Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To...
Transcript of Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To...
![Page 1: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/1.jpg)
Children’s Mental Health Rule 79 Targeted Case Management Training Part 1: Mission, Philosophy and Structure
June 24 – June 25, 2019
1
Telesea Everett| Rule 79 Trainer – DHS Rule 79
![Page 2: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/2.jpg)
Welcome
Getting to know your trainer
Housekeeping
• Restrooms/Breaks
• Cell Phones
• Orientation on training Materials (e.g. handouts, Idea Catcher, parking lot)
• Schedule for the day, policy on breaks
2
![Page 3: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/3.jpg)
Part 1 – Case Management Mission, Philosophy andStructure
Day One:
Introduction 0.5 hours
Historical Perspective 1.5 hours
Integrated Care 1.0 hours
Service Requirements 2.5 hours
Wrap Up (check parking lot, other questions, plan for tomorrow)
0.5 hours
6/12/2019 Minnesota Department of Human Services | mn.gov/dhs 3
![Page 4: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/4.jpg)
Who is here today?
New Children’s Mental Health County Case Managers
• To meet the training requirements for Rules 9520.0912 Subp 4
• Case managers who do NOT have 2,000 hours of supervisedexperience in the delivery of services to children with severeemotional disturbance
• This includes persons with a bachelor’s degree without 2,000 hours of experience as well as persons qualifying as case manager associates and certain immigrants as defined under MS 245.472, Subd. 4 (h) 2.
4
![Page 5: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/5.jpg)
About you
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Ice Breaker
Share your name, where you work, at least one thing you are hoping to gain from this training
Pick one:
1) Share a fact about yourself (not too controversial or incriminating) that others might find surprising.
2) Describe the aspect of working with children and families that you find most satisfying
5
![Page 6: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/6.jpg)
Terms of participation
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• Respect others
• Take risks
• Be open and honest
• Listen actively
• Be accountable
• Maintain confidentiality
6
![Page 7: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/7.jpg)
Training Philosophy
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• Disclaimer: Not “everything you need to know”
• Adult learning
• To “educe” or draw out
• Experiential, “hands-on” activities
• Breadth over depth
• The “4 As”
7
![Page 8: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/8.jpg)
Historical Perspective
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Goal:
Understand the values, principles and legislation that serve as the foundation for children’s mental health case management.
Objectives:
• Identify the responsibilities held by counties as local mental health authorities
• Define the continuum of mental health services established by the Children’s Mental Health Act
• Describe components of a system of care
8
![Page 9: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/9.jpg)
Then and now
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•The “Minnesota Miracle”
•Minnesota Rankings of Child Health and Well-being
9
![Page 10: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/10.jpg)
Significance of Child Poverty
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• One in three Latino babies and one in two black babies are born into poverty
Increased vulnerability to physical health, mental health and developmental problems; limited access to care
Undiagnosed physical health, mental health and developmental problems closely linked to school failure, chemical use and criminal activity
•
•
10
![Page 11: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/11.jpg)
A Call to Action to Dismantle the Cradle to Prison Pipeline
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 11
![Page 12: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/12.jpg)
Discuss
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• Describe your reactions to the child well-being statistics shared in this section. What did you find most surprising? Most encouraging? Most discouraging?
• How optimistic are you feeling about the future of children in Minnesota?
• If you had the power to make immediate changes in policies affecting children and families, what would you change and why?
12
![Page 13: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/13.jpg)
Legislative Framework for Children’s Mental Health System
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• 1968: First comprehensive review of state’s Children’s Mental Health System
1989: Passage of Children’s Mental Health Act
• Established a mission
• Defined counties as local mental health authorities
• Mandated a full continuum of services
• Endorsed a System of Care Philosophy
•
13
![Page 14: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/14.jpg)
Mission of Children’s Mental Health Act
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Minnesota Statutes 245.487, subd. 3
Mission of children's mental health service system.
As part of the comprehensive children's mental health system established under sections 245.487 to 245.4889, the commissioner of human services shall create and ensure a unified, accountable, comprehensive children's mental health service system that is consistent with the provision of public social services for children and that:
14
![Page 15: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/15.jpg)
Mission of Children’s Mental Health Act – cont.
