NAMI Basics Education Program

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• NAMI Basics Education Program
• The fundamentals of caring for you, your family
  and your child with mental illness
• Companion Power Point Presentation
• 2008

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Class 1 Agenda

• Welcome
• Introductions to NAMI
• Introduction to Teachers
• Introduction to NAMI Basics evaluation
• Introduction to the NAMI Basics program
• Participant Introductions
• Welcome to Holland
• This is the illness your family has to live with
• Adjourn

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NAMI Basics Evaluation Duke University Dr.
Barbara Burns
Columbia University Dr.
Kimberly Hoagwood
University of Louisiana Dr. Catherine
Estis

• Goal Offer course to more parents/caregivers
  free of charge
• Demonstrate effectiveness
• What do participants learn?
• Impact on family
• Measure
• Before/after/3 month follow up
• Forms
• Informed consent
• 4 brief questionnaires
• Participation in the study is not required to
  take the course
• Questions?

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NAMI

• National Alliance on Mental Illness
• NAMI Tennessee, 45 affiliates
• NAMI Robertson County
• Support group to start in January
• Founded in 1979
• Nations largest grassroots mental health
  organization
• Mission
• Improve lives of adults and children with
  mental illness
• And their families
• Support, Education, Advocacy, Research
• Membership
• 25.00 family, three level membership
• 3.00 open door, three level membership
• Membership not required, but helps NAMI be the
  nations voice on mental illness

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NAMI Basics

• For Families, other direct caregivers of
  children/youth
• Child diagnosed, or might have
• Mental illness, or
• Emotional disturbance
• Goals
• Give information to help caregivers
• Help caregivers cope with traumatic impact of
  mental illness on entire family
• Decision tools to help you get care for your
  child
• Help you care for yourself and the rest of the
  family
• Handout 1 NAMI Basics Principles

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Discussion

• How do you feel about the idea that mental
  illnesses are brain disorders?
• Physical illnesses
• Like diabetes or heart conditions
• Its not your fault
• But, you can take action to improve
• Resiliency
• Recovery

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Class Introductions

• Your name
• Your occupation
• Age diagnosis of your child(ren)
• Your relationship to child
• Parent, grandparent, foster-parent..
• Most pressing issue
• 50 words or less
• What you hope to get from this class

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Stigma Mental Illness

• Not casserole illnesses
• Families, neighbors friends dont know what to
  say
• Avoid us
• Stigma is a mark of shame
• Tipper Gore The last great stigma of the 20th
  century is the stigma of mental illness.
• NAMI is erasing stigma discrimination against
  individuals families
• Pride in family resiliency
• Childs successes despite challenges
• Handout 2 Stigma Mental Illness
• Handout 3 The Facts

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Discussion

• Why does society keep blaming families?
• Think of a time when you felt blamed for your
  childs problems with mental illness
• What was that like?

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Welcome to Holland

• Handout 4 Welcome to Holland
• Typical vs. Atypical
• There is no normal child
• Our childrens brain disorders are invisible
• Public sees behavior, not disability
• Blame adds to family burden
• Handout 5 Mental Illness as a Catastrophic
  Event
• But, our families have strength
• Handout 6 Predictable Stages of Emotional
  Reactions Among Family Members Dealing with
  Mental Illness

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Catastrophic StressorsClass 1 Chart 1

• An unanticipated event
• No time to prepare for it
• No previous experience about how to handle it
• Has a high emotional impact
• Involves threat or danger to self or others

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Predictable Stages of Emotional ReactionsClass
1 Chart 2

• Stage 1 Dealing with the Catastrophic
  Event
• Stage 2 Learning to Cope going through the
  mill
• Stage 3 Moving into Advocacy CHARGE
• Every reaction is normal
• Once you know where you are,
• then you can determine what you need.
• Discussion What do you think about the
  Predictable Stages?

