MENTAL HEALTH & MENTAL DISORDERS

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1 Central California Training Academy MENTAL HEALTH & MENTAL DISORDERS Trainer s Outline California Common Core Curricula for Child Welfare Workers

2 MENTAL HEALTH & MENTAL DISORDERS California Common Core Curricula for Child Welfare Workers COMPETENCIES AND LEARNING OBJECTIVES CORE COMPETENCIES The trainee will understand mental health issues which affect families served by the child welfare system. The trainee will obtain knowledge and skills to work effectively with families challenged by mental disorders and mental health issues within the frame of the family s cultural, environmental and family dynamics. LEARNING OBJECTIVES Knowledge: recognize how commonly occurring mental disorders can affect a person s ability to parent. K2. The trainee will be able to recognize the range of social functioning and intervention responses among children, adolescents, and adults who experience symptoms of mental and emotional K3. The trainee will be able to recognize that biological, psychological, cultural and environmental factors influence the mental health functioning of family members. K4. The trainee will be able to describe the role of the child welfare worker and the roles of various health care and mental health professionals who work with parents, adolescents and children with mental health K5. The trainee will be able to recognize common case plan interventions that are most often used by child welfare workers to assist children, adolescents and caregivers suffering from mental Skills: S1. Utilizing a case scenario, the trainee will be able to identify possible symptoms, warning signs, and behaviors that could indicate a mental health concern. S2. Utilizing a case example, the trainee will be able to analyze and articulate how cultural factors influence behavior and how this behavior can be misconstrued as symptomatic of mental disorder. Values: V1. The trainee will value the child welfare worker s role in educating families, collaterals, service providers, and colleagues about common misperceptions associated with certain mental V2. The trainee will value continued awareness and the demonstration of sensitivity to cultural differences and their implications when working with families with mental health issues. V3. The trainee will value the importance of seeking out clinical case consultations and thinking critically when working with children, youth and families regarding mental health concerns and diagnoses. *Based on Information Compiled by J. Cremer 2

3 Introduction Facts and Stats Labeling and Stigma Culture & Mental Health Definitions MENTAL HEALTH & MENTAL DISORDERS Agenda Strength Based Perspective: Understanding Mental Health from a Lifespan Perspective Common Diagnoses and Implications for Child Welfare Anxiety Disorders Mood Disorders Psychosis Personality Disorders Factitious Disorders Case Planning implications for each of the above Resources, Interventions, & Referrals *Based on Information Compiled by J. Cremer 3

4 Executive Summary MENTAL HEALTH & MENTAL DISORDERS Course Description The Mental Health and Mental Disorders Training provides an overview of common mental health diagnoses and the effects these diagnoses may have on parenting safely and effectively. The training focuses on recognizing and integrating signs and symptoms of mental health issues in considering risk, prognosis, family strengths and resources and common case plan interventions. Additionally, the training highlights the cultural influences which can sometimes impact mental health and receiving the appropriate mental health intervention in order to stabilize and strengthen a family. Finally, participants will learn key concepts related to mental health such as chronic versus acute symptoms and other terms related to mental health. The course utilizes lecturette, case studies, small group interaction, and video demonstrations to help participants integrate the information. Target Audience This training is appropriate for new workers. New workers will be exposed to new information to assist with beginning case work while recognizing signs and symptoms and building their awareness of possible case interventions. Outcome Objectives 1. Recognize how various mental disorders and early warning signs 2. Recognize the difference between chronic and acute symptoms and the potential prognosis of commonly found mental health 3. Recognize that biological, psychological, cultural and environmental factors influence the mental health functioning of family members and can sometimes be misconstrued as mental illness. 4. Describe the role of the child welfare worker and the roles of various health care and mental health professional who work with parents, adolescents and children with mental health 5. Identify common case plan interventions that are most often used by child welfare workers to assist children, adolescents and caregiver suffering from mental Ways that Supervisors can support the Transfer of Learning from the classroom to the job BEFORE the training 1. Supervisors should ask the worker to consider what makes someone mentally ill and to write down their view of mental illness to take with them to the training. 2. Supervisors should ask the worker to list all symptoms of a mental illness that he/she can brainstorm and how these symptoms might affect parenting. AFTER the training 1. Supervisors should ask the trainee to discuss what he/she learned in the training to challenge his/her view of what makes someone mentally ill and what this means about the ability to parent. 2. Supervisors should request the trainee name two key case plan interventions for clients with mental health issues and describe a case in which these two interventions would be most effective. *Based on Information Compiled by J. Cremer 4

