Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence
Depressive Disorders
Depressive disorders, which include major depressive disorder, dysthymic disorder and bipolar disorder, adversely affect mood, energy, interest, sleep, appetite and overall functioning. In contrast to the normal emotional experiences of sadness, feelings of loss or passing mood states, symptoms of depressive disorders are extreme and persistent and can interfere significantly with a young
person’s ability to function at home, at school and with peers.
Major depressive disorder (major depression) is characterized by five or more of the following symptoms: persistent sad or irritable mood, loss of interest in activities once enjoyed, significant change in appetite or body weight, difficulty sleeping or oversleeping, psychomotor agitation or slowing, loss of energy, feelings of worthlessness or inappropriate guilt, difficulty concentrating and recurrent thoughts of death or suicide.
Dysthymic disorder, a typically less severe but more chronic form of depression, is diagnosed when depressed mood persists for at least one year in children and is accompanied by at least two other symptoms of depression (without meeting the criteria for major depression). Youth with dysthymic disorder are at risk for developing major depression.
Although bipolar disorder (manic-depressive illness) typically emerges in late adolescence or early adulthood, there is increasing evidence that this illness also can begin in childhood. Bipolar disorder beginning in childhood or early adolescence may be a different, possibly more severe form of the illness than older adolescent and adult-onset bipolar disorder. Research has revealed that when the illness begins before or soon after puberty, it is often characterized by a continuous, rapid-cycling, irritable and mixed manic and depressive symptom state that may co-occur with disruptive behavior disorders (particularly attention-deficit hyperactivity disorder or conduct disorder) or may have features of these disorders as initial symptoms. Diagnosis and treatment of depressive disorders in children and adolescents are critical for enabling young people with these illnesses to live up to their full potential.
Anxiety Disorders
Anxiety disorders, as a group, are the most common mental illnesses that occur in children and adolescents regardless of foster care status. Researchers estimate that the prevalence of any anxiety disorder among children and adolescents in the US is 13% in a six-month period.
Generalized anxiety disorder is characterized by persistent, exaggerated worry and tension over everyday events.
Obsessive-compulsive disorder (OCD) is characterized by intrusive, unwanted, repetitive thoughts and behaviors performed out of a feeling of urgent need.
Panic disorder is characterized by feelings of extreme fear and dread that strike unexpectedly and repeatedly for no apparent reason, often accompanied by intense physical symptoms, such as chest pain, pounding heart, shortness of breath, dizziness or abdominal distress.
Tuesday, March 24, 2009
Saturday, March 21, 2009
Systems Challenges
Systems Challenges
Children and youth can find themselves involved with several social systems: foster care, mental health and their own families. All three systems share the same ultimate goals: to enable children to live safely with their families, attend and make progress in local schools, participate in the social and cultural life of their communities and develop the skills to live independently as young adults and contribute to society.
Foster care sees these goals through the mandates of child safety, permanence and well-being. Mental health’s vision is characterized by the fulfillment of age-appropriate developmental-intellectual, emotional and social milestones in the child’s family, schools and community. Families want their children to be successful and to belong. Families want to be asked what they know, what they think will or will not work and what support or resources they may need for their child and family to reach goals. Yet in spite of the connections among these goals, foster care, mental health and families face numerous systemic challenges that require an uncommon level of collaboration to resolve.
Challenges in the Foster Care System
• Staff turnover hinders the ability to meet the special needs of children and youth who have serious emotional disturbances. New staff often receive inappropriate training or insufficient supervision to support the child, the foster parent and the biological parent. When a child is oppositional or aggressive, both the foster parent and child need adequate support; otherwise, a disrupted placement and another rejection for the child result.
• The growing needs of seriously emotionally disturbed children and youth and the inconsistent availability of foster parent training and support result in high foster parent turnover. The result: placement disruption, inconsistent treatment and increased trauma for the child.
• Foster parents need to be considered partners in the treatment of children in their care.
• The legislatively mandated focus and media attention on the safety needs of children increase child welfare professionals’ anxiety and take time away from attending to the emotional and trauma needs of the children for whom they are responsible.
• Increased mental health challenges of children require training to ensure earlier recognition and intervention. Younger children who display aggressive or sexually inappropriate behaviors are an increasing challenge for staff and foster parents who have limited training and support.
• Access to mental health services for referred children and youth is limited.
Introduction Health
From birth, a black male on average seems fated to a life so unhealthy that a white man can only imagine it. He will die before just about anyone else, man or woman, of any race. Compared to a white man, there’s a far greater chance he is a time bomb of diabetes, high blood pressure, obesity, heart disease, drug abuse or AIDS. Yet, the
prospects are even better that he will be murdered, most likely shot, before
he dies of a preventable disease. Either way, sometime during his life this same black man also may well suffer mental or emotional illness.
