2. 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

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

4. 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

5. 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

6. 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;

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

8. 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

9. Adverse Childhood Experiences

10. 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

11. 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.

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

13. 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.)

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

15. 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

16. 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.

17. 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

18. 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.)

19. 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)

20. 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 states are expected to legalize recreational marijuana

21. 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!

22. 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

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

24. 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.

25. 26

26. 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!

27. 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

28. 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

29. 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

30. 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

31. 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

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

33. 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.

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

35. 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

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

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

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

39. 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

40. 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

41. 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)

42. 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.

43. 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.

44. 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

46. 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

47. Washoe YouthBuild

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

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

50. 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

51. 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

52. 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.

53. 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

54. 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!

55. 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)

56. 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

57. 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

58. 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

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

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

61. 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

62. Washoe YouthBuild

64. Real Talk SBIRT Fact Sheet
s/2017/06/28/13/36/Real_Talk_SBIRT_Fact_ Sheet
Resources to Assist in Fighting the Opioid Epidemic
s/2018/10/12/14/45/Resources_to_Assist_in _Fighting_the_Opioid_Epidemic
Counseling and Case Management at a YouthBuild Program
s/2016/06/21/09/35/Counseling_and_Case_ Management_at_a_YouthBuild_Program
Strategies for Implementing Trauma-Informed Care at a YouthBuild Program
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
and-guidance-trauma-informed-approach

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

66. Pat McNeil Jerome Kolker
Associate Director of Substance Use Intervention
YouthBuild USA
Jerome Kolker
Clinical Social Work/Therapist
Consultant for YouthBuild USA

67. Jeremy Stocking Chris Jones Program Director Lead Case Manager
The Children’s Cabinet
Chris Jones
Lead Case Manager

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