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Changing the World for Children, Youth, and Families with Complex

Behavioral Health Issues

A CCISC Seminar Series for Children, Youth, and Family Behavioral Health Providers and Partners

ZiaPartners © 2007Christie A. Cline, MD, MBAPresidentcac@swcp.com

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Welcome to this CCISC Seminar Series

Designed to help CYF providers and partners understand and use the value-driven quality improvement process called the Comprehensive, Continuous, Integrated Systems of Care Model (CCISC) to implement co-occurring capable child, youth and family behavioral health care.

“You cannot solve a problem using the same consciousness that created it.” Albert Einstein (paraphrase)

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For your Future Reference: Seminar Contents (1 of 2)

Welcome to this CCISC Seminar Series

Seminar 1: Introduction to CCISC

Seminar 2: Epidemiology of co-occurring issues and the relevance of co-occurring capability in Child, Adolescent, and Family Systems of Care

Seminar 3: Principles of Integrated Treatment and Core Practices for Co-occurring Capable Child, Adolescent, and Family Care

Seminar 4: Developmental Issues Related to Co-occurring Disorders

Seminar 5: Working with Families and Care Givers of Child and Adolescent Clients

Seminar 6: Prevention and Early Intervention

Seminar 7: Empathy, Hope, Engagement and Motivation

Seminar 8: Functioning as an Integrated Team in Empowered Partnership with Adolescents and Their Families

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Seminar Contents (2 of 2)

Seminar 9: The Process of Screening and Identification of Need

Seminar 10: Integrated Longitudinal Strength-based Assessment (ILSA™) for Adolescents and Families

Seminar 11: Using Stages of Change in an Integrated Framework for Working with Adolescents, Young Adults and Families

Seminar 12: Integrated Treatment Planning and Integrated Treatment Interventions

Seminar 13: Continuity of Care and Community-based Learning and Skill Building

Seminar 14: Homeless Youth and Other High Risk Kids in the Community

Seminar 15: Juvenile Justice and Behavioral Health

Seminar 16: Child and Adolescent Systems of Care as System Partners: Issues and Answers

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Background Material for Seminar 4

Quick overview of CCISC Quick review of epidemiology Quick review of terms--Co-occurring

conditions and disorders, Co-occurring issues, and the concept of “co-occurring families”

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CCISC Quick Review

Uses quality improvement partnerships to create services to be “more about the individuals and families”

Transforms systems, programs, practices and competencies by applying values and principles to decision making

Helps everyone move toward Co-occurring or “Complexity” Capability as the core of service

Relies on principles and practices drawn from sound research

Begins with what individuals and families say helps

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CONSUMER/FAMILY SYSTEM STANDARDS

WELCOMING ACCESSIBLE INTEGRATED CONTINUOUS COMPREHENSIVE

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Epidemiology of Co-occurring Issues in Child, Adolescent, and Family

Systems of Care

Quick Review

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Epidemiology of COD-Adolescents (NEATTC)

43% receiving mental health services had been diagnosed with a co-occurring SUD.

CMHS (2001)national health services study

13% of adolescents with significant emotional and behavior problems reported substance dependence.

SAMHSA 1994-96 National Household Survey 62% of males and 82% of females entering SUD treatment had

a co-occurring psychiatric disorder. SAMHSA/ CSAT 1997-2002 study

75-80 % of adolescents receiving inpatient substance abuse treatment have a coexisting mental disorder

NMHA, 2005

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Juvenile Justice (NEATTC)

Nearly two-thirds of incarcerated youth with SUD have at least one other mental health disorder.

As many as 50% of substance abusing juvenile offenders have ADHD.

Among incarcerated youth with SUD, nearly 33% have a mood or anxiety disorder.

Those exposed to high levels of traumatic violence might experience symptoms of posttraumatic stress as well as increased rates of substance abuse.

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Trauma (NEATTC)

40 – 90% have been victimized 20-25% report in past 90 days, concerns

about recurrence Associated with higher rates of

– substance use– HIV-risk behavior– Co-occurring disorders

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Developmental Issues Related to Co-occurring Disorders

Seminar 4:

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Learning Objectives

Objective 1: Gain an understanding of some of the important developmental issues related to children, early adolescents, adolescents, and young adults that impact the development of co-occurring conditions.

Objective 2: Understand the significant impact of co-occurring disorders on normal adolescent development.

Objective 3: Learn common substance use issues, patterns of use for pre-teens to early adults, and their relation to family issues and emotional disturbance.

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Learning Objectives (continued)

Objective 4: Learn the most commonly diagnosed psychiatric and behavioral disorders in childhood and adolescence, and the relationship of those disorders to the emergence of substance use and abuse.

Objective 5: Understand three important clinical issues related to the delivery of co-occurring capable care to children and adolescents.

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Protective Factors and Risk

Overview of Protective Factors

Overview of Early Developmental Risk Factors

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Review of Healthy Adolescent Development

• Biological and Psychological Development• Cognitive Development****• Social Development

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Developmental Theories

Puberty and physiological change (Tanner) Separation/individuation (Mahler, Blos) Identity formation and autonomy (Erickson) Cognitive development-Formal Operational Thinking

(Piaget) Moral development (Kohlberg, et. al.) Transition and transformation-The Road to

Adulthood

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Developmental Life Strategies

Role experimentation Practicing Questioning and challenging Peer bonding Here & now focus Sense of invulnerability

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Cognitive Development

Shift from “Concrete to Formal Operational” thinking capacity with the emergence of abstract and conceptual processes

Omnipotence & Omniscience Meta-Cognition (the ability to think about

one’s thinking) Egocentricity (Early-Middles)

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The Impact of Co-occurring Issues on Adolescent Development

Biological Psychological Social Spiritual

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Common Patterns of Use and the Emergence of Substance Use Disorders

Age of Onset of Use Age-related Patterns of Use Behaviors in a Context Use, Misuse, Abuse and Dependence in

Youth

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Generic Use Patterns

Pre-teens and young teens – Inhalants– Tobacco– Alcohol (to some extent)

Younger teens add– Marijuana– Club drugs (a newer phenomenon)

Older teens add– Other stimulant drugs (e.g.:cocaine, methamphetamine)– Other opioid and sedative drugs (e.g.:heroin, Oxycontin)

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Common Mental Health Conditions

Developmental Disorders ADD/ADHD Learning Disorders Oppositional Defiant Disorder Conduct Disorder Mood Disorders Anxiety Disorders Trauma Spectrum Other: Psychotic Disorders and Eating Disorders

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Co-occurring Conditions

Independent conditions or disorders “Common conditions commonly co-occur” Particularly high risk co-morbidities Targeted prevention and early intervention

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Starting Places for Co-occurring Capable Care for Children, Youth and Families

Welcoming and Engagement Empathic Hopeful Integrated Relationships Integrated Screening and Assessment,

including developmental Stage/developmentally-matched planning,

interventions and outcomes