Aps study group assessing 2016 june

Dr Michael Carr-Gregg
Child and Adolescent Psychologist
@MCG58
When to really worry
- Assessing the
Adolescent at risk -

Today
• Toilets
• Mobile Phones
• Notes
• Finish at 4.30 pm

Program
9.30-11.00am – Session 1 – Group Quiz & Research
Summary
11 am - Morning Tea
11.30 – 1pm – Session 2 – Paradigms & tools for Assessment
1 pm - Lunch
2-3pm – Session 3 – Case Study and group practice
3 pm Afternoon Tea
3.30- 4.30 - Session 4 – Feedback and Close

Is this the most vulnerable generation?

The rationale for this study group
• Adolescence and young adulthood are
significant periods of
–Social
–Emotional
–Physical
–Neurophysiologic development

Session 1
Group Quiz & Research
Summary

Quiz
How much do you really
know about the
developmental
psychology of
teenagers?

Question 1: Approximately How many brain cells
in the average 14-year-old girl?
100
billion
a) 100 billion b) 200 billion c) 300 billion d) 400 billion

Question 2: What is the minimum amount of
sleep an average 15-year-old girl requires?
a) 7 hours b) 8 hours c) 9 hours d) 10 hours

Question 3: What is the
most important source of
energy for a 13-year-old
girl’s brain?
a) oxygen
b) glucose
c) electricity
d) water

Question 4: In 1860, the
average age at menarche
(a girl’s first period) in
the UK was 15 years old.
What is it today?
a) 14-15 years
b) 13-14 years
c) 12-13 years
d) 11-12 years

Question 5: According to a recent study what percentage of
teenagers in secondary school skip breakfast?
a) 12% b) 22% c) 32% d) 42%

Question 6: In the last 5
annual surveys
conducted by Mission
Australia, what one issue
consistently rates
number one as teens’
biggest worry?
a) Body Image
b) Bullying
c) School & study
problems
d) Coping with
stress

Question 7: In the latest national survey of secondary students and
sexual health by Latrobe University, what percentage of young
people expressed significant dissatisfaction with sex education at
schools, citing irrelevance to their real experiences, lack of
relationship advice and lack of discussion of same-sex issues as
problems?
a) 25%
b) 35%
c) 50%
d) 65%

Question 8: Which of the following conditions in
adolescent females have the highest mortality
rate?
a) Anorexia
b) Depression
c) schizophrenia
d) anxiety

Question 9: According to research undertaken by
Bond University last year, what proportion of
Australian video/computer gamers were female?
a) 17%
b) 27%
c) 37%
d) 47%

Question 10: A 2004 study published in the Medical
Journal of Australia showed that the rate of deliberate
self-harm in young women was 11%. What was the
greatest predictor of this behaviour?
a) Being bullied
b) Having a friend or family
member who had self
harmed
c) Being from a different
cultural background
d) Being diagnosed with a
depressive illness

Question 11: A 2006 New Zealand study found
that one-third of students with which particular
medical condition have had suicidal thoughts?
a) Diabetes
b) Asthma
c) Arthritis
d) Acne

Question 12: Which of the following is true about
same-sex attracted young people compared to their
heterosexual peers, according to a study by Young and
Well CRC in 2014?
a) They are 6 times more
likely to try and take their
own life
b) They are 5 times more
likely to use illicit drugs
c) They are 3 times more
likely to be bullied at
school
d) They are 4 times more
likely to suffer a major
depressive illness

Question 13: What is the greatest predictor of a
future suicide attempt or completed suicide?
a) A history of self harm
b)A history of depression
c) A history of previous attempts
d)A history of anxiety disorders

Question 14: The National Health and Medical
Research Council (NHMRC) issued guidelines in 2009
suggesting that young people should not drink until
they are how old?
a) 16
b) 18
c) 21
d) 25

Question 15: According to the National Drug and
Alcohol Research Centre, the most commonly used
drug in drink spiking is?
a) Gamma
Hydroxybutyrate
(GHB)
b) Cocaine
c) Rohypnol
d) Ethanol (Ethyl
Alcohol)

Question 16: Which of the following
antidepressants has the US Food and Drug
Administration (FDA) approved for use with
children over 8 years old?
a) Zoloft (sertraline)
b) Prozac (fluoxetine)
c) Paxil (paroxetine)
d) St. John's wort (Hypericum
perforatum)

Question 17: Which of the following drugs
cause the most deaths in young people in
Australia?
a) Heroin
b) Alcohol
c) Ice
d) Ecstasy

Answers to
the Quiz
How much do you really
know about the
developmental
psychology of
teenagers?

