CAMH’s Concurrent Youth Unit (CYU) is an intensive, co-ed treatment program for youth presenting with moderate to severe addiction to substances and accompanying complex mental illness. The CYU team serves youth aged 14–18, and during the summer when academic programing is on break, the unit accepts patients up to 21 years of age. The 12-bed inpatient unit opened in July 2012.
Clients present with a range of mental health issues such as psychosis, bipolar disorder, anxiety and depression. They often have multiple substance misuse issues.
“Most youth have been exposed to trauma, have disrupted schooling and impaired family relationships,” explains Marisa Tacconelli Termine, Manager of the CYU. “Some youth demonstrate disordered eating, may first be seen as having anxiety around food intake, and may have an impaired body image. We’ve also seen a significant issue with disordered sleep in youth, and often due to using drugs, partying, or online gaming,” she says. “Clients may be involved with the law, in gangs, in the sex trade and trafficking, victims of abduction, rape and exposed to other severe traumas.”
The Concurrent Youth Unit team
The unit has seen its share of client struggles and successes. One client had several substance abuse issues, anxiety and depression, and had been involved with the legal system. After building strong therapeutic relationships at the CYU, and after discharge, the client moved to a new school and received an award as student of the month.
Another client was admitted with cannabis-induced psychosis and hearing voices. After individual therapy and medication, the client rejoined academic studies, did volunteer work, had plans for employment and returned to living with family.
Jessica Savoie, a Child Youth Worker who has been with the team since it started in 2012, shared another client success story.
“We had a patient who engaged in therapy, and received much direction and support while treated at CAMH and is now in neuroscience studies at university,” recalls Jessica.
Supporting patients toward recovery
“I work with the team ensuring that our patients have a predictable, safe environment for their recovery,” says Jessica.
“I work on building trust so youth let us in their recovery journey,” says Jessica. “Building trust with patients is a process over time. It includes helping patients feel empowered and building their skills, coaching them in positive communication styles so they can advocate for themselves, and helping them with self-soothing skills they can use.”
Some of the self-soothing tools on the unit include sensory stress balls, sound machines with soothing nature sounds, music, colouring materials aromatherapy. Relaxation and deep breathing techniques are also part of the unit’s programming.
The unit’s interprofessional team includes registered nurses and child youth workers who work on 24/7 shifts, plus social workers, psychiatrists, an in-take worker, and a recreational therapist. In addition, the staff includes part-time or shared access to a psychologist, a dietician, a pediatrician, volunteers, teachers, a pharmacist, resident doctors, a hospitalist, a psychometrist and advanced practice support.
Because of this, there is a wide range of daily supervised programing for the patients. “Our team supports therapy and programming for patients such as Mindfulness, Dialectical Behavioural Therapy, Cognitive Behavioural Therapy, gym activities, swimming and classroom studies through a partnership with the Toronto District School Board, and options for individual time,” says Jessica.
“When some youth first arrive to the CYU, their initial instinct is to bond with peers through discussing previous substance use as this has been a large part of their lives for the past number of years,” explains Jeff Mudrick, a Recreational Therapist on the CYU. “We work with clients throughout their admission to help shape peer conversations away from substances and towards more positive social interactions, such as discussing interests and hobbies.”
Strong, supportive team
On this fast-paced unit, having a strong team is key.
“It’s a tightknit, outgoing and supportive team. It can be stressful and challenging at times as you are working with teenagers with varying emotions and behaviours, but it’s very rewarding as you see these clients become open to change. Staff really, really care about each other and clients,” says Jeff.
Jessica echoes the sentiment. “Over the past five years since the CYU first formed as a unit, we have the confidence to talk about challenges, rise from those and work together to overcome them. We can be honest with each other, support each other and come up with solutions that work for everyone.”
“The team approach is very strong, supportive, open and trusting on this unit. We care deeply about our patients,” says Jessica.
“The team component is key,” says Tom Colquhourn, a Social Worker with the unit. “We meet regularly to discuss patient treatment planning and debrief regularly to stay safe, connected and grounded.”
Next steps of care and discharge planning
The average length of stay on the CYU is four to six weeks. Youth go on progressively longer passes away from the unit, starting with a few hours and often progressing to full weekends, so they can practice the skills that they have learned on the unit and generalize them to their home environment.
When clients are discharged from the CYU they may be referred to residential treatments outside of CAMH, or may return home to live with family or caregivers. After care and support is coordinated with resources in their home community. Some clients may be connected to other CAMH programs and often will attend the Youth Day Hospital or see psychiatry and social work for follow up in the Youth Addictions and Concurrent Disorders Service.
Often with help, patients establish goals at the start of their stay and this often begins at the intake process, says Marisa. “We try to redirect them to the reasons they came to us and support their commitment to their goals.”
“We are trying to break the cycle of abuse that patients experience and shift away from the life they knew into a new direction,” adds Jessica. “We are behind them so they are not walking alone in their recovery. We understand and validate their experience. We help them build their skills so that they can use those skills independently when they leave the unit.”
Published on July 24, 2017