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
(1) identifies children who are eligible for mental health services;
(2) makes preventive services available to all children;
(3) assures access to a continuum of services that:(i) educate the community about the mental health needs of children;
(ii) address the unique physical, emotional, social, and educational needs of children;
(iii)are coordinated with the range of social and human services provided to children and their families by the Departments of Education, Human Services, Health, and Corrections;
(iv) are appropriate to the developmental needs of children; and
(v) are sensitive to cultural differences and special needs;
15
![Page 16: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/16.jpg)
Mission of Children’s Mental Health Act – cont.
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
(4) includes early screening and prompt intervention to:
(i)identify and treat the mental health needs of children in the least restrictive setting appropriate to their needs; and
(ii) prevent further deterioration;
(5)provides mental health services to children and their families in the context in which the children live and go to school;
16
![Page 17: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/17.jpg)
Mission of Children’s Mental Health Act – cont.
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
(6)addresses the unique problems of paying for mental health services for children, including:
(i) access to private insurance coverage; and(ii) public funding;
(7)includes the child and the child's family in planning the child's program of mental health services, unless clinically inappropriate to the child's needs; and
(8)when necessary, assures a smooth transition from mental health services appropriate for a child to mental health services needed by a person who is at least 18 years of age.
17
![Page 18: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/18.jpg)
Statutory definition of Severe Emotional Disturbance
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Mn. Stats. 245.4871, Subd. 6. Child with severe emotional disturbance.
For purposes of eligibility for case management and family community support services, "child with severe emotional disturbance" means a child who has an emotional disturbance and who meets one of the following criteria:
(1)the child has been admitted within the last three years or is at risk of being admitted to inpatient treatment or residential treatment for an emotional disturbance; or
(2)the child is a Minnesota resident and is receiving inpatient treatment or residential treatment for an emotional disturbance through the interstate compact; or
.
18
![Page 19: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/19.jpg)
Statutory definition of Severe Emotional Disturbance
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 19
Mn. Stats. 245.4871, subd. 6
(3) the child has one of the following as determined by a mental health professional:
(i) psychosis or a clinical depression; or
(ii) risk of harming self or others as a result of an emotional disturbance; or
(iii)psychopathological symptoms as a result of being a victim of physical or sexual abuse or of psychic trauma within the past year; or
(4)the child, as a result of an emotional disturbance, has significantly impaired home, school, or community functioning that has lasted at least one year or that, in the written opinion of a mental health professional, presents substantial risk of lasting at least one year
![Page 20: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/20.jpg)
Statutory definition of Emotional Disturbance
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Mn. Stats. 245.4871, Subd. 15 Emotional disturbance
"Emotional disturbance" means an organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that:
(1) is detailed in a diagnostic codes list published by the commissioner; and
(2)seriously limits a child's capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, school, and recreation.
"Emotional disturbance" is a generic term and is intended to reflect all categories of disorder described in the clinical code list published by the commissioner as "usually first evident in childhood or adolescence."
20
![Page 21: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/21.jpg)
System of Care Bubble Map
Education
Juvenile Justice
Public Assistance
Informal Support
Mental Health
Health Care
Child Welfare
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 21
![Page 22: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/22.jpg)
Integrated Care
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Integrated Care: Where we’re going?
