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Effective Use of Revised Child COD Supplemental Forms: MH 552, MH 553, MH 554. Your Trainers. Joy Chudzynski, Psy.D. UCLA Integrated Substance Abuse Programs Thomas E. Freese, Ph.D. UCLA Integrated Substance Abuse Programs. Introduction: What we will cover.

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Your trainers
Your Trainers

Joy Chudzynski, Psy.D.

UCLA Integrated Substance Abuse Programs

Thomas E. Freese, Ph.D.

UCLA Integrated Substance Abuse Programs


Introduction what we will cover
Introduction:What we will cover

Review of substance use in children and adolescents

Review screening and assessment in developing appropriate interventions for those who are using or are at-risk for using alcohol / drugs.

Review Revised Forms MH 552, 553, 554

Practice New Forms

Wrap-Up, Q & A



Prevalence
Prevalence .…

• In 2012, 60% of Students age 12-17 report that drugs are used, kept or sold on their school grounds.1

• 52% say there is a place on or near school grounds where students go to drink, smoke, or use drugs during school. 1

• Before the age 13, 21% of high school students reported that they tried alcohol; 8% reported that they tried marijuana before the age of 13. 2

1 National Center on Addiction and Substance Use, 2012

2 Centers for Disease Control and Prevention, 2012


Children adolescents with substance use disorders
Children & Adolescents with Substance Use Disorders...

• Are largely undiagnosed;

• Are distributed across diverse health and social service systems;

• Are more likely to be involved in the juvenile justice system;

• Have higher rates of child abuse(neglect, physical and sexual abuse);

• Have high co-morbidity with psychiatric conditions.


More than half of new illicit drug users begin with marijuana
More than half of new illicit drug users begin with marijuana

National Survey on Drug Use and Health (NSDUH), 2010


Drug use is highest among those in their late teens and twenties
Drug use is highest among those in their late teens and twenties

National Survey on Drug Use and Health (NSDUH), 2010


National survey data substance abuse dependence among youth 12 17
National Survey Data: Substance Abuse/Dependence among Youth (12-17)

National Survey on Drug Use and Health, 2002–2011


Adolescents receiving substance abuse tx in county programs los angeles n 1 591
Adolescents Receiving (12-17)Substance Abuse Tx. in County Programs, Los Angeles (N=1,591)

FY 07/1/11-06/30/12


Adolescents receiving substance abuse tx in county programs los angeles n 1 5911
Adolescents Receiving (12-17)Substance Abuse Tx. in County Programs, Los Angeles (N=1,591)

FY 07/1/11-06/30/12


Total open children and tay in 457 dmh directly operated contracted programs july 2012 dec 2012
Total Open Children and TAY in 457 DMH (12-17)Directly Operated/Contracted Programs(July, 2012 – Dec, 2012)


Children and tay clients with dual codes completed july 2012 dec 2012
Children and TAY Clients (12-17)with Dual Codes Completed(July, 2012 – Dec, 2012)



Facts about adolescent cod
Facts About (12-17)Adolescent COD

• In 2011, 2.0 million youth (8.2% of the population aged 12-17) reported at least one major depressive episode (MDE) in the past year.

• Among 12-17 year olds who had past year MDE, 36% had used illicit drugs during the same period.

SOURCE: 2011 National Survey on Drug Use and Health, SAMHSA.


Substance use among youth by mde in past year 2011
Substance Use among Youth*, by MDE in Past Year (2011) (12-17)

SOURCE: 2011 National Survey on Drug Use and Health, SAMHSA.


