Transcript Prevalence of diagnosable mental health problem in

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ADHD Training Course in Optimal Treatment: Psychopharmacology and Behavior Therapy
A Hands-on Training Course in ADHD Diagnosis and Treatment
The non-profit REACH Institute offers high impact training for health care professionals in the
diagnosis and treatment of ADHD (attention deficit hyperactivity disorder). This course is
designed for family physicians, pediatricians, GPs, nurses and nurse practitioners,
psychiatrists, and neurologists (as well as child and adolescents psychiatrists who want to be
“at the top of their game” in delivering the latest scientifically proven treatments for
ADHD. Led by Peter S. Jensen, MD, NIMH lead investigator of the NIMH multisite MTA
Study and author of over 300 peer-reviewed articles and chapters, and author/editor of over a
dozen books for researchers, clinicians, and parents, this course brings together four crucial
components in diagnosing and treating ADHD, and achieving optimal outcomes for children
and families.
These four components of ADHD knowledge and skill are 1) accurate ADHD diagnosis using
reliable rating tools, 2) state-of-art medication titration and medication monitoring, selection
among available agents based on treatment targets and environmental demands, determine
which of the various psychostimulants or non-stimulants should be used initially, determining
necessary methods for maximizing benefits and reducing medication side effects, 3)
individualizing an ADHD treatment plan for each child and family, including the role of
parental treatment preferences, and 4) learning how to deliver behavioral therapy that helps
children (and families) learn skills that medication cannot teach, such as social skills, improved
parent-child relationships, peer relationships and social skills, improved self-esteem,
responsibility-taking, and self-monitoring,
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Checking in on Teen Mental Health
Important Announcement Regarding TeenScreen’s Closure
Over the past 13 years, TeenScreen National Center at Columbia
University has been committed to making a difference in the lives
of adolescents. In our effort to reduce the impact of mental illness
on our young people, hundreds of thousands of teenagers have
been offered preventive mental health Read More
www.teenscreen.org
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Founded in 2008, REACH Grenada's mission is to improve the emotional
and social wellbeing of abused and abandoned children by providing
training, support and wellness programs for these children and their
caregivers, thus securing a brighter future.
REACH Grenada works with children residing in Grenada's care homes
where many were previously victims of physical, sexual and/or
emotional abuse, neglect and abandonment. Our multi-dimensional
programs promote children's long-term healthy development, thus
alleviating the effects of early childhood adversity.
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REACH model seeks to encourage Resiliency, Empathy, healthy
Attachments, key Competencies, and overall Health and well-being.
www.reachgrenada.org
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CAP PC has partnered with the REACH Institute to provide primary care
physicians with a premier education program, the Mini Fellowship in
Child and Adolescent Mental Health. This is a CME training program
developed by the REACH Institute in recognizing, assessing, and
managing mild-moderate mental health problems in children and
adolescents. This intensive training is lead by Peter Jensen, M.D. and a
group of internationally renowned medical teachers. The program is at no
cost to participating PCPs and consists of a three day dynamic workshop,
involving interactive learning methods. The program also includes twice
monthly case-based phone conferences for 6 months. For more
information please visit http://www.thereachinstitute.org or contact
Melanie Louis at [email protected]
CAP PC is a collaboration between the Departments of Psychiatry at the University at Buffalo,
University of Rochester, Columbia University/New York State Psychiatric Institute, SUNY
Upstate, and North Shore/Long Island Jewish, along with the REACH Institute.
http://www.cappcny.org/home/
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The Fellowship is a part-time post-graduate program consisting of
12 intensive, interactive three-day weekends, meeting every other
month (Jan, Mar, May, July, Sept, Nov.) over the course of two
years.
Fellows have the opportunity to learn directly from world
luminaries, including Chief Faculty, Ed Tronick, T. Berry
Brazelton, Dan Siegel, Bruce Perry, Charles Zeanah, Joy Osofsky,
Kevin Nugent, Beatrice Beebe, George Downing, Peter Fonagy,
and many more.
http://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health
•Prevalence of diagnosable
mental health problem in
children: 20.9%*
•Anxiety disorders 13.0%
•Mood disorders 6.2%
•Disruptive disorders 10.3%
•Substance use disorders 2%
*Surgeon General’s Report, 1999, children and
adolescents
*Costello and Pantino, 1987: 13-20%
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•Many children and adolescents with
emotional/behavioral problems could be
identified in primary care settings
•Primary Care is the ideal context because it is
accessible and less stigmatizing for most families
than specialty care
•Among children and adolescents referred to a
mental health specialist, less than ½ reach a mental
health professional and are treated
•There are existing tools for identifying children
with psychosocial problems in the primary care
setting
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•Lengthy delays can occur between onset on
MH problems and initiation of adequate Rx
•Delays in Rx are associated with poorer
outcomes, more distress, compromise Rx
success, increase contact with law enforcement
Improved communication between the
professionals can yield improved outcomes
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•Total score
•3 subscale scores
–Attention
–Externalizing
–Internalizing
17 item or 35 item formats (PSC 17 or PSC 35)
12% middle income children “screen-in” or have
positive scores; higher for lower income
children[2]
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Emotional and physical health go together in children. Because parents are often the first to notice a problem with their
child’s behavior, emotions, or learning, you may help your child get the best care possible by answering these questions.
