Ab presentation

integrating AOD and
mental health work
with young people
Talking Point May 2013
A framework for resilience based intervention
2013
Andrew Bruun
Director of Research, Education, Advocacy & Practice YSAS
M: 0407 310 344
abruun@ysas.org.au

Vulnerability
All young people are vulnerable to
disruptions and challenges during the
transition from childhood to adulthood.
Vulnerability becomes problematic when
negative behaviours or experiences
multiply and there are few or no supports
in place to assist young people.
The individual developmental, social &
environmental context in which young
people grow up can mean they confront
issues that they do not have the skills,
knowledge or support to get through.

Positive Adaptation:
Developmental regulation
Positive adaptation, through regulated exposure to adversity
involves a developmental progression, such that new
vulnerabilities and/or strengths often emerge with changing life
circumstances
Developmental problems arise when children and young
people are not exposed to enough adversity and risk, or so
much that it is impossible to overcome
Masten, A. S., Obradovi, J. & Burt, K. B. (2006). Resilience in emerging adulthood: Developmental perspectives on continuity
and transformation. In J. J. Arnett & J. L. Tanner (Eds.), Emerging adults in America: Coming of age in the 21st century (pp.
173–190). Washington, DC: American Psychological Association Press.

Common protective factors
(development & resilience)
 Effective parents and caregivers
 Connections to other competent and caring adults
 Problem-solving skills
 Self-regulation skills
 Positive beliefs about the self
 Beliefs that life has meaning
 Spirituality, faith and religious affiliations
 Socioeconomic advantages
 Pro-social, competent peers and friends
 Effective teachers and schools
 Safe and effective communities

Protective systems
 Human attachment system (beginning with primary
care givers and expanding with development to
include families, peers and significant others)
 The human intelligence and information processing
system (a human brain in good working order)
 The mastery / motivation system (motivation to
adapt and opportunities for agency)
 The self-regulation system (Self-control and
emotion regulation)
 Religious and cultural systems
 School and community based systems

Protective systems
• “The greatest threats to young people occur when these
key systems and the capacity they represent are
damaged or destroyed and never restored. Nurturing,
supporting, and restoring these fundamental adaptive
systems for human development are top priorities for
promoting competence or resilience in young people
and preparing them to weather the storms of life”
Masten, A. (2009) Ordinary magic: Lessons from research on resilience in human development (p32).

Past or current issues and
adverse experiences
 Abuse (physical, sexual, emotional) and neglect
 Exposure to violence (domestic and other)
 Excessive family conflict and/or breakdown
 Complicated grief
 Physical health complaints (particularly involving
 persistent pain)
 Academic failure and tenuous school connection or
premature disconnection

Past or current issues and
adverse experiences (cont)
Adverse experiences are often the source of significant
trauma and can result in:
 Insecurity and a compromised sense of safety
 A sense of powerlessness, hopelessness and fear.
 Damaged self-concept and feelings of shame, guilt and
rage.
 Difficulties in regulating impulses and emotions increasing
the likelihood of:
• Disrupted and conflicted relationships with
significant others
• Reduced participation and social exclusion

An accumulation of adverse experiences
(developmentally and/or in a short timeframe) can
contribute to a range of health and behavioural
problems:
 Substance use problems
 Mental illness and a range of mental health problems
 Problems with anger and aggression
 An antisocial orientation and offending behaviour
 Self-injury
 Persistent suicidality
issues and conditions

Complexity and vulnerability
Complexity
The number adverse experiences or problems
Etiology & severity or each adverse experience or problem
The extent to which particular problems are either highly advanced or in
an early stage of development
Whether problems cluster together to intensify the risk of harm or
reinforce each other to form long-term, negative chain effects that can
entrench health and behavioural problems.
Determining vulnerability:
Requires investigation of the young person’s developmental stage and an
analysis of the nature and quality of the resources and assets that can be
mobilised to deal effectively with the adversities he or she has to contend
with.

Resilience
The same factors that interact to foster and protect healthy
development and optimal functioning also support resilience.
All young people can develop their capacity to be resilient
given the right conditions
Johnson, B. & Howard, S. (2007) Causal chain effects and turning points in young people’s lives: a resilience perspective.
Journal of Student Wellbeing, Vol. 1, No. 2, pp. 1-15.
“Resilience is not only an individual's capacity to overcome
adversity, but the capacity of the individual's environment to
provide access to health-enhancing resources in culturally
relevant ways.”
Ungar, M. (2005) A Thicker Description of Resilience. International Journal of Narrative Therapy and Community Work, 3 & 4,
89-95.

