Counseling Children and Adolescents ECG 558

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Counseling Children and AdolescentsECG 558

• Chapter 10
• Counseling At-Risk Children
• and Adolescents

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Introduction

• Changing socioeconomic factors have changed
  family environments in recent years
• Poverty, economic instability, marital
  transitions, social changes, new technologies
  violence have influenced children/adolescents
• Challenges faced by todays youth are as great as
  ever before
• Fewer adults function as role models support
  systems

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Poverty as a Major Risk Factor

• Poverty is related to poor physical health, low
  educational attainment, and psychological
  disorders
• Four factors contribute to increased poverty
  among children decreased economic growth
  changes in employment structure cut in
  government benefits for children increase in
  single-parent families
• Poverty experienced at younger age has greater
  negative effects than at older age
• Poverty rates for ethnic minority children are
  higher than for Caucasian children
• Effects of poverty are multifaceted (less access
  to services, more health problems, more family
  dysfunction)

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Socializing Systems Family Context

• Children are greatly influenced
• Characteristics of healthy families open system,
  adaptive, flexible
• Parental Divorce Family Blending
• Domestic violence
• Child sexual abuse
• Parenting Behavior
• Permissiveness vs. restrictiveness
• Hostility vs.warmth
• Anxious/emotional involvement vs calm detachment
  dimensions

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Two Issues in the Family Context

• Changing family structure
• divorce rates are rising
• blended families are a reality for many
  children
• working parents place extra caretaking
  responsibilities on children
• Dysfunctional families
• dysfunction in families is stressful for all
  members and can cause disorders
• family environments that put children at risk
  are
• a. Violence in the home
• b. Child Abuse
• c. Neglect
• d. Homicide
• e. Sexual abuse

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Socializing Systems Peer Context

• Peer influence
• Drug use
• Peer group interventions
• Cooperative learning groups
• Drawback peers teach reinforce deviance
  behavior negative peer effects

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Socializing Systems School Context

• Healthy school environments consist of
• Strong leadership
• Collaboration
• Sense of fairness and respect
• Discipline
• Community support
• Academic curriculum

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Socializing Systems

• School Context
• Community support is important
• Constrained by deficient social capital
• School structure, size philosophy influence
• School Dropout
• Low academic motivation, history of problems with
  authority, frequent absences, pregnancy/
  marriage, working, family conflict, drug abuse,
  minority status, 2 years behind
• School Violence
• Increased incidents
• Fighting/intimidation
• Weapons

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The School Context

• Strong correlations between school difficulties
  and the development of serious problems
• Schools can reduce risk and promote positive
  adjustment for all students
• Schools should promote positive peer interactions
• School size, structure, and philosophy have
  influence on learning environment and at-risk
  students
• Adolescence oftentimes brings on more school
  problems (for instance, truancy, reduced
  motivation)
• Gender role socialization may contribute to
  problems for girls in schools
• School dropout is higher for the students already
  at risk
• Rising school violence

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A Framework for Prevention and Intervention

• Factors contributing to mental health problems in
  youth are diverse
• Families, schools, communities, and society
  contribute to these problems and help maintain
  them
• J. J. McWhirter et al. (2007) proposed a
  comprehensive prevention/intervention framework
  (At-risk, Approach, Context Continuums)

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At-Risk ContinuumThe degree to which youth are
at risk for serious behaviors and problems

• Minimal favorable demographics
• Remote less favorable demographics
• High negative demographics
• Imminent Negative demographics yet have
  developed gateway behaviors
• Highest engaged in serious problem behaviors,
  or depressed/suicidal

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Approach ContinuumAppropriate types of
prevention/intervention for various levels of
risk

• Universal appropriate for all ages, not just
  the at-risk children preventive
• Selected aim at those who share some
  circumstances/experiences Ex Head start
• Booster Sessions review/reinforce components of
  universal selected approaches
• Indicated treatment approaches used w/kids at
  imminent risk for serious problem behaviors
• Second-chance Programs used w/kids who have
  engaged in severe problem behaviors

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Contexts ContinuumIncludes early involvement
(family,school,society/ community) in broad-based
prevention/intervention

• Family context provide culturally appropriate
  family-strengthening opportunities promoting
  interaction/communication/health-care/ parent
  training/ family counseling/ special programs
• School-based - early compensatory programs, after
  school care, generic programs infused in the
  curriculum, second chance, school-based
  programs,etc
• Society/Community improved economic conditions,
  housing, childcare, job opportunities etc

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DepressionIncidence and Characteristics

