Co-occurring Disorders and Youth Engagement
J is a 16-year-old who has been referred to a youth and family services agency after a school suspension for possession of marijuana. J lives with his mother and younger sister; his father is incarcerated. J has been using marijuana daily for 6 months and has started skipping school. He has symptoms of depression (sleep disturbance, anhedonia, irritability). His mother is overwhelmed and works two jobs. J is resistant to counseling and says he doesn't have a problem. The case manager must engage J and his family.
1. What engagement strategies should the case manager use to build rapport with J?
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The case manager should use a non-judgmental, curious stance. Start by exploring J's interests and strengths (e.g., music, sports) to build alliance. Avoid focusing immediately on substance use; instead, discuss his goals (e.g., finishing school, getting a job). Use motivational interviewing: ask open-ended questions, reflect, and affirm autonomy. For example, 'What would need to happen for you to consider cutting back?' Acknowledge his frustration with suspension and his family situation. Offer practical help (e.g., tutoring, transportation) to show tangible support. Involve his mother by validating her efforts and offering parenting support. Consider meeting J in a community setting (e.g., coffee shop) to reduce stigma.
2. How should the case manager address the co-occurring depression and substance use?
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The case manager should recognize that depression and substance use are intertwined and require integrated treatment. Screen for depression using a validated tool (e.g., PHQ-9). Coordinate with a mental health provider for assessment; cognitive behavioral therapy (CBT) can address both. Consider psychiatric evaluation for medication if depression is moderate to severe. Educate J and his mother that marijuana may worsen depression and that reducing use can improve mood. Set small, achievable goals (e.g., attend one counseling session, try a week of reduced use). Monitor for safety risks (suicidal ideation) and involve crisis services if needed. Use a harm-reduction approach if abstinence is not immediately feasible.