22
![Page 23: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/23.jpg)
Integrated Care: Where we’re going
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Goal: Understand why case management is delivered with respect to the physical and mental needs of the client
Objectives:
1. Define the concept of prevention
2. Describe the advantages associated with integrating physical and mental health care
3. Identify key features of a comprehensive benefit set
4. Define how the case manager’s role has changed in light of the 2007 Mental Health Initiative
23
![Page 24: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/24.jpg)
2007 Mental Health Initiative
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Ensuring all citizens have access to the right care, at the right time, in the right location
Based on deficiencies in state mental health system noted by the Minnesota Mental Health Action Group (MMHAG)
24
![Page 25: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/25.jpg)
2007 Mental Health Initiative
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Deficiencies along three themes:
•Fragmentation
•Inefficiency
•Inequity
25
![Page 26: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/26.jpg)
2007 Mental Health Initiative
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Consequences of Fragmentation
•Many singers, no chorus
•Unrecognized and/or untreated health problems
•Delayed care
•Primary care setting becoming the “de facto” provider of mental health services
26
![Page 27: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/27.jpg)
2007 Mental Health Initiative
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Inefficiency:
•The “fatal flaw” of the US health system
•Gaps in coverage
•Financial disincentives
27
![Page 28: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/28.jpg)
2007 Mental Health Initiative
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Inequity:
•Affordable care for some, medical debt for others
•Working poor at distinct disadvantage
28
![Page 29: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/29.jpg)
Integrated Care Approach
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Definition of integrated care:
•Prevention
•Optimal health
•Biopsychosocial perspective
29
![Page 30: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/30.jpg)
Integrated Care Approach
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Three levels of integration
•Practice
•Policy
•Legal
30
![Page 31: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/31.jpg)
Integrated Care Approach
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Integrated care programs in Minnesota
•Preferred Integrated Networks
•Health Care Homes
31
![Page 32: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/32.jpg)
Integrated Care Approach
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Comprehensive Benefit Set:
•Improve outcomes
•Ease access
•Expand choice
•Eliminate stigma
32
![Page 33: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/33.jpg)
Evolving Role of the Case Manager: Working with the MCO’s
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Two service tracks: fee-for-service and managed care
Guidance for working with the MCO’s
Case transitionsMental Health Targeted Case Management Universal Transfer form
(updated 2015)
https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6063-ENG
33
![Page 34: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/34.jpg)
Evolving Role of the Case Manager
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Integrated Approach to Case Management
•Basic assessment of health problems and diseases
•Monitoring access to basic health services
•Helping clients manage health care information
•Facilitating communication among health care providers
34
![Page 35: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/35.jpg)
Evolving Role of Case Manager
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Evidence-based practice
•Data-driven decisions
•Establishing necessity
35
![Page 36: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/36.jpg)
Evolving Role
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Discussion:
What are your reactions to the way the case manager’s role is being defined by current policy?
What do you find encouraging or discouraging about these changes?
36
![Page 37: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/37.jpg)
Service Requirements
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 37
![Page 38: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/38.jpg)
Mandated Responsibilities of a Case Manager
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 38
![Page 39: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/39.jpg)
Service Requirements: Goal and Objectives
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Goal: Apply Rule 79 standards to the practice of Children’s Mental Health case management
Objectives:
1. Define the core services of a case manager
2. Identify allowable mental health targeted case management activities
3. Describe the eligibility criteria for mental health targeted case management
39
![Page 40: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/40.jpg)
Guiding principles
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•Child Centered
Family focused
Culturally competent
Community-based
•
•
•
40
![Page 41: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/41.jpg)
Child-Centered
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•Relationship is the “anesthesia”
“Ages and stages” perspective
Questioning stance
Strengths-based
•
•
•
41
![Page 42: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/42.jpg)
Family-focused
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•“It can’t be about us without us”
•“Inheritances” children receive from families
•Symbolic
•Behavioral
42
![Page 43: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/43.jpg)
Culturally competent
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•Definition
Culture applies to all people, not just people of color
A journey not a destination
Culture reveals strengths and opportunities
•
•
•
43
![Page 44: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/44.jpg)
Culturally Competent
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• The need for a culturally competent Children’s Mental Health system:
• “Failing to prepare is preparing to fail”
• Minnesota youth population by 2030
• Number of white children decreases by 1%
• Number of racial and ethnic minority children increases by 72%
• Children of color up to 50% less likely to receive needed mental health services
• Research on what works for children of color lacking
44
![Page 45: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/45.jpg)
Community-based
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•Least restrictive setting
Availability
Accessibility
Utilization
•
•
•
45
![Page 46: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/46.jpg)
Bronfenbrenner’s Ecological Model: Placing the child/familyinto context
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 46
![Page 47: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/47.jpg)
Group Activity
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Exploring InfluencesList examples of how the child/family domain can be impacted by each of the other domains
47
![Page 48: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/48.jpg)
Case Management Structure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Purpose: to help the child with severe emotional disturbance (SED) and the child’s family obtain needed health, mental health, social, educational, vocational, and recreational services:
Core Services:
• Assessment
• Planning
• Referral and linkage
• Monitoring
48
![Page 49: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/49.jpg)
Case Management Structure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 49
![Page 50: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/50.jpg)
What case management isn’t
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
What case management isn’t:•Direct mental health services
•Skills training
•Transportation service
•Legal Services
50
![Page 51: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/51.jpg)
Case Management Structure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Child Welfare Targeted Case Management (CW TCM) activities not allowable for Children’s Mental Health Targeted Case Management (CMH TCM)
• Research gathering and completion of documentation required by the foster care program
• Assessing adoption placements
• Recruiting or interviewing for potential foster care providers
• Serving legal papers
51
![Page 52: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/52.jpg)
Case Management Structure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
CW-TCM claimable activities but not CMH TCM continued….
