Anxiety Disorders
Panic DisorderPanic disorder affects about 2.4 million adult Americans and is twice as common in women as in men. A panic attack is a feeling of sudden terror that often occurs with a pounding heart, sweating, nausea, chest pain or smothering sensations and feelings of faintness or dizziness. Panic disorder frequently occurs in addition to other serious conditions like depression, drug abuse, or alcoholism. If left untreated, it may lead to a pattern of avoidance of places or situations where panic attacks have occurred. In about a third of cases, the threat of a panic attack becomes so overwhelming that a person may become isolated or housebound—a condition known as agoraphobia. Panic disorder is one of the most treatable of the anxiety disorders through medications or psychotherapy. Early treatment of panic disorder can help prevent agoraphobia.
Obsessive-Compulsive Disorder (OCD)
OCD affects about 3.3 million adult Americans, and occurs equally in men and women. It usually appears in childhood. Persons with OCD suffer from persistent and unwelcome anxious thoughts, and the result is the need to perform rituals to maintain control. For instance, a person obsessed with germs or dirt may wash his hands constantly. Feelings of doubt can make another person check on things repeatedly. Others may touch or count things or see repeated images that disturb them. These thoughts are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. Severe OCD can consume so much of a person's time and concentration that it interferes with daily life. OCD responds to treatment with medications or psychotherapy.
Post-Traumatic Stress Disorder (PTSD)
PTSD affects about 5.2 million adult Americans, but women are more likely than men to develop it. PTSD occurs after an individual experiences a terrifying event such as an accident, an attack, military combat, or a natural disaster. With PTSD, individuals relive their trauma through nightmares or disturbing thoughts throughout the day that may make them feel detached, numb, irritable, or more aggressive. Ordinary events can begin to cause flashbacks or terrifying thoughts. Some people recover a few months after the event, but other people will suffer lasting or chronic PTSD. People with PTSD can be helped by medications and psychotherapy.
Generalized Anxiety Disorder (GAD)
GAD affects about 4 million adult Americans and twice as many women as men. GAD is more than day-to-day anxiety. It fills an individual with an overwhelming sense of worry and tension. A person with GAD might always expect disaster to occur or worry a lot about health, money, family, or work. These worries may bring physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, trouble swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded, out of breath, or nauseous, or might have to go to the bathroom often. When people have mild GAD, they may be able to function normally in social settings or on the job. If GAD is severe, however, it can be very debilitating. GAD is commonly treated with medications.
Social Anxiety Disorder
Social phobia affects about 5.3 million adult Americans. Women and men are equally likely to develop social phobia, which is characterized by an intense feeling of anxiety and dread about social situations. These individuals suffer a persistent fear of being watched and judged by others and being humiliated or embarrassed by their own actions. Social phobia can be limited to only one type of situation—fear of speaking in formal or informal situations, eating, drinking, or writing in front of others—or a person may experience symptoms any time they are around people. It may even keep people from going to work or school on some days, as physical symptoms such as blushing, profuse sweating, trembling, nausea, and difficulty talking often accompany the intense anxiety. Social phobia can be treated successfully with medications or psychotherapy.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD affects as many as 2 million American children and is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. People who are hyperactive always seem to be in motion. They can't sit still and may dash around or talk incessantly. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. While the cause of ADHD is unknown, in the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new ways.
Depressive Disorders
About 18.8 million American adults experience a depressive illness that involves the body, mood, and thoughts. Depression affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. People with a depressive illness cannot just "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years.
Depression can occur in three forms:
Major Depressive Disorder
Major depressive disorder involves a pervading sense of sadness and/or loss of interest or pleasure in most activities that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. This is a severe condition that can impact a person's thoughts, sense of self worth, sleep, appetite, energy, and concentration. The condition can occur as a single debilitating episode or as recurring episodes.
Dysthymia
Dysthymia involves a chronic disturbance of mood in which an individual often feels little satisfaction with activities of life most of the time. Many people with dysthymia also experience major depressive episodes in their lives leading to a recurrent depressive disorder. The average length of an episode of dysthymia is about four years.
Bipolar Disorder
Bipolar Disorder, or manic-depressive illness, is a type of mood disorder characterized by recurrent episodes of highs (mania) and lows (depression) in mood. These episodes involve extreme changes in mood, energy, and behavior. Manic symptoms include extreme irritable or elevated mood; a very inflated sense of self-importance, risk behaviors, distractibility, increased energy, and a decreased need for sleep.
The most important thing to do for people with depression is to help them get an appropriate diagnosis and treatment. Treatment, usually in the form of medication or psychotherapy, can help people who suffer from depression.
*Do not ignore remarks about suicide.
If someone tells you they are thinking about suicide, you should take their distress seriously, listen, and help them get to a professional for evaluation and treatment. If someone is in immediate danger of harming himself or herself, do not leave the person alone. Take emergency steps to get help, such as calling 911. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Eating Disorders
Anorexia Nervosa
People with this disorder see themselves as overweight despite their actual body weight. With this disorder, a person works to maintain a weight lower than normal for their age and height. This is accompanied by an intense fear of weight gain or looking fat. At times, a person can even deny the seriousness of their low body weight. Eating becomes an obsession and habits develop, such as avoiding meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, like compulsive exercise or purging by vomiting or using laxatives. Some people fully recover after a single episode; some have a pattern of weight gain and relapse; and others experience a deteriorating course of illness over many years.
Bulimia Nervosa
Bulimia is characterized by episodes of binge eating—eating an excessive amount of food at once with a sense of lack of control over eating during the episode—followed by behavior in order to prevent weight gain, such as self-induced purging by vomiting or misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Schizophrenia
More than 2 million Americans a year experience this disorder. It is equally common in men and women. Schizophrenia tends to appear earlier in men than in women, showing up in their late teens or early 20s as compared to their 20s or early 30s in women. Schizophrenia often begins with an episode of psychotic symptoms like hearing voices or believing that others are trying to control or harm you. The delusions— thoughts that are fragmented, bizarre, and have no basis in reality—may occur along with hallucinations and disorganized speech and behavior, leaving the individual frightened, anxious, and confused. There is no known single cause of schizophrenia. Treatment may include medications and psychosocial support like psychotherapy, self-help groups, and rehabilitation.
Showing posts with label CEUs for LCSWs LCSW. Show all posts
Showing posts with label CEUs for LCSWs LCSW. Show all posts
October 29, 2010
April 12, 2010
Common Stress Reactions Following Exposure To Trauma
Common Stress Reactions Following Exposure To Trauma
Psychological and EmotionalInitial euphoria, relief
Guilt about surviving or not having suffered as much as others
Anxiety, fear, insecurity, worry
Pervasive concern about well-being of loved ones
Feelings of helplessness, inadequacy, being overwhelmed
Vulnerability
Loss of sense of power, control, well-being, self-confidence, trust
Shame, anger over vulnerability
Irritability, restlessness, hyperexcitability, impatience, agitation, anger, blaming (anger at source, anger at those exempted, anger at those trying to help, anger “for no apparent reason”)
Outrage, resentment
Frustration
Cynicism, negativity
Mood swings
Despair, grief, sadness
Periods of crying, emotional “attacks” or “pangs”
Feelings of emptiness, loss, hopelessness, depression
Regression
Reawakening of past trauma, painful experiences
Apathy, diminished interest in usual activities
Feelings of isolation, detachment, estrangement, “no one else can understand”
Denial or constriction of feelings; numbness
“Flashbacks,” intrusive memories of the event, illusions, pseudo-hallucinations
Recurrent dreams of the event or other traumas
Cognitive
Poor concentration
Mental confusion, slowness of thinking
Forgetfulness
Amnesia (complete or partial)
Inability to make judgments and decisions
Inability to appreciate importance or meaning of stimuli
Poor judgment
Loss of appropriate sense of reality (denial of reality, fantasies to counteract reality)
Preoccupation with the event
Repetitive, obsessive thoughts and ruminations
Over-generalization, over-association with the event
Loss of objectivity
Rigidity
Confusion regarding religious beliefs/value systems; breakdown of meaning and faith
Self-criticism over things done/not done during trauma
Awareness of own and loved ones’ mortality
http://www.aspirace.com
Psychological and EmotionalInitial euphoria, relief
Guilt about surviving or not having suffered as much as others
Anxiety, fear, insecurity, worry
Pervasive concern about well-being of loved ones
Feelings of helplessness, inadequacy, being overwhelmed
Vulnerability
Loss of sense of power, control, well-being, self-confidence, trust
Shame, anger over vulnerability
Irritability, restlessness, hyperexcitability, impatience, agitation, anger, blaming (anger at source, anger at those exempted, anger at those trying to help, anger “for no apparent reason”)
Outrage, resentment
Frustration
Cynicism, negativity
Mood swings
Despair, grief, sadness
Periods of crying, emotional “attacks” or “pangs”
Feelings of emptiness, loss, hopelessness, depression
Regression
Reawakening of past trauma, painful experiences
Apathy, diminished interest in usual activities
Feelings of isolation, detachment, estrangement, “no one else can understand”
Denial or constriction of feelings; numbness
“Flashbacks,” intrusive memories of the event, illusions, pseudo-hallucinations
Recurrent dreams of the event or other traumas
Cognitive
Poor concentration
Mental confusion, slowness of thinking
Forgetfulness
Amnesia (complete or partial)
Inability to make judgments and decisions
Inability to appreciate importance or meaning of stimuli
Poor judgment
Loss of appropriate sense of reality (denial of reality, fantasies to counteract reality)
Preoccupation with the event
Repetitive, obsessive thoughts and ruminations
Over-generalization, over-association with the event
Loss of objectivity
Rigidity
Confusion regarding religious beliefs/value systems; breakdown of meaning and faith
Self-criticism over things done/not done during trauma
Awareness of own and loved ones’ mortality
http://www.aspirace.com
March 18, 2010
GIRL POWER! Is Good Mental Health
GIRL POWER!
Is Good Mental Health
GIRL POWER! is paving the way for girls to build confidence, competence, and pride in themselves, in other words, enhancing girls' mental wellness. Girl Power! is also providing messages and materials to girls about the risks and consequences associated with substance abuse and with potential mental health concerns. For instance, did you know:
Girls are seven times more likely than boys to be depressed and twice as likely to attempt suicide.*
Girls are three times more likely than boys to have a negative body image (often reflected in eating disorders such as anorexia and bulimia).*
One in five girls in the U.S. between the ages of 12 and 17 drink alcohol and smoke cigarettes.*
Girls who develop positive interpersonal and social skills decrease their risk of substance abuse.*
Girls who have an interest and ability in areas such as academics, the arts, sports, and community activities are more likely to develop confidence and may be less likely to use drugs.*
On the other hand, this also is a time when girls may make decisions to try risky behaviors, including drinking, smoking, and using drugs.*
The Girl Power! Campaign, under the leadership of the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration (SAMHSA) is collaborating with the Center for Mental Health Services (CMHS) to provide this valuable mental health information.
* Girl Power! Hometown Media Kit, Center for Substance Abuse Prevention, 1997.
Substance Abuse and Mental Health
Results from a study of nearly 6,000 people aged 15 to 24 show that among young people with a history of both a mental disorder and an addictive disorder, the mental disorder is usually reported to have occurred first. The onset of mental health problems may occur about 5 to 10 years before the substance abuse disorders.**
This provides a "window of opportunity" for targeted substance abuse prevention interventions and needed mental health services.
** "National Comorbidity Survey," Ronald C. Kessler, Ph.D., et al., American Journal of Orthopsychiatry, June 1996.
What Is Mental Health?
Mental health is how we think, feel, and act in order to face life's situations. It is how we look at ourselves, our lives, and the people we know and care about. It also helps determine how we handle stress, relate to others, evaluate our options, and make choices. Everyone has mental health.
