SFBT Assignment

Submitted by Rickard Jean-Noel
Session 5: Doing Something Different
Members:Members: grandparents only for this session–parents of all grandchildren are/were abusing opioids.

Grandparents: Adam and EveRichardson–Ethiopian Decent, ages 65 and 60, Grandson Noah Shepherd, age 15, mixed race student (Ethiopian and Asian) Mother (Lilith Shepherd) Ethiopian, incarcerated for the death of her husband. She killed him by accident during a domestic violence incident.
Father (Abel Shepherd) Asian, deceased, and killed by wife during a domestic violence incident where they were fighting over illegal drugs.
Referred for: fighting in school and robbing other students for their lunch money
Background: Mother is currently incarcerated for the death of husband. Both parents suffered from drug abuse and therefore raised the child in a violent environment. Grandparents takes child to visit mother once a week, when possible.

Grandparents: Abraham and Sarah Justice–Native American, both aged 52, Mother: Jessica Justice age 25, Native American, in treatment for her addiction.
Granddaughter Rachel Freedom 13, Native American and White, Father: Johnathan Freedom, age 26, lives in another state because he felt that he needed his “freedom”.
Referred for: failing grades and cursing in class
Background: Jessica is currently in an inpatient facility due to her addiction. Her child’s father, Mr. Freedom did as he name said in search of some. He currently does not provide for his daughter and so the grandparents had to care for the child. The father’s whereabouts are currently unknown.

Grandfather: Moses Rivers –Egyptian, age 60, Grandson Aaron Rivers 14, Egyptian and Jewish
Mother: Cleopatra Nile,Egyptian, deceased, died from overdose when son was 10
Father: Brutus Peters, incarcerated for murdering his best friend
Referred for: Smoking weed in the school bathrooms
Background: Grandfather Moses is currently caring for grandson Aaron due to the death of his mother. Aaron’s mother died from a drug overdose and his father is currently incarnated for the death of his best friend Caesar.

Grandfather: Joseph Freeman – African and Jewish decent, age 57,
Granddaughter: RebeccaFreeman, African, Jewish, and Greek12,
Mother: Jessica Freeman, African and Jewish decent, actively using, living in the home, and is prostituting to support her habit.
Referred for: Committing sexually inappropriate acts in school.
Background: It is unknown who Rebecca’s father is. Her mother has been a drug addict and a prostitute for some time. Grandfather blames himself because he used to be a pimp and Jessica’s mother was one of his workers.

Grandmother: EstherMorningsun– Persian, age 62 Grandson Mark Mountain 9, Persian and Latino
Mother: Ruth Mountain, Persian, age 28, currently in treatment
Father: David Mountain,Latino, age 29, currently in treatment
Referred: attacking teachers and causing food fights
Background: Both of Mark’s parents are currently in drug treatment for heroin addiction. The child was found in the home alone and was sent to live with his grandmother Esther.

Goals/Learning Objectives

• Rules and regulations will be created in the group setting, which will be applied in the home.
• Participants will name one thing that they would like to do differently in the home.
• Participants will use the list of changes that they want to see in their families and apply it after therapy and record the process in a journal.
• Participants will develop ways to better communicate for a more peaceful environment.
• Grandparents and grandchildren will receive education on opioids for prevention and to get a better understanding on what is it their family member is going through.
• Participants will receive naloxone (Narcan, Evzio) training. They will provide them with the skills needed if they were to ever to be in life or death situation.

Group Session 5

Agenda

1. 20 mins–“Allow Me to Reintroduce Myself” – Check-in

• I as the group instructor will introduce myself and the course. I will provide them with a breakdown of what we are attempting to accomplish which is “Doing Something Different”. Once I have introduced myself, the grandparents and grandchildren will introduce themselves as well and give a short background of themselves.
• Materials: Everyone will receive writing paper, a colored marker, and cardboard to write their names on. They will also receive a stick pad to use as name tags. This is for when we are in a circle, we are able to identify each other.
• Each participant will also share with the group what is their favorite treat to eat. This will be a great icebreaker to get everyone relaxed and in a happy mood.
• Participants will sit a circle and will pass a ball around to indicate to the person that they have chosen will speak next in the group.

