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MODEL FOR THE TREATMENT OFSUBSTANCE DEPENDENT YOUTH

IN RESIDENTIAL FACILITIES



TABLE OF CONTENTS

FOREWORD BY THE MINISTER ACKNOWLEDGEMENTS1. INTRODUCTION2. PRINCIPLES

2.1 Accountability2.2 Appropriateness2.3 Child Centered2.4 Continuity of Care/Aftercare2.5 Continuum of Care2.6 Effective and efficient2.7 Empowerment2.8 Family-Centered

2.9 Family Preservation2.10 Rights of Young People2.11 Integration2.12 Normalization2.13 Participation2.14 Permanency Planning2.15 Restorative Justice3. APPLICABLE LEGISLATION4. MODEL FOR THE TREATMENT OF

SUBSTANCE DEPENDENT YOUTH INRESIDENTIAL FACILITIES

4.1 Description4.2 Goals5. ESSENTIAL ELEMENTS6. STRATEGIES, PROCESSES AND

METHODS7. PREPARATION FOR IMPLEMENTATION

8. CONCLUSION9. GLOSSARY

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FOREWORD

Increasing levels of substance abuse amongst young peopleacross all echelons of our society prompted the National

Department of Social Development to develop an appropriate andeffective response to this social issue. Research findings andincreasing pressure on existing treatment programs confirm theabove issue as well as the fact that young people are becomingdependent on substances at an earlier age than ever before.

In a report on research carried out on trends in alcohol and other drug use in South Africa, Parry et al (2004) concluded that “the

study points to the need for AOD (alcohol and other drug use)intervention programs that target young people and the need for continued monitoring of adolescent AOD use in the future”.

A review of existing treatment programs led to a consultativeworkshop, attended by representatives from existing registeredtreatment centres and a range of role-players with expertise inchild and youth care and substance abuse. This resulted in the

formulation of a Best Practice Model, which reflects the coreelements essential to a treatment program for young peopleunder the age of 18, within the context of a child's rights culture.

Furthermore and included in this Model, are unique interventionssourced from existing treatment programs, for possibleadaptation in different settings.

The unique nature of this Model facilitates its adaptation to abroad range of child and youth care residential settings, whichincludes secure care facilities, children's homes and places of safety specialized in-patient treatment centres.

DR ZST SKWEYIYAMINISTER OF SOCIAL DEVELOPMENT

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ACKNOWLEDGEMENTS

The National Department of Social Development would like tothank the following for their invaluable contributions to the

formulation of this document:

The Working Task Team consisting of representatives from theNational Department of Social Development, the KwaZulu-Natal Provincial and Durban Regional Offices of theDepartment of Social Welfare and Population Developmentrespectively, Durban Children's Home (Siyakhula), National

Association of Child Care Workers and SANCA Durban Alcohol and Drug Centres.

All those who participated in the consultative process in anyway, by attending the workshop held in Durban on 15 April2004 and/or making written representation.

The respective Management Boards of Durban Children's

Home (Siyakhula) and SANCA Durban Alcohol and DrugCentres for making available their respective Directors andstaff to undertake the compilation of the Best Practice Modelfor the Residential Treatment of Young People Dependent onChemical Substances, and to pilot this model.

The young people at Durban Children's Home (Siyakhula) and

SANCA Durban Alcohol and Drug Centres (Warman House)for their participation in the pilot project.

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1. INTRODUCTION

The Department of Social Development observed an increasein young people reporting for in patient drug treatment. It is

alarming that more and more patients with heroin addictionreport for treatment, especially young people. This led to theDepartment of Social Development to engage in a project todevelop a best practice treatment model for young peoplewhich after completion, would be replicated in all theprovinces of South Africa.

In view of the situation that is facing young people in thecountry, it is imperative for the Department of SocialDevelopment; in partnership with other stakeholders; todevelop comprehensive youth programs that will address theproblem of substance abuse among the youth, whilst notignoring the other age categories.

This model is based on the Minimum Norms and Standards for Inpatient Treatment Centers, Minimum Standards for Childand Youth Care, Prevention and Treatment of DrugDependency Act 20 of 1992, Constitution of South Africa andthe child care policies and legislation.

