Understand Clients Mental Health Diagnosis & Appropriately Interact with them


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Definition of mental illness. The causes of mental illness. Tips on how to empower youth with mental health disorders. Ways to teach skills to youth who have the following diagnosis: Reactive Attachment, Post Traumatic Stress Disorder, Oppositional Defiant Disorder, ADHD, Spectrum Disorders,

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  • Instructor ’s notes: The most important person to give you information regarding a mental health diagnosis is the Clinician. Make sure to ask the Clinician any questions you may have about the diagnosis. The consultant’s are also a great source of information in terms of what to expect behaviorally from a youth with a certain diagnosis. If this information is not enough, the caseworker should also have a good idea about the youth’s behaviors and cycles. Make sure when talking to caseworker’s you are just getting information and not asking advice on behavioral interventions; leave that for treatment planning.
  • Instructor ’s notes: Spend some time talking about “labels” and some of the negative implications of labeling youth: hurts self esteem; may take is personally and as if they are “broken” or something is wrong with them; they may also use it as a excuse for negative behaviors. It is also important to understand their limitations based on the diagnosis. For example, a child with Autism or Asperger ’s may have some processing limitations and may need some changes in the structure and/or teaching for it to be successful. Again, staff with the clinician and consultant for ideas.
  • Again, the diagnosis is something they currently have. It does not mean it will be there forever (ex: depression, anxiety, PTSD all can go into remission). It is not an excuse for negative behaviors or attention seeking behaviors; however keep in mind it may create limitations or barriers that you may need to work with.
  • These are some diagnosis we see a lot with village youth, however this list is definitely not all of them.
  • This is one of the toughest, if not the toughest diagnosis for a child to have. These kids will either attach very easily (disinhibited) or it will take a long time to gain their trust (inhibited). One way to help these kids feel safe is to be very structured and consistent with consequences. Rules help them feel safe. If they feel their safety is in jeopardy, they will go into fight or flight mode. For example, we often see kids with RAD “punish” the family teachers after their days off because they feel they were left.
  • These children were most likely severely neglected, did not get their basic needs met, passed around between family members or have been in and out of different foster placements most their lives. The child will sabotage a long-term, most likely adoptive placement, in order to protect themselves from getting hurt. They believe they are ultimately going to be rejected so they try and make it happen; “on their own terms”. These children will “punish” their foster parents by acting out in extreme ways until the placement fails. If the child is in a short term placement (ex: group home) there will still be some noticeable acting out behaviors as they will feel rejected when it is time to leave the home.
  • Children who have suffered sexual or physical abuse will sometimes be diagnosed with PTSD.
  • A lot of the time, these children have lived in a state of hyperarousal or “walking on eggshells”. They have trouble calming down or regulating emotions. They may get triggered by something you are unaware of. For example: raised voices or slamming doors. Other possibilities include the dark (a lot of sexual abuse takes place at night or in the dark). Anything to trigger one of the senses: sights, sounds, smells, touches or tastes. This is a form of anxiety so sometimes medication can be helpful.
  • If the child is not paying attention at school but does not have the same trouble at home, chances are it is not ADHD.
  • The three Spectrum Disorders are all different from one another. Make sure you understand which diagnosis the youth has and what the most prevalent symptoms are. This is an important diagnosis to make sure to take the time and understand. It will most likely effect how the youth interacts with foster parents, peers, teachers, etc. There will most likely need to be a lot of teaching done around boundaries as they often have a hard time picking up on social cues.
  • In children, only one of the symptoms have to be present for more days than not. Medication does help with symptoms of anxiety.
  • Medication does help with depression. If the child makes any kind of self harm remark or behavior, make sure to staff it with the consultant and if needed, the clinician. Sometimes it will be attention seeking however we need to take it seriously.
  • If you notice signs and symptoms of something that could be a diagnosis, feel free to staff it with the clinician and the treatment team. Make sure you do not assume they have a diagnosis just because they exhibit a few symptoms.