A young girl's mental health affects her daily life and future. Schoolwork, relationships, and physical health can be affected by mental health. Like physical health, mental health is important at every stage of life. Caring for and protecting a child's mental health is a major part of helping that child grow to become the best she can be.
Girls' independence is usually encouraged in childhood, and their strengths nurtured. Most girls become emotionally, mentally, and physically healthy young adults. But sometimes, during the transition from childhood to adolescence, extra care is necessary, so that a girl's self-esteem and coping skills are not diminished. For more information on teen mental health, call 1-800-789-2647 and ask for the brochure: "You and Mental Health: What's the Deal?" (Order # CA-0002)
Nurturing Your Child's Mental Health
Parents and other caregivers are responsible for children’s physical safety and emotional well-being. Parenting styles vary; there is no one right way to raise a child. Clear and consistent expectations for each child, by all caregivers, are important. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills. The following suggestions are not meant to be complete.
Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise.
Be aware of stages in child development so you don’t expect too much or too little from your child.
Encourage your child to express her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety.
Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.
Promote mutual respect and trust. Keep your voice level down—even when you don’t agree. Keep communication channels open.
Listen to your child. Use words and examples your child can understand. Encourage questions.
Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.
Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your child’s feelings or behaviors or if you are unable to control your own frustration or anger.
Encourage your child’s talents and accept limitations.
Set goals based on the child’s abilities and interests—not someone else’s expectations. Celebrate accomplishments. Don’t compare your child’s abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.
Foster your child’s independence and self-worth.
Help your child deal with life’s ups and downs. Show confidence in your child’s ability to handle problems and tackle new experiences.
Discipline constructively, fairly, and consistently. (Discipline is a form of teaching, not physical punishment.) All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from her mistakes.
Love unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills.
Mental Health Problems
Many children experience mental health problems that are real and painful and can be severe.
Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 children may have a serious emotional disturbance that severely disrupts his or her ability to function.
Tragically an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.
Is Good Mental Health
GIRL POWER! is paving the way for girls to build confidence, competence, and pride in themselves, in other words, enhancing girls' mental wellness. Girl Power! is also providing messages and materials to girls about the risks and consequences associated with substance abuse and with potential mental health concerns. For instance, did you know:
Girls are seven times more likely than boys to be depressed and twice as likely to attempt suicide.*
Girls are three times more likely than boys to have a negative body image (often reflected in eating disorders such as anorexia and bulimia).*
One in five girls in the U.S. between the ages of 12 and 17 drink alcohol and smoke cigarettes.*
Girls who develop positive interpersonal and social skills decrease their risk of substance abuse.*
Girls who have an interest and ability in areas such as academics, the arts, sports, and community activities are more likely to develop confidence and may be less likely to use drugs.*
On the other hand, this also is a time when girls may make decisions to try risky behaviors, including drinking, smoking, and using drugs.*
The Girl Power! Campaign, under the leadership of the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration (SAMHSA) is collaborating with the Center for Mental Health Services (CMHS) to provide this valuable mental health information.
* Girl Power! Hometown Media Kit, Center for Substance Abuse Prevention, 1997.
Substance Abuse and Mental Health
Results from a study of nearly 6,000 people aged 15 to 24 show that among young people with a history of both a mental disorder and an addictive disorder, the mental disorder is usually reported to have occurred first. The onset of mental health problems may occur about 5 to 10 years before the substance abuse disorders.**
This provides a "window of opportunity" for targeted substance abuse prevention interventions and needed mental health services.
** "National Comorbidity Survey," Ronald C. Kessler, Ph.D., et al., American Journal of Orthopsychiatry, June 1996.
What Is Mental Health?
Mental health is how we think, feel, and act in order to face life's situations. It is how we look at ourselves, our lives, and the people we know and care about. It also helps determine how we handle stress, relate to others, evaluate our options, and make choices. Everyone has mental health.
A young girl's mental health affects her daily life and future. Schoolwork, relationships, and physical health can be affected by mental health. Like physical health, mental health is important at every stage of life. Caring for and protecting a child's mental health is a major part of helping that child grow to become the best she can be.
Girls' independence is usually encouraged in childhood, and their strengths nurtured. Most girls become emotionally, mentally, and physically healthy young adults. But sometimes, during the transition from childhood to adolescence, extra care is necessary, so that a girl's self-esteem and coping skills are not diminished. For more information on teen mental health, call 1-800-789-2647 and ask for the brochure: "You and Mental Health: What's the Deal?" (Order # CA-0002)
Nurturing Your Child's Mental Health
Parents and other caregivers are responsible for children’s physical safety and emotional well-being. Parenting styles vary; there is no one right way to raise a child. Clear and consistent expectations for each child, by all caregivers, are important. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills. The following suggestions are not meant to be complete.
Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise.
Be aware of stages in child development so you don’t expect too much or too little from your child.
Encourage your child to express her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety.
Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.
Promote mutual respect and trust. Keep your voice level down—even when you don’t agree. Keep communication channels open.
Listen to your child. Use words and examples your child can understand. Encourage questions.
Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.
Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your child’s feelings or behaviors or if you are unable to control your own frustration or anger.
Encourage your child’s talents and accept limitations.
Set goals based on the child’s abilities and interests—not someone else’s expectations. Celebrate accomplishments. Don’t compare your child’s abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.
Foster your child’s independence and self-worth.
Help your child deal with life’s ups and downs. Show confidence in your child’s ability to handle problems and tackle new experiences.
Discipline constructively, fairly, and consistently. (Discipline is a form of teaching, not physical punishment.) All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from her mistakes.
Love unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills.
Mental Health Problems
Many children experience mental health problems that are real and painful and can be severe.
Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 children may have a serious emotional disturbance that severely disrupts his or her ability to function.
Tragically an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.
March 12, 2010
Mental Health Links - Suicide
Mental Health Links - Suicide
Organizations
Iowa State Prevention Programs
http://www.idph.state.ia.us/bhpl/healthy_iowans_2010.asp
This web site provides an overview of Iowa’s prevention programs for violence and abusive behavior.
Ohio's Suicide Prevention Program
http://www.mh.state.oh.us/kids/suicideprev/suicide.prevention.plan.pdf
Ohio's Suicide Prevention Plan is the next step in saving lives and reducing suicidal behaviors by developing a comprehensive strategy in response to a very complex set of issues.
National Police Suicide Foundation
http://www.psf.org/index.htm
The numbers of deaths due to suicide are 2 to 3 times the number of line of duty deaths among law enforcement agencies and emergency workers. The mission of the National P.O.L.I.C.E. Suicide Foundation is to provide suicide awareness and prevention training programs and support services that will meet the psychological and spiritual needs of emergency workers and their families.
National Resource Center for Suicide Prevention and Aftercare
http://www.thelink.org/html/nrc.htm
The NRC's goal is to provide suicide-related community education in the areas of prevention, intervention, and aftercare, as well as healing support services for families, youth, and those affected by the psychological trauma of suicide.
National Center for Suicide Prevention Training
http://www.ncspt.org/courses/orientation/
The National Center for Suicide Prevention Training (NCSPT) currently has two internet-based workshops. The first one, “Locating, Understanding, and Presenting Youth Suicide Data” and is available on an ongoing basis. The second workshop, "Planning and Evaluation for Youth Suicide Prevention" is being prepared for pilot testing. This web site provides more information on the trainings.
National Strategy for Suicide Prevention Indicators
http://www.nsspi.org/
The goal of the National Strategy for Suicide Prevention Indicators project is to identify and develop indicators for each of the strategy's objectives. Indicators are measured in order to quantify the achievement of an objective.
Klingenstein Third Generation Foundation
http://ktgf.org/index.html
One of the two areas of interest for this foundation are Childhood and Adolescent Depression, including suicide and suicide prevention. Grants have primarily fallen under the categories of Intervention and Referral, Prevention, Public Education/Training, and Infrastructure. The Foundation also sponsors a Fellowship Program for post-doctoral research in depression.
American Association of Poison Control Centers
http://www.aapcc.org
The American Association of Poison Control Centers is a Nationwide organization of poison centers and interested individuals. It provides a forum for poison centers and interested individuals to promote the reduction of morbidity and mortality form poisoning and sets voluntary standards for poison centers. It also produces publications and holds a yearly conference.
American Association of Suicidology
http://www.suicidology.org/index.cfm
The American Association of Suicidology is dedicated to the understanding and prevention of suicide. The organization promotes research, public awareness programs, and education and training for professionals and volunteers.
American College of Emergency Physicians
http://www.acep.org
The American College of Emergency Physicians promotes the highest standards of patient care through its advocacy and leadership. This web site contains information on the organization, fact sheets, information on continuing education, and many other resources.
American Correctional Health Services Association
http://www.corrections.com/achsa/
The ACHSA mission is to be the voice of the correctional healthcare profession, and serve as an effective forum for communication addressing current issues and needs confronting correctional healthcare.
American Foundation for Suicide Prevention
http://www.afsp.org
The American Foundation for Suicide Prevention is the only international non-profit organization dedicated to funding the research and education needed to prevent suicide.
First World Report on Violence and Health (Full Report)
http://www.who.int/violence_injury_prevention/violence/world_report/wrvheng/en/
This report, produced by the World Health Organization, is written mainly for researchers and practitioners. Its goals are to raise global awareness about the problems of violence and to make the case that violence is preventable and that public health systems have a crucial role to play in addressing its causes and consequences.
Befrienders International
http://www.befrienders.org/
Befrienders International is a network of centers run by trained volunteers that offer a free listening service that is non-judgmental and completely confidential. People are befriended by telephone, letter and email, and in face-to-face meetings.
American School Health Association
http://www.ashaweb.org
The American School Health Association unites the many professionals working in schools who are committed to safeguarding the health of school-aged children. The Association, a multidisciplinary organization of administrators, counselors, dentists, health educators, physical educators, school nurses and school physicians, advocates high-quality school health instruction, health services and a healthful school environment.
Association of Maternal and Child Health Programs
http://www.amchp.org
The Association of Maternal and Child Health Programs is an organization representing State public health leaders and other individuals and organizations working to improve the health and well being of all women, children, youth, and families. The group accomplishes its mission through partnerships with government agencies and the participation of its members, families, advocates, health care purchasers, providers, academic and research professionals, and others at the National, State and local levels.
Association of State and Territorial Health Officials
http://www.astho.org
The Association of State and Territorial Health Officials is a National non-profit organization representing the State and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. Its members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy, and to assuring excellence in State-based public health practice. This site provides information on events, policy statements, and publications.
Georgia's Suicide Prevention Plan
http://www.georgiasuicidepreventionplan.org
People can stop suicide. This fact is the foundation of the Georgia Suicide Prevention Plan. This web site provides the plan’s text and staff contact information.
Selected Reviews of Suicide Research - 2001
http://www.nimh.nih.gov/suicideresearch/suibib2001.cfm
This list of review articles was compiled by the NIMH Suicide Research Consortium, whose members have found the articles useful when providing technical assistance to grant applicants.
SOS High School Suicide Prevention Program
http://www.mentalhealthscreening.org/sos_highschool
The SOS Suicide Prevention Program provides school health professionals with all the educational materials necessary to replicate this easy-to-use program in a variety of school settings. Schools have the flexibility to make use of the materials in as large or small a program as their needs and resources dictate. The program can also be blended into an existing health curriculum. You can find out more about it at their web site.
Students Against Destructive Decisions
http://www.saddonline.com
Students Against Destructive Decision strive to provide students with the best prevention and intervention tools possible to deal with the issues of underage drinking, other drug use, impaired driving and other destructive decisions. Their site has a number of resources including fact sheets, a resource center, a list of events, and newsletters.
