Social Psychology: Assessment Formulation in CMH

1. Social Psychology: Assessment & Formulation in CMH

2. Definition: children�s mental health assessment is a process to gather and organize information about a youth or child in order to better understand their behaviour in all facets. A good assessment includes the second part: a formulation. How Do We Conduct an Assessment? Observe the child Ask questions to the child, family, and friends Rely on previous reports or assessments ( pediatrician, psychologist, speech therapist) - Use tools to evaluate behaviour. (CAFAS � Child & Adolescent Functional Assessment Scale, BCFPI - Brief Child & Family Phone Interview, and other assessment tools.

3. Observe The Child Watch the child when they are at play alone, as they interact with peers and with adult or their parents. Watch for their eye contact and physical demeanor. Remember our communication is 90% non-verbal. Behaviour is communication. Take the time to observe, take notes, then think.

4. Ask Questions? Keep it simple: how are you day? how�s it going? what�s new? It looks like something is bothering you, what? When talking to parents, use a team approach. When you blame them, they will become defensive. How would you ask about a student who is often tired in your class?

5. Read The OSR and Request Additional Information from Parents The OSR is the beginning of your AX. Read it, or at least skim it for pertinent reports. Request psychological, PT, OT, speech reports, etc. from the parents.

6. Use Tools to Evaluate Use your EA or Resource Teacher to get an idea of where the child is struggling academically. In Children�s Mental Health (CMH): CAFAS: Child and Adolescent Functional Assessment Scale. A tool that rates behaviour on 8 subscales: School/Work, Home, Community, Behavior Towards Others, Moods/Emotions, Self-harm, Substance Use, and Thinking.

7. CAFAS Two subscales for caregivers: Material needs and family/social support. Each subscale will be rated 30-severe, 20-moderate-, 10-mild and 0-minimal. The child will have a total score. Rating of 20-40 outpatient treatment. Rating of 50-90 more than outpatient. Rating of 100-130 more than outpatient and multiple sources of supportive care.

8. CAFAS Rating 140 & higher: intensive treatment, usually out of the home and including all family members. Example: School/Work Subscale Minimal (0): Minor problems are satisfactorily resolved. Schoolwork is commensurate with ability and youth is learning disabled.

9. CAFAS Mild Impairment (10): Non-compliant behaviour results in teacher or immediate supervisor bringing attention to problems or structuring youths activities so as to avoid predictable difficulties, more than other youth. Moderate Impairment (20): Frequent truant, approx. once every two weeks for several consecutive days. Failing at least half of courses and this is not due to lack of ability or physical disability.

10. CAFAS Non compliant beh. Which results in persistent or repeated disruption of group functioning or becomes known to authority futures other than classroom teacher. Severe Impairment (30): Expelled or equivalent from school due to beh. Judged to be a threat to others because of aggressive potential, monitoring needed. Chronic truancy resulting in negative consequences ie) loss of credit, failing courses or tests, parents notified.

11. Formulation Definition: a summary, a distillation, a series of hypotheses, an explanation and a bridge between data collection and treatment planning OR your best guess as to what is going on with the individual/family! Use the Four P�s. Predisposing, Precipitating, Perpetuating and Protecting.

12. Formulation: Four P�s Predisposing: the genetic traits, prenatal/ postnatal. Precipitating: the triggers, how does it start. Perpetuating: what keeps it going. Protective: What keeps the child safe, or better off.

13. Formulation: Four P�s. Biological Psychological Familial Social Weerasekera, P., (1993) Formulation: A Multiperspective Model. Canadian Journal of Psychiatry. Vol.38 (5). p. 351-359.

14. Assessment In CMH our Assessment is set up to include: The child�s view of the problem The parent�s view of the problem The child and parent�s view of strengths And the worker�s view of strengths We also include the �Reason for Referral�: That means what does it look like.

15. Formulation: Four P�s. Case Scenarios: 1. Shillah is a 9 year old female student at your local elementary school. She was diagnosed with ADHD at age 7. She lives with her biological mother Cindy and her mother�s boyfriend Rick� 2. Matt is a 14-year-old student at your high school. He lives with his father who is the sole caregiver. His father is on disability due to�

18. When you Need to Report a Disclosure of Abuse You report an educated suspicion or true knowledge about a child�s welfare to the Children�s Aid Society (CAS). If a child discloses that someone has abused them: emotionally, verbally, sexually, or psychologically you must report it. It is your duty by law as a professional.

19. How Do I Report to CAS? When a child tell you�, then you... Complete the necessary documentation that your school board requires. Make your call to CAS (North Bay 472-0910). Ask to speak to an Intake Worker and have ready: The name of the child, DOB, parent�s names, address, phone number, other siblings who reside in the home.

20. How Do I Report: continued Call ASAP, at the next recess or at lunch. This allows CAS to organize other services or police. Don�t probe with too many questions as the child will have to retell the story to CAS. Get just enough info. to allow you to know that you are concerned. If you are unsure if the concern is serious enough, call the Intake worker and run the scenario by him/her, they will tell you if you need to report. Do the reporting yourself, do not get your principal to report for you.

21. Reasons for Referral to ACFS. Working at Algonquin Child and Family Services we encounter families and kids that struggle with: Depression; an unhappy feeling that persists over weeks or months. Not smiling, not playing with peers, little or no interest in peers, low or no energy. Eating Disorder; body image issues, self esteem. Perfectionism, addictions. More typical in females.

22. Reasons for Referral to ACFS Suicidal Ideation: Feelings of hopelessness and/or helplessness with thoughts of ending life or self-harm. Divorce and Separation: guilt, responsibility, instability, taking sides, caught in the middle.

23. Reasons for Referral to ACFS Trauma: abuses; sexual, emotional, physical, verbal and psychological. Flat affect, poor boundaries, sleepy, flashbacks witness to domestic violence or a death. Difficulty with concentration, hyper- vigilant, etc. Family Conflict: Constant arguing, manipulation, yelling, threats, no rules or too many rules. Parents with mental health issues.

24. Reasons for Referral to ACFS Grief/Loss: Death, separation of loved one. Nightmares, sad, low affect, no energy, crying often, daydreaming. Fire Setting: Plays with fire, can�t stop, takes risks with fire. Obsesses with fire in drawing, thinking, talking. More typical in males. Self Harm: Cutting, burning, scratching, with any tool; knife, scissors, nails, pins. Low self-esteem, asking for help, trying to cope with a stress, thought distortions. More typical in females.

25. Reasons For Referral to ACFS Addictions: Alcohol, street drugs, gambling, Internet. Note: Community Counseling referral for these issues.

26. How to Address The Different Ages? Do you address a 6 year old in the same way you would a 11 or 17 year old? Refer back to Piaget or other developmental stages. Asking the question�How do you ask? The End.