2016 IDEAS MENTAL HEALTH ISSUES IN CHILDREN AND YOUTH Torin D. - - PowerPoint PPT Presentation

MENTAL HEALTH ISSUES IN CHILDREN AND YOUTH Torin D. Togut Attorney at Law EDUCATING ALL STUDENTS JUNE 7-10, 2016

• ST. SIMONS, GEORGIA

2016 IDEAS

(1) Will learn what are the primary mental health diagnoses in children. (2) Will learn about the demographics of mental health disorders in children. (3) Will be able to list key Diagnostic Statistic Manual – 5 diagnoses of children with mental health disorders. (4) Will be able to summarize medications and side effects for treatment

• f mental health disorders in children.

(5) Will be able coordinate resources for the treatment and care of children and youth with mental health disorders. (6) Will be able summarize the System of Care in Georgia for the treatment and care of children and youth with mental health disorders. (7) Will be able to strategize with other stakeholders to address the needs of children and youth with mental health disorders. (8) Other

GOALS FOR SESSION

CONFUSION?

The term childhood mental disorder means all mental disorders that can be diagnosed and begin in childhood (for example, attention- deficit/hyperactivity disorder (ADHD), Tourette syndrome, behavior disorders, mood and anxiety disorders, autism spectrum disorders, substance use disorders, etc.). Mental disorders among children are described as serious changes in the ways children typically learn, behave, or handle their emotions. Symptoms usually start in early childhood, although some of the disorders may develop throughout the teenage years. The diagnosis is often made in the school years and sometimes earlier. Some children, however, are not recognized or diagnosed with a mental disorder.

Source: Centers for Disease Control

WHAT ARE MENTAL HEALTH ISSUES?

A report from the Centers for Disease Control and Prevention (CDC), Mental Health Surveillance Among Children —United States, 2005–2011, at http://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm?s_cid=su 6202a1_w, describes federal efforts on monitoring mental disorders, and presents estimates of the number of children with specific mental

• disorders. The report was developed in collaboration with key federal

partners, the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute of Mental Health (NIMH), and Health Resources and Services Administration (HRSA). This is the first report to describe the number of U.S. children aged 3–17 years who have specific mental disorders, which compiles information from different data sources covering the period 2005–2011. It provides information on childhood mental disorders where there is recent or

• ngoing monitoring. These include ADHD, disruptive behavioral disorders

such as oppositional defiant disorder and conduct disorder, autism spectrum disorders, mood and anxiety disorders including depression, substance use disorders, and Tourette syndrome. Source: CDC

WHAT ARE MENTAL HEALTH DISORDERS?

The following are key findings from this report about mental disorders among children aged 3–17 years:

• Millions of American children live with depression, anxiety,

ADHD, autism spectrum disorders, Tourette syndrome or a host of other mental health issues.

• ADHD was the most prevalent current diagnosis among

children aged 3–17 years.

• The number of children with a mental disorder increased

with age, with the exception of autism spectrum disorders, which was highest among 6 to 11 year old children.

CENTERS FOR DISEASE CONTROL STUDY

Boys were more likely than girls to have ADHD, behavioral

• r conduct problems, autism spectrum disorders, anxiety,

Tourette syndrome, and cigarette dependence. Adolescent boys aged 12–17 years were more likely than girls to die by

• suicide. Adolescent girls were more likely than boys to have

depression or an alcohol use disorder. References National Research Council and Institute

• f

Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009. Centers for Disease Control and Prevention. Mental health surveillance among children – United States, 2005—2011. MMWR 2013;62(Suppl; May 16, 2013):1-35.

CENTERS FOR DISEASE CONTROL STUDY

Data collected from a variety of data sources between the years 2005-2011 show:

• Children aged 3-17 years currently had:

ADHD (6.8%)

• Behavioral or conduct problems (3.5%)
• Anxiety (3.0%)
• Depression (2.1%)
• Autism spectrum disorders (1.1%)
• Tourette syndrome (0.2%) (among children aged 6–17 years)
• Adolescents aged 12–17 years had:
• Illicit drug use disorder in the past year (4.7%)
• Alcohol use disorder in the past year (4.2%)
• Cigarette dependence in the past month (2.8%)

CENTERS FOR DISEASE CONTROL STUDY

References National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009. Centers for Disease Control and Prevention. Mental health surveillance among children – United States, 2005—2011. MMWR 2013;62(Suppl; May 16, 2013):1-35.