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Symptoms of Mental Illness

• Handout 7 Double edged sword of mental illness
• Positive Traumatic changes in childs behavior
• Negative Traumatic losses due to brain disorder
• Self-Care is essential
• Put your own mask on first
• Then you can help your child
• Handout 8 Course Syllabus

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Class 2 Agenda

• Human Development
• The Biology of Mental Illness
• Getting an Accurate Diagnosis
• Overview of some of the illnesses
• Adjourn

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Human Development

• Freud, Erickson, Piaget, Koplewicz
• Children develop in stages
• One stage must be completed before the next can
  begin
• Handout 1 Theories of Development
• Freud Childs development depends on interaction
  with parents (mother).
• Must achieve one stage before the next
• Erickson Lifelong human development
• Piaget Brain helps navigate stages
• Handout 2 Koplewicz- children go through similar
  stages at different rates
• Where your child is in developmental process
• What your child is working on
• Brain Development conception 3yrs, fastest
  brain development

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Brain CellClass 2 Handout 3
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The Human BrainClass 2 Handout 4
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The Limbic SystemClass 2 Handout 5
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ADHD ADD

• Core symptoms for gt6 months
• Inattention
• Cant pay attention to details
• Avoid, dislike activities that require attention
• Distractible, forgetful, careless, disorganized
• Do not finish schoolwork
• Hyperactivity Impulsivity
• Agitation, fidgeting, squirming
• Interrupts, speaks out of turn
• On the go, acts as if driven
• Intrudes on others, escalates when reprimanded
• Combined type
• Low frustration tolerance
• Symptoms have persisted since early childhood
• Something was off from the beginning
• Describe child as never slowing down
• May misread the child as bad or stupid, wonder
  why the child is always in trouble in school

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Major Depression

• Core symptom is not sadness, but irritability and
  aggressiveness
• Extreme irritability, aggressiveness
• Angry all the time, sullen,
• Physical complaints, headaches, stomachaches
• Drop in grades, wont do homework
• Negative self-judgment, hypersensitive to
  criticism
• Overreact to disappointment, frustration
• Unable to have fun, withdraw
• Lethargic, doesnt care
• Sleep and appetite, too much or too little
• May have hallucination, delusion, paranoia
• Observations from Home
• Nothing pleases the child
• Child is no fun to live with
• Observe that child puts on a good face in
  public
• Worst symptoms at home

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Depression in Teens

• Twice as many girls as boys
• May mask with high performance or by hiding at
  school or home
• Sad, hopeless, empty
• Sensitive, overreact to rejection, criticism,
  disappointment
• Grouchy, sulky
• Lethargic, no energy, sleepy
• OR cant control hyperactivity
• Restless, aggressive, antisocial
• High risk of substance abuse
• Think they are different, no one understands
• Stop caring about appearance
• Thoughts of death
• Increased risk of suicide
• 3rd leading cause of death ages 15 - 19

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Bipolar Disorder

• Strong family history of bipolar
• Extreme mood swings, may be rapid
• Mania
• Hair trigger arousal, set off by slightest thing
• Irritable, oppositional, negative behavior
• Rage usually controlled at school
• Hyperactive, distractible, inattentive
• Grandiose behavior
• Hypersexual activities comments
• Sensitivity to heat
• Craving for carbohydrates
• Psychotic episodes delusions, hallucinations
• Depression
• Observations from home
• Child always different, ragged sleep cycles,
  nightmares
• Severe separation anxiety
• Sleep disturbance
• Extreme physical sensitivity
• Child worse at home than at school

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Bipolar in Teens

• Manic
• Insomnia, active late at night
• Gonna do many things, unrealistic expectations
• Rapid, insistent speech
• All or nothing thinking
• Spending sprees
• Reckless driving, DUI, car accidents
• Hyper-sexuality, no regard for consequences
• Lying, cutting class, sneaking out at night to
  party
• Psychotic delusions (may have romantic
  delusions), hallucinations
• Depression
• Crying, gloom doom thinking
• Moodiness, irritable
• Fatigue, oversleeping, no energy
• Insecurity, low self-esteem
• School avoidance, plays sick, physical complaints
• Isolation, pushes people away
• Suicidal thoughts, attempts

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Oppositional Defiant Disorder Conduct Disorder

• ODD
• Negative, hostile, defiant
• Persistent arguing, belligerent, stubborn
• Intense rigidity, inflexibility
• Touchy , resentful
• CD
• Aggression, cruelty to people animals
• Destructiveness
• Deceitfulness
• Disobedience
• Lack of remorse
• Observations from Home
• Angry with child who doesnt obey
• Shocked, embarrassed by childs behavior
• Overwhelmed by criticism
• Many school suspensions
• Cant take the child anywhere

