Framework

2 Core Tools Framework Screening Tools Child and Youth Mental Health (CYMH) Screening Questions CRAFFT Secondary Assessment Tools Depression: KADS6, TASR-A Anxiety: SCARED ADHD: SNAP-IV 18 Referral Ministry of Children and Family Development – Child and Youth Mental Health Services Psychiatrists Pediatricians RACE Strongest Families BC Kelty Resource Centre Mood Enhancing Prescription/Worry Reducing Prescription Teen Functional Assessment (TeFA)/ Child Functional Assessment (CFA) CBIS Medication Algorithms Side effects Scales (Kutcher Side Effect Scale for ADHD Medication (KSES-A), Short Chehil-Kutcher Side (sCKS) Effects ScaleKutcher Side Effect Scale for ADHD Medication (KSES-A)Short Chehil-Kutcher Side (sCKS) Effects Scale Treatment and Management Tools Primary Assessment Tool Clinical Global Impression Scale (CGI)

3

Initial Screening

5  Historical Factors  Parental history of mental disorder  Family history of suicide  Childhood diagnosis of other disorders: Mental Health Screening Q’s by renjith krishnan

6  Marked change in usual: › Emotions › Behavior › Cognition, or › Functioning  Based on youth or parent report One or more of the above answered as YES child or youth is in a high risk group. The more YES answers, the higher the risk Mental Health Screening Q’s freedigital Hooded Person by Ambro

7 1.Over the past few weeks have you been having difficulties with your feelings, such as feeling sad, blah or down most of the time? ›If YES – consider a depressive disorder ›Apply the KADS evaluation Mental Health Screening Q’s 2.Over the past few weeks have you been feeling anxious, worried, very upset or are you having panic attacks? ›If YES – consider an anxiety disorder ›Apply the SCARED evaluation ›Proceed to the Identification, Diagnosis and Treatment of Child and Adolescent Anxiety Disorders Module

8 3.Overall, do you have problems concentrating, keeping your mind on things or do you forget things easily (to the point of others noticing and commenting)? ›If YES – consider ADHD ›Apply the SNAP-IV evaluation ›Proceed to the Identification, Diagnosis and Treatment of the Child and Adolescent ADHD Module by Boaz Yiftach Mental Health Screening Q’s

9 4. There has been a marked change in usual emotions, behaviour, cognition or functioning (based on either youth or parent report)  If YES – probe further to determine if difficulties are on-going or transitory.  Consistent behaviour problems at home and/or school may warrant referral to Strongest Families. by Boaz Yiftach Mental Health Screening Q’s

10  Overall, do you have problems concentrating, keeping your mind on things or do you forget things easily (to the point of others noticing and commenting)?  If YES – consider ADHD  Apply the SNAP-IV evaluation  Proceed to the Identification, Diagnosis and Treatment of the Child and Adolescent ADHD Module Mental Health Screening Q’s by Boaz Yiftach

11  Positive for Depression + Anxiety or ADHD › Apply KADS and protocol for Depression › After treatment, review for presence of continued Anxiety Disorder or ADHD  If continues positive for Anxiety Disorder › Refer to specialty mental health services  If continues positive for ADHD › Follow the protocol in the ADHD toolkit, OR › Refer to specialty mental health services Next Steps …

12 Use of SCARED in Assessment 12 Anxiety disorder is suspected: if score of 25 or higher 12

13 Kutcher Adolescent Depression Scale (KADS)

14 SNAP-IV Teacher and Parent 18-item Rating Scale

15  Psychotherapeutic Support & Non-Specific Interventions  Engaging the School  12 Steps to SSRI Treatment  Treatment of Anxiety Disorder  Treatment of Major Depressive Disorder  Treatment of ADHD  Side Effects Tools & Monitoring Treatment  Medication Adherence  Safety & Contingency Planning  Referral Flags Freedigitalphotos.net by Sujin Jetkasettakorn Treatment of Anxiety, MDD &ADHD

Psychotherapeutic Support & Non-Specific Interventions

17 Psychotherapeutic Support by Photostock

18  Approach › Create a supportive and safe space › Be real – you are you! › Compassionate & non-judgmental › Active listening  Eye contact, verbal & non-verbal › Ask for clarification  “Help me understand…” › Emotional Identification › Don’t surmise too quickly › If you don’t understand – inquire further › If you don’t know the answer – ASK › Establish confidentiality and the limits of – BE CLEAR Psychotherapeutic Support by Photostock

19  Enhance Motivation › Ask:  Questions to assess readiness for change  Pros and cons of staying the same/of engaging in change  What things were like before life became problematic  What things would be like if problem(s) was reduced/resolved › Examine:  What will get in the way & what will help  How caregivers can support youth’s efforts  Motivational issues › Use solution-oriented language Psychotherapeutic Support

20  Provide Education (to patient & caregivers) › Educate over 2 – 3 visits › What is a disorder and how is this diagnosed › Family history: things run in families › Very treatable! › Non-specific self-help strategies › Specific therapies can help (use CBIS) › Medications – how to and how not to › How will we know it’s working – monitoring/measure Psychotherapeutic Support

