The Complexity of Diagnosis and Behavior of Students Placed Residentially

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1 The Complexity of Diagnosis and Behavior of Students Placed Residentially Louis J. Kraus, MD Chief of Child & Adolescent Psychiatry Rush University Medical Center

2 Conflicts of Interest Medical Director of Chicago Metropolitan Easter Seals Therapeutic Day Schools Psychiatric Director of the Sonya Shankman Orthogenic School

3 Why is it that children placed in Therapeutic Day Schools and Residential Programs seem more complex? For Example: One out of every 88 kids is on the Autism Spectrum Confusion in diagnosis such as Bipolar Disorder in children as: ADHD, behavior disorders, Unipolar Depression and Anxiety Disorders

4 Early Intervention Some of the very complex children with Mental Health Disorders are being identified far earlier than they were in the past. Associated with this, they are being found eligible for special education. These more complex children are ultimately being placed residentially and in therapeutic day schools.

5 The Illinois Department of Juvenile Justice (IDJJ) has reported decreased numbers of complex mentally ill youth compared to years prior. In my opinion, at least some of these children are being helped through their school districts and through the Department of Mental Health.

6 Over the past decade or so, school districts have become far more educated regarding mental health issues and I have seen many examples of their attempts to work with these children, in a far more comprehensive way than previously observed, resulting in more impaired students being referred.

7 The Internet savvy parents and an increased tendency for parents to hold school districts responsible for their children s behavioral difficulties, setting up a more adversarial system.

8 Response to Intervention (RTI) School district s reluctance to complete comprehensive assessments can lead to delayed interventions targeted to a specific difficulty which may lead to worsening pathology and difficulty in meeting a Child s Basic Education Needs

9 Not every child with behavior problems needs sensory breaks. There is a need to have a clear understanding of the etiology of a students presentation.

10 New DSM 5 Diagnosis Disruptive Mood Dysregulation Disorder Temper outbursts Inconsistent with developmental level Behavioral episodes three or more times per week Mood is irritable/angry More than 12 months At least 2 or 3 settings Age of onset prior to age 10 No manic symptoms Not during depressive episode or other significant mental health disorder Not substance related

11 Will this decrease the incidence of those children identified with social maladjustment (Behavior Disorders)?

12 A number of residential facilities have closed in Illinois in part because the state has not paid in a timely manner (9-12 months) for kids with ICG grants. As a result, an increased number of residential facilities are not accepting applicants with ICG grants.

13 As such, the pool of applicants are smaller. Exclusionary criteria seem to be less of a concern

14 Facilities, whether day programs or residential, need to know their limits in what types of students they can and cannot treat.

15 Common Areas of Concern-Exclusionary Criteria Fire Setting Sexually Acting Out Significant Eating Disorders Repetitive Suicidal Attempts Significant Behavioral Issues Alcohol & Substance Use Disorders

16 Common Do s Do you check with prior treatment programs? Do you check with prior treaters? Do you make sure the file is complete? Do you check with care staff regarding admission concerns?

17 Most Common Reasons for Termination Behavioral acting out Risk of harm to self or others A lack of developmental/educational progress Substance use Families pulling their children out, typically because of family related conflicts

18 What To Do Assist admissions process Ongoing communication with staff, family and school Address concerns as soon as possible Multidisciplinary meetings

19 Thank You!