Innovative Interventions in Child and Adolescent Mental Health

Christine Lynn Norton

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136924132
• Edition: 1
• Topic: Sozialwissenschaften
• Subtopic: Sozialarbeit

Innovative Interventions in Child and Adolescent Mental Health is a unique composite of the literature on various innovative interventions for children and adolescents, and provides a developmental and neurobiological rationale for utilizing innovative interventions with this population. Based on the latest research, this book emphasizes that children and adolescents need more than just talk therapy. These innovative interventions can be applied in a variety of practice settings including schools, juvenile justice, community-based counseling centers, and residential treatment. This book bridges the gap between theory and practice, and provides a historical, theoretical, and research-based rationale, as well as a helpful case study, for each type of intervention being discussed.

1.
REINVENTING THE WHEEL

From Talk Therapy to Innovative Interventions

Christine Lynn Norton

Overview of Chapter

This chapter sets the context for using innovative interventions in child and adolescent mental health and includes the following sections:

• Introduction

• Child and Adolescent Mental Health: Background, Prevalence, and Treatment Needs

• The Need for Innovative Interventions: Creating a Developmental and Neurobiological Rationale

• Innovative Interventions: Promoting Neural Integration

• Commonalities of Innovative Interventions: The Six Aptitudes

• Summary

• Activities to Extend Your Learning

Introduction

There is always one moment in childhood when the door opens and lets the future in.

— Deepak Chopra

As those concerned with child and adolescent mental health, we can only hope that this quote is true for all children, and yet we know that sometimes children’s and adolescent’s life experiences, particularly traumatic ones, can close the door to the future. The idea for this book came from my work as a clinical social worker with children and adolescents. I have worked in a variety of settings including outpatient community mental health, youth and family counseling, schools, juvenile justice, youth mentoring programs, and wilderness and adventure therapy. The greatest gains I have seen young people make in therapy have come from corrective emotional experiences that have occurred outside of a talk therapy setting.

People are always saying, “you don’t have to reinvent the wheel,” but if the wheel isn’t working so well, then maybe you do. The “wheel,” in this case, is traditional talk therapy with children and adolescents. While this book does not have an axe to grind with talk therapy, it seeks to provide a developmental and neurobiological rationale to promote the idea that children and adolescents need more than just talk therapy. The goal of this book is to advocate for a more holistic approach to child and adolescent treatment of mental health issues, setting the stage for innovative interventions that may reach young people on a deeper, more integrated level. What is clearly needed most is an interactive blend of therapies applied across the system of care that can foster optimum emotional and mental integration in children and adolescents.

If therapy is to meet the developmental needs of children and adolescents, than our work as mental health professionals becomes about providing them with experiences that produce new evidence of self—experiences that facilitate empathy, connection, creativity, and wellness. These experiences can help them to create a new narrative about their lives, one that is more cohesive, more hopeful, and allows them to begin to see themselves in a new place and begin to “let the future in.” Saari’s (1991) work reaffirms this idea. She discusses the concept of transcontextualization, which she defines as the ability to imagine oneself in a different situation or emotional place. The interventions presented in this book all have the ability to foster this type of creativity and imagination. For children and adolescents this is critical, and is related to the development of both identity and sense of purpose (Norton, 2010). In fact, transcontextualization is necessary if children and adolescents are going to let the future in and move forward into adulthood in a more confident and robust manner. Letting the future in is a beautiful way to reconsider mental health treatment for children and adolescents, and is something the interventions in this book attempt to do through art, music, story, wilderness and adventure, connection with animals, and contemplation.

Child and Adolescent Mental Health: Background, Prevalence, and Treatment Needs

Childhood is a vulnerable time in human development. During the childhood years, children need a supportive care-taking surround in which to grow and develop. Likewise, adolescence is a developmental period that is rife with both pitfalls and opportunities for growth. According to Highland (1979), development is both a cause and a cure of stress for children and adolescents. Children and adolescents are idealistic, impressionable, and curious about the meaning of life. They take risks, some positive and some detrimental, all with the goal of discovering more about who they are and their place in the world. While many young people weather the storms of childhood and adolescence just fine, others struggle with intense socioenvironmental stressors such as chronic poverty and violence, and others still with debilitating mental health problems.

Background of Child and Adolescent Mental Health

It has not always been widely recognized that children and adolescents can suffer from mental health problems. Childhood was assumed to be a relatively carefree period of development, with the thinking being that children did not have to deal with the stressors that afflict most adults (American Psychiatric Association, 2002). It is now acknowledged that mental disorders in childhood and adolescence are not stagespecific, and are the result of genetic, developmental, psychosocial, and physiologic factors. Research showing that children suffer from mental disorders began in the 1960s, yet it wasn’t until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association in 1980 that child and adolescent mental disorders were classified in a separate section (National Institute of Mental Health, 2001).

Mental health problems that appear in children and adolescents can disrupt emotional, neurological, cognitive, and relational functioning. They appear in youth from all different races, ethnicities, social classes, and backgrounds. However, according to the U.S. Department of Health and Human Services (1999), children with the following risk factors are at greater risk of developing mental health problems:

• physical problems

• intellectual disabilities (mental retardation)

• low birth weight

• family history of mental and addictive disorders

• multigenerational poverty

• caregiver separation

• abuse and neglect

There has also been a lot of recent research done on the impact of various types of trauma on child and adolescent mental health (Malchiodi & Perry, 2008). With the increasing effects of immigration, war, natural disaster, and childhood sex trafficking occurring in the United States, the number of children and adolescents who experience some kind of trauma in their lives can be expected to rise, increasing the mental health needs of this population.

