A look at what “works” and recommended best practices September 5, 2019 Substance Use, Trauma, and Other Challenges: Effective Case Management Strategies A look at what “works” and recommended best practices

Mark Smith Workforce Analyst U.S. Department of Labor, Employment and Training Administration

Patrick L. McNeil, M.Ed. Jerome Kolker, LCSW, BCD Associate Director of Substance Use Intervention YouthBuild USA, Inc. Jerome Kolker, LCSW, BCD Clinical Social Work/Therapist YouthBuild USA, Inc. SBIRT Consultant

Jeremy Stocking Chris L. Jones Program Director Lead Case Manager The Children’s Cabinet Washoe YouthBuild Chris L. Jones Lead Case Manager The Children’s Cabinet Washoe YouthBuild

To identify and provide insight into some of the personal challenges, including trauma, that many participants bring that can impede their in- program success and post-program career paths; To share the strategies and processes of Screening, Brief Intervention and Referral to Treatment (SBIRT) and its application for Construction Plus and other YouthBuild programs; To examine and define the roles of participant case management in YouthBuild programs; To review some best practices programs can incorporate to maximize effectiveness leading to better participant and program outcomes; and To share some peer-based best practices that “work” with regard to participant in-program retention, progress, and post-program placement;

Jerome Kolker, LCSW, BCD Clinical Social Work/Therapist YouthBuild USA, Inc. SBIRT Consultant

Identifying and Addressing Barriers that can Impede Success Learning abilities and style Extreme poverty Substance use disorders Unaddressed health issues Homelessness Dysfunctional family situations Criminal or gang activity Troubled romantic and family relationships, including violence Childhood trauma Little or no work ethic Low self-esteem Anticipation of discrimination Lack of trust Lack of positive role models Lack of a positive set of values Fear of success and fear of leaving the program

Adverse Childhood Experiences

Why Is This Important? Because ACEs are: Surprisingly common Occur in clusters The basis for many of the problems being displayed by YouthBuild students Strong predictors of later social functioning, well-being, health risks, disease, and death

ACES Impact Learning 51% of students with 4+ ACE scores had learning and behavior problems in school This is compared to only 3% of students with NO ACE score Source: Burke, N.J., Hellman, J.L., Scott, B.G., Weems, C.F & Carrion, V.C. (June 2011). “The Impact of Adverse Childhood Experiences on an Urban Pediatric Population,” Child Abuse and Neglect, 35, No. 6. ACES impacts learning Source: Burke, N.J., Hellman, J.L., Scott, B.G., Weems, C.F & Carrion, V.C. (June 2011). “The Impact of Adverse Childhood Experiences on an Urban Pediatric Population,” Child Abuse and Neglect, 35, No. 6.

Patrick L. McNeil, M.Ed. Associate Director of Substance Use Intervention YouthBuild USA, Inc.

Which substance(s) below are you seeing most often in your programs? You may choose more than one answer Alcohol Marijuana Opioids/Prescription Drugs Methamphetamines Cocaine Other (i.e. Synthetics, Club Drugs, etc.)

Substance Use – Big Picture Most YouthBuild programs struggle with how to best address substance use/abuse among its participants.

Why does it Matter? Many YouthBuild programs report that substance use/abuse serves as a serious impediment to: Program retention of students Work site safety Achieving outcomes in the classroom Successful post-program placement

Substance Use/Abuse in YouthBuild YouthBuild participants that use illicit substances periodically or frequently are often masking hidden problems and may be using the drugs as a “coping” mechanism.

Other Reasons Participants Are Using? Escape from school and family To be accepted by their peers Family influence/environment Everybody does it Curiosity/bored Pill-popping society Gang influence To feel “normal” Ethnic culture influence

10 Most Commonly Used Drugs Alcohol Marijuana Opioids/Pills (OxyContin, Hydrocodone, Fentanyl, Vicodin, Percocet, Adderall, etc.) Cocaine Heroin Club Drugs (Ecstasy, Molly, Special K, etc.) Methamphetamine (Crystal Meth) Hallucinogens (LSD, Ketamine, Cough syrup, etc.) Vaping (Dabbing) Other (Synthetic Drugs, K-2, SPICE, Flakka, etc.)