State and Territorial Injury Prevention Directors' Association
http://www.stipda.org
The mission of the State and Territorial Injury Prevention Director’s Association is to promote, sustain, and enhance the ability of State and Territorial public health departments to reduce death and disability associated with injuries. It accomplishes its mission by disseminating information on state-of-the-art injury prevention and control policies and strategies.
Suicide Among the Aged (Canada)
http://www.suicideinfo.ca/csp/go.aspx?tabid=118
This web site illustrates, through statistics, that suicide rates for the elderly exceed suicide rates among adolescents.
Suicide Prevention Action Network of USA (SPAN)
http://www.spanusa.org
The Suicide Prevention Action Network USA is a non-profit national organization that links the energy of those bereaved or touched by suicide with the expertise of leaders in science, health, business, government and public service to achieve the goal of significantly reducing the national rate of suicide by the year 2010.
Suicide Prevention Advocacy Network - California
http://www.span-california.org
Suicide Prevention Advocacy Network-California (SPAN-California) was founded in 1999 as a force for suicide prevention, an arena for collaboration among agencies, and a voice in the California state capital.
The Project Hope Foundation
http://www.project-hope.co.nz
The Project Hope Foundation is dedicated to reducing depression and suicide (especially youth suicide). It has books, videos and instructions on self-education and how to run Life Skills Open Forums.
Training Institute for Suicide Assessment and Clinical Interviewing
http://www.suicideassessment.com/
This group provides mental health professionals with information on the development of suicide prevention skills, crisis intervention skills, and clinical interviewing skills.
University of Washington, MCH Program
http://depts.washington.edu/mchprog/cmh_home.html
On December 8-9, 2002, the Northwest Children's Public Health Network: Building an Action Agenda for Mental Health was held in Seattle, Washington. Representatives from six States met to identify issues specific to the region and their communities and to outline State plans for promoting mental health in children and young people. Four plenary speakers presented information on mental health at various stages of childhood and adolescence and took part in a panel discussion. The details of the meeting are found on this web site.
World Health Organization Fact Sheet on Violence
http://www.who.int/violence_injury_prevention/violence/world_report/wrvh1/en/
This fact sheet, prepared by the World Health Organization, contains worldwide statistics for suicide and self inflicted injuries.
World Health Organization Report on Violence and Health - Summary
http://www.who.int/violence_injury_prevention/violence/world_report/en/Full%20WRVH%20summary.pdf
This document is a comprehensive summary to the World Health Organizations first World Report on Violence and Health.
Online Resources
National Vital Statistics Reports
http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_08.pdf
This report presents the final 1999 data on U.S. deaths and death rates according to demographic and medical characteristics. Trends and patterns in general mortality, life expectancy, and infant mortality are also described.
New Freedom Commission on Mental Health Subcommittee on Suicide Prevention
http://www.mentalhealthcommission.gov/subcommittee/Suicide_Prevention_Outline.doc
Summary Report
Hawaii State Department of Health: Suicide
http://www.state.hi.us/health/shpda/shinjury.pdf
This is a report by the State of Hawaii on injury prevention, both accidental and self-inflicted. IT touches on suicide, domestic violence, and drug and alcohol abuse.
In Harm's Way: Suicide in America
http://www.nimh.nih.gov/publicat/harmaway.cfm
This fact sheet from the National Institute of Mental Health provides statistics about suicide incidents in the United States.
Media Coverage of Suicide
http://www.afsp.org/education/mediacoverage2.8.htm
This site, provided by the American Foundation for Suicide Prevention, illustrates various harmful ways in which the media can depict suicide.
Minnesota Department of Health Report to the Minnesota Legislature: Suicide Prevention Plan
http://www.health.state.mn.us/divs/opa/suicide.pdf
This report to the Minnesota Legislature details the development of the State’s suicide prevention plan.
EL SUICIDIO EN LOS ADOLESCENTES
http://www.aacap.org/publications/apntsfam/suicide.htm
Cada año miles de adolescentes se suicidan en los Estados Unidos. El suicidio es la tercera causa de muerte más frecuente para los jóvenes de entre 15 y 24 años de edad, y la sexta causa de muerte para los de entre 5 y 14 años.
National Organization for People of Color Against Suicide - Statistics
http://www.nopcas.com/stats/
This web site provides statistics on the amount of people who have committed and attempted suicide. It also lists conferences for suicide survivors.
National Registry of Effective Prevention Programs
http://www.modelprograms.samhsa.gov
Information on effective programs that enhance outcomes for substance abuse, violence and high-risk behaviors in community, family, school, clinical, faith-based, and workplace settings.
Depression and Bipolar Support Alliance (DBSA) - Suicide
http://www.dbsalliance.org/info/suicide.html
If you or someone you know suffers from depression or manic depression (also known as bipolar disorder), you understand all too well its symptoms may include feelings of sadness and hopelessness. These feelings can also include thoughts of self-harm or suicide.
Louisiana's Youth Suicide Prevention Program
http://www.dhh.state.la.us/NEWS/YouthSuicide02.htm
The Louisiana Youth Suicide Prevention Task Force is a Statewide response to the U. S. Surgeon General's call to action to prevent suicide. The mission of the Task Force is to develop a Statewide plan on youth suicide prevention in Louisiana. This press release provides more information on the Task Force as well as suicide statistics for Louisiana.
Guidelines for School Based Suicide Prevention Programs
http://www.suicidology.org/associations/1045/files/School%20guidelines.pdf
These guidelines, compiled by the Prevention Division of the American Association of Suicidology, can be used by schools to help prevent suicide. They are in PDF format.
Florida Suicide Prevention Coalition
http://www.floridasuicideprevention.org/
In August, 2002, the Florida Suicide Prevention Task Force announced the Statewide Suicide Prevention Strategy to reduce the incidence of suicide in Florida by one-third by 2005.
Canadian Association for Suicide Prevention
http://www.thesupportnetwork.com/CASP/main.html
This site provides resources and information about suicide prevention. It also contains new bulletins and a list of links to related sites.
A Call to Collaboration: The Federal Commitment to Suicide Prevention
http://www.sprc.org/library/collabcall.pdf
A Call to Collaboration: The Federal Commitment to Suicide Prevention highlights the Department of Health and Human Services' activities and their link to the National Strategy for Suicide Prevention, the plan which will guide the nation's suicide prevention efforts for the next decade.
Air Force Suicide Prevention Program
http://www.osophs.dhhs.gov/ophs/BestPractice/usaf.htm
The Suicide Prevention Program of the Air Force is described and highlighted as one of the nation's most effective health prevention programs.
Children's Safety Network - Injury Data
http://www.injuryprevention.org/info/data.htm
This web page provides charts and tables illustrating children’s injury data for each U.S. State and Territory.
Homicide and Suicide Risks Associated with Firearms in the Home
http://www.annemergmed.com/article/PIIS0196064403002567/fulltext?kwhquery=Homicide+and+Suicide+and+Risks+and+Associated+and+with+and+Firearms+and+Home&search_area=platform%2Bmedline&search_articletype=all&search_cluster=phoenix&search_currenturi=http%3A%2F%2Fjournals.elsevierhealth.com%2Fsearch%2Fquick&search_datecombo=0%3AALL&search_dateradio=combo&search_discipline=all&search_doi=&search_federated=yes&search_issue=&search_keyword=&search_language=all&search_medline=yes&search_mode=platform&search_monthendcombo=jan&search_monthstartcombo=jan&search_operator1=and&search_operator2=and&search_preview=no&search_reqcount=20&search_reqfirst=1&search_resulturi=%2FBRAND%2Fsearch%2Fresults&search_s200=yes&search_searchuri=%2FBRAND%2Fsearch%2Fadvanced&search_sort=relevance&search_startpage=&search_submode=&search_text1=Homicide+and+Suicide+Risks+Associated
This is a document about injury prevention titled, Homicide and Suicide Risks Associated With Firearms in the Home: A national case-control study.
Assisted Suicide and End-of-Life Decisions
http://www.apa.org/pi/aseol/introduction.html
A Report from an American Psychological Association Working Group
Assisted Suicide: A Disability Perspective
http://www.ncd.gov/newsroom/publications/1997/suicide.htm
Written for the National Council on Disability, this paper analyzes the issues related to assisted suicide and discusses current court cases.
At a Glance: Suicide Among the Elderly
http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp
The National Strategy for Suicide Prevention provides this fact sheet on suicide among the elderly.
If You Are Thinking About Suicide...READ THIS FIRST
http://www.metanoia.org/suicide/
The information on this site is intended to help and support persons who may be feeling suicidal.
Legislative Advisories From the American Association on Child and Adolescent Psychiatry
http://www.aacap.org/legislation/Lalerts.htm
These legislative alerts, provided by the American Academy of Child and Adolescent Psychiatry, concern Congressional action on issues related to the health of children and adolescents.
A Public Health Approach to Preventing Suicide
http://www.sprc.org/library/phaprev.pdf
This brochure illustrates how better data collection, including the National Violent Death Reporting System, can inform prevention strategies and make a real difference.
Oklahoma State Youth Suicide Prevention Plan
http://www.health.state.ok.us/program/ahd/spsp.pdf
The Oklahoma Youth Suicide Prevention State Plan works to address the problem of suicide by introducing multi-level strategies that communities can customize based on available resources and experiences.
Preventing Suicide: Individual Acts Create a Public Health Crisis
http://www.cfah.org/factsoflife/vol7no8.cfm
This site provides a resource of background information, interviews, and statistics for health reporters.
Reporting on Suicide: Recommendations for the Media
http://www.afsp.org/education/recommendations/
This is the full report of media recommendations presented on the American Foundation for Suicide Prevention Web site. This resource contains links to the specific media recommendations as well as an introduction to the topic area, a list of danger signs, examples of reporting, and frequently asked questions.
Reporting on Suicide: Recommendations for the Media
http://www.nimh.nih.gov/suicideresearch/mediasurvivors.cfm
This National Institute of Mental Health Web site presents media recommendations that were produced in the spirit of the public-private partnership recommended by the Surgeon General’s National Strategy for Suicide Prevention.
Suicide Prevention
http://mentalhealth.samhsa.gov/suicideprevention
The National Strategy for Suicide Prevention is a collaborative effort between the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, the Health Resources and Services Administration, and the Indian Health Services. The site has a wealth of resources including a newsroom, links State Suicide Prevention Programs, features publications, and much more.
Suicide Warning Signs
http://mentalhealth.samhsa.gov/publications/allpubs/walletcard/engwalletcard.htm
Tennessee Suicide Prevention Strategies
http://www.state.tn.us/mental/mhs/suicdeprev.pdf
The Tennessee strategy for suicide prevention builds on the fifteen points raised in “The Surgeon General’s Call to Action to Prevent Suicide, 1999.” This publication lists each of the fifteen points and Tennessee’s responses.
The Centre for Suicide Prevention, Manchester, England
http://www.national-confidential-inquiry.ac.uk/
The Centre for Suicide Prevention at the University of Manchester brings together projects on policy and service planning. This United Kingdom research centre in the field of suicidal behaviour carries out studies of suicide and homicide by those in contact with mental health services.
The National Association of Injury Control Research Centers
http://www.naicrc.org
An organization devoted to promoting scholarly activity in injury control, the Association addresses issues relevant to the prevention, acute care and rehabilitation of traumatic injury through multiple activities in research; research dissemination; program development and evaluation; consultation; and education and training.
The Surgeon General's Call To Action To Prevent Suicide, July 1999
http://www.surgeongeneral.gov/library/calltoaction/default.htm
The Surgeon General and the U.S. Department of Health and Human Services outline more than a dozen steps that can be taken by individuals, communities, organizations, and policymakers on this site. Site provides links to other related resources.