•Home investigations
•Providing transportation
•Administering foster care subsidies
•Making placement arrangements
52
![Page 53: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/53.jpg)
Case Management Structure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Clarifying “dual” case management
• Mental Health Targeted Case Management and Child Welfare Targeted Case Management
• Mental Health Targeted Case Management and Developmental Disabilities Case Management
• Mental Health Targeted Case Management and Rehabilitation Services
53
![Page 54: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/54.jpg)
Case Management Structure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Group Activity:
Case Management or not case management
54
![Page 55: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/55.jpg)
Case management process
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
1) Request or referral for CMH TCM services
2) Eligibility determination (see slides #18 - 20)
•Diagnostic assessment requirements
•Presumptive eligibility
3. Case Manager Assigned
55
![Page 56: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/56.jpg)
Case Management Process
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
4.Case manager completes Functional Assessment within 30 days of meeting the child.
5.Case manager complete Individual Family Community Support Plan (IFCSP) within 30 days of meeting the child
6. Case manager refers and links child and family to services
7.Case manager monitors and reviews child’s progress, coordinating and evaluating services.
56
![Page 57: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/57.jpg)
Case Management roles and responsibilities
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 57
![Page 58: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/58.jpg)
In-service Considerations
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
•Billing and reimbursement
•Caseload size
•Supervision
•Training
•Transition age youth
58
![Page 59: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/59.jpg)
In-service Considerations
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
How do you support a child/youth and their family in making the decision whether they should continue to receive Children’s Mental Health case management services or be referred for Adult Mental Health case management services?
59
![Page 60: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/60.jpg)
Day 1
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Wrap up
60
![Page 61: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/61.jpg)
Part 1, Day 2
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Welcome back!
61
![Page 62: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/62.jpg)
Part 1 – Case Management Mission, Philosophy andStructure
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Day Two:
Child Development 1.0 hours
Diagnostic Assessment 2.0 hours
Treatment Approaches 2.0 hours
Psychiatric Medications 0.5 hours
Wrap Up (check parking lot, other questions, plan for tomorrow)
0.5 hours
62
![Page 63: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/63.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 63
![Page 64: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/64.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Goal:
Apply knowledge of child development to case management service delivery
64
![Page 65: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/65.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Objectives:
•Identify protective factors in the development of a child
•Define critical child development concepts including attachment, attunement, and mirroring
•Describe the notion of developmental trauma and its typical consequences
65
![Page 66: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/66.jpg)
Child Development
“Before I got married I had six theories about bringing up children. Now, I have six children and no theories.”
