1. 1 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 © 2007 Christie A. Cline, MD, MBA President cac@swcp.com

2. 2 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)

3. 3 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

4. 4 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 theCommunity Seminar 15: Juvenile Justice and Behavioral Health Seminar 16: Child and Adolescent Systems of Care as System Partners: Issues and Answers

5. 5 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”

6. 6 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

7. 7 CONSUMER/FAMILY SYSTEM STANDARDS WELCOMING ACCESSIBLE INTEGRATED CONTINUOUS COMPREHENSIVE

8. 8 Epidemiology of Co-occurring Issues in Child, Adolescent, and Family Systems of Care Quick Review

9. 9 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

10. 10 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.

11. 11 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

12. 12 Developmental Issues Related to Co-occurring Disorders Seminar 4:

13. 13 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.

14. 14 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.

15. 15 Protective Factors and Risk Overview of Protective Factors Overview of Early Developmental Risk Factors

16. 16 Review of Healthy Adolescent Development Biological and Psychological Development Cognitive Development**** Social Development

17. 17 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

18. 18 Developmental Life Strategies  Role experimentation  Practicing  Questioning and challenging  Peer bonding  Here & now focus  Sense of invulnerability

19. 19 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)

20. 20 The Impact of Co-occurring Issues on Adolescent Development Biological Psychological Social Spiritual

21. 21 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

22. 22 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)

23. 23 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

24. 24 Co-occurring Conditions Independent conditions or disorders “Common conditions commonly co-occur” Particularly high risk co-morbidities Targeted prevention and early intervention

25. 25 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