1. Mental Health Issues in Transition An Integration of Robert Baer’s Timelines for Transitional Planning and Eric Ericson’s Psychosocial Stages of Development Scott Campbell, MSW, LSW Disability Resource Coordinator Southeastern Ohio Center for Independent Living

2. Why do we care? People with disabilities are often helped, even pushed, through the system (just name the system) without any consideration of the impact on their emotional/psychological development.

3. Co-Morbidity of Mental Health and Disability in the United States http://www.infouse.com/disabilitydata/mentalhealth/mentalhealth.pdf Uses Four Different Definitions of Disability: Functional disability, any serious symptoms of mental illness that severely interfered with life for the past year Work disability, is defined as a limitation in or inability to work as a result of physical, mental or emotional health conditions. Perceived disability refers to whether people consider themselves to have a disability or are considered by others to have one. Disability program recipient includes anyone covered by Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), special education or related services and/or disability pensions. )

4. Disability status In Millions % of U.S. Pop % of People with Men tal Disorders Any disability 16.4 6.3% 69.8% (1 or more of 4) 1) Functional disability 15.0 5.8% 63.8% 2) Work disability 6.1 2.3% 30.0% 3) Perceived disability 8.4 3.2% 35.8% 4) Disability program 4.3 1.7% 18.3% recipient Figure 3: Prevalence of disability among those with mental disorders Sources: Adler (1996); Kennedy, et al. (1997) Survey: NHIS-D, 1994-95 More than two-thirds of people with mental disorders have a disability.

5. Introduction to Eric Ericson The stages of a person’s life are characterized by the person’s interaction with their environment. These stages are defined by internal conflicts the outcome of which determines the course of the life cycle. All stages are inter-related. This presentation is an attempt to show how these stages impact the lives and transition of those with disabilities.

6. Psychosocial Stages During the Primary Level 1.Trust vs. mistrust Ages birth to two years The child learns to trust or mistrust parental figures based on the parent’s reaction to the child’s needs. An outcome of mistrust leads to withdraw from others.

7. Impact of Stage One on Transition a. Trust is gained over time as the child learns any skill through encouragement. b. A final outcome of mistrust would be the result of lack of encouragement and lead to withdraw hindering future initiative for transition.

8. 2. Autonomy vs. Shame and Doubt Ages two years to four years Autonomy is the willingness and desire to try new things on one’s own. An outcome of shame and doubt leads to repetitive behaviors due to lack of willingness to try new things and thus step out of one’s comfort zone.

9. Impact of Stage Two on Transition a. Autonomy coincides with the development of disability awareness. i.e. I am my own person, a person of value, with my disability. b. Pampering the child in stage one in an effort to gain the child’s trust leads to shame and doubt. c. The child becomes dependent on the parent and unwilling to try new things which results in a sense of shame and doubt regarding one’s own abilities.

10. 3. Initiative vs. Guilt Ages four to six years Initiative is the sense of purpose which develops as a result of the willingness to obtain things on one’s own. A child engages in active investigation of his/her environment, including people. If that active investigation is discouraged the child develops a sense of inhibition which in turn leads to guilt for not taking initiative.

11. Impact of Stage Three on Transition a.An outcome of autonomy in stage two aids in the development of the initiative to seek desired wants. b. An outcome of shame and doubt in stage two would cause a lack of initiative. c. An outcome of initiative in stage three encourages the child to seek inclusive activities and to be active as opposed to passive in the development of social roles with peers.

12. 4.Industry vs. Inferiority Ages six years to twelve years Industry is the eagerness to build skills. To accomplish tasks on one’s own and to work together with others to accomplish tasks.

13. Impact of Stage Four on Transition a.An outcome of industry leads to competence in one’s own skills and thus the development of positive work habits. b. An outcome of inferiority would lead one lack of competence in one’s own skills thus enhancing the lack of initiative and presence of guilt described on stage three.

14. 5. Psychosocial Stage During Middle School and High School Identity vs. Identity Confusion Ages twelve to twenty two years Social interactions with peers are the main focus. Note that peer groups include those with and without disabilities.

15. Psychosocial Stage During Middle School and High School cont. Identity vs. identity confusion continued… Identity is linked to work and career goals Identity is also linked to interaction with peer groups

16. Impact of Stage Five on Transition Consider... Does the youth/young adult receive his/her identity from themselves or based on social interactions with others? What type of understanding of his/her disability does the child have? Are their interests based on their own ambitions or are they conformed with those of their peers?

17. Future Psychosocial Stages The psychosocial stages identified thus far represent the age groups that transition deals with. Future stages include: –Intimacy vs. isolation ages 22-34 –Generativity vs. stagnation ages 34-60 –Integrity vs. Despair ages 60-death

18. Future Consideration This presentation is an attempt to scratch the surface on an issue that is just beginning to be explored. Further discussion can be found in the American Psychological Association’s Guidelines for Assessment and Treatment with Individuals Who Have Disabilities http://forms.apa.org/pi/disability/guidelines.pdf