The document outlines a training program for crisis intervention teams focused on child and adolescent mental health, identifying the challenges faced by officers in understanding the increasing rates of mental illness among youth. It emphasizes the importance of building partnerships between law enforcement, schools, and mental health providers, while providing guidelines for effective intervention strategies and understanding various mental health disorders in children and adolescents. Key topics include the differences in perception between adults and youth, mental health statistics, treatment options, and practical approaches to engaging with affected individuals.

1. Crisis Intervention Team Training Advanced Child and Adolescent CITMichael R. Peterson MA LAMFTExecutive Director Steve M. Wickelgren MA MFT PresidentMinnesota CIT Officers AssociationJane Marie Sulzle, RN, CNS, MSPrairieCare

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.--Socrates, Fifth Century BC

3. Training ObjectivesDefine the problemBuilding a TeamUnderstanding the differences between Adult and Child/Adolescent Mental HealthAssessing stakeholders needs and resourcesBuilding a PartnershipIdentify the target audience Develop a Training modelMarket training

5. Define the ProblemOfficers struggled to understandIncrease in kids diagnosed with mental IllnessLack of knowledge about community resourcesUnderstanding the difference ODD, ADD, ADHD, Bipolar, or just a kidParent strugglesSchool/Community

6. What emotion do you see?DIFFERENCES IN PERCEPTIONAdults see Surprise: In the adult brain, reading emotions involves the prefrontal cortex.Adolescents see Anger: In the adolescent brain, it involves the amygdala.

7. Building a TeamWho caresWho is impactedWho can helpWillingness to commit time and resourcesInterested in future solutionsUnderstanding of the problemEnthusiasm

8. Understanding the Differences Listen to the expertsResearch Care about kidsDevelopmental markersWhat is adolescentsWhen is a person an adultWhy

10. StakeholdersKidsParentsSchoolsPolice CourtsMental Health providersSubstance abuse treatmentCommunity advocates

11. UnderstandingParentsParents do the best they can with what they have.

12. Building PartnershipsPrairieCareNAMI MinnesotaSchool StaffCounty Social ServicesMobile Crisis TeamsSchool Resource OfficersLocal Police and Sheriff Departments

13. Identify the AudiencePolice OfficersSheriffs DeputiesSchool Security OfficersJuvenile CorrectionsMobile crisis workersMental Health Providers

14. Develop the TrainingBuild off current Minnesota Cit Officers Association CIT Memphis Model curriculumIdentify differencesIdentify the similaritiesIdentify resources availableDevelop child and adolescent role play scenarios

15. MarketingPost on WebsiteAttend conferencesMN SRO associationMN Sheriffs associationMN Police chiefs associationMental Health conferencesEmail notices

16. Children's Mental Health and Crisis Intervention

17. Outline of presentationEnvironment and biologyStatistics about mental healthDiagnoses and medications to treat them

19. Organic versus BehavioralOCD BrainAnxious BrainNormal brainBipolar brainDepressed brain

20. Prevalence of Mental Illness in Children and Adolescents5% of children 10-15% of adolescents 1 of 5 have a mental illness, 2 of 5 get the care they need.15-20% incidence of MI in adults

21. UntreatedSchool failureFamily conflicts Substance abuseViolence SuicideMay increase risk of juvenile justiceHave at least one mental disorder66 % boys75% girlswww.mentalhealth.samhsa.govFast Facts about children and mental healthSecondary effects

22. Bipolar DisorderBipolar Disorder I, II and NOSLittle agreement about diagnostic criteriaDoes Bipolar Disorder really exist in children?What does it look likeCo-morbid with ADHDMost challenging to treatHigh co-morbid with drug use/abuse

23. What does bipolar disorder look like?Between 20-25% of children who first present with MDD will eventually prove to have bipolar.“ADHD on speed” 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. Very difficult to diagnosis/treat

24. Medication for Bipolar DisorderAtypical antipsychoticsAbilify, Seroquel, Risperdal, Zyprexa, GeodonShould follow lab work as starting, 3 months out and annuallyWeight showed be followed closelyMay cause “dulling”EPS (Extrapyramidal side effects) movement disorders that require immediate interventions

25. Atypical AntipsychoticsAbilifyMiddle range for weight gainHelps with frontal lobe functioningAkathisiaSeroquelSedation, calmingWeight gainGreat to help with sleepZyprexaMost significant for weight gain, but works wellReally helps with aggression

