Philadelphia Community Services for Children and Adolescents
Services:
- Evaluations, Diagnosis and Treatment
- Special Education
- Vocational Education
- Services In Homes and Communities
- Day Treatment
- Residential Treatment
- Inpatient Hospitalization
- Suicide
- Psychiatric Emergencies
- Crisis Intervention
- Special Services
- Financial And Health Care Benefits
- Advocacy And Support
- Medication
- Types Of Psychological Evaluations
- Child Sexual Abuse
- Legal Rights
- Grievance and Appeal rights
- Glossary
Guide Web site map
Appendix F: Children and Adolescents Mental Health: A Definition of Terms and List of Resources
This appendix contains three sections: a glossary of terms, specific definitions of attention-deficit / hyperactivity disorder and emotional disturbance, and a list of national organizations that are helpful sources of information.
A. Glossary
This glossary contains terms used frequently when dealing with the mental health needs of children. The list is alphabetical. Words highlighted by italics have their own separate definitions. The term service or services is used frequently in this glossary. The reader may wish to look up service before reading the other definitions.
The terms in this glossary describe ideal services. This help may not be available in all communities.
Accessible Services- Services that are affordable, located nearby, and are open during evenings and weekends. Staff is sensitive to and incorporates individual and cultural values. Staff is also sensitive to barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home, rather than travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list.
Appropriate Services- Designed to meet the specific needs of each individual child and family. For example, one family may need day treatment services while another family may need home-based services. Appropriate services for one child or family may not be appropriate for another family. Usually the most appropriate services are in the child's community.
Assessment- A professional review of a child's and family's needs that is done when they first seek services from a caregiver. The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. The assessment identifies the strengths of the child and family. Together, the caregiver and family decide what kind of treatment and supports, if any, are needed.
Case Management- A service that helps people arrange appropriate and available services and supports. As needed, a case manager coordinates mental health, social work, education, health, vocational, transportation, advocacy, respite, and recreational services. The case manager makes sure that the child's and family's changing needs are met. (This definition does not apply to managed care.)
Child Protective Services- Designed to safeguard the child when there is suspicion of abuse, neglect, or abandonment, or when there is no family to take care of the child. Examples of help delivered in the home include financial assistance, vocational training, homemaker services, and day care. If in-home supports are insufficient, the child may be removed from the home on a temporary or permanent basis. The goal is to keep the child with his or her family whenever possible.
Children And Adolescents At Risk For Mental Health Problems- Children are at higher risk for developing mental health problems when certain factors occur in their lives or environment. Some of these factors are physical abuse, emotional abuse or neglect, harmful stress, discrimination, poverty, loss of loved one, frequent moving, alcohol and other drug use, trauma, and exposure to violence.
Continuum of Care:- A term that implies a progression of services that a child would move through, probably one at a time. The more up-to-date idea is one of comprehensive services. See systems of care and wraparound services.
Coordinated Services- Child-serving organizations, along with the family, talk with each other and agree upon a plan of care that meets the child's needs. These organizations can include mental health, education, juvenile justice, and child welfare. Case management is necessary to coordinate services. (Also see family-centered services and wraparound services.)
Crisis Residential Treatment Services- Short-term, round-the-clock help provided in a non-hospital setting during a crisis. For example, when a child becomes aggressive and uncontrollable despite in-home supports, the parent can have the child temporarily placed in a crisis residential treatment service. The purpose of this care is to avoid inpatient hospitalization, to help stabilize the child, and to determine the next appropriate step.
Cultural Competence- Help that is sensitive and responsive to cultural differences. Caregivers are aware of the impact of their own culture and possess skills that help them provide services that are culturally appropriate in responding to people's unique cultural differences, such as race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. They adapt their skills to fit a family's values and customs.
Day Treatment- Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy. It lasts at least four hours a day. Day treatment programs work with mental health, recreation, and education organizations and may be provided by them.
