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COUN 6785: Social Change in Action:

Prevention, Consultation, and Advocacy

Social Change Portfolio

R Campbell

Contents

Introduction

Scope and Consequences

Social-ecological Model

Theories of Prevention

Diversity and Ethical Considerations

Advocacy

The phenomena that children who are exposed to parents abusing substances becoming substance abusers themselves is not a new one. Children removed from their parents due to their parents’ substance misuse have been exposed to substance misuse themselves for, in many cases, a substantial period of time. Substance misuse, as a factor for removal of children is widely seen in cases where children have been removed from their own family (Traube, 2012). Family variables, such as children’s exposure to their own parents substance misuse, can directly impact the substance misuse of a child (Marino et. al., 2018). Proactive counseling with young adults that have been exposed to the substance misuse of their parents could assist by providing a support system so that these young adults do not continue the cycle of substance misuse that they have been exposed to.

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Young adults that have been removed from their own parents due to their parents’ substance misuse are at greater risk of substance misuse themselves. Okaloosa County, Florida is a predominately middle-class community with families having a median income of approximately $63,000 per year (County Health Rankings and Roadmaps, 2018). One important figure when looking at Okaloosa County is that of the population, 22 percent of the population is under the age of 18 (County Health Rankings and Roadmaps, 2018). In 2019, there were 93 young adults in extended foster care in Northwest Florida (Department of Children and Families, 2020). This number is an increase of 5 young adults from the previous year (Department of Children and Families, 2020). Of those 93 young adults in extended foster care 57 of the young adults were removed from their parents in Okaloosa County (S. Wood, personal communication, June 15, 2020). Of the 57 young adults removed in Okaloosa County 48 were removed from their parents due to their own parents’ substance misuse (S. Wood, personal communication, June 15, 2020). Unfortunately for those in Okaloosa County the ratio of mental health providers to the members of the community is 620:1 (County Health Rankings and Roadmaps, 2018).

As previously stated young adults that have been exposed to substance misuse are at a higher likelihood of abusing substances themselves. Young adults that engage in substance misuse are at risk of a myriad of social and health problems due to their substance misuse. For those young adults that engage in substance misuse while in highschool, there is a higher likelihood that these youth will drop out of college if they were to engage in higher education (Patrick et. al., 2016). Further, young adults that engage in substance misuse or alcohol misuse are more likely to suffer from harms related to their own physical and mental health and in other developmental areas (Christie et. al., 2018). The consequences related to youth substance misuse paints the picture of why these youth need assistance to reduce their own substance misuse.

The establishment of preventative substance misuse treatment for those young adults that have been exposed to their own parents’ substance misuse may reduce the negative impacts that exposure of substance misuse may have on the lives of those young adults.

Reducing Substance Misuse of Children of Substance Abusers

Individual

Although many teens or adolescents do not believe that they have any control over their lives there are many things they can do to support their overall mental health. For example, by taking account of their own personal self worth, through techniques such as diet and exercise, these adolescents can ensure their well-being is being met through their own actions (American Mental Wellness Association, 2020). Adolescents that have been removed from their own families may also have added support in their own self by utilizing these techniques to make positive choices in their own lives (American Mental Wellness Assocation, 2020).

Many factors at an individual level could lead to risk factors for mental health issues and substance misuse for those who have been removed from their own family due to substance misuse. Many of those who have been removed from their own families suffer educationally which would put them at risk based on their own poor academic achievement (American Mental Wellness Association, 2020). Furthermore, the experience of being removed from a parent or a caregiver based on the caregivers acts could lead to negative beliefs toward onceself creating a negative view on their life (American Mental Wellness Association, 2020).

Family

The role of the family in preventing substance misuse in adolescents cannot be understated. Family has been shown to play a significant role in the reduction of substance misuse in adolescents (Mehus, 2018). Adolescents from a household that has positive communication and receive praise or high caring are less likely to engage in substance misuse (Mehus, 2018). Further, when adolescents are properly monitored it is less likely that these adolescents will engage in substance misuse (Mehus, 2018). These behaviors of effective parents support the adolescent by ensureing that the child has secure attachment with a caregiver (American Mental Wellness Association, 2020).

Children that have been removed from their parents based on their own parents substance misuse are likely to not have received many of these protective factors in the adolescents. Further, as many of their own parents have history of use of substances combined with mental health problems, these factors would put the adolescent children of substance misusers at risk (American Mental Wellness Association, 2020). Further, as these children have been removed from their parents they have been abused or neglected in some way by their parents putting them further at risk (American Mental Wellness Association, 2020). These risk factors could be replaced were the child being removed be placed in a supportive environment.

Peer Group

Social relationships make up the fabric of the lives of many teens. In fact, it has been shown that the ability to make friends can be a strong support for many adolescents (American Mental Wellness Association, 2020). Further, supportive relationships with others within one’s own peer group can provide added protection to an adolescents mental health (American Mental Wellness Association, 2020). The concept of peer group can be an important one when looking at a youth that might not have a significant family relationship in their own lifes.

