Evidence Based Therapies with Gender Diverse Youth

Transcription

1 Evidence Based Therapies with Gender Diverse Youth Kynetta L.V. McFarlane, PsyD. Victoria Borsukevich, LISW Lourdes Hill, PCC-S Tina Mason, PhD, LISW-S

2 Evidenced Based in Psychology(EBPP) Integration. Best Research Clinical Expertise Patient Characteristics, Values, Context (American Psychological Association., 2006) 2

3 Cultural Humility Cultural humility principles Lifelong Learning and Critical Self-reflection Recognize and Change Power Imbalances Institutional Accountability (Tervalon, & Murray-Garcia, 1998) 3

4 Family Based Intensive Treatment FBIT Intensive Home-Based Treatment Services Definition IHBT is an Evidence-Based Practice IHBT is an intensive, time-limited mental health service for youth with serious emotional disabilities and their families, provided in the home, school and community Comprehensive set of services (CPST; Behavioral Health Counseling and Therapy; Crisis Response; mental health assessment; supportive services) integrated by a team of providers Main Purpose: Placement prevention Reunification Stabilization and safety (Ohio Mental Health Addictions Services., 2013) 4

5 Identifying Risk and Safety Concerns Self Harm Behaviors Suicidal ideation, gestures, attempts Self Injurious Behaviors Community Safety To persons To property Trauma Abuse and neglect Family violence Temperament: Poor emotional regulation; Reactivity; Impulsivity Risk taking/ Thrill seeking Personal Safety/Risk Runaway Sexual acting out Unrestricted internet access Sexting Cyberbullying Ecological Risk Neighborhood Negative peer involvement: Gang activity Destabilizing Factors Lack of parental monitoring and supervision Parental disabilities: MH, MRDD, SA Availability of weapons Youth substance use (Shepler,1991; Shepler & Cleminshaw, 1999) 5

6 Comprehensive Service Array Matched to Need Recovery & Resiliency Supportive Environments and Positive Functioning Adaptive Developmental Skill Sets Basic Needs and Safety (Shepler,1991; Shepler & Cleminshaw, 1999) 6

7 Gender Identity Gender awareness Gender psychoeducation Disclosure of gender Gender identity exploration Transition exploration Integration (Lev, 2000) 7

8 Multisystemic Therapy (MST) Intensive, home-based treatment for adolescents with delinquent behaviors and their families. Systemic approach to look at all parts of child life. Ultimate goal is to avoid out of home placement. Heavy focus on parenting and relationships. MST is a path with a set of guiding principals. It is designed to be filled in with details of whatever this particular family needs! (Borduin, 1995; Durso & Gates, 2012)

9 Caregiver Focus Maintaining boundaries and hierarchies AND building warmth with child. Family therapy provides opportunities for balanced discussions and for families to interact on gender issues. Work with CG s on own needs. Focus on future planning and sustainability. (Borduin, 1995)

10 Youth Focus MST Medical- can help kids with sticking to medication, hormones, etc. Effective communication. Address increased risk of substance abuse. Address other MH concerns- in treatment, sustained with parents, and future linkage. (Marshal, et al., 2008)

11 Multi-Systemic Focus Gender diversity can add complexity to many parts of life youths environments are often maintaining factors of behavioral problems! Avoid simplifying behavior problems as leading to/ because of gender. Address bullying and victimization. Create authenticity and safety in all environments! (Borduin, 1995)

12 Dialectical Behavioral Therapy (DBT) Cognitive Behavioral Treatment of Borderline Personality Disorder Dialectical Behavioral Therapy with Suicidal Clients (Linehan, 1993; Miller, Rathus, & Linehan, 2006) 12

13 Dialectical Behavioral Therapy (DBT) Coremindfulness Distress Tolerance Interpersonal Effectiveness Emotion Regulation Walking the Middle Path (Miller, Rathus, & Linehan, 2006) 13

14 Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Originally developed to treat children and adolescents who have experienced sexual abuse Now being used to treat children with multiple types of traumas and complex (multiple) traumas. Workgroup on LGBT+ addendum (Cohen, Mannarino,& Deblinger, 2017) 14

15 Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Education Relaxation Emotional Expression and Regulation Cognitive Coping Trauma Narrative & Exposure Parent/Child Sessions Future Growth (Cohen, Mannarino,& Deblinger, 2017) 15

16 References American Psychological Association. (2006). Evidence-based practice in psychology. American Psychologist, 61, DOI: / X Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2017). Treating trauma and traumatic grief and children and adolescents (2 nd ed.) New York, NY: Guilford Press. Durso, L.E. & Gates, G.J. (2012). Serving our youth: Findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of Becoming Homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund Henggeler, S.W., Schoenwald, S.K., Borduin, C.M, Rowland, M.D., & Cunningham, P.B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2 nd ed.) New York, NY: Guilford Press. 16

17 References Lev, A. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York, NY: The Haworth Clinical Practice Press. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A metaanalysis and methodological review. Addiction,103, Miller, A.L., Rathus, J.H. &, Linehan, M.M. (2006). Dialectical behavior therapy with suicidal adolescents, New York, NY: Guilford Press. Ohio Mental Health Addictions Services. (2013). Intensive home based treatment (IHBT) services. Retrieved from Certification/rules/ pdf 17

18 References Shepler, R. N. & Cleminshaw, H. (1999). Community-based intervention for families. In L. VandeCreek and T.L. Jackson (Eds.), Innovations in clinical practice: A source book ( ). Sarasota, Florida: Professional Resource Press. Shepler, R. (1991). Integrating home-based practice: A transdisciplinary model for treating multi-need families. In P. Cibik, S. Gwatkin, C. Pastore, & R. Shepler (Eds.), A practitioner s guide to home-based services: A resource manual ( ). Akron, OH: The Center for Family Studies, The University of Akron. Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9,

19 Disclosure The presenters have no actual or potential conflict of interest in relation to this program or presentation. 19