2. 30 mins– “Rules to Live By”

• Group participants will set house rules for the session that they will also attempt to apply in their homes. This exercise will help them to collectively create rules that will apply in their everyday lives. Both the grandparents and the grandchildren will be able to add rules to the list. Every family will receive a copy of the list and place it somewhere in the home where everyone is able to see it. This affirmation will help to create stability in the household and unity among the participants.
• There will also be established penalties for breaking or not following the rules. This will help to create discipline for the participants that will then transition into their homes and personal lives.
• We will also attempt to establish a balance in the home, school, and church life by setting rules according to the culture of each environment. This will help grandparents and grandchild to better understand their tone and behavior in public and in private settings.

3. 25 mins– “A Change Will Come”

• During this exercise, grandparents will sit in a circle alongside their grandchild and come up with solution-based practices. They will come up collectively with ideas to what they can do differently. Grandparents will come up with creative ways to get to know the personality of their grandchild better. One way they will do this is with music. They will play music from 5 different genre to see which one the child reacts to the most.
• Grandchildren will also share with the grandparent one thing that they do not like that the grandparent or parent did/does. This will help the grandparent to see things from the grandchildren’s point of view.
• Grandparent will share one thing that they wish that they could have done differently with their children but will work on with grandchild. They will attempt activities at home such as: reading bedtime stories, watching movies together, helping them with their homework.
• Grandparents will find new ways to discipline grandchildren. In majority of the group member’s culture, it is normal to spank children, however we shall take a more progressive approach which would include grounding the child, taking away toys and privileges such as TV.

4. 20 mins– “Right the Wrongs”

• During this time, the grandparents and grandchildren will admit to one another what they felt that they did wrong in the past, and what they can do to fix it. They will also if permittable work on the relationship with the parent if they are still alive. This will help bridge the gap and create a possibility for future reunification. This will also help to repair past traumas that may have occurred in the past.
• Grandparent and grandchild will log information into their logbooks on the changes that they would like to do. They will then apply the practices and track the changes in behavior and attitude. This will help both the grandchild and the grandparent to be accountable for their actions and help them to be more committed to the goal of changing for the better.
• Grandparent and grandchild will try to do one positive activity together a week and will chose to work on one negative thing a week. They will track the progress and compare the results with the group at the end of the month. A full review of the logs will be conducted and shared with the group at the completion of the program. This will help the group members to hold each other accountable.

5. 35 mins- “Knowledge is Power”

• Grandparents and grandchildren will be provided with education in regards to Opioids. The main theme of this group is “Doing Something Different Day”, and therefore we will attempt to do life different for the grandchild by educating them on how to make different decisions from the decisions that their parents made every day. This will also help the grandparents prevent the grandchild from going down the same path as the parent. We will do this by providing them information on Opioids. The following information will be provided:

1. Who’s at Risk? “Anyone who uses opioids for long-term management of chronic pain is at risk for opioid overdose, as are individuals who use heroin or misuse prescription pain relievers” ( SAMHSA Opioid Overdose Prevention Toolkit Page 1)
2. How many people are affected by this? “An estimated 2.1 million people in the U.S. struggle with an opioid use disorder.  Rates of opioid overdose deaths are rapidly increasing.  Since 2010, the number of opioid overdose deaths has doubled from more than 21,000 to more than 42,000 in 2016, with the sharpest increase occurring among deaths related to illicitly made fentanyl and fentanyl analogs (synthetic opioids)” (https://www.hhs.gov/surgeongeneral/priorities/opioids-and-addiction/opioids-overdose-prevention/index.html)
3. What is an Opioid? “Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. When used correctly under a health care provider’s direction, prescription pain medicines are helpful. However, misusing prescription opioids risks dependence and addiction” (https://www.hhs.gov/opioids/prevention/index.html)
4. What are some warning signs of Opioid abuse? “Side effects of opioid use includes: Constipation, nausea, vomiting, dry mouth, sleepiness and dizziness, confusion, decreased breathing, itching and sweating, a change in peer group, carelessness with grooming, decline in academic performance, missing classes or skipping school, loss of interest in favorite activities, change in eating and sleeping habits, deteriorating relationships with family and friends” (https://dphhs.mt.gov/opioid/getthefacts).
5. What are the symptoms of this disorder? : (https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder)

