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MENTAL HEALTH
& MENTAL DISORDERS:
OVERVIEW & IMPLICATIONS
FOR WORKING WITH
FAMILIES INVOLVED IN CHILD
WELFARE
FEBRUARY 2015 (V2.1, FINAL)
CA Common Core Curricula
for Child Welfare Workers
ADULT LEARNING NEEDS
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
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My brain is full!
Tell me how and why
Keep it real!
Variety is the spice of
life!
AGENDA: BEFORE LUNCH
 Introduction (Learning Objectives, Etc.)
 Labeling, Stigma & Bias
 Strength Based Perspective
 Facts and Stats
 New in CA Child Welfare:
Katie A. & Trauma-Informed Practice
 Culture & Mental Health
AGENDA: AFTER LUNCH
 Treatment Considerations
 Overview of Common Diagnoses &
Implications for Child Welfare
 Resources, Interventions & Referrals
 Self-Care
 Brief Review: Job Aids in Appendices
A NOTE ABOUT THIS COURSE
 Some information about children and
youth’s mental health will be covered…
 BUT, most of this course will pertain to adult
mental health – through the lens of Child
Welfare Workers working with parents of
children/youth who come to the attention
of Child Welfare Services.
QUIZ QUESTION #1:
 What is the term that describes health
conditions that are characterized by
alterations of thinking, mood, or behavior or
some combination associated with distress
and/or impaired functioning? (Refers to all
diagnosable mental disorders.)
BRIEF DISCUSSION:
LEARNING OBJECTIVES
 Briefly review the Learning Objectives
 Which ones stand out to you? For what
reasons?
 What else, if anything, would you like to get
out of the training today?
BRIEF ACTIVIT Y:
STIGMAS/LABELS ICEBREAKER
1. Write down 1 or 2 common stigmas or labels
you’ve heard about people with mental
illness on 3x5 card (include reasons for writing
down those particular ones).
2. Meet 3 other people in the room from other
tables.
• Compare your stigmas/labels (& reasons for choosing
them).
• Ask each other about the ones you wrote down.
3. Let’s talk: Answers and implications for Child
Welfare practice?
DISCUSSION:
LABELING AND STIGMAS
 What are some of the labels we put on
mental illness?
 What are the stigmas to be aware of with
mental illness/disorders?
 How does this impact CW?
*See training packet, p.5
ACTIVITY:
SMALL GROUP DISCUSSION
At your tables:
1. Reflect back and discuss:
• How did your family define “crazy”?
• How did your culture (as you define it)
handle parents who were mentally ill?
• As you were growing up, who did you
know who fit this description?
2. More recently: What are some words
you’ve heard at work, used to describe
someone with a mental illness?
(Large group debrief…)
LARGE GROUP DISCUSSION:
BIAS AT WORK
 Early messages become our templates for
biases in the future
 What happens if you add other layers of
potential bias?
 What should your role be in helping with
systemic bias?
WAYS TO FIGHT BIAS: COMPASSION
QUIZ QUESTION #2
“Mental illness is nothing to be ashamed
of, but stigma & bias shame us all.”
Can you guess who said this? (1 st person
who guesses correctly gets a prize!)
HOW TO ADDRESS STIGMA & BIAS, AND
SUPPORT CHILDREN & FAMILIES?
Knowledge (update)
Compassion
Connections
Advocacy
What else?
WAYS TO FIGHT BIAS:
UPDATING KNOWLEDGE
WAYS TO FIGHT BIAS:
CONNECTION &
COLLABORATION
STRENGTHS
AND PROTECTIVE INFLUENCES
 Symptoms manifest differently for different
individuals
 Same diagnoses are more debilitating for
some individuals than others
SMALL GROUP ACTIVITY (OPTIONAL):
STRENGTHS OF THE MENTALLY ILL
ON FLIP CHART @ YOUR TABLES:
LEFT SIDE OF FLIP
CHART:
List mitigating
factors that can
help decrease
severity of living
with mental illness
RIGHT SIDE OF FLIP
CHART:
List strengths that
can help symptoms
be more bearable
and increase
functionality
AND REPORT OUT…
CARD SORT ACTIVITY:
FACTS AND STATS
1. Clear your tables: Put away all handouts
and clear space on your tables.
2. Trainer distributes set of cards to each
table (leave face down until trainer
says)
3. Match the correct statistical information
with the applicable term for all cards.
