Session Five: Substance Abuse, Mental Health, And Domestic Violence and Their impact on Permanency.

Session Five:Substance Abuse,

Mental Health,And Domestic Violence

and Their impact on Permanency

Session Five: Substance Abuse, Mental

Health, and Domestic Violence, and Impact on Permanency

Three of the core issues of child welfare: Domestic Violence, Substance Abuse and Mental Health

Issues, shaded under an umbrella of poverty, will be reviewed, discussed and examined, specifically

as they relate to permanency for children and youth. Participants will learn skills for building their

practice knowledge and coaching skills with families to develop accommodations to address

these issues and to treat and address these concerns in their communities.

Session Five Competencies

Knows and understands the power

and complexities of substance abuse; mental health; and

domestic violence as they relate to permanency.

Session Five Objectives

Explain how domestic violence, poverty, substance abuse and mental health issues contribute to abuse and neglect. Describe how different prescription and illegal substances affect an individual’s ability to engage in interpersonal relationships and effectively parent a child/ren. Explain how Fetal Alcohol Spectrum Disorders (FASD) and other alcohol and substance related neurological disorders can shape a child’s behavior and relationships. Demonstrate assisting families in reframing behaviors and understanding primary and secondary behavioral symptoms of children affected by FASD and other substances. Describe community-based interventions of treatment for substance-affected families.

Substance Abuse

Differences between Use, Abuse and Dependence

Use: simply means drinking, smoking, inhaling, injecting, or swallowing a chemical substance but not necessarily abusing it.

Difference between Use, Abuse and Dependence

Dependence: Maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring at any time in the same 12-month period:


1. Tolerance; 2. Withdrawal; 3. Use in larger amounts or over a

longer period of time than intended;

4. Persistent desire or unsuccessful efforts to reduce substance use;


5. Devotion of a large portion of time to obtaining, using, or recovering from the use of the substance;

6. Reduction of important social, recreational, or occupational activities due to substance use;


7. Continuing use of the substance, despite knowing that a persistent or recurrent physical or psychological problem is likely to have been related to substance use.


Abuse: Harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs, which may include marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives ).


Substance abuse is manifested by one or more of the following, occurring within a 12-month period:


1. Recurrent substance use leading to a failure to fulfill major role obligations at work, school, or home;

2. Recurrent substance use in physically hazardous situations


3. Recurrent legal problems caused by substance use;

4. Continuing use of substance despite having persistent or recurrent social or interpersonal problems initiated or exacerbated by the effects of the substance.

Addiction as an illness

Regardless of the substance involved, addiction is a mental illness just like depression, schizophrenia, or an anxiety disorder.

People who abuse substances are suffering from a debilitating illness, not from a flaw in their character or a moral shortcoming.

Addiction is an illness

This does not mean they are not responsible for their actions.

But it does mean that they are entitled to the same respect, the same services, and the same treatment as anyone else.

Effects on Children

Children living in homes where a caregiver abuses substances suffer from a variety of physical, mental, and emotional health problems at a greater rate than the general population.

Treatment is Critical

When families are struggling with substance abuse and child maltreatment, both problems must be addressed to ensure the safety of children.

Ending the drug dependency will not automatically end child maltreatment, but parenting skills will improve little until this step is taken.

Conclusions

Substance abuse and substance dependence complicate and interfere with the healthy development of children.

Moreover, parents struggling with substances are likely to encounter great difficulties and perhaps insurmountable obstacles on the road to achieving family reunification.

Conclusions

“One day at a time for the rest of my life” is an adage commonly repeated in recovery groups.

This statement indicates that the work of recovery is never complete.

Conclusions

In working with substance abusing parents, progress and not perfection should be the primary objective and benchmarks of success in the child welfare system.

MENTAL HEALTH CARE

Statistics

18% to 22% of children and adolescents suffer from one or more diagnosable Mental, Emotional and Behavioral (MEB) disorders in the US.

