Social Competence in Adolescents in Residential Treatment for SUD 2013 Addictions and Mental Health Ontario Conference Jenepher Lennox Terrion, PhD, University of Ottawa Sue O'Rielly, CQI Manager, DSYTC

Workshop Objectives Participants will: Understand the meaning of social competence. Become aware of research evidence on the social competence of adolescents in residential treatment and how these compare to adolescent norms. Be introduced to a validated scale which can be used to measure social competence in adolescents. Explore how their own and other participants’ experiences reflect the research findings. Discuss strategies for building social competence with clients in their own practices.

Overview of Presentation 1.What is Social Competence? 2.Social Competence and Substance Abuse: What’s the link? 3.Research Collaboration between DSYTC and UOttawa 4.Discussion: Practical implications 5.Workshop Activity

What is Social Competence? Social competence = Social skills that are critical to healthy outcomes in childhood and later life. Social Competence Social Skills Peer Relationships Social skills and peer relations are reciprocal: – peer relations are the outcome of social skills but also influence the ongoing development of social skills how we communicate influences who our friends are and what they are like and this, in turn, influences the development of our social skills. Examples of social competence in children and adolescents: – academic and task-related competence (e.g. success in school and in developmentally appropriate activities) – cooperation with peers (e.g. getting along with others), – reinforcement of peers’ behaviors (e.g. behaviors that encourage others to continue what they are doing) – social initiation behaviors (e.g. inviting others to interact).

Social Competence and Substance Abuse: What’s the link? Importance of Social Competence Several previous studies have shown that youth with good social competence have lower rates of substance use, depression, delinquency, aggression, and other problem behaviors (Dalley et al., 1994; Pentz, 1983; Scheier et al., 1999; Sørlie et al., 2008; Stepp et al., 2011). Social Competence Deficits A study of elementary school youth showed that those scoring poorly on self-reported and teacher-rated measures of social competence were more likely to initiate substance use early (Jackson et al., 1997). Previous research has shown that social skills deficits are one of the risk factors for substance abuse in youth (Gaffney et al., 1998; Griffen et al., 2001; Hover & Gaffney, 1991; Webb & Baer, 1995; Wekerle et al., 2009: Werner, 1986).

Research Questions Do youth who attend residential addiction treatment differ from a normed sample of youth in measures of social competence? Are there gender differences in social competence among youth who attend residential addiction treatment?

Methods: Setting - The Dave Smith Youth Treatment Centre Agency Mission: ‘ to provide youth and families in need with integrated, evidence-based addiction treatment, delivered by competent professionals within a caring and compassionate environment ’. 3-month residential addiction treatment and continuing care program for adolescents years of age based in Ottawa, ON Gender segregated treatment, 14 male beds and 10 female beds. Core treatment program is the A dolescent C ommunity R einforcement A pproach Residential programming includes: Individual therapy, group therapy, academic programming, a contingency management program, prosocial activity, exercise and healthy nutrition. Agency commitment to ongoing quality improvement and continuous learning including research.

Methods : Recruitment and Measurement Recruitment: – Consecutive clients admitted to the DSYTC between April and October 2012 were included in the study – Inclusion criteria: Youth remained in treatment for a minimum of 2 weeks Measurement: – The Home & Community Social Behavior Scales (HCSBS) 64-item screening and assessment behavior rating scale that has demonstrated reliability and validity in measuring social competence and antisocial behavior (this study focused only on social competence) Items depict routine or commonly occurring behaviors Takes only a few minutes for the Addiction Counsellor to complete

Methods: Home & Community Social Behavior Scales Social Competence is broken into 2 subscales (each with 16 questions). Behavior Frequency is described on a 5-point scale from Never to Frequently. Peer relations (peer related social adjustment): measures the dynamics of developing appropriate social relationships with other youth. Item examples are: Cooperates with peers. Invites peers to participate in activities. Will give in or compromise with peers when appropriate. Self-management/compliance (adult-related social adjustment) : a measure of how consistently an adolescent is able to meet the expectations of adults who are in authority. Item examples are: Completes chores without being reminded. Listens to and carries out directions from parents or supervisors. Follows family or community rules.