Cod and juvenile justice
COD and Juvenile Justice (12-17)

• Nearly two-thirdsof incarcerated youth with substance use disorders have at least one other mental health disorder;

• As many as 50% of substance abusing juvenile offenders have ADHD;

• About 30% of incarcerated youth with substance use disorders have a mood or anxiety disorder;

• Those exposed to high levels of traumatic violence might experience symptoms of posttraumatic stress as well as increased rates of substance abuse


Trauma among adolescents presenting for treatment for sud
Trauma among Adolescents Presenting for Treatment for SUD (12-17)

• 40-90% have been victimized

• 20-25% report in past 90 days, concerns about reoccurrence

• Associated with higher rates of

- Substance use

- HIV-risk behaviors

- Co-occurring disorders


Substance use among those with developmental disabilities dd
Substance Use among those with Developmental Disabilities (DD)

• Prevalence of use among those with DD may be twice as high

• Exposure and experimentation among those with a DD may be delayed, but problems arise sooner after

initial use

• Social, academic, economic, and mental health issues may cause stresses that contribute to use.

• Parents/teachers/providers often “protect” such individuals from information or education, and delay identifying and addressing experimentation, use, abuse.

Westermeyer et al., 1996; National AIA Resource Center , 2005



Screening and assessing children and adolescents for substance use risk

Screening and Assessing (DD) Children and Adolescents for Substance Use Risk


What is the difference between

What is the Difference between… (DD)

What’s Going On in These Pictures?


Screening
Screening (DD)

Conducted with large numbersof people to identify the potentialthat a problem exists

Screening is intended to be broad scale and produce false positives

Screening leads to more in-depth assessment and intervention for people identified with a potential problem


Assessment
Assessment (DD)

Assessment is individualized andspecific.

Assessment is designed to identify particular needs and rule-out false positives

Assessment leads to more individualized intervention for those identified with a problem


What can be determined through the screening and assessment process
What can be determined through the screening and assessment process?

The interplay between the substance use and the mental health problem, and the degree to which substance use affects mental health functioning

The frequency, duration and quantity of use and resulting diagnosis (i.e., substance abuse or dependence)

Use of Screening (MH554), Parent (MH552), and Supplemental COD Assessment (MH 553) forms ensures that the topic will be raised and those who need additional assessment and intervention are appropriately identified.

This will better inform the Treatment Plan and help identify substance use interventions that support Mental Health Goals.


Rationale for revising cod child forms
Rationale for Revising process?COD Child Forms

  • Health Reform = new expectations / requirements for the delivery of more integrated and evidence-based care, and better documentation of service.

  • Substance use/abuse cannot be the principal mental health diagnosis of a DMH consumer, yet many are severely impacted by substance use which compounds mental health symptoms.

  • There have been system-wide challenges aligning substance use issues and mental health diagnoses when screening and assessing COD among Child and Adolescent consumers.

  • DMH designed new forms (with the help of UCLA and others) to help clinician engage, and gather appropriate information to assist in development of COD interventions that will improve mental health functioning.

  • Implementation of IBHIS allowed for revisions and streamlining.


Cod child screening mh 554 revisions

COD Child Screening process?(MH 554) Revisions


Mh 554 revisions cod substance abuse screener
MH 554 Revisions process?COD Substance Abuse Screener

  • Must be interviewer-administered to all children 11 and older (clinical judgment if <11)

  • # of Screener Questions Streamlined: 15 Qs 10 Qs

  • Less formal language (styled after CRAFFT and other EB screeners for adolescent SU)

  • Several Qs removed about specific consequences

  • 2 Qs added about general consequences and family member substance use

  • Qs (e.g., tolerance, loss of control) that support Diagnosis moved to Child Assessment to be completed by AMHD/Clinical staff

  • Any YES leads to Administration of the COD Assessment Form (MH 553)


Risk factors for children age 11 and under
Risk Factors for Children process?Age 11 and Under

  • Parental/caregiver substance abuse

  • Substance use endemic in school/neighborhood

  • School performance slipping (grades, detention)

  • Shift in friends

  • Moodiness

  • Unexplained burns/sores/injuries

  • What else?


