1) The presentation outline splits attendees into groups to brainstorm solutions for three scenarios involving children in care experiencing challenges. 2) The first scenario involves a 7-year-old boy, Jimmy, with a history of abuse and neglect who is having sleep problems and behavioral issues. Medication has been prescribed to help him settle at bedtime and focus in class. 3) The second scenario involves a 15-year-old youth, Dakota, with substance abuse issues who frequently returns intoxicated to his group home and is administered his medication. 4) The third scenario involves a 15-year-old girl, Joanna, living with her grandmother who has started self-harming since starting an antidepressant

1. ALIGN PRESENTATION OUTLINE
Date:
Jan 28 2016 at West Edmonton Mall Conference
Time:
1400 to 1600
Attendees:
15
Materials:
Masking Tape
Markers
Large paper pad
Plan:
Make presentation interactive. Split people up into three groups. Each group assigned a
scenario to brainstorm. Each group assigns a recorder, time keeper, and presenter. Fifteen
minutes to problem solve. Presenters discuss solutions and present to rest of the group.
Discussion ensues and repeats for each different scenario. Presentation ends off with summary
of key points of scenarios for take away.
Scenario 1
Jimmy is a seven year old boy living in a foster home. Fourteen months ago, he was
apprehended from his biological parents due to domestic violence, exposure to parental
substance use, neglect, and sexual abuse.
Over the last six months, Jimmy has presented with increasingly disrupted sleep patterns. He is
often difficult to rouse in the morning before school and often engages in temper tantrums.
During the late evening, he becomes increasingly restless and irritable. Episodes of angry
outbursts and various acting out behaviors manifest around bed time. Jimmy has great
difficulties settling and falling asleep, often not until close to midnight. His foster parents have
began dreading the daily routine of trying to get Jimmy to bed at night and getting him up in the
morning for school.
The teacher reports that Jimmy looks tired and disengaged during class. He is frequently
oppositional with direction and squabbles with the teaching students and other students. He
often gets into fights with other kids during recess.

2. The pediatrician wants to introduce medication to help Jimmy settle. He has prescribed
clonidine to help with his impulsivity, restlessness, and anger at bedtime. Based on his
response, the pediatrician tells foster mother that he may slowly introduce doses of clonidine
during the day to help Jimmy maintain during class.
He has also ordered a low dose of melatonin specifically to help with sleep induction.
What are the pros and cons of introducing medication to help a child settle in the evening and
sleep?
How might dysregulated cortisol levels resulting from toxic stress affect a child at bedtime?
Scenario 2
Dakota is a 15 year old youth who has been placed in a group home. The facility is short staffed
and many in home amenities and activities have been cut due to funding. This has affected the
routine and structure of the program. As a result, the occupants often come and go as they
please and stay out for lengthy periods of time.
Dakota has a polysubstance abuse history. Historically, he has admitted to indulging in crystal
meth, marijuana, alcohol, and cocaine. He has a pattern of AWOLing from group homes and
using while he is out.
Dakota frequently returns to the group home intoxicated. His speech can be slurred and
incoherent. He gets restless and has conversations with the wall in his room. Group home staff
are often conflicted with administering medications but because Dakota willingly accepts his
Risperdal, staff go ahead and administer the medication.
What could be some of the risks involved with the decision to administer medication?
What proactive measures could have been taken to deal with this situation?
Scenario 3:
Joanna is a fifteen year old girl in kinship care with her maternal grandmother in Edmonton.
Their relationship is a challenging one and the two are often at odds fighting and arguing.
Her bio father has been incarcerated for the last decade while bio mother struggles with
homelessness, drug addiction, and mental health problems that affect her ability to provide
basic needs and care.
Throughout her childhood, Joanna has been repeatedly exposed to parental substance abuse,
domestic violence, homelessness, and neglect. She has been diagnosed with generalized
anxiety disorder and post traumatic stress disorder. Her child psychiatrist has recently started
trialing Joanna on a selective serotonin reuptake inhibitor antidepressant Celexa to help
manage the symptoms of anxiety. Consent approval was acquired by CFS and Joanna has now
been taking the medication for about two weeks.

3. At a recent case conference with her psychologist, caseworker, and Joanna, her grandmother
reported that Joanna has started cutting herself and trying to hide it from her. Joanna becomes
angry with her grandmother for bringing it up and they engage in a fierce argument. The
professionals ask questions and learn that Joanna has started feeling suicidal and agitated
since around the time of medication commencement.
When Joanna was asked why she did not want to tell people, she said “ I dunno…I didn’t want
to get in trouble and I didn’t think it was a big deal”
What proactive measures could have been taken to deal with this situation?
Key Points Power Point Summary for Emphasis and Take Away
3 slides total:
Medications and Kids in Care
– Offering perspective on risk (side effects) and benefits to global functioning
(school, placement, relationships)
– What quality of life improvements might the child gain from using medication to
help sleep?
• Better sleep can mean more receptiveness to learning in school
• Improvement in mood regulation and frustration tolerance can help with
social interactions and transitioning activities
• Possibility to make new friends and maintain them
• Consideration of disrupted cortisol levels due to exposure to toxic stress
that may increase towards bed time --- Google Deborah Gray, MSW
Psychotropic Medication Safety Planning
o Increased risk of suicidal ideation and self harming actions.
o Ensure coordination efforts are clearly documented
o Should be in place between child, caseworker, mental health professionals,
school board, caregivers for activation of suicidal ideations or self harming
gestures
 Planning should take place prior to commencement of any psychotropic
medication
 If possible, involve child/teen in planning
 Call the doctor if this starts occurring. Go to nearest emergency room if
there are imminent safety concerns
.

4. Consider coordinating a treatment plan to deal with AWOLS, and illicit substance/alcohol
ingestion if youth has history of doing so:
o Be proactive and have a plan in place before such an event occurs
o Make sure to speak with prescribing physician to get direction
o Involve the child and treatment team (SW, school, prescribing doctor, youth
worker etc.)
o Drugcocktails.ca is a great site to look up specific medicatons and what can
occur when you mix in street drugs
o Ensure interventions and efforts are clearly documented to protect yourself and
agency