Because I Said So: How to Support Juvenile Clients through Change Louisiana Association of Drug Court Professionals April 11-13, 2012 Jane E. Pfeifer,

“Because I Said So”:How to Support Juvenile Clients

through Change

Louisiana Association of Drug Court Professionals

April 11-13, 2012

Jane E. Pfeifer, MPA

Why do kids do what they do?

• Lack of control over their environment

• Brain development

• Different priorities

• Peer pressure

• To piss us off

What’s up with the parents?

• Single parents• Overworked/overscheduled parents• Grandparents• Overwhelmed parents• Parents who have given up• Parents who have their own AOD problems• Parents who seem like they “don’t care”• Enabling parents/parents who are part of the

problem• Parents who are doing everything right

A Word About Brain Development

Teenage brains are much more influenced by emotional arousal, peer pressure, and risk taking than adult

brains, because their impulse control and judgment is less well developed.

Laurence Steinberg, a Temple University psychology professor and director of the John D. and Catherine T. MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice:

They think differently…

• To appreciate consequences of risky behavior, one has to have the ability to think through potential outcomes and understand the permanence of consequences, due to an immature prefrontal cortex, teens are not skilled at doing this

• Teens do not take information, organize it, and understand it in the same way that adults do—they have to learn how to do this

They see…and process, things differently

• Adolescents are not very skilled at distinguishing the subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of miscues—leads to lack of communication and inappropriate behavior

• Differences in processing, organization, and responding to information/events leads to misperceptions and misunderstanding verbal and non-verbal cues

Special Issue on Juvenile Drug Courtshttp://www.ndci.org/publications/drug-court-review/s

pecial-issue-juvenile-drug-courts

Practical Strategies

Strengths Perspective

Dennis Saleebey, University of Kansas

“…explore and exploit clients’ strengths.”

“The problem is not the person.”

Asset Identification

Search Institute

(www.search-institute.org)

• 40 developmental assets– Internal Assets– External Assets

• Protective factors

First Question:

Q.: What agency/organization provides primary case management services for your Drug Court?

Engagement

Whose job is it to engage the youth?

Engagement

Engagement activities are intended to identify and fulfill the client's immediate needs, often with something as tangible as a pair of socks or a ride to the doctor.

Center for Substance Abuse Treatment. Comprehensive Case Management for Substance Abuse

Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration; 1998 (Treatment improvement protocol; no. 27).

Increasing Motivation

Whose job is it to assist the youth in increasing his or her motivation?

Increasing Motivation

• Stages of Change

• Motivational Strategies

In a recent study, clients assigned to receive motivational interviewing techniques at intake had significantly better retention rates at the 28-day follow-up than clients who received the standard intake evaluation. (Carroll, et al., 2006.)

Stages of Change Readiness (Prochaska and DiClemente, 1992)

Precontemplation

Contemplation

Preparation

Action

Maintenance

Stages of Change

Pre-contemplationPre-contemplationPre-contemplationPre-contemplation

ContemplationContemplationContemplationContemplation

PreparationPreparationPreparationPreparation

ActionActionActionAction

MaintenanceMaintenanceMaintenanceMaintenance

Relapse-L

apse-Change

Relapse-L

apse-Change

Relapse-L

apse-Change

Relapse-L

apse-Change

Stages of Change

• Not thinking about changing

• Happy user

• Learned helplessness

• Has no intention to take action within the next 6 months

Pre-contemplationPre-contemplationPre-contemplationPre-contemplation

Stages of Change

• Thinking about changing

• Ambivalence

• Chronic contemplators

• Intends to take action within the next 6 months.

ContemplationContemplationContemplationContemplation

Stages of Change

• Decision made

• Firm plans

• Possibly recent attempts at change

• Intends to take action within the next 30 days.

• Has taken some behavioral steps in this direction.