Virginia Youth Suicide Prevention Plan
http://www.vahealth.org/civp/preventsuicideva/
The Virginia Youth Suicide Prevention Plan addresses youth suicide in the Commonwealth by focusing on several key areas including: leadership, public awareness, media education, school-based strategies, surveillance, and evaluation. On this site there are statistics, free publications, and the number of a hotline for people contemplating suicide or people who know someone contemplating suicide.
Washington State Youth Suicide Prevention Program
http://www.yspp.org
The mission of the Youth Suicide Prevention Program is to reduce suicide attempts and deaths among Washington State youth. Working toward that goal, the group builds public awareness, offers training, and supports communities taking action.
Wisconsin Suicide Prevention Strategy
http://www.dhfs.state.wi.us/dph_emsip/InjuryPrevention/SuicidePrevention.htm
This report details Wisconsin’s Suicide Prevention Strategy. It provides a framework for getting every interested person in Wisconsin involved in preventing suicide and is designed to guide individuals, agencies, organizations in local communities and at regional and State levels in suicide prevention efforts.
Organizations
Iowa State Prevention Programs
http://www.idph.state.ia.us/bhpl/healthy_iowans_2010.asp
This web site provides an overview of Iowa’s prevention programs for violence and abusive behavior.
Ohio's Suicide Prevention Program
http://www.mh.state.oh.us/kids/suicideprev/suicide.prevention.plan.pdf
Ohio's Suicide Prevention Plan is the next step in saving lives and reducing suicidal behaviors by developing a comprehensive strategy in response to a very complex set of issues.
National Police Suicide Foundation
http://www.psf.org/index.htm
The numbers of deaths due to suicide are 2 to 3 times the number of line of duty deaths among law enforcement agencies and emergency workers. The mission of the National P.O.L.I.C.E. Suicide Foundation is to provide suicide awareness and prevention training programs and support services that will meet the psychological and spiritual needs of emergency workers and their families.
National Resource Center for Suicide Prevention and Aftercare
http://www.thelink.org/html/nrc.htm
The NRC's goal is to provide suicide-related community education in the areas of prevention, intervention, and aftercare, as well as healing support services for families, youth, and those affected by the psychological trauma of suicide.
National Center for Suicide Prevention Training
http://www.ncspt.org/courses/orientation/
The National Center for Suicide Prevention Training (NCSPT) currently has two internet-based workshops. The first one, “Locating, Understanding, and Presenting Youth Suicide Data” and is available on an ongoing basis. The second workshop, "Planning and Evaluation for Youth Suicide Prevention" is being prepared for pilot testing. This web site provides more information on the trainings.
National Strategy for Suicide Prevention Indicators
http://www.nsspi.org/
The goal of the National Strategy for Suicide Prevention Indicators project is to identify and develop indicators for each of the strategy's objectives. Indicators are measured in order to quantify the achievement of an objective.
Klingenstein Third Generation Foundation
http://ktgf.org/index.html
One of the two areas of interest for this foundation are Childhood and Adolescent Depression, including suicide and suicide prevention. Grants have primarily fallen under the categories of Intervention and Referral, Prevention, Public Education/Training, and Infrastructure. The Foundation also sponsors a Fellowship Program for post-doctoral research in depression.
American Association of Poison Control Centers
http://www.aapcc.org
The American Association of Poison Control Centers is a Nationwide organization of poison centers and interested individuals. It provides a forum for poison centers and interested individuals to promote the reduction of morbidity and mortality form poisoning and sets voluntary standards for poison centers. It also produces publications and holds a yearly conference.
American Association of Suicidology
http://www.suicidology.org/index.cfm
The American Association of Suicidology is dedicated to the understanding and prevention of suicide. The organization promotes research, public awareness programs, and education and training for professionals and volunteers.
American College of Emergency Physicians
http://www.acep.org
The American College of Emergency Physicians promotes the highest standards of patient care through its advocacy and leadership. This web site contains information on the organization, fact sheets, information on continuing education, and many other resources.
American Correctional Health Services Association
http://www.corrections.com/achsa/
The ACHSA mission is to be the voice of the correctional healthcare profession, and serve as an effective forum for communication addressing current issues and needs confronting correctional healthcare.
American Foundation for Suicide Prevention
http://www.afsp.org
The American Foundation for Suicide Prevention is the only international non-profit organization dedicated to funding the research and education needed to prevent suicide.
First World Report on Violence and Health (Full Report)
http://www.who.int/violence_injury_prevention/violence/world_report/wrvheng/en/
This report, produced by the World Health Organization, is written mainly for researchers and practitioners. Its goals are to raise global awareness about the problems of violence and to make the case that violence is preventable and that public health systems have a crucial role to play in addressing its causes and consequences.
Befrienders International
http://www.befrienders.org/
Befrienders International is a network of centers run by trained volunteers that offer a free listening service that is non-judgmental and completely confidential. People are befriended by telephone, letter and email, and in face-to-face meetings.
American School Health Association
http://www.ashaweb.org
The American School Health Association unites the many professionals working in schools who are committed to safeguarding the health of school-aged children. The Association, a multidisciplinary organization of administrators, counselors, dentists, health educators, physical educators, school nurses and school physicians, advocates high-quality school health instruction, health services and a healthful school environment.
Association of Maternal and Child Health Programs
http://www.amchp.org
The Association of Maternal and Child Health Programs is an organization representing State public health leaders and other individuals and organizations working to improve the health and well being of all women, children, youth, and families. The group accomplishes its mission through partnerships with government agencies and the participation of its members, families, advocates, health care purchasers, providers, academic and research professionals, and others at the National, State and local levels.
Association of State and Territorial Health Officials
http://www.astho.org
The Association of State and Territorial Health Officials is a National non-profit organization representing the State and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. Its members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy, and to assuring excellence in State-based public health practice. This site provides information on events, policy statements, and publications.
Georgia's Suicide Prevention Plan
http://www.georgiasuicidepreventionplan.org
People can stop suicide. This fact is the foundation of the Georgia Suicide Prevention Plan. This web site provides the plan’s text and staff contact information.
Selected Reviews of Suicide Research - 2001
http://www.nimh.nih.gov/suicideresearch/suibib2001.cfm
This list of review articles was compiled by the NIMH Suicide Research Consortium, whose members have found the articles useful when providing technical assistance to grant applicants.
SOS High School Suicide Prevention Program
http://www.mentalhealthscreening.org/sos_highschool
The SOS Suicide Prevention Program provides school health professionals with all the educational materials necessary to replicate this easy-to-use program in a variety of school settings. Schools have the flexibility to make use of the materials in as large or small a program as their needs and resources dictate. The program can also be blended into an existing health curriculum. You can find out more about it at their web site.
Students Against Destructive Decisions
http://www.saddonline.com
Students Against Destructive Decision strive to provide students with the best prevention and intervention tools possible to deal with the issues of underage drinking, other drug use, impaired driving and other destructive decisions. Their site has a number of resources including fact sheets, a resource center, a list of events, and newsletters.
State and Territorial Injury Prevention Directors' Association
http://www.stipda.org
The mission of the State and Territorial Injury Prevention Director’s Association is to promote, sustain, and enhance the ability of State and Territorial public health departments to reduce death and disability associated with injuries. It accomplishes its mission by disseminating information on state-of-the-art injury prevention and control policies and strategies.
Suicide Among the Aged (Canada)
http://www.suicideinfo.ca/csp/go.aspx?tabid=118
This web site illustrates, through statistics, that suicide rates for the elderly exceed suicide rates among adolescents.
Suicide Prevention Action Network of USA (SPAN)
http://www.spanusa.org
The Suicide Prevention Action Network USA is a non-profit national organization that links the energy of those bereaved or touched by suicide with the expertise of leaders in science, health, business, government and public service to achieve the goal of significantly reducing the national rate of suicide by the year 2010.
Suicide Prevention Advocacy Network - California
http://www.span-california.org
Suicide Prevention Advocacy Network-California (SPAN-California) was founded in 1999 as a force for suicide prevention, an arena for collaboration among agencies, and a voice in the California state capital.
The Project Hope Foundation
http://www.project-hope.co.nz
The Project Hope Foundation is dedicated to reducing depression and suicide (especially youth suicide). It has books, videos and instructions on self-education and how to run Life Skills Open Forums.
Training Institute for Suicide Assessment and Clinical Interviewing
http://www.suicideassessment.com/
This group provides mental health professionals with information on the development of suicide prevention skills, crisis intervention skills, and clinical interviewing skills.
University of Washington, MCH Program
http://depts.washington.edu/mchprog/cmh_home.html
On December 8-9, 2002, the Northwest Children's Public Health Network: Building an Action Agenda for Mental Health was held in Seattle, Washington. Representatives from six States met to identify issues specific to the region and their communities and to outline State plans for promoting mental health in children and young people. Four plenary speakers presented information on mental health at various stages of childhood and adolescence and took part in a panel discussion. The details of the meeting are found on this web site.
World Health Organization Fact Sheet on Violence
http://www.who.int/violence_injury_prevention/violence/world_report/wrvh1/en/
This fact sheet, prepared by the World Health Organization, contains worldwide statistics for suicide and self inflicted injuries.
World Health Organization Report on Violence and Health - Summary
http://www.who.int/violence_injury_prevention/violence/world_report/en/Full%20WRVH%20summary.pdf
This document is a comprehensive summary to the World Health Organizations first World Report on Violence and Health.
Online Resources
National Vital Statistics Reports
http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_08.pdf
This report presents the final 1999 data on U.S. deaths and death rates according to demographic and medical characteristics. Trends and patterns in general mortality, life expectancy, and infant mortality are also described.
New Freedom Commission on Mental Health Subcommittee on Suicide Prevention
http://www.mentalhealthcommission.gov/subcommittee/Suicide_Prevention_Outline.doc
Summary Report
Hawaii State Department of Health: Suicide
http://www.state.hi.us/health/shpda/shinjury.pdf
This is a report by the State of Hawaii on injury prevention, both accidental and self-inflicted. IT touches on suicide, domestic violence, and drug and alcohol abuse.
In Harm's Way: Suicide in America
http://www.nimh.nih.gov/publicat/harmaway.cfm
This fact sheet from the National Institute of Mental Health provides statistics about suicide incidents in the United States.
Media Coverage of Suicide
http://www.afsp.org/education/mediacoverage2.8.htm
This site, provided by the American Foundation for Suicide Prevention, illustrates various harmful ways in which the media can depict suicide.
Minnesota Department of Health Report to the Minnesota Legislature: Suicide Prevention Plan
http://www.health.state.mn.us/divs/opa/suicide.pdf
This report to the Minnesota Legislature details the development of the State’s suicide prevention plan.
EL SUICIDIO EN LOS ADOLESCENTES
http://www.aacap.org/publications/apntsfam/suicide.htm
Cada año miles de adolescentes se suicidan en los Estados Unidos. El suicidio es la tercera causa de muerte más frecuente para los jóvenes de entre 15 y 24 años de edad, y la sexta causa de muerte para los de entre 5 y 14 años.
National Organization for People of Color Against Suicide - Statistics
http://www.nopcas.com/stats/
This web site provides statistics on the amount of people who have committed and attempted suicide. It also lists conferences for suicide survivors.
National Registry of Effective Prevention Programs
http://www.modelprograms.samhsa.gov
Information on effective programs that enhance outcomes for substance abuse, violence and high-risk behaviors in community, family, school, clinical, faith-based, and workplace settings.
