Mental Health Triage for Children and Youth: - PowerPoint Presentation

Slide1

Mental Health Triage for Children and Youth: Actionable Steps to Support Mental/Behavioral Health

Dawna-Cricket-Martita Meehan, Ph.D.

Center for School-Based Mental Health Programs

Miami University

Slide2

Learning ObjectivesAt the end of this session, participants will be able

to…

R

ecognize

the signs and symptoms

of common mental health and behavioral health issues experienced by children and

youth

;

I

mplement

action steps to support children and youth

experiencing mental health and behavioral health

concerns;

I

dentify

appropriate referral pathways

that can help

children and youth

in need of mental health resources and supports.

Slide3

Opioid EpidemicSchool Shootings

Slide4

1 in 6 school-aged youth: significant impairments

in life functioning due to a

mental

illness

(e.g., ADHD,

behavioral problems, conduct problems, anxiety, and/or

depression)

1

in 4

youth: growing

up in

poverty

and may be

exposed to violence, chronic insecurity, loss, hardship, and disruption of

life

1

in 5

youth: high

levels of

traumatic adverse childhood

experiences

1

in 4

students:

bullied by

peers

1

in 10

adolescents:

victim of

physical violence by a dating

partner

Suicide

is 2

nd

leading

cause of death for youth

(ages

of

10-24)

Slide5

Whereas approximately 20% of all children and adolescents have a mental health

disorder

,

50

%

of youth involved in the child welfare system have mental health disorders

Slide6

Oftentimes, we ask…“

What’s wrong

with

you?”

Slide7

A Poem

by Abdullah

Shoaib

Slide8

Changing the conversation to…

“What happened

to you?”

Slide9

Now Read From the Bottom Up…

Slide10

Strength-Based Approaches

emphasize individuals’

strengths

,

capabilities

, and

resources

allow individuals to see

opportunities

,

hope

, and

solutions

Slide11

Positive Youth DevelopmentA

n

intentional

,

prosocial

approach that

engages youth

within their communities, schools, organizations, peer groups, and families in a manner that is

productive

and

constructive

; recognizes, utilizes, and enhances young people’s

strengths

; and promotes

positive outcomes

for young people by providing

opportunities

, fostering

positive relationships

, and furnishing the

support

needed to build on their

leadership strengths

.

Slide12

Strength-Based Approaches for Positive Youth Development

Slide13

CASA volunteers are in an ideal position to be a positive, strength-based advocate in a young person’s life.

Slide14

Building a

Strength-Based Approach for Positive Youth Development through a…

Slide15

…Comprehensive & Coordinated Continuum of Mental Health/ Behavioral Health Supports

Slide16

Slide17
MH/BH Awareness Training

All adults and youth are trained to recognize the signs and symptoms of MH/BH issues and refer individuals in need of help to appropriate strength-based, asset-driven resources and support

MH/BH Awareness Training

Examples include:

Youth Mental Health First Aid training

Red Flags National

Question, Persuade, Refer

Safety & Violence Prevention

training

(Ohio HB 276/HB 1)

Slide18

MH/BH Awareness:

Action Steps for CASA Volunteers

Pay attention

to and notice what the children and teens you serve are experiencing in their lives

Recognize and identify the signs and symptoms

of MH/BH concerns in the children and teens you serve

Take action

to help children and teens who display signs and symptoms of MH/BH concerns

Please

note:

You are NOT being asked to

diagnose

MH/BH concerns

You are NOT being asked to

treat

MH/BH concerns

Slide19

Recognize the

Signs

and S

ymptoms

C

ommon

MH/BH issues experienced by children

and teens

:

Anxiety Disorders

Generalized

Anxiety

Disorder, Panic Disorder, Social

Anxiety

Disorder, Separation

Anxiety

Disorder, Specific Phobias

Stress Related Disorders

Acute Stress Disorder, PTSD

Mood Disorders

Disruptive Mood Regulation Disorder, Major Depressive Disorder, Dysthymia

Obsessive-Compulsive Disorders

Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Skin-Picking Disorder

Disruptive Behavioral Disorders

Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder

Slide20

Recognize the

Signs

and S

ymptoms

Other common issues

experienced by children

and teens

:

Adverse Childhood Experiences (ACES)

Trauma (resulting from ACES or other experiences)

Bullying

Interpersonal/Dating Violence

Suicidal Ideation

Slide21

Recognize

the

Signs

and S

ymptoms

Slide22

Recognize the Signs and Symptoms of Anxiety

Being very afraid when away from parents (

separation anxiety

)

Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (

phobias

)

Being very afraid of school and other places where there are people (

social anxiety

)

Being very worried about the future and about bad things happening (

general anxiety

)

Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (

panic disorder

)

Irritability and/or anger

Problems sleeping, such as sleeping too much or too little

P

hysical

symptoms like fatigue, headaches, or stomachaches

Slide23

Recognize the Signs and Symptoms of Stress/PTSD

Feeling numb, detached, or being emotionally unresponsive

Reliving the event over and over in thought or in play

Nightmares and sleep problems

Becoming very upset when something causes memories of the event

Lack of positive

emotions

Emotions

not feeling real

Intense ongoing fear or

sadness

Irritability and angry outbursts

Constantly looking for possible threats, being easily startled

Acting helpless,

hopeless,

or withdrawn

Denying that the event happened or feeling numb

Avoiding places or people associated with the event

Being restless, fidgety, or have trouble paying attention and staying

organized

Slide24

Recognize the Signs and Symptoms of Depression

Feeling sad, hopeless, or irritable a lot of the time

Not wanting to do

things

Not enjoying

fun things

Having

a hard time paying attention

Feeling worthless, useless, or guilty

Showing self-injury and self-destructive

behavior

Showing

changes in eating patterns

eating a lot more or a lot less than usual

Showing changes in sleep patterns

sleeping a lot more or a lot less than normal

Showing changes in energy

being tired and sluggish or tense and restless a lot of the

time

Slide25

Recognize the Signs and Symptoms of Obsessions and Compulsions

Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or

distress

Having to think about or say something over and over (for example,

counting,

or repeating words over and over silently or out loud)

Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)

Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go

away

Slide26

Recognize the Signs and Symptoms of Attention-Deficit and Hyperactivity

Daydream a lot

Forget or lose things a lot

Squirm or fidget

Talk too much

Make careless mistakes

Take unnecessary risks

Have a hard time resisting temptation

Have trouble taking turns

Have difficulty getting along with

others

Slide27

Recognize the Signs and Symptoms of Behavior Problems

Often being angry or losing one’s temper

Often arguing with adults or refusing to comply with adults’ rules or requests

Often resentful or spiteful

Deliberately annoying others or becoming annoyed with others

Often blaming other people for one’s own mistakes or misbehavior

Breaking serious rules, such as running away, staying out at night when told not to, or skipping school

Being aggressive in a way that causes harm, such as  bullying, fighting, or being cruel to animals

Lying, stealing, or damaging other people’s property on purpose

Slide28

Recognize the Signs and Symptoms of Adverse Childhood Experiences (ACES) & Trauma

Difficulty trusting others

Uncertain about the reliability/predictability of others

Interpersonal difficulty

Social isolation

Difficulty seeking help

Clingy, difficulty with separations

Sensorimotor development problems

Hypersensitivity to physical contact

Somatization

Oppositional

behavior

Excessive compliance

Sleep disturbance

Eating disorders

Reenactment of traumatic event/past

Pathological self-soothing practices

Difficulty paying attention

Lack of sustained curiosity

Problems processing

information

Slide29

Recognize the Signs and Symptoms of Adverse Childhood Experiences (ACES) & Trauma