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ODD CD in Teens

• When not treated early, ODD CD worsens in teens
• Truancy, school failure, expulsion
• Reckless, accident prone
• Low self-esteem covered by cockiness.
• Substance abuse
• Serious harm to others bullying, physical abuse,
  rape
• Encounters with criminal justice system

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Anxiety Disorder

• Most common childhood mental illnesses
• Separation Anxiety (panic disorder)
• Intense anxiety at separation from parents
• Worry that parents will die
• Refusal to sleep alone, will not go to sleepovers
• Plays sick to avoid school
• Overanxious Disorder (GAD)
• Overall worries
• Dread of making mistakes, perfectionist
• Too serious, tense, unsure, cant take criticism
• Deaf to reassurance
• Avoidant Disorder (social phobia)
• Acute shyness
• Restriction of social contacts to family
• Fear of being singled out, evaluated, called on
• Phobic about specific situations
• Observations from home
• Concern over repeated school absences
• Meltdowns occur when activities are forced

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Anxiety Disorders in Teens

• Panic Disorder
• Heart pounding, chest pain, shortness of breath
• Sweating, trembling
• Feeling of choking, nausea, dizziness
• Fear of dying, losing control, going crazy
• Social Phobia
• Fear of specific social situations
• Dread of humiliation, embarrassment
• Avoidance of feared situations
• Social Phobia (generalized)
• Fears most situations
• Inability to start conversations
• Fear of participating in small groups
• Fear of talking to authorities

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Obsessive Compulsive Disorder (OCD)

• Almost as common as ADHD
• Twice as many boys as girls
• Obsessions
• Fear of contamination (germs)
• Fear of danger to self/others (fire, death,
  illness)
• Fixation on lucky/unlucky numbers
• Need for symmetry/exactness
• Excessive doubts
• Forbidden, aggressive, perverse thoughts
• Compulsions
• Ritual handwashing, showering, grooming, cleaning
• Repetitive counting, touching, going in/out,
  writing/erase/re-writing
• Continuous checking, questioning, hoarding
• Observations from home
• Family must cooperate with rituals to avoid
  tantrums
• Child too exhausted to play or join family
  activities
• Bewildered angry at childs inability to
  control behaviors
• Compulsions swamp home life, more subdued in
  public

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Childhood Onset Schizophrenia

• Rare, 1 in 40,000
• Slow emergence of psychotic symptoms
• Early inhibition, withdrawal, sensitivity
• Problems with conduct
• Anxious, disruptive in social situations
• Poor motivation and follow-through
• School failure, special ed required
• Inability to make friends, disinterested
• Confusion about what is real, hears voices,
  delusions
• Little emotion shown, speaks rarely,
• Inappropriate emotion
• Infrequent eye contact/body language
• Observations from home
• Child hears voices saying bad things about him
• Stares at things that arent there
• Child not interested in making friends
• Odd behaviors pervasive in all parts of childs
  life
• Child appears blank, delays answering
  questions, asks for statements to be repeated.

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Schizophrenia

• Onset late teens
• More common, 1 in 100
• Prodromal
• Uncontrollable crying not linked with source of
  sadness
• Agitation, weight loss, lack of attention to
  hygiene
• Withdrawal, isolation, grades drop
• Odd sensory experiences, odd beliefs rituals
• Feelings of cosmic importance, intensely
  religious
• Suspicious, feeling of being watched, disliked
• Acute Positive symptoms
• Delusions hallucinations
• Grossly disorganized behavior, bizarre actions
• Bizarre body postures, pacing, rocking, grimacing
• Residual Negative symptoms
• Blunted emotional responses
• Lack of motivation, no goal directed activities
• Inability to relate to others
• Lack of insight that one is ill
• Poverty of speech, brief responses

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Class 3 Agenda

• Telling Our Stories
• Treatment Options Available
• The Medication Dilemma
• Adjourn

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Telling Our StoriesClass 3 Chart 1

• Childs name and age
• Childs diagnosis/diagnoses
• How old was the child when symptoms began?
• What were the symptoms?
• How is the child doing now? In school? At home?
• How are YOU right now? Where are you on the
  Stages chart?