• Adult depression differs from depression in
  childhood and adolescence
• Dysthymia-chronic sense of dysphoria that is less
  intense than depression
• Signs frequent physical complaints-headaches,
  stomaches, muscle aches, fatigue-, school absence
  or poor performance, running away, outburst of
  anger, irritability or crying, boredom, lack of
  interest, alcohol or substance abuse, heightened
  social sensitivity, difficulty in friendships,
  fear of death Also associated with anxiety,
  disruptive behaviors, substance-abuse, diabetes,
  increased suicide risk

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Depressive Disorders

• Incidence and Characteristics (cont)
• Depression affects approximately 30 of
  adolescents
• Depression affects approximately 2-5 of children
• Females are twice as likely as males to express
  depression
• Depression is not a developmental phase
• Both the developmental process as well as the
  psychological, social, and biological components
  of depression need to be taken into consideration

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DepressionTreatment

• Take cultural factors into account
• Counselors need to use developmentally
  appropriate interventions
• Preventative, community-based programs that
  promote healthy families
• School-based training/educational/topic specific
• Cognitive-behavioral therapy is most effective
• Antidepressant medications/ psycho social
  interventions
• Combination of CBT medications

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SuicideIncidence and Characteristics

• Suicide is the third leading cause of death
  ages 10-24
• Leading cause of the death of Gay and Lesbian
  adolescents
• American Indians have the highest suicide rate
  among ethnic minority adolescents
• Hispanic adolescents are more likely for suicide
  than European American or African American
• Females are 3 times more likely than males to
  attempt males are 5 times more likely to
  complete suicide
• Depression, difficult adjustments, emotional
  ambivalence, anger, ineffective communication,
  and stressful living conditions contribute to
  suicidal ideation
• Loneliness, impulsivity, risk-taking, low
  self-esteem, faulty thinking patterns also
  associated with higher suicide risk

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Suicide Assessment

• Multifaceted approach necessary
• Clinical interview - helpful in assessing risk
• Risk factors include family history of suicide,
  previous suicide attempts, substance abuse,
  anxiety, hopelessness/ depression, current family
  problems, other current stressors
• Self-report measures

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SuicidePrevention/Intervention

• Focus on underlying environmental and
  interpersonal characteristics associated with
  suicide(depression, lack of social support, poor
  problem-solving skills, hopelessness)
• School setting is a good place for primary
  prevention
• Offer family support programs (Family Resource
  Center)
• Early intervention should minimize frequency and
  severity of suicidal ideation
• Suicide screenings
• Establishment of interdisciplinary crisis teams
  (teachers, school counselors, parents, nurses,
  community)
• McWhirter et al. (2007) use of four-step model
  for managing a suicide crisis
• 1. assess lethality
• 2. written agreement emergency phone
• 3. monitor and track clients behavior for 1-3
  days
• 4. inform the childs parents

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Substance AbuseIncidence and Characteristics

• Pathological use of a substance that causes
  significant impairment in functioning
• Statistics - p. 349 in text
• Drugs most used by adolescents in US Alcohol,
  Tobacco, Marijuana

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Substance AbuseRisk Factors

• Individual Factors- aggressiveness, neg moods,
  withdrawal, mental health issues, withdrawal,
  impulsivity, conduct disorders, ADHD, depression,
  learning disorders
• Peer Factorsassociation w/drug abusers
• Family Factors Older sibling abuses, high
  family conflict, poor parenting practices,
• School Factors academic failure, subsequent
  drop-out, inappropriate classroom behavior,
  aggression toward others, etc
• Community Factors poverty, lax drug laws/abuse,
  high availability of drugs

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Substance Abuse Prevention and Treatment

• Preventive interventions typically occur in
  school settings and may be universal, selected or
  indicated interventions
• Schools mostly use information-based preventive
  interventions
• Treatment occurs most often outside the school
  setting

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Substance Abuse Prevention and Treatment

• Outside Interventions
• Treatment sites
• Outpatient
• Day treatment
• Inpatient Residential
• Types of treatment
• 12-step program
• Cognitive behavioral-based interventions
• Family-based interventions
• Therapeutic communities

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Substance Abuse Prevention and Treatment

• School-Based Interventions
• Student Assistance Programs (SAP)
• Only available in some school sites
• Students are aware that substance abuse
  disclosure can lead to negative consequences
  rather than support (Zero tolerance policies)
• Motivational Interviewing
• Work with Students resistance rather than
  against it
• Listen for challenges the student is currently
  facing (school disciplinary consequences,
  problems at home,
• Use skills of reflection to communicate
  understanding

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Summary

• Counseling process with children and adolescents
  in crisis is complex
• Need for comprehensive interventions
• Knowledge of community and school programs and
  resources
• Advocacy for broader social and policy change