Answer 1: Approximately how
many brain cells in the average 14-
year-old girl?
100
billion
a) 100 billion
b) 200 billion
c) 300 billion
d) 400 billion

Answer 2: What is the minimum amount of
sleep an average 15-year-old girl requires?
a) 7 hours
b) 8 hours
c) 9 hours
d) 10 hours

Answer 3: What is the
most important source of
energy for a 13-year-old
girl’s brain?
a) oxygen
b) glucose
c) electricity
d) water

Answer 4: In 1860, the
average age at menarche
(a girl’s first period) in
the UK was 15 years old.
What is it today?
a) 14-15 years
b) 13-14 years
c) 12-13 years
d) 11-12 years

Answer 5: According to a recent study what percentage of
teenagers in secondary school skip breakfast?
a) 12% b) 22% c) 32% d) 42%

Answer 6: In the last 5 annual surveys conducted by
Mission Australia, what one issue consistently rates
number one as teens’ biggest worry?
a) Body Image
b) Bullying
c) School & study
problems
d) Coping with
stress

Answer 7: In the latest national survey of secondary students and
sexual health by Latrobe University, what percentage of young
people expressed significant dissatisfaction with sex education at
schools, citing irrelevance to their real experiences, lack of
relationship advice and lack of discussion of same-sex issues as
problems?
a) 25%
b) 35%
c) 50%
d) 65%

Answer 8: Which of the following conditions in
adolescent females have the highest mortality
rate
a) Anorexia
b) Depression
c) schizophrenia
d) anxiety

Answer 9: According to research undertaken by
Bond University last year, what proportion of
Australian video/computer gamers were
female?
a) 17%
b) 27%
c) 37%
d) 47%

Answer 10: A 2004 study published in the Medical
Journal of Australia showed that the rate of deliberate
self-harm in young women was 11%. What was the
greatest predictor of this behaviour?
a) Being bullied
b) Having a friend or family
member who had self
harmed
c) Being from a different
cultural background
d) Being diagnosed with a
depressive illness

Answer 11: A 2006 New Zealand study found
that one-third of students with which particular
medical condition have had suicidal thoughts?
a) Diabetes
b) Asthma
c) Arthritis
d) Acne

Answer 12: Which of the following is true about same-
sex attracted young people compared to their
heterosexual peers, according to a study by Young and
Well CRC in 2014?
a) They are 6 times more
likely to try and take their
own life
b) They are 5 times more
likely to use illicit drugs
c) They are 3 times more
likely to be bullied at
school
d) They are 4 times more
likely to suffer a major
depressive illness

Answer 13: What is the greatest predictor of a
future suicide attempt or completed suicide?
a) A history of self harm
b)A history of depression
c) A history of previous attempts
d)A history of anxiety disorders

Answer 14: The National Health and Medical Research
Council (NHMRC) issued guidelines in 2009 suggesting
that young people should not drink until they are how
old?
a) 16
b) 18
c) 21
d) 25

Answer 15: According to the National Drug and
Alcohol Research Centre, the most commonly used
drug in drink spiking is?
a) Gamma
Hydroxybutyrate
(GHB)
b) Cocaine
c) Rohypnol
d) Ethanol (Ethyl
Alcohol)

Answer 16: Which of the following
antidepressants has the US Food and Drug
Administration (FDA) approved for use with
children over 8 years old?
a) Zoloft (sertraline)
b) Prozac (fluoxetine)
c) Paxil (paroxetine)
d) St. John's wort (Hypericum
perforatum)

Answer 17: Which of the following drugs
cause the most deaths in young people in
Australia?
a) Heroin
b) Alcohol
c) Ice
d) Ecstasy

What does the latest
research say about
teenagers in Australia?

Is this journey more difficult now than 30
years ago?

Is this the predominant parenting paradigm in
Australia today?
A child is not morally, emotionally or intellectually prepared to play the role of ‘friend’.

barriers to care
• Developmental compression
• Early sexualisation
• Lack of ritual and tradition
• Family breakdown
• Bullying/cyberbullying
• Concerns about confidentiality
• The attitudes and
communication styles of
practitioners
• Unfriendly service
environments
• The availability and cost of
services
• Developmental characteristics
of young people
http://www.yawcrc.org.au/news/article/228

What do you think is the number one
concern for young people aged 15-19
today?

What are young Australians worried
about?
• Research shows that young
Australians are highly concerned
with:
– coping with stress
– school or study problems
– body image
– depression

Very Latest Study
• largest-ever survey
of youth mental
health
• 1 in 7 children
experienced a
mental disorder
• 1 in 10 self
harming
• 15% of 16-17 year
old girls suicidal
ideation

626% increase in calls about
mental health since 1996
246% increase in calls about suicide

What about youth suicide in Australia?
• Suicide data is poor,
limited and often
unavailable
• The official number of
suicide deaths reported
is generally some 20-
30% below the actual
number
Has it gone up or down since 2006?