More or less, the picture also is grim for Hispanic, Native American, and
other men of color. Nothing in the biological makeup of men of color explains the remarkable gulf between their health and white men’s. Instead, insidious social
factors — foremost racism — primarily are behind it. Uninsured,
impoverished, and poorly educated, men of color are more often blocked,
rather than helped, by the nation’s health care system. When they end
up at a clinic or hospital — mainly for emergencies — they find few on
staff who share their culture or language. Even so, men of color are
widely seen as solely responsible for promoting and preserving their
health. If the scope of the health crisis gripping men of color isn’t clear, this report is intended, in part, to starkly detail it. To be non-white is to be doomed to a life that is significantly less healthy. This sad reality stems from an array of familiar social and political drawbacks, including widespread poverty, with which white men typically aren’t burdened. Racism, however, is almost undeniably at the root of the socioeconomic disparities. Still, despite the gloom and doom, this report is informed, in large part,
by an optimistic trend. Pioneering health agencies, community organizations,
and other advocates are beginning to search for answers to the health crisis. At its most concrete, the report describes some of the early programs and projects that may be
models for promoting changes that improve the health of men of color,
particularly those in poverty. And most importantly, based on some of
the insight that is now emerging, the report sets out in sim ple, concrete
terms public policies that could profoundly influence the grave status quo.
Children and youth can find themselves involved with several social systems: foster care, mental health and their own families. All three systems share the same ultimate goals: to enable children to live safely with their families, attend and make progress in local schools, participate in the social and cultural life of their communities and develop the skills to live independently as young adults and contribute to society.
Foster care sees these goals through the mandates of child safety, permanence and well-being. Mental health’s vision is characterized by the fulfillment of age-appropriate developmental-intellectual, emotional and social milestones in the child’s family, schools and community. Families want their children to be successful and to belong. Families want to be asked what they know, what they think will or will not work and what support or resources they may need for their child and family to reach goals. Yet in spite of the connections among these goals, foster care, mental health and families face numerous systemic challenges that require an uncommon level of collaboration to resolve.
Challenges in the Foster Care System
• Staff turnover hinders the ability to meet the special needs of children and youth who have serious emotional disturbances. New staff often receive inappropriate training or insufficient supervision to support the child, the foster parent and the biological parent. When a child is oppositional or aggressive, both the foster parent and child need adequate support; otherwise, a disrupted placement and another rejection for the child result.
• The growing needs of seriously emotionally disturbed children and youth and the inconsistent availability of foster parent training and support result in high foster parent turnover. The result: placement disruption, inconsistent treatment and increased trauma for the child.
• Foster parents need to be considered partners in the treatment of children in their care.
• The legislatively mandated focus and media attention on the safety needs of children increase child welfare professionals’ anxiety and take time away from attending to the emotional and trauma needs of the children for whom they are responsible.
• Increased mental health challenges of children require training to ensure earlier recognition and intervention. Younger children who display aggressive or sexually inappropriate behaviors are an increasing challenge for staff and foster parents who have limited training and support.
• Access to mental health services for referred children and youth is limited.
Introduction Health
From birth, a black male on average seems fated to a life so unhealthy that a white man can only imagine it. He will die before just about anyone else, man or woman, of any race. Compared to a white man, there’s a far greater chance he is a time bomb of diabetes, high blood pressure, obesity, heart disease, drug abuse or AIDS. Yet, the
prospects are even better that he will be murdered, most likely shot, before
he dies of a preventable disease. Either way, sometime during his life this same black man also may well suffer mental or emotional illness.
More or less, the picture also is grim for Hispanic, Native American, and
other men of color. Nothing in the biological makeup of men of color explains the remarkable gulf between their health and white men’s. Instead, insidious social
factors — foremost racism — primarily are behind it. Uninsured,
impoverished, and poorly educated, men of color are more often blocked,
rather than helped, by the nation’s health care system. When they end
up at a clinic or hospital — mainly for emergencies — they find few on
staff who share their culture or language. Even so, men of color are
widely seen as solely responsible for promoting and preserving their
health. If the scope of the health crisis gripping men of color isn’t clear, this report is intended, in part, to starkly detail it. To be non-white is to be doomed to a life that is significantly less healthy. This sad reality stems from an array of familiar social and political drawbacks, including widespread poverty, with which white men typically aren’t burdened. Racism, however, is almost undeniably at the root of the socioeconomic disparities. Still, despite the gloom and doom, this report is informed, in large part,
by an optimistic trend. Pioneering health agencies, community organizations,
and other advocates are beginning to search for answers to the health crisis. At its most concrete, the report describes some of the early programs and projects that may be
models for promoting changes that improve the health of men of color,
particularly those in poverty. And most importantly, based on some of
the insight that is now emerging, the report sets out in sim ple, concrete
terms public policies that could profoundly influence the grave status quo.