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Getting Treatment

• Request Minimize provider bashing
• Disclaimer We discuss general terms, cannot
  suggest specific treatment,
• Step 1 Pediatrician
• May refer to mental health
• Offer to treat child, including medication
• Refer to school counselor
• Handout 1 Value of Early Identification
• Step 2 Contact community mental health agency
• Handout 2 Mental Health Professionals
• Talk to others regarding who to see, providers,
  clergy, families
• May have a waiting list, pediatrician in the
  interim
• Step 3 Evaluation is the treatment foundation
• Handout 3 Psychiatric Evaluation
• YOU are the CEO of your childs care

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Discussion

• What was the process like getting treatment for
  your child?
• Was there a downside when you got the evaluation?
• What was the hardest part of the evaluation for
  you?
• How did you feel when you heard the diagnosis?
• Handout 4 Bio-psycho-social dimensions

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Treatment Options

• Outpatient Child lives at home, goes for
  appointments
• Inpatient Child goes to hospital or residential
  treatment
• When child poses risk to self/others
• Day treatment/partial hospitalization
• Child at home for night, but in program all day
• Once level of treatment is decided, treatment is
  recommended
• Treatment plan
• You and your child should be part of your childs
  treatment planning
• Outcomes
• Symptom reduction, improved school attendance,
  family relationships, decreased involvement with
  the law, substance abuse
• Prevent need for more restrictive service,
  decrease hospitalization or out-of-home placement

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Discussion

• Tell us about your experience so far with
  navigating mental health treatment options.

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Medication

• Ground rule 1
• We wont be playing doctor
• Ground rule 2
• We will discuss general questions only.
• Medication types have increased due to ability to
  study neurotransmitters activity in the synapses

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Class 3 Handout 7 Two neurons in synaptic
contact
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Psychiatric Medication and Children

• Few pharmacology studies on children, no
  long term studies
• FDA approval is difficult, clinical literature
  builds case for off label use
• Handout 11 FDA meds approved for Children and
  Youth
• Black Box Warning May cause serious adverse
  effects
• FDA requires black box warning on antidepressants
  increased risk of suicide
• Does not mean medication caused behavior
• BUT needs monitoring to catch suicidality early

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Risks of Anti-Depressants

• Suicidal thoughts are part of depression
• 2 phase response to anti-depressants
• Initial lift in energy before mood lifts
• Energized state of despair, increased suicide
  risk
• Did anti-depressant cause suicidal thinking
• Or was it part of the illness?
• Either way, we must watch our kids closely during
  medication change
• Since 2007, when black box warning issued
• Decreased prescription of anti-depressants
• Increased depression in children teens
• Increased suicide rates in children teens
• NAMI favors
• Informed consent of risks/benefits of treatment
• Vs. risks of no treatment.
• Careful monitoring,
• Comprehensive treatment.

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Discussion

• What is your experience with deciding to use or
  not use medication with your child?
• Handout 12 Classes of psychotropic medication
• Handout 13 Parents Top Ten
  How to make sure your child gets the best
  possible treatment
• More tip sheets in resource section
• Name one thing you will do to take care of
  yourself this week

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Class 4 Agenda

• Family Burden
• Communication Skills
• Problem Solving Skills
• Tips for Handling Difficult Behavior in Children
• Crisis Preparation and Responses
• Adjourn

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Family Burden

• Dealing with a childs mental illness affects the
  well-being of the entire family
• Family feels alone, shunned
• Handout 1 Minimizing negative impact on other
  family members
• Improving skills for difficult situations
• Reduces family turmoil due to mental illness
• Roles of other family members change
• Other children may resent blame the ill child
• Parents may resent each other, especially about
  how to handle childs mental illness
• We cannot sacrifice the rest of the family to
  take care of the ill child
• Handout 2 Minimizing Negative Impact on Family
  Members

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Discussion

• How has it been for you?
• caring for your child with mental illness
• while also living the rest of your life?
• How have your other children handled the
  challenge?
• What about your job?
• What about your personal life?