Depression and Bipolar Support Alliance (DBSA) - Suicide
http://www.dbsalliance.org/info/suicide.html
If you or someone you know suffers from depression or manic depression (also known as bipolar disorder), you understand all too well its symptoms may include feelings of sadness and hopelessness. These feelings can also include thoughts of self-harm or suicide.
Louisiana's Youth Suicide Prevention Program
http://www.dhh.state.la.us/NEWS/YouthSuicide02.htm
The Louisiana Youth Suicide Prevention Task Force is a Statewide response to the U. S. Surgeon General's call to action to prevent suicide. The mission of the Task Force is to develop a Statewide plan on youth suicide prevention in Louisiana. This press release provides more information on the Task Force as well as suicide statistics for Louisiana.
Guidelines for School Based Suicide Prevention Programs
http://www.suicidology.org/associations/1045/files/School%20guidelines.pdf
These guidelines, compiled by the Prevention Division of the American Association of Suicidology, can be used by schools to help prevent suicide. They are in PDF format.
Florida Suicide Prevention Coalition
http://www.floridasuicideprevention.org/
In August, 2002, the Florida Suicide Prevention Task Force announced the Statewide Suicide Prevention Strategy to reduce the incidence of suicide in Florida by one-third by 2005.
Canadian Association for Suicide Prevention
http://www.thesupportnetwork.com/CASP/main.html
This site provides resources and information about suicide prevention. It also contains new bulletins and a list of links to related sites.
A Call to Collaboration: The Federal Commitment to Suicide Prevention
http://www.sprc.org/library/collabcall.pdf
A Call to Collaboration: The Federal Commitment to Suicide Prevention highlights the Department of Health and Human Services' activities and their link to the National Strategy for Suicide Prevention, the plan which will guide the nation's suicide prevention efforts for the next decade.
Air Force Suicide Prevention Program
http://www.osophs.dhhs.gov/ophs/BestPractice/usaf.htm
The Suicide Prevention Program of the Air Force is described and highlighted as one of the nation's most effective health prevention programs.
Children's Safety Network - Injury Data
http://www.injuryprevention.org/info/data.htm
This web page provides charts and tables illustrating children’s injury data for each U.S. State and Territory.
Homicide and Suicide Risks Associated with Firearms in the Home
http://www.annemergmed.com/article/PIIS0196064403002567/fulltext?kwhquery=Homicide+and+Suicide+and+Risks+and+Associated+and+with+and+Firearms+and+Home&search_area=platform%2Bmedline&search_articletype=all&search_cluster=phoenix&search_currenturi=http%3A%2F%2Fjournals.elsevierhealth.com%2Fsearch%2Fquick&search_datecombo=0%3AALL&search_dateradio=combo&search_discipline=all&search_doi=&search_federated=yes&search_issue=&search_keyword=&search_language=all&search_medline=yes&search_mode=platform&search_monthendcombo=jan&search_monthstartcombo=jan&search_operator1=and&search_operator2=and&search_preview=no&search_reqcount=20&search_reqfirst=1&search_resulturi=%2FBRAND%2Fsearch%2Fresults&search_s200=yes&search_searchuri=%2FBRAND%2Fsearch%2Fadvanced&search_sort=relevance&search_startpage=&search_submode=&search_text1=Homicide+and+Suicide+Risks+Associated
This is a document about injury prevention titled, Homicide and Suicide Risks Associated With Firearms in the Home: A national case-control study.
Assisted Suicide and End-of-Life Decisions
http://www.apa.org/pi/aseol/introduction.html
A Report from an American Psychological Association Working Group
Assisted Suicide: A Disability Perspective
http://www.ncd.gov/newsroom/publications/1997/suicide.htm
Written for the National Council on Disability, this paper analyzes the issues related to assisted suicide and discusses current court cases.
At a Glance: Suicide Among the Elderly
http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp
The National Strategy for Suicide Prevention provides this fact sheet on suicide among the elderly.
If You Are Thinking About Suicide...READ THIS FIRST
http://www.metanoia.org/suicide/
The information on this site is intended to help and support persons who may be feeling suicidal.
Legislative Advisories From the American Association on Child and Adolescent Psychiatry
http://www.aacap.org/legislation/Lalerts.htm
These legislative alerts, provided by the American Academy of Child and Adolescent Psychiatry, concern Congressional action on issues related to the health of children and adolescents.
A Public Health Approach to Preventing Suicide
http://www.sprc.org/library/phaprev.pdf
This brochure illustrates how better data collection, including the National Violent Death Reporting System, can inform prevention strategies and make a real difference.
Oklahoma State Youth Suicide Prevention Plan
http://www.health.state.ok.us/program/ahd/spsp.pdf
The Oklahoma Youth Suicide Prevention State Plan works to address the problem of suicide by introducing multi-level strategies that communities can customize based on available resources and experiences.
Preventing Suicide: Individual Acts Create a Public Health Crisis
http://www.cfah.org/factsoflife/vol7no8.cfm
This site provides a resource of background information, interviews, and statistics for health reporters.
Reporting on Suicide: Recommendations for the Media
http://www.afsp.org/education/recommendations/
This is the full report of media recommendations presented on the American Foundation for Suicide Prevention Web site. This resource contains links to the specific media recommendations as well as an introduction to the topic area, a list of danger signs, examples of reporting, and frequently asked questions.
Reporting on Suicide: Recommendations for the Media
http://www.nimh.nih.gov/suicideresearch/mediasurvivors.cfm
This National Institute of Mental Health Web site presents media recommendations that were produced in the spirit of the public-private partnership recommended by the Surgeon General’s National Strategy for Suicide Prevention.
Suicide Prevention
http://mentalhealth.samhsa.gov/suicideprevention
The National Strategy for Suicide Prevention is a collaborative effort between the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, the Health Resources and Services Administration, and the Indian Health Services. The site has a wealth of resources including a newsroom, links State Suicide Prevention Programs, features publications, and much more.
Suicide Warning Signs
http://mentalhealth.samhsa.gov/publications/allpubs/walletcard/engwalletcard.htm
Tennessee Suicide Prevention Strategies
http://www.state.tn.us/mental/mhs/suicdeprev.pdf
The Tennessee strategy for suicide prevention builds on the fifteen points raised in “The Surgeon General’s Call to Action to Prevent Suicide, 1999.” This publication lists each of the fifteen points and Tennessee’s responses.
The Centre for Suicide Prevention, Manchester, England
http://www.national-confidential-inquiry.ac.uk/
The Centre for Suicide Prevention at the University of Manchester brings together projects on policy and service planning. This United Kingdom research centre in the field of suicidal behaviour carries out studies of suicide and homicide by those in contact with mental health services.
The National Association of Injury Control Research Centers
http://www.naicrc.org
An organization devoted to promoting scholarly activity in injury control, the Association addresses issues relevant to the prevention, acute care and rehabilitation of traumatic injury through multiple activities in research; research dissemination; program development and evaluation; consultation; and education and training.
The Surgeon General's Call To Action To Prevent Suicide, July 1999
http://www.surgeongeneral.gov/library/calltoaction/default.htm
The Surgeon General and the U.S. Department of Health and Human Services outline more than a dozen steps that can be taken by individuals, communities, organizations, and policymakers on this site. Site provides links to other related resources.
Virginia Youth Suicide Prevention Plan
http://www.vahealth.org/civp/preventsuicideva/
The Virginia Youth Suicide Prevention Plan addresses youth suicide in the Commonwealth by focusing on several key areas including: leadership, public awareness, media education, school-based strategies, surveillance, and evaluation. On this site there are statistics, free publications, and the number of a hotline for people contemplating suicide or people who know someone contemplating suicide.
Washington State Youth Suicide Prevention Program
http://www.yspp.org
The mission of the Youth Suicide Prevention Program is to reduce suicide attempts and deaths among Washington State youth. Working toward that goal, the group builds public awareness, offers training, and supports communities taking action.
Wisconsin Suicide Prevention Strategy
http://www.dhfs.state.wi.us/dph_emsip/InjuryPrevention/SuicidePrevention.htm
This report details Wisconsin’s Suicide Prevention Strategy. It provides a framework for getting every interested person in Wisconsin involved in preventing suicide and is designed to guide individuals, agencies, organizations in local communities and at regional and State levels in suicide prevention efforts.
March 11, 2010
Answers in the Aftermath
Answers in the Aftermath
A guide to mental health concerns for victims of violent crime
As a survivor of violent crime, you may face a wide range of emotional and physical struggles, along with some difficult questions that often surface: Why did this happen to me? How will I ever heal from this? Why can’t I connect with others the way I did before? When will I start to feel “normal” again? While the answers may be different for each individual, there are some striking similarities in how trauma affects nearly all victims. Understanding the nature and impact of violent trauma can be essential to the healing process. This brochure is intended as a guide to help you along the path to healing and to avoid some of the common pitfalls along the way.
What is Post Traumatic Stress Disorder (PTSD)?
PTSD is a mental health condition that can be caused by experiencing or observing virtually any kind of deep emotional trauma, especially one that is unexpected. Millions of people in the United States suffer from PTSD, resulting from many different types of trauma—from enduring years of domestic violence to a single violent attack that lasts but a few seconds. PTSD is characterized by both emotional and physical suffering; many afflicted by it find themselves unintentionally revisiting their trauma through flashbacks or nightmares. PTSD can make you feel isolated, disconnected, and “different” from other people—and it can even begin to affect the most routine activities of everyday life. PTSD is a potentially serious condition that should not be taken lightly.
Why is substance abuse common following a traumatic event?
Since violent trauma can bring about so many changes, questions, and uncertainties, many survivors turn to alcohol and illicit drugs in an attempt to get some relief from their almost round-the-clock emotional turmoil and suffering. Substance abuse and mental health problems often accompany violent trauma. All survivors of trauma manage their experiences in different ways. Substance abuse, however, is not only an ineffective tool in healing from trauma, but it also can present a host of additional problems that make the healing process even more difficult.
What can I do if I am experiencing PTSD or if substance abuse becomes a problem for me?
According to a recent study conducted by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, the most effective way to combat trauma, substance abuse, and mental health problems is through an integrated, holistic approach, taking into account how each individual problem affects the others. To begin, it can help to share your experiences and concerns with a service provider (e.g. counselor, physician, victim witness coordinator) who can assist in developing a plan to address all of your struggles comprehensively. Psychologists and counselors with experience treating trauma survivors can be very helpful in working through PTSD, and there are prescription drugs available to help ease PTSD symptoms.
PTSD can make you feel isolated, disconnected, and “different” from other people—and it can even begin to affect the most routine activities of everyday life.
What can I do to begin the healing process?
There are some positive steps that you can take right away to begin healing. Here are some suggestions:
Recognize your loss.
Establish safety for yourself.
Respect the way you feel and your right to feel that way.
Talk about your feelings with those you trust.
Connect with other survivors of violence, many of whom experience similar difficulties.
Do not be afraid to seek professional help.
Try to recognize triggers that may take you back to the memory and fear of your trauma.
Try to be patient and avoid making rash decisions—it can take time to figure out where you are, where you want to be, and how to get there.
Take care of yourself—exercise, eat right, and take a deep breath when you feel tense.
Try to turn your negative experience into something positive—volunteer, donate, or do something else to constructively channel your energy and emotions.
Do not abandon hope—believe that healing can and will take place.
A guide to mental health concerns for victims of violent crime
As a survivor of violent crime, you may face a wide range of emotional and physical struggles, along with some difficult questions that often surface: Why did this happen to me? How will I ever heal from this? Why can’t I connect with others the way I did before? When will I start to feel “normal” again? While the answers may be different for each individual, there are some striking similarities in how trauma affects nearly all victims. Understanding the nature and impact of violent trauma can be essential to the healing process. This brochure is intended as a guide to help you along the path to healing and to avoid some of the common pitfalls along the way.