Friday, March 20, 2009
Pockets of Hope
Pockets of Hope
With these circumstances, it is understandable that many who are involved in child welfare can end up feeling frustrated and helpless. But there are pockets of hope—people and organizations that are brainstorming and implementing solutions that could ultimately serve as guideposts for communities across the country.
One organization that is trying to make a difference is A Home Within. Their mission is to support and enhance the emotional well-being of children in foster care by addressing the low numbers of available mental health providers. Their innovative Children’s Psychotherapy Project (CPP) offers long-term individual psychotherapy with experienced clinicians to foster children and adolescents. With 10 chapters nationwide and one in Australia, directors are actively recruiting experienced therapists who are willing to volunteer their time. Therapists are asked to take one foster child into weekly psychotherapy for as long as that child needs treatment.
Another newer approach is therapeutic foster care, also called treatment foster care. An evidenced-based practice that was originally started to help children and youth in the juvenile justice system, it has now grown to include those in foster care and is being introduced in a number of communities nationwide. This model actively includes foster parents in mental health treatment by having them provide the primary intervention in their homes. In order to do so, they receive mental health training, consultation and regular clinical support. Therapeutic foster care usually lasts six to twelve months and is often used as an alternative to residential treatment. “Many kids need to be in foster care that is actively supported by mental health providers,” says Marshall from the American Institutes for Research. “We need a lot more of this model out there.”
Solutions are also being developed and examined at a national level. In 1992, Congress passed legislation creating the Comprehensive Mental Health Services Program for Children and Their Families. This program in turn funded 85 state and local communities to build a “system of care” approach. This philosophy aims to help children and adolescents access individually-tailored mental health services near their homes through the close collaboration of local organizations and providers. Preliminary studies show this approach is more effective than traditional, uncoordinated mental health services.
Because children in foster care find themselves involved with several systems at once (families, foster care, mental health, school), this collaborative approach is ideal. In 1999, the Surgeon General’s Report on Mental Health outlined three evidence-based interventions that reflect effective system of care principles for foster youth: therapeutic foster care, intensive case management and wrap-around services, and Multisystemic Therapy (MST), a home and community-based intervention that addresses conduct-related mental health needs by intervening in all systems that impact youth. Studies
With these circumstances, it is understandable that many who are involved in child welfare can end up feeling frustrated and helpless. But there are pockets of hope—people and organizations that are brainstorming and implementing solutions that could ultimately serve as guideposts for communities across the country.
One organization that is trying to make a difference is A Home Within. Their mission is to support and enhance the emotional well-being of children in foster care by addressing the low numbers of available mental health providers. Their innovative Children’s Psychotherapy Project (CPP) offers long-term individual psychotherapy with experienced clinicians to foster children and adolescents. With 10 chapters nationwide and one in Australia, directors are actively recruiting experienced therapists who are willing to volunteer their time. Therapists are asked to take one foster child into weekly psychotherapy for as long as that child needs treatment.
Another newer approach is therapeutic foster care, also called treatment foster care. An evidenced-based practice that was originally started to help children and youth in the juvenile justice system, it has now grown to include those in foster care and is being introduced in a number of communities nationwide. This model actively includes foster parents in mental health treatment by having them provide the primary intervention in their homes. In order to do so, they receive mental health training, consultation and regular clinical support. Therapeutic foster care usually lasts six to twelve months and is often used as an alternative to residential treatment. “Many kids need to be in foster care that is actively supported by mental health providers,” says Marshall from the American Institutes for Research. “We need a lot more of this model out there.”
Solutions are also being developed and examined at a national level. In 1992, Congress passed legislation creating the Comprehensive Mental Health Services Program for Children and Their Families. This program in turn funded 85 state and local communities to build a “system of care” approach. This philosophy aims to help children and adolescents access individually-tailored mental health services near their homes through the close collaboration of local organizations and providers. Preliminary studies show this approach is more effective than traditional, uncoordinated mental health services.