9% to 13% of these children and youth are severely impaired in their daily functioning, depending on the type of diagnosis, number of symptoms, and co-morbidity.

Statistics

Externalizing disorders such as conduct disorders, Attention Deficit Hyperactivity Disorder (ADHD), and oppositional disorders are more commonly found in BOYS.

Internalizing disorders such as mood and anxiety disorders are more frequently identified in GIRLS.

Statistics

Only about one in five children who needs mental health services actually receives them.

Among those living in poverty, in rural communities, and those who are members of minority groups, these figures are much lower.

Statistics

Up to 80% of children entering foster care have significant MEB disorders.

Compared with other children, foster children had higher levels of emotional and behavior problems, more often had physical, learning or mental health conditions that limited their psychosocial functioning, and were less engaged in school and more likely to have been expelled

Statistics

According to a national study among children in foster care, just 15.8% of those in care for at least 12 months received any mental health services.

Of children who scored within the clinical range on a well-established measure of child behavior problems (47.9% of children in the sample), 36.2% received no mental health services at all

Types of Disorders

The most common disorders up to age 25 are:

- conduct disorder; - oppositional defiant disorder

(ODD); - attention deficit hyperactivity

disorder (ADHD);

Types of Disorders

- anxiety disorders, including posttraumatic stress disorder (PTSD);

- mood disorders; - substance abuse disorders.

Disorders

Some MEB disorders such as the autism spectrum disorders and pervasive developmental disorders, bipolar disorder, eating disorders, schizophrenia, and obsessive compulsive disorder are less frequent.

Disorders

However, these disorders are often profoundly challenging to those children and youth who have them and to their families and others who care for them.

Disorders

Perhaps even more important than the presence of a diagnosis of an MEB disorder or constellation of disorders in children is the impact of the disorder on a child’s psychosocial functioning.

Disorders

Although an anxiety disorder may be limiting to a child and frustrating to the immediate family, research suggests that it is the so-called externalizing disorders—substance abuse, disruptive behavior disorders, and ADHD—that have the most detrimental effect on a child’s functioning across all life domains.

Treatment

Psychopharmacological Interventions: - Methylphenidate (ADHD); - Serotonin reuptake inhibitors - SSRI (depression); - Clomipramine (obsessive compulsive disorder)

Treatment

Evidence-Based Psychosocial Interventions: - Individual or group psychotherapy, especially cognitive-behavioral. Also supportive, psychodynamic and interpersonal therapies;

Treatment

- Parent management training, like parent-child interaction therapy (PCIT); multisystemic family therapy (MST); multidimensional family therapy (MDFT); brief strategic family therapy (BSFT).

Treatment

Mental health treatment is not a mandated service—it requires the client’s consent;

Treatment cannot occur without a formal clinical diagnosis of the client;

Services are provided on the basis of “medical necessity” and clinical judgement.

Working with MH

Individual line workers can make a difference by: - getting to know a MH worker in your area - finding out about the criteria for referrals and area resources.

Working with MH

Supervisors and managers can make a difference by sitting down with MH representatives to: - resolve the system conflicts that can hold up cases- get a sense of what their counterparts are doing

Working with MH

- open lines of communication. If each knows what the other is doing on an ongoing basis, we’ll be less likely to replicate or impede each other’s efforts to help clients, and we’ll be able to avoid embarrassing and troublesome situations (e.g., when a family has two home visits from two different agencies on the same day).

Working with MH

Remember that both systems are facing the issue of how to do more with less. One solution is to share resources.

Understand that each area program does things differently and try to find out how things work in your community;

Working with MH

If difficulty arises regarding legal and confidentiality issues, remember that MH isn’t trying to be difficult, they’re trying to comply with increasingly complex guidelines.

Working with MH

Learn about mental illness; Avoid stigmatizing mental illness; Balance flexibility with firmness; Good supervision is critical;

Working with MH

Confidentiality; Monitor your level of involvement; Focus on strengths; Treat everyone is a person first.

