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Advanced Child and Adolescent CIT


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Presented by: Michael R. Peterson MA LAMFT
Executive Director
Steve M. Wickelgren MA MFT
Minnesota CIT Officers Association
Jane Marie Sulzle, RN, CNS, MS

Published in: Education, Health & Medicine
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Advanced Child and Adolescent CIT

  1. 1. Crisis Intervention Team Training Advanced Child and Adolescent CIT<br />Michael R. Peterson MA LAMFT<br />Executive Director <br />Steve M. Wickelgren MA MFT <br />President<br />Minnesota CIT Officers Association<br />Jane Marie Sulzle, RN, CNS, MS<br />PrairieCare<br />
  2. 2. Our youth now love luxury. They have bad manners, contempt for authority; they show disrespect for their elders and love chatter in the place of exercise; they no longer rise when elders enter the room; they contradict their parents, chatter before company, gobble up their food and tyrannize teachers.<br />--Socrates, Fifth Century BC<br />
  3. 3. Training Objectives<br />Define the problem<br />Building a Team<br />Understanding the differences between Adult and Child/Adolescent Mental Health<br />Assessing stakeholders needs and resources<br />Building a Partnership<br />Identify the target audience <br />Develop a Training model<br />Market training <br />
  4. 4.
  5. 5. Define the Problem<br />Officers struggled to understand<br />Increase in kids diagnosed with mental Illness<br />Lack of knowledge about community resources<br />Understanding the difference ODD, ADD, ADHD, Bipolar, or just a kid<br />Parent struggles<br />School/Community<br />
  6. 6. What emotion do you see?<br />DIFFERENCES IN PERCEPTION<br />Adults see Surprise: <br /> In the adult brain, reading emotions involves the prefrontal cortex.<br />Adolescents see Anger: In the adolescent brain, it involves the amygdala. <br />
  7. 7. Building a Team<br />Who cares<br />Who is impacted<br />Who can help<br />Willingness to commit time and resources<br />Interested in future solutions<br />Understanding of the problem<br />Enthusiasm<br />
  8. 8. Understanding the Differences <br />Listen to the experts<br />Research <br />Care about kids<br />Developmental markers<br />What is adolescents<br />When is a person an adult<br />Why <br />
  9. 9.
  10. 10. Stakeholders<br />Kids<br />Parents<br />Schools<br />Police <br />Courts<br />Mental Health providers<br />Substance abuse treatment<br />Community advocates<br />
  11. 11. UnderstandingParents<br />Parents do the best they can with what they have.<br />
  12. 12. Building Partnerships<br />PrairieCare<br />NAMI Minnesota<br />School Staff<br />County Social Services<br />Mobile Crisis Teams<br />School Resource Officers<br />Local Police and Sheriff Departments <br />
  13. 13. Identify the Audience<br />Police Officers<br />Sheriffs Deputies<br />School Security Officers<br />Juvenile Corrections<br />Mobile crisis workers<br />Mental Health Providers<br />
  14. 14. Develop the Training<br />Build off current Minnesota Cit Officers Association CIT Memphis Model curriculum<br />Identify differences<br />Identify the similarities<br />Identify resources available<br />Develop child and adolescent role play scenarios<br />
  15. 15. Marketing<br />Post on Website<br />Attend conferences<br />MN SRO association<br />MN Sheriffs association<br />MN Police chiefs association<br />Mental Health conferences<br />Email notices<br />
  16. 16. Children's Mental Health and Crisis Intervention<br />
  17. 17. Outline of presentation<br />Environment and biology<br />Statistics about mental health<br />Diagnoses and medications to treat them<br />
  18. 18.
