Prevention Guide: Addressing Substance Use And Mental Health Disorders

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A group of young people have a conversation. Photo byAlexis Brown via UnsplashA group of young people participate in communitycleanup. Photo by Dolly Reaves, Project Coordinator forCarter County Drug Prevention CoalitionFront (top) cover photo: A trio of young people laugh together. Photo by Priscilla Du Preez via UnsplashFront (bottom) and back cover photo: A group of people stand with their arms around each other’s shoulders.Photo by Helena Lopes via Unsplash


INTRODUCTIONAt NRPA, we believe parks and recreation are vital tocommunity health and well-being. Access to thesespaces, programs and services remains essential tocommunity vitality and is a key factor in advancinghealth equity, improving individual and community-levelhealth outcomes, and enhancing quality of life. Park andrecreation professionals are uniquely positioned to create,in partnership and in power with community membersand key collaborators, the people-centered communitywellness hubs needed to address public health threatsand harness the full potential of community to ensure allpeople can thrive.The need for integrating more targeted and intentionalmental health and substance use preventionprogramming into community-based services, like parksand recreation, has never been more evident. Researchshows1 a link between the time these programs areimplemented and positive health outcomes later in life.The earlier children and youth receive substance useand mental health education, the less likely they are tobegin drug use and experience adverse life outcomes.The alarming statistics around substance use and mentalhealth disorders, coupled with the ongoing challengesof the coronavirus (COVID-19) pandemic, social isolation,gun violence, the effects of climate change and theongoing fight to dismantle systemic racism, call for swiftaction and investment in education, training, partnershipbuilding and programmatic interventions to supporthealth and well-being for all.This resource serves as a guide for park and recreationprofessionals to better understand their role in youthdevelopment, substance use prevention and promotingmental health. The guide provides an overview of thesubstance use and mental health crisis in relation toparks and recreation, as well as how professionals canaddress these challenges and support positive youthdevelopment using the outlined strategies.AUTHORS AND ACKNOWLEDGEMENTSAuthors include NRPA Program Specialist Lauren Kiefert(lead) and NRPA Director of Health Allison Colman.NRPA would like to thank the following individuals forcontributing to the development of this resource: Erik Peterson and Marisa Paipongna from TheAfterschool Alliance Daniel Hatcher from the Alliance for a HealthierGeneration Patricia Roberts from the City of Port St. Lucie Parksand Recreation Department Shelly Strasser from West Allis-West MilwaukeeRecreation and Community Services Department Mercedes Santoro from Los Angeles CountyDepartment of Parks and Recreation Karen Jordan and Erik Dihle from Baltimore CityDepartment of Recreation and ParksA group of hands in the center, representing teamwork. Photo byfauxels via Pexels[1] NIDA. (2020). “Chapter 1: Why Is Early Childhood Important to Substance Abuse Prevention?” Retrieved from