5 Trainer s Tips This is a curriculum that is designed to make use of the expertise of a mental health practitioner in educating participants with a wide variety of education and experience in mental health. As such, it is expected that the trainer will add examples from the trainer s professional and personal experiences to help illustrate the points and clarify the material. While examples of mental health dynamics, signs, and symptoms are particularly illustrative, these examples need to have a child welfare link. The trainer must approach all aspects of this curriculum through the child welfare lens. It is the difference between a college course on mental health and a training for new child welfare workers. Trainers must be able to cross over from the practice of mental health to the applications and links between mental health and child welfare. Additionally, the trainer must have some working knowledge of child welfare issues in order to address standardized common themes in all of California s Common Core Series. The first of the common theme to be addressed is the link to the Adoption and Safe Families Act (ASFA) which legislated on a federal level the Child and Family Services Review (CFSR) of all states. As related to mental health, ASFA encourages greater partnership with community partners in order to help families build independence from child welfare and reliance on a home community. ASFA also requires that child welfare focus on safety, permanence, and well-being. Mental health issues could fall under each of these overarching goals of ASFA. The Mental Health curriculum stresses the need for care coordination between the mental health provider and the child welfare system. This is especially crucial when dealing with a long term mental illness as these clients will probably need continued mental health support long after child welfare has completed its work. The trainer needs to stress both of these links: partnership and the need for long term support for families struggling with mental health problems to the goals of ASFA. The second common theme is fairness and equity. The significant problem of disproportional representation of children of color in the child welfare system must be addressed in each training. To do so, the trainer must have a working knowledge of the fairness and equity issues that are challenging the child welfare system. The trainer must be prepared to discuss fairness and equity challenges as they relate to mental health services, assessment, advocacy, and service planning as all of these *Based on Information Compiled by J. Cremer 5

6 directly relate to child welfare assessment, advocacy, and service planning. Additionally, each of the CORE trainings must challenge workers to examine their biases and how biases can impact decision making. The trainer must be prepared to help identify the ways bias can impact mental health assessment and service planning and to encourage workers to examine individual biases. A third common theme is that of strength based perspective. The culture of today s child welfare work is in process of shifting from a problem focus to a strength based focus. This is also true for the current culture of mental health. However, the very nature of diagnosing mental illnesses requires some attention to the pathology a person might be representing. As a result, many times mental health trainings tend to focus on the pathology of a family system rather than the strengths. This curriculum will prove challenging in this same manner for most mental health trainers. Helping participants to recognize the coping, resources, and supports that a mentally ill person/family has developed is one way to bring a strength based perspective. In order to help participants integrate an understanding of how mental health can impact safety, permanence, and well being, the trainer must use specific language familiar in mental health and also specific language familiar in child welfare. By associating terms from the two disciplines, participants will be more likely to transfer learning from one CORE class to another and transfer learning to their jobs. For instance, the terms chronic and acute are used in mental health to describe symptom pictures and are often associated with prognosis. The child welfare terms safety, risk, and protective capacity are often associated with minimum sufficient level of care. Trainers who train this curriculum should be well versed in the meanings of all of these terms and how they interrelate and cross disciplines. Participants must learn how chronic vs. acute can impact safety vs. risk and how prognosis can impact protective capacity and ultimately minimum sufficient level of care. The child welfare terms are taught in the Critical Thinking CORE Curriculum which could be a valuable resource for any mental health trainer. These terms are not re-taught in the mental health curriculum but need to be a part of the trainer s process points for group discussion and exercises. *Based on Information Compiled by J. Cremer 6

