Youth AOD Services in NZ

Youth AOD Services in NZ
From little things, big things grow
Grant Christie
How should we describe Youth AOD
services in New Zealand?
Once upon a time...
Ad hoc, inconsistent, developing, diverse, variable, nonexistent
In the future
Comprehensive, consistent, effective, evidence-based,
culturally responsive, CEP-enhanced
Youth AOD vs CAMHS – how are they
different / the same?
Engagement-focused services – CAPA is not
enough
Primary care interventions – liaison
depends on strong specialist services
Youth AOD vs CAMHS – how are
they different / the same?
Black and white twin
sisters Kian (left) and
Remee (right), seven
years after they came
into the world
The same genetic
building blocks but
quite different
appearance
Youth AOD services – similar to CAMHS
Multidisciplinary
Culturally responsive
CEP capable
Collaborative
Family inclusive
Linked to primary care and the community
Range of difficulties
Mean domain scores in each service including 95%
confidence intervals for mean
Total problems
Leisure
Peer Relations
Domains
Work
School
Family system
Substance
use service
participants
Social skills
Psychiatric sympts
Health
Mental
health
service
participants
Behaviour
Substance use
0
10
20
30
40
50
Mean domain scores %
60
70
Youth AOD services – different to CAMHS
AOD focus
Family via young person
Mobile
Engagement
Minimisation of harm
MH focus
Young person via family
Office - based
Triage/assessment
Treatment of disorder
Young people with AOD problems…
Are more likely to be male, Maori, poor, in trouble with the law,
out of school, low parental supervision, past trauma and adversity,
impulsive, angry
HELP-SEEKING behaviour
HELP-GETTING
‘I don’t have a health problem’
‘I’m not crazy – not going to a mental health service’
‘I don't fit in, often in trouble, don’t do normal’
Engagement-focused services –
CAPA is not enough
What does
it take to
decide to
change?
Traditionally health services are based on the
assumption…
That young people and their families believe
They have a problem
They need help
Someone is able to help them
CAPA = demand management tool
Low or inconsistent/intermittent demand
but high need
We need services that take time to…
build trust and relationships
persuade about the value of change
Factors associated with engagement
and retention in treatment
 Service responsiveness
 Realistic goal setting
 Therapeutic alliance
 Family involvement
 Practical support and semi-formal contact
 Group work
 Aftercare and transitions
Service responsiveness
 Interesting
 Responsive and confidential
 Respectful, trustworthy, warm, flexible
 Caring, committed and optimistic staff
Realistic goal setting
 Goals need to be
 Achievable
 Negotiated between young person, parents, practitioner
 Initial motivation isn’t related to outcome (nor self
efficacy)
 Support YP to understand reasons to change
 Build motivation and awareness
 Treatment builds confidence and self efficacy
Therapeutic alliance
 Effective and collaborative bond between therapist and
patient
 Addresses questions and anxieties
 Respects their wishes
 Aided by
 Orienting yp’s to services
 Making treatment voluntary
 Confidentiality
 Poor alliance leads to quick treatment drop out
Family involvement
 Alliance with family important
 Secures early changes in substance use and behaviour
 Can assist with enhancing engagement in tx later
Designing AOD services for YP
Individual interventions
Family interventions
Group interventions
Detoxification expertise
CEP - enhanced
Close liaison with CAMHS
Liaison
Primary care liaison
What is effective liaison?
Contact that leads to well-being or minimisation of harm
1. Appropriate referrals
2. Brief AOD interventions
3. Longer interventions
What is primary care for youth?
Family doctor  - all good if you have family with
effective help-seeking strategies
Any kind of youth service, schools, alt eds, NGO that
isn’t a secondary or tertiary service
Don’t get picky about what or where this is. Designate
this and you immediately begin to lose some of those
you are trying to target.
How do you get to Primary Care?
Whatever young people end up accessing
or wherever they seek help from,
if not primary care, it should be a point from which they are
supported to get there
Primary care
Family
What AOD work can Primary Care do?
A lot
If they have time, training and effective back up
Research evidence for Brief Interventions in
primary care is good
Unfortunately practice differs from research
Primary care liaison depends on strong
specialist services

Ok, what should I do then?

I can do that… but can you show me first?

Can I check in with you once I have done a few?

Can I call you if I get into trouble?

This is getting hard – help!

I’m out of my comfort zone… Can you take over?
Examples of AOD in primary care
GP asks parents (with SUD) about their teenagers use –
provides advice about early warning signs and refers to
informational website
School nurse completes a BI with young person – follows
up on progress regarding plan to cut down
Youth Justice social worker discusses AOD with YP and
refers to Youth Health service for check up
Alt ed counsellor supports young person to complete an
e-therapy
Final thoughts
Youth AOD vs CAMHS
Should complement and strengthen each other
Engagement-focused services
CAPA has helped services better understand the needs of the
populations they serve
Taught CAMHS to let go of patients
Intermediary step prior to CEP engagement oriented services
Primary care interventions
Strong specialist services can advise, steer, support, mentor
Improve access, early intervention
Influence into other spheres (parental substance abuse, COPMIA)