Addictions and Mental Health Branch - Government of Alberta
Does remand of children who experience drug addiction into provincial custody increase chances of treatment and recovery?
How to better support youth in their drug recovery journey while in the Protection of Children Drug Act (PChAD) program.
Patient and client interviews, community ideation and validation workshops to create a clear picture of the desired transformation and areas for improvement.
Support to integrate PChAD into community services and recommendations to introduce peer support counsellors to the program for better client engagement and positive outcomes.
Addictions and Mental Health Branch - Government of Alberta
Our team was invited by Alberta Health to lead the PChAD consultation with young people, families and guardians to describe the current experience and present recommendations for change. In the past both guardians/parents and youth who used the PChAD program were minimally involved with the evaluation and design of the program. We conducted user interviews with guardians and youth of the PChAD program and completed two community engagement workshops with stakeholders to validate learnings and receive feedback on the PChAD program.
Broad community engagement
What we did
We knew that work on this project would be complex and difficult. Because of the nature of the program, we were often talking with parents that had lost a child, clients that were still at risk for using drugs, and we were working under very tight deadlines.
The purpose of the first workshop was to create a dialogue among service providers in the province about the challenges and observations around the treatment journey for youth.
The Design Lab then interviewed guardians and families to understand experiences and describe areas for improvement in the PChAD program. Three peer interviewers met with youth who had extensive experience with the addictions support programs (including PChAD) in Alberta to get a better understanding of their journey and identify areas for improvement.
A concluding community workshop was held near the end of the project to review what was learned and gather recommendations from youth and guardians for the PChAD program.
"People do drugs to numb the pain or survive. When you get dumped by your whole family and get on the street it f**** with your brain."
How we did it
We knew that the youth and families we were interested in interviewing would be harder to reach, vulnerable and marginalized. Evidence demonstrates that “hard to reach” populations tend to distort their responses or avoid answers to sensitive topics due to their fear of privacy, social desirability and experience with stigma. In addition, as researchers, our power and privilege can create multiple blind spots and insulate us from truly understanding the individuals. To mitigate these challenges, the Design Lab approached young adults with lived experience to conduct youth interviews.
Sarah, Sean and Florence
In partnership with the addiction community, we recruited three young adults to conduct youth interviews. These three people had personal experience with addictions. Sarah is 21 years old and serves on the Youth Advisory Council for PChAD. Sean is 20 years old and was in a rehab program for seven months when he was 17 years old. Florence is a 24-year-old Indigenous transgender woman who has been to PChAD 3 times in her youth. The peer interviewers led the interviews with support from the Design Lab for notetaking.
Families and Guardians
Ali Abid and Marlies van Dijk from the Design Lab led the parent/guardian interviews, all held over the phone.
The goals of the user interviews were to:
Collect details about the program.
Understand barriers and challenges when accessing PChAD.
Hear ideas to improve services and address issues.
Inform the recommendations
These interviews were semi-structured with a qualitative style; the interviewer had conversation goals to explore with the respondent, but questions were open-ended and were not asked in the same way or the same order to each interviewee and not necessarily asked every time.
Common questions were:
Tell me about your overall experience with PChAD?
How could the PChAD program be improved?
Can you tell us about using the justice system in your PChAD experience?
Do you feel PChAD was an effective part of you/your child’s recovery journey? Why?
How do you feel about the level of family involvement during your/your child’s PChAD experience?
Was the program culturally relevant and safe? (Indigenous perspective)
A journey map is a visual representation of how humans interact with a service or a system. It helps uncover needs and challenges and pinpoints opportunities to change the human experience.
The Design Lab used thematic analysis of all the interviews to identify emotions, quotes, and opportunities for both families and youth.
"I wouldn't have stopped if it wasn't for the staff who cared about me." However, Brodie went to PChAD 5 times and what made him change was that "the detox helps you enough to clear your mind to start thinking of what are you going to do with your life"
Before this project, little was known about the experiences of youth and families with the PChAD program. Our work created a better understanding of the end-to-end PChAD journey for people who participate in the program. Using design thinking, we were able to focus on the experiential aspect of the service and highlight stories from the youth and their families.
This project created the space for advocates, families, clinicians, government, administrators, and non-profit agencies to collectively provide feedback on challenges for this population.
Journey Map: Opportunities
For most youth, the PChad program is not long enough.. Detoxification from drugs takes at least ten days and is not a good opportunity to engage in treatment conversations, given both the youth's physical and psychological state. Many of the youth said it took them 1-2 months in a treatment program to be ready to start working on their addiction. Some families had extended the PChAD stay to 15 days (total). The primary motivator for these families wanting a longer extension was to keep their kids safe. They felt that by keeping their child longer at PChAD, they could protect their child from negative peer influences and ending up dead. One parent said, "I would rather have a safe child than a dead one!"
Key learnings from discovery workshop:
Navigating the system is complex. The entire PChAD program and, more specifically, the court process can be traumatizing and can damage the relationship between parent and child. One parent highlighted the tension between parents protecting their child and their child’s right to privacy by stating, “Parents do have the right to protect their children. However, youth also have a right to their privacy, so there is a disconnect there.”
Service providers acknowledged that the role of PChAD is assessment, not treatment, and there needs to be more links to recovery, long-term treatment and community-based options. A few of the service providers noted that “for adolescent treatment it generally takes about 45 days to establish any new habits, and literature review on treatment duration is 3 – 6 months.”
Attendees also noted the variation between rural and urban communities as a pain point. Specifically, rural areas lack police support, have fewer addiction and mental health resources, and accessibility for families/youth. One provider mentioned that families in rural communities do not have access to police escort and have to transport their child themselves to the PChAD program in the city.
Workshop attendees shared concerns around the regional variability of the PChAD program. Some PChAD programs (e.g., Calgary) offered more extensive services and better integration with voluntary treatment post-PChAD than others. Also, some attendees raised concerns around bed availability both in PChAD and voluntary programs.
Key learnings from community workshop: Validation and Future State
The attendees validated the findings from the journey map and felt that it was reflective of their PChAD experience. There was agreement that these youth often have complex needs and require a lot of support (mental health, neurodevelopmental, family etc.).
Some attendees expressed concern that involuntary confinement can be destabilizing for youth, since they might relapse after being release from PChAD. This was contrasted with remarks from the participants that youth would not voluntarily go to PChAD. Key barriers for youth discharged from PChAD were: Post-treatment beds are voluntary, and youth are not ready to go. One service provider shared that youth who have attended PChAD 4-5 times are more willing to opt for treatment. There was also a discussion that PChAD is less effective for youth who are into ”heavier” drugs, and alternative interventions need to be considered.
There was a discussion on the difference between physical vs. psychological detox. Physical detox within the PChAD program is achievable, however, the psychological dependency requires more time. Therefore, transitioning youth to a treatment program after PChAD would help address the psychological dependence.
A lack of communication and integration of services between institutions (i.e., justice and healthcare system) can lead to family and youth feeling they are “spinning their wheels”. In addition, some support/treatment services have limiting criteria and waitlists, where families can be turned away.
Overall, the attendees felt these workshops were valuable in bringing in multiple stakeholders together to discuss and understand each other's perspectives. Attendees shared their sincere appreciation to the peer interviewers for their approach to the interviews and obtaining authentic responses.
“I could tell the kids were not sure about me at first – whether they could trust me or not – but after we got started I felt they were pretty open with me. I could tell some kids were still giving me bullshit – but it sure helped that I was not some dude in a suit asking questions.”
Sean, Peer Interviewer