Suicide is the leading cause of death for both
adult males and females aged 15- 44 years

Between 2006 and 2014, there has been a 22%
increase in the number of suicide deaths in
Australia
financial costs of suicide have been estimated at $17.58 billion, or 1% of GDP

Between 8 - 10 Australians die by suicide
everyday and there is an estimated 180 people
who attempt suicide
In 2014, suicide accounted for 97,066 years of potential life lost

Why is this of particular importance to
those of us who work with young
people?

• 7 people a day in Australia will die by suicide
• 75% of all psychological problems start under
the age of 25
• 50% of all psychological problems start under
the age of 15
• more people die by their own hand than
are killed in road accidents or by skin
cancer

A REPUTABLE REPORT
RELEASED halF way through
2013

Mental disorders
affect 1 in 4
secondary students
(Slade, 2009)
Mental disorders
affect 1 in 7 primary
students (Slade, 2009)

THE CHALLENGE
75% of mental illness emerges
before age 25
(Kessler, 2005)
80% males and 70%
females aged 16 to 24 with
mental disorders do not
seek help (Australian Bureau of Statistics,
2008, National Survey of Mental Health and Wellbeing:
Summary of Results, 2007. Cat No 4326.0)

Youth smoking (7% smoke daily)
Use of illicit drugs (18% using illicit
drugs)

• The gap between rich and poor is
increasing as is percentage of young
children living in jobless families.
• Over one in six children live at or below
the poverty line in 2010

Early identification not happening
• of these behavioral risks and
emotional problems enables
health professionals to
provide:
– appropriate support
– implement preventative
strategies,
• which is likely to lead to
significant reductions in rates
of morbidity and mortality.

Session 2
Paradigms & tools for
Assessment

Paradigms to use in screening young
people

Key
developmental
tasks of adolescence
• Achieving independence from
parents and other adults
• Development of a realistic, stable,
positive self- identity
• Formation of a sexual identity
• Negotiating peer and intimate
relationships
• Development of a realistic body
image
• Formulation of their own
moral/value system
• Acquisition of skills for future
economic independence

http://headspace.org.au/friends-and-
family/understanding-adolescence-for-families/

Stages of Adolescence
Early Middle Late
Security
Exploration
Co-operate Spark

Early years
• 'callous-unemotional'
behaviors in the toddler
years that include
– lack of empathy
– lying
– little emotion
• in children which
when these behaviors are
not corrected, children could
get into trouble with the law
later in life.

4 world model
(Dr john Court 1999)
Peer
World
Family
World
Inner
World
School
World
risk
risk
risk
risk
protective
protective
protective
protective

Parenting
There is no
such thing as a
perfect parent

• Supportive parents gave their children high levels of
trust, showed a high level of interest in them and
spent a lot of time with them
• Strict parents were defined as giving their children
little independence, not trusting them and
imposing lots of rules
• Indulgent parents were not strict at all and spent an
average amount of time with their children
• Easygoing parents showed low levels of interest
with their child
• Harsh parents did not trust their children and gave
them little independence

What’s The
parenting style?
• Control, criticism,
obedience, punishment
• Minimal expression of
warmth and affection,
• focus on bad behaviour –
• Children do not learn to
think for themselves
• No rules or boundaries,
• No moral language
• Too many choices
• Minimal involvement
• clear, reasonable
expectations for their
adolescents
• Supervision, monitoring
with consequences
• Reinforcing the good
behaviour

John Carr-Gregg
10.1.20 – 15.3.12

• http://www.dailymotion.com/video/x36fnhw

Resilience (Werner 1971)
Charismatic Adult
Social/Emotional
competencies
Spirituality
+ self talk
Islands of competence

5 worlds of young people in 2011
Inner
world

So we need to screen young
people
how do we do it effectively
and respectfully?

the headspace psychosocial
assessment interview
• designed to
– assist with engaging
young people
– building rapport
– assessing the full
range of mental
health disorders
common in young
people

• The Centre of Excellence
adapted the American
HEEADSSS assessment
interview.
• This included:
– changing the language
to suit the Australian
context
– extending the domains
covered to allow the
detection of more
serious mental
disorders.

the headspace psychosocial
assessment interview
• The tool consists of a set of
'screening' and 'probing'
questions.
• Practitioners who do not feel
confident to conduct the full
interview with a young person
should choose only to complete
the screening questions they
feel competent to address. If
these screening questions
suggest the need, refer on to
another experienced
practitioner for a full
assessment.