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Communication Skills

• Good communication is difficult
• Expressing what you want to say
• So others understand what you mean
• Understanding what others mean to say
• Add mental illness
• Concentration problems
• Information processing problems
• Intense, unpredictable emotions
• Families living with mental illness
• Extra need for good communication skills
• You cannot control what your child says
• Or perceives you to say
• You CAN control words and tone you use
• When parent communication changes
• Childs communication eventually follows
• Handout 3 Communication Guidelines

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I-Statements

• Handout 4 I-Statements
• Specific, direct comments
• What you think, feel and want
• You take responsibility
• You say what you mean directly, but calmly
• Calm facial expression eye contact with child
• I feel _______________ (feeling)
• When you __________________ (action)

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I-StatementFollow-Up

• Invitation to come to a win-win solution
• Help me.
• Lets work together on.
• Process feelings with reflective response
• Before problem solving
• As opposed to YOU Statements
• Child feels accused defensive
• I-statements
• Focus on facts, no blaming
• Parent expresses feelings
• Dont express doubt.
• Say what you mean and mean what you say.
• Good for positive feedback constructive
  criticism

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Reflective Response

• Focus on feelings of other person
• Our children feel safe venting their feelings on
  us
• We need to talk to our children about their
  behavior, but also acknowledge their perception
• Park your feelings
• Listen for your childs perceptions feelings
• Handout 5 Reflective Response
• Acknowledge childs lived experience
• Validate that anyone with that experience would
  feel the way they do
• Communicate that you understand what your child
  believes and feels
• Do not correct your child until you have
  reflected their perceptions feelings

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Collaborative Problem SolvingPlan BClass 4
Chart 1

• Empathy (plus reassurance)
• Define the problem
• Invitation
• Typical view
• Children do well if they want to
• CPS Children do well if they can

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Crisis Preparation Response

• How to prepare for explosive episodes
• Rages
• Violent behavior
• Psychotic episodes
• Self-injurious behaviors,
• Suicidal threats, gestures
• 10 Markers of Bipolar Rage
• Rages most often occur at night
• Rages roar out of nowhere at the drop of a hat
• Rage takes a predictable course
• Build-up
• Explosion
• Exhaustion
• Great volume of rage cannot be imitated
• Gory thinking during rage
• Child will destroy precious objects during
• Child reports rage as sense of heat
• Rage is felt as entity that takes over

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Rage Escalation Phases

• Dysphoric phase
• Everything annoys them
• Provocative phase
• Child looking for a fight
• Explosive phase
• Brain frontal lobes inoperative
• Limbic brain takes over
• Child catapulted into anything goes
• Handout 8
  Survival Strategies for Managing Rage
• Handout 9 One Mothers Story
• Regardless of type of violence,
  safety is always the priority
• Call for help when you need it

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Self-Injury

• May include
• Carving, scratching, biting, branding, marking,
  picking at skin hair, burning, cutting
• Variety of causes
• Mental illness
• Risk-taking display
• Expression of individuality
• Attention seeking for desperation, anger
• Suicidality
• For youth who cannot express emotion
• Self-injury may relieve tension for some
• Others feel hurt, angry, afraid, hateful
• What to do if your child self-injures
• Do not ignore it
• Talk with your child,
• Use I-statements, reflective response problem
  solving
• Watch your child for recurring signs

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Suicide

• Shockingly common
• 3rd leading cause of death ages 15 24
• 6th leading cause of death ages 5 -14
• Handout 10 Suicide Myths Facts
• Handout 11 Warning Signs
• What to do
• Ask your direct questions
• Are you thinking of killing yourself?
• How do you plan to do it?
• If there is a plan, call for professional help
• Youth Villages
• May need hospitalization
• Often not always warning signs
• Talking about death,
• Will not be here any more
• Giving away prized possessions
• Listening to music about death,
• Writing about death
• Grades drop

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Crisis Plan

• Handout 12 Crisis SPIN
• Safety
• Plan
• Intervene
• Negotiate
• Handout 13 Crisis Plan
• Who needs to be involved
• Steps to follow based on acuity
• One place for childs information quick access
• Once plan is developed
• Every family member reads it
• Understands their part
• Place it where it can easily be found
• Handout 14 Relapse Plan
• Steps to take BEFORE symptoms get to crisis level
• Crisis and relapse plans to be developed when
  child is in good shape,
• NOT during crisis

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Discussion

• What are the first symptoms that let you know an
  episode is beginning for your child?
• Remember the airplane
• Grab your oxygen mask first
• Then help your child
• Embrace the situation as a mission,
• Not a burden
• Become skillful at helping your child through
  dire times
• Never give up hope!

