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Introduction to Mental Health in Child Welfare

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Introduction to Mental Health in Child Welfare Presented by: Dr. Jayme Jones – PowerPoint PPT presentation

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Title: Introduction to Mental Health in Child Welfare


1
Introduction to Mental Health in Child Welfare
  • Presented by
  • Dr. Jayme Jones

2
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Excessive anxiety worry about multiple events
    or activities
  • Psychological manifestations
  • Worry
  • Fearfulness
  • Apprehension
  • Anxious anticipation
  • Avoidance
  • Obsessions

3
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Physical manifestations
  • Racing heart/Heart Palpitations
  • Shortness of breath
  • Trembling/Shaking
  • Dizziness
  • Muscle tension
  • Agitation
  • Compulsions

4
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Common profiles
  • Generalized Anxiety
  • Panic Attacks
  • Agoraphobia
  • Phobia
  • Obsessive Compulsive Disorder (OCD)

5
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Post-Traumatic Stress Disorder (PTSD)
  • Profile
  • Traumatic Event
  • Re-experiencing
  • Flashbacks/Recurrent Thematic Dreams
  • Avoidance
  • Thoughts
  • Activities
  • Arousal
  • Sleep disturbance
  • Irritability
  • Poor Concentration
  • Hypervigilance/Increased Startle Response

6
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Prevalence
  • 1 2 Panic
  • 1 3 OCD
  • 7 11 Specific Phobia
  • 3 13 Social Phobia
  • 8 PTSD

7
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Familial/genetic components
  • Increased incidence of all anxiety disorders
    among first degree relatives
  • Environmental components
  • Negative experience
  • Transmission of Anxiety

8
Adult Major Mental Illnesses
  • Anxiety Disorders
  • Gender factors
  • 2 to 3 times more common among women
  • OCD the same
  • Cultural factors
  • Focus of anxiety
  • Presentation of symptoms
  • Impact on family
  • Restriction of behaviors
  • Transmission of Anxiety

9
Adult Major Mental Illnesses
  • Mood Disorders
  • Depression
  • Psychological manifestations
  • Depressed mood (or irritability)
  • Frequent crying
  • Loss of interest
  • Poor concentration
  • Feelings of guilt and worthlessness
  • Thoughts of death and/or suicide

10
Adult Major Mental Illnesses
  • Mood Disorders
  • Depression
  • Physical manifestations
  • Weight change
  • Sleep disturbance
  • Motor Slowness
  • Fatigue

11
Adult Major Mental Illnesses
  • Mood Disorders
  • Mania
  • Psychological manifestations
  • Expansive or elated mood
  • Inflated self-esteem/grandiosity
  • Talkative/flight of ideas
  • Distractible
  • Increase in goal directed activity
  • Excessive involvement in pleasurable activities

12
Adult Major Mental Illnesses
  • Mood Disorders
  • Mania
  • Physical Manifestations
  • Decreased need for sleep
  • Appetite Changes

13
Adult Major Mental Illness
  • Mood Disorders
  • Prevalence
  • Depression
  • 10-25 women
  • 5 to 12 men
  • Bipolar .4 to 1.6

14
Adult Major Mental Illness
  • Mood Disorders
  • Familial/genetic components
  • Depression - 1.5 to 3 times more common among 1st
    degree relative
  • Bipolar - 10 to 15 times more common
  • Environmental components
  • Situational stressors

15
Adult Major Mental Illness
  • Mood disorders
  • Gender factors
  • More women than men especially in US and Europe
  • Cultural factors
  • Somatic concerns
  • Nerves Latino and Mediterranean cultures
  • Imbalance weakness, tiredness - Asian cultures
  • Heart - Middle Eastern

16
Adult Major Mental Illnesses
  • Mood disorders
  • Impact on Family
  • Difficulty with self and other care
  • Neglect
  • Possible suicide

17
Adult Major Mental Illnesses
  • Psychotic Disorders
  • Symptoms
  • Impaired Reality
  • Delusions not culturally acceptable
  • Hallucinations
  • Affect Impairment
  • Thought Impairment