What is Post Traumatic Stress Disorder (PTSD)?
PTSD is a mental health condition that can be caused by experiencing or observing virtually any kind of deep emotional trauma, especially one that is unexpected. Millions of people in the United States suffer from PTSD, resulting from many different types of trauma—from enduring years of domestic violence to a single violent attack that lasts but a few seconds. PTSD is characterized by both emotional and physical suffering; many afflicted by it find themselves unintentionally revisiting their trauma through flashbacks or nightmares. PTSD can make you feel isolated, disconnected, and “different” from other people—and it can even begin to affect the most routine activities of everyday life. PTSD is a potentially serious condition that should not be taken lightly.
Why is substance abuse common following a traumatic event?
Since violent trauma can bring about so many changes, questions, and uncertainties, many survivors turn to alcohol and illicit drugs in an attempt to get some relief from their almost round-the-clock emotional turmoil and suffering. Substance abuse and mental health problems often accompany violent trauma. All survivors of trauma manage their experiences in different ways. Substance abuse, however, is not only an ineffective tool in healing from trauma, but it also can present a host of additional problems that make the healing process even more difficult.
What can I do if I am experiencing PTSD or if substance abuse becomes a problem for me?
According to a recent study conducted by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, the most effective way to combat trauma, substance abuse, and mental health problems is through an integrated, holistic approach, taking into account how each individual problem affects the others. To begin, it can help to share your experiences and concerns with a service provider (e.g. counselor, physician, victim witness coordinator) who can assist in developing a plan to address all of your struggles comprehensively. Psychologists and counselors with experience treating trauma survivors can be very helpful in working through PTSD, and there are prescription drugs available to help ease PTSD symptoms.
PTSD can make you feel isolated, disconnected, and “different” from other people—and it can even begin to affect the most routine activities of everyday life.
What can I do to begin the healing process?
There are some positive steps that you can take right away to begin healing. Here are some suggestions:
Recognize your loss.
Establish safety for yourself.
Respect the way you feel and your right to feel that way.
Talk about your feelings with those you trust.
Connect with other survivors of violence, many of whom experience similar difficulties.
Do not be afraid to seek professional help.
Try to recognize triggers that may take you back to the memory and fear of your trauma.
Try to be patient and avoid making rash decisions—it can take time to figure out where you are, where you want to be, and how to get there.
Take care of yourself—exercise, eat right, and take a deep breath when you feel tense.
Try to turn your negative experience into something positive—volunteer, donate, or do something else to constructively channel your energy and emotions.
Do not abandon hope—believe that healing can and will take place.
March 01, 2010
After an Earthquake: Mental Health
After an Earthquake: Mental Health
Following a natural disaster, when many people have suffered great losses, it is normal to feel sad, angry, or nervous.
Some who have experienced a disaster may have bad feelings right away. Others may not notice a change until much later, after the crisis is over. It can take time to feel better and for things to return to normal, especially with so much loss. Many people find support and comfort by talking to surviving family members, close friends, doctors, nurses, and religious leaders. Sometimes, help from mental health professionals may be needed.
Medical follow up will be important for the health and wellbeing of many survivors. Survivors should be encouraged to share questions and concerns about their health with their doctors.
Links to CDC resources and those of other organizations are below. Survivor experiences and needs may differ, so some sites may be more helpful to some than others.
Information available in French, Haitian-Creole, and English:
•Mental Health Information for the Public
•Mental Health Information for Professionals
•Mental Health Advisory for Health Professionals Providing Care for Survivors of the 2010 Haitian Earthquake
•General Mental Health Resources
How to find mental health services in the U.S. by state and information for developing cultural competence in disaster mental health programs.
Care Tips for Survivors of a Traumatic Event: What to Expect in Your Personal, Family, Work, and Financial Life
Things to Remember When Trying to Understand Disaster Events
Signs that Adults Need Stress Management Assistance
Ways to Ease the Stress
Things to Remember When Trying to Understand Disaster Events
No one who sees a disaster is untouched by it.
It is normal to feel anxious about you and your family's safety.
Profound sadness, grief, and anger are normal reactions to an abnormal event.
Acknowledging our feelings helps us recover.
Focusing on our strengths and abilities will help you to heal.
Accepting help from community programs and resources is healthy.
We each have different needs and different ways of coping.
It is common to want to strike back at people who have caused great pain. However, nothing good is accomplished by hateful language or actions.
Signs that Adults Need Stress Management Assistance
Difficulty communicating thoughts
Difficulty sleeping
Difficulty maintaining balance
Easily frustrated
Increased use of drugs/alcohol
Limited attention span
Poor work performance
Headaches/stomach problems
Tunnel vision/muffled hearing
Colds or flu-like symptoms.
Disorientation or confusion
Difficulty concentrating
Reluctance to leave home
Depression, sadness
Feelings of hopelessness
Mood-swings
Crying easily
Overwhelming guilt and self-doubt
Fear of crowds, strangers, or being alone
Ways to Ease the Stress
Talk with someone about your feelings– anger, sorrow, and other emotions-- even though it may be difficult.
Don't hold yourself responsible for the disastrous event or be frustrated because you feel that you cannot help directly in the rescue work.
Take steps to promote your own physical and emotional healing by staying active in your daily life patterns or by adjusting them. This healthy outlook will help yourself and your family. (i.e. healthy eating, rest, exercise, relaxation, meditation.)
Maintain a normal household and daily routine, limiting demanding responsibilities of yourself and your family.
Spend time with family and friends.
Participate in memorials, rituals, and use of symbols as a way to express feelings.
Use existing supports groups of family, friends, and church.
Establish a family emergency plan. Feeling that there is something that you can do can be very comforting.
* When to Seek Help: If self help strategies are not helping or you find that you are using drugs/alcohol in order to cope, you may wish to seek outside or professional assistance with your stress symptoms.
Mental health advisory for health professionals providing care for survivors of the 2010 Haitian earthquake
Updated February 24, 2010
In the aftermath of disasters, many survivors will show acute reactions to stress. Reactions to stress may appear immediately after traumatic events or days and even weeks later. Although many reactions to stress may also be symptoms of psychiatric disorders if they persist, reactions to stress are expected responses to traumatic events in the context of disasters. Reactions to stress may be confusing and frightening, and some may view their reactions as signs of weakness or mental illness. Providing reassurance that it is very natural to have physical and emotional responses after a disaster can help to reduce distress and promote better functioning. Common reactions include:
•Physical Reactions: rapid heart rate, trembling hands, unexplained somatic symptoms (e.g., headaches, backaches, chest or abdominal pain), dizziness, blurry vision, sweating/trembling/shaking for no reason, sleep problems, loss of appetite, feeling choked or smothered
•Cognitive Reactions: problems concentrating or remembering things, confusion, disorientation
•Emotional Reactions: feeling tense and nervous, excessive fatigue, crying often or easily, feeling numb, being angry or irritable, feeling nervous or anxious around reminders of the earthquake, and nightmares/intrusive memories/mental images related to the earthquake
•Interpersonal Reactions: problems in relationships with family or friends, conflict, withdrawal, isolation
In evaluating patients, clinicians should keep in mind that some patients may present with signs and symptoms that appear to be reactions to stress but may also be manifestations of medical illness. Adverse reactions to medications or having recently stopped taking medications are other potential causes of physical or mental status changes that should be considered as part of a clinical evaluation.
Grief – Grief is normal and to be expected given the extensive loss of life that occurred after the earthquake; however sometimes grief can become so severe or persistent as to interfere with daily function to a degree that warrants clinical attention.
Long-Term Psychological Responses: The majority of people who experience reactions to stress after disasters and emergencies show resilience and do not go on to develop long-term psychopathology. However, in some survivors, the symptoms do not resolve. Posttraumatic Stress Disorder (PTSD), anxiety disorders, major depression, or other psychiatric disorders may develop. Such illnesses may be serious, even fatal, and warrant prompt follow up.
Depending on the severity of symptoms, level of function, potential risks, clinical questions, and/or other factors, referral to a mental health professional (and/or another health professional) may be warranted even in the absence of a psychiatric disorder.
Suicidal or homicidal ideation may occur in a variety of psychiatric disorders, and warrant immediate attention.
Alcohol and substance use may also increase suicide risk, as well as the risk of motor vehicle crashes and violence. Alcohol and substance use may increase following natural disasters.
Some examples of symptoms that may be indicative of PTSD include: dissociation (e.g., feeling unreal or outside oneself, having "blank" periods of time that one cannot remember); intrusive re-experiencing (e.g., disturbing memories, nightmares, or flashbacks); avoidance of reminders of the disaster (e.g., avoiding activities that remind one of the earthquake, withdrawing from other people); emotional numbing (e.g., unable to feel emotion, as if empty); hyper-arousal (e.g., startle responses, rage, extreme irritability, intense agitation). Diagnostic criteria for PTSD and other psychiatric disorders are included in the most recent edition of the DSM IV (American Psychiatric Association, 2000).
Risk Factors: People who have experienced any of the following are more likely to experience long-term difficulties and may be at higher risk for developing psychopathology:
•Direct and indirect exposure to the earthquake and its impact, e.g., being injured in the earthquake, seeing injured or dead people, hearing people screaming
•Loss of loved ones or friends
•Exposure to prior traumas (e.g., disasters, sexual abuse, motor vehicle crashes, combat)
•Pre-existing mental health issues such as depression or anxiety disorders
•Social isolation
•Multiple relocations and displacements
•Loss of home, valued possessions, neighborhood, or community
•Recent or subsequent major life stressors or emotional strain (e.g., intense emotional demands, searching for survivors, interacting with bereaved family members)
•Extreme fatigue, weather exposure, hunger, or sleep deprivation
Cross-Cultural Issues: Clinicians should be aware that in Haitian culture, there is stigma associated with experiencing or disclosing behaviors associated with mental illness, and there are different culturally appropriate ways of expressing grief, pain, and loss. Haitian patients may be reluctant to discuss or admit to mental health problems, or may refer to stress and psychiatric symptoms in culturally-specific ways, e.g., referring to saisissement (rapid heartbeat and cool blood, due to trauma), and supernatural causes of symptoms, e.g., voudou and hexes. Any discussions of mental health or reactions to stress should be explained in culturally sensitive, supportive, and non-stigmatizing ways.
Children: Children’s immature abilities to understand and process the immediate and long-term effects of emergencies make them among the most vulnerable members of affected communities. Because of stigma in Haitian culture around mental illness, many children may be reluctant to discuss or admit to mental health problems. Likewise, prior caregivers in Haiti may not have fully explored such issues, even prior to the earthquake. Clinicians should consider potential mental health and developmental issues. Reactions to stress differ depending on developmental level and are generally marked by changes in typical behavior for the specific child or adolescent. Some children will warrant referral to a mental health professional.
Acknowledging Psychological Distress: Clinicians should be aware that many patients may be reluctant to acknowledge psychiatric symptoms or distress. Earthquake survivors may fear being stigmatized within their community or denied entrance to the United States, and aid workers and military personnel may fear being penalized professionally if they have psychiatric diagnoses noted on their medical records. Whenever mental health referrals are warranted, added care should be taken to explain and arrange such referrals to the patient and his/her caregivers in a culturally sensitive, supportive, and non-stigmatizing way.
Potential for Misattribution of Symptoms of Non-Psychiatric Medical Conditions to Psychological Distress – In the aftermath of the earthquake, some patients may experience symptoms of head injury, cardiovascular disease, infection, or other undiagnosed medical conditions which may present themselves through mental status changes. Health care providers examining patients who have survived the earthquake need to be alert to that possibility.
Following a natural disaster, when many people have suffered great losses, it is normal to feel sad, angry, or nervous.