21  Coping Skills › Helpful & unhelpful ways of coping  Review skills  Increase healthy coping skills › Review wellness strategies  Healthy eating, regular activity, sleep  Make a plan › Relaxation & calming strategies  Mental imagery  Meditation  Muscle relaxation  Deep breathing Psychotherapeutic Support by Graur Razvan Ionut

22  Cognitive Strategy › Help identify important problem(s) at present › Help identify and challenge unhelpful thoughts › Teen comes up with solutions to problems › Teen practices challenging anxious/depressive thoughts › ASK:  What is interfering with your life most right now?  What are you most afraid of/concerned about?  What is the thought that causes the most distress?  How realistic is this thought?  Ask for evidence for and against the thought  Ask for a more realistic thought Psychotherapeutic Support

23  Behavioral Strategy › Avoidance Reduction › Gradually expose › Trusted person  Take youth to settings that trigger  sessions › ASK:  What are you currently avoiding or having distress with?  Is this behavior causing problems or difficulties?  Are there times you can face your fear and not avoid?  Who can help you with this?  When could you try this? Psychotherapeutic Support by Sujin Jetkasettakorn

24  Be Realistic › Discuss expectations › Discuss potential obstacles › Youth & family  Support  Engagement › Goals: o Decrease symptoms o Make symptoms manageable o Improve functioning o Set goals for recovery Psychotherapeutic Support by Photostock

25  Be Responsive › Urgent matters in office hours  Phone, , text messaging › Frequent face-to-face visits  15 – 20 minutes › Monitor/support wellness activities  Exercise, sleep & healthy diet › Access to care  Emergencies  Review crisis plan with teens & parents Psychotherapeutic Support by Andy Newson

26  Be Collaborative › Include caregivers in support plan  With youth consent › Care with other health providers:  Communication  Coordination  Collaboration Psychotherapeutic Support by renjith krishnan

27  Exercise  Sleep  Consistent Daily Routine  Positive Social Contact  Healthy Nutrition  Music & Movement  Bright Light  Avoid Drugs (including recreational drugs) Non-Specific Interventions by Photostock

28  Healthy Nutrition › Regular meals › Healthy snacks › Discourage:  Skipping breakfast  Excessive caffeine & sugar  Music & Movement › Improves mood › Decreases stress › Upbeat music and dance by zirconicusso Non–Specific Interventions

29  Bright Light › For lower moods/energy › Special lamp used  6 – 9 a.m. & 6 – 9 p.m. › Exposure to 2,500 lux or more in › winter months  Avoid Drugs (including recreational drugs) › Use alcohol in moderation  Alcohol can decrease anxiety and lead to misuse/abuse › Nicotine is also an effective anxiolytic  Can lead to addiction and long term negative health outcomes Non-Specific Interventions

30 by Graur Codrin Sleep Assessment

31  Develop outline of self-regulatory activities › Collaboratively developed › Child & parent implement – meaningful to individual › The importance of prescription!  MEP tool for managing stress › Helps child & family identify and plan daily activities › Found in Clinicians Tool Kit  Review MEP at office visits Mood Enhancing Prescription (MEP)/Worry Reducing Prescription (WRP)

32 Mood Enhancing Prescription (MEP) Worry Reducing Prescription (WRP)

33 Teen Function Assessment (TeFA) Child Functional Assessment (CFA)

34 Some clinicians like to use the Clinical Global Impression Scale (CGI) to monitor outcomes. This scale can be used in evaluating treatment for any mental disorder. Another Way to Monitor Treatment Outcomes … by Danilo Rizzuti

35  Compare how much the patient has improved or worsened relative to their baseline state at the  beginning of medication treatment. Clinical Global Impression Improvement Scale (CGI) 0 = Not Assessed 1 = Very Much Improved 2 = Much Improved 3 = Minimally Improved 4 = No Change 5 = Minimally Worse 6 = Much Worse 7 = Very Much Worse by Jscreationzs

36 USE CGI at every mental health visit Clinical Global Impression Improvement Scale (CGI)

37 C - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs? R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A - Do you ever use alcohol/drugs while you are by yourself, ALONE? F - Do you ever FORGET things you did while using alcohol or drugs? F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use T - Have you gotten into TROUBLE while you were using alcohol or drugs? Adolescent Alcohol & Substance Use Screen (CRAFFT)

38  Stress reducing strategies › Family members & caretakers › Other significant persons  Teacher, School counselor, Coach, Neighbor › Ask youth who can help › Ask parents for info on state & functioning  Youth & parents may have differing opinions Enlisting the Help of Others by Digitalart

39   or Vancouver Kelty Mental Health Resource Centre

Referral Flags

41 Referral Flags ID stockxchng Refer at 3 different points Emergency Referral (prior to treatment initiation) >Suicide ideation with intent or plan >Major depressive episode with psychosis >Delusions or hallucinations

42 › Urgent Referral (treatment may be already initiated) › Usual Referral Referral Flags

43  Helpline for Children › (free – no area code required) › 24 hours/7 days › Do not have to give your name  Immediate danger › or local police  Resources › Ministry of Children and Family Development › › See “Handbook for Action on Child Abuse and Neglect” Abuse or Neglect Concerns