Transcript SSE – 160 Introduction to Child and Youth Services

SSE – 160
Introduction to Child and
Youth Services
Chapter 9
Methods and Practices in Mental
Health Agencies
Methods and Practice in Mental
Health Agencies
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Child and adolescent health is a relatively new area of
discovery and practice and encompasses emotional
regulation, conflict resolution, the ability to love self and
others, and adequate functioning in family, school, and
community systems.
This chapter focuses on understanding young people with
mental disorders and promoting their mental health;
preventing developmental psychopathology; the emotional
difficulties of children; and the major types of mental disorders
experienced by children and adolescents, including stress
and anxiety, mood disorders, disruptive behavior disorders,
cognitive deficits and head injuries, eating disorders,
schizophrenia and autism, and substance abuse.
Promoting the Mental Health of
Children and Adolescents
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Mental health difficulties of children and adolescents are
often difficult for adults to comprehend and accept (Dulmus &
Wodarski, 1996).
Five factors contribute to this situation:
1. Some evidence exists that children’s behavioral and
emotional problems have increased in the United
States (Achenback & Howell, 1993).
2. Mental disorders of children and adolescents can
vary from mild to severe.
3. Some mental health problems threaten the lives of
children and adolescents.
4. Individual children often have more than one disorder.
Promoting the Mental Health of
Children and Adolescents
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Five factors (cont.):
5. Stigma associated with many mental health disorders,
confusion about their origin and nature, and concern
about becoming mentally ill affect access, use, and
effectiveness of mental health service delivery for
children and adolescents (Rog, 1992).
Many mental health services for children and adolescents
exist including case management of service coordination;
community-based inpatient psychiatric care, etc. (refer to
page 194).
Promoting the Mental Health of
Children and Adolescents
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Special categories for child and adolescent mental
disorders, including speech, learning, and feeding
disturbances and elimination disorders, first appeared in the
DSM-II publication of the American Psychiatric Association
(APA, 1968).
Currently in the DSM-IV-TR, disorders usually first
diagnosed in infancy, childhood, or adolescence, include
mental retardation, characterized by low intellectual and
adaptive functioning; learning disorders, characterized by
lower than expected academic functioning, etc. (refer to
page 195).
Promoting the Mental Health of
Children and Adolescents
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For diagnosis, prevention, intervention, and rehabilitation to
be effective, it is helpful for young people to understand their
mental health difficulties. They also need to be understood
and receive support from practitioners, relatives, teachers,
classmates, friends, and neighbors.
Social workers attempt to accomplish such ends by
providing parallel services to family members, conducting
interviews, implementing group work, and offering psychoeducation to schools and communities.
Prevention of Developmental
Psychopathology
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The prevention of mental disorders among infants, children,
and adolescents occurs at three levels (Berlin, 1990).
Primary prevention encompasses efforts to maintain mental
health among youngsters who show no signs of mental
disorders. It involves the recognition of potential
developmental problems and intervention to prevent the
emergence of such problems as disabling disorders.
Secondary prevention involves work with children and
adolescents who have some signs and symptoms of mental
illness yet are functioning well. It encompasses very early
recognition of disturbances or disorders and prompt and
early intervention to prevent serious limitations of the
capacities of young people to live, function and adapt
adequately.
Prevention of Developmental
Psychopathology
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Secondary prevention is useful in helping parents who have
children with disabilities, working with neglected and abused
children, etc. (refer to page 196).
Tertiary prevention is akin to rehabilitation in that it involves
working with children and adolescents who have been
severely impacted by mental disorders. It involves early
treatment of mental disorders to enable functional
adaptation in living. Problems that are dealt with include
child and adolescent schizophrenia, depression, antisocial
behavior, etc. (refer to page 196).
Prevention of Developmental
Psychopathology
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Dumka, Roosa, Michaels, and Suh (1995) developed a fivestage model for prevention program development that they
used to create an intervention. The Raising Successful
Children Program, designed to reduce child mental health
problems among low-income, ethically diverse families.
First stage of the model is problem analysis, consisting of
defining the problem / goal, identifying risk and protective
factors, and determining accessibility of the risk group.
Second stage is program design, consisting of consulting
the target group, selecting change objectives, choosing
outcome evaluation instruments, picking change models,
deciding on the extensiveness of the prevention program,
planning a recruitment and retention strategy, and designing
the procedural elements of the program.
Prevention of Developmental
Psychopathology
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Third stage is pilot testing, it consists of recruitment and
retention evaluation, process evaluation, formulative
evaluation, and program revision.
Fourth stage is advanced testing.
Fifth stage is dissemination.
Emotional Problems of Children
and Adolescents
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In the course of their development, young children
normatively learn to display their emotions. Positive
emotions include love, joy, contentment, and happiness.
Negative emotions include guilt, sadness, frustration, anger,
fear, shame and embarrassment.
