Behavioral and Mental Health Promotion

Question 1

Theories Of Well-Being

Answer 1

Science of Thriving: holistic view of the central role of safe, stable, nurturing relationships (SSNR) related to development and flourishing; proactive approach

Culture of Health: based on well-being as central to every aspect of our lives

Health Outcomes from Positive Experience (HOPE): actively promoting positive experiences and preventing and/or buffering the effects of adversity

Question 2

Science of Thriving Six Concepts

Answer 2

• Capacity for positive human development in the face of adversity
• Well-being is a learned ability
• Interplay of human health and dynamics within the social, emotional, and environmental context we co-create
• A balance between conventional focus on negative development, risk factors, and pathology; focus on strengths
• Self-led healing, resilience, and well-being
• Development of social and emotional skills

Question 3

The Science of Early Childhood Development

Answer 3

Concept 1: responsive relationships and positive experiences build strong brain architecture (neural connections made, gene expression altered, the brain develops)
Concept 2: Adversity disrupts the foundations of learning, behavior, and health (Toxic stress responses can impair development; ACES - abuse, neglect, household dysfunction)
Concept 3: Protective factors in early years strengthen resilience (even one stable, responsive relationship can prevent developmental disruption)

Question 4

Temperament

Answer 4

Inborn characteristics that describe an individual’s emotional and behavioral response style across situations; affects caretaker-child interactions

• Types: difficult, slow-to-warm-up, easy
• Characteristics of temperament: activity level, intensity of reaction, adaptability or flexibility tolerance, persistence and attention span, distractibility, rhythmicity, threshold of response, approach/withdrawal, mood

Question 5

Attachment patterns

Answer 5

Secure attachment: parent is sensitive, responsive, available; child feels valued/worthwhile

Insecure and avoidant attachment: Is insensitive to child’s cues, avoids contact, rejects; child feels no one is there for him/her

Insecure attachment characterized by the violence and resistance: parent shows inconsistent patterns of care, unpredictable (depressed); child feels they should keep the adults engaged because he/she never knows when they will get attention back; child is anxious, dependent, and clingy

Question 6

Resilience

Answer 6

Ability to overcome difficulty and succeed in life

• Can be learned, promoted, and supported through protective relationships, skills, and experiences
• Self-regulation: transition from reflexive responses in the newborn period to the ability to recognize and control one’s thoughts and actions

Question 7

Spiritual Integrity / Morality / Faith

Answer 7

Spiritual integrity: a sense of meaning and purpose; one has direction, control, and promise of a future

Morality: the quality of being that encompasses that which is right (justice or fairness) and that which is good (empathy or kindness)

Faith: the basis for developing beliefs, values, and meaning; closely linked to spirituality

Question 8

Assessment of Mental Health

Answer 8

• “Do you have any concerns or worries about your child’s mental/emotional health for his/her behavior, or has there been a changes in how he/she usually behaves at home or at school?”
• Avoid rapidly firing questions and make eye contact
• Schedule a follow-up if non-emergent

Question 9

Behavioral Assessments

Answer 9

• Infant/early childhood - Observe unstructured play
• School-age children and adolescents - Have the child/adolescent draw a picture of themselves and family, and tell a story about the picture

Relationship is a VITAL SIGN
- PRN (protect, relate, and nurture)

Question 10

Six Key dimensions Affecting Family Functioning

Answer 10

• Resources available to the family
• Transitions and stresses
• Child-rearing styles
• Values
• Roles and structures
• Coping style of the family

Question 11

Screening Tools for Social-Emotional Development

Answer 11

• Routine screening of mothers for PPD
• Ages and Stages Social Emotional, ed. 2 (1-72 months)
• Pediatric Symptom Checklist 17 and 35 item (4-16 years)
• KYSS Assessment Questionnaire (older infants and toddlers, preschool, school-age children and teens)
• Survey of Wellness in Young Children (<5 years old)
• Strengths and Difficulties (SDQ) - Parent report, Youth report, teacher report; Baseline and follow-up
• Child Behavior Checklist 2 (CBCL) - Preschool, school-age for parent and teacher, and youth
• Temperament (4 months to 6 years)
• Temperament and Atypical Screening (TABS) - 11 months to 71 months
• Sensory Processing Disorder Checklist (infant/toddler; preschool; school-aged; adolescent/adult)
• Adverse Childhood Questionnaire (ASE-Q) - child, teen, and teen self-response

Question 12

Purposeful Parenting - The 6 Ps

Answer 12

Protective, personal, progressive, positive, playful, purposeful

Question 13

Discipline

Answer 13

• Discipline is education that molds the behavior, mental capacities, or moral character of an individual
• Expectations must be appropriate to that age, development, personality, temperament, strengths, and weaknesses of the child
• Establishing structure/family routines is one of the easiest ways to provide discipline
• Praise, with a specific description of what was accomplished, paired with the social values, is good reinforcement
• Consequences help children learn to socialize. Appropriate planned consequences are prompt, logically related to the behavior, appropriate to the child’s age and developmental capabilities and the right size. Time-out, being sent to the child’s room, restricting a favorite activity, and turning off the television or video games are examples of successful consequences. Loss of privilege with a brief explanation teaches the child the why of the discipline.
• Teaching problem-solving is also a part of discipline
• Treat children with respect and empathy, even when being reprimanded for misbehavior
• Parents may also need a “time-out” from the child to cool down and regain self-control
• Use flexible limits setting (“You have to wear a coat, but you may choose the blue or red one.”)

