how to talk so mental health will listen

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How to Talk So Mental Health Will Listen Shaping Supports to Fit the Person Jeff Sneddon, LCSW

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How to Talk So Mental Health Will Listen. Shaping Supports to Fit the Person Jeff Sneddon, LCSW. Introduction. Who am I and why am I here? Context of Presentation Review Some Facts. Agenda. What is currently in our bag of Tricks The Why’s and How’s of Mental Health Assessments - PowerPoint PPT Presentation

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Page 1: How to Talk So Mental Health Will Listen

How to Talk So Mental Health Will Listen

Shaping Supports toFit the Person

Jeff Sneddon, LCSW

Page 2: How to Talk So Mental Health Will Listen

IntroductionWho am I and why am I here?

Context of Presentation

Review Some Facts

Page 3: How to Talk So Mental Health Will Listen

Agenda

What is currently in our bag of Tricks The Why’s and How’s of Mental Health

Assessments Diagnostic Process and Difficulties What is Therapy, What do we Want, and

What do we do? Working with insurance, CCO’s Open discussion and problem solving Evaluation

Page 4: How to Talk So Mental Health Will Listen

What is currently in our bag of tricks: Objectives

Review the critical components of Case Management Services that we have at our disposal for use in referring individuals for Behavioral Health Services and Advocacy.

Page 5: How to Talk So Mental Health Will Listen

What is currently in our bag of tricks?American with Disabilities Act

◦ Title II Section 201-204Rehabilitation Act

◦ Section 504 Oregon Revised Statutes

◦ ORS 659A.103 and 659A.142Oregon Administrative Rules

◦ 309-011-0070 thru 309-011-0095Person Centered Planning and Referral

ProcessDevelopment and Monitoring of Plans of

Care.

Page 6: How to Talk So Mental Health Will Listen

Bag-O-Tricks: ADAAn individual with a disability who, with or

without reasonable modifications to rules, policies, or practices…, meets the essential eligibility requirements for the receipt of services or participation in programs or activities provided by a public entity shall by reason of such disability be excluded from participation in or be denied the benefits of…

Page 7: How to Talk So Mental Health Will Listen

Bag-O-Tricks: ORSIt is the public policy of Oregon to

guarantee individuals the fullest possible participation in the social and economic life of the state…to participate in and receive the benefits of the services, programs, and activities of state government…without discrimination on the basis of disability; and

It is unlawful practice to exclude from participation in or deny the benefits of the services programs or activities or to make any distinction, discrimination, or restriction because of a disability.

Page 8: How to Talk So Mental Health Will Listen

Bag-O-Tricks: Rehab Act Agencies that receive Federal financial

assistance can not deny individuals the opportunity to participate in or benefit from programs, services or other benefits.

Page 9: How to Talk So Mental Health Will Listen

Bag-O-Tricks: Person Centered Planning and Referral Process Person Centered Planning looks at an

individuals wants, needs, and desires systemically with input from families, friends, and paid care givers.

Address unmet needs and make referrals to resources to secure unmet needs.

Ability to provide critical information to resources to assist in accessing services and supports.

Page 10: How to Talk So Mental Health Will Listen

Bag-O-Tricks: Plans of CareCase Managers/Personal Agents assist in

the development of plans of care and individualized measurable goals to meet an agreed upon outcome.

Case Mangers/Personal Agents Monitor the plans of care to and continue to address any unmet needs or provide guidance for revision.

Page 11: How to Talk So Mental Health Will Listen

Assessments: ObjectivesUnderstand what a Bio-Psycho-Social

Assessment includes. Know how to prepare ourselves to be

able to assist with providing assistance and support to our consumers.

Page 12: How to Talk So Mental Health Will Listen

Bio-Psycho-Social AssessmentImportant basic questions to know:What is the primary concern? How long has this been occurring?How often does this happen?Has there been a recent significant change or event?Are there any other behaviors of concern?Are there any medical conditions or

medications?What is the developmental and social history?

Page 13: How to Talk So Mental Health Will Listen

Bio-Psychosocial Assessment DomainsIdentification and Chief ComplaintBiological Psychological Social Environmental Risk FactorsMental Status ExaminationClinical FormulationDiagnosisRecommendations for intervention

Page 14: How to Talk So Mental Health Will Listen

Diagnositics: ObjectivesIncrease our understanding of the

diagnostic process. Understand how modifications can be

made to criteria.