BACKGROUNDYouth and teen substance use in the United Statescontinues to be an ongoing public health issue.According to the Centers for Disease Control andPrevention (CDC)2, approximately 14 percent of highschool students reported use of illicit substances orinjection drugs — which includes inhalants, cocaine,heroin, methamphetamines, hallucinogens, etc. Fourteenpercent of students also reported non-prescription useof opioids. Tobacco, specifically in the form of electroniccigarettes and vapes, also have become increasinglypopular among the teen population. While data shows3that fewer students engaged in high-risk substance usebetween 2009 and 2019, one in seven students are stillreporting lifetime use of any illicit drug or prescriptionmedication. In fact, the misuse of opioids among teenshas increased over the past three years — indicatinga shift in illicit drug preference that the United Stateshas been experiencing as a whole. The use of thesesubstances4, especially during vulnerable youth andteenage years, can have detrimental and lasting effectsinto young adulthood and beyond. Early drug useimpacts growth and development — specifically braindevelopment and cognitive functioning. There is also alink between early drug use and other risky behaviors,including reckless driving, delinquency and unsafe sexualactivity. Additionally, substance use can contribute topoor physical and mental health outcomes later in life,impacting an individual’s ability to properly function andbe a contributing member of society. Risk factors5 forearly substance use include the following: Family history of substance use Parental substance use and/or favorable parentalattitudes toward this behavior Family rejection of sexual orientation or genderidentity Connection to or socializing with others who usesubstances Low academic achievement and/or lack of schoolconnectednessChildhood traumaMental health issuesMental health disorders among youth are described aschanges6 in the way children learn, behave or handletheir emotions, causing distress and problems gettingthrough the day. The CDC states that the most commonmental health disorders among youth today includeattention-deficit/hyperactivity disorder (ADHD), anxietyand depression. In fact, 9 percent of children ages 2 to 17have been diagnosed with ADHD; 14 percent of childrenages 3 to 17 have been diagnosed with anxiety or abehavior disorder; 3 percent of children ages 3 to 17 havebeen diagnosed with depression. Many of these disordersare “co-occurring,” meaning more than one mental healthcondition is diagnosed at the same time. Additionally,data shows that both anxiety and depression havebeen steadily rising over time. Between 2009 and2019, a substantially increasing percentage of highschool students7 have experienced persistent feelings ofsadness or hopelessness and have seriously consideredattempting suicide, made a suicide plan or attemptedsuicide. In fact, 37 percent of adolescents (46.6 percentfemales, 26.8 percent males) and 66.3 percent ofLGBTQ adolescents have reported persistent feelings ofsadness or hopelessness. It is no surprise that associatedrisk factors are similar to those of early substance use8: Family history of mental illness Childhood trauma Parental substance use Poor academic achievement Peer rejection Community violence[2] Centers for Disease Control and Prevention. (2020). “High-Risk Substance Use Among Youth.” Retrieved from[3] Centers for Disease Control and Prevention. (2019). Youth Risk Behavior Survey Data Summary & Trends Report: 2009–2019. Retrievedfrom[4] Centers for Disease Control and Prevention. (2020). “Teen Substance Use & Risks.” Retrieved from[5] Centers for Disease Control and Prevention. (2020). “High-Risk Substance Use Among Youth.” Retrieved from[6] Centers for Disease Control and Prevention. (2020). “Data and Statistics on Children’s Mental Health.” Retrieved from[7] Centers for Disease Control and Prevention. (2019). Youth Risk Behavior Survey Data Summary & Trends Report: 2009–2019. Retrievedfrom[8] (2020). “Risk & Protective Factors.” Retrieved from

Another rising cause for concern in communitiesacross the country is the impact of Adverse ChildhoodExperiences (ACEs)9 and trauma on youth mental andbehavioral health outcomes. According to the CDC,the term ACEs is used to describe all types of abuse,neglect and other traumatic experiences that occur toyouth under the age of 18. ACEs include situations, suchas exposure to substance use in the home, domesticviolence, racism or divorce, which cause toxic stressand can lead to risky health behaviors, chronic healthconditions, low life potential and early death. As thenumber of ACEs a person experiences increases, so doesthe risk of potential negative life outcomes: Injury (fractures, traumatic brain injury, burns)Mental health (depression, anxiety, suicide, posttraumatic stress disorder)Maternal health (unintended pregnancy, pregnancycomplications, fetal death)Infectious disease (HIV, sexually transmitted diseases)Chronic disease (cancer, diabetes)Risky behaviors (alcohol and substance misuse,unsafe sexual activity)ROLE OF PARKS AND RECREATIONServing as providers of — and connection points to —a multitude of public health services and resources,park and recreation professionals play a vital role inpreventing and supporting those with mental healthand substance use disorders by creating supportive andpositive experiences and healthy environments. When itcomes to mental health and substance use, there is noone-size-fits-all approach. It takes a village to address thecomplexities of adverse childhood experiences, mentalillness and substance use disorder, and requires supportfrom all areas of an individual’s life — such as family,friends, employers, health professionals, medical doctorsand the greater community and environment — includingparks and recreation.time in the outdoors and connect with communitymembers, all of which act as protective factors againstthese diseases.Park and recreation professionals are crucial in protectingagainst the development of mental health and substanceuse disorders and the negative health impacts of ACEsby supporting both positive community experiencesand healthy community environments. Park andrecreation agencies provide opportunities to engage inprogramming and activities that create strong socialconnections, focus on mindfulness, explore workforceand career development, support family engagement,foster cultural enrichment and provide academic supportand engage in physical activity and other recreationalprogramming. At the same time, access to qualityparks and green spaces supports a healthy and vibrantcommunity while providing the opportunity to spendPark and recreation departments offer the unique abilityto allow space for youth in an inclusive and welcomingenvironment. Involving youth in conversations anddecision making is crucial when creating programmingand services aimed at this population. When space foryouth voice is made, children and teens feel supported,valued and appreciated. Not only do these assetspromote positive youth development, but also they helpstaff and decision-makers understand what is mostimportant to youth and what programs and supportswould be most beneficial.Additionally, park and recreation professionals arefrontline staff, often serving as caring and trusted adultsthat promote positive youth development by focusingon instilling the support and strength that youth needto succeed. Such professionals also act as advocatesfor substance use and mental health by seeking outfunding for related programming and resources, as wellas engaging in partnerships with other like-mindedcommunity groups, agencies and coalitions focused onadvancing community health and well-being.[9] Centers for Disease Control and Prevention. (2020). “About the CDC-Kaiser ACE Study.” Retrieved from

