2. Children and Mental Health Presented by Amanda Baleiko

3. Other Mental Disorders in Children Anxiety Disorders –Highest prevalence among children and adolescence Separation anxiety disorder Generalized anxiety disorder Social phobia Obsessive compulsive disorder

4. Separation Anxiety Disorder Children may cling to parent and have difficulty falling asleep at night. 4% of children and adolescents suffer from separation anxiety.

5. Generalized Anxiety Disorder Children worry excessively about all upcoming events and occurrences. Children may become perfectionists and seek constant approval. Approximately 5% of all ages will suffer over a lifetime.

6. Social Phobia Characterized by a fear of being embarrassed in social situations, performing in front of or conversing with others, or eating, drinking or writing in public. Reactions include tremors, sweating,clinging, and timidness. Lifetime prevalence ranges from 3-13%

7. Obsessive Compulsive Disorder Characterized by recurrent, time consuming obsessive or compulsive behaviors that cause distress and/or impairment. 0.2-0.8% of children and 2% of adolescents are afflicted.

8. Treatment of Anxiety Phobias: –Systematic desensitization –Modeling –Cognitive behavioral therapy Generalized anxiety and Separation anxiety –SSRIs –Psychodynamic treatment OCD –SSRIs –Cognitive behavioral therapy

9. Autism Most common pervasive developmental disorder Severely compromised ability to engage in social interactions. Rooted in brain abnormalities and genetics. Treatment –Promote social and language development. –Halperidol (antipsychotic) and SSRIs prove to be helpful.

10. Disruptive Disorders Oppositional defiant disorder Conduct disorder

11. ODD Child displays a pattern of disobedience, defiance and hostility toward various authority figures. Characterized by persistent fighting and arguing, being consistently annoyed or annoying, losing temper, non-compliance, and resentfulness.

12. Conduct Disorder Children behave aggressively –Bullying –Assaulting –Animal cruelty –Vandalism and theft –Substance abuse 1-4% among 9-17 year olds Both biological and psychosocial in nature Treatment – parent training

13. Substance Abuse Disorders Many have an additional mental disorder. Family therapies are superior to other treatment approaches.

14. Eating Disorders 3% of young women have one of the 3 main eating disorders: –Anorexia Nervosa –Bulimia Nervosa –Binge-eating disorder

15. Eating Disorders (cont.) Anorexia Nervosa –Low body weight –Fear of weight gain –Poor body perception Bulimia Nervosa –Binge-eating followed by compensatory activities Binge-eating - Uncontrolled consumption without compensatory activities. Treatment: psychotherapy and antidepressants

16. Treatment Interventions Outpatient Partial hospitalization/day treatment Residential treatment centers Inpatient treatment

17. Outpatient –6-12 weeks –Psychotherapy Partial hospitalization –Structured daily environment –Combines education, counseling and family interventions. RTCs –More restrictive –24 hr. facility –Treatments include: psychoanalytic, educational, behavior management, group therapy, and medication management Inpatient –Most restrictive –Children with severe disorders

18. Community Based Interventions Case management Home-based services Therapeutic foster care Therapeutic group homes Crisis services

19. Case Management Coordinates services for children and families from multiple providers (CYICM) Home-Based Intensive services within the home. Preserve family integrity Create support system Strengthen coping skills Therapeutic Foster Care Private homes with trained foster parents *best treatment/cost ratio Therapeutic Group Homes Learning social and psychological skills 5-10 clients/home Individual/group therapy and behavior modification Crisis Services Furnish immediate care in emergency situations 1. Evaluation 2. Intervention and stabilization 3. Follow-up

20. Service Delivery Utilization – many children who need services aren’t getting them (70%) –Stigma associated with mental health services –Cost of treatment Early termination - 40-60% of families drop-out Poverty – minority children Culture – racial/ethnic differences in help- seeking

21. Service Financing Private Sector Health insurance model Long term care is not covered Limited hospital stays Denial of needed treatment Financed by managed care Public Sector Wide ranging services Medicaid and state/local departments of mental health are required to support Offers long term funding CHIP – program for uninsured children IDEA – schools are mandated to provide special education services

22. Culturally Appropriate Services Mental health programs attempting to serve diverse populations must incorporate an understanding of culture, traditions, beliefs, and culture-specific family interactions into the design, and form working partnerships in the community.

23. Support and Assistance for Families Family is defined as a “partner in care” Family support – assistance for families to cope with the stresses of caring for a child with emotional disabilities Counseling (support groups) –Helps parents to better understand and communicate with their children Education –Strengthens skills needed to interact with the system

24. Integrated Systems Model A large number of children are served in systems other than mental health 1. Mental health services must be driven by the needs and preferences of the child and family 2. The management of services must be community based and collaborative 3. Services must be responsive to cultural backgrounds

25. THE END Thanks for your patience!