Increased

medical problems

Problems with coordination and balance

Problems with emotional regulation

Easily upset and/or difficulty calming

Difficulty describing emotions and internal experiences

Difficulty knowing and describing internal states

Problems with communicating needs

Poor impulse control

Self-destructive behavior

Aggressive behavior

Problems

focusing on/completing tasks

Difficulty planning and anticipating consequences

Learning difficulties, developmental delays

Problems with language development

Lack of continuous/predictable sense of self

Poor sense of separateness

Disturbance of body image

Low self-esteem

Shame and

guilt

Slide30

Recognize the Signs and Symptoms of Bullying

… of being bullied

Unexplainable injuries

Lost or destroyed clothing, books, electronics, or jewelry

Frequent headaches or stomach aches

, feeling sick or faking illness

Changes in eating habits, like suddenly skipping meals or binge

eating (may

come home from school hungry because they did not eat

lunch)

Difficulty sleeping or frequent nightmares

Declining grades, loss of interest in schoolwork, or not wanting to go to school

Sudden loss of friends or avoidance of social situations

Feelings of helplessness or decreased self esteem

Self-destructive behaviors such as running away from home, harming themselves, or talking about suicide

… of bullying others

Get into physical or verbal fights

Have friends who bully others

Are increasingly aggressive

Get sent to the principal’s office or to detention frequently

Have unexplained extra money or new belongings

Blame others for their problems

Don’t accept responsibility for their actions

Are competitive and worry about their reputation or

popularity

Slide31

Recognize the Signs and Symptoms of Interpersonal/Dating Violence

Excessive

jealousy

Constantly

checking in

with partner

or making

partner

check in with him or

her

Attempts

to isolate

partner

from friends and

family

Insulting

or putting down people that

partner cares about

Is

too serious about the relationship too

quickly

Has

had a lot of bad prior relationships - and blames all of the problems on the previous

partners

Is

very

controlling; may

include giving

partner

orders, telling

partner

what to wear, and trying to make all of the decisions for

partner

Blames partner when he or she treats partner badly by telling partner all of the ways partner provoked him or her

Does not take responsibility for own actions

Has an explosive temper (“blows up” a lot)

Pressures partner into sexual activity with which partner is not comfortable

Has

a history of fighting, hurting animals, or brags about mistreating other

people

Believes

strongly in stereotypical gender roles for males and

females

Partner worries

about how

he or she will

react to the things

partner says

or

being

afraid of provoking

him or her

He or she owns

or uses

weapons

Refuses

to

let partner

to end the

relationship

Slide32

Recognize the Signs and Symptoms of Suicide

Preoccupation with death (e.g., recurring themes of death or self-destruction in artwork or written

assignments)

Intense sadness and/or hopelessness

Not caring about activities that used to matter

Social withdrawal from family, friends, sports, social activities

Sleep

disturbance (either not sleeping or staying awake all night)

Giving away possessions

Risky behavior

Lack of energy

Inability to think clearly/concentration problems

Declining school performance/increased absences from school

Increased irritability

Changes in

appetite

Substance

abuse

Slide33

Remember Your Action Steps…

Pay attention

to and notice what the children and teens you serve are experiencing in their lives

Recognize and identify the signs and symptoms

of MH/BH concerns in the children and teens you serve

Take action

to help children and teens who display signs and symptoms of MH/BH concerns

Please

note:

You are NOT being asked to

diagnose

MH/BH concerns

You are NOT being asked to

treat

MH/BH concerns

Slide34
MH/BH Response Techniques

All adults and youth know what to do when they recognize signs and symptoms of MH/BH issuesExamples include:

ALGEE Action Plan

A=assess

for risk of suicide or

harm

L=listen non-judgmentally

G=give

reassurance and

information

E=encourage

appropriate professional

help

E=encourage

self-help and

other

support

strategies

Build

p

ositive

relationships

using

a framework like

the

Developmental

Relationship Framework from Search

Institute

Slide35

MH/BH Response Techniques:

Action Steps for CASA Volunteers

Build positive relationships

with the children and teens you serve

When you recognize and identify the signs and symptoms of MH/BH concerns in the children and teens you serve,

take action

to help:

Talk

with children and teens about their MH/BH concerns

Listen

(without distraction) to what they have to say

Teach

them how to recognize the signs and symptoms of MH/BH concerns

Educate

them about MH/BH concerns they may be experiencing

Help

them identify coping strategies to mitigate their symptoms

Advocate

for them if they are in need of professional mental health help

Slide36

Slide37

Developmental Relationships Framework

Search Institute has identified five elements—expressed in 20 specific actions—that make relationships powerful in young people’s lives

.