Some who have experienced a disaster may have bad feelings right away. Others may not notice a change until much later, after the crisis is over. It can take time to feel better and for things to return to normal, especially with so much loss. Many people find support and comfort by talking to surviving family members, close friends, doctors, nurses, and religious leaders. Sometimes, help from mental health professionals may be needed.
Medical follow up will be important for the health and wellbeing of many survivors. Survivors should be encouraged to share questions and concerns about their health with their doctors.
Links to CDC resources and those of other organizations are below. Survivor experiences and needs may differ, so some sites may be more helpful to some than others.
Information available in French, Haitian-Creole, and English:
•Mental Health Information for the Public
•Mental Health Information for Professionals
•Mental Health Advisory for Health Professionals Providing Care for Survivors of the 2010 Haitian Earthquake
•General Mental Health Resources
How to find mental health services in the U.S. by state and information for developing cultural competence in disaster mental health programs.
Care Tips for Survivors of a Traumatic Event: What to Expect in Your Personal, Family, Work, and Financial Life
Things to Remember When Trying to Understand Disaster Events
Signs that Adults Need Stress Management Assistance
Ways to Ease the Stress
Things to Remember When Trying to Understand Disaster Events
No one who sees a disaster is untouched by it.
It is normal to feel anxious about you and your family's safety.
Profound sadness, grief, and anger are normal reactions to an abnormal event.
Acknowledging our feelings helps us recover.
Focusing on our strengths and abilities will help you to heal.
Accepting help from community programs and resources is healthy.
We each have different needs and different ways of coping.
It is common to want to strike back at people who have caused great pain. However, nothing good is accomplished by hateful language or actions.
Signs that Adults Need Stress Management Assistance
Difficulty communicating thoughts
Difficulty sleeping
Difficulty maintaining balance
Easily frustrated
Increased use of drugs/alcohol
Limited attention span
Poor work performance
Headaches/stomach problems
Tunnel vision/muffled hearing
Colds or flu-like symptoms.
Disorientation or confusion
Difficulty concentrating
Reluctance to leave home
Depression, sadness
Feelings of hopelessness
Mood-swings
Crying easily
Overwhelming guilt and self-doubt
Fear of crowds, strangers, or being alone
Ways to Ease the Stress
Talk with someone about your feelings– anger, sorrow, and other emotions-- even though it may be difficult.
Don't hold yourself responsible for the disastrous event or be frustrated because you feel that you cannot help directly in the rescue work.
Take steps to promote your own physical and emotional healing by staying active in your daily life patterns or by adjusting them. This healthy outlook will help yourself and your family. (i.e. healthy eating, rest, exercise, relaxation, meditation.)
Maintain a normal household and daily routine, limiting demanding responsibilities of yourself and your family.
Spend time with family and friends.
Participate in memorials, rituals, and use of symbols as a way to express feelings.
Use existing supports groups of family, friends, and church.
Establish a family emergency plan. Feeling that there is something that you can do can be very comforting.
* When to Seek Help: If self help strategies are not helping or you find that you are using drugs/alcohol in order to cope, you may wish to seek outside or professional assistance with your stress symptoms.
Mental health advisory for health professionals providing care for survivors of the 2010 Haitian earthquake
Updated February 24, 2010
In the aftermath of disasters, many survivors will show acute reactions to stress. Reactions to stress may appear immediately after traumatic events or days and even weeks later. Although many reactions to stress may also be symptoms of psychiatric disorders if they persist, reactions to stress are expected responses to traumatic events in the context of disasters. Reactions to stress may be confusing and frightening, and some may view their reactions as signs of weakness or mental illness. Providing reassurance that it is very natural to have physical and emotional responses after a disaster can help to reduce distress and promote better functioning. Common reactions include:
•Physical Reactions: rapid heart rate, trembling hands, unexplained somatic symptoms (e.g., headaches, backaches, chest or abdominal pain), dizziness, blurry vision, sweating/trembling/shaking for no reason, sleep problems, loss of appetite, feeling choked or smothered
•Cognitive Reactions: problems concentrating or remembering things, confusion, disorientation
•Emotional Reactions: feeling tense and nervous, excessive fatigue, crying often or easily, feeling numb, being angry or irritable, feeling nervous or anxious around reminders of the earthquake, and nightmares/intrusive memories/mental images related to the earthquake
•Interpersonal Reactions: problems in relationships with family or friends, conflict, withdrawal, isolation
In evaluating patients, clinicians should keep in mind that some patients may present with signs and symptoms that appear to be reactions to stress but may also be manifestations of medical illness. Adverse reactions to medications or having recently stopped taking medications are other potential causes of physical or mental status changes that should be considered as part of a clinical evaluation.
Grief – Grief is normal and to be expected given the extensive loss of life that occurred after the earthquake; however sometimes grief can become so severe or persistent as to interfere with daily function to a degree that warrants clinical attention.
Long-Term Psychological Responses: The majority of people who experience reactions to stress after disasters and emergencies show resilience and do not go on to develop long-term psychopathology. However, in some survivors, the symptoms do not resolve. Posttraumatic Stress Disorder (PTSD), anxiety disorders, major depression, or other psychiatric disorders may develop. Such illnesses may be serious, even fatal, and warrant prompt follow up.
Depending on the severity of symptoms, level of function, potential risks, clinical questions, and/or other factors, referral to a mental health professional (and/or another health professional) may be warranted even in the absence of a psychiatric disorder.
Suicidal or homicidal ideation may occur in a variety of psychiatric disorders, and warrant immediate attention.
Alcohol and substance use may also increase suicide risk, as well as the risk of motor vehicle crashes and violence. Alcohol and substance use may increase following natural disasters.
Some examples of symptoms that may be indicative of PTSD include: dissociation (e.g., feeling unreal or outside oneself, having "blank" periods of time that one cannot remember); intrusive re-experiencing (e.g., disturbing memories, nightmares, or flashbacks); avoidance of reminders of the disaster (e.g., avoiding activities that remind one of the earthquake, withdrawing from other people); emotional numbing (e.g., unable to feel emotion, as if empty); hyper-arousal (e.g., startle responses, rage, extreme irritability, intense agitation). Diagnostic criteria for PTSD and other psychiatric disorders are included in the most recent edition of the DSM IV (American Psychiatric Association, 2000).
Risk Factors: People who have experienced any of the following are more likely to experience long-term difficulties and may be at higher risk for developing psychopathology:
•Direct and indirect exposure to the earthquake and its impact, e.g., being injured in the earthquake, seeing injured or dead people, hearing people screaming
•Loss of loved ones or friends
•Exposure to prior traumas (e.g., disasters, sexual abuse, motor vehicle crashes, combat)
•Pre-existing mental health issues such as depression or anxiety disorders
•Social isolation
•Multiple relocations and displacements
•Loss of home, valued possessions, neighborhood, or community
•Recent or subsequent major life stressors or emotional strain (e.g., intense emotional demands, searching for survivors, interacting with bereaved family members)
•Extreme fatigue, weather exposure, hunger, or sleep deprivation
Cross-Cultural Issues: Clinicians should be aware that in Haitian culture, there is stigma associated with experiencing or disclosing behaviors associated with mental illness, and there are different culturally appropriate ways of expressing grief, pain, and loss. Haitian patients may be reluctant to discuss or admit to mental health problems, or may refer to stress and psychiatric symptoms in culturally-specific ways, e.g., referring to saisissement (rapid heartbeat and cool blood, due to trauma), and supernatural causes of symptoms, e.g., voudou and hexes. Any discussions of mental health or reactions to stress should be explained in culturally sensitive, supportive, and non-stigmatizing ways.
Children: Children’s immature abilities to understand and process the immediate and long-term effects of emergencies make them among the most vulnerable members of affected communities. Because of stigma in Haitian culture around mental illness, many children may be reluctant to discuss or admit to mental health problems. Likewise, prior caregivers in Haiti may not have fully explored such issues, even prior to the earthquake. Clinicians should consider potential mental health and developmental issues. Reactions to stress differ depending on developmental level and are generally marked by changes in typical behavior for the specific child or adolescent. Some children will warrant referral to a mental health professional.
Acknowledging Psychological Distress: Clinicians should be aware that many patients may be reluctant to acknowledge psychiatric symptoms or distress. Earthquake survivors may fear being stigmatized within their community or denied entrance to the United States, and aid workers and military personnel may fear being penalized professionally if they have psychiatric diagnoses noted on their medical records. Whenever mental health referrals are warranted, added care should be taken to explain and arrange such referrals to the patient and his/her caregivers in a culturally sensitive, supportive, and non-stigmatizing way.
Potential for Misattribution of Symptoms of Non-Psychiatric Medical Conditions to Psychological Distress – In the aftermath of the earthquake, some patients may experience symptoms of head injury, cardiovascular disease, infection, or other undiagnosed medical conditions which may present themselves through mental status changes. Health care providers examining patients who have survived the earthquake need to be alert to that possibility.
February 26, 2010
Helping Children and Youth With Bipolar Disorder
Helping Children and Youth With Bipolar Disorder: Systems of Care
This fact sheet provides basic information on bipolar disorder in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder that causes persistent, overwhelming, and uncontrollable changes in moods, activities, thoughts, and behaviors. A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.
Although bipolar disorder affects at least 750,000 children in the United States 1 , it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.
Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses—which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.
What Are the Signs of Bipolar Disorder?
Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of “highs” and “lows,” called “mania” and “depression,” with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:
Excessively elevated moods alternating with periods of depressed or irritable moods;
Periods of high, goal-directed activity, and/or physical agitation;
Racing thoughts and speaking very fast;
Unusual/erratic sleep patterns and/or a decreased need for sleep;
Difficulty settling as babies;
Severe temper tantrums, sometimes called “rages”;
Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, “super-confident” thinking and behaviors;
Impulsivity and/or distractibility;
Inappropriate sexual activity, even at very young ages;
Hallucinations and/or delusions;
Suicidal thoughts and/or talks of killing self; and
Inflexible, oppositional/defiant, and extremely irritable behavior.
What Happens After a Bipolar Disorder Diagnosis?
If a qualified mental health provider has diagnosed your child with bipolar disorder, the provider may suggest several different treatment options, including strategies for managing behaviors, medications, and/or talk therapy. Your child’s mental health care provider may also suggest enrolling in a system of care, if one is available.
What Is a System of Care?
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families, children, and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. Specifically, a system of care can help by:
Tailoring services to the unique needs of your child and family;
Making services and supports available in your language and connecting you with professionals who respect your values and beliefs;
Encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and
Providing services from within your community, whenever possible.
How Can I Find a System of Care for My Child With Bipolar Disorder?
Contact the system of care community in the box on the back of this fact sheet. If none is listed or that system of care community is not in your area, visit mentalhealth.samhsa.gov/cmhs and click “Child, Adolescent & Family” and then “Systems of Care” to locate a system of care close to you. If you prefer to speak to someone in person to locate a system of care, or if there is not a system of care in your area, contact the National Mental Health Information Center by calling toll-free 1.800.789.2647 or visiting mentalhealth.samhsa.gov.
Are Systems of Care Effective?
National data collected for more than a decade support what families in systems of care have been saying: Systems of care work. Data from systems of care related to children and youth with bipolar disorder reflect the following:
Children and youth demonstrate improvement in emotional and behavioral functioning.
Caregivers report that children and youth have a reduction in conflicts with others in the family.
Caregivers experience an increased ability to do their jobs.
Caregivers report fewer missed days and a reduction in tardiness from work.
Children and youth with bipolar disorder improve in school-related tasks, such as paying attention in class, taking notes, and completing assignments on time.
Children and youth with bipolar disorder have fewer contacts with the juvenile justice system after enrolling in a system of care.