Children who feel very sad for a limited period of time are
reacting to a loss in a normative, acceptable manner.
However, children who continue to grieve a loss for a very
long period of time may develop a mood disorder.
Emotional Problems of Children
and Adolescents
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Psychological tasks for bereaved children occur at three
stages (Baker & Sedney, 1996).
Early tasks associated with grieving encompass the child’s
understanding that someone has died and its implications,
and protection of themselves, their physical bodies, and
their families.
Middle-phase tasks are associated with mourning a loss.
The tasks include emotional acceptance of the loss (refer to
page 197).
Late tasks, which sequentially follow the middle-phase
tasks, include forming a new sense of personal identity that
incorporates the loss and the identification with the
deceased person.
Emotional Problems of Children
and Adolescents
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Goals for the treatment of the emotional problems of
children and adolescents include the furtherance of (a)
the experience and expression of positive emotions, (b)
the reduction of the experience and expression of
negative emotions, ( c) the experience and expression of
emotions to fall within a normal range, and (d) the
situational appropriateness of the experience and
expression of emotions.
Types of Mental Disorders
Stress and Anxiety
 Social workers help young people to acquire cognitive
coping skills. Children and adolescents learn to develop
their confidence in and ability to make reassuring selfstatements about coping with anxiety, imagery, progressive
relaxation exercises, and social skills.
 For many young people, anxiety or nervousness is
normatively associated with developmental transitions.
Children experience anxiety when separating from their
parents or when entering school for the first time, for
example. Anxiety is usually related to youngster’s difficulty in
coping with stress.
Types of Mental Disorders
Stress and Anxiety
 Some children develop 1 or more of 5 anxiety disorders.
1. Obsessive-compulsive disorder (OCD) which is
characterized by repetitive intrusive thoughts or
behaviors that are meant to control anxiety but are
disruptive, dysfunctional, and ineffective in controlling
anxiety.
2. Generalized anxiety disorder (GAD) they tend to
worry about both the improbable and probable events
on a fairly regular basis. They have a marked need
for reassurance.
3. Phobias, or specific fears that come about as a result
of conditioning or association and are detrimental to
children and adolescents, because they restrict their
activities. Treatable by behavioral therapy.
Types of Mental Disorders
Stress and Anxiety
4. Panic disorder consists of repeated panic attacks
with no readily identifiable cause. These attacks are
so terrifying that children and adolescents with panic
disorder avoid anxiety-producing places or situations.
5. Post-traumatic stress disorder (PTSD) children and
adolescents who experience traumatic stressors, such
as physical or sexual abuse or being subject to a
disaster.
*Treatments for anxiety disorders include cognitive-behavioral
treatment; individual psychotherapy; family therapy; parent
training; and medication
Major Depression, Suicidal
Behavior, and Manic-Depressive
Disorder
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3 to 6 percent of children and as many as 12 percent of
adolescents experience depression.
 Children and adolescents with major depression make
cognitive errors, endorse negative attributions, and have low
self-esteem.
 It is difficult to recognize depression in adolescents because
mood swings are a normative aspect of adolescence.
 Children and adolescents who experience major depression
and do not value their current lives are at risk for attempting
suicide.
Major Depression, Suicidal
Behavior, and Manic-Depressive
Disorder
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Osman and colleagues (1998) created the Reasons for Living
Inventory for Adolescents, a measure that is useful in
assessing adolescent suicidal behavior. Five correlated
factors were identified.
1. Future optimism
2. Suicide-related concerns
3. Family alliance
4. Peer acceptance and support
5. Self-acceptance
A suicide by a child or adolescent signals or indicated failure
to the parents, they blame themselves for not having
prevented the suicide.
Major Depression, Suicidal
Behavior, and Manic-Depressive
Disorder
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Some children or adolescents who are at risk for suicide
experience manic-depressive disorder. Bi-polar disorder or
manic-depressive illness is marked by exaggerated mood
swings between extreme lows or depression and extreme
highs, namely excitedness or manic phases, with moderated
mood periods interspersed.
Clinicians usually have a more difficult time diagnosing manicdepressive disorder than depression.
Aggression and Conduct Disorder
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Oppositional defiant disorder (ODD), which is diagnosed
when a youngster behaves in a hostile and defiant manner
for at least 6 months. If conduct disorder (CD) is present,
(ODD), which can start in preschoolers, is not diagnosed.
School-aged youngsters who act out their feelings or
impulses toward others in extensive destructive activity for a
period of 6 months or longer manifest CD, which is a
disruptive behavior disorder.
Aggression and Conduct Disorder
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Two pathways exist to CD
1. Is the onset of conduct problems in early
childhood, for example in preschool.
2. Is the onset of conduct problems in adolescence.
This is the more prevalent pathway.
