the essentials of mental health care in can n.
Skip this Video
Loading SlideShow in 5 Seconds..
The Essentials of Mental Health Care in CAN PowerPoint Presentation
Download Presentation
The Essentials of Mental Health Care in CAN

Loading in 2 Seconds...

play fullscreen
1 / 37

The Essentials of Mental Health Care in CAN - PowerPoint PPT Presentation

  • Uploaded on

The Essentials of Mental Health Care in CAN. Lucy Berliner ISPCAN Honolulu September 28, 2010. Colleagues. Here: Tine Jensen, University of Oslo & Norwegian Centre for Violence and Traumatic Stress Studies Lutz Goldbeck , University Hospital Ulm Not Here:

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'The Essentials of Mental Health Care in CAN' - kevlyn

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
the essentials of mental health care in can

The Essentials of Mental Health Care in CAN

Lucy Berliner



September 28, 2010

  • Here:
    • Tine Jensen, University of Oslo & Norwegian Centre for Violence and Traumatic Stress Studies
    • Lutz Goldbeck, University Hospital Ulm
  • Not Here:
    • David Kolko, University of Pittsburgh
    • Ben Saunders, Medical University of South Carolina
    • Laura Murray, Johns Hopkins University
    • Shannon Dorsey, University of Washington
what do we know
What Do We Know
  • Emotional and behavioral problems for CAN
    • The usual: anxiety (incl PTS), depression, behavior problems
    • Effects vary
    • Not all children need formal therapy interventions
    • Some interventions (lack of ) can make children worse
      • Remaining in an environment where the children are very scared all the time
      • Multiple out of home placement moves
  • There are effective treatments
the special case of attachment insecurity
The Special Case of Attachment Insecurity
  • Insecure attachment rates are high
  • Insecure attachment is an adaptation, not a pathology
    • Perceptions matter (e.g., labeling, reduced expectations)
  • Secure attachment can be achieved
    • Many standard parent-child interventions
      • Promote attachment security


      • Reduce child behavior problems
the essentials
The Essentials
  • Identify abuse/trauma/neglect
  • Establish basic safety
  • Determine what the problem is
  • Engage the family and child
  • Systematically address current mental health problems
    • Child
    • Child-parent
identify abuse trauma neglect
Identify Abuse/Trauma/Neglect
  • Ask routinely
    • Child welfare, mental health, health, juvenile justice
  • Why?
    • Children will tell
    • Demonstrates:
      • Normalization (e.g., not alone)
      • Validation
    • Begin exposure
basic safety
Basic Safety
  • Consider psychological as well as physical
  • Separate when necessary (minority of cases)
    • Sexual assault
    • Serious and very serious physical abuse
  • Reduce risk
    • Explicitly address violence (don’t avoid)
    • Written safety plan
    • Reduced force contract
    • Monitoring (formal and informal)
assess to determine problem
Assess to Determine Problem
  • Identify the target problem
    • Clinical interview (specific)
    • Standardized measures
    • Observation
    • Collateral (when indicated)
  • Give Feedback
    • To child/family
    • Achieve agreement
approach to clinical interview
Approach to Clinical Interview
  • Communicate interest and commitment to be helpful; be warm
  • Take open-ended, inquiring, non-judgmental stance
  • Elicit child and family perspective
  • Use prompts and then listen and encourage elaboration
  • Focus more on the ***here and now***, less on history except as critical to understanding the clinical problem(s) now

Posttraumatic Stress Disorder (PTSD):

Child PTSD Sx Scale (CPSS)

  • Kids 7/8 and older
  • Add up child’s responses to sx items 1-17
  • Clinical score: 12+
  • May use DSM IV algorithm for dx
  • Impairment questions (7 at the bottom) not scored
anxiety scared
Anxiety: SCARED
  • Kids 7/8 +
  • Add up responses
  • Anxiety scale:

Clinical = 3+

  • PTS scale:

Clinical = 6+

depression moods and feelings q
Depression: Moods and Feelings Q

Kids 7/8+

Add up responses

Clinical = 11+

overall problems pediatric symptom checklist 17 psc 17
Overall Problems: Pediatric Symptom Checklist-17 (PSC-17)