CENTERS FOR DISEASE CONTROL STUDY

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be used in all clinical settings by clinicians of different theoretical orientations. It can be used by mental health and other health professionals, including psychiatrists and

• ther physicians, psychologists, social workers, nurses, occupational and

rehabilitation therapists, and counselors. DSM-5 can also be used for research in clinical and community populations. DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text. Source: American Psychiatric Association

DIAGNOSTIC STATISTICAL MANUAL - V

ARE WE ALL SPEAKING THE SAME LANGUAGE?

• One in five children has a diagnosable mental health problem, nearly

two-thirds of them get little or no help.

• Untreated mental health problems can disrupt children’s functioning at

home, school and in the community. Without treatment, children with mental health issues are at increased risk of school failure, contact with the criminal justice system, dependence on social services, and even suicide.

• Parents and family members are usually the first to notice if a child has

problems with emotions or behavior. The observations of teachers and

• ther caregivers, can help determine whether families need to seek help

for their child.

SYMPTOMS OF MENTAL HEALTH DISORDERS

The following signs may indicate the need for professional help:

• Decline in school performance
• Poor grades despite strong efforts
• Constant worry or anxiety
• Repeated refusal to go to school or to take part in normal activities
• Hyperactivity or fidgeting
• Persistent nightmares
• Persistent disobedience or aggression
• Frequent temper tantrums
• Depression, sadness or irritability

SYMPTOMS OF MENTAL HEALTH DISORDERS

Resources Treatment of Children with Mental Illness. National Institute of Mental Health. Learning Disabilities Basics. Learning Disabilities Association of America. Parenting a Child with AD/HD. Children and Adults with Attention Deficit/Hyperactivity Disorder. Children's Depression Checklist Learning Disabilities AD/HD in Kids Autism

SYMPTOMS OF MENTAL HEALTH DISORDERS

ANTIDEPRESSANTS: The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include: Fluoxetine Citalopram Sertraline Paroxetine Escitalopram The most common side effects listed by the FDA include: Nausea and vomiting Weight gain Diarrhea Sleepiness Sexual problems

Source: National Institute of Mental Health http://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml

MEDICATIONS AND SIDE EFFECTS

Anti-Anxiety Medications: Benzodiazepines used to treat anxiety disorders include: Clonazepam Alprazolam Lorazepam The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include: Nausea Blurred vision Headache Confusion Tiredness Nightmares Source: National Institute of Mental Health

MEDICATIONS AND SIDE EFFECTS

Stimulants used to treat ADHD include: Methylphenidate Amphetamine Dextroamphetamine Lisdexamfetamine Dimesylate The most common side effects include: Difficulty falling asleep or staying asleep Loss of appetite Stomach pain Headache Less common side effects include: Motor tics or verbal tics (sudden, repetitive movements or sounds); Personality changes, such as appearing “flat” or without emotion. Source: National Institute of Mental Health

MEDICATIONS AND SIDE EFFECTS

Some of the common typical antipsychotics include: Chlorpromazine Haloperidol Perphenazine Fluphenazine Some of the common atypical antipsychotics include: Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Lurasidone Source: National Institute of Mental Health

MEDICATIONS AND SIDE EFFECTS

Antipsychotics have many side effects (or adverse events) and risks: Drowsiness Dizziness Restlessness Weight gain (the risk is higher with some atypical antipsychotic medicines) Dry mouth Constipation Nausea Vomiting Blurred vision Low blood pressure Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines) Source: National Institute of Mental Health

MEDICATIONS AND SIDE EFFECTS

Typical antipsychotic medications can also cause additional side effects related to physical movement, such as: Rigidity Persistent muscle spasms Tremors Restlessness Source: National Institute of Mental Health MEDICATIONS AND SIDE EFFECTS

Anticonvulsants used as mood stabilizers include: Carbamazepine Lamotrigine Oxcarbazepine Some mood stabilizers side effects include: Itching, rash Excessive thirst Frequent urination Tremor (shakiness) of the hands Nausea and vomiting Slurred speech Changes in vision Loss of coordination Source: National Institute of Mental Health

MEDICATIONS AND SIDE EFFECTS

Some possible side effects linked anticonvulsants (such as valproic acid) include: Drowsiness Dizziness Headache Diarrhea Constipation Changes in appetite Weight changes Back pain

Source: National Institute of Mental Health

MEDICATIONS AND SIDE EFFECTS

Some Side Effects of Anticonvulsants: Agitation Mood swings Abnormal thinking Uncontrollable shaking of a part of the body Loss of coordination Uncontrollable movements of the eyes Blurred or double vision Ringing in the ears Source: National Institute of Mental Health MEDICATIONS AND SIDE EFFECTS

• ADHD is characterized by a pattern of behavior, present in

multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings. The symptoms will are divided into two categories of inattention and hyperactivity and impulsivity that include behaviors like failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an inability to remain seated in appropriate situations.