18
Adult Major Mental Illnesses
  • Psychotic Disorders
  • Prevalence
  • .5 to 1.5
  • Familial/genetic components
  • First degree relatives 10 times higher
  • Environmental components
  • Stressors
  • Family Communication Patterns

19
Adult Major Mental Illnesses
  • Psychotic Disorders
  • Gender factors
  • Men develop earlier (18 to 25 v. 25 to 35)
  • 3-10 of women after 40
  • Women better pre-morbid functioning, more
    affective symptoms, paranoid delusions and
    hallucinations
  • Men more negative symptoms
  • Women have better prognosis (fewer
    hospitalizations, shorter durations, more
    improved with medication)

20
Adult Major Mental Illnesses
  • Psychotic Disorders
  • Cultural Factors
  • Catatonic behavior more common in non-Western
    countries
  • Impact on family
  • Delusions and hallucinations re family
  • Impaired self and other care
  • Neglect
  • Abuse

21
Childhood Major Mental Illnesses
  • Attention Deficit Hyperactivity Disorder
  • Symptom Profile
  • Inattention
  • Hyperactivity and Impulsivity
  • Familial/genetic components
  • Higher likelihood among first degree relatives
  • Environmental components
  • Differences in reporting

22
Childhood Major Mental Illnesses
  • Attention Deficit Hyperactivity Disorder
  • Prevalence
  • 3 to 5 of school age children
  • Gender differences
  • 41 to 91
  • Impact on family
  • Increased interaction with schools
  • Increased need for behavioral management
  • Increased risk for abuse

23
Childhood Major Mental Illnesses
  • Anxiety Disorders
  • Differences in symptom profiles
  • More physical symptoms
  • Crying, tantrums, freezing, or clinging
  • Increase in activity level
  • Washing, checking and ordering

24
Childhood Major Mental Illnesses
  • Anxiety Disorders
  • Separation Anxiety Disorder
  • 4 of children
  • Frequent in children whose mothers have panic
    disorder
  • Post-Traumatic Stress Disorder
  • Distressing events change to generalized
    nightmares of monsters, rescuing others, or
    threats to self
  • Repetitive play

25
Childhood Major Mental Illnesses
  • Anxiety Disorders
  • Gender factors
  • OCD more common in boys
  • Impact on family
  • Increased need for emotional support
  • Increased risk for emotional abuse

26
Childhood Major Mental Illnesses
  • Mood Disorders
  • Differences in symptom profiles
  • More irritability
  • Increase in physical complaints
  • Friends dropped or ignored
  • Increase is risk-taking behavior
  • Constant search for distractions and new
    activities
  • Aggressive behavior
  • Mania - adolescents often have psychotic symptoms

27
Childhood Major Mental Illnesses
  • Mood Disorders
  • Prevalence
  • Depression
  • 2-5 of pre-pubescent children
  • 1.5 adolescent males
  • 7 adolescent females
  • Mania
  • rare in childhood
  • .5 of adolescents

28
Childhood Major Mental Illnesses
  • Mood Disorders
  • Gender factors
  • Equal numbers in childhood
  • Impact on family
  • Often ignored in childhood
  • Attributed to personality traits in adolescents
  • Risk of suicide often ignores

29
Childhood Major Mental Illnesses
  • Psychotic Disorders
  • Differences in symptom profiles
  • Delusions and hallucinations less elaborate
  • More visual hallucinations
  • Prevalence
  • Less than .5
  • Gender factors none noted
  • Impact on family

30
Application Exercise
  • A 24 year-old man tells you he recently consulted
    his physician because of dizziness and difficulty
    falling asleep. During your interview, he is
    visibly distressed, gulping before he speaks,
    sweating, and continually fidgeting in his chair.
    He reports that he always feels tense, and
    worries about anything and everything.