PreparationPreparationPreparationPreparation

Stages of Change

• Overt behavioral change• ‘Stopping’ main issue• Grief issues• Counter-conditioning• Stimulus control• Contingency management• Has changed overt behavior for less

than 6 months

ActionActionActionAction

Stages of Change

• Sustained behavior over time

• Alternatives established

• Later, becomes a non-issue

• Has changed overt behavior for more than 6 months.

MaintenanceMaintenanceMaintenanceMaintenance

What is MOTIVATIONAL INTERVIEWING?

• Intervention designed to mobilize client’s internal resources for change by enhancing intrinsic motivation.

• A style of being with people, not just a set of techniques

• An important goal is to clarify values and amplify discrepancies

• Purpose is to move person through the stages of change

from Morgenstern-”Motivational Interviewing”

Philosophy of Motivational Interviewing

• MI is a technique in which you become a helper – not a dictator – in the change process for your client.

• In criminal justice we are used to telling people what to do.

• This is a different style of interview and counseling.

Goal Of Motivational Interviewing

The goal of MI is to create a safe and supportive rapport with a person, in order to facilitate their thinking about their behavior and whether/how they might go about making changes.

Confrontation: A Goal Not a Style

AMBIVALENCE

“I want to but I don’t want to”

Important Assumptions in Motivational Interviewing

• Clients are AMBIVALENT about changing.

• There are BOTH pros AND cons to getting off of drugs vs. continuing to use.

Ambivalence about quitting

• We in criminal justice don’t typically see that for the client there are at least some good reasons to continue to use.

• MI recognizes that ambivalence about quitting is NORMAL.

Change Importance

of Change

A

B

I

L

I

T

Y

Low importance: Low confidence

These people don’t see the need for change nor do they believe that could effectuate the change, if they decided to change

Low importance: High confidence

These people are confident they can make the change but are not convinced that change is needed.

T

O

C

H

A

N

G

E

High importance: Low confidence

Here the problem is not the willingness of the person to change but the person’s confidence in their ability to change

High importance: High confidence

These people see the necessity of change and believe they can succeed.

Exercise

Share an example with your team of how you, in your role, can assist with increasing motivation.

DEVELOPING DISCREPANCY

• Motivation for change is enhanced when clients perceive the discrepancies between their current situations and behaviors, and their hopes and goals for the future.

• Let the client present the argument for change.

• “Tell me the good parts about using.”• “Tell me the negatives.”

You will often hear about damaged family relationships, especially with the client’s children.

• “How do these weigh out to you?”• “Where do you think you go from here?”

Have the client state the solution of what he must do to achieve his stated goals, desires, wants, and

wishes.

Take Home Message:

• Motivation to change is elicited from the client, and not imposed from without.

• It is the client's task, not the interviewer’s, to articulate and resolve his or her ambivalence.

Exercise

• Pair up• Pick a real-life behavior change you want to

make (be sure it’s one you want to share!)• One is the case manager and one is the drug

court participant—then switch.• As the case manager, help your partner

develop discrepancy. By the end, and without asking directly, see if you can determine if your partner is low importance/low ability; low importance/high ability; high importance/low ability; high importance/high ability.

Meeting Client’s Needs• “client’s” not “clients’”• What does this client need?• How do we know?

– Assessment– Interviewing-ASK HER!

• Comprehensive case management– Realistic case planning– Incremental objectives

• Treatment matching– Gender appropriate– Culturally relevant

What do youth in Drug Court need?

Case Planning Questions

• Is there more than one case plan?

• If there is, can they be combined?

• If they can’t, how can your team be sure they don’t contradict each other?

• Do all team members know what’s on all case plans?

• Does the youth know what’s on all case plans?!

Involve the Youth…

in case planning– What are their goals?

– What do they want to change?

“Case planning happens with the client,

not to the client.”

What Goals are set for Youth?

• Are there target behaviors that all youth must achieve?

• Are they different in the beginning of the program?

• Does your department/agency have differing goals for youth than the drug court, or are they consistent?

• How individualized can goals be for each youth?

Exercise

• As a team:– identify two strengths of your case

management services.– identify two challenges with your case

management process, and discuss possible solutions.