John Wilmot
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 66
![Page 67: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/67.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Significance of child development for case managers
•Past informs the present
•Increase in number of children served under the age of 5
•Children are identified as meeting SED criteria with undetected developmental problems
•Contact with younger siblings
67
![Page 68: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/68.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
“Ages and Stages” Framework
•Cognitive
•Social-Emotional
•Speech and Language
•Fine Motor
•Gross Motor
68
![Page 69: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/69.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Estimate the age at which each ability/skill typically emerges
69
![Page 70: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/70.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Start to understand danger 4 years
Show interest in other children 18 months
Often do the opposite of what is asked 2 years
Let the caregiver know what he/she wants 18 months
Speaking single words 16 months
70
![Page 71: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/71.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Follow a 3-step direction 5 years
Understand common words like bye, all gone 9 months
Understand simple home rules 4 years
Use toilet during the day and stays dry at night 3 years
Thinks about others feelings of others 3 years
71
![Page 72: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/72.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Red Flags
•Impairment in social interaction
•Impairment in communication
•Repetitive behaviors and restricted interests
72
![Page 73: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/73.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Limitations of theories
Nature and Nurture
•Temperament•Psychopathology
Risk and Protective Factors
73
![Page 74: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/74.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Attachment: Ultimate protective factor
•A secure connection to a reliable, responsive, and nurturing caregiver
•Babies “hard-wired” to attach
•Attachment memory
•Effects of Maternal stress
74
![Page 75: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/75.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Mirroring and Attunement•Caregiver’s ability to read child’s emotional cues and respond appropriately to his/her needs
•The “glue” for interpersonal bonds•Basis for self-regulation
75
![Page 76: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/76.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Attachment in the real world
WCCO - Marshmallow Text reproduced by Dr. David Walsh
Discussion: What are the social-emotional competencies demonstrated by kids who are successful with the marshmallow challenge?
76
![Page 77: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/77.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
If there are current deficits, was there trauma/stress during timeframe?
Collecting a “brain history”
77
![Page 78: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/78.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Developmental Trauma: Overwhelming level of stress experienced by children who experience a profound loss of control
Stress biology
•Positive
•Tolerable
•Toxic
78
![Page 79: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/79.jpg)
Child Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Consequences of toxic stress•Fight/flight•Dissociation•Insecure attachment
79
![Page 80: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/80.jpg)
Childhood Development
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 80
Group Discussion: Brainstorm some mental health conditions or diagnoses.
•Which conditions have symptoms similar to the fight/flight or dissociative responses?
•Why is it important to make the distinction between trauma and other mental health conditions?
![Page 81: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/81.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Goal:
Apply knowledge of child mental health conditions to case management service delivery
Objectives:
• Define the concept of clinical significance
• Describe the cognitive basis for depression and anxiety
• Identify key considerations involved in accurately diagnosing Attention-Deficit Hyperactivity Disorder, and Bipolar Disorder
• Describe strategies for obtaining necessary diagnostic information from mental health professionals
81
![Page 82: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/82.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Overview of Diagnostic and Statistical Manual:
Clinical Significance
Onset Frequency
Duration Pervasiveness
Impairment
82
![Page 83: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/83.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Group Activity:
• Label or not to label?
Benefits
Disadvantages
83
![Page 84: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/84.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Assessment of Intellectual Ability
•What IQ tells us:
POUR: process, organize, understand, and retain
•IQ “genetically based?”
•Emotional Intelligence
84
![Page 85: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/85.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
What IQ doesn’t tell us may be more important:
Enrichment opportunities• 10,000-hour Rule• Concerted Cultivation
85
![Page 86: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/86.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Other enrichment factors•Unintentional Cultivation•Premature Structuring•Alternative Elaboration•Multiple Intelligences (see handout)•Scaffolding•Expectations
86
![Page 87: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/87.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Emotional Intelligence turns IQ on its head:
• Self-awareness: Recognizing one’s own emotions, values, strengths, and limitations
• Self-management: Managing one’s behavior and emotions to achieve goals
• Social awareness: Showing understanding and empathy to others
• Relationship skills: Forming positive relationships, working in teams, effectively dealing with conflict
• Responsible decision making: Making ethical, constructive decisions about personal and social behaviors
87
![Page 88: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/88.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Emotional IntelligenceBell Labs Story
88
![Page 89: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/89.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Components of a high quality Diagnostic Assessment
What to look for: features of a good Diagnostic Assessment
(refer to handout here)
• DHS recommended template• Child/Adolescent Diagnostic Assessment - DHS
5704A (completed by parent/caregiver)
• Child/Adolescent Diagnostic Assessment - DHS
5704B (completed by clinician)
89
![Page 90: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/90.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Tips for Case Managers•Don’t hesitate to ask questions•Be persistent
90
![Page 91: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/91.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Components of a comprehensive assessment
• Evidence of core symptoms
• Clinical significance
• HistoryDevelopmental Educational
Family Cultural
Mental Health Physical healthChemical Health
• Giftedness?