  19. 19. Organic versus Behavioral<br />OCD Brain<br />Anxious Brain<br />Normal brain<br />Bipolar brain<br />Depressed brain<br />
  20. 20. Prevalence of Mental Illness in Children and Adolescents<br />5% of children <br />10-15% of adolescents <br />1 of 5 have a mental illness, 2 of 5 get the care they need.<br />15-20% incidence of MI in adults <br />
  21. 21. Untreated<br />School failure<br />Family conflicts <br />Substance abuse<br />Violence <br />Suicide<br />May increase risk of juvenile justice<br />Have at least one mental disorder<br />66 % boys<br />75% girls<br /><br />Fast Facts about children and mental health<br />Secondary effects<br />
  22. 22. Bipolar Disorder<br />Bipolar Disorder I, II and NOS<br />Little agreement about diagnostic criteria<br />Does Bipolar Disorder really exist in children?<br />What does it look like<br />Co-morbid with ADHD<br />Most challenging to treat<br />High co-morbid with drug use/abuse<br />
  23. 23. What does bipolar disorder look like?<br />Between 20-25% of children who first present with MDD will eventually prove to have bipolar.<br />“ADHD on speed”<br /> Doesn’t need much sleep, goes from very sad (irritable) to wild and crazy in a flash, grandiosity is seen as “I don’t have to, you’re not the boss of me.” “I don’t need directions”, scary risk takers, can rage for hours. <br />Very difficult to diagnosis/treat<br />
  24. 24. Medication for Bipolar Disorder<br />Atypical antipsychotics<br />Abilify, Seroquel, Risperdal, Zyprexa, Geodon<br />Should follow lab work as starting, 3 months out and annually<br />Weight showed be followed closely<br />May cause “dulling”<br />EPS (Extrapyramidal side effects) movement disorders that require immediate interventions<br />
  25. 25. Atypical Antipsychotics<br />Abilify<br />Middle range for weight gain<br />Helps with frontal lobe functioning<br />Akathisia<br />Seroquel<br />Sedation, calming<br />Weight gain<br />Great to help with sleep<br />Zyprexa<br />Most significant for weight gain, but works well<br />Really helps with aggression<br />
  26. 26. Atypical Antipsychotics (cont)<br />Risperdal<br />Weight gain<br />Breast enlargement, lactation<br />Dulling<br />FDA approved for kids in autism spectrum<br />Geodon<br />Difficult to use<br />Fewest side effects<br />Not very effective<br />
  27. 27. Medications for Bipolar Disorder (cont.)<br />Mood stabilizer<br />Anti-seizure medications<br />Depakote, Trileptal, Lamictal<br />Can cause dulling, weight gain, life-threatening rash, pancreatitis, <br />Depakote needs frequent lab draws<br />Lithium<br />Frequent lab draws<br />Very narrow window between helpful level and toxic<br />Can cause thyroid to stop functioning<br />
  28. 28. Need to Know Info (NKI)<br /> Very erratic, unpredictable behavior<br />Defiant<br />Can be difficult to finesse <br />Little ones can be very aggressive, like a toddler response<br />Adolescents more grandiose<br />
  29. 29. Psychosis<br />Person (adult or child) is experiencing hallucinations, delusions, distorted thinking. <br />Bipolar Disorder, Mania<br />Schizophrenia<br />Depression<br />Paranoia <br />Drugs<br />Medications<br />
  30. 30. Schizophrenia<br />Rare in children<br />Children under 12:1 in 40,000<br /> Adolescents: 3 out of every 1,000<br />Hallmarks<br />Disheveled appearance <br />Odd expressions and behaviors<br />Little to no emotional expression<br />Hearing voices, seeing things, bizarre beliefs, odd speech<br />
  31. 31. What you might see<br />Behavior seen<br />Irrational<br />Paranoid <br />Someone is out to get them<br />Conspiracy <br />Delusional<br />Has special powers<br />“God”<br />Can see, hear, know things others do not<br />Physically strong<br />What to do<br />Be calm<br />Go slow<br />Do not use humor, they don’t understand<br />Avoid confrontation, they don’t understand<br />Play with them to get them to cooperate.<br />
  32. 32. What you might see (cont.)<br />Behaviors (cont)<br />Hyperactive/reactive<br />Agitated<br />Rapid, disorganized speech<br />Poor self control<br />Very poor judgment<br />No insight<br />Arguing is useless<br />Calm the environment<br />
