Transcript Substance Abuse Among Emerging Adults with Criminal Justice

+
Multisystemic
Therapy for
Emerging
Adults (MST-EA)
with mental health conditions &
criminal justice involvement


Reducing
recidivism in
transition age
youth offenders

Treating
mental illness
and cooccurring
substance use
disorders
Improving
functioning in
school, work,
independent
living, and
relationships

A researchbased
approach for
a high risk
justice
population
Ashli J. Sheidow
Oregon Social Learning Center
Leila Connor
North American Family Institute (NAFI)
+
Agenda

What is MST-EA: Brief Overview

Emerging Adults as a High-Risk Group

Treatment Focus

Treatment Team

Treatment Elements

MST-EA Research

Identifying Referrals

DC Team Outcomes
+ What is MST-EA?

Adaptation of MST

Intensive, in-home treatment for young adults
age 17-21

Treatment for highest risk young adults

Designed specifically for young adults with
mental illnesses and criminal activity

Clients may have significant trauma & may have
substance abuse

Fills a gaping hole in treatment options:
Few treatments available for this age group
+
Youth in Transition to Adulthood:
Older Adolescents and Emerging Adults
+
Functional Abilities Increase with
Psychosocial Development
Complete schooling
& training
Contribute to/head
household
Develop a
social network
Become financially
self-supporting
Obtain/maintain
rewarding work
Be a good citizen
+ Mental Health Conditions

MH diagnosis causes substantial
impairment in family, social, peer, school,
work, community functioning

Serious Mental Illness (SMIs)

Serious Mental Health Conditions
(SMHCs) OR

Serious Emotional Disturbance OR

Psychiatric Disability
+ SMI Onset Age Curve
+
“Conversion” to Psychosis
6 Severe and psychotic
(loss of reality testing)
SOPS Positive Symptom Scale
5 Severe but not
psychotic
4 Moderately severe
3 Moderate
2 Mild
1 Questionable
0 Absent
Childhood
Early Adolescence
Late Adolescence
Emerging Adult
+ Why focus a recidivism
reduction intervention on those
with mental health conditions?

Adolescents and adults with
mental health conditions at high
risk of arrest

Many individuals with mental
health conditions are known to
systems and can be referred for
intervention
+ Peak age of antisocial activity
+
Rates of victimization
3000
2500
2000
12-17
18-25
26-34
1500
1000
Estimated
Non-sexual
assault rates
(per
100,000)
500
0
Male Female Male Female Male Female Male Female
Total
White
Black
Hispanic
+
CHILD SYSTEM
ADULT SYSTEM
Education
Child Welfare
Juvenile Justice
Child Mental Health
Medicaid
Criminal Justice
Adult Mental Health
Medicaid
Housing
Vocational Rehabilitation
Substance Abuse
Birth
Death
AGE        
+ Emerging Adult Offenders
with MH Conditions
 Simply
addressing mental health
needs found unsuccessful in reducing
offending in adults
 Treatment
needs to focus on the
entire ecology to bring about the
most change:

social network

basic needs

education

vocational skills

relationship skills
+ MST-EA Treatment Targets

Antisocial Behavior

Mental Illness

Substance Use and Trauma Problems

Housing & Independent Living Skills

Social Network (Positive Family Relations & Peers)

Career Goals (Education/Vocation)

Relationship Skills, Conflict, and Prosocial Peers

As needed, teaching parenting curriculum
+ MST-EA
Team
 3 Therapists
 On-Site
Supervisor
 Off-Site Trainer/Consultant
 Psychiatrist/Nurse
Practitioner
support for medication management
 MST-EA
Coaches for Independent
Living and Vocational Skills
 Full Team
Caseload = 12 (4 clients/therapist)
+ Program Capacity
Started
accepting
cases Dec
2013
12
11
10
9
**
8
Maximum
team
caseload =
12
7
6
5
4
*
3
2
1
0
Program Capacity
*2 Therapists hired/trained
Program Caseload
**Final and 3rd Therapist hired/trained
Final
therapist
started July
2014
+ Approach

In-Home treatment

Young adults ages 17-21

Flexibility to meet with clients whenever
and wherever they are comfortable

24/7 emergency availability

Treatment averages 8 months (generally
is 4-12 months, depending on need)

