11/26/2013 C H A R L I E B I S S

The Mental Health of Our Children and Their Families

What Everyone Should Know

Objectives

Historical Context

Public Health Model for Mental Health

Normal Development Context

When to Seek Help

Mental Health Disorders Prevention Treatment

Trauma Context

Historical Context

1900 State Hospital Movement

1960 Community Mental Health Movement

1985 Child Adolescent Service System Project

2001 Trauma Movement

2010 Public Mental Health Movement

Public Health is what we do as a society to assure the

conditions in which people can be healthy.

4 Core Concepts

Focuses on entire population

Promotes everyone’s good health with policy, accurate data, solid research

Determines risk and protective factors and social determinants

Constantly assesses Intervenes with policy

Assures access to quality care

10M Report 2009 Preventing Mental Health, Emotional, Behavioral Disorders Among

Young People

Prevention is a paradigm shift

Mental Health and Physical health are inseparable

Successful Prevention is interdisciplinary

Mental, Emotional, Behavior disorders are developmental

Coordinated community level systems are needed to support young people

Public Health Pyramid

What is Children’s

Mental Health?

Early Childhood Mental Health

The Social, emotional and behavioral well-being of young children and their families

The developing capacity to: Experience, regulate, and express emotion

Form close, secure relationships

Explore the environment and learn

Adapted from ZERO TO THREE

Mental Health can be compromised at many critical times in a child’s development.

Professionals need to promote mental health in activities that are aimed at:

Prevention

Risk Assessment

Diagnosis

Risk Factors

Genetic

Chronic Medical Illness

Social Risk (Poverty, Violence)

Family Risk

Skill Deficiencies (Child & Family)

Protective Factors

Positive Self Esteem

Active Style of Responding to Stress

Ability to Elicit Positive Attention from Adult

Risk and Protective factors

Resilient children tend to have had environments that are supportive in critical ways and the capacity for resilience develops over time in the context of environmental support (Egeland, Carlson & Sroufe,1993)

Prevalence

½ of all lifetime Mental Illness begins by age 14

21% of children (9-17) have a diagnosable Mental Disorder

1-5 get help

Pediatric behavioral developmental and Mental Health issues are more common than cancers, cardiac problems, and renal problems combined

Psychosocial Screening

Indicates severity of symptoms

Assesses severity within given time period

Assesses the environments where symptoms occur

Provides a way to begin the conversation

Pediatric Symptom Checklist

35 or 17 questions

When to Refer

Dysfunction in many domains home, school, peers

Family or child asks for referral

You are uncertain what to do

Child psychotic or suicidal

Child not responding to treatment

Promote Mental Health Wellbeing Birth to 11 Months

It is about the relationship between parent and child

Child Brings Parent Brings

Temperament Stress

Physical attractiveness Past experiences with Children

Health Their experience of being nurtured

Energy Emotional and Physical Health

Concerning Behaviors with Infants

Poor Eye Contact

Not Bright Energy or Smiling at Parent

Lack of Vocalization

Not Settling with Parent’s Voice

Low Activity Level

Issues

Attachment

Secure

Insecure and avoidant

Insure by ambivalence and resistance

Child Maltreatment

Promote Mental Health Wellbeing Early Childhood 1-4

Developmental Task

Ability to rely on self

Able to learn self discipline with limits

Able to direct energies and interact with others (parents, child care, etc.)

Autonomy and independence develops from the base of caring, connectedness, and trust with family.

When behaviors are off track:

Look at:

A – Antecedents

B – Behavior

C – Consequences

When behaviors are off track:

Look at:

Developmental Capacity

Physical Health Conditions

Temperament

Child and Environment

Attachment of Child & Family

Family Understanding of Child’s Behavior

Other Context in Family or Community

Time to do Autism Screen if:

Child has little interest in:

Being held

Wanting to be close

Interacting

Smiling

Eye contact

Vocalization

Social play

Promote Mental Health and Emotional Well-being: Middle Childhood 5 to 10 Years

Major cognitive development

Mastery of cognitive, physical, social skills

Growing independence

Interest in friendship

More aware of world around them

Development of self esteem

Success at school depends on social skills

Positive connections to adults

Family needs to promote positive social skills and reinforce desire behavior.

Protective Factors Keep Child Resilient in Face of Risk Factors

Warm Supportive Relationship between Parents and Children

Positive Self–Esteem

Good Coping Skills

Positive Peer Relationships

Interest in and Success at School

Good relationship with other adults

Ability to articulate feelings

Parents are doing well in all environments

Common Disorders

Attention Deficit/hyperactivity disorder ADHD 3-6% of all children

Overactive Impulsive

Inactive to:

• Learning • Having fun • Relationships

ADHD

Family and school should emphasize:

Learning Impulse Control

Building Self Esteem

Acquiring Coping Skills

Building Social Skills

Anxiety Disorders

Anxiety can be a normal feeling but too much is bad.

Look at ADHD and depression

Causes for Assessment

Mood Disorders

Depression

Bipolar

Overwhelming feeling of sadness, sleep problems, loss of interest in activities

When is the last time you really had a good time?

Bullying

½ school age child have been bullied

Verbal, Physical, Relational, Extortion, Cyber Bullying

Substance Abuse

Parents Model Behavior!

EDUCATE

EDUCATE

EDUCATE

Promoting Mental Health and Emotional Well-Being: Adolescence – 11 to 21 Years

Learning to cope with stress and adversity

Involvement in personally meaningful activities

Perspectives of interested parties

Developmental factors

Focuses on cultural factors

Protective Factors

Sports, Music, Prosocial Community Service

Solid Peer Relationships

Family Attachment

Ability to Problem Solve

Ability to talk about Feelings

Depression and Anxiety

Wide mood changes are normal, but unreasonable fear, anxiety, lasting depression, low self esteem, and

feeling worthless is not.

Depression and Anxiety

These feelings might look: Sad

Irritable

Angry

Bored

Difficulty at: School

Home

Friends

Suicide

As many as 20% contemplate it

2nd leading cause of death

Need talk openly about it

Trauma

ACE Study

10 Childhood Traumas

Count the Kind

Starling Results

Adverse Childhood Experiences Adverse Childhood Experiences

Social, Emotional, &

Cognitive Impairment

Adoption of Health-risk Behaviors

Disease, Disability

Early Early

Death Death

The Influence of Adverse

Childhood Experiences Throughout Life Life

Death B

Death

Birth

Adverse Childhood Experience (ACE) Are Common

Abuse: Emotional 10.6% Physical 28.3% Sexual 20.7% Neglect: Emotional 14.8% Physical 9.9% Household Dysfunction: Mother Treated Violence 12.7% Household Substance Abuse 26.9% Household Mental Illness 19.4% Parent Separation/Divorce 23.3% Incarcerated Family Member 4.7% N 17, 337

Number of categories adverse childhood experiences are summed …

ACE score Prevalence 0 36.1% 1 26.0% 2 15.9% 3 9.5% 4 or more 12.5%

Adverse Childhood Experiences Score

Trauma Informed Care

Survivors need to be respected, informed, connected, and hopeful

Find out about relationship between trauma and systems of substance abuse, eating, depression, anxiety

Work with family, friends, others to empower survivor