Because children in foster care find themselves involved with several systems at once (families, foster care, mental health, school), this collaborative approach is ideal. In 1999, the Surgeon General’s Report on Mental Health outlined three evidence-based interventions that reflect effective system of care principles for foster youth: therapeutic foster care, intensive case management and wrap-around services, and Multisystemic Therapy (MST), a home and community-based intervention that addresses conduct-related mental health needs by intervening in all systems that impact youth. Studies
Thursday, March 19, 2009
Important Mental Health
Important Mental Health
When life becomes chaotic and feels like it is falling apart, it is easy to feel alone and depressed. And when you are an abused or neglected child who has been separated from family and shuttled from home to home, the feelings can become incredibly overwhelming and isolating—perhaps even spinning out of control. For many in foster care, the result of this kind of emotional trauma is the development of a mental health disorder. They find themselves in a system that is ill-equipped to provide the mental health services they need and that can further impede their progress towards emotional well-being.
According to the World Health Organization, nearly 20% of children and adolescents worldwide suffer from some type of emotional or behavioral problem. The U.S. Surgeon General reports that roughly 1 in 10 American children experience a mental illness severe enough to cause significant impairment. The prevalence of mental health problems of youth in foster care is even more staggering. “Anywhere from 40 to 85% of kids in foster care have mental health disorders, depending on which report you read,” says Stephen Hornberger, director of behavioral health for the Child Welfare League of America.
The reasons for these high numbers are understandable. Children in foster care are struggling to cope with the traumatic events that brought them into care, including parental abuse or neglect, homelessness and exposure to domestic violence and substance abuse. While they struggle to deal with the tremendous loss of their family, they also frequently blame themselves for being removed. Many children long to
return to their families, regardless of the history of mistreatment. At a time when they desperately need a sense of consistency and stability, they are living in the uncertain world that is foster care: multiple placements, unpredictable contact with family and the inability to control their own lives. These conditions can be a hotbed for serious emotional disturbances.
Although it is clear that a large number of children and youth in foster care are in need of mental health care, studies show that less than one-third receive mental health services. One of the reasons is the lack of experienced mental health professionals available to this population. “There is a shortage of well trained providers who can deal specifically with loss issues,” says Dr. Toni Heineman, clinical psychologist and executive director of A Home Within, a nonprofit organization dedicated to helping meet the mental health needs of children in foster care. Heineman adds that a recent, informal survey revealed that only 3% of mental health providers work with children in foster care. Those that do are often inexperienced trainees unfamiliar with navigating the child welfare system and only available for one year. “Being abused, neglected and removed from their family are extraordinarily painful experiences for these kids,” she says. “Put them with people who aren’t well trained and it can be an overwhelming experience for both parties.”
When life becomes chaotic and feels like it is falling apart, it is easy to feel alone and depressed. And when you are an abused or neglected child who has been separated from family and shuttled from home to home, the feelings can become incredibly overwhelming and isolating—perhaps even spinning out of control. For many in foster care, the result of this kind of emotional trauma is the development of a mental health disorder. They find themselves in a system that is ill-equipped to provide the mental health services they need and that can further impede their progress towards emotional well-being.
According to the World Health Organization, nearly 20% of children and adolescents worldwide suffer from some type of emotional or behavioral problem. The U.S. Surgeon General reports that roughly 1 in 10 American children experience a mental illness severe enough to cause significant impairment. The prevalence of mental health problems of youth in foster care is even more staggering. “Anywhere from 40 to 85% of kids in foster care have mental health disorders, depending on which report you read,” says Stephen Hornberger, director of behavioral health for the Child Welfare League of America.
The reasons for these high numbers are understandable. Children in foster care are struggling to cope with the traumatic events that brought them into care, including parental abuse or neglect, homelessness and exposure to domestic violence and substance abuse. While they struggle to deal with the tremendous loss of their family, they also frequently blame themselves for being removed. Many children long to
return to their families, regardless of the history of mistreatment. At a time when they desperately need a sense of consistency and stability, they are living in the uncertain world that is foster care: multiple placements, unpredictable contact with family and the inability to control their own lives. These conditions can be a hotbed for serious emotional disturbances.
Although it is clear that a large number of children and youth in foster care are in need of mental health care, studies show that less than one-third receive mental health services. One of the reasons is the lack of experienced mental health professionals available to this population. “There is a shortage of well trained providers who can deal specifically with loss issues,” says Dr. Toni Heineman, clinical psychologist and executive director of A Home Within, a nonprofit organization dedicated to helping meet the mental health needs of children in foster care. Heineman adds that a recent, informal survey revealed that only 3% of mental health providers work with children in foster care. Those that do are often inexperienced trainees unfamiliar with navigating the child welfare system and only available for one year. “Being abused, neglected and removed from their family are extraordinarily painful experiences for these kids,” she says. “Put them with people who aren’t well trained and it can be an overwhelming experience for both parties.”