How you progress through the screen
Commence each domain with
screening question
Are there concerns?Yes No
Proceed to probing
questions
Proceed to next
domain

WHAT PSYCHOMETRIC TESTS MIGHT
ONE USE IN ADDITION TO THE
HEADDSS SCREEN?

• a 42-item self report
instrument designed to
measure the three related
negative emotional states of
depression, anxiety and
tension/stress.
• is in the public domain, and
may be downloaded from
this website.

When a young person presents
• usually many psychosocial issues that should be
addressed are missed
• may initially disclose a certain issue
• Clinician should take the opportunity to conduct a
holistic assessment
• this can lead to
– early intervention
– implementation of prevention strategies for
issues or risks that may otherwise go
unaddressed.
– individualized treatment program that is
likely to lead to better long-term
prognosis

Getting young people to speak about risky
behaviors or difficult issues
• is a challenge
• likely to be contingent
on
–trust
– confidentiality
–direct questioning

H home
E education/employment/eating/exercise
A activities/peers
D drugs/cigarettes/alcohol
S sex/sexuality/(abuse)
S suicide/depression screening/other
symptoms
S safety/spirituality
John M Goldenring & Eric Cohen
Contemporary Pediatrics July 1988 pp 75-90
Original domains - ‘Heads’ approach

• Home and
environment
• Education and
employment
• Activities
• Drugs and alcohol
• Relationships and
sexuality
• Conduct difficulties
and risk taking
• Anxiety and eating
• Depression and
suicide
• Psychosis and mania
Expanded Domains

Tips for
engagement
and
interviewing
• The note an interviewer
strikes at the outset may
affect the entire outcome
– Introduce yourself to the
young person first
– Ask the young person to
introduce you to others who
may be present
– This gives the young person
a clear message that you are
interested in him/her

Don’t begin
the interview
asking:
• Why are you here?
• What’s up?
• What’s the meaning of life?
• Chat with the young person about lighter,
non-threatening topics
• Provide an outline of what’s going to
happen, including the range of questions
• Let the young person know they can choose
not to answer any of the questions
• Create an empathetic stance by
acknowledging they may feel uncomfortable
at times
• Focus on strengths eg: VIA Me

Build rapport so that the young person feels
their concerns have been heard
– The young person should
come away feeling that
someone cares and that it
might be useful to return
– The goal isn’t just to elicit
information about what
might be ‘wrong’ with the
young person
– Consider the use of the VIA
Me strengths test with
video…
http://www.viame.org/s
urvey/Account/Register

Spend time during the
interview asking for
feedback
– Check that you
understand the young
person’s main concerns
and difficulties
– Clarify the young
person’s goal in coming
to the assessment
– Before concluding, ask if
they have any questions
or anything more to add

Parents, family members, or other adults
should not be present during the interview
unless the young person specifically gives
permission, or requests it
The amount of time
spent with the young
person alone
depends on his/her
developmental age
and stage

The headspace interview covers 10
domains
• Home and Environment
• Education and Employment
• Activities
• Alcohol and Other Drugs
• Relationships and Sexuality
• Conduct difficulties & Risk-taking
• Anxiety
• Eating
• Depression and Suicide
• Psychosis and Mania

Use discretion in terms of how
screening and probing questions are
framed
• Given the age range of adolescents
(12-25), the young person’s
developmental stage needs to be
taken into account
• For example, in the Drugs and
Alcohol domain, ask a 12-15 year
old if s/he drinks or uses drugs,
whereas for a 16-25 year old, ask
how often they use such substances

• Young people would like to
discuss more sensitive topics
with a health professional
• 1 in 5 young people report not
sharing important information
with health professional
because of fear parents would
find out
• Many psychologists report they
are insufficiently trained about
confidentiality and other
medicolegal aspects of
adolescent health
Matters
Sanci et al, MJA 2005

Raising and discussing confidentiality with the
young person in this interview
–Ask the young person their
understanding of confidentiality
to begin the conversation.
–Confidentiality must be assured
and limits to confidentiality
discussed.
–Discuss consent to contact other
sources when necessary.

Exclusions:
• the young person is at risk of harming
or killing themselves,
• at risk of harming someone else or
committing a serious criminal offence,
or
• they are being threatened or harmed
(physical/sexual abuse) by someone
else.
• Notifiable infection
• Public safety
Disclosure to a third party: Consent must be given

http://au.reachout.c
om/
Confidentiality

Under what
circumstances
would you
break confidentiality
with a 15 year old?

• When asked to rate the
importance of 13 considerations
for determining whether to inform
parents about risk-behaviours in
their children, participants
indicated that their most
important consideration was:
• the intensity of the risk-
behaviour.
• the seriousness of the risk-
behaviour
• desire to protect the
adolescent
• frequency of the risk-behaviour
• duration of the risk-behaviour.
http://blogs.rch.org.au/cah/files/2011/07/Breaching-Confidentiality-with-Adolescents-
What-do-Australian-Psychologists-Think.pdf

“…If you bungle raising your
children, I don't think
whatever else you do
matters very much.”

