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Introduction to Mental Health
in Child Welfare
Presented by:
Dr. Jayme Jones
Adult Major Mental Illnesses
• Anxiety Disorders
– Excessive anxiety & worry about multiple events
or activities
– Psychological manifestations
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Worry
Fearfulness
Apprehension
Anxious anticipation
Avoidance
Obsessions
Adult Major Mental Illnesses
• Anxiety Disorders
• Physical manifestations
– Racing heart/Heart Palpitations
– Shortness of breath
– Trembling/Shaking
– Dizziness
– Muscle tension
– Agitation
– Compulsions
Adult Major Mental Illnesses
• Anxiety Disorders
– Common profiles
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Generalized Anxiety
Panic Attacks
Agoraphobia
Phobia
Obsessive Compulsive Disorder (OCD)
Adult Major Mental Illnesses
• Anxiety Disorders
– Post-Traumatic Stress Disorder (PTSD)
• Profile
– Traumatic Event
– Re-experiencing
• Flashbacks/Recurrent Thematic Dreams
– Avoidance
• Thoughts
• Activities
– Arousal
• Sleep disturbance
• Irritability
• Poor Concentration
• Hypervigilance/Increased Startle Response
Adult Major Mental Illnesses
• Anxiety Disorders
– Prevalence
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1 – 2% Panic
1 – 3% OCD
7 – 11% Specific Phobia
3 – 13% Social Phobia
8% PTSD
Adult Major Mental Illnesses
• Anxiety Disorders
– Familial/genetic components
• Increased incidence of all anxiety disorders among
first degree relatives
– Environmental components
• Negative experience
• “Transmission” of Anxiety
Adult Major Mental Illnesses
• Anxiety Disorders
– Gender factors
• 2 to 3 times more common among women
• OCD the same
– Cultural factors
• Focus of anxiety
• Presentation of symptoms
– Impact on family
• Restriction of behaviors
• “Transmission” of Anxiety
Adult Major Mental Illnesses
• Mood Disorders
– Depression
• Psychological manifestations
– Depressed mood (or irritability)
– Frequent crying
– Loss of interest
– Poor concentration
– Feelings of guilt and worthlessness
– Thoughts of death and/or suicide
Adult Major Mental Illnesses
• Mood Disorders
– Depression
• Physical manifestations
– Weight change
– Sleep disturbance
– Motor Slowness
– Fatigue
Adult Major Mental Illnesses
• Mood Disorders
– Mania
• Psychological manifestations
– Expansive or elated mood
– Inflated self-esteem/grandiosity
– Talkative/flight of ideas
– Distractible
– Increase in goal directed activity
– Excessive involvement in pleasurable activities
Adult Major Mental Illnesses
• Mood Disorders
– Mania
• Physical Manifestations
– Decreased need for sleep
– Appetite Changes
Adult Major Mental Illness
• Mood Disorders
– Prevalence
• Depression
– 10-25% women
– 5 to 12% men
• Bipolar .4 to 1.6%
Adult Major Mental Illness
• Mood Disorders
– Familial/genetic components
• Depression - 1.5 to 3 times more common
among 1st degree relative
• Bipolar - 10 to 15 times more common
– Environmental components
• Situational stressors
Adult Major Mental Illness
• Mood disorders
– Gender factors
• More women than men especially in US and Europe
– Cultural factors
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Somatic concerns
“Nerves” – Latino and Mediterranean cultures
“Imbalance” weakness, tiredness - Asian cultures
“Heart” - Middle Eastern
Adult Major Mental Illnesses
• Mood disorders
– Impact on Family
• Difficulty with self and other care
• Neglect
• Possible suicide
Adult Major Mental Illnesses
• Psychotic Disorders
– Symptoms
• Impaired Reality
– Delusions – not culturally acceptable
– Hallucinations
• Affect Impairment
• Thought Impairment
Adult Major Mental Illnesses
• Psychotic Disorders
– Prevalence
• .5 to 1.5
– Familial/genetic components
• First degree relatives 10 times higher
– Environmental components
• Stressors
• Family Communication Patterns
Adult Major Mental Illnesses
• Psychotic Disorders
– Gender factors
• Men develop earlier (18 to 25 v. 25 to 35)
– 3-10% of women after 40
• Women better pre-morbid functioning, more
affective symptoms, paranoid delusions and
hallucinations
• Men more negative symptoms
• Women have better prognosis (fewer
hospitalizations, shorter durations, more
improved with medication)
Adult Major Mental Illnesses
• Psychotic Disorders
– Cultural Factors
• Catatonic behavior more common in nonWestern countries
– Impact on family
• Delusions and hallucinations re: family
• Impaired self and other care
• Neglect
• Abuse
Childhood Major Mental Illnesses
• Attention Deficit Hyperactivity Disorder
– Symptom Profile
• Inattention
• Hyperactivity and Impulsivity
– Familial/genetic components
• Higher likelihood among first degree relatives
– Environmental components
• Differences in reporting
Childhood Major Mental Illnesses
• Attention Deficit Hyperactivity Disorder
– Prevalence
• 3 to 5 % of school age children
– Gender differences
• 4:1 to 9:1
– Impact on family
• Increased interaction with schools
• Increased need for behavioral management
• Increased risk for abuse
Childhood Major Mental Illnesses
• Anxiety Disorders
– Differences in symptom profiles
• More physical symptoms
• Crying, tantrums, freezing, or clinging
• Increase in activity level
• Washing, checking and ordering
Childhood Major Mental Illnesses
• Anxiety Disorders
– Separation Anxiety Disorder
• 4% of children
• Frequent in children whose mother’s have panic
disorder
– Post-Traumatic Stress Disorder
• Distressing events change to generalized nightmares
of monsters, rescuing others, or threats to self
• Repetitive play
Childhood Major Mental Illnesses
• Anxiety Disorders
– Gender factors
• OCD more common in boys
– Impact on family
• Increased need for emotional support
• Increased risk for emotional abuse
Childhood Major Mental Illnesses
• Mood Disorders