4. 1 st Table Team with all correct matches
wins a prize!
5. Debrief answers together
FACTS & STATS: DEBRIEF OF CORRECT
ANSWERS FOR SPECIFIC POPULATIONS
 General statistics on mental illness
 Antepartum and/or Postpartum parents
 LGBTQ youth
 Foster Youth vs. general population of
children
 Foster Youth prescribed psychotropic
medications
FACTS & STATS: USE OF PSYCHOTROPIC
MEDICATIONS, CA CWS/CMS DATA:
Percentage of Children Authorized Psychotropic Medications
by Placement Type
Jan-Mar 2014
60
55.9
50
40
30
26.5
25.4
25.6
18.6
20
12.3
10
24.1
6.7
12.4
9.9
5.1
3.9
%
%
Court
Specified
Group
Shelter
Transitional GuardianHousing Dependent
%
%
FFA
%
%
Foster
%
%
Kin
%
%
Pre-Adopt
%
%
0
Runaway
Trial Home
Visit
All
Activity: MOVIE CLIP “HEALING NEEN”
http://vimeo.com/15851924
 Clip 1: 1:10 – 9:28
 Clip 2: 11:55 – 12:40
 Debrief:
How did you feel seeing these clips?
What did you see in the movie
that links with some of the facts
and statistics we just covered?
QUOTE (#2) TO THINK ABOUT:
MENTAL HEALTH & ADDICTIONS
 It is impossible to understand addiction
without asking what relief the addict finds,
or hopes to find, in the drug or addictive
behavior.
- Gabor Maté
CULTURAL PRACTICE
OR MENTAL ILLNESS?
In a large group:
Consider a cultural practice within your
family’s culture that could be mistaken as a
sign of mental illness.
What would those practices be?
CULTURE AND CHILD WELFARE:
LIA LEE
In small groups:
1. Read scenario about Lia Lee
2. Answer the questions at the end of the
scenario with your table group
3. Debrief with large group
IMPLICATIONS FOR PRACTICE
 Biases can shape our decision making
 Community and systemic bias can impact
our client families negatively
 Cultural practices can be misdiagnosed
and misinterpreted
 Child Welfare has a role in prevention and
advocacy for children and families living
with mental illness
 We have an ethical obligation to
understand
EXCITING NEW
CALIFORNIA CHILD WELFARE PRACTICES
 Katie A./Pathways to Well-Being: Child
welfare staff haven’t historically screened all
children & youth coming into care, and some
of them have had significant needs for
support – we need to craft case plans that
include support for mental health needs.
 Trauma Informed Practice: A different way of
being with families, acknowledges that
trauma can have an impact on entire family,
and we need to assess and support
interventions that address this in case plans.
KATIE A./
PATHWAYS TO WELL-BEING

WHAT IS IT?: Class-Action Lawsuit in CA that further
spells out and holds accountable the roles of Child
Welfare Workers and Mental Health personnel in
supporting mental/behavioral health needs of
children & youth

WHO IS ELIGIBLE FOR SERVICES? Children & Youth in
Foster Care (or at imminent risk of entering Foster
Care)…
KATIE A./PATHWAYS TO WELL-BEING
Implications for Child Welfare practice:
MUST SCREEN children and youth for mental
health issues
REFER children/youth to trauma-informed and
evidence-based practices
MONITOR children/youth’s health & well-being
MUST COLLABORATE with Mental Health providers
as part of Child & Family TEAMS!
Check with your supervisor for more countyspecific details!
KATIE A.
 How is Child Welfare practice different with
Katie A, anyway?
Review the differences between old model
of multi-disciplinary coordination vs. new
environment of working in Child & Family
Teams…
*Turn to pages 18-21 in packet
TRAUMA-INFORMED PRACTICE
 WHAT IS IT? *See trainee content, p. 23… for
definitions of trauma-informed practice and
different kinds of trauma
 WHO IS ELIGIBLE FOR SERVICES? Child Welfare
Workers need to use this lens/perspective when
working with ALL children, youth AND
parents/caregivers
Activity: MOVIE CLIP “HEALING NEEN”
http://vimeo.com/15851924
 Clip 3: 12:48 through 16:00
 Clip 4: 19:20 thru 20:41
 Debrief:
 What stands out to you about
the role of trauma in these
clips?
 About the role of substance
abuse?