Question 14

Prevent and mitigate effects of stress

Answer 14

-Help children figure out how to turn off their stress response (primary prevention)
- Intervene early if unable to turn off stress response!
Secondary prevention: Working collaboratively to identify and implement appropriate management strategies or to explain and reinforce value of mental health recommendations
Tertiary prevention: Addresses major losses in trauma, in addition to any significant behavioral symptoms that impair daily functioning

• Any child who experiences trauma should be referred to a mental health specialist

Question 15

Cognitive behavioral therapy restructuring

Answer 15

1. Identify the situation
2. Name the feeling
3. Determine the thought
4. Challenge the thought
5. Make a decision - do things mostly support my thought or not?

Question 16

ABC strategy for assessing in managing behavioral difficulties

Answer 16

Antecedent - What led up to this? (Avoid or prepare for situations that are likely to cause behavior, and if possible, give cues)

Behavior - What did the child think? (Interpret, ignore, teach, or manage behavior - give it meaning and modify response)

Consequences - What did you do? (Remain calm, not reactive and consistent; model or show what to do, rather than tell what not to do)

Question 17

Behavioral issues - 4 visit approach:

Answer 17

1. Review complete mental health assessment, identify strengths, and use the ABC technique
2. Establish a clear approach with family involvement
3. Follow up on progress and troubleshoot
4. Ensure progress has been made

Question 18

Sensory processing disorder (SPD)

Answer 18

Sensitive to touch and pull away from home/cuddling; have trouble with transitions, family gatherings, parties, etc.

• Early diagnosis and treatment increases positive child outcomes
• Help structure the environment and promote regulatory functioning
• Hyporesponsive child - active play
• Hyper-responsive child - calming activities
• OT if covered
• Therapy includes sensory stimuli and sensory-rich environment; sensory nourishment or a sensory diet
• Sensory issues are frequently found in premature children, gifted children, and those with neurodevelopmental disorders (autism and attention deficit disorder) and fragile X syndrome
• Sensory issues occur with environmental factors, such as institutionalization, severe physical or sexual abuse, poverty, lead poisoning, and alcohol and drug exposure

Question 19

Bullying

Answer 19

Unwanted and aggressive behavior by another youth or group of youths that involves power imbalance and is repeated or likely to be repeated multiple times (Physical, relational/social, cyberbullying)

• Threatens well-being; affects sense of safety
• Management: evaluate youth’s risk factors
• Determine if youth is perpetrator, victim, or both; if weapons were used or threatened
• Report to CPS and law enforcement
• Ideally, stop it before it starts; be familiar with resources in schools and community

Question 20

Red Flags for Behavior Problems Referral

Answer 20

Behavior is: frequent, persistent overtime, uncommon for child’s age, maladaptive, turned inward (depression or self-destruction), turned outward (complaints or aggression), disruptive, or distancing (withdrawal, denial, or somatization)

Question 21

Red flags for Sensory Processing Difficulties

Answer 21

Infants and toddlers

• Problems eating or sleeping
• Refuses to go to anyone but a specific person
• Irritable when being dressed
• Rarely plays with toys
• Resist cuddling
• Cannot calm self
• Floppy or stiff body, motor delays

Preschoolers

• Overly sensitive to touch, noises, smells, and other people
• Difficulty making friends
• Difficulty dressing, eating, sleeping, and/or toilet training
• Clumsy; poor motor skills; weakness
• In constant motion; in everyone’s face and space
• Frequent or long temper tantrums

Grade schoolers

• Overly sensitive to touch, noise, smells, other people
• Easily distracted, fidgety, craves movement; aggressive
• Easily aroused
• Difficulty with handwriting activities
• Difficulty making friends
• Unaware of pain and/or other people

Adolescents and adults

• Overly sensitive to touch, noise, smells, and other people
• Poor self-esteem; afraid of failing at new tasks
• Lethargic and slow
• Always on the go; impulsive; distractible
• Leaves tasks uncompleted
• Clumsy, slow, poor motor skills or handwriting
• Difficulty staying focused at work and in meetings

Question 22

Single parent households

Answer 22

• Children experience grief because separation or divorce is a loss of family as the child knows it
• Anticipatory guidance for families experiencing separation and divorce: advise parents to prepare the child for the impending break up; explain to parents the need to discuss key issues with their children; discuss the need for consistency; suggest self-help measures; acknowledge grief; discuss when referral for mental health counseling might be indicated
• Children with a deployed parent might have more emotional difficulties
• Role-shifting and behavior problems possible with longer deployment

Question 23

Teen parents

Answer 23

Predictors of teen motherhood:

• Victim of sexual abuse as a child
• Adverse events in childhood
• Being a child of an addicted parent
• Family history of mental illness
• Lack of family involvement
• Poor academic achievement or school dropout
• Loss of a parent by death, separation, divorce, or foster placement
• Living in an impoverished social environment where adolescent pregnancy is commonplace and accepted
• Confusion about own sexual orientation

Can lead to isolation, exhaustion, and depression

Children are more likely to have low birth weight and ongoing child health problems, to grow up in homes without fathers, and to be raised in poverty

Ask about support system

Determine school status, child care arrangements, financial situation, and plans for future

Question 24

Adoption

Answer 24

Assessment: Legal status, circumstances surrounding adoption, contact with birth parents?

Timing of finalizing adoption/waiting period

Known/suspected medical problems, history, genetic concerns, birth history

Management: Recommend earlier disclosure of adoption to child