26. Atypical Antipsychotics (cont)RisperdalWeight gainBreast enlargement, lactationDullingFDA approved for kids in autism spectrumGeodonDifficult to useFewest side effectsNot very effective

27. Medications for Bipolar Disorder (cont.)Mood stabilizerAnti-seizure medicationsDepakote, Trileptal, LamictalCan cause dulling, weight gain, life-threatening rash, pancreatitis, Depakote needs frequent lab drawsLithiumFrequent lab drawsVery narrow window between helpful level and toxicCan cause thyroid to stop functioning

28. Need to Know Info (NKI) Very erratic, unpredictable behaviorDefiantCan be difficult to finesse Little ones can be very aggressive, like a toddler responseAdolescents more grandiose

29. PsychosisPerson (adult or child) is experiencing hallucinations, delusions, distorted thinking. Bipolar Disorder, ManiaSchizophreniaDepressionParanoia DrugsMedications

30. SchizophreniaRare in childrenChildren under 12:1 in 40,000 Adolescents: 3 out of every 1,000HallmarksDisheveled appearance Odd expressions and behaviorsLittle to no emotional expressionHearing voices, seeing things, bizarre beliefs, odd speech

31. What you might seeBehavior seenIrrationalParanoid Someone is out to get themConspiracy DelusionalHas special powers“God”Can see, hear, know things others do notPhysically strongWhat to doBe calmGo slowDo not use humor, they don’t understandAvoid confrontation, they don’t understandPlay with them to get them to cooperate.

32. What you might see (cont.)Behaviors (cont)Hyperactive/reactiveAgitatedRapid, disorganized speechPoor self controlVery poor judgmentNo insightArguing is uselessCalm the environment

33. Medications for SchizophreniaAtypical antipsychoticsRisperdal, Zyprexa, Geodon, Seroquel, Abilify, and ClozarilWeight gain, more in kids

34. Metabolic disorders

35. High cholesterol

36. Flat affect

37. Sedation

38. Extra pyramidal symptoms, (EPS)Other medicationsTypical antipychoticsHaldol, Prolixin, Thorazine, Trilafon, MellerilDulling (slow thinkingFlat affectEPS/ temporaryTardive DyskinesiaInvolunary movements that are permanent

39. NKIVery rare in children/adolescentsMore likely chemically induced or secondary to other disorder (depression, bipolar disorder)Very unpredictableJoin in their delusions/hallucinations, don’t challenge them.Very unpredictable

40. Psychotic disorderhttp://www.youtube.com/watch?v=QPXkwYM9G-s&NR=1

41. Attention Deficit/Hyperactivity DisorderImpulsiveDoes without thinking; stealing, blurting, buyingInattentive; disorganized, can’t follow directionsHyperactive; can’t sit or stand still, constant motion, will walk/run from parentsCombination of all three

42. ADHDOften co-morbid with learning disabilities (trouble reading, writing)Often co-morbid chemical dependency.Very often with kids with Bipolar disorderImpairs executive functioning; organization, movement, time understanding.

43. MedicationsStimulants: Concerta, Adderall, Vyvanse, Daytrana Patch, Metadate, Focalin, Dexedrine, RitalinDaytrana patch and Vyvanse with hx of chemical abuse.Decrease appetiteCause mania and depression.Can cause trouble getting to sleep.Only work the day they take them and not into the evening!

44. NKIWill run without thinking, little ones get lost, older kids when they are in troubleWill “mouth off” without thinking, often will have remorse later. Don’t react!Can’t remember 2-3 step directionsCan’t stand still, move with them. Don’t make them be still, often they think better when moving.If you are working with them in the evening MEDICATIONS HAVE WORN OFFSeldom see just a child with ADHD, likely co-morbid with something else.

45. Depression1 in 33 kids, 1 in 8 adolescents Are more irritableDefiantBig sleep problemsCan’t do homeworkDoesn’t spend time with friendsGives things away

46. DepressionDepressionUnusual in young childrenMore common in adolescents; more girls than boys.Can be chronic (dysthymia)20% of children who present with depression actually have Bipolar DisorderSymptoms:Irritable in young children, sad in adolescentsWithdrawnLow energySuicidal ideationSelf-harmDifficulty concentrating

47. Suicide in adolescenceEvery year, nearly 5,000 people between age 15 and 24 commit suicide.Suicide is the 2nd leading cause of death in adolescents. Suicide threats/attempts within schools can occur in “clusters”.