Cod child parent caregiver questionnaire mh 552 revisions

COD Child Parent / Caregiver Questionnaire process?(MH 552) Revisions


Mh 552 revisions cod parent caregiver screener
MH 552 Revisions process?(COD Parent/Caregiver Screener)

  • Must be interviewer-administered for all children 11 and older (clinical judgment if <11); explore family and consumer risk.

  • # of Screener Questions Streamlined: 16 Qs 8 Qs

  • Less formal language (styled after CRAFFT and other EB screeners for adolescent SU)

  • Some Qs retained or collapsed

  • Some Qs about specific use behaviors removed

  • Any YES; use clinical judgment regarding administration of COD Assessment Form (MH 553)


Cod child assessment mh 553 revisions

COD Child Assessment process?(MH 553) Revisions


Mh 553 revisions supplemental cod assessment
MH 553 Revisions process?(Supplemental COD Assessment)

  • AUDIT C (EB Alcohol screener) – 3 Questions Added

  • Drug categories added and specified to reflect current adolescent drug use trends

  • Quantity and frequency of use combined, Route of Administration added

  • Positives/Negatives of use delineated to help support impact of SU on MH functioning improved documentation of MH as Primary with SU exacerbating MH symptoms.

  • Qs (e.g., tolerance, loss of control) that support Diagnosis moved to Child Assessment to be completed by AMHD/Clinical staff

  • Administer if any YES on 554, use clinical judgment if

    YES on 552


Practice with the revised forms
Practice with the process?Revised Forms

  • Form pairs.

  • One person will play the clinician and the other will play “Marco.”

  • Practice using the Revised Child Screener (MH554) and COD Assessment Forms (MH553).

    • Experience with new forms?

    • Thoughts / Feedback?


Practice marco
Practice: “Marco” process?

15-year old freshman in high school, has been referred to DMH by school following a series of physical fights on campus, one with a teacher.

Threatened suicide on two occasions in the past 2 years, both following a brief reunion with his father who is in jail on gang-related crimes.

Spends free time with older cousin who attended his high school until recently when he was kicked out for getting caught with marijuana and pills in his backpack.

Continues to get mostly C’s and B’s in school.

Reports feeling “bummed out” about life, isolated, angry at his mother and her new boyfriend who recently moved into the house with his mom and Marco’s younger brother.


1. Precontemplation process?

Definition:

Not yet considering change or

is unwilling or unable to change.

Primary Task:

Raising Awareness—Connect SU and MH Sxs

6. Recurrence

Definition:

Experienced a recurrence

of the symptoms.

Primary Task:

Cope with consequences , relate toMH functioning as precursorand outcome

2. Contemplation

Definition:

Sees the possibility of change but

is ambivalent and uncertain.

Primary Task:

Resolving ambivalence/

Helping to choose change

Stages of Change:Primary Tasks in Linking MH and SU

5. Maintenance

Definition:

Has achieved the goals and is

working to maintain change.

Primary Task:

Develop new skills to maintainimprovements in MH and SU

3. Determination

Definition:

Committed to changing.

Still considering what to do.

Primary Task:

Help identify appropriate strategies to improve MH/reduce SU

4. Action

Definition:

Taking steps toward change but

hasn’t stabilized in the process.

Primary Task:

Help implement change strategies

to decrease MH Sxs and SU


1. Pre- process?contemplation

2.

Contemplation

3.

Determination

4.

Action

5.

Maintenance

6.

Recurrence


Practice with the revised forms1
Practice with the process?Revised Forms

  • Working in pairs, determine what stage of change Marco is in.

  • Identify one MH goal appropriate for Marco

  • Identify one or more SU interventions that would help move Marco toward this MH goal.


Thank you
Thank you!! process?

[email protected]

www.uclaisap.org

www.psattc.org

http://sbirt.samhsa.gov/about.htm

http://www.motivationalinterview.org

http://www.niaaa.nih.gov/

http://www.drugabuse.gov/


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