3 genetic clocks
Emotional
Maturity
Intellectual
Maturity
Physical
Maturity

Are Year 12’s Particularly at risk?

• 941 Victorian final-
year high school
students
• 19% had thought of
suicide or self-harm.
• 31% of students
were severely
depressed
• 41% suffered
anxiety.

HEADDS provides
• Rapport
• Risk
• Recommendations

Key factors in rapport
• Spend time discussing less
sensitive issues
• Reassure them of
confidentiality
• Adopt a non-judgemental
approach
• Demonstrate an interest in
the yp themselves not just
the problem

Use a third person approach to ask
sensitive questions
“…many young people your
age have tried alcohol or
other drugs. I wonder have
any of your friends ever
tried any drugs or alcohol.”
“…How about you, what
have you used?”

Domain 1: Home and Environment
• Where do you live? Who lives
at home with you? How long
have you lived there? Is this
stable accommodation for
you?
• What are your relationships
like at home? Are there any
problems/fights that worry
you?
• Do you feel okay and safe at
home?

• Do you have any brothers or sisters? How
old are they?
• Who are you closest with in your family?
• Have there been any changes in your
family/home recently (e.g. someone
left/arrived)?
• Are your parents well/OK? What do your
parents do for a living?
• What kinds of things do you and your
family argue about the most? What
happens in the house when there is a
• fight?
• Is there anything you would like to change
about your family? Why?
• Have you ever had to live away from home?
• Are you spending time ‘couch surfing’,
moving frequently between friends or
relatives?
• Are any agencies involved in your housing
or accommodation?

Checking
for abuse
“Working with young people I
have learned from some that
their relationship with their
parents is a difficult one; by this
I mean they argue and fight.
Some young people have told
me that they wish their parents
did not drink so much or use
drugs.
Is this a situation in your
house?
Has anything like this happened
to you?”

Domain 2:
Education
and Employment
• So you’re at
school/working/looking for
work. How’s that going?
• Do you enjoy school/work?
What do you/don’t you like
about it?
• Do you go every day? How
many days have you missed
over the past 2 weeks? When
did your attendance start to
decline?
• How do you feel you’re
coping with school/work?
How do you feel about this?
• Many young people
experience bullying at school
or at home via the internet
or mobile phones, have you
ever experienced this?

Examples of
Probing
Questions
– Are you doing what you want to do at
school/work? What would you prefer?
– Tell me about your friends at
school/work? How do you get along with
your peers? Is your school a safe place?
– Have you ever been treated badly or
been in conflicts at school? What
happened?
– Have you been bullied? Have you been a
bully? Have you been a
witness/bystander to bullying? What
kind of
– bullying (face to face, cyber) and what
was the content (physical, sexual)?
– How much school/work do you miss?
Have you ever been suspended/fired?
– Why is it so tough at school/work? Do
you need help with this?
– Does this ever get you down?

Domain 3: Activities
• What do you like doing?
• What does a usual day involve
for you? (Describe for me a
normal day in your life?)
• Do you have friends that you
hang out with? What kinds of
things do you like to do
together?
• Do you mainly spend time on
your own? Is that OK with you?

Probing
questions
– Are most of your friends
from school/work or
elsewhere? Are they the
same age as you?
– Do you have one close
friend or a few friends?
– Do you spend time doing
things with your family?
What do you do?
– What do you do on the
weekends?
– Do you ever feel lonely or
left out of activities?
What happens and how
do you feel?

Talking to Young people about
Videogames
• For years we’ve been told that
videogames make us socially
isolated, aggressive and lazy,
• recent research suggests the
opposite can be true.
• (Johnson et. al., 2013),
assessed more than 200
research papers ard
uncovering strong links
between gaming and positive
mental health.

Ask them questions…
• Positive associations were
found between videogame play
and emotional state, vitality,
engagement, competence, self-
acceptance, self-esteem,
resilience, social connections
and functioning.
• This new understanding of the
benefits of gaming is
challenging current practice and
the way we think about and talk
about videogames with young
people

• Reading about this research
has changed the way I view
gaming behaviour in my work
with young people. It's great
to be able to speak with
young men in particular
about its usefulness in coping
with stress" Dr Anna Sidis,
Clinical Psychologist, Eastern
Suburbs Mental Health Team.

8 Questions we want you to ask
1. What kinds of games do you play?
2. When you are gaming, what things do you
like to do in the game?
3. How do you feel when you are gaming?
4. Do you normally play on your own or with
other people?
5. What time of day and for how long do you
normally play?