  • Understand Clients Mental Health Diagnosis & Appropriately Interact with them

    1. 1. Understanding a youth ’s mental health diagnosis and how to appropriately interact with them
    2. 2. What is mental illness? <ul><li>“ Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning.” </li></ul><ul><ul><li>http://www.nami.org/template.cfm?section=about_mental_illness </li></ul></ul>
    3. 3. Why do we need them? <ul><li>A mental health diagnosis guides treatment </li></ul><ul><ul><li>Treatment plans cannot be written without a diagnosis </li></ul></ul><ul><li>Billing </li></ul><ul><ul><li>In order to get reimbursed for services such as therapy, a youth need to have a billable diagnosis. </li></ul></ul>
    4. 4. Where to get your information <ul><li>Speak to the youth ’s Clinician </li></ul><ul><li>Consultant </li></ul><ul><li>Caseworker and/or parent/s </li></ul>
    5. 5. What causes mental illness? <ul><li>Mental Health Issues can come from a variety of reasons: examples include but are not limited to: </li></ul><ul><ul><li>Genetics/biochemistry </li></ul></ul><ul><ul><li>Difficult family background-unstable caregivers, domestic violence, substance abuse </li></ul></ul><ul><ul><li>Stressful life events-death, abuse </li></ul></ul><ul><ul><li>Biochemistry </li></ul></ul>
    6. 6. Important to Remember: <ul><li>Be careful of labeling </li></ul><ul><ul><li>Be aware of statements such as “he is ADHD” or “she is RAD”. Instead, use phrases such as “he has ADHD” or “she has RAD”. </li></ul></ul><ul><ul><li>Their diagnosis is not an excuse to act out; but make sure you understand any limitations they may have </li></ul></ul>
    7. 7. <ul><li>Do not forget to empower the youth </li></ul><ul><ul><li>They will often make statements to suggest they cannot control their behaviors because of a missed medication or because they have ADHD. Empower them by saying “the medication helps but ultimately you are in control of your behaviors”. </li></ul></ul>Important to Remember:
    8. 8. Common Diagnosis: <ul><li>Reactive Attachment Disorder </li></ul><ul><li>Post Traumatic Stress Disorder </li></ul><ul><li>Oppositional Defiant Disorder </li></ul><ul><li>Anxiety Disorders (other than PTSD) </li></ul><ul><li>Mood Disorders </li></ul>
    9. 9. RAD: <ul><li>Reactive Attachment Disorder: </li></ul><ul><ul><li>Markedly disturbed and developmentally inappropriate ways of relating socially in most contexts; inhibited or disinhibited type. </li></ul></ul><ul><ul><li>Consistent rules, boundaries and consequences are very important </li></ul></ul><ul><ul><li>They will often go into “fight or flight” mode </li></ul></ul>
    10. 10. RAD cont.: <ul><ul><li>These children have learned at a young age that “adults cannot be trusted”. </li></ul></ul><ul><ul><li>Do not discuss placement changes at it will increase anxiety and cause sabotaging behaviors. </li></ul></ul><ul><ul><li>Do not promise “adoption” to children with this diagnosis; they will attempt to destroy the relationship and unfortunately, will often win. </li></ul></ul>
    11. 11. PTSD: <ul><li>Post Traumatic Stress Disorder : Anxiety Disorder that develops after a traumatic event. </li></ul><ul><li>The event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity. </li></ul><ul><li>The trauma is so overwhelming that it interferes with the individual's ability to cope. </li></ul>
    12. 12. PTSD cont.: <ul><li>Common signs and symptoms: </li></ul><ul><ul><li>Flashbacks </li></ul></ul><ul><ul><li>Nightmares/dreams </li></ul></ul><ul><ul><li>Often in a state of hyperarousal </li></ul></ul><ul><ul><li>Will sometimes go into fight or flight mode if triggered </li></ul></ul>