Resilience
Resilience is not an intrinsic trait but a dynamic process
occurring under specific circumstances - It is never an across
the board phenomenon and no young person is invulnerable.
Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227-238.
There are huge individual differences in young people’s
exposure to the ‘bad’ experiences that constitute environmental
risks.
Harvey, J. & Delfabbro P. H. (2004) Psychological resilience in disadvantaged youth: A critical overview. Australian
Psychologist, March; 39(1): 3 – 13

Hidden Resilience
The experience of disadvantage and social exclusion means
that not all young people have access to useful and necessary
resources and assets that most young people might take for
granted (Johnston and Howard, 2007).
Negative social discourses characterising young people with
substance use as delinquent, disordered, dangerous or deviant
can mask their strengths and efforts to meet their needs.
Ungar, M. (2005). A Thicker Description of Resilience. International Journal of Narrative Therapy and Community Work, 3 and
4, 89-95.

Resilience based practice
Intention:
To create the conditions that enable young people to
gain as much control as possible over their own health
and well being
 This involves young people and those involved in
their care having access to resources and assets that
make it possible for them to meet their needs, fulfil
their aspirations, and respond effectively to
environmental influences (to adapt).

Resilience based practice
Five key domains of need:
 Protection from harm and the capacity to respond to
crisis (safety)
 Stability and the capacity to meet basic needs
 Opportunities for participation and constructive
activity (education, work, recreation, etc)
 Developmentally conducive connections (people,
culture, places)
 Greater control of health compromising issues and
behaviours (e.g. harmful substance use, mental
health problems, homelessness, offending, etc)

Constructive
Participation
• Educational
• Vocational
• Recreational
• Community
Developmentally
conducive
Connections
• Family & Sig other
• Culture
• Place
Resilience framework
Co-occurring
health
compromising
issues and
behaviours
•Substance
misuse
•Mental health
problems
•Disconnection
from school and
work
•Homelessness
•Complex grief
•Trauma (PTSD)
•Anti-social /
offending
behaviour
Stability &
Basic needs
• Safe and
comfortable
spaces where
young person
feels connected,
welcome
• Adequate
housing with
certainty of tenure
• Income
•Regulated
experience
(constructive limit
setting)
Crisis &
Immediate
Risk
• Protection
from harm
•The capacity to
deal effectively
with issues that
are causing (or
have the
potential to
cause) harm
and jeopardize
safety
Evidence
Based/
Therapeutic
Interventions
Social Ecology:
Resources
•Material
•People
•Socio-cultural
•Health / community
Skills / Knowl /
Attributes
•Living skills
•Self management
•Interpersonal skills
•Cultural competence
Beliefs/Values/
Identity
•Self concept /world
view
•Meaning making
Physical&SocialCapitalCultural&humancapital

Resilience based practice (RBP)
Young people with the right mix of opportunity, motivation and
resources can move beyond defensive coping into adjustment and
positive adaptation.
Practitioners seek to protect and nurture a young person’s capacity to
be resilient by altering exposure to risk, influencing the experience of
risk, averting chain reactions of negative experience and fostering
healthy adaptation and growth.
Well-timed interventions geared to respond at critical moments, have
the potential to disrupt negative cascading effects or initiate healthy
developmental processes and positive adaptation.
Masten, A. (2009) Ordinary magic: Lessons from research on resilience in human development
Ungar, J. (2011). Counseling in Challenging Contexts: Working with individuals and families across clinical and
community settings. California: Brooks/Cole.

AOD needs identification &
service planning model
•3 or more different drugs
used in the last 4 weeks (ex.
Tobacco)
•Daily/Almost Daily use of at
least 1 drug in the last 4
weeks (ex. Tobacco)
•Meets criteria for substance
dependence
•Ever injected any drug
•Involvement in substance
related risk behaviours and
the experience of harm
AODSeverity
Vulnerability/Life complexity
Typical
complexity for age
NotusingLowHigh
Severe
Additional
Complexity
High Extreme
AOD
Severity Indicators

•Acute housing problems (last 4
weeks)
•Not involved in education or work
(last 4 weeks)
•Conflict with family or relatives (last
4 weeks)
•Not satisfied with physical health
•Moderate or High emotional
distress (last 4 weeks)
•Current offending or involved in
criminal justice system (ever)
•Formal diagnosis of mental health
condition (ever)
•Attempted suicide or self harmed
(ever)
•Experience of abuse and neglect or
child protection involvement (ever)
AODSeverity
Typical
complexity for age
NotusingLowHigh
Severe
Additional
Complexity
High Extreme
Complexity
Indicators

•Severe and high risk AOD
use interrelated with
characteristics of high to
extreme vulnerability
•Need interrelated AOD
problems and complexity
addressed simultaneously
by a range of
interventions
AODSeverity
Typical
complexity for age
NotusingLowHigh
Severe
Additional
Complexity
High Extreme
Service required