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Class 5 Agenda

• Record Keeping
• Overview of the Mental Health System
• Overview of School Systems role
• Overview of Juvenile Justice system
• Introduction to Transition Issues
• Adjourn

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Record Keeping

• You are the primary advocate for your child, the
  CEO of your childs care.
• Inform yourself of each systems responsibilities
  and resources
• Be prepared with facts about your child
• Keep your own records
• Simple is better. Just do it.
• 3 ring binder with dividers
• Folders in an accordion file
• Section headings
• Personal
• Medical
• School
• Mental Health/Crisis/Relapse
• Legal
• Each section
• Official documents
• Medication record
• Conferences, prep, notes and follow-up
• phone call logs, emails, letters

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Record Keeping System

• Handout 1 Record Keeping System
• Handout 2 Portable Treatment Record
• Handout 3 4 Sample forms
• Phone log
• Phone/Meeting documentation
• Handout 5 Behavior Change Log
• Note changes in your child as they occur
• Parental Record will
• Decrease the chance of the same mistakes
  happening twice.
• Decrease the time needed for a medical history
  during intake.
• Allows more time for the provider to actually
  evaluate your child
• Provide proof when necessary
• Be available to grab go in a crisis

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Mental Health System

• Nationally, the mental health system does not
  work well for children and adolescents.
• Shortage of qualified personnel
• 2 systems
• Private
• Paid by private health insurance or individual
  out of pocket
• Private providers have the right to refuse public
  health care clients or anyone who cant pay fees
• Public
• Government (federal, state, local) or non-profits
• May charge a sliding fee based on income
• Public providers usually accept
• Medicaid (TennCare)
• SCHIP (CoverKids)
• Medicare
• Handout 6 Government Insurance Programs
• Handout 7 Medicaid and SCHIP eligibility
• Handout 8 Supplemental Security Income SSI
• Handout 9 Private Insurance

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Mental Health Services

• Regional Mental Health Institutes (RMHI)
• State hospitals
• Community Mental Health Centers
• Handout 11 State Plan for Childrens Mental
  Health Services
• Vision System of Care for Children and Youth
• Some of these service types only exist in a few
  locations
• Handout 12 Rights of Individuals Receiving
  Services

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Patients Rights

• Confidentiality
• Illegal/unethical for mental health professionals
  
• To share information about your childs treatment
• To even acknowledge that your child is receiving
  services at the agency/facility
• UNLESS you give written consent to release
  information
• If you are concerned that your/ your childs
  rights have been violated
• Use grievance procedure provided by agency
• Or contact Department of Mental Health and
  Developmental Disabilities
• 1-800-560-5767
• http//state.tn.us/mental/policy/oca1.html
• Contact TN Disability Law Advocacy Center

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School System

• Children spend most of their waking hours at
  school
• They learn to navigate the world
• Rights provided by federal law
• Americans with Disabilities Act (ADA)
• Handout 13 Education laws for children with
  disabilities
• Individuals with Disabilities Education Act
  (IDEA)
• Section 504, Rehabilitation Act
• More information in Additional Resources
• Unfunded mandates Schools need to provide
  services with no federal dollars
• Handout 14 Eligibility criteria IDEA vs. 504
• 504 For child who needs minor accommodations
• IDEA For child who needs more extensive changes
  and supports
• Handout 15 Emotional Disturbance (ED) criteria
• Educational assessment, NOT medical diagnosis
• Our children usually qualify as ED
• Also learning disabled, autism