Youth VoiceYoung people are becoming active by makingdecisions, reflecting on learning, planningfor action, and advocating for changethroughout their lives, as well as throughoutthe communities they represent. Thisis achieved by working with adults incommunities to create positive, effective andsustainable A group of young people sit together. Photo by Naassom Azevedo viaUnsplashPREVENTION STRATEGIES FOR PARK ANDRECREATION LEADERS: POSITIVE YOUTHDEVELOPMENT AND SOCIAL SUPPORTSEvidence-Based Substance Use PreventionProgrammingSignificant progress has been made in developingprevention programming for youth and teen substanceuse. To date, the most successful programs target riskand protective factors at the individual, family and/orcommunity levels and follow evidence-based theoriesand practices10. Below are examples of youth programsthat park and recreation professionals should considerimplementing into their own youth programming: Hidden in Plain Sight11 Hidden in Plain Sight is a presentation featuringa teenager’s bedroom set up with drugparaphernalia and other indicators of substanceuse disorder. Parents, grandparents, caregiversand teachers are given the opportunity toexplore the mock bedroom and identify signsof alcohol, tobacco and other substance use.Prevention specialists, law enforcement andsubstance use counselors also are present,helping guide the participants along their searchand explaining various substance use trends,signs, symptoms and lingo to provide educationand raise awareness about drug use and availableresources within the community. wreckED12 WreckED is a community-based presentationdesigned to engage youth in a discussion aboutalcohol and other drug abuse. The Partnershipfor Drug-Free Kids developed a teen-focusedsubstance abuse prevention program13 for teensages 15 to 19, educating youth about the realitiesand consequences of substance use. wreckEDencourages teens to think in depth about theirown and friends’ behavior regarding alcoholand other drugs, and to consider potentialconsequences of using. The program alsoencourages participants to proactively look outfor their peers who may be engaging in riskybehaviors.[10] PMC. (2011). “Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents.” Retrieved from[11] The Center For Prevention & Counseling. (n.d.). “Hidden In Plain Sight.” Retrieved from[12] Southwest Behavioral & Health Services. (2020). “WreckED.” Retrieved from [13] Mentor. (2020). “Resource Library.” Retrieved from

Operation Prevention14 The Drug Enforcement Administration (DEA) hasjoined forces with Discovery Education to provideno-cost online tools that support every memberof the community with the power of prevention.This educational initiative is designed to inspirelife-changing conversations and equip peopleCASE STUDYThe Icelandic Prevention Model15Over the past 20 years, Iceland has seen a dramaticdecline in youth substance use. In the 1990s, Icelandicsocial scientists at the Icelandic Center for SocialResearch and Analysis (ICSRA), along with policymakersand practitioners, collaborated to better understandsocietal factors that influenced youth and teen substanceuse, as well as potential prevention efforts. ICSRA workedto develop an evidence-based approach involving a widerange of key stakeholders. The three pillars of successare:1. Evidence-based practice2. Using a community-based approach3. Creating and maintaining a dialogue around research,policy and practiceICSRA relied on both global research findings and localobservations related to individual and societal factors thatcontribute to youth substance use specific to Iceland.From this data, it was determined that a communitybased, bottom-up approach would be the mostsuccessful. To do this, the group emphasized having allrelevant stakeholders at the table to build a network ofsupport, while monitoring and seeking opportunitiesfor positive youth development. The interventionalso focused on reducing substance use throughstrengthening the supportive role of parents, schools, andby leveraging the available surrounding opportunities. Amodel was developed that built upon traditional planningmodels (cycles of evidence, reflection and action) butincluded unique characteristics of Icelandic spirit andtemperament.from all walks of life with the knowledge andrefusal skills needed to steer clear of substanceuse. The program is for students in grades 3 to12, available in both English and Spanish, plusadditional resources for educators, families andprofessionals.Several factors distinguish this model16 from otherprevention approaches and applications:1. Due to Iceland’s size and values, everything was ableto happen quickly and confidently2. Community-based, bottom-up approach3. Partnership, trust and communication between keystakeholders4. Commitment and involvement of patrons from thehighest levels of Icelandic society5. Child well-being in the form of parents, free-timeactivity, peers and school are of utmost importanceto substance use preventionThe key to a successful substance use preventionprogram is an integrated, comprehensive and evidencebased approach that includes the four main areas of achild’s life: parents, peers, school and organized activities.Involvement of political and influential partners alsois key to support on the ground efforts and providenecessary funding for organized free-time activities.The Icelandic Method: Four Steps171.A coalition of social scientists and policymakers usedata to identify the scope of the problem and theapproach to be pursued2. Action shifts to the local level as teammembers discuss local data in communities andneighborhoods throughout the county3. Local action in multiple sites informed by nationaldata — infusing the unique spirit, talents andimaginations of neighborhoods, towns and regions4. Integrative reflection — as activities are reviewed byparticipants, process and outcome data are analyzedin conjunction with national data[14] Operation Prevention. (2020). Retrieved from[15] Planet Youth. (n.d.). “The method.” Retrieved from[16] Astho. (2019). “Using the Icelandic Model to Prevent Teenage Substance Use.” Retrieved from[17] Planet Youth. (n.d.). “The method.” Retrieved from

