Tracey Sutton, MSW, LCSW
Family Support Services
Of North Idaho
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A tapestry captures a moment in time. Using
complex and rich designs and images, the
artist tells a story of people, events, culture,
beliefs and spiritual understanding.
A tapestry is a metaphor for who we are as
people. The threads of the past and present
are woven together. The threads of decisions
are how the present is connected to the past
and future.
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“Mental health problems among
children and adolescents
constitute a public health crisis
for our nation.”
(Subcommittee on Children and Family, President’s New Freedom Commission, p. 1)
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Identify the unique qualities and challenges
of psychosocial rehabilitation for children.
Develop practical ways to integrate
attachment theory and a strengths-focused
approach to support caregivers in providing
an emotionally responsive environment that
will enhance the child's self-esteem and
confidence on their trajectory toward greater
resiliency.
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Discuss ethnic and cultural considerations,
including history of oppression and trauma,
when developing a family-centered treatment
plan.
Identify the skills necessary for youth to
thrive in their living, learning and social
environments, as well as the community
resources available to help in the acquisition
of those skills.
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“promote quality of life, community
integration, and successful transition to
adulthood for children and youth who have
experienced serious emotional or behavioral
difficulties that significantly impair the ability
to function successfully in home, school,
family or community life.”
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“services focus on empowering young people
and their families to develop the skills and
access the resources needed to increase their
capability to thrive in the living, working,
learning and social environments of their
choice.”
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“undertaken in the spirit of partnership and
collaboration between youth, caregivers, and
providers. The services are individualized,
driven by each young person and his or her
family, and build on existing strengths. They
promote each young person’s positive
development, while supporting his/her
movement along a developmental trajectory
that will result in a successful transition to
adulthood.”
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Successful transition to adulthood
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Increase capability to thrive
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Promote positive development
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Does the child/youth believe that something
can be done to help them with their behaviors
and improve their daily functioning?
Does the family believe that something can
be done to help the child/youth with their
behaviors and improve their daily
functioning?
How is CPSR different than what has already
been tried?
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Explanations about the problem behaviors
and views about its etiology profoundly affect
ideas about treatment.
Often, different family members hold
divergent beliefs about what should be done.
Conflicts over the “appropriate” treatment
may constrain effectiveness and polarize
participants.
Madson, 2007
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To qualify for CPSR children must:
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Be under 17-yrs old
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Have serious emotional disturbance
•
Functional impairment as measured by the
Child and Adolescent Functional Assessment
Scale (CAFAS) or Preschool and Early
Childhood Functional Assessment Scale
(PECFAS)
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SAMSA definition of Severe Emotional
Disturbance:
“A diagnosable mental disorder found in
persons from birth to 18-yrs of age that is so
severe and long lasting that it seriously
interferes with functioning in family, school,
community or other major life activities.”
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The idea of recovery needs to be expanded to
include resiliency when we speak of PSR for
children.
Systems of care must focus on facilitating
recovery, and on building resilience, not just
managing symptoms.
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Individual: intellectual functioning, easygoing
temperament, self-efficacy, self-confidence,
talents, close relationships to caring parent
figures.
Parenting: authoritative, warmth, structure, high
expectations, socioeconomic advantages and
connection to extended family networks.
Community: bonds to pro-social adults,
connections to pro-social organizations and
attending effective schools.
Masten & Coatsworth (1998)
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Social Learning Theory
People learn from one another, via
observation, imitation, and modeling.
Experiential theory
Concrete experience (or “DO”)
Reflective observation (or “OBSERVE”)
Abstract conceptualization (or “THINK”)
Active experimentation (or “PLAN”)
Behavior change and improved
functioning occur as children learn
and implement new ways of
coping, behaving and thinking and
as the child’s environment shifts to
support desired behaviors.
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The child and family strengths, deficits and
treatment needs should be clearly identified
in the areas of psychiatric, medical,
educational, social support/behavior toward
others, family, basic living skills, housing,
finances, cultural considerations and
community.
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Successful transition to adulthood
Increase capability to thrive
Promote positive development
What do these overall goals mean within the
cultural context of the family?
The individualized treatment plan will include
specific goals and objectives with clearly
stated tasks and outcomes to acknowledge
success.
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Interventions are home and community
based, child/family centered, culturally
sensitive, individualized, integrated across
providers and functional areas, and use
evidence based practices.
Specific services could include skill building,
coordination of collateral agencies (school,
day-care, probation, etc).
The focus of intervention efforts are five-fold:
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Establish a working relationship with the child
and his or her care givers.
Increase motivation and hope for the child
and family.
Teach the child and caregivers a broad range
of cognitive and behavioral skills designed to
remediate symptoms and improve
functioning.
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Allow the child and family to rehearse new
behaviors or skills repeatedly in natural
environments to the point of mastery.
Alter environments so that desirable
behaviors are reinforced and undesirable
behaviors are ignored or consequence.
Nathan J. Williams – CenterPoint Behavioral & Mental Healthcare, Inc.
Nampa, Idaho (2009)
Interventions take place in the home or natural
community settings and are likely to include:
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Teaching children to be better observers of
their own emotional states, level of emotional
arousal and common triggers that generate
unpleasant feelings.