• Children must have at least six symptoms from either (or both)

the inattention group of criteria and the hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17 years) must present with five. Source: American Psychiatric Association

DSM-5 ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Using DSM-5, several of the individual’s ADHD symptoms must be present prior to age 12 years. DSM-5 includes no exclusion criteria for people with autism spectrum disorder, since symptoms of both disorders co-

• ccur. However, ADHD symptoms must not occur exclusively

during the course of schizophrenia or another psychotic disorder and must not be better explained by another mental disorder, such as a depressive or bipolar disorder, anxiety disorder, dissociative disorder, personality disorder,

• r

substance intoxication or withdrawal. Source: American Psychiatric Association

ATTENTION DEFICIT HYPERACTIVITY DISORDER

• Oppositional defiant disorder is characterized by repeated angry,

defiant, disobedient behavior with authority figures.

• An individual can have both conduct disorder and ODD. It was
• riginally thought that a person might graduate from ODD to

conduct disorder but could not have both.

• Symptoms

such as aggressive behaviors must now be demonstrated more than one time per week to be considered abnormal.

• The criteria have a severity rating indicating a behavior’s degree
• f pervasiveness across different settings. This rating will reflect

whether an individual, for example, displays defiant behavior with

• ne parent only or with all adults.

Source: Psychiatric News

DSM-5 OPPOSITIONAL DEFIANT DISORDERS

• Intermittent explosive

disorder is characterized by an extreme expression of anger or rage that is out of proportion to the individual’s situation.

• The types of aggressive outbursts now to be considered are:

physical aggression , verbal aggression, and nondestructive/non- injurious physical aggression.

• Frequency of behavior criteria is more detailed.
• Criteria indicates that aggressive outbursts are impulsive and/or

angry in nature and must result in marked distress, cause significant problems in work/school or interpersonal functioning,

• r be the cause of financial or legal problems. An individual must

be at least 6 years old to receive this diagnosis.

Source: Psychiatric News

DSM-5 INTERMITTENT EXPLOSIVE DISORDERS

• Conduct disorder is characterized by actions that violate other

individual's rights or societal norms. The criteria for conduct disorder have not changed except for an added specifier for children who are lacking in “pro-social behaviors” (social skills).

• The

new specifier replaces the DSM-IV stigmatizing descriptive phrase of “callous and unemotional.” Research indicates that people with conduct disorder who do not have adequate pro-social behaviors are frequently diagnosed with a severe form of the disorder requiring different treatment considerations. Source: Psychiatric News

DSM-5 CONDUCT DISORDER

• Severe mood swings that are different from their usual mood swings
• Hyperactive, impulsive, aggressive or socially inappropriate behavior;
• Risky and reckless behaviors that are out of character, such as having

frequent casual sex with many different partners (sexual promiscuity), alcohol or drug abuse, or wild spending sprees;

• Insomnia or significantly decreased need for sleep;
• Depressed or irritable mood most of the day, nearly every day during a

depressive episode;

• Grandiose and inflated view of own capabilities;
• Suicidal thoughts or behaviors in older children and teens; and
• Children with bipolar disorder experience symptoms in distinct
• episodes. Between these episodes, children return to their usual behavior

and mood. Source: Mayo Foundation for Medical Education and Research DSM-5 BIPOLAR DISORDER

Depressive disorders include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues

• f duration, timing, or presumed etiology.

Source: DSM Library.

DSM-5 DEPRESSIVE DISORDERS

Georgia Department of Behavior Health and Developmental Disabilities Georgia’s Children, Young Adults and Families System of Care Overview. https://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/related_files/site_pa ge/GA%20SOC%20Presentation%20for%20Symposium%20P1.pdf Rehabilitation and Treatment http://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/related_files/site_pa ge/Treatment%20vs%20Rehabilitation%202014-08-05%20Final.pdf Georgia’s System for Care Collaborative for Children and Youth with Mental Disorders. https://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/related_files/site_pa ge/Innovations%20in%20Children%E2%80%99s%20Mental%20Health.pdf

RESOURCES

I AM READY FOR ANYTHING!