Client safety (suicidality, homicidality,
victimization) is a top priority
+ Treatment Techniques
 Individualized
 Social
assessment of “drivers”
Network Assessment
 Intensive
Focus on Safety
 Cognitive
Behavioral Therapies
 Motivational
Interviewing (MI) for
Engagement
 MI
& Contingency Management for SA
 Schooling
 Prosocial
and Vocational Focus
& Recreational Activities
+ Substance Abuse
 Majority
of youth present with
substance abuse concerns
 MST-EA
uses drug screening
(including screening for synthetics)
 Evidence-based
interventions
including MI and CM
 Goal
to treat EA in community setting
 BUT, inpatient
considered when there
is significant safety risk
+ Retention in Treatment

All reasonable attempts are made to
engage a young adult in treatment
 Therapist
flexibility to meet at any
time/place help overcome most
engagement issues
 EA
sets goals they want to work on
 EA’s
own social network is included for
support
 However, not
all clients engage:
Discharged after 2 weeks of no contact
+ Client Overview & Outcomes
 Clients
are youth from high crime, high
poverty locations
 Program
success =

Client retention in treatment

Success in education and/or
employment

Improved social relationships

Decreased/eliminated SU

Decreased MH symptoms

No criminal acts
+Treatment
Retention
Even among those
who did not
complete treatment,
most were
maintained for a
large dose of
treatment (16wks)
Treatment ranged
from 4 to 12 months
(Median = 7-8)
Moved
2%
Restrictive
Placement
12%
Engagement
Lost
20%
Other
Complete
Treatment
15%
Complete
Success
(goals met
&
sustainable)
51%
+ Research: Major outcomes
 77%
demonstrated a clear
reduction in mental health
symptoms
 Mental
health symptoms fell
substantially
 20
symptoms  5-6
symptoms
+ Research: Major outcomes
cont’d

89% had no new arrests during treatment

Post-treatment criminal charges:


Charges in 6 mos post intervention were
less than those in 6 mos prior to
treatment

Rate of arrests dropped by 17 points in 6
mos post intervention vs. 6 mos prior to
treatment
Safety: No suicides and homicides
+ Research: Other functional
outcomes
 89%
living in the community at
discharge
 75%
in school and/or employed
 74%
improved communication
skills
 83%
had substance use
problems at intake and 62% of
these demonstrated clear
reduction
+ Research: Other functional
outcomes cont’d
 Improvements
 Social
in:
support
 Exposure
to peer delinquency
 Working
 Living
in out-of-home settings
+ Snapshot of current cases
10 Current Cases (2 Pending Intakes)

100% Living in community (not in restricted placement)

100% Not homeless

78% In school and/or employed

44% No new arrests

78% No new arrests for drug-related offenses

67% No hard drug use

11% No THC use

56% Decreased drug use problems

67% Decreased mental health problems

89% Improved communication skills (reduced conflict)
+ Current Treatment Success
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Nearly all
(75%+)
goals
met=
44%
Majority
(50%+)
goals met=
33%
Less than
50% goals
met= 22%
Goal Completion of Current Cases
(if they were to close as of today)
+ Treatment Non-Completion

The remaining 4 cases the team has served
closed prematurely:

1 Client went missing and could not be
found by any services or DYRS

1 Client & parent decided to utilize other
services they had been offered (officebased rather than home-based services)

2 Client Indirect Ending (despite
persistence by team, the client could not
be engaged)
+Other Recent Program “Wins”


Education is a challenge due to the limited
programs that fit our EA’s educational needs

2 cases graduated with high school diplomas

1 case enrolled in college for next semester
Housing is a challenge as their criminal
behaviors can lead to limited housing
options

A 20 yr old EA with extensive history of
physical aggression successfully placed in a
foster home

A EA who had not remained in the community
for longer than 6 months since he was 12 yrs
old is on month 10 living in the community
and appears successful
+Identifying Referrals
 Age
17-21
 Criminal
activity in past 18 months
 Possibly
have mental illness
(screening will be completed)
 Youth
has relatively stable housing
or plan for housing
 May
have significant trauma;
May have substance abuse
+
Youth NOT appropriate for
referral

Likely to be placed/incarcerated

Currently suicidal, homicidal or
psychotic

Primary behavior is sexual offense

Has had MST or FFT in past year

Diagnosis of Autism, Pervasive
Developmental Disorder or
Mild/Moderate/Severe MR
+
Multisystemic
Therapy for
Emerging
Adults (MST-EA)
with mental health conditions &
criminal justice involvement


Reducing
recidivism in
transition age
youth offenders

Treating
mental health
and cooccurring
substance use
disorders
Improving
functioning in
school, work,
independent
living, and
relationships

A researchbased
approach for
a high risk
justice
population
Ashli J. Sheidow, Ph.D.
[email protected]
Leila Connor
[email protected]