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2. PRINCIPLES

These principles provide the foundations of the Best PracticeModel.

2.1 Accountability

Everyone who intervenes with young substance dependentpersons and their families should be accountable for thedelivery of an appropriate and quality service.

2.2 Appropriateness

All services to young substance dependent persons and their families should be the most appropriate for the individual, thefamily and the community.

2.3 Child Centered

Positive developmental experiences; support and capacitybuilding should be ensured through regular assessment andevaluation of programs which strengthen the substancedependent person's development over time.

2.4 Continuity of Care/Aftercare

The changing social, emotional, physical, cognitive, spiritualand cultural needs of substance dependent persons and their family should be recognized and addressed throughout theintervention process. Links with continuing support andresources must be encouraged after disengagement from thesystem.

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2.5 Continuum of Care

Young substance dependent persons and their familiesshould have access to a range of differentiated services on a

continuum of care, ensuring access to the least restrictive andmost empowering environment and/or program/s appropriateto their individual developmental and therapeutic needs.

2.6 Effective and efficient

All services rendered to substance dependent young persons

and their families should be rendered in the most effective andefficient way possible.

2.7 Empowerment

The resourcefulness of each substance dependent youngpersons and their families should be promoted by providingopportunities to use and build their own capacity and support

networks and to act on their own choices and sense of responsibility.

2.8 Family-Centred

Support and capacity building should be provided throughregular assessment, planning and ongoing evaluation of

programs which enhances the family's functioning over time.

2.9 Rights of Young People

The rights of young people as established in the UNConvention and SA Constitution shall be protected.

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2.10 Integration

Services to substance dependent young persons and their families should be holistic, inter-sectoral and delivered by a

multi-disciplinary team.

2.11 Normalization

Young substance dependent persons and their familiesshould be exposed to challenges, activities and opportunitiesat the social, emotional, cognitive, physical and cultural levels

respectively which promotes participation, development,resilience and social functioning.

2.12 Participation

Young substance dependent persons and their familiesshould be actively involved in all the stages of the interventionprocess.

2.13 Permanency Planning

Every young substance dependent person should beprovided with the opportunity to build and maintain lifelongrelationships within a family and/or community.

2.14 Restorative Justice

The approach to substance dependent young persons introuble with the law should focus on restoring societalharmony and putting wrongs right rather than punishment.The young person be held accountable for his or her actionsand where possible make amends to the victim.

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3. APPLICABLE LEGISLATION

• Basic Condition of Employment Act Amended, 2002

(Act No.10 of 2002)•

Child Care Act as amended, 1983 (Act No. 74 of 1983)• Child Justice Bill 2003

• Correctional Service Amendment Act, 1992 (Act No.122

of 1992)• Domestic Violence Act, (Act No. 116 of 1998)

• Drug Trafficking Act, 1992 (Act No.140 of 1992)

• Employment and Equity Act

• Heath Act, 1977 (Act No. 63 of 1977)

• Health Professional Act, 1974 (Act No. 56 of 1974)

• Labour Relations Act, (Act No.66 of 1995)

• Medicine and Related Substance Control Act Amended,

2002 (Act No. 59 of 2002)• Mental Health Care Act, 2002 (Act No. 17 of 2002)

• Non Profit Organisations Act, 1997 (Act No. 71 of 1997)

• Nursing Act, 1978 (Act No. 50 of 1978)

•Occupancy Health and Safety Act, 1993 (Act No. 85 of 1993)

• Pharmacy Act, 1974 (Act No. 53 of 1974)

• Prevention and Treatment of Drug Dependency Act,

1992 (Act No. 20 of 1992)• Probation Services Act, (Act No. 116 of 1991)

• Promotion Equality and Prevention of Unfair

Discrimination Act, 2002 (Act No. 52 of 2002)

• Public Finance Management Act,1999 (Act No. 1 of 1999)• S.A. Constitution Act, 1996 (Act No. 108 of 1996)

• S.A. School Act, (Act No. 84 of 1996)

• Social Work Act, 1978 (as amended) (Act No. 110 of 1978)