91
![Page 92: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/92.jpg)
Diagnostic Assessment - Depression
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Major symptoms of depression:• Feelings of powerlessness and hopelessness (including suicidal thoughts)
• Loss of interest in previously enjoyed activities
• Agitation or slowing of behavioral
• Loss of energy
• Impaired concentration and short-term memory
• Changes in sleep, appetite, weight
• Crying spells
• Young people - irritability
92
![Page 93: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/93.jpg)
Diagnostic Assessment- Bipolar
Over diagnosed, underdiagnosed or misdiagnosed?• Fastest growing mood diagnosis among children
• Minimal evidence that actual rates of Bipolar has increased
• Explanations for increased frequency of diagnosis
• Disruptive Mood Dysregulation
93
![Page 94: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/94.jpg)
Diagnostic Assessment- Bipolar
Symptoms of Manic Mood• Abnormally and persistently elevated, expansive or irritable mood
for at least one week.• Increased engagement in goal-directed activities• Excessive involvement in pleasurable activities that have high
potential for painful consequences• Irritability and/or anger• Distractibility• Decreased need for sleep• Pressured thoughts and speech (racing thoughts)• Grandiosity
94
![Page 95: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/95.jpg)
Diagnostic Assessment-Bipolar
Diagnostic Criteria of Bipolar
• Unusual to find mania without subsequent or preceding period of depression
• Distinguish from ADHD. Manic state triggered by steroid medications, stimulant medication, acute stress or trauma
• Antidepressant induced mania (“affective switch). Non-response to 3 or more antidepressant trials
• Family history
• Phases often less discrete among children than adults
6/12/2019 Minnesota Department of Human Services | mn.gov/dhs 95
![Page 96: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/96.jpg)
Diagnostic Assessment- Disruptive MoodDysregulation Disorder
• Severe temper outbursts at least three time per week• Sad, irritable or angry mood almost every day• Reaction is bigger than expected• Child must be at least six years old• Symptoms begin before age ten• Symptoms are present for at least a year• Child has trouble functioning in more than one place (e.g. home,
school and/or with friends)
96
![Page 97: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/97.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Major symptoms of anxiety:
• Extreme worry, nervousness child finds difficult to control
• Fear out of proportion to actual threat
• Going to great lengths to avoid source of fear
• Often accompanied by physical distress (sleep problems, stomach aches, headaches, muscle tension). If individual can’t escape from anxiety, it can convert to physical symptoms.
97
![Page 98: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/98.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Types of Anxiety
•Generalized Anxiety Disorder
•Phobias
•Panic Attack
•Obsessive-Compulsive Disorder
98
![Page 99: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/99.jpg)
Diagnostic Assessment
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Depression and Anxiety
• Depression and anxiety often co-occur
• The Cognitive Model
• Activating event
• Beliefs
• Consequences
• Cognitive Distortion: catastrophizing and unrealistic appraisal
99
![Page 100: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/100.jpg)
Diagnostic Assessment
Group Activity: Cognitive Distortion Grid
Minnesota Department of Human Services | mn.gov/dhs6/12/2019 100
![Page 101: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/101.jpg)
Diagnostic Assessment: Anxiety and Depression
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Blinders: make you pay attention only to the negative things in a situation and keeps you from seeing the good things
Magnifying Glass: blows things up to be much worse than they actually are or makes a big thing out of nothing
Quick Sand: tries to get you to focus on the negative thought (get stuck) when it’s ok to move on
Crystal Ball: predicts that things will not go well or will be bad before they happen
101
![Page 102: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/102.jpg)
Diagnostic Assessment: Oppositional Defiant Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Group Activity
Think about the most challenging child with whom you have worked
•What was particularly difficult about working with him/her?
•What emotions did you experience during your efforts?
102
![Page 103: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/103.jpg)
Diagnostic Assessment Oppositional Defiant Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
At least 4 of the following symptoms are present for 6 months or more:• Often loses temper, frequent temper tantrums
• Often argues with adults
• Active defiance and refusal to comply with adult requests and rules
• Deliberately annoys others
• Blames others for his/her mistakes
• Often touchy or easily annoyed by others
• Often angry and resentful
• Often spiteful and vindictive
103
![Page 104: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/104.jpg)
Diagnostic Assessment: Oppositional Defiant Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Common Assumptions
“He/she knows better”
“He/she is doing it on purpose”
“He/she is being manipulative”
“It’s my fault. I’m doing something wrong.”