Staff TrainingAnother prevention strategy for park and recreationprofessionals to implement is providing ongoing trainingand professional development for all staff to be moreknowledgeable about mental health and substance usedisorders, including identifying risk factors, recognizingsigns and symptoms of substance use and mentalhealth challenges, and being able to provide availableresources to someone in need. These trainings can evenbe offered to local community members as well, in aneffort to expand knowledge about these diseases. Whencommunities are properly trained on the complexitiesof mental health and substance use — as well as theassociated stigmas — individuals are more likely toreceive the help and treatment they need. Some trainingopportunities include:Training about Mental HealthMental Health First Aid (MHFA) and Youth MentalHealth First Aid (YMHFA) are part of a national skillbased training course that teaches participants aboutmental health and substance use. Participants learn howto identify, understand and respond to signs of mentalillness and substance use disorders. The training providesthe skills necessary to reach out and provide initial helpand support to someone who may be developing amental health or substance use problem or experiencinga crisis. The training is tailored to either adults (18 ) oryouth (ages 12 to 18) and takes the fear and hesitationout of starting conversations about mental health andsubstance use disorders by improving understandingand providing an action plan that teaches participants tosafely and responsibly identify and address a potentialcrisis. When more people are equipped with these skills,more people are able to get the help they need. Find acourse near you18 or email info@mentalhealthfirstaid.orgto schedule a training for your agency or community.Building Knowledge Around Trauma-Informed Care andAdverse Childhood ExperiencesThe CDC uses the term Adverse Childhood Experiences(ACEs) to describe all types of abuse, neglect and othertraumatic experiences that occur to youth under the ageof 18. ACEs include things like exposure to substance usein the home, domestic violence, racism or divorce, whichcause toxic stress and can lead to risky health behaviors,chronic health conditions, low life potential and earlydeath. As the number of ACEs a person experiencesincreases, so does the risk of potential negative lifeoutcomes: Injury (fractures, traumatic brain injury, burns) Mental health (depression, anxiety, suicide, posttraumatic health disorder) Maternal health (unintended pregnancy, pregnancycomplications, fetal death) Infectious disease (HIV, sexually transmitted diseases) Chronic disease (cancer, diabetes) Risky behaviors (alcohol and substance misuse,unsafe sexual activity)However, the presence of ACEs does not necessarilymean an individual will experience poor health outcomes.Positive life experiences and/or protective factors canprevent children from going through adversity andexperiencing negative life situations. Recreational and outof-school time programs, including formal and informalmentoring programs, provide a variety of protectivefactors that lower a child’s chance of experiencing ACEs.These programs offer children safe places to play outsideof school hours, free or affordable facilities for engagingin health and wellness activities, social opportunities andchances to connect youth to their peers.Trauma-Informed Care is an important concept toconsider when working in recreational settings. TheBuffalo Center for Social Research defines TraumaInformed Care as an approach that assumes an individualis more likely than not to have a history of trauma.It recognizes the presence of trauma symptoms andacknowledges the role trauma may play in an individual’slife. From an organizational perspective, TraumaInformed Care changes culture to emphasize respectingand appropriately responding to the effects of trauma atall levels. The intention of Trauma-Informed Care is notto treat individuals, but to provide support and relatedservices in a way that is accessible and appropriate tothose who may have experienced trauma. The risk fortriggering or worsening trauma symptoms and retraumatizing individuals increases when not using thisapproach.[18] Mental Health First Aid. (2020). “Find A Course.” Retrieved from