• The Criminal Procedure Act, 1977 (Act No. 51 of 1977,

Section 296)• Tobacco products Control Amended Act,1999 (Act No. 12 of

1999)

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4. MODEL FOR THE TREATMENT OF SUBSTANCEDEPENDENT YOUTH IN RESIDENTIAL FACILITIES

4.1 Description

This best practice model promotes a holistic integratedapproach to residential treatment that is designed to addressand respond to the unique needs of young people sufferingfrom substance abuse. Treatment is rendered within atherapeutic milieu, within a child's rights context, whichensures the safety of the young person, and recognizes the

importance of developmental assessment. The modelpromotes a strong therapeutic approach within a child caresetting, ensuring that each young person is responded to interms of his/her individual needs.

4.2 Goals

4.2.1 To create a cost-effective therapeutic program which

ensures that each young person receives a holistic responseto his/her specific needs. This response is provided within adevelopmental context, which ensures respect for the youngperson's individuality.

4.2.2 To ensure that therapeutic programs offered respondto the treatment needs of young people, thereby ensuring that

the young person experiences his/her rights.

4.2.3 To provide an opportunity for the replication of theBest Practice Model, thereby ensuring a uniform response toyoung people who are substance dependent, in line with childcare policy for young people in residential settings, and thepolicy on minimum standards for residential programs for thetreatment of substance dependence.

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5. ESSENTIAL ELEMENTS

5.1 The model promotes the developmental approach inresponding to young people accessing treatment.

Continuous assessment ensures that strengths anddevelopmental areas are highlighted, with developmentalchallenges and other issues receiving a holistic response tothe unique identified needs of the individual.

5.2 The medical model is applied in terms of describingthe substance dependent behavior, and defining the specific

areas requiring a medical response. Medical assessmentand evaluation is an ongoing requirement.

5.3 The ecological perspective is incorporated in themodel, with family/significant other involvement beingrecognized as being crucial to the young person's recovery.Family members/significant others are encouraged toparticipate in a meaningful manner throughout the therapeutic

intervention process.

5.4 The model embodies outreach and networking, asthe most relevant support systems needed by the youngperson are assessed during and after the treatment period.

5.5 While the therapeutic program is eclectic, it functions

from the same philosophical approach drawing on a range of existing models including, but not restricted to, the medicalmodel, systems theory, ecological approach, therapeuticcommunity theory, Minnesota model, Circle of Courage modeland the Adolescent Development Program Model. This resultsin a wide range of options being available, thereby ensuringthat the unique needs of young people can be met.

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5.6 All personnel intervening with young people must betrained in terms of knowledge and interventions specific toaddictive behaviour management and they must have a clear understanding of the development needs of young people. All

personnel and young people must understand the rulespertinent to the treatment program, as well as theconsequences of non-compliance with these rules.

5.7 Children's rights are interwoven through everyaspect of the program, thus ensuring the protection of therights of young people. Furthermore, young people are

educated in terms of these rights and the responsibilities thataccompany them.

5.8 A trained multi-disciplinary team is required toensure that young people are assessed and treatedholistically. This further ensures that a range of responsesand expertise is available to assist, and give direction, toidentified developmental areas. It is essential that trained

child and youth care workers form part of this team, as their expertise in terms of life space work, behavior managementand activity programs is vital for the development of youngpeople.

5.9 Trained medical personnel need to be available toaddress and manage medical issues, which may arise as a

result of the substance abuse. Other medical professionalssuch as psychiatrists need to be available to assist with thediagnosis and treatment of young people with a possible dualdiagnosis status.

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5.10 Aftercare is a crucial element in the young person'srecovery. This component needs to be purposefully designedand planned in a manner which creatively uses existingresources, or develops resources in areas that are under-

resourced. Aftercare must provide both the young person andthe family with the necessary ongoing support on the youngperson's disengagement from the program.

6. STRATEGIES, PROCESSES AND METHODS

6.1 Pre-admission is a vital process necessary for

identifying the need and motivation of each young person,preparing him/her for the therapeutic process, and assessingthe support, which family/ significant others will bring to thetreatment process.

