Synergy Conference October 1, 2014 Amy S Hill, LPCC-S. LICDC-CS, Associate Director Delaware-Morrow Mental Health & Recovery Services Board 1
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1 Synergy Conference October 1, 2014 Amy S Hill, LPCC-S. LICDC-CS, Associate Director Delaware-Morrow Mental Health & Recovery Services Board 1
2 1 in 5 young people have one or more mental, emotional, or behavioral challenges. 1 in 10 have challenges severe enough to impair their functioning. In the USA, 75-80% of children in need of mental health services do not receive them due to stigma, lack of screening, lack of available services & providers, &/or cultural beliefs Half of all mental health issues begin by age 14. Suicide is the third leading cause of death for ages % of youth in the child welfare system have a diagnosable mental health disorder. 67% of youth in the juvenile justice system have a diagnosable mental health disorder. 2
3 ATTITUDES MATTER No matter the cause Mental illnesses are brain disorders that are Chemically & Biologically Based. 3
4 7 MYTHS ABOUT CHILD MENTAL HEALTH 1. A child with a mental disorder is damaged for life. 2. Psychiatric problems result from personal weakness. 3. Mental disorders result from bad parenting. 4. A child can manage a mental disorder through willpower. 5. Therapy for kids is a waste of time. 6. Children are overmedicated. 7. Children grow out of mental health problems. 4
5 5
6 The Impact of Trauma 6
7 DEFINING TRAUMA Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual s functioning and physical, social, emotional, or spiritual well-being. SAMHSA-National Center for Trauma-Informed Care 7
8 TRAUMA IS THE SUM OF THE: Event Experience Effect 8
9 EVENT & CIRCUMSTANCES May include o Actual or potential threat of physical or psychological harm o Withholding of material or relational resources essential to healthy development 9
10 EXPERIENCE o How an individual experiences an event or circumstances helps determine whether it is a traumatic event o Event may be experienced as traumatic for one individual but not another o How event is experienced may be linked to such factors as cultural beliefs, availability of social supports, or to individual s developmental stage 10
11 EFFECTS o Long-lasting adverse effects result from individual experience of event o Adverse effects can occur immediately or over time o Sometimes individual may not recognize the connection between the effects & event 11
12 COMMON RESPONSES TO TRAUMATIC EVENTS o Fear & anxiety o Sadness or depression o Guilt & shame o Anger & irritability o Behavior changes o Physical symptoms 12
13 ADVERSE EFFECTS o Usually responses to trauma lessen with time & the experience becomes less painful o If the symptoms do not lessen over time or disrupt life making it hard to continue daily activities, it may be Posttraumatic Stress Disorder (PTSD) 13
14 PTSD SYMPTOMS o Re-experiencing the event o Avoiding situations that remind you of the event o Feeling numb o Hyperarousal 14
15 SCOPE OF THE PROBLEM 60% of men experience at least one traumatic event - about 8% develop PTSD 50% of women experience at least one traumatic event - about 20% develop PTSD Some events like combat & sexual assault have higher prevalence of PTSD Individuals with mental health problem &/or have family members who have had mental health problems are more likely to develop PTSD 15
16 IMPACT OF ADVERSE CHILDHOOD EXPERIENCES Adverse Childhood Experiences (ACE) The more types of ACEs Neurobiological Impact & Health Risk The greater the neurobiological impacts & health risks Long-term Health & Social Problems The more serious lifelong consequences to health & well-being. SAMHSA 10 X10 Wellness Campaign 16
17 ADVERSE CHILDHOOD EXPERIENCES Abuse of Child Physical Abuse 28% Contact Sexual Abuse 22% Emotional Abuse 11% 17
18 ADVERSE CHILDHOOD EXPERIENCES Trauma in Child s Household Environment Alcohol/drug use by household member 27% Not raised by both biological parents 23% Chronically depressed, emotionally disturbed or suicidal household member 17% Mother treated violently 13% Incarcerated household member 6% 18
19 ADVERSE CHILDHOOD EXPERIENCES Neglect of Child Physical Neglect 19% Emotional Neglect 15% 19
20 Impacts Of Childhood Trauma & Adoption Of Health Risks To Ease Pain Of Trauma Neurobiological Disrupted development Depression/other mental health challenges Panic reactions Health Risks Suicide attempts Alcohol and/or drug abuse Self injury Violent and aggressive behavior SAMHSA 10 X10 Wellness Campaign 20