8 Questions we want you to ask
6. Does the time you spend playing, take away
from other activities in your life?
7. Is it ever hard to stop gaming or is it pretty
easy to control how much time you spend
on it?
8. Overall, what are the good and bad things
about gaming for you?

The question…
What gets them up in the morning?

Domain 4: Alcohol and Other Drugs
• Do you drink? Smoke? Have you
tried or used drugs? What have
you tried?
• What do you like about it? What
don’t you like?
• Have you regularly used alcohol or
drugs to help you relax, calm down
or feel better?
• Have you had any problems with
family, friends, police (or courts)
related to drinking or using drugs?
• Would any of your friends or family
say you have a problem with
drinking or drugs?

Probing
questions
• What were you drinking the last time you
got drunk (or stoned/high)? Why? Could
you remember everything? How did you
get home?
• How do you (and your friends) take
drugs?
• Do any of your family drink, smoke or use
other drugs? If so, how do you feel about
this? Is it a problem for you?
• In the last three months, what is the
longest time you have gone without any
alcohol or drug use?
• Have you tried to have any periods
without alcohol or drug use and how did
these go?
• Have you ever thought about changing or
reducing your drug and alcohol use?

Domain 5:
Relationships
and Sexuality
• Are you in a relationship? (If no:
Have you ever been in one? If yes:
What’s your relationship like?)
• Do you identify as
straight/bisexual/gay/lesbian?
(Or: Are you attracted to males or
females or both? Or if no
relationship: Even though you
haven’t had a relationship yet, are
you interested in boys or girls?
Perhaps you’re not sure?)
• For young people who identify as
same sex attracted: Have you ever
had any negative experiences
about being gay/bisexual/lesbian?

Probing
questions
• Have you ever had sex, perhaps in a relationship or
perhaps casual sex (this can include oral, anal or
vaginal sex)? If no, skip the next 2 questions
• Have you had sex in the last year? If no, skip next
question
• Have you been tested for sexually transmitted
infections in the last year? If no, the young person
should be referred to a GP for appropriate STI tests
(either within your headspace centre, or to an
external GP or sexual health clinic
• For young people who are sexually active:
– Do you use any form of protection?
– What sort? Do you ever have unprotected sex?
– Have you ever felt pressured or uncomfortable
about having sex? (Use clinical judgment as to
whether to probe further, depending on young
person’s response. Depending on your
experience and training in managing disclosures
of sexual abuse, you may follow up with: Have
you ever been abused, or been forced into
having sex? Who did this? When?)

What the research says?
Source: Mitchell A, Patrick K, Heywood W, Blackman P, Pitts M. 2014. 5th National Survey
of Australian Secondary Students and Sexual Health 2013, (ARCSHS Monograph Series
No. 97), Australian Research Centre in Sex, Health and Society, La Trobe University,
Melbourne, Australia.

Domain 6:
Conduct
difficulties and
Risk Taking
• Have you deliberately harmed
or injured yourself – like cutting,
burning, or scratching yourself –
when not feeling suicidal?
• When did it start? How often?
Do you do this to manage stress,
emotions, to cope? Have you
had to get medical assistance
for this?
• Have you put yourself in unsafe
situations (e.g. unsafe sex, risky
driving)?
• Have you ever wanted to hurt
someone else? Have you acted
on this? What has stopped you
from doing anything?
• Do you often feel out of control
(with your behaviour)?

Probing questions
• Many young people get frustrated with others. Have you ever felt like
this or acted on your frustrations? How?
• Have you ever thought about or felt like hurting someone else?
• Have you ever done something on the spur of the moment that you
later regretted?
• Do you get in lots of arguments with your family because they have
problems with your behaviour?
• Are you in trouble at school? Do you feel picked on by teachers?
• Have you ever been involved with the police? Have you ever been
charged?
• Do you belong to a group/gang?
• Do you have any tattoos or body piercings? Where did you get these
done? If not at a licensed tattoo parlour or beautician, the young
person should be referred to a GP for appropriate STI and Blood Borne
Virus tests

Domain 7:
Anxiety
• It’s normal to feel anxious in certain
situations (e.g., heights, public speaking).
Are there times when you feel unusually
anxious, nervous or stressed?
• Have you ever felt really anxious all of a
sudden – e.g., for no reason at all? What
was it like? (Consider describing some
common symptoms, e.g., heart racing,
shortness of breath, fear of losing
control...)
• Do you think you feel more anxious or
worry more than your friends?
• Are there situation or objects that you
avoid because you feel too anxious? How
does this affect your day-to-day life?