• Taking larger amounts or taking drugs over a longer period than intended.
• Persistent desire or unsuccessful efforts to cut down or control opioid use.
• Spending a great deal of time obtaining or using the opioid or recovering from its effects.
• Craving, or a strong desire or urge to use opioids
• Problems fulfilling obligations at work, school or home.
• Continued opioid use despite having recurring social or interpersonal problems.
• Giving up or reducing activities because of opioid use.
• Using opioids in physically hazardous situations.
• Continued opioid use despite ongoing physical or psychological problem likely to have been caused or worsened by opioids.
• Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount)
• Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

6. What forms of treatment is available? “To treat those with opioid use disorder, it is crucial to expand access to evidence-based treatments, including medication-assisted therapy (MAT). MAT is a comprehensive way to address the needs of individuals that combines the use of medication (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies” (https://www.cdc.gov/drugoverdose/prevention/treatment.html)

• We believe that once the Grandparents and grandchildren are equipped with this detailed information, they stand a better chance at prevention and treatment, if needed.

6. 20 mins- “Save A Life”

• During this portion of the group we will learn more about Naloxone (Narcan), and how to use it to preserve a life of someone that is having an overdose. Because some of the family members have died from overdose, it would be very important to learn to use Narcan. This would help in “Doing Something Different”, by knowing what to do in future situations.
• What is Naloxone (Narcan)? : “Naloxone is a medication approved by the Food and Drug Administration (FDA) to prevent overdose by opioids such as heroin, morphine, and oxycodone. It blocks opioid receptor sites, reversing the toxic effects of the overdose. Naloxone is administered when a patient is showing signs of opioid overdose. The medication can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection” (https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone)
• Narcan kits will be provided to grandparents to have in the home, as well as an instruction guild to serve as a refresher.

Problems/Solutions – Predict 2 potential challenges that might arise in your group. These challenges might be related to the content or material covered or to interpersonal dynamics among members. Make suggestions about how you might address the problems.

Problem #1:  The grandparents might be timid in regards to sharing certain aspects of their lives with other group members due to shame. They might be afraid of how they might be judged as a failure of a parent because of their child’s addiction.

Solutions: The group instructor will remind the members of the group that we are all in this together and is it all of the members of the group that are facing very similar issues and that we are all here to receive help. We will do exercises to break the ice, such as naming your favorite treat. Majority of the times, they will be individuals in the group that might share the same favorite treat, showing that they have more in common than initially thought. Standing in a circle will also give them a visual of how alike they are and seeing one another’s faces might put them all at ease.

Problem #2: Another problem would be to maintain confidentiality with the participants. Some participants can very private, this is very common among older folks. Especially those dealing with a not so great situation, such as having a child as an addict and having to raise the grandchild.

Solutions: Inform all participants that we are HIPAA compliant and have those sign confidentiality agreements. Also remind them that they are in a “safe space” and have them agree to one another not to disclose the information that is shared in the group. We will also be adherent to the Social Workers Code of Conduct. Participants will also include in their ground rules specific confidentiality rules that they will hold each other to. This will help hold them each accountable.

References

1. SAMHSA Opioid Overdose Prevention Toolkit Page 1
2. Webster LR, Cochella S, Dasgupta N, Fakata KL, Fine PG, Fishman SM, Grey T, Johnson EM, Lee LK, Passik SD, Peppin J. An analysis of the root causes for opioid-related overdose deaths in the United States. Pain Medicine. 2011 Jun 1;12(suppl_2):S26-35.
3. https://www.hhs.gov/surgeongeneral/priorities/opioids-and-addiction/opioids-overdose-prevention/index.html
4. https://www.hhs.gov/opioids/prevention/index.html
5. https://dphhs.mt.gov/opioid/getthefacts
6. https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder
7. https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone
8. https://www.cdc.gov/drugoverdose/prevention/treatment.html