Focus

Growing up with no place to go

Substance use program helps youth find their way

By Astrid Van Den Broek

Faith’s* coming of age story begins with the Transitional Aged Youth Substance Use Program at North York General Hospital. Her parents had admitted her to the Toronto hospital to deal with her addiction to marijuana, Ecstasy and cocaine. Social worker Erika Rukin from the youth program came to see her and found her a month-long drug rehabilitation program. When that was finished, Faith started counselling with Rukin twice a week. “I was 16 when I went into the youth program, and I felt like I could be more comfortable there. Everyone else was around my age,” says Faith, who is now almost 18 and still touches base with Rukin once a week. “It wasn’t like a Narcotics Anonymous meeting, where it’s all older people and you can’t really relate to them.”

That, in a nutshell, is what makes the program unique. It serves a distinct clientele in an equally distinct way: the clientele are young people with substance use issues, and often mental health issues. But they’ve “aged out” of traditional youth programs, which often end at 18. Yet these youth may still be too young for adult programs. To fill this gap and the needs of transition-aged youth, the program is relatively unstructured, designed that way to reflect the often unstructured lives of youth. It involves an outreach program and barrier-free referrals. Another key feature is employing a social worker who also works for the adult addiction program at the hospital. These elements make the youth program stand out as an example of how services can help ease the transition to adulthood.

One noticeable gap in services for youth is with the transition-aged group between 16 and 24. These young people are often caught between the youth and adult health care systems.

The program launched in 2007 in response to a geographic need. “Over the years, we’ve been trying to fill in the gaps for services in the north end of Toronto and beyond,” says Stuart Goldman, the program’s manager. One of the more noticeable gaps was this transition-aged group between 16 and 24, caught between the youth and adult health care systems.

Getting youth into the program often requires reaching out to the community. Recently, the program has forged partnerships with organizations such as the Toronto District School Board. “Our age range is 16 to 24, but our statistics show that 16–19-year-olds are less likely to come to our clinic, so we’re trying to get them where they’re at,” says Rukin. At schools such as Avondale Secondary Alternative School in the city’s north end, the program consults with staff about student needs. “Staff might think a group or presentations around substance use would be helpful, or they might ask us to do a parent night,” says Rukin.

Four years after it was launched, the program boasts impressive results. Its small staff, which includes Goldman, a medical director and three part-time social workers, served about 170 clients through 1,200 to 1,400 consultations in 2010. The drop-out rate is about average, says Goldman. “There’s no real end to the program,” he notes. “It’s not very structured like the adult program, where you’re in for a certain number of weeks. That wouldn’t work well with youth. They can come and go as they please. We work on launching them into a new plan, whether it’s back to school, work, moving out or staying off drugs, for example.”

That flexible approach helped Chris. Two years ago, Chris came home from university for the December holidays in a puzzling state: three counsellors at university had suggested he had a mood disorder. On a later visit home, Chris experienced a psychotic break, followed by depression and substance use problems. That spring, with the help of a physician, Chris’s family enrolled him at North York General Hospital’s day program, where he was diagnosed with substance-induced psychosis.

In August, one of Chris’s counsellors suggested he join the transition program. “That was the best thing that could happen,” says Chris’s mother, Jane. “The one-on-one, rather than a group setting, was really good for Chris. And it was very focused, with cognitive behavioural-therapy, for example.” The Monday night parents group also helped Jane and her husband “to understand the difference between regular, expected teenage behaviour and what’s not regular behaviour, “says Jane. “Chris had been using marijuana, but I thought it was just recreationally. We learned about substance abuse and dependency at the group.”

Looking ahead, Rukin says the program plans to form more partnerships as part of its growth plan. “Key for us is building community partnerships; I don’t know if in the addiction field that’s well practised,” she says. “But it’s all about going where your clients are at.”

*All consumer and family member names have been changed