Treatments to CD include parent training in handling the
behavior of the child or adolescent; family therapy;
problem solving, etc (refer to page 202). Treating CD
successfully is difficult.
Attention Deficit Hyperactivity
Disorder
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Some children are unable to sit still, focus attention, take
turns, and keep quiet. They are impulsive, easily distracted,
bother others, interfere with learning, and disrupt attentional
processes in the classroom. They are currently labeled as
having ADHD.
Three types of ADHD
1. Inattentive ADHD – low attention spans, etc (refer
to page 203).
2. Hyperactive-impulsive ADHD – fidget and squirm,
don’t stay seated or quiet, etc.
3. Most common type of ADHD is combined ADHD –
the combination of the inattentive and hyperactiveimpulsive types.
Attention Deficit Hyperactivity
Disorder
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5% of children have ADHD, about three times as many boys
have ADHD as do girls.
According to Barkley (1989), six approaches have proven
efficacy with children with ADHD:
1. Medication (stimulants and anti-depressants).
2. Behavior therapy in the clinic or laboratory.
3. Parent training.
4. Training teachers in the classroom behavior
management.
5. Cognitive-behavior therapy.
6. Combined treatments.
Cognitive Deficits and Head
Injuries
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The physical causes of cognitive deficits of children and
adolescents include illness, disease, and accident.
Head injuries affect the brain and impede the cognitive and
language development and functioning of the child or
adolescent.
The psychosocial causes of cognitive deficits of children and
adolescents include poverty, inadequate housing, and nonaccidental injury. Child welfare authorities are mandated to
protect the child from further maltreatment.
Global cognitive deficits, which include mild, moderate,
severe, and profound levels of retardation, influence many
aspects of functioning.
Cognitive Deficits and Head
Injuries
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Social workers reduce risk factors for cognitive deficits in
children and help family members acquire the resources
needed for improving the cognitive functioning of their
children.
Cognitive skills are enhanced and cognitive deficits are
remediated by social workers using a team approach with
participation from school, health, and child welfare
practitioners. Neurodevelopmental social workers provide
clinical social services to children and adolescents with
acute and chronic illnesses and their families.
Eating Disorders
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Young people with eating disorders are afraid of gaining weight.
Children and adolescents who have eating disorders such as
anorexia nervosa eat too little and are put at risk for starvation,
even death.
Other youngsters with bulimia nervosa eat too much food at one
time, putting their health at risk with becoming overweight. To
prevent gaining the weight, they get rid of the food they have
eaten by taking enemas or laxatives, exercising incessantly, and
vomiting.
Many persons with eating disorders are adolescent females who
are concerned about their appearance and body image.
Eating disorders are related to depression in children and
adolescents, but also represent a particular class of disorders in
their own right.
Schizophrenia and Autism in
Children
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Children with schizophrenia usually have a poor pre-morbid
adjustment, high rates of insidious onset, and poor
outcomes (Asarnow, 1994).
Symptoms exhibited by very young children with
schizophrenia include lethargy (newborns), preservation (312 months), and hypotonic and phobias (2 years) (Bryan,
1993).
The ability of children with schizophrenia to experience
pleasure is less than that of other children. Youngsters who
have schizophrenia have difficulties in contact with reality as
observed by their delusions or disordered thoughts and
hallucinations; they sense things that objectively do not
exist.
Schizophrenia and Autism in
Children
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Social workers distinguish between healthy children who
have imaginary playmates and youngsters with
schizophrenia and related disorders who hear and see
things or people.
3 out of every 1,000 adolescents has schizophrenia. It is
treated by psychotropic medications.
Autism or autism spectrum disorder appears during infancy.
Such children show little awareness of others and have
major problems in interpersonal interaction and
communication.
1 out of 1,000 children have autism spectrum disorder, and
it is treated by behavior therapy.
Substance Abuse
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Many adolescents with substance abuse disorders also have
other mental disorders.
Substance abuse during adolescence is sometime a precursor
to adult substance abuse with attendant health, mental health,
occupational, and social difficulties.
Environmental factors play an important role in adolescent
substance abuse. However, at times, family members do not
realize that their child is abusing drugs.
Adolescents with substance abuse disorders participate in the
purchase and sale of a wide range of licit and illicit substances,
including alcohol, nicotine, caffeine, marijuana, cocaine, and
heroin.
Substance abuse is a socially learned phenomenon.
Youngsters who are exposed to models who participate in
substance abuse are tempted to engage in such activity.
Substance Abuse
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Motivational factors also play a role in substance abuse and
recovery. Recovery from substance abuse requires
motivation to return to a drug-free state.
 Social class and culture play significant roles in substance
abuse. Norms about the use of various substances, such as
alcohol, vary widely among ethnic groups.
 Drug abuse prevention programs, which have had varying
rates of success, focus on education about the nature and
effects of harmful substances.