Parent/caregiver report4-17 years

Total Score clinical = 15+

Internalizing clinical = 5+

Attention clinical = 7+

Externalizing clinical = 7+

engagement in services
Engagement in Services
  • Overcoming barriers
    • Beliefs about counseling
    • Prior unhelpful experiences
    • Problem solving concrete obstacle
  • Increasing in motivation to change
    • Assessing stage of change
    • Moving towards change
initial encounter to enhance treatment engagement
Initial Encounter to Enhance Treatment Engagement
  • Elicit client concerns
  • Communicate hope and confidence “I can help you”
  • Find out about previous counseling experiences or attitudes toward therapy and provide psychoed
  • Proactively addressing things that could keep people from coming back – the concrete barriers
stages of change
Stages of Change

Not ready On the fence Ready

(Precontemplation) (Contemplation) (Action)

key strategies
Key Strategies
  • Secure agreement to discuss topic
  • Explore importance
    • Goal is to increase
  • Explore confidence
    • Goal is to increase
  • End on good terms
    • Summarize
    • Praise effort

Reasons NOT to Change

Reasons to Change

Results of NOT Changing

Results of Changing

Decisional Balance Scale

change talk
Change Talk
  • Always attend (pay attention and respond) to change talk
  • Elicit disadvantages of status quo
    • Negative aspects of not changing (elicit the specifics)
    • “What will happen if you don’t change?”
  • Identify advantage of change
    • Positive aspects of change (elicit the specifics)
    • “What will be better if you do change?”
addressing identified mental health problems
Addressing Identified Mental Health Problems
  • Strategies across all targets:
    • Feedback on the nature and level of the problem
    • Information about the condition (s)
      • What it is
      • Causes and what keeps it going
      • Treatment model
    • Managing negative emotions
    • Promoting accurate and helpful cognitions
clinical targets
Clinical Targets
  • Depression
  • Anxiety
    • Includes PTSD
  • Behavioral
    • Oppositionality
    • Conduct
    • Conflict
    • Attention
key ingredient changing behavior
Key Ingredient: Changing Behavior
  • Anxiety = Exposure
    • Child faces fears (real and imagined)
  • Depression = Activation
    • Child increase activities that produce positive affect
    • Child takes steps toward goals
  • Behavioral Problem = Interactional skills
      • Parent uses positive parenting
      • Parent and child learns social skills (communication, problem solving)
gradual exposure steps
Gradual Exposure Steps
  • Explain mechanism
  • Imaginal and in vivo
    • Imaginal = imagining the feared situation
    • In vivo = facing cues in environment
  • Make a plan
  • Gradual steps
  • Reinforce safety
  • Do SUDs ratings before, during and after
  • Never leave the session with high anxiety
behavioral activation steps
Behavioral Activation Steps
  • Identify goals (“build the life you want”):
    • Have friends
    • Accomplish a task
    • Get on team
  • Break steps into small pieces
  • Make a specific plan
  • Anticipate obstacles
find a positive action that lifts mood
Find a Positive Action that Lifts Mood
  • Listen to music, watch a funny show or smell a flower
  • Notice difference in mood
  • Experience control over emotions
behavior problems steps
Behavior Problems Steps
  • Working with the caregiver is KEY
  • If you aren’t seeing the caregiver, in most cases, you can’t treat the behavior (especially with young kids)
    • PCIT, Triple P, Incredible Years, Helping the Noncompliant Child
  • So…who’s buy-in do you need?
first functional behavior analysis
FIRST: Functional Behavior Analysis
  • Define the problem behavior: What’s it look like, sound like?
    • Make it behavioral
  • Define the positive opposite
  • Get the details: Frequency, Duration, Intensity
  • Plan depends on the details
key components
Key Components
  • Increase positive time together
    • Planned child-lead, fun, parent-child interactions
  • Praise
    • Attend to/praise positive behavior (positive opposite)
  • Selective attention
    • Actively ignore minor irritating (attention-seeking) behavior
  • Giving effective instructions
    • Reasonable, understandable and doable instructions
  • Rewards Plan
    • Always start here; make them meaningful
  • Consequences for misbehavior
    • Non-violent
    • Consistently and immediately applied
maximizing effectiveness of mental health intervention
Maximizing Effectiveness of Mental Health Intervention
  • Promote family as primary resource for child
  • Take a collaborative approach with families and children that involves them in all aspects of the process
  • Identify and reinforce natural supports and resources
  • Make formal intervention as brief as is necessary
summary of essentials
Summary of Essentials
  • Assess problems/needs for child and family
  • Have some form of measurement of progress
  • Engage and motivate child and family
  • Secure agreement for treatment focus
  • Select treatment approach matched to identified problem (s)
  • Apply interventions systematically
anxiety and depression manuals
Anxiety and Depression Manuals
finding evidence supported treatments on the web
Finding Evidence Supported Treatments on the Web