1. Youth and Co-Occurring Disorders

2. Disorders First Diagnosed in Infancy, Childhood or Adolescence Attention Deficit/Hyperactivity Disorder Attention Deficit/Hyperactivity Disorder Conduct Disorder Conduct Disorder Oppositional/Defiant Disorder Oppositional/Defiant Disorder Other frequently diagnosed disorders Depressive disorders Depressive disorders Anxiety disorders Anxiety disorders Posttraumatic Stress Disorder Posttraumatic Stress Disorder Bipolar Disorder Bipolar Disorder

3. Co-Occurring Prevalence Rates From the reading assignment Among inpatient substance abuse cx 75-80% cod Risk of substance dependence-youth with mental disorder 4X greater than general population Of incarcerated youth with sud 2/3 have another d/o Among substance abusing offenders 50% have ADHD

4. Signs of depression in youth (NIMH report) Frequent vague physical complaints Frequent vague physical complaints Frequent absence or poor performance at school Frequent absence or poor performance at school Talk of or efforts to run away from home Talk of or efforts to run away from home Outburst of shouting, complaining, crying, irritability Outburst of shouting, complaining, crying, irritability Boredom Boredom Lack of interest in playing with friends Lack of interest in playing with friends

5. Signs of depression, cont. Substance abuse Substance abuse Social isolation Social isolation Poor communication Poor communication Fear of death Fear of death Extreme sensitivity to rejection or failure Extreme sensitivity to rejection or failure Increased irritability, hostility or anger Increased irritability, hostility or anger Reckless behavior Reckless behavior Difficulty with relationships Difficulty with relationships

6. Assessment What observations can you make related to the MSE? What observations can you make related to the MSE? What symptoms are apparent? What symptoms are apparent? Assess: Assess: Dangerousness Dangerousness Therapy-interfering-behavior Therapy-interfering-behavior Quality-of-life-interfering behavior Quality-of-life-interfering behavior Skill training opportunities Skill training opportunities What skills is Miller using? What skills is Miller using?

7. Values and Principles-Page 1 Early identification and intervention Early identification and intervention Access to comprehensive services Access to comprehensive services Least restrictive environment Least restrictive environment Full family involvement and linkage between service systems Full family involvement and linkage between service systems Care coordination Care coordination Smooth transition to adult services when needed Smooth transition to adult services when needed Children’s rights protected and advocacy Children’s rights protected and advocacy No discrimination No discrimination

8. Discussion questions: Mental Health Treatment for Youth 1. Identify and discuss the four services included in the Service Continuum. 2. List one or two key points for each service. 3. Identify the Promising Practices. Choose one to discuss in detail. What questions about it do you have? 4. What approaches are ineffective with youth?

9. Service Continuum-Justice system- involved youth 1. Prevention Universal Universal Selective Selective Indicated Indicated 2. Diversion Policies and Programs and Community-Based Alternatives to Incarceration 3. Mental Health Screening, Assessment, Referral and Treatment 4. Aftercare Services

10. What works? Multisystemic Therapy Multisystemic Therapy Functional Family Therapy Functional Family Therapy Wraparound Wraparound Cognitive-Behavioral Therapy Cognitive-Behavioral Therapy Multidimensional Treatment Foster Care Multidimensional Treatment Foster Care

11. What doesn’t work?

12. Suicide attempt rates Overall Rate 3% Kids with major depression 22% Kids with sud 25% “Runaways” 3X the risk Aggressive bx in boys 2X the risk Panic attacks in girls 3X the risk

13. Prevalence Rates Mental Disorders-general youth population 22% Mental Disorders-Juvenile Justice population 60% PTSD in incarcerated girls 50% Anxiety or mood disorders 1/4 - 1/3 Incarcerated and suicidal 19%

14. DVD-Youth Assessment Engagement Engagement Screening- http://www.chestnut.org/li/gain/ Screening- http://www.chestnut.org/li/gain/ Quadrant Quadrant Diagnosis Diagnosis Cultural and linguistic supports and needs Cultural and linguistic supports and needs Problem domains Problem domains Treatment plan Treatment plan ***What are the most important points re: assessment of youth?

15. Important points Youth have less autonomy than adults, affecting engagement Youth have less autonomy than adults, affecting engagement Level of severity is evaluated differently. Level of severity is evaluated differently. Diagnosis is less important than behavior. Diagnosis is less important than behavior. Culture is first, a source of support. Culture is first, a source of support. Multisystemic approach is needed. Multisystemic approach is needed. Rolling with resistance. Rolling with resistance. S/I-follow up with risk assessment. S/I-follow up with risk assessment.

16. Characteristics of effective treatment for youth with COD 1. Integrated 2. Comprehensive 3. Intensive 4. Long term 5. Aftercare

17. Bipolar Disorder in Kids: The Conversation on KUOW, 94.9 http://www.kuow.org/program.php?id=13 475 http://www.kuow.org/program.php?id=13 475

18. Review symptomotology 1. In your group you will be assigned a disorder. 2. Develop the scenario according to the instructions. 3. Trade scenarios with another group. 4. Identify sx and signs of disorders. 5. Identify the most likely diagnosis.