 Adolescent substance abuse is treated in mental health and
substance abuse impatient hospitals and outpatient clinics.
Youngsters who are addicted to drugs take many years to
overcome their addictions as they spiral through treatment
programs.
Mental Health Services
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The child mental health services system consists of
mental health and substance abuse, general health,
education, child welfare. And juvenile justice sectors,
which have inpatient, residential, partial, outpatient,
emergency, and preventive components (Burns, Angold
& Costello, 1992).
A team approach is used to provide individualized and
culturally sensitive care to children and adolescents and
their family in or near their home.
School Mental Health
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Many mental health problems have their roots in or are
exacerbated by children’s school experiences (Maughan,
1988).
 Children and adolescents with mental health problems
generally attend school.
 Learning disorders affect the ability of young people to
receive or express information. About 5% of the public
school children are identified as having a learning disorder.
 Youngsters in special education programs include those
with mental retardation and other developmental disabilities
that require major instructional accommodations, and those
with severe emotional and behavioral problems that make it
difficult for them to get along with others.
School Mental Health
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More children receive mental health services in schools
than in mental health settings (Zahner, Pawelkiewicz,
DeFrancesco, & Adnopoz, 1992).
The West Australian Child Health Survey recommends
finding ways to raise the level of parental involvement
and support of the schools; increasing support of
students, parents and teachers; and alleviating extreme
poverty in the community.
Family Mental Health
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The mental health of children and adolescents occurs within
a family context. Many mental health problems, such as
anxiety, depression, and CD, occur within families (Kazdin,
1991).
 Social workers assess to what extent mental disorders are
prevalent within a family, to what extent they are inherited
genetically or transmitted psychosocially from one
generation to another, and to what extent the family
dynamics are conducive to mental health.
 Family difficulties, including violence, separation and
divorce, and child maltreatment influence the social and
emotional development of young people and are related to
their mental health (Goodyear, 1990).
Family Mental Health
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Attachment theory is a component of a developmental
perspective furthering the understanding of mental disorders
of children and adolescents (del Carmen & Huffman, 1996).
Social workers involve family members in enhancing the
mental health of children and adolescents. The parents of
only children with mental health problems are usually more
willing to seek help than parents of two children (Richards &
Goodman, 1996).
Racial minority children and adolescents, including African
Americans and Native Americans, have greater difficulty
attaining adequate mental health care than do the majority of
children and adolescents.
Family Mental Health
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Strategic Structural Systems Engagement, a planned
and purposeful way of joining and diagnosing a family
from the initial contact to the first therapy interview, has
been shown to be effective in bringing hard-to-reach
Hispanic families into treatment (Santisteban,
Szapocznik, Perez-Vidal, Kurtines, Murray, & LaPerriere,
1996).
Sexual Abuse
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Sexual abuse is sometimes accompanied by other forms of
child maltreatment, including physical or emotional abuse or
neglect, which makes treatment more complex.
Sexual abuse is a serious child and family welfare problem
that often has serious mental health consequences. Many
cases of dissociative identity disorder appear to follow
sexual abuse.
Sexual abuse puts adolescents at risk of sexually acting out
and makes them vulnerable to pregnancy and sexually
transmitted diseases, which are the main risks of teenage
sexual behavior.
1 out of 4 sexually active adolescents are infected with a
sexually transmitted disease prior to high school graduation
(Pruitt, 1999).
Sexual Abuse
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About one million teenagers become pregnant each year,
with almost half giving birth. Many adolescents report a
high prevalence of engaging in HIV-related risk behaviors
(DiClemente, Stewart, Johnson, & Pack, 1996). Long-term
consequences of sexual abuse include difficulty in
informing constructive adult sexual relationships.
Many juvenile sex offenders are victims of sexual abuse.
Treatment of adolescent sex offenders is usually
confrontational and punitive. A survey of practitioners by
Muster (1992) suggested that treatment ought to be
flexible and not limited to a confrontational style.
Community Mental Health
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Community and public health factors, such as crime and
stress, are related to the development and manifestation of
mental disorders.
In conducting assessments of children and adolescents,
social workers consider five broad questions pertaining to
mental health in their communities.
1. To what extent are mental health disorders of
children and adolescents manifested within the
community?
2. How do community services and agencies prevent
and treat mental disorders of children and
adolescents?
3. How does community functioning affect the mental
well being of young people?
Community Mental Health
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4. How do community mental health agencies affect or
interact with the functioning of other community
agencies with which the youngster is involved?
5. How successfully are mental disorders treated within
the community?
Most mental disorders of children and adolescents can be
treated or managed within supportive communities. For
example, the YWCA, YMCA, YWHA, YMHA, scouting and
Boys and Girls Clubs.
Many settings including hospital, clinics, employee
assistance centers, family service agencies, and child
guidance and evaluation clinics, promote the mental health
of children and adolescents.