System of Care (SOC) is a spectrum of effective, community- based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is

• rganized

into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community and throughout life (Stroul and Friedman 2011). Source: Linda Y. Henderson Smith, Ph.D., LPC

DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES SYSTEM OF CARE

Legal Mandate: O.C.G.A. §§ 49-5-220 and 49-5-225

O.C.G.A. 49-5-220 Legislative findings and intent; State Plan for the Coordinated System of Care for the severely emotionally disturbed children or adolescents (a) the General Assembly declares its intention and desire to: 1) Ensure a comprehensive mental health program consisting of early identification, prevention, and early intervention for every child in Georgia: 2) Preserve the sanctity of the family unit; 3) Prevent the unnecessary removal of children and adolescents with a severe emotional disturbance from their homes; 4) Prevent the unnecessary placement of these children out of state; 5) Bring those children home who through the use of public funds are inappropriately placed out of state; and

SYSTEM OF CARE (SOC)

6) Develop a coordinated system of care so that children and adolescents with a severe emotional disturbance and their families will receive appropriate educational, nonresidential and residential mental health services, and support services, as prescribed in an individualized plan. (b) In recognition of the fact that services to these children are provided by several different agencies, each having a different philosophy, a different mandate, and a different source of funding, the Division of Mental Health, Developmental Disabilities, and Addictive Diseases of the Department of Human Resources shall have the primary responsibility for planning, developing, and implementing the coordinated system of care for severally emotionally disturbed children. Further, it recognizes that to enable severely emotionally disturbed children to develop appropriate behaviors and demonstrate academic and vocational skills, it is necessary that the Department

• f Education provide appropriate education in accordance with P.L. 94-142

and the Division of Mental Health, Developmental Disabilities, and Addictive Disease of the Department of Human Resources provide mental health treatment.

SYSTEM OF CARE (SOC)

Individualized Strengths-Based Natural Supports Collaboration Persistence Community-Based Culturally Competent Team-Based Outcome-Based Family-Drive Youth-Guided Source: Linda Y. Henderson Smith, Ph.D., LPC http://www.tapartnership.org/systemsOfCare.php

SYSTEM OF CARE (SOC)

Age: Children and youth from birth to 21 years of age. Diagnosis: The child or youth must have an emotional, socio-emotional, behavioral or mental disorder diagnosable under the DSM-IV or its ICD- 9-CM equivalents. Disability: The child or youth is unable to function in the family, school

• r community, or in a combination of these settings. Or, the level of

functioning is such that the child or adolescent requires multi-agency intervention. Duration: The identified disability must have been present for at least 1- year or, on the basis of diagnosis, severity or multi-agency intervention, is expected to last more than 1-year. Source: Linda Y. Henderson Smith, Ph.D., LPC

FOCUS OF SOC

“ LET US WORK AS A TEAM”

ITD TEAM Department of Community Health Department of Human Services – DFCS Department of Juvenile Justice Department of Public Health Department of Education Georgia Parent Support Network The Carter Center Together Georgia The Center of Excellence Get Georgia Reading - Campaign for Grade Level Reading *Federal Consultant – Center for Disease Control The IDT is a workgroup of the Behavioral Health Coordinating Council Source: Linda Henderson-Smith, Director of Office of Children, Youth Adults and Families, DBHDD

COLLOBORATIVE SYSTEM OF CARE

Georgia Families 360°

• A new managed care program for a special population of

Medicaid eligible children, youth, and young adults

• Designed to better meet member needs by coordinating

medical, behavioral, dental and pharmacy services

• All children, youth, and young adults in Foster Care
• All children, youth, and young adults receiving Adoption

Assistance

• Select youth involved in the juvenile justice system who

reside in non-secure community residential settings Source: Susanne Lindsey, Director Georgia Families 360°, Georgia DCH