•Low level or emerging
AOD use combined with
3 or more characteristics
of high to extreme
vulnerability (see above:
Cohort 1)
•Often younger but at
serious risk of AOD
problems developing
and escalating
•Need early
intervention to prevent
transition to cohort 1
(entrenched harmful
AOD use)
AODSeverity
Typical
complexity for age
NotusingLowHigh
Severe
Additional
Complexity
High Extreme
Service
required

Serious AOD problem
combined with 1 or 2
indicators of additional
complexity
•Retains connection with
family, school, employment,
constructive activity
• Stable living circumstances
• Little or no involvement with
health and welfare services
Need AOD specific
intervention and early
intervention to maintain
connectedness and
participation (prevent
transition to cohort 1)
AODSeverity
Typical
complexity for age
NotusingLowHigh
Severe
Additional
Complexity
High Extreme
Service
required

Outreach: Modality
Description
• Flexible and responsive medium for connecting with and delivering
services to hard to reach groups. Can offer services in environments
where young people congregate and/or feel comfortable. Invloves
care and recovery co-ordination and timely interventions.
Objectives:
• Locate and connect with targeted young people
• Provide therapeutic interventions according to need and readiness of
young people and context
• Care and recovery co-ordination

Outreach: Interventions
• Service promotion & case finding
• Assertive engagement
• Case work (including assessment & individualised care
planning)
• Liaison & advocacy
• Health education & health promotion
• Foundational counselling
• Behavioural & other psychosocial interventions
• Family support
• Home-based withdrawal
• Secondary consultation to other services

Clinical: Modality
Description
• Sessional services are currently provided within youth AOD services
on the basis of 1-2 hour appointments (e.g. counselling), or as brief
consultations. Suitable where life complexity and vulnerability are in
check – suitable for AOD specific counseling and family focused
interventions
Objectives:
• Offer the types of specialist interventions that are potentially best
provided in a clinic based setting (see next slide)

Clinical: Interventions
• AOD counselling (employing EB therapeutic models)
• Pharmacotherapy
• Specialist mental health care for a range of serious mental
health problems including: major depression, PTSD, other
anxiety disorders, bipolar disorder, psychotic illnesses
• Family therapy
• Grief and loss counselling
• Sexual assault counselling
• Medical care

Day program: Modality
Description
• Day Programs provide safe, stimulating and flexible environments that
young people can access in their own time and to the extent that they
desire.
Objectives:
• To offer a wide range of resources, programs and services that
motivate, encourage and support young people to move away from
problematic behaviours and contexts, towards more stable and
healthy lifestyle.

Day Program: Interventions
• A safe place to spend time /
respite
• Supervised or monitored recovery
• Primary health care
• Personal care facilities
• Health education
• Life skills programming
• Motivational interviewing
• Behavioural & other
psychosocial interventions
• Peer support
• Supported referral and
linkages
• Activity based therapeutic
programming
• Secondary consultation to
other services

Youth Residential Withdrawal: Modality
Description
• Structured environment providing up to two weeks (or more) of safe,
AOD free, age appropriate accommodation in a unit that is
continuously staffed.
Objectives:
• Stabilise of client’s mental and physical health and increase access
to ongoing care
• Break the escalating cycle of AOD dependence and high risk
behaviour
• Build pro-social connections to support longer term behaviour
change

Youth Residential Withdrawal: Interventions
• Comprehensive primary health care
• Medically supervised AOD withdrawal & pharmacotherapy
• Health education
• Mental health care
• Integrated psycho-social care planning (co-ordinated with other
services)

Residential rehabiitation: Modality
Description
• Long term residential rehabilitation geographically separate from
community of origin. Provision of a holding environment - a physically
and emotionally safe place to live and grow. Common to employ a
therapeutic community model
Objectives:
• To provides a safe, stable, and structured environment within which
young people can be assisted to secure and develop a diverse range
of resources and assets needed for resilience and to learn to live in
the world without needing to turn to alcohol and other drugs for
answers.

Residential Rehabilitation: Interventions
• Community as therapeutic vehicle
• Primary health care and health education
• Activity based therapeutic programming
• Life skills programming
• Peer support
• Supported referral and linkages

Supported accommodation: Modality
Description
• Provision of structured community based accommodation in which
young people are provided with a range of supports while living
independently or semi-independently.
Objectives:
• To provide a long term safe stable living environment and the support
required to develop personally and build the diverse range of
resources and assets needed for resilience and to live well without
resorting to misuse of alcohol and other drugs.

Supported accommodation: Interventions
• Assessment and therapeutic care planning
• Medical care and Health education
• Education and vocational transitions
• Family focussed interventions
• Peer support
• Supported referral and linkages

Maximum security prison
War zone
Youth
service A
Youth
service B
Systematisation & Compassion
UnstructuredStructured
Compassion
Systemisation
Alienation Person Centred

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