6.2 Young people are assessed medically on the day of admission in order to determine the extent of their substanceuse/abuse and the physical effects thereof. The assessment

also identifies the medical protocol, which is indicated.

6.3 Each young person must be developmentallyassessed within three weeks of admission in order to establishan Individual Development Plan. Assessment is an ongoingprocess and regular reviews monitor the progress in terms of reaching set targets.

6.4 The therapeutic program ensures that all aspectsrequired for the healthy functioning of the young person oncehe/she returns to the family and community, is taken intoconsideration during the treatment process. Key topics needto be covered within the therapeutic program. These includeeducation on substance dependence, management of specific behaviors and emotions related to substancedependence, relapse prevention, aftercare, self- awarenessand personal growth, health and hygiene, communication

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skills, spirituality, sexuality, HIV and Aids, education, diversityand other life skills. The length of the program should bebetween three and twelve months.

6.5 Ongoing training and supervision of all teammembers is essential in providing an accountable andintegrated service. It further develops the skills andknowledge of the staff team and fosters team building andcommitment

6.6 Volunteers provide meaningful contributions to the

program. It is important to ensure that their involvement iscarefully supervised within a structured volunteer program,that there is a clear purpose for their involvement and that theyare empowered with training, support and direction.

6.7 The restorative approach is applied to conflictsituations that may arise within the program. This ensuresthat harmony is restored between the victim and the

perpetrator, and promotes the concept of peace. Skillsattained by staff members through using this approach can beutilised should the program be used as a diversion option bythe court.

6.8 An educational component is provided. Thiscomponent takes into consideration the particular needs of

individual young people whilst in treatment and involvesnetworking with relevant school authorities and other creativeresponses for literacy.

6.9 The incorporation into the treatment program of AA, Alanon, NA and other community support systems isimportant as it ensures that young people are provided withconcrete experience on how to access support when needed.

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6.10 A structured activity program providing sportingactivities, music, crafts and art is important in terms of assisting young people to discover new strengths, to learnhow to utilise their free time effectively and how to have fun.

6.11 Skills development is also part of the therapeuticprogram, where a young person is assessed and linked to askills development initiative to empower him/herself.

7. PREPARATION FOR IMPLEMENTATION

7.1 All staff working in the program receive the relevanttraining which includes Substance Abuse training, AdolescentDevelopment Program training, Developmental Assessmenttraining, Behaviour Management training and Basic ChildCare training.

7.2 All legislative requirements and relevantguidelines/policy related to minimum standards, need to be in

place. Staff must be aware of these requirements, havereceived the required training and have the capacity to meetthem.

7.3 Trainers need to be identified, trained and appointedin order to offer the relevant training and mentorship, therebyensuring an effective service delivery.

7.4 Awareness programs and marketing strategiespromoting the availability of the service, need to be developedand implemented.

7.5 It is essential that recognised established servicespracticing the Model fulfill a mentoring function in terms of support, input and ongoing training to organisations wantingto replicate the Model.

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7.6 Adequate funding is critical in order to ensure thesuccessful implementation, replication and sustainability of programs for the residential treatment of young peopledependent on substances.

8. CONCLUSION

The model will serve as a guide to promote uniformity in themanagement of substance abuse amongst the youth inresidential facilities. The pilot phase was completed in March2005 and the practice guideline was developed to guide

service providers on how to implement the model.

GLOSSARY

Addictive Behaviour:- refers to:• A strong desire or sense of compulsion to engage in a

particular behaviour (especially when the opportunity to engage in

such behaviour is not available).• Impaired capacity to control the behaviour (notably in terms

of controlling its onset, staying off, or controlling the level at which thebehaviour occurs).• Discomfort or distress when the behaviour stops.

• Persisting with the behaviour despite clear evidence that it

is leading to problems.

(Ref: Pols, Dr R, Farrin, Ms J A Sirenko, (1994) Handbook for MedicalPractitioners & other Health Care Workers Australian GovernmentPrinting. Canberra

Adolescent Development Program: refers to the strengthening of young people by focusing on existing strengths and providingopportunities for the development of new strengths. Thedevelopmental curriculum encourages new learning. The expressionand articulation of feelings and emotions is encouraged and youngpeople are provided with support and empathy during these times.