COLLOBORATIVE SYSTEM OF CARE

Georgia Families 360°

• Reduce disruption
• Increase stability
• Foster permanency and long term independence
• Improve

health

• utcomes

through intensive care coordination

• Integrated coordination of all healthcare services
• Engagement of a primary care physician and primary dental

provider

• Comply with and support state and federal policies

Source: Susanne Lindsey, Director Georgia Families 360°, Georgia DCH

COLLABORATIVE SYSTEM OF CARE

MY HEAD HURTS

Populations Changes: The new Juvenile Code redefines the population served in the community by specifying CHINS cases, the establishment of limits on restrictive custody for the two categories of designated felons, and the emphasis on youth being served in least restrictive settings. Unified Data Collection: A statewide merged data collection for all of juvenile justice that will give full legal information from all juvenile courts. Evidenced Based Practices: There is a new emphasis on evidenced based practices, services and assessments. Source: Natalie Towns, Director

• f

Office

• f

Federal Programs GA DJJ and Ursual Davis, System of Care Section Director DFCS

JUVENILE JUSTICE REFORM

House Bill 242- Article 5 Article 5-Children in need of Services Child in Need of Services (CHINS) means:

• A child adjudicated to be in need of care, guidance, counseling, structure, supervision,

treatment or rehabilitation and who is adjudicated to be: Truant

• Habitually disobedient, ungovernable
• A runaway (24 hours plus)
• Guilty of child-only offense
• Loitering after midnight
• On probation for unruly
• Hanging out in bars
• Delinquent but not in need of treatment or rehabilitation

Source: Natalie Towns, Director of Office of Federal Programs GA DJJ and Ursual Davis, System of Care Section Director DFCS

JUVENILE JUSTICE REFORM

HB 242 Impact DFCS Policy and Practice The passing of HB 242 resulted in several changes to language and practice of child welfare in the following areas:

• CHINS (Children in Need of

Services)-DFCS Role Provide necessary and appropriate services

• Collaborate/coordinate with other child-serving agencies
• Seek appropriate placement resources when necessary
• Develop and monitor a case plan for a CHINS who is placed in foster care
• Temporary protective custody of physician
• Custody orders are no longer temporary

Source: Natalie Towns, Director of Office of Federal Programs GA DJJ and Ursual Davis, System of Care Section Director DFCS

JUVENILE JUSTICE REFORM

DFCS Policy: CHINS (Children in Need of Services)-DFCS Role Provide necessary and appropriate services:

• Collaborate/coordinate with other child-serving agencies;
• Seek appropriate placement resources when necessary;
• Develop and monitor a case plan for a CHINS who is placed

in foster care;

• Temporary protective custody of physician;
• Custody orders are no longer temporary;

Source: Natalie Towns, Director of Office of Federal Programs GA DJJ and Ursual Davis, System of Care Section Director DFCS

JUVENILE JUSTICE REFORM

DFCS SOC Unit

• To provide dynamic leadership in the development, coordination,

and implementation of interagency collaboration of services to families and children with mental, emotional, and developmental issues and concerns. The System of Care unit focuses on building strong partnerships with

• ther

professionals, families, and communities that serve this population.

• The primary focus of the System of Care unit is to develop,

enhance, and monitor assessment and service provision to children and youth in this population who come to the attention

• f the Division.

Source: Natalie Towns, Director of Office of Federal Programs GA DJJ and Ursual Davis, System of Care Section Director DFCS

JUVENILE JUSTICE REFORM

SOC DFCS Unit Goals

• Improving access to health services( behavioral health,

physical health, developmental) for youth involved with DFCS;

• Improving effectiveness of service provision
• Improve knowledge base and skill-set of

DFCS staff regarding well-being needs of youth

• Improve collaboration with internal and external partner
• rganizations and teams in regard to well-being needs of

youth Source: Natalie Towns, Director

• f

Office

• f

Federal Programs GA DJJ and Ursual Davis, System of Care Section Director DFCS

JUVENILE JUSTICE REFORM

WHERE DO I GO NEXT?

Basic Underpinnings: The System of Care Philosophy Core Values

• The system of care should be child centered and family focused, with the

needs of the child and family dictating the types and mix of services provided.

• The system of care should be community based, with the focus of services

as well as management and decision making responsibility resting at the community level.

• The system of

care should be culturally competent, with agencies, programs, and services that are responsive to the cultural, racial, and ethnic differences of the populations they serve.