Current Trends Prescription Drugs (Opioids misuse and abuse) Poly Drug Use (Mixing multiple drugs/alcohol) Vaping (Dabbing - This emerging trend is the ingestion of THC concentrates via electronic cigarettes (also known as e-cigarettes or vaping pipes) Mollys and Laced Mollys (Enhanced form of ecstasy) Primo (Marijuana laced with ANYTHING such as cocaine, crack, and/or heroin)

Marijuana Update Marijuana is now legal for “adult recreational use” in 11 states (Colorado, Washington, Oregon, Alaska, California, Nevada, Massachusetts, Maine, Vermont, Michigan, Illinois) and Washington, D.C. Marijuana is now legal for medical use in 33 states and Washington, DC … and effectively decriminalized in almost every state In the next few years, another 10-12 states are expected to legalize recreational marijuana

Marijuana Use Messaging Our goal is to move participants into a career pathway that will offer a living wage and growth potential. If drugs and alcohol are an issue, none of this is possible. We must convey that they will not get hired and/or will lose employment if they fail drug tests or show up to work under the influence of substances. The legalization of marijuana does not change this!

Comprehensive Approach In YouthBuild programs, substance use/abuse is a pervasive problem that can be effectively addressed with prevention strategies, combined with a variety of intervention strategies that include: Substance Abuse Education Screening and Assessment Motivational Interviewing Drug Testing Brief Interventions Counseling/Case Management Appropriate Referrals Progressive Sanctions

Jerome Kolker, LCSW, BCD Clinical Social Work/Therapist YouthBuild USA, Inc. SBIRT Consultant

What Is Case Management? Case management is a client-centered strategy for providing assessment-based services to meet individual and program goals. Case management should occur both within the YouthBuild program, ensuring that all members of the staff are pursuing the same goals for an individual participant, as well as beyond the confines of the program, seeking and obtaining additional resources and services as necessary.

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Case Management Essentials Relationship Get to know participant Develop trust Build rapport Motivate, support, empower Ensure confidentiality Inquiry Be authentic Be curious Listen more than you talk Seek to understand Meet them where they are!

Case Management Essentials The individual development plan (IDP), sometimes called a life plan, is developed with each YouthBuild participant and has three purposes: Identify and set employment, education, and personal development goals Identify service objectives and a service plan of action needed to achieve the identified goals Document services provided and results

Documentation Reporting MIS Data: Tracks participant performance, grant outcomes, and overall success Maintaining Case Files: Serves as a roadmap and assists in the data entry Ensuring Quality Case Note Documentation: Follow-thru is not possible in absence of case notes

Case Management Essentials Regularly Scheduled Meetings We recommend bi-weekly or monthly scheduled meetings (at a minimum) Do not just meet with participants when they are in crisis or trouble! Use motivational interviewing techniques

Supportive Services Depending on what services the program itself will provide, there is likely to be a need to identify and build relationships with external providers of certain resources. These services should include the following: Substance abuse treatment centers Childcare Housing for homeless students Health and dental care Legal assistance Mental health care, including professional counseling Parenting and family planning counseling

Case Management Recap Relationship is first Assessment is essential and ongoing Participants may not know how to make informed choices Choices will change Use MI when possible Have milestones and timelines Help participant dream “big” Be encouraging but realistic Case Manager not alone, this is a whole program responsibility

What is trauma? Why is it important? Addressing Trauma What is trauma? Why is it important?

Addressing Trauma Trauma refers to intense and overwhelming experiences that involve serious loss, threat, or harm to a person’s physical and/or emotional well being. These experiences may occur at any time in a person’s life. They may involve a single traumatic event or may be repeated over many years. These trauma experiences often overwhelm the person’s coping resources. This often leads the person to find a way of coping that may work in the short run but may cause serious harm in the long run.