Important Mental Health
Important Mental Health
When life becomes chaotic and feels like it is falling apart, it is easy to feel alone and depressed. And when you are an abused or neglected child who has been separated from family and shuttled from home to home, the feelings can become incredibly overwhelming and isolating—perhaps even spinning out of control. For many in foster care, the result of this kind of emotional trauma is the development of a mental health disorder. They find themselves in a system that is ill-equipped to provide the mental health services they need and that can further impede their progress towards emotional well-being.
According to the World Health Organization, nearly 20% of children and adolescents worldwide suffer from some type of emotional or behavioral problem. The U.S. Surgeon General reports that roughly 1 in 10 American children experience a mental illness severe enough to cause significant impairment. The prevalence of mental health problems of youth in foster care is even more staggering. “Anywhere from 40 to 85% of kids in foster care have mental health disorders, depending on which report you read,” says Stephen Hornberger, director of behavioral health for the Child Welfare League of America.
The reasons for these high numbers are understandable. Children in foster care are struggling to cope with the traumatic events that brought them into care, including parental abuse or neglect, homelessness and exposure to domestic violence and substance abuse. While they struggle to deal with the tremendous loss of their family, they also frequently blame themselves for being removed. Many children long to
return to their families, regardless of the history of mistreatment. At a time when they desperately need a sense of consistency and stability, they are living in the uncertain world that is foster care: multiple placements, unpredictable contact with family and the inability to control their own lives. These conditions can be a hotbed for serious emotional disturbances.
Although it is clear that a large number of children and youth in foster care are in need of mental health care, studies show that less than one-third receive mental health services. One of the reasons is the lack of experienced mental health professionals available to this population. “There is a shortage of well trained providers who can deal specifically with loss issues,” says Dr. Toni Heineman, clinical psychologist and executive director of A Home Within, a nonprofit organization dedicated to helping meet the mental health needs of children in foster care. Heineman adds that a recent, informal survey revealed that only 3% of mental health providers work with children in foster care. Those that do are often inexperienced trainees unfamiliar with navigating the child welfare system and only available for one year. “Being abused, neglected and removed from their family are extraordinarily painful experiences for these kids,” she says. “Put them with people who aren’t well trained and it can be an overwhelming experience for both parties.”
When life becomes chaotic and feels like it is falling apart, it is easy to feel alone and depressed. And when you are an abused or neglected child who has been separated from family and shuttled from home to home, the feelings can become incredibly overwhelming and isolating—perhaps even spinning out of control. For many in foster care, the result of this kind of emotional trauma is the development of a mental health disorder. They find themselves in a system that is ill-equipped to provide the mental health services they need and that can further impede their progress towards emotional well-being.
According to the World Health Organization, nearly 20% of children and adolescents worldwide suffer from some type of emotional or behavioral problem. The U.S. Surgeon General reports that roughly 1 in 10 American children experience a mental illness severe enough to cause significant impairment. The prevalence of mental health problems of youth in foster care is even more staggering. “Anywhere from 40 to 85% of kids in foster care have mental health disorders, depending on which report you read,” says Stephen Hornberger, director of behavioral health for the Child Welfare League of America.
The reasons for these high numbers are understandable. Children in foster care are struggling to cope with the traumatic events that brought them into care, including parental abuse or neglect, homelessness and exposure to domestic violence and substance abuse. While they struggle to deal with the tremendous loss of their family, they also frequently blame themselves for being removed. Many children long to
return to their families, regardless of the history of mistreatment. At a time when they desperately need a sense of consistency and stability, they are living in the uncertain world that is foster care: multiple placements, unpredictable contact with family and the inability to control their own lives. These conditions can be a hotbed for serious emotional disturbances.
Although it is clear that a large number of children and youth in foster care are in need of mental health care, studies show that less than one-third receive mental health services. One of the reasons is the lack of experienced mental health professionals available to this population. “There is a shortage of well trained providers who can deal specifically with loss issues,” says Dr. Toni Heineman, clinical psychologist and executive director of A Home Within, a nonprofit organization dedicated to helping meet the mental health needs of children in foster care. Heineman adds that a recent, informal survey revealed that only 3% of mental health providers work with children in foster care. Those that do are often inexperienced trainees unfamiliar with navigating the child welfare system and only available for one year. “Being abused, neglected and removed from their family are extraordinarily painful experiences for these kids,” she says. “Put them with people who aren’t well trained and it can be an overwhelming experience for both parties.”
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