Source: Georgia Department of Human Resources

http://www.gaccchildlaw.org/Local%20Interagency%20Planning%20Teams%20(LIPT)%20Han dbook.pdf; http://www.lmcme.org/partners/lipt-local-interagency-planning-team/

LOCAL INTERAGENCY PLANNING TEAM

Guiding Principles

• Children with emotional disturbances should have access to a comprehensive array of

services that address the child's physical, emotional, social and educational needs.

• Children with emotional disturbances should receive individualized services in

accordance with the unique needs and potentials of each child and guided by an individualized service plan.

• Children with emotional disturbances should receive within the least restrictive, most

normative environment that is clinically appropriate.

• The families and surrogate families of children with emotional disturbances should be

full participants in all aspects of the planning and delivery of services.

• Children with emotional disturbances should receive services that are integrated with

linkages between child-serving agencies and programs and mechanisms for planning, developing, and coordinating services.

• Children with emotional disturbances should be provided with case management or

similar mechanism to ensure that multiple services are delivered in a coordinated and therapeutic manner and that they can move through the system of services in accordance with their changing needs. Source: Georgia Department of Human Resources

LOCAL INTERAGENCY PLANNING TEAM

• Early identification and intervention for children with emotional

disturbances should be promoted by the system of care in order to enhance the likelihood of positive outcome.

• Children with emotional disturbances should be ensured smooth

transitions to the adult service system as they reach maturity.

• The rights of children with emotional disturbances should be

protected, and effective advocacy efforts for children and youth with emotional disturbances should be promoted.

• Children

with emotional disturbances should receive services without regard to race, religion, national origin, sex, physical disability or other characteristics, and services should be sensitive and responsive to cultural differences and special needs. Source: Stroul, B. & Friedman, R. (1986). A System of Care for Children & Youth With Severe Emotional Disturbances. Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.

LOCAL INTERAGENCY PLANNING TEAM

O.C.G.A. § 49-5-225. Local interagency committees; membership; function

• f committees:

(a) At least one local interagency committee shall be established for each region of the Division of Mental Health, Developmental Disabilities and Addictive Diseases

• f

the Department

• f

Human Resources whose permanent membership shall include a local representative from each of the following: (1) The community mental health agency responsible for coordinating children’s services; (2) The Division of Family and Children Services of the Department of Human Resources; (3) The Department of Juvenile Justice: (4) The Division of Public Health of the Department of Human Resources: (5) A member of the special education staff of the local education agency;

LOCAL INTERAGENCY PLANNING TEAMS

c) The local interagency committees shall: (1) Staff cases and review and modify as needed decisions about placement of children and adolescents in out-of-home treatment or placement, monitor each child’s progress, facilitate prompt return to the child’s home when possible, develop a reintegration plan shortly after a child’s admission to a treatment program, review the individual plan for the child or adolescent and amend the plan if necessary, and ensure that services are provided in the least restrictive setting consistent with the effective series; and (2) Be the focal point for the regional plan, if any. Source: Georgia Department of Human Resources

LOCAL INTERAGENCY PLANNING TEAMS

TARGET POPULATION

• Youth has received documented services through other services such as Core

Services and exhausted less intensive out-patient programs. Treatment at a lower intensity has been attempted or given serious consideration, but the risk factors for

• ut-of-home placement are compelling
• The less intensive services previously provided must be documented in the clinical

record (even if it via by self-report of the youth and family).

• Youth and/or family has insufficient or severely limited resources or skills

necessary to cope with an immediate behavioral health crisis;

• Youth and/or family behavioral health issues are unmanageable in traditional
• utpatient treatment and require intensive, coordinated clinical and supportive

intervention;

• Because of behavioral health issues, youth is at immediate risk of out-of-home

placement;

• Because of behavioral health issues, youth is at immediate risk of legal system

intervention or is currently involved with DJJ for behaviors/issues related to SED and/or the Substance-related disorder. Source: Georgia Department of Behavioral Health and Developmental Disabilities

DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES (BHDD)

OBJECTIVES OF SERVICE

• A service intended to improve family functioning by clinically stabilizing the

living arrangement, promoting reunification or preventing the utilization of out

• f home therapeutic venues (i.e. psychiatric hospital, psychiatric residential

treatment facilities, or residential treatment services) for the identified youth.

• Defuse the current behavioral health crisis, evaluate its nature and intervene to

reduce the likelihood of a recurrence;

• Ensure linkages

to needed psychiatric, psychological, medical, nursing, educational, and other community resources, including appropriate aftercare upon discharge (i.e. medication, outpatient appointments, etc.);

• Improve the individual child’s/adolescent’s ability to self-recognize and self-

manage behavioral health issues, as well as the parents’/responsible caregivers’ capacity to care for their children.