 What do you think might be
some reasons we are showing
these clips in this training?
A TRAUMA-INFORMED
CHILD WELFARE SYSTEM
Essential Elements:
1.Maximize safety…
2.ID trauma-related needs…
3.Enhance child well-being & resilience.
4.Enhance family well-being & resilience.
5.Enhance the well-being & resilience of those
working in the system.
6.Partner with youth & families
7.Partner with agencies & systems…
TRAUMA AND
THE CHILD WELFARE POPULATION
 Prevalence
 Effects of trauma exposure on children
 Trauma and overwhelming emotion: what it
looks like (next slide)
*See training packet, p. 23
Trauma & overwhelming emotions: what
it looks like…
Over-controlled behavior
Under-controlled behavior
Trauma-exposed children’s maladaptive
coping strategies
Can lead to behaviors that undermine
healthy relationships
May disrupt foster placements
*See training content, p. 25
TRAUMA HISTORIES
AND THE CHILD WELFARE SYSTEM
History of traumatic experiences may
affect/impair parents’/other caregivers’:
Judgments about safety
Relationships
Capacity to regulate their emotions
Self-esteem
Development of maladaptive coping strategies
Result in trauma triggers/reminders
Vulnerability to other life stressors
Karen & Sam’s story, part i:
the lens of trauma
At your small table groups:
1. Select recorder and someone to report out
2. Read story about Karen & Sam AND review
content (1 person/content area):
 Katie A. content, *p. 21
 7 Essential Elements *p. 23
 Trauma & Child Welfare Population *pp. 25-26
 Parents (and other caregivers) w/ trauma
histories… *pp. 28-29
3. Answer questions on flip chart/scratch paper
4. Report out to the large group
QUOTES TO THINK ABOUT:
MH AND TRAUMA
 You can’t patch a wounded soul with a
Band-Aid.
- Michael Connelly
 Sometimes the appropriate response to
reality is to go insane.
- Philip K. Dick
WAYS TO FIGHT BIAS AND SUPPORT
CHILDREN & FAMILIES: ADVOCACY
ADVOCACY
In your small groups:
1. Brainstorm a list of ways Child Welfare
Workers can act as advocates for
mentally ill children, youth and families
2. Write down list
3. Prepare to share with rest of class
4. Report out
RESOURCES, INTERVENTIONS &
REFERRALS: DEMONSTRATION
Let’s go to the website for the California
Evidence-Based Clearinghouse for Child Welfare
and look around: http://www.cebc4cw.org/
Who are they?
What do they do?
What kinds of programs do they provide
rankings for?
What is their ranking system?
Implications for Child Welfare work: Why does
this matter?
QUIZ QUESTION #3
 What type of assessment is it called when
an individual’s functioning at a specific
point in time is assessed, including:
Assessment of thinking, perception,
orientation, suicidality/homicidality, and
memory (useful when suspecting delusions,
dementia, hallucinations, or harm to self or
others)?
Takes 30-60 minutes to complete and is
based on the individual’s self report…
1 st person to answer correctly – gets a prize!
ANXIETY DISORDERS
 Panic Disorders
 Agoraphobia
 Generalized
Anxiety Disorder
SYMPTOMS:
ANXIETY DISORDERS
TRAUMA- AND
STRESSOR-RELATED DISORDERS
 Post-Traumatic Stress Disorder
karen & sam’s story, part II:
the lens of anxiety & stressors
In small groups:
1.Read Karen & Sam’s story, Part II
2.Use the job aid charts in trainee packet
to consider what is diagnosis, signs of
escalation, risk factors
3.Answer the questions following the story
and fill out the blank charts in trainee
packets
4.Debrief: Table groups report out
Karen & sam’s story, part II:
continued
Large group debrief:
 Strengths of family
 Hypotheses about what is going on
 Symptoms appear chronic or acute?
 Implications for parenting?
 Your role?
DEPRESSIVE DISORDERS
 Major Depressive Disorder
 Dysthymia (persistent depressive disorder)
SYMPTOMS:
DEPRESSIVE DISORDERS
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Feels sad, empty or hopeless
Markedly less interest or pleasure in daily
activities
Significant weight loss or gain
Loss of energy
Insomnia or Hypersomnia
Difficulty concentrating
Psychomotor agitation or retardation
Feelings of worthlessness or inappropriate
guilt
Thoughts of death or suicid e
SYMPTOMS: BIPOLAR AND
RELATED DISORDERS
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 Excessive talking
 Flight of ideas
 Distractibility
 Increase in goal-directed activities
or psychomotor agitation
 Risk taking behavior
*Suicide risk is estimated to be
at least 15 times the general population.
