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Client Psychiatric Issues for CEOs

Gain a functional understanding of attachment disorder in foster children and learn techniques to enhance attachment and promote healing. Presented by Daniel M. Marble, LCSW.

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Client Psychiatric Issues for CEOs

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  1. Client Psychiatric Issues for CEOs Presented by Daniel M. Marble, LCSW Social Service Consultant And The Western Child Welfare Law Center Client Psych Issues--Dan Marble

  2. Introduction Today you will gain a functional understanding regarding the establishment and support of the agency’s treatment philosophy and milieu. Allow you to better recognize the pathology of your client population so that you can establish better risk management procedures. Allow you to employ policy and budgetary decisions which support treatment priorities. Client Psych Issues--Dan Marble

  3. Overview and Objectives • Examine major pathology types. • Program Milieu • Course Objectives Client Psych Issues--Dan Marble

  4. Major Pathology Types AmongFoster Children • Attachment Disorder • ADD/ADHD • Depression/loss/morning • Others Client Psych Issues--Dan Marble

  5. ATTACHMENT “The Tie that Binds” An Overview of Attachment Disorder Client Psych Issues--Dan Marble

  6. Attachment • A lasting psychological connection between human beings. • The emotional bond that grows between child and caretaker. • Begins in utero and develops over time. • Infants are predisposed to attach. • It exists in a continuum-no perfect attachment or total lack of attachment. Client Psych Issues--Dan Marble

  7. Attachment Disorder Causes • Abuse: physical/emotional/sexual • Neglect • Sudden separation-primary caregiver • Inadequate or changing daycare • Undiagnosed or painful illness Client Psych Issues--Dan Marble

  8. Symptoms of Attachment Disorder in Older Children • Act superficial and phony-(strangers and those they feel they can manipulate) • Avoid eye contact unless lying or conning • Indiscriminate affection with strangers • Lack of ability to feel\empathize/care • Extreme control problems/sneaky • Leave a trail of destruction-pets and all possessions • Constant lying Client Psych Issues--Dan Marble

  9. More Symptoms-Older Children • Highly impulsive • Learning disorders-my way or the highway • No cause and effect thinking • Little or no conscience • Abnormal eating patterns • Other kids avoid them (3Cs) conscience, control, cruelty • Speech (Interrupt, noise and control) Client Psych Issues--Dan Marble

  10. Still More Symptoms • Inappropriately demanding • Abnormal speech patterns • Lie (False allegations, believed =power) • Divide and conquer (Mom vs. Dad) • Abuse their caregivers Client Psych Issues--Dan Marble

  11. Techniques to Enhance Attachment • Holding and touching • Reciprocal games and activities • Teaching emotions • Assessing/discussing attachment • Looking for opportunities to nurture • Clarification of life events • Promoting family identification • Firm, consistent discipline Client Psych Issues--Dan Marble

  12. Holding and Touching • As much physical contact as the child can tolerate • Snuggling while reading or watching TV • Parents should wear soft clothing and short sleeves for as much skin to skin contact as possible • At meals the child can sit between two nurturing parents Client Psych Issues--Dan Marble

  13. Reciprocal Games and Activities • Hide and seek • Feeding each other • Singing together • Dancing and moving together in unison • Use movies and stories to describe attachment, such as Dumbo • Face painting Client Psych Issues--Dan Marble

  14. Teaching Emotions • Look for opportunities to comment on the child’s feelings • Point out congruent facial expressions • Stand in front of a mirror and make faces representing various feelings Client Psych Issues--Dan Marble

  15. Assessing/Discussing Attachment • Discussions about how it feels to belong or not to belong to a family • Talk about closeness and trusting • When the child lies, talk about how this represents their inability to trust you • Represent trusting as feeling strong enough to trust Client Psych Issues--Dan Marble

  16. Looking for Opportunities to nurture • Notice times when the child is hurt or sick or frightened and come to their aid • Make a big deal out of bandaging and kissing a skinned knee • Rock, hold and comfort Client Psych Issues--Dan Marble

  17. Clarification of Life Events • Make sure the child knows about its history • Help the child build a photo album about their past life • Gather and tell stories about past events in the child’s life • Help put together a Life History Book Client Psych Issues--Dan Marble

  18. Promoting Family Identification • Develop and talk about family rituals around holidays, birthdays • Make family rituals out of everyday events such as bed time or meals Client Psych Issues--Dan Marble

  19. Firm, Consistent Discipline • This is one of the primary attachment techniques • Keep the environment as stable and organized as possible • Do not use physical or separation or isolation types of punishment • Time outs should be in a chair in the same room as the adult • The “one minute scolding” Client Psych Issues--Dan Marble

  20. Treatment Approach Client Psych Issues--Dan Marble

  21. Treatment Approach Client Psych Issues--Dan Marble

  22. Treatment Approach Client Psych Issues--Dan Marble

  23. Patience Pays Off • Be prepared for the process to take longer then you thought • Be prepared for setbacks • Be prepared for the many breakthroughs that will make your staff feel like it was all worth it Client Psych Issues--Dan Marble