DSM-IV-TR (Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition Text-Revised)- An official manual of mental health problems developed by the American Psychiatric Association. This reference book is used by psychiatrists, psychologists, social workers, and other health and mental health care providers to understand and diagnose a mental health problem. Insurance companies and health care providers also use the terms and explanations in this book when they discuss mental health problems.
Early Intervention- A process for recognizing warning signs that individuals are at risk for mental health problems and taking early action against factors that put them at risk. Early intervention can help children get better faster and prevent problems from becoming worse.
Emergency And Crisis Services- A group of services that is available 24 hours a day, seven days a week, to help during a mental health emergency. When a child is thinking about suicide, these services could save his or her life. Examples: telephone crisis hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care.
Family-Centered Services- Help designed for the specific needs of each individual child and his or her family. Children and families should not be expected to fit into services that don't meet their needs. See appropriate services, coordinated services, wraparound services, and cultural competence.
Family Support Services- Help designed to keep the family together and to cope with mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parent training, crisis services, and respite care.
Home-Based Services- Help provided in a family's home for either a defined time or for as long as necessary to deal with a mental health problem. Examples include parent training, counseling, and working with family members to identify, find, or provide other help they may need. The goal is to prevent the child from being placed out of the home. (Alternate term: in-home supports.)
Independent Living Services- Support for a young person in living on his or her own and in getting a job. These services can include therapeutic group care or supervised apartment living. Services teach youth how to handle financial, medical, housing, transportation, and other daily living needs, as well as how to get along with others.
Individualized Services- Designed to meet the unique needs of each child and family. Services are individualized when the caregivers pay attention to the child's and family's needs, strengths, ages, and stages of development. See appropriate services and family-centered services.
Inpatient Hospitalization- Mental health treatment in a hospital setting 24 hours a day. The purpose of inpatient hospitalization is: (1) short-term treatment in cases where a child is in crisis and possibly a danger to self or others, and (2) diagnosis and treatment when the child cannot be evaluated or treated appropriately in an outpatient setting.
Managed Care- A way to supervise the delivery of health care services. Managed care may specify the caregivers that the insured family can see. It may also limit the number of visits and kinds of services that will be covered.
Mental Health- Mental health refers to how a person thinks, feels, and acts when faced with life's situations. It is how people look at themselves, their lives, and the other people in their lives; evaluate the challenges and the problems; and explore choices. This includes handling stress, relating to other people, and making decisions.
Mental Health Problems- Mental health problems are real. These problems affect one's thoughts, body, feelings, and behavior. They can be severe. They can seriously interfere with a person's life. They're not just a passing phase. They can cause a person to become disabled. Some of these disorders are known as depression, bipolar disorder (manic-depressive illness), attention deficit hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia, and conduct disorder.
Mental Disorders- Another term used for mental health problems.
Mental Illnesses- This term is usually used to refer to severe mental health problems in adults.
Plan of Care- A treatment plan designed for each child or family. The caregiver(s) develops the plan with the family. The plan identifies the child's and family's strengths and needs. It establishes goals and details appropriate treatment and services to meet particular needs.
Residential Treatment Centers- Facilities that provide treatment 24 hours a day and can usually serve more than 12 young people at a time. Children with serious emotional disturbances receive constant supervision and care. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long-term than inpatient hospitalization. Centers are also known as therapeutic group homes.
Respite Care- A service that provides a break for parents who have a child with a serious emotional disturbance. Some parents may need this help every week. It can be provided in the home or in another location. Trained parents or counselors take care of the child for a brief period of time. This gives families relief from the strain of taking care of a child with a serious emotional disturbance.
Serious Emotional Disturbance- Diagnosable disorders in children and adolescents that severely disrupt daily functioning in the home, school, or community. Some of these disorders are depression, attention-deficit/ hyperactivity disorder, and conduct and eating disorders. Serious emotional disturbances affect one out of 20 young people.
Service- A type of support or clinical intervention designed to address the specific mental health needs of a child and his or her family. A service could be received once or repeated over a course of time as determined by the child, family, and service provider.