Do you consider your program to be trauma informed? Yes No I don’t know

Trauma-Informed Care? “A trauma-informed care (TIC) approach is based on the recognition that many behaviors and responses (often seen as symptoms) expressed by survivors and consumers are directly related to traumatic experiences that often cause mental health, substance abuse, and physical health concerns.” National Center for Trauma Informed Care Substance Abuse and Mental Health Service Administration

TIC Guiding Values Understand the impact & prevalence of trauma Communicate with compassion Promote safety Earn trust Embrace diversity

TIC Guiding Values Provide holistic care Respect human rights Purse the person’s strengths, choice, and autonomy Share power Barnes, Meyer, and Williamson

Patrick L. McNeil, M.Ed. Associate Director of Substance Use Intervention YouthBuild USA, Inc.

What is SBIRT? An intervention based on “motivational interviewing” strategies Screening: Universal screening for quickly assessing use and severity of alcohol; illicit drugs; and prescription drug use, misuse, and abuse Brief Intervention: Brief motivational and awareness- raising intervention given to support no use or intervene when use is present Referral to Treatment: Referrals to specialty care for participants with substance use disorders

The SBIRT Purpose YB participant (intrinsic) commitment to change Advance the theory of harm reduction Use of motivational interviewing strategy Post-program ability to pass employer drug tests Obtain and retain post-program employment

Participant Screening Screening should be UNIVERSAL to all YouthBuild participants (Allows for no discrimination or stereotypes) Provides staff with early information needed to work effectively with participants Confidential (with caveat of risk of harm)

Brief Interventions Brief interventions are evidence-based practices designed to motivate individuals at risk of substance use disorders or self-harm to change their behavior by helping them understand how their substance use puts them at risk.

Motivational Interviewing Motivational interviewing is more than just listening empathically. It is listening with a quiet mind and tuning in to the other person’s meaning and stage. It is paying attention and understanding where the other person is in their journey so that you can ask the right questions.

Jeremy Stocking Chris Jones Program Director Lead Case Manager The Children’s Cabinet Washoe YouthBuild Chris Jones Lead Case Manager The Children’s Cabinet Washoe YouthBuild

The Children’s Cabinet Services Food and Shelter Transitional Living Crisis Intervention Parenting Classes Case Management Child Care Subsidy Academic Support Child Care Resource and Referral Assistance Tutoring Free Family Counseling Job Training Washoe YouthBuild

Washoe YouthBuild

Community Partners Truckee Meadows Community College Community Services Agency My Journey Home Habitat For Humanity Northern Nevada Literacy Council

Employment and Apprenticeship Partnerships Laborers Union Electricians Union Painters, Drywall and Floor Covering Union Plumbers and Pipe Fitters Union Heavy Operators Union

Employment and Apprenticeship Partnerships Created a Competency Profile which includes information regarding if a participant has passed a recent drug test Participants will not be referred to an employment partner or apprenticeship by Washoe YouthBuild staff if the participant has not passed a recent drug test

Legal Recreational Use of Marijuana in Nevada Washoe YouthBuild promotes a drug-free program regardless of legalization All program policies and procedures are to be followed Creating an environment for participants to obtain employment in construction industry

Washoe YouthBuild Substance Use Policy At entry, all participants are drug tested within first 30 days First Positive Drug Test - Attend at least one program that promotes a clean and sober life style, such as NA, AA, etc. Second Positive Drug Test - Attend scheduled substance use evaluation, attend recommended counseling, and participant cannot participate in hands-on construction activities until negative drug test Third Positive Drug Test - Participant is subject to dismissal from the program and referred to a substance abuse agency Participants will also be tested for substances if they appear to be under the influence of any mind-altering chemical. If the test results come back positive, they will be asked to leave the program immediately and will not be able to participate in programming until they meet with their case manager.