Source: Georgia Department of Behavioral Health and Developmental Disabilities

BHDD

ALLOWABLE ACTIVITIES

• Family Therapy
• Individual Therapy
• Family Training
• Skills building
• Team meeting

UNALLOWABLE ACTIVITIES

• Transportation
• Observation/Monitoring
• Tutoring/Homework Completion
• Diversionary Activities (i.e. activities without therapeutic value)
• Babysitting

Source: Georgia Department of Behavioral Health and Developmental Disabilities

BHDD

Psychiatric Residential Treatment Facility (PRTF) Services Provide comprehensive mental health and substance abuse treatment to children, adolescents, and young adults 21 years of age and younger who, due to severe emotional disturbance, are in need of quality active treatment that can only be provided in an inpatient treatment facility and for whom alternative, less restrictive forms of treatment have been unsuccessful or are not medically indicated. PRTF programs are designed to promote a successful return of the youth or young adult to the home community. Focus is on improvement of residents’ symptoms through the use of strength- and evidence-based strategies and active family engagement. The program encourages family participation in the treatment planning and implementation processes and timely discharge planning and aftercare. Source: Georgia Department of Behavioral Health and Developmental Disabilities

BHDD

PRTF SERVICES

• Diagnostic and assessment services
• Development of an individualized treatment/resiliency plan
• Psychiatric services
• Nursing services
• Medication monitoring and management
• Evidenced-based treatment interventions
• Individual, family, and group therapy
• Substance abuse education
• Activities that support the development of age-appropriate daily living skills
• Activities that support parents’ abilities to reintegrate the youth into home &

community Source: Georgia Department of Behavioral Health and Developmental Disabilities

BHDD

PRTF Services

• Crisis intervention
• Overall health monitoring
• Activities promoting the youth’s ability to manage his/her own health
• Consultation with other professionals
• Educational activities
• Non-medical transportation
• Ongoing discharge planning
• These services are provided to youth/young adults in order to promote

stability and build toward age-appropriate functioning in their daily environments. Source: Georgia Department of Behavioral Health and Developmental Disabilities

BHDD

LET ME THINK ABOUT THIS

Peer Review Research (RTI) Approach for Students with Challenging Behaviors

• Tier 1: To prevent problem behaviors in all students
• Tier 2: To reduce high-risk problem behaviors with more focused,

intensity, frequently for students in small groups

• Tier 3: To reduce problem behaviors that are resistant to change with

individualized services, supports, and interventions. Source: Florida’s Positive Behavior Support Project: Response to Intervention for Behavior, 2008

http://flpbs.fmhi.usf.edu/pdfs/Response%20to%20Intervention%20for% 20Behavior%20a%20Technical%20Assistance_UPDATED_010509.pdf

See Federal Policy and Guidance – School-wide Positive Behavior Support Implementation Blueprint and Self-Assessment – 05/10/2006

SCHOOL WIDE POSTIVE BEHAVIOR SUPPORTS

Tier 1: All effective school-wide systems have seven major components in common a) an agreed upon and common approach to discipline, b) a positive statement of purpose, c) a small number of positively stated expectations for all students and staff, d) procedures for teaching these expectations to students, e) a continuum of procedures for encouraging displays and maintenance of these expectations, f) a continuum of procedures for discouraging displays of rule-violating behavior, and g) procedures for monitoring and evaluation the effectiveness of the discipline system on a regular and frequent basis. Source: Florida’s Positive Behavior Support Project: Response to Intervention for Behavior, 2008 https://www.bing.com/videos/search?q=response+to+intervention+f

• r+behavior&&view=detail&mid=B085D8DC5C97318672E5B085D8

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PBIS SUPPORTS, SERVICES AND INTEVENTIONS

Tier 2: Continuous availability

• 2. Rapid access (within 72 hr.)
• 3. Very low effort by teachers
• 4. Consistent with school-wide expectations
• 5. Implemented by all staff/faculty in a school
• 6. Flexible intervention based on assessment
• 7. Match between the function of the problem behavior and the intervention
• 8. Adequate resources for implementation (weekly meetings, plus 10 hours a

week)

• 9. Student chooses to participate, and
• 10. Continuous monitoring of student behavior for decision-making.