31
Application Exercise
  • A 38 year old single mother of four children
    reports feelings of intense sadness for the past
    two months. Seven months ago she was laid-off
    from her job, the familys sole source of income.
    About six weeks ago, she began having difficulty
    sleeping and lost her appetite, resulting in
    weight loss. She has little energy and no
    interest in activities that she normally enjoyed.
    She reported that household chores seemed
    overwhelming and were impossible to do. Her
    children have missed several days of school
    during the past three weeks because she is unable
    to get them ready.

32
Application Exercise
  • Mr. W., a thirty-two-year-old factory worker, has
    been married for eight years. He and his wife
    have two children. One morning, Mr. W. told his
    wife that he was bursting with energy and ideas,
    that his job was unfulfilling, and that he was
    just wasting his talent. That night he slept very
    little, spending most of the time at a desk,
    writing furiously. The next morning he left for
    work at the usual time, but returned at 1100am,
    his car overflowing with aquariums and other
    equipment for tropical fish. He had quit his job
    and withdrawn all the money from the familys
    savings account and spent it on the equipment. He
    told his wife that the night before he had worked
    out a way to modify existing equipment so that
    fish wont die anymore. Well be millionaires.

33
Application Exercise
  • Eight months ago, a 27 year old females
    boyfriend had been stabbed to death during a
    mugging from which she escaped unharmed. After a
    period of mourning she appeared to return to her
    usual self. Shortly after the arrest of the man
    accused of the murder, she began to have
    nightmares and vivid memories of the night of the
    stabbing. Her friends noted that she startled
    easily and seemed to be pre-occupied. She began
    to sleep restlessly, and her work suffered
    because of her poor concentration.

34
Application Exercise
  • A 6 year old girl was referred to DCFS by her
    teacher who suspected child abuse. During your
    interview, the girl sits calmly while you ask her
    about her friends and school, and answers all of
    your questions. When you begin to ask questions
    related to the referral question, she begins to
    run around the room and speak very quickly about
    non-related topics. She does not respond to your
    questions. She then climbs on a desk, from which
    you have to remove her for her safety.

35
Impact of culture, language and social context
  • Perceptions of mental illness and the causes vary
    by culture
  • Beliefs about health, healing and wellness also
    vary by culture
  • Culture influences attitudes toward health care
    providers
  • Latinos are more likely to terminate treatment
    prematurely - (60-75) after one session

  • Source Sergio A. Aguilar-Gaxiolo, MD,
    PhD

36
Impact of culture, language and social context
  • Disparity in access to and quality of mental
    health services
  • African-American and Latino youth identified and
    referred at the same rate, but less likely to
    receive specialized mental health services
  • Asian-American and Latino children have highest
    rates of depression
  • Under-representation of providers from culturally
    and linguistically diverse groups

  • Source Sergio A. Aguilar-Gaxiolo, MD,
    PhD

37
 Intervention and Planning
  • Identification vs. Assessment and Treatment
  • The role of the CSW
  • Referral sources
  • Documentation (Strength Based)
  • Needed information
  • Objective Observations (Behaviorally-specific)

38
     Intervention and Planning
  • Documentation (Strength Based)
  • Needed information
  • Consultation with Collaterals
  • SCSW
  • Psychiatrist
  • School Staff
  • Therapist
  • Interventions Provided
  • Specific
  • Examples

39
Intervention and Planning
  • Documentation concerns
  • Confidentiality
  • Impact on Case Planning
  • How would you integrate information about mental
    health into the case plan?    
  • Referral for therapy
  • Referral for medication evaluation
  • Follow-up

40
Youth Suicide
  • 3rd leading cause of death among adolescents
  • Approximately 5 to 8 of adolescents attempt
    suicide
  • Approximately 1 in 5 Latinas make a suicide
    attempt

41
Crisis Intervention
  • Types
  • Suicide
  • Homicide
  • Danger to Child
  • Response of the CSW

42
Crisis Intervention
  • Three levels of intervention
  • 1st Informal (Nuclear Extended Family)
  • 2nd Community Faith Based Organizations
  • 3rd Formal (DCFS)
  • Assistance
  • When to get it
  • Where to get it

43
Vignette Application Exercise
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