Gloria Chaim

Group and Individual Couple Treatment for Substance Abuse Clients: A Pilot Study

Brief Couples Therapy is an eight-session, structured treatment for couples with substance-abuse problems. A randomized control study was conducted to compare a group format of BCT (Multiple Couples Treatment) to an individual couple format (Individual Couple Treatment). Twenty-seven couples were recruited and 20 completed treatment. Six-month follow-up data showed significant improvement in Brief Symptom Inventory and Adverse Consequences scores in both treatment groups. Male clients in both conditions and female clients in the ICT condition improved significantly in Dyadic Adjustment scores. Over two-thirds of the substance-abuse clients were able to meet or maintain their drug use goals at the end of treatment. These findings, together with the positive evaluation by the clients, support the use of BCT as a treatment modality for couples with substance use problems.

Collaborating with community-based services to promote evidence-based practice: Process description of a national initiative to improve services for youth with mental health and substance use problems.

Many youth with significant mental health (MH) and/or substance use (SU) difficulties do not receive specialized services. Collaboration between service providers, researchers, and other stakeholders is essential to improve youth service system capacity to provide evidence-based services to meet the complex array of needs of youth. Facilitators and barriers of implementing evidence-based practice have been identified, but few studies provide examples of the processes of collaboration and implementation for youth MH services. This study explicates the design features and implementation processes of a project to improve screening activities in youth services. These processes supported the building of 16 collaborative networks of service providers from diverse youth-serving sectors (e.g., MH, youth justice, child welfare) in urban, rural, suburban, and remote Canadian communities. These cross-sectoral networks implemented an evidence-based practice (screening youth aged 12–24 years for MH and SU problems using the Global Assessment of Individual Needs—Short Screener [GAIN-SS]) across their services. Materials and resources were provided by a centralized research team. Core project components were standardized and adherence to these components was monitored. Over 800 service providers participated in cross-sectoral networks, capacity-building events, joint data analysis, or interpretation and recommendation sessions. Across the 89 participating agencies, service providers for 84% of participating youth implemented the evidence-based practice accurately in accordance with project protocols, with 98% of positive screens reviewed and addressed according to organizational protocols. Service provider feedback is reported. Facilitators, barriers, and implications of promoting implementation of evidence-based practices across sites and sectors are discussed.

Integrated collaborative care teams to enhance service delivery to youth with mental health and substance use challenges: protocol for a pragmatic randomised controlled trial

Introduction Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access evidence-based services in a timely fashion. To address MHA system gaps, this study tests the benefits of an Integrated Collaborative Care Team (ICCT) model for youth with MHA challenges. A rapid, stepped-care approach geared to need in a youth-friendly environment is expected to result in better youth MHA outcomes. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth-friendly and family-friendly, and be more cost-effective, providing substantial public health benefits. Methods and analysis In partnership with four community agencies, four adolescent psychiatry hospital departments, youth and family members with lived experience of MHA service use, and other stakeholders, we have developed an innovative model of collaborative, community-based service provision involving rapid access to needs-based MHA services. A total of 500 youth presenting for hospital-based, outpatient psychiatric service will be randomised to ICCT services or hospital-based treatment as usual, following a pragmatic randomised controlled trial design. The primary outcome variable will be the youths functioning, assessed at intake, 6 months and 12 months. Secondary outcomes will include clinical change, youth/family satisfaction and perception of care, empowerment, engagement and the incremental cost-effectiveness ratio (ICER). Intent-to-treat analyses will be used on repeated-measures data, along with cost-effectiveness and cost-utility analyses, to determine intervention effectiveness. Ethics and dissemination Research Ethics Board approval has been received from the Centre for Addiction and Mental Health, as well as institutional ethical approval from participating community sites. This study will be conducted according to Good Clinical Practice guidelines. Participants will provide informed consent prior to study participation and data confidentiality will be ensured. A data safety monitoring panel will monitor the study. Results will be disseminated through community and peer-reviewed academic channels. Trial registration number Clinicaltrials.gov NCT02836080.

