Adult Behavioral Health. Regional Meetings Spring 2017

Transcription

1 Adult Behavioral Health Regional Meetings Spring 2017

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3 TRIGGERS IN MEDICAL SETTINGS Invasive Procedures Removal of clothing Physical Touch Personal questions that may be embarrassing/distressing Power dynamics of relationship Gender of healthcare provider Vulnerable physical position Loss of and lack of privacy

4 WHAT IS THE ACE STUDY? 10 question measurement of Adverse Childhood Experiences CDC and Kaiser Permanente 17,000 adult participants at various sites Still being tracked today More than 100 papers/articles based on results

5 ACE SCORE QUESTIONS 1 AND 2 Did a parent or other adult in the household often or very often Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? Did a parent or other adult in the household often or very often Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

6 ACE SCORE QUESTIONS 3 AND 4 Did an adult person at least 5 years older than you ever Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you? Did you often or very often feel that No one in your family loved you or thought you were important or special? or Your family didn t look out for each other, feel close to each other, or support each other?

7 ACE SCORE QUESTIONS 5 AND 6 Did you often or very often feel that You didn t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Were your parents ever separated or divorced?

8 ACE SCORE QUESTIONS 7 AND 8 Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife? Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

9 ACE SCORE QUESTIONS 9 AND 10 Was a household member depressed or mentally ill, or did a household member attempt suicide? Did a household member go to prison?

10 ACE SCORES 1/3 of adults have an ACE score of 0 The majority of adults with an ACE score of 0 have few, if any, risk factors for diseases that are common causes of death in the US.

11 An ACE Score of 4 or more results in having multiple risk factors for these diseases or the disease themselves. An ACE score of 6 or more results in a 20 year decrease in life expectancy.

12 ADVERSE CHILDHOOD EXPERIENCES SMOKING AS AN ADULT or more ACE Score

13 ADVERSE CHILDHOOD EXPERIENCES ADULT ALCOHOLISM % Alcoholic >=4 ACE Score

14 ACE SCORE INTRAVENOUS DRUG USE % Have Injected Drugs or more ACE Score

15 CHILDHOOD EXPERIENCES UNDERLIE CHRONIC DEPRESSION % With a Lifetime History of Depression >=4 ACE Score Women Men

16 CHILDHOOD EXPERIENCES UNDERLIE LATER SUICIDE % Attempting Suicide >=4 ACE Score

17 ACE SCORE UNINTENDED PREGNANCY OR ELECTIVE ABORTION % have Unintended PG, or AB Unintended Pregnancy Elective Abortion or more ACE Score

18 ACE SCORE SERIOUS JOB PROBLEMS % with Job Problems or more ACE Score

19 Before Diagnosing Medical conditions need to be ruled out Effects of a substance or medication need to be ruled out Must have a negative impact on functioning Should not be better explained by another mental disorder

20 PTSD Experiencing, witnessing or learning that a traumatic event occurred to a loved one Intrusive symptoms Avoidance symptoms Alterations in cognitions and mood beginning or worsening after the traumatic event. Alterations in arousal and reactivity beginning or worsening after the traumatic event

21 Anxiety Rating Scales Separation Anxiety Social Anxiety GAD GAD 7 SCARED Developmentally inappropriate and excessive fear or anxiety about separation from attachment figures Marked fear or anxiety about one or more social situations Excessive anxiety and worry more days than not for at least 6 months about various events

22 YOUNG ADULTHOOD TWENTIES-THIRTIES Common Conditions Schizophrenia Bipolar Disorder Substance Abuse

23 Schizophrenia 1 month period (or less if treated) Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Negative symptoms Level of functioning is markedly below the level achieved prior to onset Signs of the disturbance persist for at least 6 months

24 Bipolar Bipolar I 1 Manic Episode Elevated, expansive or irritable mood and increased activity and energy for 1 week Present most of the day, nearly every day Bipolar I & II Hypomanic Episode 4 Consecutive days of the above symptoms

25 Bipolar Three or more Inflated self esteem/grandiosity Decreased need for sleep More talkative or pressure to keep talking Flight of ideas/racing thoughts Distractibility Increase in goal directed activity/ psychomotor agitation Activities that have high potential for painful consequences

26 YOUNG ADULTHOOD Common Effects on the Family System Failure to Launch Prolonged Financial Support Legal Problems

27 MIDDLE ADULTHOOD FORTIES-FIFTIES Common conditions Depression Substance Abuse Common Effects on the Family System Prolonged Financial Support Legal Problems Caregiver Role

28 LATE ADULTHOOD SIXTIES AND OLDER Common conditions Cognitive Impairment Comorbid Medical and Mental Health Issues Common Effects on the Family System Legal Problems Caregiver Role

29 QUESTIONS?