    13. 13. ODD: <ul><li>Oppositional Defiant Disorder: A pattern of negative, hostile and defiant behaviors. </li></ul><ul><ul><li>Often loses temper, argues, refuses to comply with requests, blames, lies, easily annoyed or deliberately annoys others. </li></ul></ul>
    14. 14. ADHD: <ul><li>Attention Deficit Hyperactivity Disorder: Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development. </li></ul>
    15. 15. ADHD cont: <ul><li>Can be predominantly inattentive, hyperactive-impulsive or combined. </li></ul><ul><li>Has to occur in at least 2 or more settings </li></ul><ul><li>Medication does help with symptoms of ADHD </li></ul>
    16. 16. Spectrum Disorders: <ul><li>Aspergers/Autism/Pervasive Developmental Disorder: </li></ul><ul><ul><li>Impairment in areas of development such as: social interaction, communication and restricted interest in activities. </li></ul></ul><ul><ul><li>They may have a hard time with peer relationships (or not be interested at all) </li></ul></ul>
    17. 17. Spectrum Disorders cont.: <ul><ul><li>Trouble picking up on social cues. </li></ul></ul><ul><ul><li>May have some language delays. </li></ul></ul>
    18. 18. Anxiety Disorders (other than PTSD): <ul><li>Other than PTSD, the most common anxiety disorder is Generalized Anxiety Disorder </li></ul><ul><ul><li>Excessive anxiety or worry </li></ul></ul><ul><ul><li>Finds it difficult to control the worry </li></ul></ul>
    19. 19. Anxiety Disorders cont.: <ul><ul><li>Restlessness or feeling on edge </li></ul></ul><ul><ul><li>Easily fatigued </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Sleep disturbance </li></ul></ul>
    20. 20. Mood Disorders: <ul><li>Major Depressive Disorder </li></ul><ul><ul><li>Dysthymis Disorder </li></ul></ul><ul><li>Bipolar Disorder </li></ul><ul><li>Mood Disorder NOS (not otherwise specified) </li></ul>
    21. 21. Mood Disorders cont. Major Depressive Disorder <ul><li>Characterized by one or more major depressive episodes </li></ul><ul><li>Dysthymic Disorder: chronically depressed mood for most of the day more days than not for at least 2 years (does not meet criteria for a major depressive episode) </li></ul>
    22. 22. Mood Disorders cont. Major Depressive Disorder cont: <ul><li>Depression looks different in children: </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Depression should be considered if there are changes in behavior without a identifiable trigger </li></ul></ul><ul><li>Take seriously any kind of self harm and/or suicidal thoughts/behaviors. </li></ul>
    23. 23. Mood Disorders cont. Bipolar Disorder: <ul><li>There are several different types of Bipolar Disorders </li></ul><ul><li>Generally speaking, this diagnosis if viewed as a “cycle” between depressive symptoms and manic symptoms. </li></ul>
    24. 24. Mood Disorders cont. Mood Disorder NOS: <ul><li>Common diagnosis in children </li></ul><ul><li>Usually diagnosed if moods are unstable yet they do not fit any other criteria </li></ul>
    25. 25. Ending Thoughts: <ul><li>Make sure to allow the Clinician to make the diagnosis. </li></ul><ul><li>Staff concerns: the treatment team is there to help and support! </li></ul>
    26. 26. Ending Thoughts: <ul><li>No matter what the youth ’s diagnosis is, use the Teaching Family Model </li></ul><ul><ul><li>It gives the child consistency which ultimately gives them a feeling of safety </li></ul></ul><ul><li>A diagnosis is not permanent! </li></ul>
    27. 27. References: <ul><li>National Institute of Mental Health </li></ul><ul><ul><li>www.nimh.nih.gov </li></ul></ul><ul><li>National Alliance on Mental Health </li></ul><ul><ul><li>www. nami.org </li></ul></ul><ul><li>American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. </li></ul>