Provide effective education that develops an
understanding of the link between thoughts,
feelings and behaviors.
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Provide psychoeducation on social learning
principles or on the child’s diagnosis.
Teach specific cognitive and behavioral
coping skills such as thought stopping,
relaxation, self-talk, problem solving, social
skills, perspective-taking, positive activity
scheduling.
Practice skills with coaching and feedback.
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Design reinforcement systems.
Directly reinforce positive behaviors and
consistently consequence inappropriate
behaviors.
Williams – (2009)
Tools for presenting material:
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Didactic instruction, therapeutic games
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Role plays, puppets
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Modeling, coaching
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Workbooks, therapeutic stories
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Hope & Respect – all children have the capacity for
learning and growth.
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Culturally Relevant – culture is central to recovery.
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Shared Decision-Making – facilitate partnerships with
all people and community systems/agencies involved
in supporting children, youth & families
Strengths Based – build on the strengths &
capabilities of each young person to promote
resilience & recovery
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Family Centered – practices are designed to
address the unique needs of each individual
served, consistent with the values, hopes &
aspirations of the individual and his/her
family system.
Community Integration – engage children in
age- and developmental appropriate
activities that promote positive growth.
Empowerment – promote selfdetermination & empowerment, & honor
family voice and choice.
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Natural Supports – identify and link children, youth
and families to community resources.
Quality of Life – improve all aspects of the lives of
young people and their families including social,
educational, financial, intellectual, physical and
spiritual domains.
Health & Wellness – promote a holistic view of
wellness & encourage life-long habits for
improving & maintaining physical & mental health.
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Evidence Based – best practices that
produce outcomes congruent with
empowerment, resilience & personal
recovery.
Accessible & Coordinated – services must
be readily accessible to children &
adolescents whenever, wherever and for as
long as they are needed into adulthood.
Services must be well coordinated with
other treatments and practices.
CPSR providers typically feel well prepared to
work with children and youth, however
there is also a need to understand the
experience of caregivers.
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Considerable strain related to coping with the
needs of their child/youth and coordinating
services.
Family members experience depression,
fatigue and frustration with services systems
that are uncoordinated.
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Safety is the core issue for children with
disordered attachment and other attachment
related problems. They are distant and
distrustful because they feel unsafe in the
world. They keep their guard up to protect
themselves, but it also prevents them from
accepting love and support.
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Set limits and boundaries. Consistent
boundaries make the world seem more
predictable and less scary.
Take charge, yet remain calm when the child
is upset or misbehaving. Remember that
“bad” behavior means that the child doesn’t
know how to handle what he or she is feeling
and needs your help.
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Be immediately available to reconnect
following a conflict. Conflict can be especially
disturbing for children with insecure
attachment or attachment disorders. After a
conflict or tantrum where you’ve had to
discipline the child, be ready to reconnect as
soon as he or she is ready.
Own up to mistakes and initiate repair. When
you let frustration or anger get the best of
you or you do something you realize is
insensitive, quickly address the mistake.
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Try to maintain predictable routines and
schedules. A child with an attachment
disorder won’t instinctively rely on loved
ones, and may feel threatened by transition
and inconsistency.
Respond to the child’s emotional age.
Children with attachment disorders often act
like younger children, both socially and
emotionally. You may need to treat them as
though they were much younger, using more
non-verbal methods of soothing and
comforting.
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Shock/Denial/Disbelief
Emerging awareness of a difference in
their child and a lack of clarity about what
is happening.
Recognition
Initial awareness of a mental illness.
Questions such as “what did I do wrong?”
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Coping
Adjustment to the frequent crises &
disruption in normal family life.
Advocacy
The family becomes more proactive in the
community. Increased assertiveness, less
self-blame, less blame of professionals.
Time is spent to developing new roles and
relationships with professionals.
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Friesen, B. J. (2007). Recovery and Resilience in Children’s Mental Health: Views from the Field.
Psychiatric Rehabilitation Journal ,31(1), 38-48.
Hopkins, G.L., McBride, D, Marshak, H.H., Preier, K., Stevens, J.V., Kannenberg, W ., et al. (2007).
Medical Journal of Australia, 186(10). 71-73.
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Lefley, H.P. (2009). Family Psychoeducation for Serious Mental Illness. New York: Oxford University
Press.
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Madson, W.C. (2007). Collaborative Therapy With Multi-Stressed Families (2nd ed.). New York: The
Guilford Press.
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Masden, A., & Coatsworth, J.D. (1998). The development of competence in favorable and unfavorable
environments: Lessons from research on successful children. American Psychologist, 53(2),
205-220.
Williams, N.J. (2009). Preliminary Evaluation of Children’s Psychosocial Rehabilitation for Youth With
Serious Emotional Disturbance. Research on Social Work Practice, 19(1), 5-18.
Williams, N.J. (2009). Dose-Effect of Children’s Psychosocial Rehabilitation on the Daily Functioning of
Youth with Serious Emotional Disturbance. Child Youth Care Forum, 38, 273-286.