48. Acute Suicidal IdeationChronic Suicidal IdeationWhat was the trigger?What have been other symptomsLethality? Are they on medication that could cause this?Is how they cope with stressCommon in Borderline Personality DisorderMay have history of self-injuring behaviorDon’t belittle, they will escalate their lethality.Frequent non-lethal attempts.

49. Medications Side effectsMania, weight gain, weight loss, sedation, activation, impotence, suicidal ideationMania, weight loss, dry mouth, dizzy, impotenceActivation, decreased energy, suicidal ideationSSRI’s: Prozac, Celexa, Lexapro, Luvox, PaxilSNRI’s: Cymbalta, EffexorNDRI: Wellbutrin

50. NKISlow to process, wait for them to answerSlow to moveThey will likely not look at you, not about youBe empatheticMedications may be making worse, either more suicidal or manic.

51. Autism Spectrum Disorders/PDD1 in 150 kids Autism, Asberger’s SyndromeSymptoms:Impairment in social interactionNonverbals: eye contact, gestures, facial expressionsPeer difficultiesStereotypic interestsCommunication problems: use of speech and type of playNonverbals: eye contact, gestures, facial expressionsPeer difficultiesTalks language literally!!!!Will power struggle with you

52. Behaviors you might seeSignificant trouble with sensory issues: light, sound, texturesEasily overwhelmed and confusedHas a special interest, find out what it isCan be manipulated with special interestTransitions are very difficultVery persistent

53. MedicationsAntidepressantsProzac, Celexa, Zoloft, Luvox, Lexapro, PaxilStimulantsConcerta, Ritalin, Adderall, Metadate, Focalin, Daytrana patch, VyvanseStratteraBlood pressure medicationsClonidine, TenexAtypical antipsychoticsRisperdal and Abilify are both FDA approved, but also use Seroquel, Geodon, and Zyprexa

54. NKIDO NOT TOUCHDO NOT JOKE, remember they take language literally.Quiet the environmentDecrease light and soundDecrease number of peopleFind out their special interestNo power strugglesYou can talk them downDistraction works well.

55. Has been exposed to a trauma that felt life threateningTriggers are often unknownReactive, fear basedFight or flight responseUse “soothing” responsesMove slowly, deliberately, NO SURPRISES!!!!!Post traumatic Stress Disorder

56. Did not have a healthy attachment as infantMost often children who are adoptedChildren separated from motherMother’s with significant depressionBehavior is very defiantReacts in aggressionLittle social thought“Stuff” is very important to them, can be bribed.Reactive Attachment Disorder

57. Oppositional Defiant DisorderODD:5-15% of school aged childrenA 6 month pattern of negative, hostile and defiant behavior, including:Blames othersArgumentativeDefies adultsAnnoys others and is easily annoyedI seldom diagnosis, usually a reason for behavior.

58. Conduct Disorder6% of the population (4:1 M/F)Violates basic rights of others/ societal rules Aggression toward people and/or animalsDestruction of propertyTheft or deceitfulnessLikely has source, PTSD, RAD, et al

59. AntipsychoticsAtypical antipsychoticsTypical antipsychoticsMedications to treat

60. Myths and Misperceptions“All teenagers are moody/hormonal”“She’s just trying to get attention””She’s just trying to get out of school”“He’s just a bad kid.” “It’s all the parent’s fault.”“She just needs to get up and get outside.”It only happens to weak people/poor people.It will never happen to me or my family.

61. When negotiating choices…..Negotiate = both sides get their needs metFind a way to honor some of the subject’s needs.Allow choices when possible. (increases sense of control and safety)Only offer two choices: be prepared s/he will make the “wrong” choice.Be open to a modified version of the two choices. “I can’t do that, but there in another option …”

62. Engaging the FamilyUnderstand that your presence may alter the child’s behavior.Use parent interview to determine: History/severity of problemHistory of mental health care/parent interventionWhat has helped in the pastMedical problems/medicationsAvailable supports/resourcesParent’s ability to keep child safeAssess parents’ contribution to the problem. Expect parent to follow child to ED and participate in assessment. Treating parents as part of the solution; working together will increase compliance.

63. Adolescent brains are a work in progress

66. Questions?