7 Mental Health Trainer s Outline Topic/Time Objective Description of Training Methodology 9:00/20min Introduction 9:20/ 30 min Labeling and Stigma V1 The trainee will value the child welfare worker s role in educating families, collaterals, service providers, and colleagues about common misperceptions associated with certain mental S2 Utilizing a case example, the trainee will be able to analyze and articulate how cultural factors influence behavior and how this behavior can be misconstrued as symptomatic of mental disorder. Introduction to the topic and to each other: Trainer will review briefly portions of the trainer s bio which should be included in the packet. Review the objectives and the agenda Icebreaker: Write down three symptoms of a mental illness on a 3x5 card. Meet 7 other people in the room, at other tables, and compare symptoms with what they wrote down. When trainer calls time, put card on the prepared tape on the wall. Trainer review the symptoms on the cards briefly stimulating discussion about implications of these symptoms. Remind the trainees that you will be covering these under different diagnoses and that they should consider the possible impact on parenting of everyone of these as you discuss. Review Facts and Stats Small group discussion: answer the following questions: 1. How did your family define crazy? Mentally ill? 2. Was this how your larger culture defined it? 3. How did your culture handle parents who were mentally ill? Lecturette on systemic bias, stigma, and prejudice. Stress the importance of the role the worker can play in helping deal with systemic bias. Ask the trainees to consider how more than one bias can be at work for certain groups of clients who may have mental health challenges. Lead large group discussion about ways this can play out in the CW system of care. Large group process discussion about what *Based on Information Compiled by J. Cremer 7

8 9:50/30 min Culture and Mental Health 10:20/ 15 min Advocacy 10:35/ 15 min Break 10:50/ 40 min Definitions 11:20/ 20 min Strength Based Perspective: Understanding Mental Health from a Lifespan Perspective 11:40/ 20 min Anxiety Disorders Noon/ 1 hour 15 min S2 Utilizing a case example, the trainee will be able to analyze and articulate how cultural factors influence behavior and how this behavior can be misconstrued as symptomatic of mental disorder. V2. The trainee will value continued awareness and the demonstration of sensitivity to the cultural differences and their implications when working with families with mental health issues. V1 The trainee will value the child welfare worker s role in educating families, collaterals, service providers, and colleagues about common misperceptions associated with certain mental K2. The trainee will be able to recognize the difference between chronic and acute symptoms and the potential prognosis of commonly found mental health K3 The trainee will be able to recognize that biological, psychological, cultural and environmental factors influence the mental health functioning of family members. came up. Be sure to fill in the many ways that CWW must act as advocate. Individual exercise: Identify within your culture a cultural practice or belief that could be interpreted by others outside of your culture as a symptom of mental illness. Trainer can provide some examples to get the discussion going such as: believing in ghosts, talking in tongues as a religious practice, believing in demonic possession, believing in faith healing, etc. Small Group Discussion: share what you came up with with others in the group Lecturette: Cultural implications for mental health and mental illness. Tie in the above in a discussion about how different cultures see mental health and how they operationalize it. Ask group to brainstorm different ways to act as advocate for mentally ill client Exercise Card Sort of definitions. DSM IV Axes Define acute vs. chronic with the implications for parenting. Lecturette: Review the Strengths and Protective Influences information stressing the coping strategies and strengths often exhibited by someone with a mental health challenge. Tie the chronic vs. acute aspect to parenting abilities in order to illustrate the difference in safety and risk in parenting. Lecturette: about ways a person with a mental illness has had to develop strategies to cope and how some of these could be seen as strengths. Individual exercise: Make a list of some of these strengths and coping mechanisms. Lecturette: overview of anxiety disorders and their implications for parenting. Use specific examples and stories to illustrate the diagnoses and symptoms Lunch *Based on Information Compiled by J. Cremer 8