Unfortunately, for many youth, especially those removed from the custody of their own family, the youth may have a tendency to cohot with negative friends. Having only a few or negative friends could be a risk factor for these children (American Mental Wellness Association, 2020). Further, as many of these youth may only know of negative relationships it would not be surprising if they chose abusive friendships to be in as these are the relationships that they have come to know (American Mental Wellness Association, 2020).

Community

A strong sense of community support can provided added protective factors for those who have been removed from their own families. Many of those removed are granted new opportunities in the form of participation in clubs, community, or religious groups (American Mental Wellness Association, 2020). For those removed from their parents in Florida that continue in extended foster care, many of these individuals are granted to local resources through their foster parents in the form of religious affiliations and community affiliations with those that are also in extended foster care.

For those who have been removed from their families there also are the likelihood of many risk factors. Although those in extended foster care are provided with their own housing until they reach the age of 21, many of the communities that these individuals will move into are low income areas where crime is unfortunately more frequent (American Mental Wellness Association, 2020). Additionally, although these adolescents are afforded some community based services, many will lack the services they need due to overwhelming demand that the community faces (American Mental Wellness Association, 2020).

Reducing Substance Misuse of Children of Substance Abusers

When looking at any social issue that is being addressed, the target population that is being looked at needs to be assessed first. This would mean that “evidence-based prevention programs should take into account developmental considerations, and prevention workers should evaluate the appropriateness of the program, given the development and life stage of the targeted population” (Raczynski et. al., p. 19, 2013). For the target population of young adults in foster care this would mean ensuring that the prevention program is developed to ensure that it is designed to address the young adults needs based on their own developmental framework.

One theoretical framework that could be utilized with this target group would be the Stages of Change Model. In this model one enters the behavioral change process in one of five stages: precontemplation, contemplation, preparation, action, or maintenance (National Cancer Institute, 2005). Further, this model focuses on the fact that behavioral change is a continuing process, not a single act (National Cancer Institute, 2005). One benefit of this model is the fact that rather being a linear model for behavioral change it is actually a circular model whereby one can progress or regress depending on where they are within the model (National Cancer Institute, 2005). This means that an individual could be behaviorally at the contemplation stage of change and progress from that point on in their own treatment. As a provider with the Department of Children and Families in Florida we utilized the Stages of Change Model to address issues of abuse, abandonment, or neglect with families in the ‘system’. This model could further be used with young adults to prevent substance misuse by proactively providing treatment to the young adults and utilizing this model to gauge how they are progressing through services.

The Stages of Change Model has previously been utilized when working with those with teens with cannabis addiction. This research indicates that when an individual is in the action stage they are more likely to not use cannabis compared to being in the precontemplation or contemplation stage (Dupont et. al., 2017). For the purposes of this project this would indicate that it would be important to utlize services, in this case counseling, to get the target population, young adults, into the action stage of the Stages of Change Model. This would ultimately lead to more success for this population at preventing their own substance misuse.

The Take Stock in Children program in Florida is a program that offers somewhat similar services to the youth of Florida. The Take Stock in Children program offers opportunities for low income students by providing educational opportunities to these students (Take Stock in Children, 2015). Through this program, students from low income families are matched with mentors throughout their high school careers (Take Stock in Children, 2015). So long as the student continues to meet with their mentor and meets minimum educational standards the child will be guaranteed a scholarship for college in the future (Take Stock in Children, 2015). Through this program, 96% of participants graduate high school on time and then enroll in some form of college (Take Stock in Children, 2015). My program would be similar to this in that teens would be matched with a counselor, rather than a mentor, to prevent their own substance misuse in the future.

Reducing Substance Misuse of Children of Substance Abusers

Members of subgroups of populations can be at greater risk of many mental health concerns including substance misuse. Members of the LGBT community are at greater risk of substance misuse than their heterosexual counterparts (Wishart et. al., 2020). In fact many LGBT youth had not only a greater risk of substance misuse but their substance misuse was to a higher level than their counterparts (Wishart et. al., 2020). This phenomena is not a new one. In fact, sexual minority females have also been shown to have higher levels of substance misuse which has numerous negative outcomes such as increased sexually transmistted diseases and higher numbers of sexual partners (Oshri et. al., 2014). The numerous negative impacts that substance misuse could have on members of this particular subgroup highlight the importance of addressing this issue with not only all young adults but those of sexual minorities in particular. Therefore, it would be important to identify these youth and promote their participation with mental health providers proactively to ensure they are receiving positive mental health supports to promote abstinence from controlled substances and/or alcohol.