Please indicate which statement best describes your child.
Please mark under the heading that best describes your child:
Never
Sometimes
Often
1. Complains of aches and pains
1 _______
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2. Spends more time alone
2 _______
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3. Tires easily, has little energy
3 _______
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4. Fidgety, unable to sit still
4 _______
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5. Has trouble with teacher
5 _______
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6. Less interested in school
6 _______
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7. Acts as if driven by a motor
7 _______
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8. Daydreams too much
8 _______
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9. Distracted easily
9 _______
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10. Is afraid of new situations
10 _______
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11. Feels sad, unhappy
11 _______
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12. Is irritable, angry
12 _______
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13. Feels hopeless
13 _______
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14. Has trouble concentrating
14 _______
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15. Less interested in friends
15 _______
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16. Fights with other children
16 _______
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17. Absent from school
18. School grades dropping
19. Is down on him or herself
20. Visits the doctor with doctor finding nothing wrong
21. Has trouble sleeping
22. Worries a lot
23. Wants to be with you more than before
24. Feels he or she is bad
25. Takes unnecessary risks
26. Gets hurt frequently
27. Seems to be having less fun
28. Acts younger than children his or her age
29. Does not listen to rules
30. Does not show feelings
31. Does not understand other people’s feelings
32. Teases others
33. Blames others for his or her troubles
34. Takes things that do not belong to him or her
35. Refuses to share
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Total score ______________
Does your child have any emotional or behavioral problems for which she or he needs help? ( ) N ( ) Y
Are there any services that you would like your child to receive for these problems? ( ) N ( ) Y
If yes, what
services?______________________________________________________________________________________________
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The PSC consists of 35 items that are rated as “Never,” “Sometimes,” or
“Often” present and scored 0, 1, and 2, respectively. The total score is
calculated
by adding together the score for each of the 35 items. For children and
adolescents ages 6 through 16, a cutoff score of 28 or higher indicates
psychological
impairment. For children ages 4 and 5, the PSC cutoff score is 24 or
higher (Little et al., 1994; Pagano et al., 1996). The cutoff score for the YPSC
is 30 or higher. Items that are left blank are simply ignored (i.e., score
equals
0). If four or more items are left blank, the questionnaire is considered
invalid.
A positive score on the PSC or Y-PSC suggests the need for further
evaluation
www.brightfutures.org
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•CRAFFT –screening for drug use and alcohol
•PHQ-9 – depression screening for adolescents
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The majority of adolescents have used alcohol or another drug by the
time they have reached 12th grade. Alcohol is the most commonly used
drug among adolescents and is responsible for more mortality and
morbidity in this age group than all other drugs combined. Use typically
begins during early adolescence, with peak initiation during grades 7
through 9. By the 12th grade, 80% of high school seniors report having
used alcohol, 62% report having gotten drunk, and 31% report heavy
episodic use.
Among adolescents who drink alcohol, 38% to 62% report having had
problems related to their drinking, such as interference with work,
emotional and psychological health problems, the development of
tolerance, and the inability to reduce the frequency and quantity of use.
Massachusetts Department of Public Health Bureau of Substance Abuse
Services
March 2009
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Have you ever ridden in a CAR driven by someone (including
yourself) who was “high” or had been using alcohol or drugs?
Do you ever use alcohol or drugs to RELAX, feel better about
yourself, or fit in?
Do you ever use alcohol or drugs while you are by yourself, or
ALONE?
Do you ever FORGET things you did while using alcohol or
drugs?
Do your family or FRIENDS ever tell you that you should cut
down
on your drinking or drug use?
Have you ever gotten into TROUBLE while you were using
alcohol or drugs?
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CRAFFT Screening Tool for Adolescent Substance
Abuse
Scoring and Interpretation:
Part A: If “yes” to any questions in Part A, ask all 6
CRAFFT questions. If “no” ask CAR question then
stop.
Part B: Score 1 point for each “YES” answer.