  33. 33. Medications for Schizophrenia<br /><ul><li>Atypical antipsychotics</li></ul>Risperdal, Zyprexa, Geodon, Seroquel, Abilify, and Clozaril<br /><ul><li>Weight gain, more in kids
  34. 34. Metabolic disorders
  35. 35. High cholesterol
  36. 36. Flat affect
  37. 37. Sedation
  38. 38. Extra pyramidal symptoms, (EPS)</li></li></ul><li>Other medications<br />Typical antipychotics<br />Haldol, Prolixin, Thorazine, Trilafon, Melleril<br />Dulling (slow thinking<br />Flat affect<br />EPS/ temporary<br />Tardive Dyskinesia<br />Involunary movements that are permanent<br />
  39. 39. NKI<br />Very rare in children/adolescents<br />More likely chemically induced or secondary to other disorder (depression, bipolar disorder)<br />Very unpredictable<br />Join in their delusions/hallucinations, don’t challenge them.<br />Very unpredictable<br />
  40. 40. Psychotic disorder<br /><br />
  41. 41. Attention Deficit/Hyperactivity Disorder<br />Impulsive<br />Does without thinking; stealing, blurting, buying<br />Inattentive; disorganized, can’t follow directions<br />Hyperactive; can’t sit or stand still, constant motion, will walk/run from parents<br />Combination of all three<br />
  42. 42. ADHD<br />Often co-morbid with learning disabilities (trouble reading, writing)<br />Often co-morbid chemical dependency.<br />Very often with kids with Bipolar disorder<br />Impairs executive functioning; organization, movement, time understanding. <br />
  43. 43. Medications<br />Stimulants: Concerta, Adderall, Vyvanse, Daytrana Patch, Metadate, Focalin, Dexedrine, Ritalin<br />Daytrana patch and Vyvanse with hx of chemical abuse.<br />Decrease appetite<br />Cause mania and depression.<br />Can cause trouble getting to sleep.<br />Only work the day they take them and not into the evening!<br />
  44. 44. NKI<br />Will run without thinking, little ones get lost, older kids when they are in trouble<br />Will “mouth off” without thinking, often will have remorse later. Don’t react!<br />Can’t remember 2-3 step directions<br />Can’t stand still, move with them. Don’t make them be still, often they think better when moving.<br />If you are working with them in the evening MEDICATIONS HAVE WORN OFF<br />Seldom see just a child with ADHD, likely co-morbid with something else.<br />
  45. 45. Depression<br />1 in 33 kids, 1 in 8 adolescents <br /> Are more irritable<br />Defiant<br />Big sleep problems<br />Can’t do homework<br />Doesn’t spend time with friends<br />Gives things away<br />
  46. 46. Depression<br />Depression<br />Unusual in young children<br />More common in adolescents; more girls than boys.<br />Can be chronic (dysthymia)<br />20% of children who present with depression actually have Bipolar Disorder<br />Symptoms:<br />Irritable in young children, sad in adolescents<br />Withdrawn<br />Low energy<br />Suicidal ideation<br />Self-harm<br />Difficulty concentrating<br />
  47. 47. Suicide in adolescence<br />Every year, nearly 5,000 people between age 15 and 24 commit suicide.<br />Suicide is the 2nd leading cause of death in adolescents. <br />Suicide threats/attempts within schools can occur in “clusters”. <br />
  48. 48. Acute Suicidal Ideation<br />Chronic Suicidal Ideation<br />What was the trigger?<br />What have been other symptoms<br />Lethality? <br />Are they on medication that could cause this?<br />Is how they cope with stress<br />Common in Borderline Personality Disorder<br />May have history of self-injuring behavior<br />Don’t belittle, they will escalate their lethality.<br />Frequent non-lethal attempts.<br />
  49. 49. Medications <br />Side effects<br />Mania, weight gain, weight loss, sedation, activation, impotence, suicidal ideation<br />Mania, weight loss, dry mouth, dizzy, impotence<br />Activation, decreased energy, suicidal ideation<br />SSRI’s: Prozac, Celexa, Lexapro, Luvox, Paxil<br />SNRI’s: Cymbalta, Effexor<br />NDRI: Wellbutrin<br />
  50. 50. NKI<br />Slow to process, wait for them to answer<br />Slow to move<br />They will likely not look at you, not about you<br />Be empathetic<br />Medications may be making worse, either more suicidal or manic.<br />