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School System

• When do you ask for help?
• Problems come up with your childs school work or
  behavior
• When you notice a problem, its probably past
  time to ask for help
• School may contact you
• Start with your childs teacher request a
  meeting
• Take your records Parents and Teachers as
  Allies
• Let teacher know you are willing to help them
  learn to deal with your child
• Teacher may need info on mental illness
• School may be reluctant to recognize childs
  disability
• Scarce resources would be required to serve your
  child
• Best to collaborate, but if not
• Advocate your childs well-being is at stake

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Special Education

• Handout 16 Special Education Process
• Individualized Education Plan (IEP)
• Like a treatment plan for education
• Developed during IEP meeting with
• Child, parents, school personnel, others you
  invite
• IEP signed by you, child school personnel
• Keep a copy in your records
• Track what is/is not implemented
• If you are not satisfied, forms on schools
  website
• Process for re-determination
• Process to file complaint
• You are not alone in this process Help is
  available
• NAMI
• Tennessee Voices for Children

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Discussion

• What are your experiences with the school system?
• What has it been like for you as a parent or
  caregiver?
• Have you found a way to make the system work for
  you and your child?
• Even if you do everything right,
• No guarantees
• School is tough for our children
• Self-esteem based on peer relationships
• Children do not have power to change schools
  often must learn to cope
• Handout 17 10 tips for school parents

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Juvenile Justice System

• If your childs behavior brings them into contact
  with the law
• Truant officers,
• Juvenile court personnel,
• Police, law enforcement
• Youth detention centers
• Majority of children in Juvenile Justice
  facilities have diagnosable mental illness TN,
  53
• JJ system does not deliver MH services
• We can hope JJ officials recognize mental illness
  and refer to treatment
• JJ personnel are stretched
• No time to learn
• Not enough time to help our children

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Juvenile Justice System

• Your child needs an advocate
• Make sure the illness gets treated first
• Then charges evaluated based on presence of MI
• Judges are usually willing to work with parents
  who are caring involved
• Having a mental illness is not an excuse to break
  the law, but can be a factor in consequences
• Good record-keeping is invaluable!
• Provide documentation to authorities
• Educate authorities about your childs illness
• Work collaboratively
• If that doesnt work
• Remember, you are not alone
• Others can help you get what is needed
• Call NAMI, TN Voices, or Disability Law
  Advocacy Center

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Discussion

• Have any of you had experience with the juvenile
  justice system?
• What has it been like for you?
• What did you learn from the experience that might
  help others?

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Transition to Adulthood

• Parental rights cease when child turns 18
• Changes
• Confidentiality changes at 18,
• You are no longer included in treatment
• TN Child can make own treatment decisions at 16
• Medicaid (TennCare)
• SCHIP (Cover Kids)
• Educational service eligibility
• Social Security benefits, childs check comes
  directly to them
• SSI
• Social Security Survivor benefits until age 22
• State custody Ends at 19

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Transition to Adulthood

• Going away to college, technical school,
  employment
• Help your child obtain MH providers in new
  location
• Dont leave it up to them
• Facilitate written referral and treatment summary
  
• Current to future providers
• Encourage child to sign up with campus office of
  disability
• Once assessment is done,
• Help is easier to get if needed
• Consider natural social supports
• Relatives
• Friends
• Clubs
• What does your child like to do?
• Faith community

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Transition to Adulthood

• Recommended documents
• IDEA transition plan (age 14)
• Help child develop skills needed in adulthood
• HIPAA release (age 18)
• Signed by child
• Necessary for you to get treatment information
• Advanced Directive (age 18)
• TN Declaration for Mental Health Treatment
• Wellness Recovery Action Plan (WRAP)
• Crisis Plan
• Optional documents
• Mental Health Power of Attorney
• Health Care Power of Attorney
• Durable Power of Attorney (finances)
• Conservatorship
• Only if child is very disabled
• Incapable of self-care or make basic decisions

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Next WeekGraduation!

• Guest Speakers
• NAMI Robertson County
• Debi Wheatley
• Melanie Brander
• Self-Care strategies
• Evaluation of Course
• Take home message sheets
• Certificates
• Refreshments?
• Celebration?

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Class 6 Agenda

• Presentation by local experts
• Review of items identified as most pressing from
  Class 1
• Self-Care
• Referral to Graduate School
• Course Evaluation
• Diplomas
• Adjourn