitoring/ High Warmth School Success School Success Positive Peer Relationships Positive Peer Relationships Maintaining Normal Developmental Pathway Maintaining Normal Developmental Pathway Delay Onset and Progression of Substance Use Delay Onset and Progression of Substance Use

Module I Introduction to Screening and Assessment of Persons with Co- Occurring Disorders: Overview and Focus on GAIN-SS

Module I Objectives Review history and expectations of training series Review history and expectations of training series Introduce and review TIP 42: Chapter 4 – Assessment Introduce and review TIP 42: Chapter 4 – Assessment Distinguish between screening and assessment Distinguish between screening and assessment The importance of screening across disciplines The importance of screening across disciplines Introduction of the GAIN-SS for screening Introduction of the GAIN-SS for screening

Substance Use Mental Health Symptoms Childhood Risk Factors Adapted from NIDA, 1998 Substance-Induced Impairment Impaired Self- Regulation Co-Occurring Disorders of Adolescence

Substance Use Mental Health Symptoms Impaired Self- Regulation Disruptive Behavior Disorders Disruptive Behavior Disorders Mood Disorders Mood Disorders Anxiety Disorders Anxiety Disorders Psychoses Psychoses Adjustment Disorders/ Transient Stressors Adjustment Disorders/ Transient Stressors

Substance Use Mental Health Symptoms Substance-Related Impairment Intoxication Intoxication Withdrawal Withdrawal Prolonged Use Prolonged Use Psychosocial Consequences of Use Psychosocial Consequences of Use Exacerbation of Symptoms Exacerbation of Symptoms

GAIN-SS Global Appraisal of Individual Needs – Short Screener Global Appraisal of Individual Needs – Short Screener Designed for use in general populations to quickly and accurately identify who would have a disorder on the full GAIN and rule out those who would not Designed for use in general populations to quickly and accurately identify who would have a disorder on the full GAIN and rule out those who would not Designed for self-administration Designed for self-administration Take 3 to 5 minutes to administer Take 3 to 5 minutes to administer

Assignments Read and review TIP 42, Chapter 4 and be prepared to discuss your initial reactions and questions. Read and review TIP 42, Chapter 4 and be prepared to discuss your initial reactions and questions. Pay particular attention to the case studies as we will be working with these cases throughout the training modules. Pay particular attention to the case studies as we will be working with these cases throughout the training modules. Review the GAIN-SS and be prepared to discuss reactions. Review the GAIN-SS and be prepared to discuss reactions. Review the Perceptions of Global Appraisal of Individual Needs – Short Screener (GAIN- SS): A Pilot Study, and bring your reactions. Review the Perceptions of Global Appraisal of Individual Needs – Short Screener (GAIN- SS): A Pilot Study, and bring your reactions.