As many programs may be serving youth who directlyor indirectly experience trauma or ACEs, NRPArecommends training community members and programstaff on how to recognize and address ACEs and applya trauma-informed approach. Find short, micro-learningopportunities on ACEs and trauma-informed care here: Practical Insights into Childhood Adversity19 Trauma Informed Care in Action20Trauma informed care follows five guidingprinciples: Safety — Ensuring physical and emotionalwell-being Real-World Application: Creatingwelcoming common areas andrespecting privacy Choice — Providing the individual withcontrol Real-World Application: Providingclear and appropriate message aboutindividuals’ rights and responsibilities Collaboration — Making decisions with theindividual and sharing power Real-World Application: Providing asignificant role for individuals in theplanning and evaluation of services Trustworthiness — Setting task clarity,consistency and interpersonal boundaries Real-World Application: Maintainingrespectful and professional boundaries Empowerment — Prioritizingempowerment and skill building Real-World Application: Providing anatmosphere that allows individuals tofeel validated and affirmed with eachcontactUnderstanding StigmaAddiction and mental health conditions can affectanyone, regardless of age, sex, race/ethnicity, backgroundor socioeconomic status.21 These individuals mustconstantly battle stigma, or the negative attitudes andbeliefs directed toward an individual or group of peoplewith certain characteristics, traits or circumstances.Stigma not only impacts society’s ability to treataddiction and mental health, but also influences anindividual’s likelihood to seek and/or to accept treatment.As some of the largest community-based organizationsfocused on improving health outcomes, park andrecreation professionals have a duty to respond to therising rates of mental health conditions and substanceuse disorders impacting communities across the country.One vital way in which professionals can respond is byfocusing on breaking down the stigma around substanceuse disorder and mental health conditions. The NationalAlliance on Mental Health22 shares various ways to breakdown the stigmas associated with mental health.As members and influencers in communities, park andrecreation professionals are in a unique position to leadefforts toward reducing mental health and substanceuse disorder stigma nationwide. By recognizing thecomplexities of these disorders and helping educate thepublic about the underlying scientific and environmentalfactors that contribute to mental illness and substanceuse disorder development, park and recreationprofessionals can play a large role in combatting negativeperceptions of mental health and substance use.For more information on stigmas, check out NRPA’sresource, Parks and Recreation: Addressing StigmaAssociated With Substance Use and Mental HealthDisorders.23Sharing Community ResourcesAdditionally, being aware of the existing resourcesthat are available within your community, as well asunderstanding how to share or access those resources,can greatly benefit those in need. Consider having akiosk of resources available in your centers and in otherpublic spaces, including resources on your websiteand social media pages; host an event for communitymembers and invite representatives/staff from localsubstance use and mental health services and otherrelated organizations; create a map of available resources,as well as a tutorial on how to access them; or develop asocial media or marketing campaign.[19] NRPA. (n.d.). “Practical Insights into Childhood Adversity.” Retrieved from[20] NRPA. (2020). “Trauma Informed Care in Action.” Retrieved from[21] SAMHSA. (2019). “Understanding addiction.” Retrieved from[22] National Alliance on Mental Illness. (2017). “9 Ways to Fight Mental Health Stigma.” Retrieved from[23] NRPA. (2020). “Parks and Recreation: Addressing Stigma Associated With Substance Use and Mental Health Disorders.” Retrievedfrom

Partnership BuildingProgramming and Program SupportsBuilding partnerships within the community is crucial tosupporting substance use and mental health efforts. Bycreating meaningful relationships with local stakeholders,park and recreation agencies can gain support and buy-infor related programs and initiatives. Support can includefinancial assistance, supplies, food, content matterexperts, services, program participants, transportation,etc. When a community comes together to support ashared goal, the more likely that goal will be reached.Partnership building also provides opportunities forpositive interactions between the varying organizationsand community members. Examples can include lawenforcement, health clinics and hospitals, mental healthservices, business owners, school systems, parents andyouth-serving organizations. This helps build trust andrapport among all parties involved, allowing for positiveand effective communication, planning, support anddecision making. These partnerships also can work tobuild trust with hard-to-reach and vulnerable populationsthat otherwise would not be involved.Programming and program supports are another waypark and recreation professionals can play a role inaddressing substance use and mental health. Parkand recreation agencies naturally offer assets that helpreduce the likelihood of substance use and mentalhealth disorders. These protective factors includeaccess to nature and the outdoors, opportunities forphysical activity, social connections and positive learningenvironments. Many programs also can be offeredthrough parks and recreation that also protect againstrisky behaviors and support holistic well-being. Considerimplementing programs focused on mental health —nature education and immersion, yoga, art, meditatio

Additionally, substance use can contribute to poor physical and mental health outcomes later in life, impacting an individual's ability to properly function and be a contributing member of society. Risk factors5 for early substance use include the following: Family history of substance use Parental substance use and/or favorable parental

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