The Hartford Youth Project

2. Presenters Peter Panzarella, M.A., M.S. Director of The Division of Substance Abuse, CT Department of Children and Families Reginald Simmons, Ph.D. Treatment Coordinator, Hartford Youth Project, Connecticut Department of Children and Families Catherine Corto-Mergins, MSW, LCSW MDFT supervisor, Village for Families and Children David Cohen, MSW MDFT Therapist, Village for Families and Children Celia Alamo, BSW MDFT therapist Assistant, Village for Families and Children

3. What is the Department of Children and Families (DCF) ?

4. DCF Connecticut Adolescent Substance Abuse Treatment Target Population: Approximately 15, 000 youth in Connecticut in need of substance abuse treatment In 1999, 1045 youth received services 70% were admitted to outpatient level of care 87% were 14-17 years of age 68% were male

5. Hartford Youth Project Purpose: To strengthen community-based substance abuse treatment for Hartford youth ages 10 to 17 by developing a comprehensive, culturally competent, gender-specific model To use the Hartford Youth Project as a model for other regions in Connecticut Federally-Funded in 2002 by the CSAT Strengthening Communities for Youth InitiativeFederally-Funded in 2002 by the CSAT Strengthening Communities for Youth Initiative

6. Why Hartford? One of the poorest cities in the country More youth from Hartford committed to juvenile training school than any other Connecticut city Significant rate of school failure and report of SA use Active community mobilization Influential Parent/Family advocacy organizations Strong Latino and African-American advocacy and service organizations Community collaboratives Pre-existing support and implementation of Evidence-Based Treatments One such community advocacy effort is the Community Partnership (NEXT SLIDE) One such community advocacy effort is the Community Partnership (NEXT SLIDE)

7. Hartford Youth ProjectObjectives Increase treatment capacity Implement cost-effective treatments modeled after the following evidenced-based treatments for adolescents: MST MDFT MET/CBT Family Support Network

8. Hartford Youth Project Objectives Provide a continuum of treatment services to include: Screening Early intervention Referral Assessment Case management Continued care

9. Hartford Youth Project Network consists of a collaboration among formal and informal entities.Network consists of a collaboration among formal and informal entities.

10. What is The Hartford Youth Project?  

11. Key Components Community Collaboration Adolescent Outreach and Engagement Standardized, Ecologically-Oriented Assessment Assessment-Driven Treatment Matching Evidence-Based Treatments Continuum of Care Family Involvement State of the Art MIS

12. Family Involvement Families are involved in development and evolution of the project Advertising informed by youth focus groups Youth representation on HYP steering committee Choice of evaluation incentives Informed cultural relevance of assessment tools

13. Family Involvement Family-Centered Service Planning Family-Driven Case Management Refer to Service Plan handout Refer to Service Plan handout

14. How is HYP Culturally-Competent? Bi-lingual, Bi-cultural engagement specialists and assessment staff Ecologically-oriented assessment and treatment matching Family-Driven, multi-domain Service-Planning Multi-systemic treatments We utilize assessments of individual characteristics, family interaction, peer relations, school experience, spirituality, etc� to acquire a rich picture of both the strengths and needs of this family. We utilize assessments of individual characteristics, family interaction, peer relations, school experience, spirituality, etc� to acquire a rich picture of both the strengths and needs of this family.

15. HYP: Outcome Evaluation Purpose: Assess the effect of treatment on substance-abusing youth served by the HYP treatment system Evaluate whether changes in the treatment system are reflected in more positive outcomes for youth Approach: Conduct pre- and post-treatment (3, 6 and 12-month) assessments with youth served (n = 180) using site-specific versions of the GAIN 5.3, GAIN M90, and ecological measures Compare youth served in the early and latter stages of the project Compare youth entering through community-based referrals vs. juvenile justice referrals

16. Multidimensional Family Therapy

17. Theory of Change Adolescent substance abuse is influenced by a combination of individual and environmental factors. MDFT is designed to work intensively with the family to reduce the influence of the factors that place an adolescent at-risk of substance abuse (such as school failure, family conflict, environmental stress), while also strengthening the presence of protective factors (such as positive parental relationship, pro-social involvement, parental monitoring).