  24. ADD/ADHD An Overview of Types And Treatment Client Psych Issues--Dan Marble

  25. Definitions • Attention Deficit Hyperactivity Disorder: A diagnostic label given children and adults who have significant problems in four main areas of their lives: • Inattention • Impulsivity • Hyperactivity • Boredom Client Psych Issues--Dan Marble

  26. More Definitions • ADD is not the result of “bad parenting” or obnoxious willful defiance on the part of the child. • It is a medical condition caused by genetic factors that result in neurological differences. • It affects one or two areas of the brain. Client Psych Issues--Dan Marble

  27. Important Characteristics • It is pervasive across all areas of life. • The problems are apparent before age 7. • Anti-social behaviors are common. • 60% also have oppositional defiant disorder Client Psych Issues--Dan Marble

  28. Dr. Daniel Amen’s Six Types • 1. Classic Type • 2. Inattentive ADD • 3. Over focused or Cingulate Function ADD • Limbic Systems Functions ADD • 5.Temporal Lobe ADD • 6. Ring of Fire Add Client Psych Issues--Dan Marble

  29. 1. Classic ADD Symptoms • Restlessness • Hyperactivity • Inability to focus • Lack of planning • Excessively Talkative Client Psych Issues--Dan Marble

  30. Classic ADD Treatment Medications • Antidepressants • Tofranil • Effexor • Stimulants • Adderall • Dexadrine • Ritalin Client Psych Issues--Dan Marble

  31. 2. Inattentive ADD Symptoms • Short attention span for routine matters. • Distractible • Poor follow-through • Spacey • Internally Preoccupied • Sluggish Client Psych Issues--Dan Marble

  32. Inattentive ADD Treatment • Same as Type 1 Client Psych Issues--Dan Marble

  33. 3. Over focused ADD Symptoms • Difficulty shifting attention • Stuck on thoughts • Stuck on behaviors • Can become oppositional-wanting to continue repetitive behavior. • Holds grudges • Ritualistic • May mimic OCD Client Psych Issues--Dan Marble

  34. Over focused ADD Treatment • Paxil • Zoloft • Prozac Client Psych Issues--Dan Marble

  35. Limbic Systems Add Treatment • Imipramine • Wellbutrin Client Psych Issues--Dan Marble

  36. 5. Temporal Lobe ADD Symptoms • Memory Problems • Spaciness/confusion • Emotional Instability • Difficulty reading social cues • Difficulty with use of language plus auditory and visual processing • Physical symptoms • Mild paranoia/anxiety • Aggressive Client Psych Issues--Dan Marble

  37. Temporal Lobe ADD Treatment • Usual Stimulants • Anticonvulsants • Depakote • Dilantin • Must have close physical monitoring Client Psych Issues--Dan Marble

  38. Overly Aggressive Overly focused Violent behavior Social problems Very verbal May appear bipolar Hyperactive Hypersensitive to: light, sound, taste, and/or touch. Impulsivity Distractible Addictive and criminal behavior Oppositional 6. Ring of Fire ADD Symptoms Client Psych Issues--Dan Marble

  39. Ring of Fire ADD Treatment • Anticonvulsants • Antipsychotics • Risperdal Client Psych Issues--Dan Marble

  40. Additional Helpful Considerations • Attention to diet • Attention to education • Alternative natural medications • Summer drug holidays Client Psych Issues--Dan Marble

  41. Diet/Health • Plenty of protein • Cut simple carbohydrates and caffeine • Plenty of exercise Client Psych Issues--Dan Marble

  42. Educational Changes • Address learning disabilities • IEP and 504 Accommodations Less homework More time on tests Tests given verbally Work closely with teachers Client Psych Issues--Dan Marble

  43. Medication Adjustments • In mild cases there is some success with Attend and Extress • Summer drug holidays Client Psych Issues--Dan Marble

  44. Counseling • ADD/ADHD clients have usually gone undiagnosed for some time. The results are residual feelings of being dumb, bad and rejected. They often dislike school as it represents failure. It is improper to treat with medication alone. Counseling is needed to address these residual issues. Client Psych Issues--Dan Marble

  45. DEPRESION An Overview Types And Treatment Client Psych Issues--Dan Marble

  46. Causes • Chemical/Biological An imbalance of serotonin and receptors • Genetic Depressed parent=child is 3X the risk • Environmental Traumatic events Peer or family conflict Client Psych Issues--Dan Marble

  47. Irritability Anxiety Symptoms Temper Tantrums Unexplained aches and pains Difficulty thinking Sleep Problems Low self esteem Feelings of guilt and hopelessness Constant Fatigue/Lacks Energy Hearing voices Feeling Suicidal Symptoms in Children Client Psych Issues--Dan Marble

  48. Symptoms in Adolescence • Sleeping too much • Weight gain or loss • Difficulty thinking and making decisions • School failure • Feeling friendless • Suicidal thoughts/Attempts • Delusions Client Psych Issues--Dan Marble

  49. Types of Depression • Endogenous Internally produced • Exogenous Externally produced • Major Depression • Manic Depressive Disorder Client Psych Issues--Dan Marble

  50. Treatment • Psychotherapy • Medication • Milieu • Environmental Manipulation Client Psych Issues--Dan Marble

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