Transcript The New Haven MDT - ct

The Impact of Mental Health Issues on
Students Behaviors and Physical Health
While in School
Enroue Halfkenny
May 5, 2011
Why This?
Evolution of this presentation
Importance of wellness
Nurses are the nurturers in our schools
offer support to many
Expected to handle a myriad of situations with expertise
Looked at as authority on all things physical and emotional
Help provide you with tangible, useful tools to
ultimately support you in your role
Demographics

In FY 08 – 09 Clifford Beers Clinic served 1,406 clients in its outpatient clinic
Hispanic, any
race
30%
Multiracial
6%
Native American
0%
Black, nonHispanic
35%
White, nonHispanic
29%
59% of CBC clients are male; 41% are females
Town Residency of Clients
Most of our outpatient clients come from these 7 towns. When including our Emergency
Mobile Psychiatric Services the number towns served increases to approximately 32.
60%
50%
55%
40%
30%
15%
20%
10%
9%
9%
3%
2%
2%
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Ne

Goals
Recognize that behavior issues and
symptoms of trauma exposure can appear
the same
Provide tools to support you in implementing
interventions that will yield the best possible
outcome to victims of trauma
Unsung Heroes
Unique role of school nurses
Responsible for entire student body
Often left to handle things on own
Liaison between family and school
Often have issues “passed off” to them
Expected to
 Be Compassionate
 Send each student back “better”
Build rapport and establish trust with all students
 meet multiple demands of days and years with out much thought
about own compassion fatigue
Why Now?
Role and expectations of nurses and Trauma
Model guide need to support you in your roles so
that we can help children with best practice
Trauma Model Vs Deficit Model
 Historically viewed children as what they did not
have
Shift to Trauma Model
Presenting Problems at Intake
Client Presenting Problems
Percent
Oppositional Behavior
41%
Depressed/Sad
40%
Anxiety-Related Symptoms
38%
Attention Difficulties
27%
School/Academic Problems
26%
Most Reported Behaviors
% of Parents Reporting
Top 5 most reported Problem Items on the Initial Survey
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Initial
54%
51%
37%
1. Arguing w/ others
Follow-up
49%
36%
11. Can’t sit still, has too
much energy
42%
30%
5. Refusing to do things
teachers/ parents ask*
Problem Item
42%
28%
3. Yelling, swearing, or
screaming at others*
28%
4. Fits of anger*
Reported Trauma
Sixty-seven percent (67%) of clients report at least one trauma at intake. The average
number of traumas reported is 3.
Post Traumatic Stress Reaction Index (n = 64)
100%
84%
90%
83%
% Met Criteria
80%
70%
56%
60%
50%
50%
Baseline
48%
6 Months
40%
30%
20%
10%
16%
15%
2%
0%
Overall
Re-Experiencing
Avoidance
Subdomains
Increased Arousal
Case Study
Lester Bentley
 Classic ADHD student v. Adjustment
Disorder with Mixed Disturbance of Mood
and Conduct
Case Study
Tara Sanabria Davila
 Two Brothers: Same trauma different
behaviors
How Students Impacted by
Trauma Get to Your Office
Distracted
Aggressive/defended
Complain of aches and pains with no apparent
medical cause
Show up in office regularly with “unfounded”
complaints
Sad
Seeking attention
Hungry or seeking other ways to be nurtured
Angry/crying
Duration of Treatment

Seven months represents the median length of stay during fiscal year 2008-09. 50% of clients receive clinic services
for 7 months or less. Their average LOS is 3 months. The other 50% receive services for more than 7 months. Their
average LOS is just under 24 months.
50 / 50
50%
< 7 mos
avg. 3 mos
50%
> 7 mos
avg. 24 mos
Now What?
Alternate Triage Focus
When no medical reason for their visit seems
evident, look for other reasons
Decision making tree
For City
Tailored Specifically for your school
Minimal Facts Approach
The Goal of Gathering Minimal Facts
Minimize additional trauma to a child
Children are re-traumatized when they are
asked to repeat their stories. In fact, they are
being asked to relive the experience each time
they repeat what happened to them.
Prevent contamination of information
Contamination of information can jeopardize
the protection of the child and the law
enforcement investigation.
Why Minimal Facts?
Children’s statements, especially those of
young children become contaminated by
discussing the abuse with too many people.
The children’s answers begin to reflect the
questions asked, rather than the reality of
responses.
Gathering Minimal Facts
Minimal facts should be gathered by a reliable
adult whom the child has made a direct statement
to.
Teachers,
Doctor
 Parent.
What to ask:
What Happened?
Who is the alleged Perpetrator?
Where did it happen?
When was the last time it happened?
After the Disclosure
When a child discloses a sexual/physical
abuse experience to you, contact the DCF
HOTLINE Immediately.
Do Not contact the parents/guardian, let
DCF and Law Enforcement handle the
situation.
Important Phone Numbers
 DCF HOTLINE:
1-800-842-2288
 Yale Child Sexual
Abuse Clinic:
(203)688-2392
Case Study
Enroue Halfkenny
 Changing procedures to change outcomes
 Impact of Positive or Less Favorable
intervention : Relationship with nurse, legal
outcome, health outcome, consistent
reporting system for multiple providers,
liability to nurses and system, fidelity of
reporting.
Always Remember
The opportunity to Build relationships with these
children is a gift- you are not betraying them or
letting them down if you call authorities when
warranted
The gift of your trusting relationship will give
them confidence to trust another, helping adult
NEVER forget to take care of yourself, as wellyou are of most use to all when you are well
cared for.
Contact Information
Enroue Halfkenny
[email protected]
Q and A