– Differences in symptom profiles
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More irritability
Increase in physical complaints
Friends “dropped” or ignored
Increase is risk-taking behavior
Constant search for distractions and new activities
Aggressive behavior
Mania - adolescents often have psychotic symptoms
Childhood Major Mental Illnesses
• Mood Disorders
– Prevalence
• Depression
– 2-5% of pre-pubescent children
– 1.5% adolescent males
– 7% adolescent females
• Mania
– rare in childhood
– .5% of adolescents
Childhood Major Mental Illnesses
• Mood Disorders
– Gender factors
• Equal numbers in childhood
– Impact on family
• Often ignored in childhood
• Attributed to personality traits in adolescents
• Risk of suicide often ignores
Childhood Major Mental Illnesses
• Psychotic Disorders
– Differences in symptom profiles
• Delusions and hallucinations less elaborate
• More visual hallucinations
– Prevalence
• Less than .5%
– Gender factors – none noted
– Impact on family
Application Exercise
• A 24 year-old man tells you he recently
consulted his physician because of dizziness
and difficulty falling asleep. During your
interview, he is visibly distressed, gulping
before he speaks, sweating, and continually
fidgeting in his chair. He reports that he
always feels tense, and worries about
anything and everything.
Application Exercise
• A 38 year old single mother of four children
reports feelings of intense sadness for the past two
months. Seven months ago she was laid-off from
her job, the family’s sole source of income. About
six weeks ago, she began having difficulty
sleeping and lost her appetite, resulting in weight
loss. She has little energy and no interest in
activities that she normally enjoyed. She reported
that household chores seemed overwhelming and
were impossible to do. Her children have missed
several days of school during the past three weeks
because she is unable to get them ready.
Application Exercise
• Mr. W., a thirty-two-year-old factory worker, has been
married for eight years. He and his wife have two children.
One morning, Mr. W. told his wife that he was bursting
with energy and ideas, that his job was unfulfilling, and
that he was just wasting his talent. That night he slept very
little, spending most of the time at a desk, writing
furiously. The next morning he left for work at the usual
time, but returned at 11:00am, his car overflowing with
aquariums and other equipment for tropical fish. He had
quit his job and withdrawn all the money from the family’s
savings account and spent it on the equipment. He told his
wife that the night before he had worked out a way to
modify existing equipment so that fish “won’t die
anymore. We’ll be millionaires.”
Application Exercise
• Eight months ago, a 27 year old female’s
boyfriend had been stabbed to death during a
mugging from which she escaped unharmed. After
a period of mourning she appeared to return to her
usual self. Shortly after the arrest of the man
accused of the murder, she began to have
nightmares and vivid memories of the night of the
stabbing. Her friends noted that she startled easily
and seemed to be pre-occupied. She began to sleep
restlessly, and her work suffered because of her
poor concentration.
Application Exercise
• A 6 year old girl was referred to DCFS by her
teacher who suspected child abuse. During your
interview, the girl sits calmly while you ask her
about her friends and school, and answers all of
your questions. When you begin to ask questions
related to the referral question, she begins to run
around the room and speak very quickly about
non-related topics. She does not respond to your
questions. She then climbs on a desk, from which
you have to remove her for her safety.
Impact of culture, language and
social context
• Perceptions of mental illness and the causes
vary by culture
• Beliefs about health, healing and wellness
also vary by culture
• Culture influences attitudes toward health
care providers
– Latinos are more likely to terminate treatment
prematurely - (60-75%) after one session
Source: Sergio A. Aguilar-Gaxiolo, MD, PhD
Impact of culture, language and
social context
• Disparity in access to and quality of mental health
services
– African-American and Latino youth identified and
referred at the same rate, but less likely to receive
specialized mental health services
– Asian-American and Latino children have highest rates
of depression
• Under-representation of providers from culturally
and linguistically diverse groups
Source: Sergio A. Aguilar-Gaxiolo, MD, PhD
Intervention and Planning
• Identification vs. Assessment and Treatment
– The role of the CSW
– Referral sources
• Documentation (Strength Based)
– Needed information
• Objective Observations (Behaviorally-specific)
Intervention and Planning
• Documentation (Strength Based)
– Needed information
• Consultation with Collaterals
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SCSW
Psychiatrist
School Staff
Therapist
• Interventions Provided
– Specific
– Examples
Intervention and Planning
• Documentation concerns
– Confidentiality
– Impact on Case Planning
– How would you integrate information about
mental health into the case plan?
• Referral for therapy
• Referral for medication evaluation
• Follow-up
Youth Suicide
• 3rd leading cause of death among
adolescents
• Approximately 5 to 8% of adolescents
attempt suicide
• Approximately 1 in 5 Latinas make a
suicide attempt
Crisis Intervention
• Types
– Suicide
– Homicide
– Danger to Child
• Response of the CSW
Crisis Intervention
• Three levels of intervention
– 1st = “Informal” (Nuclear & Extended Family)
– 2nd = Community & Faith Based Organizations
– 3rd = “Formal” (DCFS)
• Assistance
– When to get it
– Where to get it
Vignette Application Exercise