Part 14 Substance abuse services for youth in the city

I interviewed the manager of Saunalahti youth home, Sari Mäkinen, by phone. She described the youth home and its operating principles. Towards the end of the interview, we discussed ways to improve the relationship between out-of-home care and aftercare, as well as ways to develop the process of transitioning from out-of-home care to independent life.

Central location

Saunalahti youth home has seven places for young people aged 13–17 who suffer from substance abuse. The youths are placed at this unit mainly because of substance addiction. They come from different parts or Finland, but most are from the capital region.

The youth home is part of the out-of-home care system, and the youths are there as a result of an urgent placement or after having been taken into care. A referral from aftercare is possible, but rare.

The youth home is situated at a central location, near schools and services, which makes cooperation with parents easier. The parents often live nearby and can come to visit. The youths often have the opportunity to continue at the same school as before, to keep managing their affairs and to stay in contact with people close to them just as they have before.

Freedoms and limitations

The youths usually come to the youth home against their will, which distinguishes this youth home from the other communities that I have visited. This is especially linked to the age of these young people. Child welfare legislation determines that it is mandatory to interfere in the situations of youth under 18 years of age when their health or development is at risk.

Usually the youths are allowed to move about freely and to go to school on their own. The youth home can use certain measures to limit the residents’ freedom of movement. If the youth is under restriction, they are allowed to go on outings with a coach.  Constant supervision can be arranged in exceptional circumstances, meaning that a coach will keep the youth company from morning till evening. Drug screening is carried out regularly at this youth home.

The youth home does not offer replacement therapy. It is generally not provided for young people under 18 years of age, whereas in adult substance abuse services replacement therapy is in use. Mäkinen considered replacement therapy to be beneficial in some cases, because it stabilizes the way a person acts. The clients are not confused when in replacement therapy. Mäkinen has seen at her previous workplace that the therapy worked for some mothers of small infants. However, in her view it is essential to always have a proper plan for reducing the medication. It must not be allowed to become a permanent solution for years on end.

It is not possible to motivate all the young people to focus on recovery during their period in the youth home. The youths do not always understand the significance of the placement, at least not at that moment. They may later understand why others took such action. Mäkinen considers substance abuse to be about addiction, which means that family or other close relationships are not relevant at the time.

The placement period

The young people can be taken in for an assessment period, which lasts 1-2 months. During this time, their needs are assessed, as well as potential support forms for the future. On average, the youths stay at the unit from six months to a year. Mäkinen feels that usually substance abuse is not their only problem, but they may have difficulties at school, or mental health problems and other similar issues.

In Mäkinen’s view, the youths often have no ability to trust other people. Many of them have become disillusioned with their family and with officials. They do not always know why certain measures are taken. Mäkinen feels that officials should explain to the youths in plain language the reasons for taking certain kinds of action. From the young person’s point of view, it is not enough if the officials say that they are too busy.

Each youth has two personal coaches who familiarize themselves with their issues. They provide care and support. The coaches also help the youth with practical matters, making applications and having discussions with them. In addition, the personal coaches are in contact with the youth’s parents and arrange family meetings, with varying composition.

With the coaches, the youths learn to do laundry, to prepare food and to clean. The aim is that the youths learn these types of everyday chores during their time at the youth home.

With the personal coach, the youths can practice managing their money. They receive a weekly allowance of 14 €, and for remaining substance-free and for good behaviour they can earn more, up to a total of 18 €. The youths receive the money in cash. They do not have their own bank accounts, and they do not receive any money in the bank. Mäkinen considers one of the greatest challenges for these young people to be managing their spending. Learning this skill starts as late as shortly before transitioning and in aftercare. If they wish, the youths can earn extra money at the youth home’s summer jobs, for example painting things or by washing windows.

Plans for the future are made with the personal coach. According to Mäkinen, the youths have many dreams. With the coaches, they discuss ways to attain these dreams.

Most of the youths are clients of substance abuse psychiatric care or youth psychiatric care services, where they get to have discussions with people outside the youth home, about matters such as their substance abuse issues.

Family work with a resource oriented approach

At the youth home, the staff members launch a focused effort to carry out family work during the youth’s placement. Parents and other family members are brought along to participate in the work. If the youth has other important networks of people close to them, other adults can be included with the guardians’ permission, for example grandparents. If the youth has no parents or other guardians, the workers contact grandparents and other members of the extended family.

Mäkinen sees parents as being generally willing and motivated to work for their youths. If the relationship between the parents is inflamed, they nevertheless try to establish at least some kind of discussion and contact between the youth and both parents.

Meetings can be held at the family home or at the young person’s home, with varying groups of people participating. The youths may also practice visits to their own home, under certain rules.

Mäkinen describes how the work at the youth home is resource oriented. In discussions, the workers want to highlight positive thoughts, and good things are supported. In family work, the starting point is to always find something positive. Difficult issues are still not bypassed, but the youths and their parents are guided to process everything at hand.

The workers adopt different approaches to family meetings, although the main emphasis is on discussion. They also use interviews, emotion cards or questions to be answered in writing, among other things.

Peers and groups

At the youth home, the youths have peer activities, which include a community meeting, a substance abuse discussions group and a community evening.

At the community meeting, the youths and adults have discussions together. They go through each person’s current feelings, how each one is doing, and then any matters that the youths want to bring up, such as discussion on shifting bedtime to later in the evening, or a discussion about buying a Playstation. At the meeting, the participants also go through the week’s menu.

At the substance abuse discussion group, the youths discuss addictive substances and information about the topic is disseminated, but emotions are discussed, as well. Emotions can be processed in writing, by drawing, or by using a variety of cards. Talking about feelings is difficult for these young people, according to Mäkinen. The coaches aim to get the youths to discuss emotions with them, if it turns out to be difficult in a large group.

On the community evening, the youths and coaches do something fun together: they may for example go to see a film or ride motocross.

Supporting the transition stage

When a young person turns 18, they become a client of aftercare services. The aftercare services are often contacted by youth home staff in advance. A worker may visit them, or they may visit the youth home, or the contact may happen by phone.

The youth home has three transitioning apartments where the youths usually move to practice, first staying overnight and then gradually lengthening their stay until they move into their own flat. Transitioning practice is started well in advance, before the youth becomes legally of age and is due to transition, so they can get sufficient experience of independent living before switching to their own flat. Young people from other youth homes utilize the transitioning apartments, as well.

The youth home’s ’birthday’ is celebrated annually, and at that time many of the youths who have stayed there before come to visit. Mäkinen has noticed that some of them seem to be managing quite well, and others appear a bit worse off. She cannot quote exact figures on how many of the youths recover, but she believes that most of them benefit from the placement period. When they turn 18, many of them go ”out of control”. For some, the situation cools down after a while, and then it is possible to assess if the youth home period was beneficial.

Improving seamless services between out-of-home care and aftercare

Mäkinen wishes that a common practice could be established of initiating work with aftercare while out-of-home care still continues. This would contribute to the young person’s sense of security. The services would function as a seamless continuum, and there would be no gaps between them.

If aftercare could start before out-of-home care ends, the youths would have a chance to get to know the new workers. They would learn to know how aftercare functions, and what rights they have.

Mäkinen considers it a good idea that aftercare could rely on peer support from young people who have transitioned from out-of-home care before, to a greater extent than is now the case.  The youths whose life situations are good could give hope to those currently going through transition. Mäkinen refers to existing practice at the ’Selviytyjät’ (’Survivors’) team of the Pesäpuu association, which has especially highlighted these matters.