As mental health issues in childhood and adolescence have become more prevalent, systems of care for children with serious emotional disorders and their families have been developed in the last two decades (Arbuckle & Herrick, 2006), and early intervention in mental health is emerging as a new focus in the field of early childhood (Woodruff et al., 1999). Mental health practitioners, researchers, and consumers now believe that mental health services are an important and necessary support for children and adolescents who experience mental, emotional, or behavioral challenges, as well as for their families. What is less understood, however, are what particular interventions can be effective for the complex and often co-occurring issues faced in childhood and adolescence. This book seeks to compile important theories and research on innovative interventions that can be applied to a variety of child and adolescent issues.

Prevalence of Mental Disorders in Children and Adolescents

Because of the complexities of childhood and adolescence, the onset of mental disorders is often seen during childhood and adolescence (New Freedom Commission on Mental Health, 2003). Child and adolescent mental health is an important issue facing society, which some have even deemed a “public health crisis” (Stroul, 2006). According to the American Psychiatric Association (2002), 12 million American children suffer

Table 1.1 Children and Adolescents Ages 9-17 with Mental or Addictive Disorders

from mental illness; however, only one in five receives treatment. The National Institute of Mental Health (NIMH) estimates that half of all mental disorders begin by the time people are age 14 (NIMH, 2005). Likewise, nearly half of all individuals with one mental disorder met the criteria for two or more disorders (NIMH, 2005).

When these mental health issues go untreated, the consequences are severe. Not only can these disorders become prevalent over the life span, but in some cases, such as mood disorders, they can result in impairment, disability, or even death. According to The Center for Mental Health Services, 11% of children in the United States have at least one significant mental illness accompanied by impairment in home, school or peer contexts (U.S. Department of Health and Human Services, 2001). Table 1.1 highlights the most common disorders in childhood and adolescence and the prevalence of these disorders.

Child and Adolescent Mental Health Treatment: The Search for Best Practices

If children and adolescents who struggle with mental health problems do not receive appropriate treatment, these problems can escalate and become worse in adulthood. According to InCrisis (2005), 74% of 21-year-olds with a diagnosed mental health disorder were reported to have had prior difficulties. If left untreated, childhood and adolescent mental health disorders can lead to school failure, involvement in the juvenile justice system, and/or placement outside of the home. Other problems can arise such as self-destructive behaviors, family conflict, and substance abuse. The financial and emotional cost of these issues to society is incredibly high; therefore, it is important to identify serious emotional disturbances early in childhood and interrupt the cycle of mental health problems by making sure that the child receives appropriate care (New Freedom Commission on Mental Health, 2003).

The issue at hand is how one defines “appropriate care.” Various treatments, services, and methods for preventing mental disorders in children and adolescents have developed over the past several decades. Despite a growing awareness of children’s mental health issues, knowledge about treatment is still emerging. In Mental Health: A Report of the Surgeon General (1999), the report called for closing the gap between research and practice, ensuring evidence-based treatments for children. The push for evidence-based practice comes from the goal of improving treatment for child and adolescent mental health problems.

The report highlighted the guidelines established by NIMH in order for a treatment to be considered evidence-based, which include:

• at least two control group design studies or a large series of single-case design studies

• minimum of two investigators

• use of a treatment manual

• uniform therapist training and adherence

• true clinical samples of youth

• tests of clinical significance of outcomes applied

• both functioning and symptom outcomes reviewed

• long-term outcomes beyond termination

According to Fonagy (2000), the goal of using evidence-based practice in mental health treatments is to promote the effective use of resources and simultaneously allow for improvements in the clinician’s ability to identify, understand and apply the best-evaluated methods of child and adolescent mental health treatment.

While the call for research-informed practice is an important and critical step, there is also a need for practice-informed research in which mental health practitioners identify creative and effective practices for which new research questions must be applied (CSWE, 2009). Clearly, most mental health professionals can agree on the need for providing empirical support for their interventions; however, some believe that a sole reliance on evidence-based practice may limit the practitioner to administering treatments rigidly without “… variation, creativity, or flexibility and without consideration of the individual differences with which the patients present” (Nock, Goldman, Wang, & Albano, 2004, p. 777).

It is important to mention here that this book introduces innovative interventions in child and adolescent mental health, many of which do not yet qualify as “evidence-based” practices, per the specific NIMH guidelines; however, a growing body of research is provided for each intervention, along with specific ethical and cultural considerations that can help facilitate each intervention towards the use of best practices. Likewise, each intervention in this book is illustrated via a case study so that readers may begin to see how these innovative interventions play out in “real world” treatment setting. Finally, it should be said, that it is the hope of the authors in this book that each of these interventions will continue to undergo rigorous research that will eventually help to elevate them to the level of evidence-based practices, per NIMH guidelines, so that children and adolescents who are struggling can access these interventions in the context of the various systems of care in which services are provided.

Systems of Care

The interventions presented in this book provide mental health professionals w...

Table of contents

• TITLES OF RELATED INTEREST FROM ROUTLEDGE
• CONTENTS
• PREFACE
• ACKNOWLEDGMENTS
• 1. REINVENTING THE WHEEL
• 2. ART THERAPY WITH CHILDREN AND ADOLESCENTS
• 3. WILDERNESS THERAPY
• 4. MUSIC THERAPY WITH HIGH-RISK YOUTH
• 5. ANIMAL-ASSISTED APPROACHES TO CHILD AND ADOLESCENT MENTAL HEALTH
• 6. BIBLIOTHERAPY AS AN INTERVENTION APPROACH FOR CHILDREN AND ADOLESCENTS WITH EMOTIONAL DISABILITIES
• 7. MEDITATIVE PRACTICES FOR CHILDREN AND ADOLESCENTS
• Epilogue
• REFERENCES
• CREDIT LINES
• CONTRIBUTORS
• INDEX