21 EARLY BRAIN DEVELOPMENT BASICS 3 Core Concepts of Brain Structure 1. Experiences build brain structures 2. Interaction shapes brain circuitry 3. Toxic stress derails healthy development 21
22 LONG-TERM CONSEQUENCES OF UNADDRESSED CHILDHOOD TRAUMA Disease and Disability Heart disease Cancer Mental disorders Asthma HIV/AIDS Social Problems Homelessness Prostitution Delinquency, criminal behavior Inability to sustain employment Intergenerational abuse SAMHSA 10 X10 Wellness Campaign 22
23 ADVERSE CHILDHOOD EXPERIENCES INFLUENCE ON HEALTH & WELL-BEING THROUGHOUT THE LIFESPAN SAMHSA 10 X10 Wellness Campaign 23
24 SO WHAT CAN WE DO ABOUT IT? Prevention Promote resiliency/positive character development Violence prevention in schools Community education Early Intervention Identify & address trauma early Community victim-assistance Treatment Connection with appropriate services-therapy &/or medication earlier rather than later 24
25 WHAT CAN YOU DO ABOUT IT? The most important thing you can do is to develop a with a child that is,, and is based on for and of the child. 25
26 CORE VALUES OF TRAUMA-INFORMED CARE Safety: Ensuring physical and emotional safety Trustworthiness: Building trust, making tasks clear, and maintaining appropriate boundaries Choice: Prioritizing individual choice and control Collaboration: Maximizing collaboration and sharing of power with individuals Empowerment: Prioritizing individual empowerment and skill-building SAMHSA 10 X10 Wellness Campaign 26
27 WHAT INCREASES THE RISK FOR A MENTAL DISORDER? Family history (genetics) Previous symptoms (if untreated, chance of relapse is up to 70%) Stressful or traumatic experiences Inconsistent or unstable care-giving Substance use Family illness, divorce, or other disruptions Poor social skills 27
28 SEVERE EMOTIONAL DISTURBANCE (SED) Under 18 years of age Greatest risk for needing services Three factors considered: Diagnosis, Duration of impairment Level of functioning 28
29 Can be challenging for parents & siblings, putting strains on relationships. Parents/caregivers can be frustrated because they don t know what to do. May be scapegoated by the family as being the problem. More likely to be unhappy at school, absent, suspended or expelled. Their learning is negatively impacted. May be withdrawn and difficult to engage. Tend to be involved in high-risk behaviors. Providing structure with consistent, clear rules & boundaries is key. 29
30 What we See and what we Hear. Symptoms versus Diagnosis. Continuum of extremes - outside normal societal expectations. Normal to have transient symptoms during certain life stages, when persist and interfere with routine daily activities time to seek help. 30
31 ANXIETY SIGNS & SYMPTOMS Sense of looming danger Desire to escape Unrealistic worrying Self-consciousness Tension Racing heart, chest pain Shortness of breath Nausea, dizziness Numbness 31
32 MOOD SWINGS High or agitated moods fluctuating with extreme sadness Extreme irritability Distractibility Increased energy, restlessness Racing thoughts, rapid talking Alcohol/drug use Strained friendships, isolation 32
33 OBSESSIONS & COMPULSIONS Repetitive, intrusive & unwanted thoughts Rituals to stop the thoughts done excessively Repetitive rituals do not ease the thoughts, so they are repeated 33
34 BIZARRE BEHAVIORS Hallucinations (hearing voices) Delusions (false beliefs) Emotionless expression Apathy Withdrawal Inability to think logically Garbled language Paranoia 34
35 ATTENTION PROBLEMS Difficulty paying attention Easily distracted Poor follow through on instructions & tasks Does not seem to listen Disorganized Loses things Forgetful HYPERACTIVE & IMPULSIVE Difficulty sitting still & in seat Runs about or climbs when not appropriate Loud & often talks excessively Difficulty waiting turn Interrupts & intrudes on others 35
36 DISRUPTIVE BEHAVIOR Disobedient Hostile Defiant Rule-breaking Physically aggressive Bullying Destructive Truant 36
37 PROLONGED SADNESS OR IRRITABILITY Persistent deep sadness or irritable mood Feeling empty, numb emotions Sleep and/or eating problems Academic decline Difficulty concentrating Indecision Withdrawal Alcohol/drug use Acting out 37
38 LOSS OF TRUST & HOSTILITY Feelings of being detached Attempt to distance self from painful event Acting out behaviors Trouble remembering the past Appear not to care 38