Express Care

Challenge Growth

Provide Support

Share Power

Expand Possibilities

Slide38

Express Care

Show

me that I matter to

you

Be dependable

—Be someone I can

trust

Listen

—Really pay attention when we are

together

Believe in me

—Make me feel known and

valued

Be warm

—Show me you enjoy being with

me

Encourage

—Praise me for my efforts and

achievements

Slide39

Challenge Growth

Push me to keep getting

better

Expect my best

—Expect me to live up to my

potential

Stretch

—Push me to go

further

Hold me accountable

—Insist I take responsibility for my

actions

Reflect on

failures

—Help me learn from mistakes and

setbacks

Slide40

Provide Support

Help me complete tasks and achieve

goals

Navigate

—Guide me through hard situations and

systems

Empower

—Build my confidence to take charge of my

life

Advocate

—Stand up for me when I need

it

Set boundaries

—Put in place limits that keep me on

track

Slide41

Share Power

Treat me with respect and give me a

say

Respect me

—Take me seriously and treat me

fairly

Include me

—Involve me in decisions that affect

me

Collaborate

—Work with me to solve problems and reach

goals

Let me

lead

—Create opportunities for me to take action and

lead

Slide42

Expand Possibilities

Connect me with people and places that broaden my

world

Inspire

—Inspire me to see possibilities for my

future

Broaden horizons

—Expose me to new ideas, experiences, and

places

Connect

—Introduce me to people who can help me

grow

Slide43

MH/BH Response Techniques:

Action steps for CASA volunteers

when

you

recognize

the

signs and symptoms of MH/BH concerns

in

children and

teens

Slide44

How to Help Children/Teens who are Anxious

T

alk with children and teens

about their anxiety or

worries

Teach children and teens

to recognize

signs of anxiety in themselves and to ask for help when

they experience anxiety

Help them find coping strategies for their anxiety or worries

R

elaxation techniques, such

as taking three deep, slow breaths, breathing in for a count of three and out for

three

Calming/coping toolbox

Distraction techniques (think of favorite things, squeeze something, counting)

For severe and/or persistent anxiety, advocate for the child/teen to visit a mental health professional

Slide45

How to Help Children/Teens who have Stress/PTSD

Offer

support and

understanding to children and teens after a stressful

event

K

eep children/teens’

schedules and lives as similar as possible to before the

event

Encourage children and teens

to talk

about the

stressful/traumatic

event when and if they feel ready (but don’t force the issue

)

Reassure

them that their feelings are typical and that they're not "going

crazy"

Help build self-confidence by encouraging children and teens to make everyday decisions where

appropriate (PTSD

can make kids feel powerless, so helping them have control over some parts of their lives is very

healing)

Tell them that the

stressful/traumatic

event is not their

fault (

e

ncourage talking

about any feelings of guilt, but don't let them blame themselves for what

happened)

Do not criticize regressive behavior (returning to a previous level of development

)

Advocate for the child/teen to visit a mental health professional (if needed)

Slide46

How to Help Children/Teens who are Depressed

Talk

with

children and teens about

things in their lives that may be bothering them

Teach children and teens to recognize signs of

depression

in themselves and to ask for help when

feeling depressed

Promote health (healthy diet, getting enough sleep, daily exercise)

Teach coping strategies (e.g., self-worth statements, mindfulness)

Encourage fun activities and positive social interactions with others

For severe and/or persistent

depression,

advocate for the child/teen to visit a mental health

professional

Slide47

How to Help Children/Teens who experience Obsessions and Compulsions

Educate child/teen about obsessions and compulsions

Help child/teen to identify what ‘triggers’ obsessive thoughts and compulsive behaviors

