10/27/15 INDICATED PREVENTION: PRIMARY PREVENTION RESPONSE TO INDIVIDUALS/FAMILIES AT HIGHER RISK

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1 INDICATED PREVENTION: PRIMARY PREVENTION RESPONSE TO INDIVIDUALS/FAMILIES AT HIGHER RISK National Prevention Network Conference November 16-19, 2019 William W. Harris, MPS, CADC-II Jan Ryan, MA, PPS Indicated Prevention is the Primary Prevention Response to Individuals at High Risk Primary Prevention Early Intervention Treatment Maintenance Universal Prevention Selected Prevention Indicated Prevention SBIRT and other brief interventions Evidence-based practices with recovery supports (Recovery-Oriented Systems of Care ROSC) Recovery supports, self-help other peer support. (ROSC) Institute of Medicine: Indicated Preventive Interventions Targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder, or biological markers indicating predisposition for such a disorder, but who do not meet diagnostic levels at the current time. 1

2 School Student Assistance Programs: Slow down to go fast! BRRIIM = A Structured Prevention Conversation in Three Stages BRRIIM Indicated Prevention within Student Assistance More Time = Use the Protective Factors to Address Risk Settings: Student Assistance, Clinics, Community Time: 90 min. Structured Motivational Interview Age: Schools: K-12; clinics 12+ Intent: Comprehensive screen to identify strengths, concerns to use to create prevention Plan A Strategies: MI, R and P Factors, Screening Tools (supplement), BI, Stages of Change Referrals: Refer to prevention or diagnostic assessment Funding: Substance Abuse Prevention Treatment Primary Prevention, infrastructures funding 2

3 BRRIIM Strengths-Driven Planning Strengths Willingness to engage Gradua2on and job high priority Suppor2ve and respec9ul family rela2onships Respected as pastor, leader Direct about mistakes, consequences Respected by friends for understanding of AODV Willing to commit to plan Concerns Marijuana use despite family and friend concerns School credits deficient threatens gradua2on; truancy and math skills. Exposed to family losses, suicide, violence. Plan A Gradua2on plan: Meet with School Counselor for 2meline. Visit college coaches. Family: talk to his father about SHOWING UP ; family returns if Plan A is not working. Begin Brief Interven2on with Preven2on Specialist to quit, reduce AOD. Use this experience in his church leadership ac2vi2es. Alanon recommended to mother. BRRIIM Indicated Prevention IS NOT A questionnaire or quick screen An unstructured discussion Focused on only one problem Just a step before automatic referral to treatment An assessment or diagnosis Used for the creation of a Treatment Plan Designed to be after-care service Overall Impacts on MVUSD BreakThrough SAP Participants from Student Survey Because of the Break Through SAP % Agreed I am more likely to graduate from school. 96% I am less likely to drink alcohol or use other drugs. 91% I know where to go for help with personal problems. 91% My behaviors are not causing me as many problems. 80% My grades have improved. 74% I have a better relationship with my parent(s). 72% I have better relationships with my teachers or other adults at school. 69% 3

4 Student Assistance Program Outcomes Breakthrough SAP Implementations 96% of suspended students did not receive a second suspension. (CVUSD, 11-12) 40% decrease in suspensions by the third year of implementation. (MVUSD, 09-10) Higher average year-end GPA for students who participated in a BRRIIM Interview compared to those who were referred to the program but did not participate. (MVUSD) County of Riverside Southern California RC SPF identified a gap in services Tell them the good news/bad news Good News - that they did not meet the criteria for admission to treatment Bad News there are no services that we can provide and send them back out to get worse OR, admit them, inappropriately, to a 16-week treatment program. This was most often the case. 4

5 RC Individual Prevention Service Clinic Setting Immediately following the first session, 86% reported a readiness to change their marijuana use; 81% of participants reported a readiness to change their alcohol use. During a 3-month follow- up interview, 77% of the interviewees reported a reduction in alcohol use; 88% reported a reduction in drug use. RC IPS Participant Feedback and Satisfaction 95% satisfied with the initial session 84% planned on using the information they received during the session 96% would recommend IPS services to others Pre-Post Survey Findings; n =139 After 3 Months Focus Group Participants Returned and Reported Had a better outlook on their future Been motivated to improve their situation Felt like they have the support they need to make positive changes in their lives Made healthier decisions for themselves Experienced fewer problems from AOD Used the information they received from the Prevention Specialist Focus Group Findings n= 22 or 16% of the study participants 5

6 Averages Over the Last 5 Years 1.70 hrs. = Average Duration of Initial BRRIIM Interview 3.4 hrs. = Average Number of Follow-Up Education Sessions 1.70 hrs. Average Duration of Follow-Up Education Sessions Sustainable Change " Individual " Provider " System Find Your Local Indicated Prevention Find out where SBIRT is being implemented and ask where they refer those who don t get referred to TX. Ask schools how they are dealing with alcohol, drug, and violence-related school suspensions; what prevention is being offered to families. Consider working with families: learn from families how to work with families 6

7 UCLA Peer-Review Journal and Reports Harris, W. W., & Ryan, J. (2010). Indicated prevention: Bridging the gap, one person at a time. Journal of Psychoactive Drugs, 42, doi: / Summary of two evaluations of BRRIIM implemented in two Student Assistance Programs. Link to a Video created by Murrieta Valley USD BreakThrough SAP: 1d2deca67f9b2ee16da7/ Breakthrough%20SAP For More Information William W. Harris (951) wwharris@rcmhd.org Jan Ryan (760) janryanprevention@mac.com Jim Rothblatt (760) redleafresources@gmail.com Murrieta Valley Unified School District video of BreakThrough Student Assistance Program with BRRIIM 7