Results Client CharacteristicsMale (n=33) Female (n=22) Age (mean, sd)17.6 (1.3)18.0 (1.9) Times in treatment (mean, sd)1.3 (1.3)1.4 (0.9) Age first use alcohol (mean, sd)12.1 (2.5)12.8 (1.8) Age first use drugs (mean, sd)12.7 (1.4)13.2 (1.9)

Results Social Functioning Levels Home and Community Social Behavior ScaleMale (n=33) Female (n=22) Social Competence Total (n, %) At Risk (<20 th percentile) Average (20 th to 80 th percentile) High Functioning (>80 th percentile) 11 (33) 22 (67) 0 1 (5) 19 (86) 2 (9) Self-Management/Compliance (n, %) At Risk (<20 th percentile) Average (20 th to 80 th percentile) High Functioning (>80 th percentile) 6 (18.2) 21 (63.6) 6 (18.2) 2(9) 19 (86) 1 (5) Peer Relations (n, %) At Risk (<20 th percentile) Average (20 th to 80 th percentile) High Functioning (>80 th percentile) 15 (45.5) 18 (55.5) 0 3 (13.7) 17 (77.3) 2 (9)

There is a statistically significant difference between the genders (p<0.05) on the Peer Relation Scale as well as between males in treatment and the normed sample (p<0.05). HCSBS Peer Relation Levels Comparing DSYTC Youth Sample by Gender to HCSBS Norms

Study Discussion: Implications Appears to be an association between social competence and male youth attending residential addiction treatment. Possible practical implications: 1. Treatment engagement/therapeutic alliance – Client/therapist relationship, lack of likeability, responsiveness 2. Therapeutic milieu - Conflict, bullying, disruption, peer issues, rule following 3. Treatment retention Consider how having difficulties with social competence may be particularly challenging for youth attending residential addiction treatment given the social demands of living with other youth for an extended period of time 4. Post-treatment integration – Making friends with pro-social peers requires social competence. Research shows that adolescents in treatment may lack these requisite skills (Dishion et al., 1984).(i.e. ability to initiate/re-establish and maintain healthy non-using peer relationships) – Here are some of the things we’ve thought of. We’re interested in your views.

Study Discussion: Implications There appears to be an association between Social Competence and male youth attending residential treatment. Possible Treatment Implications of Low Social Competence: Treatment engagement/therapeutic alliance i.e. responsiveness Therapeutic milieu i.e. conflict, bullying, isolation, disruption, rule following Treatment retention i.e. social demands of living with other youth for 3 months Post-treatment integration- i.e. ability to initiate/re-establish and maintain healthy non-using peer relationships. Caregiver and family relationships

Workshop Section Breakout Questions 1. What do you make of the findings and how do they reflect your experience with your clients? Are there other implications we did not identify? 2. In your experience how does social competence influence post-treatment outcomes? 3. In which ways can your program/agency work to build social competence in your clients? 4. How does the social competence of your clients influence your agency’s ability to offer treatment effectively? i.e. treatment engagement/retention What strategies can help mitigate these challenges?

Questions or Comments?

References Dalley, M.B., et al. (1994). Teacher-ratings and self ratings of social competency in adolescents with low- and high-depressive symptoms. Journal of Abnormal Child Psychology, 22( 4), Gaffney, L. R., et al. (1998). Social skills, expectancies, and drinking in adolescents. Addictive Behaviors, 23 (5), Griffin, K. W., et al. (2001). Social competence and substance use among rural youth: Mediating role of social benefit expectancies of use. Journal of Youth and Adolescence, 30 (4), Hover, S., & Gaffney, L. R. (1991). The relationship between social skills and adolescent drinking. Alcohol and Alcoholism, 26, Jackson, C., et al. (1997). The early use of alcohol and tobacco: Its relation to children's competence and parents' behavior. American Journal of Public Health, 87 (3), Pentz, M. A. (1983). Prevention of adolescent substance abuse through social skill development. In T. J. Glynn, C. G. Leukefeld & J. P. Ludford (Eds.), Preventing Adolescent Drug Abuse: Intervention Strategies (pp ). Rockville, MD: National Institute on Drug Abuse. Scheier, L. et al. (1999). Social skills, competence, and drug refusal efficacy as predictors of adolescent alcohol use. J Drug Educ 29(3): Sørlie M., et al. (2008). Social competence and antisocial behavior: continuity and distinctiveness across early adolescence. J Res Adolesc., 8 (1):121–144. Stepp, S. D., et al. (2011). The Relation Between Adolescent Social Competence and Young Adult Delinquency and Educational Attainment Among At-Risk Youth: The Mediating Role of Peer Delinquency. Canadian Journal of Psychiatry, 56 (8), Webb, J. A., & Baer, P. E. (1995). Influence of family disharmony and parental alcohol use on adolescent social skills, self-efficacy, and alcohol use. Addictive Behaviors, 20 (1), Wekerle, C., et al. (2009). Substance use among adolescents in child welfare versus adolescents in the general population: A comparison of the Maltreatment and Adolescent Pathways (MAP) longitudinal study and the Ontario Student Drug Use Survey (OSDUS) datasets. London, ON: University of Western Ontario. Werner, E. (1986). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol, 47,