Practice tips

1. Afford the same respect to people with mental illness as you would to anyone else;

2. Take a strength-based perspective;

3. Watch for signs of abuse or neglect, just as you do with other parents;

Practice tips

4. Be flexible, but expect adults to take responsibility for their actions;

5. Do not try to rescue or cure the person with mental illness; instead, make referrals;

6. Communicate with your supervisor frequently;

Practice tips

7. Honor confidentiality.8. Don’t take things personally.

Don’t get frustrated. Be patient.9. Take some extra time to learn

about the person’s illness by reading or talking with professionals.

DOMESTIC VIOLENCE

Definition

Domestic violence, also known as intimate partner violence, is defined as a pattern of behavior where the batterer intentionally attempts to physically, sexually, psychologically, emotionally, or economically harm the victim with whom there is an intimate relationship.

DefinitionPhysical violence may include:

pushing shoving grabbing kicking biting hitting choking, or threatening with a weapon.

DefinitionPsychological and emotional abuse may include: humiliation isolation Fear and intimidation threats emotional withholding, and verbal attacks.

Definition

Economic abuse includes controlling or exploitative tactics that keeps victims financially dependent on abusers for economic resources.

Regardless of the type of abuse or the tactics employed, the goal of the abuser is to gain control over an intimate partner.

Prevalence

Estimates are that between 3.3 million (Carlson 1984) and ten million children (Straus 1991) witness domestic violence each year

Prevalence

However, these estimates are problematic because they are based primarily on reports from adult victims who are asked about their children’s exposure or asked whether they themselves were exposed as children to domestic violence.

Problems associated with exposure to domestic violence - categories:

1. “Behavioral, social, and emotional problems: Higher levels of aggression, anger, hostility, oppositional behavior, and disobedience; fear, anxiety, withdrawal, and depression; poor peer, sibling, and social relationships; and low self-esteem.


2. Cognitive and attitudinal problems: Lower cognitive functioning, poor school performance, lack of conflict resolution skills, limited problem solving skills, pro-violence attitudes, and belief in rigid gender stereotypes and male privilege.


3. Long-term problems: Higher levels of adult depression and trauma symptoms and increased tolerance for and use of violence in adult relationships.” (National Adoption Information Clearinghouse 2003)

The impact of domestic violence on children can be

moderated by certain factors:

1. “The nature of the violence. Children who witness frequent and severe forms of violence perceive the violence as their fault. Because they fail to observe their caretakers resolving conflict, these children may undergo more distress than children who witness fewer incidences of physical violence



2. Coping strategies and skills. Children with poor coping skills are more likely to experience problems than children with strong coping skills and supportive social networks. Children who utilize problem-solving strategies targeted directly at the source of disagreement demonstrate fewer maladaptive symptoms.



3. The age of the child. Younger children appear to exhibit higher levels of emotional and psychological distress than older children. Age-related differences might result from older children's more fully developed cognitive abilities to understand the violence and select various coping strategies to alleviate upsetting emotions.”

Policies to address

1. Identifying and assessing domestic violence in child welfare cases are critical to the safety of children;

Policies to address

2. Services to families where domestic violence has been identified (even if child abuse has not been substantiated) must include helping abused women protect themselves and their children, using non-coercive, supportive, and empowering interventions whenever possible;

Policies to address

3. Holding perpetrators of domestic violence accountable for stopping the violent behavior is essential to protecting children.

Remember...

A strong relationship with a caring, nonviolent parent is one of the most important factors in helping children grow in a positive way despite their experiences. Support can make the difference between fear and security, and can provide a foundation for a healthy future

Session Five: Substance Abuse, Mental Health, And Domestic Violence and Their impact on Permanency.

Documents

Transcript of Session Five: Substance Abuse, Mental Health, And Domestic Violence and Their impact on Permanency.