104
![Page 105: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/105.jpg)
Diagnostic Assessment: Oppositional Defiant Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Common Strategies
• Yelling
• Threatening
• Explaining
• Punishing
• Rewarding
• Giving in
105
![Page 106: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/106.jpg)
Diagnostic Assessment: Oppositional Defiant Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Alternative Concepts:
• Difficulty organizing stimulation
• Behavior communicating what child unable/unwilling to voice
• Child has experienced difficulty in the area of attachment and/or separation
• Child “stuck” in an ingrained response pattern
• Child seeking to control factors beyond his/her control
106
![Page 107: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/107.jpg)
Diagnostic Assessment: Oppositional Defiant Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Alternative Concepts (continued)
• Child being asked to perform tasks beyond his/her ability
• Child does not under sand the purpose of what he/she is being asked to do
• Child may not enjoy what he/she is being asked to do
• Child may lack confident in ability to perform tasks
• Child may have reached developmental stage of limit testing
• Child may not feel well107
![Page 108: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/108.jpg)
Diagnostic Assessment: Conduct Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Symptoms:
• A persistent pattern of violating the rights of others and accepted social norms and rules
• At least three of the following criteria are met over a 12-month period
• Aggression to people or animals
• Destruction of property (intent to destroy)
• Deceitfulness or theft
• Serious violations of rules (out all night, running away, assaulting others)
108
![Page 109: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/109.jpg)
Diagnostic Assessment: Autism Spectrum Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Rigidity, restriction, repetition in three domains: social interaction, communication, and behavior
Social:
•Lack of social emotional reciprocity (“give and take”)
•Inability to notice the needs or distress of others
•Absence of peer relationships
109
![Page 110: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/110.jpg)
Diagnostic Assessment: Autism Spectrum Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Communication:
• Inability to initiate or carry on conversations
• Stereotyped and/or repetitive use of language (echolalia)
Behavior:
• Lack of developmentally appropriate play
• Limited patterns of interest
• Inflexible adherence to purposeless routines and rituals
110
![Page 111: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/111.jpg)
Diagnostic Assessment: Autism Spectrum Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
• Autism
• Asperger’s Disorder
• Rett’s Disorder
• Child Disintegrative Disorder
• Pervasive Developmental Disorder NOS
111
![Page 112: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/112.jpg)
Diagnostic Assessment: Autism Spectrum Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Discussion Points:
•Environmental factors
•Vaccinations
•Genetic factors
•Neurological factors
112
![Page 113: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/113.jpg)
Diagnostic Assessment: Autism Spectrum Disorder
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Discussion Point
Why increased incidence? In Minnesota, about 200 diagnosed cases in 1990 to 3500 currently
• New tools for early diagnosis
• Diagnosis often subjective
• Wider net, label needed to access services
• Vitamin D deficiency
113
![Page 114: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/114.jpg)
Diagnostic Assessment: Trauma
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Posttraumatic Stress Disorder symptoms:
Exposure to an extraordinary stressor followed by intense fear, helplessness, and horror
•Hypervigilance
•Avoidance
•Re-living (flashbacks, intrusive thoughts)
•Emotional numbness or detachment
114
![Page 115: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/115.jpg)
Diagnostic Assessment: Trauma
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Definitions of traumatic event
Simply put: “a profound loss of control”
Diagnosis often complex with children
115
![Page 116: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/116.jpg)
Diagnostic Assessment: Trauma
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Response to trauma shaped by many factors
Cumulative effects (ie., bouncing ball losing resilience)
Source of trauma can predict response
•Intentional human
•Unintentional human
•Acts of nature
116
![Page 117: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/117.jpg)
Diagnostic Assessment: Fetal Alcohol Spectrum
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Definition:
•Fetal Alcohol Spectrum Disorder a term used to describe a group of birth defects that can result when a woman drinks alcohol when pregnant
Symptoms and physical features
Not in DSM. Public mental health system has no statutory responsibility to identify or treat it
117
![Page 118: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/118.jpg)
Treatment approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Goal:
Apply knowledge of evidence-based treatment approaches to case management work
Objectives:
Define cognitive-behavioral approaches to treating depression and anxiety
Identify effective interventions for ADHD, oppositionality, trauma, and developmental disorders.