Life Prep/Mental Toughness Addressing substance use during Life Prep Giving potential participants the opportunity to discusses substance use with their case manager Informing participants of scheduled drug tests

Mike was accepted into the YouthBuild Program! Referral #1 (Mike) Family: Single parent household, unmarried, low income, HS dropout Referred to YouthBuild from Youth Parole Bureau Attended YouthBuild informational meeting at The Children’s Cabinet Mike was accepted into the YouthBuild Program!

Washoe YouthBuild Assessments at Entry C-SSRS – Suicide Risk Assessment SBIRT – Screening, Brief Intervention and Referral to Treatment Casey Life Skill and Assessment – Life skill to help drive SMART goals SMART Goals – Goal plan and Individual Development Plans ACE – Traumatic events questionnaire (prior to age of 18)

Referral #1 (Mike) Presenting Needs Services Provided Financial struggles Substance abuse Educational needs Mental Health concerns Childcare Food insecurity Services Provided Created budget/My Path SBIRT HSE prep through YouthBuild Referred to counseling and Safety Plan Referred to The Children's Cabinet Childcare Subsidy Referred to The Children’s Cabinet Food Bank

Substance Use: Case Management, Individual Development Plan, and Goals Brief Interventions Daily brief interventions with participant Information on substance use and local NA or AA programs

Substance Use: Case Management, Individual Development Plan, and Goals Referral to Treatment Daily brief interventions with participant Participant attends scheduled substance abuse evaluation Case Manager follows up with substance use counselor, participant and family to set goals on recommendations established by counselor

Substance Use Partnerships Quest Counseling Crossroads Step 2 Bristlecone New Frontier Treatment Center

Referral #1 (Mike) Completed Phase 1 of Washoe YouthBuild OSHA 10 First Aid and CPR Obtained MC3 Certification HSE Certification HVAC Certification

Referral #1 (Mike) Phase 2 (Follow-up services) Weekly contact with Mike including brief interventions as needed Mike was able to obtain HVAC employment He is currently working 40 hours a week He has paid vacation, sick time, health, dental, vision insurance, and he is contributing to his 401K account

Washoe YouthBuild

Real Talk SBIRT Fact Sheet https://youthbuild.workforcegps.org/resource s/2017/06/28/13/36/Real_Talk_SBIRT_Fact_ Sheet Resources to Assist in Fighting the Opioid Epidemic https://youthbuild.workforcegps.org/resource s/2018/10/12/14/45/Resources_to_Assist_in _Fighting_the_Opioid_Epidemic Counseling and Case Management at a YouthBuild Program https://youthbuild.workforcegps.org/resource s/2016/06/21/09/35/Counseling_and_Case_ Management_at_a_YouthBuild_Program Strategies for Implementing Trauma-Informed Care at a YouthBuild Program https://youthbuild.workforcegps.org/resource s/2018/11/15/17/53/Strategies_for_Impleme nting_Trauma- Informed_Care_in_a_YouthBuild_Program SAMHSA’s Concept of Trauma and Guidance for a Trauma- Informed Approach https://nicic.gov/samhsas-concept-trauma- and-guidance-trauma-informed-approach

OSHA 510/500 Certification Training Education Webinar July 16, 2019 MIS Training Washington, DC July 16-17 and 18-19, 2019 OSHA 510/500 Certification Training Gallatin, TN August 19-30, 2019

Pat McNeil Jerome Kolker Associate Director of Substance Use Intervention YouthBuild USA pmcneil@youthbuild.org 214.384.1618 Jerome Kolker Clinical Social Work/Therapist Consultant for YouthBuild USA Kolkerjerry@gmail.com 610.986.1166

Jeremy Stocking Chris Jones Program Director Lead Case Manager The Children’s Cabinet jstocking@childrenscabinet.org 775.348.6756 Chris Jones Lead Case Manager cjones@childrenscabinet.org 775.352.8090

Mark Smith Workforce Analyst U.S. Department of Labor, Employment and Training Administration Smith.mark.w@dol.gov 202.693.3747