Probing questions
• Do you worry a lot about things that you have no
control over (e.g., bad things you see on the news)?
• Do you ever find yourself having to do things over
and over, like touching, counting, washing your
hands many times, or checking things to make you
feel better?
• Do you obsess about things, or get stuck on things,
like your homework or appearance having to be
perfect? Do family or friends think you obsess about
things? What types of things?

Domain 8: Eating
• Do you worry about your
body or your weight?
• What do you like or not like
about your body?
• Do you try things to manage
your weight (e.g., extreme
restriction of your food intake,
exercising excessively)?
• Have there been any recent
changes in your weight?
• Are any of your family
members or friends worried
about your weight or your
attitude towards your
body/food?

Probing questions
• Does it ever seem as though your eating is out of
control?
• Have you ever made yourself throw up on
purpose in an attempt to control your weight?
• Do you believe yourself to be overweight or fat
even if others tell you that you aren’t?
• Have you ever taken diet pills?
• How often do you exercise and what do you
usually do?

Nutritionists estimate that 61% of children 4 to 8
years of age, have adequate fruit and vegetable
consumption, and 1% in middle school students
Source:
http://www.examiner.com.au/story/1
423833/concern-over-healthy-eating-
in-schools/?cs=12

Facts about the MOOD FOOD
LINK
• People eating a
Mediterranean-style diet
have less depression
• diets high in processed
foods, soft drinks and
sweets lead to an
increased risk of behaviour
and emotional.

DIET LEARNING AND MENTAL
HEALTH
• Diet may also
influence the brain’s
production of a
protein called BDNF
(brain derived
neurotrophic factor)
which acts like
fertiliser for brain
cells.

BRAIN DERIVED neurotrophic factor
• can help new brain
cells to grow,
especially in some
areas such as the
hippocampus, the
part of the brain
that’s important for
learning and memory
and also for
psychiatric health.

MELBOURNE SPORTS AND
AQUATIC CENTRE

Domain 9:
Depression
and Suicide
• Do you feel sad or down more
than usual? Have you ever felt
that way in the past? For how
long?
• Have you lost interest in things
that you usually like doing?
• Are you having trouble
sleeping?
• Do you find yourself spending
less and less time with friends
or family? Would you rather
just be by yourself most of the
time? Why?

Probing questions
• Have you ever tried to hurt yourself (e.g., cutting) to calm
down or feel better?
• Have you started using alcohol or drugs to help you relax,
calm down or feel better?
• Have you thought you would be better off dead or wished you
were dead?
• Have you thought about suicide? Do you have a suicide plan?

This is a legal document – so take care

http://www.decd.sa.gov.au/speced2/files/pages/chess/hsp/Information/revised_selfharm_fin

https://www.ranzcp.org/Files/ranzcp-
attachments/Resources/Publications/CPG/Australian_Versions/AUS_Self_harm-pdf.aspx

Domain 10:
Psychosis
and Mania
• Sometimes, especially when
feeling stressed, people can
hear or see things that others
don’t seem to hear or see.
Has this ever happened to
you? How often? Does it
cause you distress?
• Have you found yourself
thinking that someone was
out to get you?
• Have you found yourself
feeling really up or racy, or
feeling like you can take on
the whole world?
• Have you ever gone for days
without sleep? How long?

Probing questions
• Have you ever felt like you have special powers that other
people don’t have or are especially important in some way?
What was this like?
• Have you felt that things around you had a special meaning
intended just for you?
• Have you felt like someone or something outside of yourself
has been controlling your thoughts, feelings, actions, or
urges?
• Have you ever felt like your thoughts were less private than
usual? For example, like your thoughts are broadcast so that
everyone can know what you’re thinking? Or that people can
read your mind?

Wrapping
up
• Give the young person an opportunity to
express any concerns you have not covered
(e.g. “I’ve asked you a lot of questions today, but
is there anything we haven’t covered that you
think is important to understand your
situation?”)
• Ask him/her for feedback about the interview
• Remind them that they are welcome to call you
or to come back in to talk about something
important to share that may later remember
• Ask the young person who they can trust and
confide in and why they trust that person. This is
important if you have not already identified a
trusted adult in the client’s life
• Tell the young person that he/she now has you
as someone who can be trusted to help with
problems and to answer questions
• Let them know you are interested in them and
you want to help them lead a fuller, healthier life

For young people who demonstrate significant risk factors,
relate your concerns
• Ask if they are willing to change or are
interested in learning more about ways
to deal with their problems, leading to a
discussion of potential follow-up and
therapeutic interventions
• Many young people do not recognize
dangerous life-style patterns because
they see their activities not as problems
but as solutions.
• The challenge lies in helping the young
person to see health risk-taking
behaviours as problems and helping to
develop better strategies for dealing with
them