9 1:15/ 20 min Anxiety Disorders 1:35/ 35 min Mood Disorders 2:10/ 15 min Break 2:25/25 min Psychosis 2:50/ 30min Personality Disorders S1 Utilizing a case scenario, the trainee will be able to identify possible symptoms, warning signs, and behaviors that could indicate a mental health concern. K5. The trainee will be able to identify common case plan interventions that are most often used by child welfare workers to assist children, adolescents and caregiver suffering from mental S1 Utilizing a case scenario, the trainee will be able to identify possible symptoms, warning signs, and behaviors that could indicate a mental health concern. K5. The trainee will be able to identify common case plan interventions that are most often used by child welfare workers to assist children, adolescents and caregiver suffering from mental S1 Utilizing a case scenario, the trainee will be able to identify possible symptoms, warning signs, and behaviors that could indicate a mental health concern. K5. The trainee will be able to identify common case plan interventions that are most often used by child welfare workers to assist children, adolescents Small Group Exercise: Read the Vignette One and Answer the Questions Trainer process the exercise in large group discussion stressing chronic vs acute and the implications for the child s safety, risk, and well-being. Lecturette: overview of mood disorders and their implications for parenting. Use specific examples and stories to illustrate the diagnoses and symptoms. Small Group Exercise: Read the Vignette Two and Answer the Questions Trainer process the exercise in large group discussion stressing the case plan implications and referral possibilities. Lecturette: overview of Psychosis and Schizophrenia and the implications for parenting Show clip from Beautiful Mind (scene in which Russell Crowe is bathing the baby) and ask participants to pick out signs of psychosis and relate to identified risk as a parent Trainer process the exercise in large group discussion stressing the case plan implications and referral possibilities. How does MSLC impact a case with a schizophrenic parent? Lecturette: overview of personality disorders and their implications for parenting. Use specific examples and stories to illustrate the diagnoses and symptoms. Unique U s exercise: after reviewing the information in the chart on personality disorders, participants, in small groups, will come up with 2 words for each personality *Based on Information Compiled by J. Cremer 9

10 3:20/ 15 min Fictitious Disorder 3:35/20min Resources, Interventions, and Referrals 3:55/5 min Training Evaluation and caregiver suffering from mental K1 The trainee will be able to recognize how various mental disorders can affect a person s ability to parent. K5. The trainee will be able to identify common case plan interventions that are most often used by child welfare workers to assist children, adolescents and caregiver suffering from mental K4. The trainee will be able to describe the role of the child welfare worker and the roles of various health care and mental health professionals who work with parents, adolescents and children with mental health. S3. Using a case scenario, the trainee will be able to describe the potential impact on parenting, risk, and permanency of symptoms and behaviors associated with mental health diagnoses of a parent or child. V2. The trainee will value continued awareness and the demonstration of sensitivity to the cultural differences and their implications when working with families with mental health issues. V3. The trainee will value the importance of seeking out clinical case consultations and thinking critically when working with children, youth and families who have a mental health diagnosis. disorder that starts with U. The words can be to sum up symptoms, risk, escalation, or case plan implication. Large group discussion of a personality disorder and the nature of chronic and acute symptoms for personality disorders and how they can impact parenting. Also discuss the challenging nature of working with families who have members with personality Lecturette: overview of fictitious Consider the safety, risk, protective capacity, and MSLC implications Lecturette: overview of interventions with families, other treating professionals and why, when, and to whom to make referrals. Small group exercise: For each of the vignettes read earlier, list three interventions for each family. Consider the helpful hints. Which aspects of the MH systems of care are to be utilized in the scenarios? Large group process regarding case collaboration in both vignettes. Distribute evaluations *Based on Information Compiled by J. Cremer 10

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