Source: Florida’s Positive Behavior Support Project: Response to Intervention for Behavior, 2008

PBIS SUPPORTS, SERVICES AND INTEVENTIONS

Tier 3:

• Functional Behavior Assessment (FBA)
• Behavior Intervention Plan (BIP)
• Behavioral Goals should focus on Person-centered planning. (PCP) is a

process for learning about an student’s preferred lifestyle. It involves creating goals that will assist students in achieving their preferred lifestyle within a collaborative team context. Most PCP plans are created with the goal of: 1) increasing participation and presence in the school and community; 2) gaining and maintaining significant relationships; 3) expressing and making choices; 4) experiencing respect and living a dignified life; and 5) developing personal skills and areas of expertise. Source: Florida’s Positive Behavior Support Project: Response to Intervention for Behavior, 2008

PBIS SUPPORTS, SERVICES AND INTEVENTIONS

Cornell University TCI: https://robertamroy.wordpress.com/2013/08/31/therapeutic- crisis-intervention-cornell-university-tci/

• Preventing crises from occurring
• De-escalating potential crises

Effectively managing acute crisis phases

• Reducing potential and actual injury to children and

staff

• Learning constructive ways to handle stressful

situations

• Developing a learning circle within the organization

Source: https://en.wikipedia.org/wiki/Therapeutic_Crisis_Intervention

THERAPEUTIC CRISIS INTERVENTIONS (TCI)

Teach students to learn skills and build empathy for others by: (1) problem solving; (2) relationship building; (3) brainstorm solutions; (4) restorative justice practices; (5) peer mediation and conflict resolution; (6) collaborative problem solving; (7) restitution or apology; (8) community service; (9) Co-curricular suspension of activities such as sports or clubs Source:TeachSafeSchools.org;

http://childandfamilypolicy.duke.edu/wp- content/uploads/2015/03/Alternatives_to_Suspension_3_2015.pdf

ALTERNATIVES TO SUSPENSION

IDEA requires two types of data collection and maintenance: (1) collection of suspension and expulsion data for public agency as a whole, to determine whether public agency is

• verusing exclusionary discipline – 34 C.F.R. §300.170; and

(2) collection of removal data for each particular students with a disability that has been removed for violating a student code of conduct, to determine whether particular student’s placement has been changed and to determine the appropriate services for a particular child – 34 C.F.R. §§ 300.530 et seq. LEGAL ANALYSIS FOR POSITIVE BEHAVIOR SUPPORTS

Office of Special Education Programs: 71 Fed. Reg. 46,539, at 46, 714 (Aug. 14, 2006) In school-suspension will not be considered a removal if all of the three of the following questions are answered in the affirmative: (a) Will the child be able to appropriately participate in the general education curriculum; (b) Will the child be able to receive the services specified in the child’s IEP: (c) Will the child be able to participate with children without disabilities to the extent provided in the child’s current placement?

DISCIPLINARY REMOVALS (ISS)

The IDEA does not define FBA’s and BIP’s and positive behavioral interventions and supports. According to peer review research, however, at a minimum, a FBA requires three

• utcomes:

(1)Description

• f

the undesirable behavior(s)

• perationally;

Prediction of the time and situations when the undesirable behavior(s) will and will not be performed across a range of typical daily routines; Definition

• f

the functioning(s)(maintaining reinforcers) that the undesirable behavior(s) produces for the

• individual. Robert E. O’Neill, et al., Functional Assessment of

Problem Behavior: A Practical Assessment Guide at 3 (1st ed. 1990). The ultimate goal of a FBA is “not to define or eliminate undesirable behavior, but to understand the structure and function

• f the behavior in order to teach and develop effective alternatives.
• Id. at 6.

FBA’S AND BIPS

• FBA’s for Children with Mental Health Disorders or Mental

Illness require a functional analysis that defines the functions

• f the challenging behavior produced for the child. Escape

and attention may be functions of a child’s behavior. Control is not a function of behavior, but an instrument to achieve a

• function. O’Neill, et al. at pp. 12-14. A child does not engage

in self-injury, aggression, or property damage solely because he may have a mental health disorder.

• For an good analysis of FBAs, BIPs, and PBIS from a

research-based perspective, see Iowa Juvenile Home and Girls State Training School, 62 IDELR 308 (SEA 2013).

MENTAL ILLNESS AND FBAS

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