CRAFFT Score
Degree of problem related to alcohol or other substance abuse
Suggested Action
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0-1
No problems reported
None at this time.
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2+
Potential of a significant problem.
Assessment required.
1. Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance
abuse. Arch Pediatr Adolesc Med 1999;153(6):591-6.
2. Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among
adolescent clinic patients. Arch Pediatr Adolesc Med 2002;156(6):607-14.
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CDC and Kaiser Permanente Collaboration
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Over decade long. 17,000 people involved.
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Looked at effects of adverse childhood
experiences over the lifespan.
Largest study ever done on this subject.
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ACEs are experiences in
childhood that are unhappy,
unpleasant, hurtful.
• Sometimes
referred to as
toxic stress or
childhood
trauma.
Regional Child Abuse Prevention Councils 2011
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80% White,
including
Hispanic
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10% Black
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10% Asian
About 50% men, 50%
women
74% had attended
college
62% age 50 or older
The higher the ACE Score,
the greater the likelihood of
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Severe and persistent emotional problems
Health risk behaviors
Serious social problems
Adult disease and disability
High health, behavioral health, correctional and
social service costs
Poor life expectancy
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Finding Your ACE Score
While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often or very often…
Swear at you, insult you, put you down, or humiliate you?
or
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1 ________
2. Did a parent or other adult in the household often or very often…
Push, grab, slap, or throw something at you?
or
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1 ________
3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
or
Attempt or actually have oral, anal, or vaginal intercourse with you?
Yes No If yes enter 1 ________
4. Did you often or very often feel that …
No one in your family loved you or thought you were important or special?
or
Your family didn’t look out for each other, feel close to each other, or support each other?
Yes No If yes enter 1 ________
5. Did you often or very often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
or
Your parents were too drunk or high to take care of you or take you to the doctor if you needed
it?
Yes No If yes enter 1 ________
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6. Were your parents ever separated or divorced?
Yes No If yes enter 1 ________
7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at
her?
or
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with
something hard?
or
Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
Yes No If yes enter 1 ________
8. Did you live with anyone who was a problem drinker or alcoholic or who
used street drugs?
Yes No If yes enter 1 ________
9. Was a household member depressed or mentally ill, or did a household
member attempt suicide?
Yes No If yes enter 1 ________
10. Did a household member go to prison?
Yes No If yes enter 1 _______
Now add up your “Yes” answers: _______ This is your ACE Score.
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Abuse of Child
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Trauma in Child’s
Household
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Emotional abuse, 11%
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Physical abuse, 28%
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Alcohol or drug use, 2%
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Contact sexual abuse,
22%
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Depressed, emotionally
disturbed, or suicidal
household member, 17%
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Mother treated violently, 13%
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Imprisoned household
member, 6%
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Loss of parent, 23%
Neglect of Child
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Emotional neglect, 19%
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Physical neglect, 15%
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Neurobiological
Impacts
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Disrupted development
Anger–rage
Hallucinations
Depression/other mental
health challenges
Panic reactions
Anxiety
Somatic problems
Impaired memory
Flashbacks
Dissociation
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Health Risks
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Smoking
Severe obesity
Physical inactivity
Suicide attempts
Alcohol and/or drug abuse
50+ sex partners
Repetition of trauma
Self injury
Eating disorders
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Violent, aggressive behavior
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If trauma/toxic stress
occurs early in life, the
brain becomes wired to
survive it.
Regional Child Abuse Prevention Councils 2011
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Drinking alcohol
Smoking tobacco
Sexual promiscuity
Using drugs
Overeating/eating disorders
Delinquent behavior
Regional Child Abuse Prevention Councils 2011
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May not be the core problem
They may be the coping devices
A way to feel safe or just feel better
Regional Child Abuse Prevention Councils 2011
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18
16
14
12
10
8
6
4
2
0
0
1
2
3
4-5
6 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
18
16
% Alcoholic
14
12
10
8
6
4
2
0
0
1
2
3
>=4
ACE Score
Regional Child Abuse Prevention Councils 2011
% Have Injected Drugs
3.5
3
2.5
2
1.5
1
0.5
0
0
1
2
3
4 or more
ACE Score
Regional Child Abuse Prevention Councils 2011
Regional Child Abuse Prevention Councils 2011
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Are conditions that increase health and well
being
Are critical for everyone regardless of age, sex,
ethnicity or racial heritage, economic status,
special needs, or the dynamics of the family
unit
Are buffers that provide support and coping
strategies
Regional Child Abuse Prevention Councils 2011
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Nurturing and Positive Relationships
Knowledge of Parenting and Child
Development
Parental Resilience
Social Connections
Concrete Support in Time of Need
Regional Child Abuse Prevention Councils 2011