18. What is MDFT? Treatment is mainly in-home 3-5 times per week for 3-6 months. Therapist Assistant has daily contact with family and/or system entity (school, social-service agency, etc.) Interventions are multidimensional and target: 1) adolescent, 2) parent,3) parent-adolescent interaction,4) family members, and 5) systems external to the family (education, juvenile justice, peers, social-services, etc..). Therapy itself is based on tenets of structural and strategic family therapy

19. MDFT Target Population 11 to 17.5 years old Living at home with or returning to a primary caregiver Substance abusing or at risk for substance abuse (co-occurring acting out behaviors and/or other psychiatric issues)

20. Treatment Team Two Therapists who conduct family, parent, and individual therapy with the adolescent One Therapist Assistant who provides case-management Supervisor who meets weekly with the therapist MDFT Consultant

21. Staff Qualifications Therapists and supervisors must have a minimum of a Masters degree in a counseling-related field. Training in Structural and/or Strategic Family Therapy is recommended Therapist Assistant needs case-management experience in the area served by provider and knowledge of formal and informal community resources Associate or Bachelors degree in a Social-Service field preferred.

22. Training Trainees undergo intensive six-month training process facilitated by model experts from Center for Treatment Research of University of Miami -Bi-Monthly On-site training (3-5 days each) -Monthly Review of therapist�s video-taped sessions and case-conceptualizations -Assessment of supervisor competency via video-tape review of supervision sessions -Weekly phone consultation by MDFT during 6 month training Competence assessed by written mastery exam and rating of last video-tape submission

23. Why will this Work? Randomized clinical trials have demonstrated long-term reductions in substance use and improvement in the functioning of highly at-risk adolescents from ethnically-diverse (White, African-American, and Hispanic) backgrounds and needing varying levels of care. Substance use continues to decrease and emotional/behavioral functioning continues to improve after treatment discharge . MDFT more effective and cost-efficient than standard outpatient and residential substance abuse treatment Add in references Add in references

24. MDFT Case Presentation Catherine Corto-Mergins David Cohen Celia Alamo When we first got our brochures we would go to the Juvenile Courts and we would leave with the Probation Officers brochures and our business cards along with a referral form which they would need to fill out when making a referral to the project. As a result we have gotten a lot of referrals from the courts and even mandated us at times to appear in court and assess a youth before being released, because they won�t release them from detention into the community unless services are in place. I�m fortunate to live in the community that I serve. Around the corner from my house there is a little gate way where a lot of these youth are selling drugs. One day as I was standing on my porch I saw that at the corner gas station three cars rushed into the lot. They were undercover officers in unmarked cars with tinted windows. My daughter being a teen and being curious went to the corner to see what was going on. A few minutes later she comes back to the house and tells me that one of the kids from our project was asking for me. He wasn�t my client but he was my co-workers client. At that point I wasn�t sure that there was anything for me to do, but I decided to cross the street anyway. When I got to where he was at I saw him already handcuffed to a couple of other kids. I went up to him and asked him what had happened, at this point I had already called my co-worker and let him know what was going on. The agent who had him handcuffed came up to me and asked me what was my relation to him I responded that I was Sandra Adorno that I worked at the Hispanic Health Council as an Engagement Specialist for the Hartford Youth Project and he was one of our client�s. She told me that she was going to hand him over to me and for me to make sure that he got home and keep him away from the other older kids that he was hanging with. At that time my co-worker showed up I explained all the details and he walked him home and let his mom know what had happened. When we first got our brochures we would go to the Juvenile Courts and we would leave with the Probation Officers brochures and our business cards along with a referral form which they would need to fill out when making a referral to the project. As a result we have gotten a lot of referrals from the courts and even mandated us at times to appear in court and assess a youth before being released, because they won�t release them from detention into the community unless services are in place. I�m fortunate to live in the community that I serve. Around the corner from my house there is a little gate way where a lot of these youth are selling drugs. One day as I was standing on my porch I saw that at the corner gas station three cars rushed into the lot. They were undercover officers in unmarked cars with tinted windows. My daughter being a teen and being curious went to the corner to see what was going on. A few minutes later she comes back to the house and tells me that one of the kids from our project was asking for me. He wasn�t my client but he was my co-workers client. At that point I wasn�t sure that there was anything for me to do, but I decided to cross the street anyway. When I got to where he was at I saw him already handcuffed to a couple of other kids. I went up to him and asked him what had happened, at this point I had already called my co-worker and let him know what was going on. The agent who had him handcuffed came up to me and asked me what was my relation to him I responded that I was Sandra Adorno that I worked at the Hispanic Health Council as an Engagement Specialist for the Hartford Youth Project and he was one of our client�s. She told me that she was going to hand him over to me and for me to make sure that he got home and keep him away from the other older kids that he was hanging with. At that time my co-worker showed up I explained all the details and he walked him home and let his mom know what had happened.