118
![Page 119: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/119.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Purpose for case managers:
To be familiar with accepted intervention approaches and better able to assess if the service the child is receiving is appropriate for their needs
119
![Page 120: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/120.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
The Minnesota Model of Evidence-Based Practice
Important takeaways from the Minnesota Model
Therapy with best support for many problem areas is cognitive-behavioral therapy
Famly involvement key component of effectiveness
Minimal support for “play” and “supportive” therapies
Known risks associated with group therapy
Relatively known about treating Autism Spectrum Disorder and Bipolar Disorder
Unnswered question about the effectiveness of indigenous or “alternative” healing methods
120
![Page 121: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/121.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
ADHD
•Psychoeducation
•Routine and structure
•Problem Solving
•Stimulus Control
Group Activity: Video (Dr. Sulik)
121
![Page 122: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/122.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
"People are not disturbed by events as much as they are by their interpretations of those events.”
Cognitive-Behavioral Approach: Adding a “D” (dispute) to the A-B-C model
• De-catastrophizing
• Realistic appraisal
• Coping plan
122
![Page 123: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/123.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Depression and Anxiety
Group Activity: Video (Dr. Sulik)
123
![Page 124: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/124.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Treatment approaches: Oppositionality
124
![Page 125: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/125.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Oppositionality
•The “3 C’s:” Choice, Control and Collaboration
•Precautions
125
![Page 126: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/126.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Oppositionality
Limitations of consequences and rewards:
• Child does not understand cause and effect
• Child cannot or does not distinguish between positive and negative experiences (The certainty of misery is better than the misery of uncertainty)
• Child des not prefer positive attention over negative attention
126
![Page 127: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/127.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Oppositionality:
Limitations of consequences and rewards continued…
• Consequence or reward is not relevant to the child’s reality
• Consequence or reward is simply code for punishment
• Can activate traumatic experiences, produce intense reactions
127
![Page 128: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/128.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Oppositionality
Effective use of consequences:
• Keep them logical, natural, timely, and proportional
• Calmly state and reinforce them
• Allow a reasonable amount of time for compliance
• Avoid coercive cycle (ie., power struggle)
• Move on without bearing a grudge
• Establish a system for addressing problems. Manage system, not child
128
![Page 129: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/129.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Conduct Disorder
•Good Support: Multi-systemic Therapy (MST)
•Minimal Support: Juvenile Justice System
•Known Risks: Group Therapy (leads to “deviance training”)
129
![Page 130: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/130.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Pervasive Developmental Disorder
“Then and Now”
Characteristics of Effective Treatment
• Earlier the better
• Active parent involvement
• Home-based component
• Structured environment
• Generalization of new skills
• High intensity
130
![Page 131: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/131.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Trauma
Initial Response
• Validate and normalize
• Plain talk
• Permission to talk (or not talk)
• Listen as long as child wants to talk
• Provide simple, declarative statements
• Create a web of support
131
![Page 132: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/132.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Cognitive-Behavioral Therapy is the gold standard in clinical treatment
• Systemic Desensitization
• Why it works:
• Organizing memories keeps them from intruding
• Integrating memory and emotion offers control
• Exposure (making the tolerable more tolerable)
132
![Page 133: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/133.jpg)
Treatment Approaches
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Evaluation
133
![Page 134: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/134.jpg)
Questions regarding Part 1
134
![Page 135: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/135.jpg)
Before you go
Minnesota Department of Human Services | mn.gov/dhs6/12/2019
Please fill out your course evaluation
135
![Page 136: Rule 79 training 062419 - Minnesota · New Children’s Mental Health County Case Managers •To meet the training requirements for Rules 9520.0912 Subp 4 •Case managers who do](https://reader035.fdocuments.us/reader035/viewer/2022071116/5ffcc461e91b14449d6a242b/html5/thumbnails/136.jpg)
Thank you!
For more information or ?’s Email: Diane.Marshall@ state.mn.us
651-431-2328