First Contact - Session Four: Stages of Change

Youth & Drugs and Mental Health: First contact

Goals for Session 4

1. Review progress and emphasize success, especially overcoming barriers to change.
2. Continue to discuss use goals in the context of life goals.
3. Discuss future treatment planning.
4. Review First Contact treatment and the changes made in all life areas.
5. For groups, review group process - emphasize sharing in group as positive risk-taking.
6. Acknowledge completion of First Contact cycle (i.e., success and achievement).
7. Complete the Stages of Change exercise with the following goals:
   • Increase awareness of change as a process.
   • Identify clients’ stage of change.
   • Make more concrete changes during First Contact treatment.
   • Identify more concrete ways of getting to the next stage.

Review of Change Process

Session 4 is the last session in the First Contact program. Consequently, the primary goals for clients in this session are to review progress and affirm whatever positive changes have taken place in their lives (even if it is only increased awareness), and, if the counsellor is leading a First Contact group, to review group process and emphasize the sharing and support that have occurred. Because many of these young clients have difficulty completing things, it is also worthwhile to acknowledge their success in completing the First Contact program. Show that you recognize the motivation and courage that it takes for them to examine the impact of substance use on their lives.

The Stages of Change exercise is included to increase clients’ understanding of change as a process and offer a long-term perspective on change. The Stages of Change exercise does not include the original terms used by Prochaska & DiClemente (1984). Instead, the terms for the stages have been modified, using everyday language that is more appealing to young clients.

Clients are asked to identify what stage they were in when they started First Contact and where they are now. This exercise highlights the changes and what they have done to make those changes. It is also helpful to talk about concrete ways to maintain gains and get to the next stage (for clients not in the maintenance stage).

Treatment Needs and Options For The Future

This session is also the time to talk with the client about treatment needs after First Contact. The recommended treatment plan will depend on the characteristics of the client, the response to treatment and the options available. For those who have responded well and have no other urgent treatment needs, continuing care is a common suggestion. For those with additional needs, such as individual, family or specific skills (e.g., anger management), treatment should also be considered. For those who have not responded to treatment, case management and referral to a more intensive intervention (e.g., community day program) may be suggested.

Guidelines For The Counsellor

1. Check-in.

Discuss progress over the past week: For tips, see Check-in exercise from Session 1.

Help clients to consolidate change:

• “Over the course of the last four weeks, what strategies have been the most helpful?”
• “Is this pattern of use (or abstinence) something you can keep up?”

2. Introduce Stages of Change Exercise Handout.

Review and consolidate progress

This exercise is a way of figuring out where you are. Change is like taking a journey. Some people aren’t interested; others are uncertain and are just thinking about it; and others are preparing themselves, and so on.

Look over the stages of change and tell us:

• “Where were you when you came in?”
• “Where are you now?”
• “What led to the change (if any)?”
• “What are the next steps (i.e. coping strategies, treatment referrals)?”

3. Discuss additional treatment options.

Look at future treatment planning:

• “What kind of additional help might be useful at this point?”
• “What would you like to work on in the next month or two?”

4. Wrap up.

Highlight changes and progress, review treatment process, and obtain feedback:

• “What led to changes (if any)?”
• “What are the next steps (e.g., coping strategies)?”
• “What did you think about being here for the past four weeks?”
• “What was the first group session like for you?”
• “How did things change for you in the group over the four weeks?” (Emphasize the ability to stick with it despite initial discomfort.)
• “What was most helpful about the program?”
• “Do you have any suggestions about how to improve these groups?”

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