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Aftercare: refers to follow-up care that offers ongoing support tomaintain sobriety/abstinence, personal growth and assists withreintegration into the community/family.

Awareness Programs: refers to structured programs which provideindividuals and groups with the opportunity to obtain information fromknowledgeable others in order to enhance personal understanding,build capacity with regards to life skills and make educated choices.

Behaviour Management: refers to the managing of behavioursexhibited by individuals or groups of young people in a manner whichis respectful and dignified, providing them with capacity and support,which enables them to learn inner control and effective social

behaviour.

Circle of Courage Model: refers to four pillars of self-esteem:belonging, mastery, independence and generosity. The four pillars(values) are related to and influence each other. When the needs ineach of these areas are met a young person is able to experience asense of well-being and wholeness.

Developmental Approach: refers to a focus on strengths rather thanpathology, to building competency rather than attempting to cure, anda strong belief (reflected in practice) in the potential within each youngperson and family regardless of the reason for referral.

Developmental Assessment: refers to the process of identifying,understanding and responding appropriately to developmental tasksand needs, through the process of seeing the young person as awhole and taking his/her context into consideration.

Disengagement: refers to the process of preparing young people for leaving the program. Particular attention must be given to therecognition of mixed feelings from the young person as well as theimportance of a clear plan for integration back into family andcommunity.

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Diversion: refers to the channeling of prima facie cases away fromthe criminal justice system on certain conditions. These conditionsare usually the participation in particular programs and/or reparationwhere possible.

Dual Diagnosis: refers to a concurrent mental health condition thatexists alongside substance related disorders. The term “dualdiagnosis” often applies here.

Ecological perspective: refers to the practice of understanding andviewing each young person within the context of, and connected to,his/her family and community.

Marketing Strategy: refers to the planned activities applied by thefacility in creating awareness of the program/s offered to the targetgroup and the community in general.

Medical Model: refers to a model based on the premise that chemicaldependence is a primary, progressive, chronic and relapsing disease.

Minnesota Model: refers to a model which is based on the premise

that persons who are chemically dependent can assist one another and has as working principles the assumptions that chemicaldependence exists, is a disease and is a multi-phasic illness.

Multi-disciplinary Team: refers to a therapeutic or multidisciplinaryteam of health and social development professional and accreditedaddiction counsellors (if members of the centre's staffing body) whoprovide treatment at the centre. See section 2.17 of the MinimumNorms and Standards for In-Patient Treatment Centres, for theminimum staff components of this team for type A and B facilities.

Restorative Approach: refers to resolving conflict in a manner whichfocuses on healing and accountability rather than punishment, andwhich involves the participation of the community surrounding anincident, including the young person and his/her family, as well as thevictim where appropriate.

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Sustainability: refers to efforts made by the facility to strengthen theprogram thereby ensuring its ongoing maintenance and hence themeeting of specific program needs.

Systems Theory: refers to looking at young people in relation to thevarious systems within which they are or have been functioning.Every part of the system is connected to every other part and thisinter-connectedness means that a change in one part will cause achange in some other part of the system, thus bringing about changein the total system.

Therapeutic Intervention/program: refers to the clinical process bywhich the patients/clients are assisted in abstaining from their drug

abuse/dependency and in participating in rehabilitation to achievetheir optimal level of functioning. This process is based on bestpractice health care principles. Treatment should be holistic and, asfar as possible, address all the patients'/clients' (and their families'and caregivers) needs, i.e. physical, psychological, social, vocational,spiritual, interpersonal and lifestyle needs.

Therapeutic Milieu/Community: refers to a residential facility which

provides the chemically dependent person with the opportunity tolearn to lead a substance free life, within a safe, structuredenvironment.

Volunteer: refers to a person who offers their knowledge skills and/or time to areas of the program in a manner which supports the overallgoal of the program. These services are provided free of charge andthe volunteer is screened and given clear direction in terms of expectations by the service provider.

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National Department of Social Development

Private Bag X 901Pretoria

0001012 312 7448/7427

www.socdev.gov.za / 0800 60 10 11

Building a Caring Society. Together.

social security: ymodel

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