An Integrative Model of Indicated Prevention

Background:

Indicated Prevention is an individualized approach for people at high risk of developing abuse or dependence towards psychoactive substances or problematic behaviours.   
At DICAD there are several indicated prevention centres, dedicated to adolescents and young people.  Adolescents referred to these centres present serious psychosocial difficulties, as well as addictive behaviours. Most of them were monitored from an early age, but these interventions were not able to avoid problematic developments.    
The complexity of the clinical and social situations of the adolescents who seek us requires integrated interventions with mental health services, children and adolescents protection services and schools, as well as other community resources. Collaborative networks must be put in place, in order to achieve the support needed. Joint efforts between institutions are proven to yield significantly improved results. 

Methods:

At Indicated Prevention centre of Loures/Odivelas, part of Eastern Lisbon Centre for Integrated Responses (CRI) an integrated intervention model was developed, that has two main pillars: the creation of a positive therapeutic relationship with the adolescents and interinstitutional collaboration.   
We will illustrate how this integrated model can work with two clinical cases: One of a 15 year old girl, cannabis user and having deviant behaviours, referred to the consultation by the legal child protection system. In her psychosocial process there were four institutions involved, from the outset and it was fundamental to put them working together; The second case is a 15 year old boy, with gaming behaviours having a huge impact on his life, school dropout and social isolation. Starting from a situation of referral refusal, DICAD’s psychologist mobilised a set of resources whose interventions had complementary and integrated roles. 

Results:

The dialogue and the organization of integrated responses between the institutions involved, resulted in favourable developments for very complex situations. In the first case, in which a mandatory therapeutic intervention had been ordered by the court, alternative proposals were accepted and fulfilled by everyone involved, including the patient. In the second case, each resource contributed with complementary interventions: family doctor for motivational elements; child psychiatry for anxiety control; the class director teacher for personal skills and to maintain a school attitude of continuous tolerance; DICAD’s psychologist on a psychotherapeutic role. To trust his abilities for evolution was possible to the adolescent. 

Conclusion:

In this integrated model, in which each institution has its role and is not isolated in its support of the adolescents, interventions gain purpose and effectiveness. It is important to highlight that one of the central elements in this model is the relationship with the adolescents, supporting them to become an unequivocally actor in their development.