System of Care- A method of delivering mental health services that helps children and adolescents with mental health problems and their families get the full range of services in or near their homes and communities. These services must be tailored to each individual child's physical, emotional, social, and educational needs. In systems of care, local organization work in teams to provide these services.
Therapeutic Foster Care- A home where a child who has a serious emotional disturbance lives with trained foster parents who have access to other support services. These foster parents received special support from organizations that provide crisis intervention, psychiatric, psychological, and social work services. The intended length of this care is usually from six to 12 months.
Therapeutic Group Homes- Community-based, home-like settings that provide intensive treatment services to a small number of young people (usually five to 10 persons). These young people work on issues that require 24-hour-per-day supervision. The home should have many connections within an interagency system of care. Psychiatric services offered in this setting try to avoid hospital placement and to help the young person move toward a less - restrictive living situation.
Transitional Services- Services that help children leave the system that provides for children and move into adulthood and the adult service system. Help includes mental health care, independent living services, supported housing, vocational services, and a range of other support services.
Wraparound Services- A "full-service" approach to developing help that meets the mental health needs of individual children and their families. Children and families may need a range of community support services to fully benefit from traditional mental health services, such as family therapy and special education. See appropriate services, coordinated services, family-centered services, and system of care.
B. Definitions
1. Attention-Deficit/Hyperactivity Disorder
a. Definition
Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurobiological disorder. Typically children with AD/HD have developmentally inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity. These characteristics arise in early childhood, typically before age 7, are chronic, and last at least six months. Children with AD/HD may also experience problems in the areas of social skills and self - esteem.
b. Incidence
AD/HD is estimated to affect from 3 to 5 percent of the school-age population. Even though the exact cause of AD/HD remains unknown, it is known that AD/HD is a neurobiologically based disorder. Scientific evidence suggests that AD/HD is genetically transmitted and in many cases results from a chemical imbalance or deficiency in certain neurotransmitters, which are chemicals that help the brain regulate behavior.
c. Characteristics
AD/HD is diagnosed according to certain characteristics described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 1994), known as DSM-IV. A child with AD/HD is often described as having a short attention span and as being easily distracted. The child will have difficulty with one or all parts of the attention process: focusing (picking something on which to pay attention), sustaining focus (paying attention for as long as is needed), and shifting focus (moving attention from one thing to another).
According to DSM-IV some symptoms of inattention are: failing to give close attention to details; making careless mistakes in schoolwork or other activities; having difficulty sustaining attention in tasks or play activities; appearing to not be listening when spoken to directly; having difficulty following through on instructions; failing to finish schoolwork, chores, or duties (not due to oppositional behavior or failure to understand instructions); having difficulty organizing tasks and activities; often avoiding, disliking, or being reluctant to engage in tasks that require sustained mental effort (schoolwork and homework); losing things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools); easily distracted by extraneous stimuli; and often forgetful in daily activities.
According to DSM-IV, some symptoms of hyperactivity are: often fidgeting with hands or feet or squirming in seat, often leaving seat in classroom or in other situations in which remaining seated is expected, often running about or climbing excessively in situations in which this is inappropriate, having difficulty playing or engaging in leisure activities quietly. Often "on the go" or acting as if "driven by a motor" and often talking excessively.
Impulsiveness with AD/HD appears when children act before thinking. According to DSM-IV, some symptoms of impulsivity are: often blurting out answers before questions have been completed, having difficulty awaiting turns, and often interrupting or intruding on others (during conversations or games).
From time to time, all children will be inattentive, impulsive, and overly active. In the case of AD/HD, these behaviors are the rule, not the exception.
d. Educational Implications
Planning for education needs begins with an accurate diagnosis. Children suspected of having AD/HD must be appropriately diagnosed by a knowledgeable, well-trained clinician (usually a developmental pediatrician, child psychologist, or pediatric neurologist). Treatment plans may include behavioral and educational interventions and sometimes medication. Parents suspecting a problem may seek the services of the local school district or an outside private professional to conduct an evaluation. For children under age five, families may want to contact early childhood programs specialized in serving the needs of youngsters with disabilities. Call the local public school system and ask about services for children with disabilities.