Ethically there are multiple issues to considered when working with young adults that are under the supervision of the Department of Children and Families. At the forefront of the ethical consideration is the concept of confidentiaility. These young adults could be considered Clients Served by Others which would require the young adult to sign a release so that the mental health counselor can provide information to other individuals also providing services to the young adult (American Counseling Association, 2014). It would also be the counselor’s duty to ensure that they are working in a productive manner with the other professional service provider (American Counseling Association, 2014). As many young adults may be under court supervision, requiring the counselor to keep members of the judiciary apprised of the young adults progress, the counselor may also be required to discuss the limitations of confidentiaility with the client as they could be considered a mandated client (American Counseling Associaiton, 2014). It would then be the counselor’s responsibility to inform the client of any limitations on confidentiaility that might arise due to the client’s being a mandated client (American Counseling Association, 2014). As these young adults are under services through many local stakeholder’s, it will be important for their counselor to provide these young adults with collaborative services in conjunction with their other service providers to ensure that the young adult is receiving adequeate, but not repetitive services.

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References:

American Counseling Association (2014). 2014 ACA Code of Ethics. Retrieved from https://www.counseling.org/Resources/aca-code-of-ethics.pdf.

Christie, G.I., Fleming, T.M., Lee A.C., & Clark, T.C. (2018). Health and social difficulties in high school students using high amounts of alcohol and drugs: implications for screening. Journal of Child & Adolescent Substance Abuse, 27(3), 180-188. https://doi-org.ezp.waldenulibrary.org/10.1080/1067828X.2018.1443865.

County Health Rankings and Roadmaps (2018). How healthy is your community. Robert Wood Johnson Foundation. Retrived from http://www.county-healthrankings.org.

Department of Children and Families (2020). Indepdent living services annual report. Retrived from: https://www.myflfamilies.com/service-programs/child-welfare/docs/2020LMRs/Independent%20Living%20Services%202019%20Annual%20Report.pdf

Dupont, H.B., Candel, M. J. J. M., Lemmens, P., Kaplan, C.D., van de Mheen, D., & De Vries, N.K. (2017). Stages of change model has limited value in explaining the change in use of cannabis among adolescent participants in an efficacious Motivational Interviewing intervention. Journal of Psychoactive Drugs, 49(5), 363-373. https://doi-org.ezp.waldenulibrary.org/10.1080/02791072.2017.1325030.

Marino, C., Moss, A. C., Vieno, A., Albery, I. P., Frings, D., & Spada, M. M. (2018). Parents’ drinking motives and problem drinking predict their children’s drinking motives, alcohol use and substance misuse. Addictive Behaviors, 84, 40–44. https://doi-org.ezp.waldenulibrary.org/10.1016/j.addbeh.2018.03.028

Mehus, C.J., Doty, J., Chan, G., Kelly, A.B., Hemphill, S., Toumbourou, J., & McMorris, B.J. (2018). Testing the social interation learning model’s applicability to adolescent substance misuse in an Australian context. Substance Use and Misuse, 53 (11), 1859-1868. https://doi-org.ezp.waldenulibrary.org/10.1080/10826084.2018.1441307.

National Cancer Institute (2005). Theory at a glance: A guide for health promotion practice. Washington DC: U.S. Department of Health and Human Services: National Institutes of Health. https://cancercontrol.cancer.gov/brp/research/theories_ project/theory.pdf

Oshri, A., Handley E.D., Sutton, T.E., Wortel, S., & Burnette, M.L. (2014). Developmental Trajectories of substance use among sexual minority girls: associations with sexual victimization and sexual health risk. Journal of Adolescent Health, 55(1), 100-106. Https://doi-org.ezp.waldenulibrary.org/10.1016/j.jadohealth.2013.11.009.

Patrick, M.E., Schulenberg, J.E., & O’Malley, P.M. (2016). High school substance use as a predictor of college attendance, completion, and dropout: a national multicohort longitudinal study. Youth & Society, 48(3), 425-447.

Raczynski, K., Waldo, M., Schwartz, J.P., & Horne (2013). Evidence-based prevention. In R. K. Conye & A. M. Horne (eds.). Prevention practice kit: Action guides for mental health professionals (pp. 1-83). Thousand Oaks, CA: SAGE.

Take Stock in Children. (2015). Retrieved from https://www.takestockinchildren.org.

Traube, D. E. (2012). GUEST EDITORIAL. The Missing Link to Child Safety, Permanency, and Well-Being: Addressing Substance Misuse in Child Welfare. Social Work Research, 36(2), 83–87. https://doi-org.ezp.waldenulibrary.org/10.1093/swr/svs043

Wishart, M., Davis, C., Pavlis, A., & Haliam, K.T. (2020). Increased mental health and pshychosocial risks in LGBQ youth accessing Australian youth AOD services. Journal of LGBT Youth, 17(3), 331-349. https://doi-org.ezp.waldenulibrary.org/10.1080/19361653.2019.1663335.