In writing
up your
notes
• Brief summary of presenting issues
• Consider using a formulation
framework, addressing the four P’s
• Predisposing factors: aspects of the
client’s background that make him/her
susceptible to presenting with the given
problems (e.g. history of mental illness in
family).
• Precipitating factors: immediate issues
or events that have caused the client to
present with or experience these
problems or symptoms now (e.g. recent
life experiences/stressors, bullying etc.).
• Perpetuating factors: factors that cause
the client’s symptoms/problems to
continue or to progressively get worse
(e.g. conflict in home, low social support,
poor coping strategies).
• Protective factors help improve the
client’s situation or symptoms.
• Risk and Protective actor framework

Session 3
Case Study and group practice

Suicide Note
“…Try to think of
what I am doing as
just finishing early. By
far the hardest thing
about this is the
impact it will have on
you. It fills me with
grief when I think
what I've done to
you.“

Suicide Notes
• “…Despite my problems, I
enjoyed my life. I liked my
house and family, going to
school, learning, my friends and
everything in between. I
especially like who I am and the
way I work - me and my future
both. I wanted to do everything
and learn everything. I wanted
to influence our morals, our
politics, our science and our
societies. ”

Suicide Note
• “…Please do not
assume you know why
I did this. Even I'm not
completely sure. It is
simply the best thing
to do. The mechanism
telling me not to kill
myself is broken…

The Parents
Merridy O'Donnell
family therapist
Derek Bolton
computer software engineer

How events unfolded…Campbell had
broken down
seen
crying at
school
Teacher asks:
Is there
something
going on
that is
upsetting you
that is
bothering
you?"
Answer: Yes
Do you
want to
talk
about it ?
“…there is
something
going on,
but I don't
want to
talk about it”
Tells teacher
that he has
no intention
of harming
himself.
Teacher
reports
concerns to
school's
director
of welfare
5 April
Campbell
farewells
father
says he will
stay at a friend's
house
before leaving
to go on a
school camp
the next day
Over the next 16 days,
Campbell moved from
hostel to hostel
parents
tried
unsuccessfully
to talk
to him
Exchange of
SMS
messages
Brother
Finds out C ‘s
location
decided
not to
try and
find him
friends
contact
him
Mum
Sends
farewell
sms

How events unfolded…
April 19th
SMS from Merridy
Goodbye, Campbell.
I can't keep hoping
that you will
respond to
my SMS's.
I love you
and take care."
Answer:
"I'm so sorry."
April 20th 5pm
Checks into central
Sydney Hotel
11pm
walks to a
nearby grocery
store to buy food
carrying
Angus’s
passport
as ID
Body found on
Adjacent building at
6am

Chief suspects in the
suicide of Campbell Bolton

Roaccutane
• Dermatologist said he’s warned
Campbell about the drug's
potential side effects
• Campbell told the dermatologist
he'd informed parents he was on
the medication“
• "Given Campbell's age, it would
have been a breach of confidence
for me to contact anyone regarding
his management without his
consent."

Homosexuality
• "I hurt from love too. Almost every
day I see a boy, some fantastic-
looking guy that makes my pulse
quicken but also make me want to
cry, and it makes me feel sad because
they will never feel the same way
about me, even if they were actually
gay, and I cannot even tell them, not
even hint about any of this to them.
He will not so much as glance at me.
There is nothing in the whole world
that has caused me more hurt than
this. Nothing."

Role of the school
“…four weeks into Term 1, 2005, I spoke to
Campbell myself. I saw what I felt was a fragility
there, and I felt that Campbell did need some support.
And I suggested to him at that time that whilst there
was support available in the school - that he might go
to an educational psychologist locally and gain a little
bit of additional support. I was particularly concerned
that he needed to turn around his motivation to study.”

Inner
World
Four Worlds of Campbell Bolton
Peer
World
Family
World
School
World
•Early emancipation
•Self-contained &
independent
•Atheist
•Homosexuality
•very bad acne –
• rigid thinking
•Used his intellect to deal
with his emotions
high-achieving middle-
class parents
high expectations
older brother Angus
completed pg degree
reserved, cerebral family
quite distant
Academically
outstanding.
Same school
School recognition
Sudden decline in
academic performance
in yr 11
Teased about acne
Secretive
Compartmentalized
friendships

Prof Graham Martin
“…some young people, like Campbell, will
do everything they can to ensure that
nobody will block their actions. …I
think what it means in preventative
terms is that we have to start much
earlier looking at connectiveness,
resilience, and a whole range of other
issues of self-esteem, you know, way
back in primary school, and building up
young people to the point where the
word "suicide" never, ever crosses their
minds.
Professor Graham Martin

How many time bombs do you have in your
school waiting to go off?

TAFN
• michael.carrgregg.gmail.com
• Twitter @MCG58

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