Many children with AD/HD experience great difficulty in school, where attention and impulse and motor control are virtual requirements for success. Children with AD/HD tend to overreact to changes in their environment. Whether at home or in school, children with AD/HD respond best in a structured, predictable environment. Here, rules and expectations are clear and consistent, and consequences are set forth ahead of time and delivered immediately. By establishing structure and routines, parents and teachers can cultivate an environment that encourages the child to control his or her behavior and succeed at learning.
Adaptations that might be helpful (but will not cure AD/HD) are: posting daily schedules and assignments, calling attention to schedule changes, setting specific times for specific tasks, designing a quiet work space for use upon request, providing regularly scheduled and frequent breaks, using computerized learning activities, teaching organization and study skills, supplementing verbal instructions with visual instructions, and modifying test delivery.
2. Emotional Disturbance
a. Definition
Many terms are used to describe emotional, behavioral, or mental disorders. Currently, students with such conditions are categorized as having a serious emotional disturbance, which is defined under the Individuals with Disabilities Education Act (IDEA) as follows:
A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects educational performance:
- An inability to learn that cannot be explained by intellectual, sensory, or health factors;
- An inability to build or maintain satisfactory interpersonal relationships with peers and teachers;
- Inappropriate types of behavior or feelings under normal circumstances;
- A generally pervasive mood of unhappiness or depression; or
- A tendency to develop physical symptoms or fears associated with personal or school problems. (Code of Federal Regulations, Title 34, §300.7(b)(9))
As defined by IDEA, serious emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have a serious emotional disturbance.
b. Characteristics
The causes of emotional disturbance have not been adequately determined. Although various factors such as heredity, brain disorder, diet, stress, and family functioning have been suggested as possible causes, research has not shown any of these factors to be the direct cause of behaviors seen in children who have emotional disturbances. These behaviors include:
- Hyperactivity (short attention span, impulsiveness);
- Aggression/self-injurious behavior (acting out, fighting);
- Withdrawal (failure to initiate interaction with others, retreat from exchanges or social interaction, excessive fear, or anxiety);
- Immaturity (inappropriate crying, temper tantrums, poor coping skills); and
- Learning difficulties (academically performing below grade level).
Children with the most serious emotional disturbances may display some of these same behaviors at various times during their development. However, when children have a serious emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.
c. Educational Implications
The educational programs for children with a serious emotional disturbance need to include attention to mastering academics, developing social skills, and increasing self-awareness, self-control, and self - esteem. Career education (both vocational and academic) is also a major part of secondary education and should be a part of the transition plan included in every adolescent's Individualized Education Program (IEP).
Behavior modification is one of the most widely used approaches to helping children with serious emotional disturbance. However, there are many other techniques that are also successful and may be used in conjunction with behavior modification. Life Space Intervention and Conflict Resolution are two such techniques.
Students eligible for special education services under the category of serious emotional disturbance may have IEPs that include psychological or counseling services. These are important related services that are available under the law and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.
There is growing recognition that families, as well as their children, need support, respite care, intensive case management services, and a multi-agency treatment plan. Many communities are working toward providing these wraparound services, and there are a growing number of agencies and organizations actively involved in establishing support services in the community. Parent support groups are also important, and organizations such as the Federation of Families for Children's Mental Health and the National Alliance for the Mentally Ill-Children and Adolescent Network (NAMICAN) have parent representatives and groups in every state. Both of these organizations are listed under the resources section of this fact sheet.
d. Other Considerations
Families of children with emotional disturbances may need help in understanding their children's condition and in learning how to work effectively with them. Help is available from psychiatrists, psychologists, or other mental health professionals in public or private mental health settings. Children should be provided services based on their individual needs, and all persons who are involved with these children should be aware of the care they are receiving. It is important to coordinate all services between home, school, and therapeutic community with open communication.