Page 15: How to Talk So Mental Health Will Listen

Using the DSM Three factors when using the DSM1. It only describes particular conditions – it

does not provide intervention strategies2. There can be some tendency to focus on

the individual pathology instead of on a client’s interaction with the environment

3. Third reason for wariness when using the DSM concerns imperfections in its categories – individuals and their behaviors are complex and difficult to place in neat, compact categories.

Page 16: How to Talk So Mental Health Will Listen

16 Major Diagnostic Classes1. Disorders Usually first Diagnosed in

Infancy, Childhood or Adolescence2. Dementia, Alzheimer, and other Cognitive

Disorders3. Substance Related Disorders4. Schizophrenia and other Psychotic

Disorders5. Mood Disorders6. Anxiety Disorders7. Somatoform Disorders 8. Factitious Disorders

Page 17: How to Talk So Mental Health Will Listen

16 Major Diagnostic Classes ctd.9. Dissociative Disorders10. Sexual Disorders11. Eating Disorders 12. Sleep Disorders13. Impulse Control Disorders14. Adjustment Disorders15. Personality Disorders16. Mental Disorders Due to a General Medical

Condition not Elsewhere Classified

Page 18: How to Talk So Mental Health Will Listen

Multi-Axial Classification System

Axis I: Clinical Disorders Axis II : Personality Disorders & Intellectual

Disability Axis III : Current general medical conditions Axis IV : Psychosocial stressors Axis V : Global Assessment of Functioning

Page 19: How to Talk So Mental Health Will Listen

Diagnostic Complications

Diagnostic OvershadowingIntellectual Distortion Psychosocial Masking Cognitive DisintegrationBaseline Exaggeration

Page 20: How to Talk So Mental Health Will Listen

Diagnostic OvershadowingA phenomenon where clinicians

attribute behavior to the developmental disability and not to a co-existing mental illness symptom.

◦An individual with profound ID believes that they can drive a car.

Page 21: How to Talk So Mental Health Will Listen

Intellectual DistortionConcrete thinking and impaired

communication result in poor communication about their own experience (Sovner, 1986).

◦ Individual describes self as ‘scared’ instead of ‘mad’ because of poor verbal skills.

Page 22: How to Talk So Mental Health Will Listen

Psychosocial MaskingImpoverished social skills and life

experiences result in unsophisticated presentation of a disorder or misdiagnosis of unusual behaviour as a psychiatric disorder (Sovner, 1986).

◦Giggling and silliness is misdiagnosed as psychosis.

Page 23: How to Talk So Mental Health Will Listen

Cognitive DisintegrationBizarre behavior is presented in response

to minor stressors that could be misdiagnosed as a psychiatric disorder (Sovner, 1986).

◦A client is highly disruptive and complains a lot after a preferred staff member leaves, but is diagnosed with schizophrenia.

Page 24: How to Talk So Mental Health Will Listen

Baseline ExaggerationPrior to the onset of a disorder there

are high levels of unusual behaviors, making it difficult to recognize the onset of a new disorder (Sovner, 1986).◦A person who already had poor social

skills and was withdrawn becomes more so and begins to experience other signs and symptoms of depression. This is missed because staff reports are inaccurate and staff turn-over means that no-one is aware of the overall change in the person’s functioning.

Page 25: How to Talk So Mental Health Will Listen

Putting it all togetherPresent a solid case for treatment Discuss the ramifications of the lack of

treatment Benefit vs AccommodationInquire about specialization and ask for a

referralSell yourself, MH does not like to do CMDiscuss how you can facilitate a IDT to

support the clinical workLiterature is one sidedDevelopmentally appropriate services

Page 26: How to Talk So Mental Health Will Listen

Helpful Links: Child Development Institute:

http://childdevelopmentinfo.com/Online Mendelian Inheritance in

Man: http://omim.org/AAIDD Reading Room:

http://www.aaidd.org

Page 27: How to Talk So Mental Health Will Listen

Evaluation and Goodbye

Jeff Sneddon, [email protected]