Client characteristics within the Chilean National Youth Addiction Treatment Demonstration System

In the context of an evaluation of a national demonstration program for youth addiction treatment in Chile, a sociodemographic and substance use profile of children and adolescents accessing services through this new program was developed. Information regarding sociodemographic factors, substance use, and problem severity; services used; and unmet needs was retrospectively gathered for all clients (685) admitted between January 1 and June 30, 2006. Thirty-two treatment centers (91.4%) provided data. The client population profile reflected severe psychosocial circumstances (e.g., 61.4% early exit from school). Of the population, 64.9% were classified in the highest substance risk level. The primary drug reported was cocaine-paste-base (52.7%). Comparisons to similar data in other countries illustrate the more severe profile of this Chilean treatment sample. The results suggest the need for increased outreach and comprehensive intersectoral approaches. Monitoring and evaluation should become part of the culture of the national drug treatment system in Chile and other countries.

HELP!!! An interactive experiential simulation of youth with concurrent disorders accessing help from “the system”

HELP!!! is an interactive, experiential simulation of the health care system that youth with concurrent mental health and addiction issues need to access for help. Using this exercise after a didactic teaching session reinforces the learning, synthesizes the knowledge for application and encourages group discussion and the sharing of participants’ knowledge. This exercise was originally developed to create an opportunity for interprofessional learning groups to experience the gaps and barriers youth encounter as they attempt to navigate the system and to act as a catalyst for creative problem solving and system change. By participating, learners experience a simulation of what youth, family members, and various professionals usually encounter in the system. This exercise elicits key issues for discussion and provides a forum for networking and the initiation of collaborative ventures for healthcare providers.

Enhancing Self-Efficacy for Help-Seeking Among Transition-Aged Youth in Postsecondary Settings With Mental Health and/or Substance Use Concerns, Using Crowd-Sourced Online and Mobile Technologies: The Thought Spot Protocol

Background Seventy percent of lifetime cases of mental illness emerge prior to age 24. While early detection and intervention can address approximately 70% of child and youth cases of mental health concerns, the majority of youth with mental health concerns do not receive the services they need. Objective The objective of this paper is to describe the protocol for optimizing and evaluating Thought Spot, a Web- and mobile-based platform cocreated with end users that is designed to improve the ability of students to access mental health and substance use services. Methods This project will be conducted in 2 distinct phases, which will aim to (1) optimize the existing Thought Spot electronic health/mobile health intervention through youth engagement, and (2) evaluate the impact of Thought Spot on self-efficacy for mental health help-seeking and health literacy among university and college students. Phase 1 will utilize participatory action research and participatory design research to cocreate and coproduce solutions with members of our target audience. Phase 2 will consist of a randomized controlled trial to test the hypothesis that the Thought Spot intervention will show improvements in intentions for, and self-efficacy in, help-seeking for mental health concerns. Results We anticipate that enhancements will include (1) user analytics and feedback mechanisms, (2) peer mentorship and/or coaching functionality, (3) crowd-sourcing and data hygiene, and (4) integration of evidence-based consumer health and research information. Conclusions This protocol outlines the important next steps in understanding the impact of the Thought Spot platform on the behavior of postsecondary, transition-aged youth students when they seek information and services related to mental health and substance use.

The service-seeking profiles of youth reporting a legal mandate or perceived coercion for substance use treatment

INTRODUCTION There is paucity of research on treatment-related coercion in youth: most research focuses on adult populations and legally mandated treatment. This study aims to examine the service-seeking profiles of youth with substance misuse issues who report a legal mandate or perceived coercion to enter treatment. METHODS Differences between youth who were legally mandated and not legally mandated, and differences between youth reporting high and low perceived coercion, were examined for demographic characteristics, mental health and substance use profiles, motivation, and readiness to change. RESULTS Compared to participants reporting low perceived coercion, those experiencing high perceived coercion reported more substance use problems, greater mental health needs, and greater external and introjected motivation. Legally mandated youth reported fewer mental health issues, lower identified motivation, and greater readiness to change than those reporting no legal mandate. DISCUSSION Many youth who present for substance use services report experiencing a sense of coercion, which suggests the potential importance of considering youth-centered strategies for involving youth in treatment planning and the development of treatment goals. Youth seeking treatment also have multiple intersecting needs which may benefit from a collaborative and integrative approach.