Optional movie clip:
“grace” from call me crazy
 Clip: 23:50 – 33:00
 Debrief:
 What, if any, safety concerns
are present?
 What are some dynamics in this relationship?
 What might the child need?
 If you were the Child Welfare Worker, what
would you do?
Karen & sam’s story, part III: the lens
of depression or bipolar disorders
In small table groups:
1.Read Karen & Sam’s story, Part III
2.Use the chart to consider what is
diagnosis, signs of escalation, and risk
factors
3.Answer the questions following the story
In large group: Debrief together.
Karen & Sam’s story, part iii:
continued
Large group debrief:
 Strengths of family
 Implications for parenting
 Chronic vs. acute
 What might be going on?
 What are other considerations?
PSYCHOTIC DISORDERS
Schizophrenia
Depressive Disorder with Psychotic
Features
SIGNS/SYMPTOMS:
PSYCHOTIC DISORDERS




Hallucinations and
delusions
Disorganized speech
(frequent derailment
or incoherent)
Grossly disorganized
or catatonic
behavior
Negative symptoms:
 Flat affect
 Avolition (Lack of
energy or
drive/apathy)

Disorganization:
 in personal care
 in social and
professional
performance


Profound disruption in
cognition and
emotions
Perceptions of reality
strikingly different
from the reality seen
and shared by others
around them
Activity: movie clip
“A Beautiful Mind”
 View the video clip
 Pick out signs/symptoms of psychosis
 Small Group Discussion:
 List signs/symptoms
 Relate to identified parental risks
 How does Minimum Sufficient Level of Care
(MSLC) impact a case with a parent exhibiting
symptoms of schizophrenia?
PERSONALITY DISORDERS
Borderline
Narcissistic
Dependent
Antisocial
SOMATIC SYMPTOM
AND RELATED DISORDERS
 Factitious Disorder Imposed on Self, Factitious
Disorder Imposed on Another
 Hero or martyr
 Exaggeration or exacerbation
 Fabrication
CONSIDER:
Safety
Risk
Protective capacity
Minimum Sufficient Level
of Care (MSLC)
QUIZ QUESTION #4
 What is an assessment by a physician to
determine if the individual could benefit
from medication (that can include a
diagnosis and a mental status exam and
takes 30-60 minutes to complete)?
1 st person to answer correctly – gets a prize!
TO CLOSE:
A FEW WORDS FROM HEALING NEEN
 Clip: 36:20 – 39:22
 Debrief:
 What can Child Welfare Workers
do differently when working with
people living with mental illness,
substance abuse, or exposed to
trauma (or all three)?
 In the spirit of Katie A & TraumaInformed Practice, what is one
thing I commit to doing differently
in my Child Welfare practice, from
this day forward?
REMEMBER SELF-CARE!
“The expectation that we can be
immersed in suffering and loss daily and
not be touched by it is as unrealistic as
expecting to be able to walk through
water without getting wet.”
Rachel Remen,
Kitchen Table Wisdom
IDEAS FOR SELF-CARE
 Remember Element #5 of Trauma-Informed
Child Welfare System; this could include:
Engage in a self-reflective practice with the
support of one or more people (e.g.,
therapeutic process, group supervision, peer
consulting group, etc.)
Seek supervision/consultation
Ask for help
Have fun outside of your job!
JOB AIDS: APPENDICES
Remember resources in the Appendix
section of Trainee Guide/Content
Appendices B – H can be used in support
of your everyday Child Welfare work on
the job
QUOTE TO THINK ABOUT:
CONNECTEDNESS & COMPASSION FOR
THOSE LIVING WITH MENTAL ILLNESSES
When“I” is replaced with “We”, even
Illness becomes Wellness.
- HealthyPlace.com
FINAL QUIZ QUESTION!
 What is the term that refers to successful
performance of mental functions resulting in
productive activities, fulfilling relationships
with other people, and the ability to adapt
to change and to cope with adversity?
LAST HOUSEKEEPING
Questions?
Fill out Participant Satisfaction Survey
Thank you!