39 SELF-INJURY / SELF-MUTILATION Emotional distress Seeks to ease psychological pain No suicidal intent Clothing may hide scars Not done to retaliate Not just girls 39
40 PREOCCUPATION WITH WEIGHT Overeating Overeating, then purging Controlling intake of nourishment to life-threatening levels Both boys & girls Skewed body image Intensified by media images 40
41 RISK FACTORS FOR SUICIDE Mental disorders (especially depression) Substance abuse Previous suicide attempt Family history Sexual abuse & other trauma Impulsive and aggressive behavior Access to means (firearms, pills) Exposure to suicide by others Sexual orientation 41
42 IF A YOUTH IS SUICIDAL o TAKE IT SERIOUSLY! o It s okay to ask, Are you having thoughts of suicide? o Ask if they have a plan o Remove the means o Be positive o Encourage them to get help, talk with someone o Refer to be assessed by a mental health professional 42
43 TREATMENT Depends on: Needs and preferences of child/family Diagnosis Type and severity of symptoms Combination of counseling/therapy and medication is most effective. Psychotropic medications should be used when the anticipated benefits outweigh the risks. Closely monitor for reactions & side effects. Expressive therapies vs. talk therapy. Other supportive services may include parenting education and behavior management. 43
44 44
45 9 Strategies To Resolve A Situation With A Youth With Mental Health Needs By The Idaho Department Of Health & Welfare 45
46 1. SAFETY Safety comes first Control the surroundings Remove harmful obstacles, distractions, upsetting influences and disruptive people Assess the environment for basic safety threats 46
47 2. CRISIS behavior results when a person suffers from a temporary break down in coping skills that include perception, decision-making and problem solving ability. 47
48 3. LANGUAGE Body Language Think about your stance, movement and facial expression. It could be very intimidating to a person having a psychotic break or in crisis. Reassure the person that no harm is intended and keep a reasonably safe distance and slow down the pace. 48
49 Verbal Language Use the person s name as often as possible to get their attention, show respect & engage. Speak quietly & concisely. Individuals having a psychotic break could be hearing voices, confused, anxious, and their senses are heightened (sounds louder, lights brighter) 49
50 4. PATIENCE Essential when working with youth that are experiencing a mental health crisis or are scared. You may need to repeat yourself often. Remember the person s cognitive functioning is impaired. 50
51 5. MOVEMENT Be aware of body movements. People in crisis often need more physical space. If possible, position yourself at or below the individual s eye level and approach from the front. Keep all movements slow and deliberate. Try to establish trust and rapport before touching the person. Honesty and sincerity are essential for maintaining trust. Gain trust by forewarning that certain things may take place. 51
52 6. ASK QUESTIONS Don t be afraid to ask them what s going on. Take responses as given. Don t argue. There s a difference between listening and active listening. 52
53 7. VENTILATION Individuals in a mental health crisis will usually reflect what the lead adult is doing. If the youth is agitated and yelling, shouting back at him/her will only make things worse. Try to model a calm behavior. If safe to do so, allow the person to yell and vent their feelings. 53
54 8. TELL THE TRUTH If at all possible, don t lie in order to gain a youth s trust or compliance. Lying might work for you in this situation, but consider the next time. The next person who has to deal with the youth at a later time will have difficulty establishing any trust or compliance. 54
55 9. PHYSICAL FORCE Use physical force as a last resort. Communication and patience works best. 55
56 SYSTEM OF CARE APPROACH Interagency Youth Cluster County-wide partnership of the primary child & family serving systems: Job & Family Services Mental Health & Recovery Services Board/Providers Board of Developmental Disabilities Family & Children First Council Juvenile Court Monitor & review cases of the most challenging multi-system youth needing services beyond the basic ones available. Advise Family & Child Teams (FACT) serving multi-system youth & families. Provide joint funding when appropriate for higher level of care services. 56
57 57
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