25. Hartford Youth Project (HYP)Referral Process

26. Demographics Family make-up Living in home: Bio-mother (45); Bio-father (38); IP-female (15); brother (13) Living outside of home Extensive extended family including other siblings living in Puerto Rico First generation, monolingual, Puerto Rican Family Acculturation process and need for culturally competent treatment approach Low socio-economic status Reside in high risk urban neighborhood

27. Presenting Problems Marijuana use Communication between mother and IP School truancy Depression History of suicidal ideation

28. MDFT Phase 1- Build Foundation/ Engagement 1-2 months of building rapport Adolescent Motivating the adolescent to engage in therapeutic process Adolescent Engagement Intervention (AEI) Encouraging a collaborative process to formulate goals Allow IP to voice their concerns and express their hopes Assess for co-morbidity, refer for psych evaluation for depressive/suicidal symptoms Parent Assess current and past stress and burden Assess current and past parenting styles Parental Reconnection Intervention (PRI) Enhance and strengthen feelings of love and commitment Motivate parents �you are the medicine�, no regrets Family Assess family interactions Understand family journey and history Develop family response to crisis (suicidal attempt) Interaction with psychiatrist

29. Phase II � Work Themes/Request Change Work with family communication Adolescent Adolescent explained that her mother was too restrictive Had conversation about adjustment to Hartford Discussion on her cutting Helped form new communication techniques Parent Instill hope about change Build sense of team between parents Address parental conflict Parent explained adolescent showed extreme disrespect towards authority Shifted content from focus on behavior to focus on emotion with parent Discipline differences ( Mother�s system of discipline) Parents trying different parenting approaches and IP reacting Psycho education on adolescent development � moving from power and control to influence Increase father involvement Family Maintaining working alliance with both adolescent and parent Age appropriate negotiation Shifted content from focus on behavior to focus on emotion with parent Facilitation of past hurts Extra-familial FWSN for external leverage Pro-social activities

30. Phase III- Seal changes and Exit Acknowledge progress and changes Review parenting style and safety plan Became less content-directive and focused more on coaching the process of the conversation Referral to Outpatient Transition from MDFT to new clinician Securing Pro-social Activities Progress of Treatment Communication between parents and IP became more frequent and substantive, no physical altercations Decrease in marijuana use IP was talking about more openly about her thoughts and feelings School truancy was not an issue No suicidal ideation at present time Parents were able to work extra-familial domain on their own

31. MDFT SUPERVISION MODEL WEEKLY INDIVIDUAL SUPERVISION (2 hr.) Role of case-conceptualization Session Planning Sheets LIVE SUPERVISION (2 x per month) VIDEOTAPE REVIEW (2 x per month) WEEKLY TEAM SUPERVISION (includes phone consult with University of Miami) 24 / 7 AVAILABILITY

32. KEY COMPONENTS OF MDFT SUPERVISION Parallel process between treatment and supervision Request change Model direct communication Assist with creativity in problem solving Instill sense of hope when clinician and family feel �stuck� Provide ongoing support

33. KEY SUPERVISION COMPONENTS (CONT.) Assist in the connection between the �big and small picture� / the generic and idiosyncratic Apply overarching principles of MDFT Assist in crafting goals / themes for the work Integrate cultural component of the family Work the �team approach� Insure quality of treatment

34. Take-Home Points Seek understanding of client�s cultural background Intervention should adapt to changing needs of family Support family(and therapist)when difficulties arise Extra-familial work is crucial David, Celia, Catherine: I felt some key take-home points were necessary. This is what I gleaned from our conversation yesterday. Reginald I felt it was important to end with some take-home points. I added several that I seemed to comprehend based on our discussions yesterday. We can alter and adjustDavid, Celia, Catherine: I felt some key take-home points were necessary. This is what I gleaned from our conversation yesterday. Reginald I felt it was important to end with some take-home points. I added several that I seemed to comprehend based on our discussions yesterday. We can alter and adjust

35. Thank You! For additional info. contact: Reginald Simmons, Ph.D. CT Department of Children and Families Phone: (860) 560-5087 Email: reginald.simmons@po.state.ct.us