Encourage child/teen to challenge the obsessive thoughts

Encourage child/teen to resist acting on the compulsions

Ensure that child/teen has support from others

Reduce stress in the child/teen’s life

For severe and/or persistent

obsessions and compulsions,

advocate for the child/teen to visit a mental health

professional

Slide48

How to Help Children/Teens with Attention-Deficit and Hyperactivity

Advocate for child/teen to have a structured, consistent schedule

Break down activities in smaller (more manageable) steps

Establish clear rules, expectations, and consequences

Determine if child/teen needs a ‘fidget’ to help concentrate better

Help child/teen simplify and organize their tasks and responsibilities

Limit distractions (e.g., quiet place for homework)

Encourage ‘out loud’ thinking to help with self-control

Encourage child/teens to take breaks, when needed (but not to ‘give up’ on tasks)

Slide49

How to Help Children/Teens with Behavior Problems

Use behavior management techniques:

Increase supervision of child/teen during ‘high-risk’ activities

Encourage child/teen to apologize to help in social conflicts

Ignore behavior that is not harmful (e.g., annoying) - “Pick your battles”

Remove privileges for misbehavior

Praise positive behaviors (behaviors opposite of misbehavior)

Offer choices whenever possible

Make tasks more manageable

Encourage child/teen to reach out for help (when needed)

If anyone’s safety is at risk, seek immediate professional help (law enforcement, medical help, mental health professionals)

Slide50

How to Help Children/Teens with ACES & Trauma

Ask “what’s happening?” rather than “what is wrong with this child?”

Recognize when child/teen is triggered by something in the environment

Respond in a calm, kind, compassionate way

Provide a safe place for child/teen to talk about what happened

Understand that behavior problems may be related to trauma

Re-establish a sense of safety

Identify coping strategies for dealing with overwhelming emotions

If symptoms become overwhelming,

advocate for the child/teen to visit a mental health

professional

Slide51

How to Help Children/Teens involved in Bullying

Be clear about expectations (e.g., anti-bullying rules)

Encourage child/teen to refuse to participate in any aspect of bullying

Reinforce prosocial, positive behaviors

Intervene on the spot if you witness bullying

Set consequences for bullying behavior

Increase supervision of children/teens in ‘hotspots’ for bullying

Encourage children/teens who are bullied to tell a trusted adult

Offer support for children/teens who are

bullied

If anyone’s safety is at risk, seek immediate professional help (law enforcement, medical help, mental health professionals

)

Slide52

How to Help Children/Teens involved in Interpersonal/Dating Violence

Educate children/teens

about dating violence

Listen (without distraction) to

children/teens

if they open up about

dating

abuse

Explain

that you are going to help

them get

out of the

situation

Work

with children/teens

to

identify

resources to help them

Provide

emotional support

to them and help build their self-esteem

Be

realistic when

talking, as children/teens

often have a false picture of romantic

relationships (explain

that abuse is not

love, and talk with them about the ways they should

treat and respect

others)

Create

an open

environment, be

open to all of

their questions, and don’t

criticize,

judge,

or jump to conclusions when

they ask

about

relationships

Slide53

How to Help Children/Teens who are Suicidal

Pay attention to warning

signs

Always take suicidal thoughts seriously (no matter how minor they may seem, or if you think child/teen does not mean them)

Talk openly with children/teens about your concerns for their safety

Never leave someone who is suicidal alone

Remove access to any harmful objects

Seek professional help right

away (911, nearest emergency room, suicide hotline)

Crisis Text Line: text “4HOPE” to 741-741

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Slide54

Remember Your Action Steps…

Build positive relationships

with the children and teens you serve

When you recognize and identify the signs and symptoms of MH/BH concerns in the children and teens you serve,

take action

to help:

Talk

with children and teens about their MH/BH concerns

Listen

(without distraction) to what they have to say

Teach

them how to recognize the signs and symptoms of MH/BH concerns

Educate

them about MH/BH concerns they may be experiencing

Help

them identify coping strategies to mitigate their symptoms

Advocate

for them if they are in need of professional mental health help

Slide55
MH/BH Resources & Information

All adults and youth have access to strength-based, asset-driven resources & information about MH/BH signs and symptoms, along with best practices to mitigate

their impact

Examples include:

MH/BH screening and evaluation tools

Best practice information briefs

MH/BH resources compendium

Referral pathways protocol

Threat assessment policies/procedures

Slide56

MH/BH Resources and Information:

Action Steps for CASA Volunteers

Know where to find resources and information

related to social, emotional, behavioral, and mental health topics

Share MH/BH resources

with children and teens that you serve to help educate them

about social, emotional, behavioral, and mental health

topics

Slide57
MH/BH Resources & Information

All adults and youth have access to strength-based, asset-driven resources & information about MH/BH signs and symptoms, along with best practices to mitigate

their impact

Slide58
MH/BH Resources & Information

All adults and youth have access to strength-based, asset-driven resources & information about MH/BH

signs and symptoms, along with best practices to mitigate

their impact

http://resources.oberlinkconsulting.com

/

http://education.ohio.gov

/

[Keyword Search = Project AWARE]

Slide59

Mindfulness techniques

using the five senses

Slide60

Slide61

Slide62

Slide63

Remember Your Action Steps…

Know where to find resources and information

related to social, emotional, behavioral, and mental health topics

Share MH/BH resources

with children and teens that you serve to help educate them

about social, emotional, behavioral, and mental health

topics

Slide64
MH/BH Continuum of Supports & Services

All adults and youth are aware of the available continuum of MH/BH supports and services

available within their community

Examples include:

Prevention

, intervention,

and treatment

partners and providers identified

Online map of resources (Ohio's School and Community Continuum of Services)

Services cards from county mental health/addiction services boards

PBIS resources (OAC Rule 3301-35-15)

Slide65

MH/BH Continuum of Supports & Services:

Action Steps for CASA Volunteers

Know where to find prevention, intervention, and treatment

supports and services

Share MH/BH supports and services

with children and teens that you serve so that they have access to appropriate social

, emotional, behavioral, and mental health

support

Slide66
MH/BH Continuum of Supports & Services

All adults and youth are aware of the available continuum of MH/BH supports and services

available within their

community

Slide67
MH/BH Continuum of Supports & Services

All adults and youth are aware of the available continuum of MH/BH supports and services

available within their community

http://continuum.oberlinkconsulting.com/

Slide68

Remember Your Action Steps…

Know where to find prevention, intervention, and treatment

supports and services

Share MH/BH supports and services

with children and teens that you serve so that they have access to appropriate social, emotional, behavioral, and mental health support

Slide69

Slide70

Did We Meet Our Learning Objectives?Are you able to…?

R

ecognize

the signs and symptoms

of common mental health and behavioral health issues experienced by children and

youth

;

I

mplement

action steps to support children and youth

experiencing mental health and behavioral health

concerns;

I

dentify

appropriate referral pathways

that can help

children and youth

in need of mental health resources and supports.

Slide71

Slide72

Opioid EpidemicSchool Shootings

Slide73

1 in 6 school-aged youth: significant impairments in life functioning due to a

mental

illness

(e.g., ADHD,

behavioral problems, conduct problems, anxiety, and/or

depression)

1

in 4

youth: growing

up in

poverty

and may be

exposed to violence, chronic insecurity, loss, hardship, and disruption of

life

1

in 5

youth: high

levels of

traumatic adverse childhood

experiences

1

in 4

students:

bullied by

peers

1

in 10

adolescents:

victim of

physical violence by a dating

partner

Suicide

is 2

nd

leading

cause of death for youth

(ages

of

10-24)

Slide74

Slide75

Just Read From the Bottom Up…

Slide76

Slide77

Contact Us:

Follow us on Facebook

& Twitter

CSBMHP Website

:

www.miamioh.edu/csbmhp

CSBMHP Phone

:

1-513-529-2450

CSBMHP Mailing Address

:

90 N. Patterson Avenue

Oxford, OH 45056

Contact Cricket Meehan @

meehandc@miamioh.edu

(513) 529-4247

Slide78