  51. 51. Autism Spectrum Disorders/PDD<br />1 in 150 kids <br />Autism, Asberger’s Syndrome<br />Symptoms:<br />Impairment in social interaction<br />Nonverbals: eye contact, gestures, facial expressions<br />Peer difficulties<br />Stereotypic interests<br />Communication problems: use of speech and type of play<br />Nonverbals: eye contact, gestures, facial expressions<br />Peer difficulties<br />Talks language literally!!!!<br />Will power struggle with you<br />
  52. 52. Behaviors you might see<br />Significant trouble with sensory issues: light, sound, textures<br />Easily overwhelmed and confused<br />Has a special interest, find out what it is<br />Can be manipulated with special interest<br />Transitions are very difficult<br />Very persistent <br />
  53. 53. Medications<br />Antidepressants<br />Prozac, Celexa, Zoloft, Luvox, Lexapro, Paxil<br />Stimulants<br />Concerta, Ritalin, Adderall, Metadate, Focalin, Daytrana patch, Vyvanse<br />Strattera<br />Blood pressure medications<br />Clonidine, Tenex<br />Atypical antipsychotics<br />Risperdal and Abilify are both FDA approved, but also use Seroquel, Geodon, and Zyprexa<br />
  54. 54. NKI<br />DO NOT TOUCH<br />DO NOT JOKE, remember they take language literally.<br />Quiet the environment<br />Decrease light and sound<br />Decrease number of people<br />Find out their special interest<br />No power struggles<br />You can talk them down<br />Distraction works well.<br />
  55. 55. Has been exposed to a trauma that felt life threatening<br />Triggers are often unknown<br />Reactive, fear based<br />Fight or flight response<br />Use “soothing” responses<br />Move slowly, deliberately, NO SURPRISES!!!!!<br />Post traumatic Stress Disorder<br />
  56. 56. Did not have a healthy attachment as infant<br />Most often children who are adopted<br />Children separated from mother<br />Mother’s with significant depression<br />Behavior is very defiant<br />Reacts in aggression<br />Little social thought<br />“Stuff” is very important to them, can be bribed.<br />Reactive Attachment Disorder<br />
  57. 57. Oppositional Defiant Disorder<br />ODD:5-15% of school aged children<br />A 6 month pattern of negative, hostile and defiant behavior, including:<br />Blames others<br />Argumentative<br />Defies adults<br />Annoys others and is easily<br /> annoyed<br />I seldom diagnosis, usually a reason for behavior.<br />
  58. 58. Conduct Disorder<br />6% of the population (4:1 M/F)<br />Violates basic rights of others/<br /> societal rules <br />Aggression toward people and/or <br /> animals<br />Destruction of property<br />Theft or deceitfulness<br />Likely has source, PTSD, RAD, et al<br />
  59. 59. Antipsychotics<br />Atypical antipsychotics<br />Typical antipsychotics<br />Medications to treat<br />
  60. 60. Myths and Misperceptions<br />“All teenagers are moody/hormonal”<br />“She’s just trying to get attention”<br />”She’s just trying to get out of school”<br />“He’s just a bad kid.” <br />“It’s all the parent’s fault.”<br />“She just needs to get up and get outside.”<br />It only happens to weak people/poor people.<br />It will never happen to me or my family.<br />
  61. 61. When negotiating choices…..<br />Negotiate = both sides get their needs met<br />Find a way to honor some of the subject’s needs.<br />Allow choices when possible.<br /> (increases sense of control and safety)<br />Only offer two choices: be prepared s/he will make the “wrong” choice.<br />Be open to a modified version of the two choices. <br />“I can’t do that, but there in another option …”<br />
  62. 62. Engaging the Family<br />Understand that your presence may alter the child’s behavior.<br />Use parent interview to determine: <br />History/severity of problem<br />History of mental health care/parent intervention<br />What has helped in the past<br />Medical problems/medications<br />Available supports/resources<br />Parent’s ability to keep child safe<br />Assess parents’ contribution to the problem. <br />Expect parent to follow child to ED and participate in assessment. <br />Treating parents as part of the solution; working together will increase compliance.<br />
  63. 63. Adolescent brains are a work in progress<br />
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  66. 66. Questions?<br />