The Core Values of Systems of Care
Although systems of care may be different for each community, all share three core values. These values play an important role in ensuring that services and supports are effective and responsive to the needs of each child, youth, and family. These core values are:
Systems of care are family-driven and youth-guided.
Systems of care are culturally and linguistically competent.
Systems of care are community-based.
Austin’s Story
At age 12, Austin appears to be a typical sixth grader—he likes to play basketball and video games, and is enrolled in an after-school horseback riding program. He is an honor roll student, and his mother describes him as compassionate, loyal, and a champion for the “underdog.” Austin and his family also manage the challenges of bipolar disorder each day.
Austin was diagnosed in first grade with attention-deficit/hyperactivity disorder and separation anxiety disorder, but Austin’s mother, Kim, recalls a series of incidents that led her to question whether her son’s mental health needs were being met. At age 9, Austin set two fires within a week. The first time it happened, Kim thought it was an isolated incident that would not be repeated— Austin said he was lighting candles.
The second time Austin set a fire, however, the situation was very different. While bringing groceries into the house, Austin set a small fire in the car. When Kim discovered signs of the fire the next morning, she says, “I immediately got on the phone and started calling his physician. Thoughts were flashing through my mind about what could have happened.”
After Kim received a referral from Austin’s physician for diagnostic testing and other mental health services, she learned that her son had been experiencing hallucinations, which were causing him to set the fires. She also learned that his extreme mood swings, as well as his unusual sleep patterns, were signs of bipolar disorder. As a result, Austin was hospitalized for 20 days and diagnosed with bipolar disorder. During this time, Austin was accepted into a system of care through a referral from his school guidance counselor.
Kim says the system of care played an important role in helping Austin make the transition from the hospital to his home—even providing transportation, as Kim’s car was being repaired at the time. System of care staff helped Kim learn more about her son’s disorder. They also helped her locate services and supports tailored to Austin’s needs, including counseling, health care, specialized schooling, after-school programs, transportation, and child care.
The system of care also empowered Kim to be a more effective advocate for Austin’s needs. Before joining the system of care, she says, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.”
Kim also assumed that professionals were best able to determine how to meet her child’s needs. After working in partnership with the system of care, Kim now knows that services and supports should be responsive to Austin’s needs and that her and her son’s input into the services and supports is crucial.
Despite the successes her family has had, Kim emphasizes that the journey to wellness is not over. In addition to coping with the symptoms of bipolar disorder, she and Austin also must overcome the stigma associated with mental illnesses. Together, Kim and Austin counter this stigma by educating others that he, and others with mental illnesses, should be known for who they are rather than the disorders they happen to have. Despite the ongoing challenges of stigma and bipolar disorder, Kim believes that the system of care has made a huge difference in terms of helping her family move forward.
What Steps Are Necessary To Enroll in a System of Care?
Although each community’s system of care is different, most children and youth in a system of care go through the following steps to be enrolled:
Step One: Diagnosis and Referral—To be considered for system of care enrollment, your child must have a diagnosed behavioral, emotional, or mental health disorder that severely affects his or her life. Additionally, most children and youth are referred to a system of care by mental health providers, educators, juvenile justice professionals, child welfare professionals, physicians, and others who might already be serving your child.
Step Two: Assessment and Intake—Once your child has been diagnosed and has been referred to the system of care, the system of care may ask you to answer some questions that will help you determine whether or not your child and family are eligible to receive services and supports. If your child and family are eligible, you may have to answer more questions so the system of care can begin to understand your needs. Throughout these steps, the system of care will work with you to fill out all of the necessary paperwork.
Step Three: Care Planning and Partnership Building—After your child and family are enrolled, the system of care will work with you to determine what services and supports best fit your child’s and family’s needs. Once the care planning is complete, the system of care will develop partnerships among you and all of those who are helping your child and family to ensure that services and supports are as effective as possible.
This fact sheet provides basic information on bipolar disorder in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.
What Is Bipolar Disorder?
Bipolar disorder is a brain disorder that causes persistent, overwhelming, and uncontrollable changes in moods, activities, thoughts, and behaviors. A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.
Although bipolar disorder affects at least 750,000 children in the United States 1 , it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.
Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses—which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.
What Are the Signs of Bipolar Disorder?
Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of “highs” and “lows,” called “mania” and “depression,” with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:
Excessively elevated moods alternating with periods of depressed or irritable moods;
Periods of high, goal-directed activity, and/or physical agitation;
Racing thoughts and speaking very fast;
Unusual/erratic sleep patterns and/or a decreased need for sleep;
Difficulty settling as babies;
Severe temper tantrums, sometimes called “rages”;
Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, “super-confident” thinking and behaviors;
Impulsivity and/or distractibility;
Inappropriate sexual activity, even at very young ages;
Hallucinations and/or delusions;
Suicidal thoughts and/or talks of killing self; and
Inflexible, oppositional/defiant, and extremely irritable behavior.
What Happens After a Bipolar Disorder Diagnosis?
If a qualified mental health provider has diagnosed your child with bipolar disorder, the provider may suggest several different treatment options, including strategies for managing behaviors, medications, and/or talk therapy. Your child’s mental health care provider may also suggest enrolling in a system of care, if one is available.
What Is a System of Care?
A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families, children, and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. Specifically, a system of care can help by:
Tailoring services to the unique needs of your child and family;
Making services and supports available in your language and connecting you with professionals who respect your values and beliefs;
Encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and
Providing services from within your community, whenever possible.
How Can I Find a System of Care for My Child With Bipolar Disorder?
Contact the system of care community in the box on the back of this fact sheet. If none is listed or that system of care community is not in your area, visit mentalhealth.samhsa.gov/cmhs and click “Child, Adolescent & Family” and then “Systems of Care” to locate a system of care close to you. If you prefer to speak to someone in person to locate a system of care, or if there is not a system of care in your area, contact the National Mental Health Information Center by calling toll-free 1.800.789.2647 or visiting mentalhealth.samhsa.gov.
Are Systems of Care Effective?
National data collected for more than a decade support what families in systems of care have been saying: Systems of care work. Data from systems of care related to children and youth with bipolar disorder reflect the following:
Children and youth demonstrate improvement in emotional and behavioral functioning.
Caregivers report that children and youth have a reduction in conflicts with others in the family.
Caregivers experience an increased ability to do their jobs.
Caregivers report fewer missed days and a reduction in tardiness from work.
Children and youth with bipolar disorder improve in school-related tasks, such as paying attention in class, taking notes, and completing assignments on time.
Children and youth with bipolar disorder have fewer contacts with the juvenile justice system after enrolling in a system of care.
The Core Values of Systems of Care
Although systems of care may be different for each community, all share three core values. These values play an important role in ensuring that services and supports are effective and responsive to the needs of each child, youth, and family. These core values are:
Systems of care are family-driven and youth-guided.
Systems of care are culturally and linguistically competent.
Systems of care are community-based.
Austin’s Story
At age 12, Austin appears to be a typical sixth grader—he likes to play basketball and video games, and is enrolled in an after-school horseback riding program. He is an honor roll student, and his mother describes him as compassionate, loyal, and a champion for the “underdog.” Austin and his family also manage the challenges of bipolar disorder each day.
Austin was diagnosed in first grade with attention-deficit/hyperactivity disorder and separation anxiety disorder, but Austin’s mother, Kim, recalls a series of incidents that led her to question whether her son’s mental health needs were being met. At age 9, Austin set two fires within a week. The first time it happened, Kim thought it was an isolated incident that would not be repeated— Austin said he was lighting candles.
The second time Austin set a fire, however, the situation was very different. While bringing groceries into the house, Austin set a small fire in the car. When Kim discovered signs of the fire the next morning, she says, “I immediately got on the phone and started calling his physician. Thoughts were flashing through my mind about what could have happened.”
After Kim received a referral from Austin’s physician for diagnostic testing and other mental health services, she learned that her son had been experiencing hallucinations, which were causing him to set the fires. She also learned that his extreme mood swings, as well as his unusual sleep patterns, were signs of bipolar disorder. As a result, Austin was hospitalized for 20 days and diagnosed with bipolar disorder. During this time, Austin was accepted into a system of care through a referral from his school guidance counselor.
Kim says the system of care played an important role in helping Austin make the transition from the hospital to his home—even providing transportation, as Kim’s car was being repaired at the time. System of care staff helped Kim learn more about her son’s disorder. They also helped her locate services and supports tailored to Austin’s needs, including counseling, health care, specialized schooling, after-school programs, transportation, and child care.
The system of care also empowered Kim to be a more effective advocate for Austin’s needs. Before joining the system of care, she says, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.”
Kim also assumed that professionals were best able to determine how to meet her child’s needs. After working in partnership with the system of care, Kim now knows that services and supports should be responsive to Austin’s needs and that her and her son’s input into the services and supports is crucial.
Despite the successes her family has had, Kim emphasizes that the journey to wellness is not over. In addition to coping with the symptoms of bipolar disorder, she and Austin also must overcome the stigma associated with mental illnesses. Together, Kim and Austin counter this stigma by educating others that he, and others with mental illnesses, should be known for who they are rather than the disorders they happen to have. Despite the ongoing challenges of stigma and bipolar disorder, Kim believes that the system of care has made a huge difference in terms of helping her family move forward.
What Steps Are Necessary To Enroll in a System of Care?
Although each community’s system of care is different, most children and youth in a system of care go through the following steps to be enrolled:
Step One: Diagnosis and Referral—To be considered for system of care enrollment, your child must have a diagnosed behavioral, emotional, or mental health disorder that severely affects his or her life. Additionally, most children and youth are referred to a system of care by mental health providers, educators, juvenile justice professionals, child welfare professionals, physicians, and others who might already be serving your child.
Step Two: Assessment and Intake—Once your child has been diagnosed and has been referred to the system of care, the system of care may ask you to answer some questions that will help you determine whether or not your child and family are eligible to receive services and supports. If your child and family are eligible, you may have to answer more questions so the system of care can begin to understand your needs. Throughout these steps, the system of care will work with you to fill out all of the necessary paperwork.
Step Three: Care Planning and Partnership Building—After your child and family are enrolled, the system of care will work with you to determine what services and supports best fit your child’s and family’s needs. Once the care planning is complete, the system of care will develop partnerships among you and all of those who are helping your child and family to ensure that services and supports are as effective as possible.
February 23, 2010
Substance Abuse and Chemical Dependency Continuing Education CEU
B. Models of Preventive Services
Two well-known models of preventive services are used when referring to behavioral programming for public health or mental health promotion and substance use prevention. They are reviewed briefly here.
for more information on this topic click link below
substance abuse ceus continuing education
The Public Health Model
Public health traditionally defines preventive services as “primary,” “secondary,” or “tertiary.” Primary preventive services, such as immunizations and programs related to tobacco, diet, and exercise, are intended to intervene before the onset of illness to prevent biologic onset of illness. Secondary preventive services include screening to detect disease before it becomes symptomatic, coupled with follow-up to arrest or eliminate the disease. The Pap test and mammography are medical examples of secondary prevention. Tertiary prevention refers to prevention of complications in persons known to be ill. Prevention of stroke through effective treatment of hypertension is an example of tertiary prevention. Much of disease management is tertiary prevention. In the public health model, the three levels of prevention are separate and distinct.
The Continuum of Health Care Model According to the Institute of Medicine (IOM)
When dealing with substance use and other behavioral disorders in clinical settings, the levels of prevention are less distinct than with physical illnesses. The tasks of identifying risk factors and detecting earlystage disease are usually accomplished by patient or family interview. Initial management of both risk and early stage disease is often conducted via patient and family counseling by the primary care provider. Thus, the continuum of the health care model is more practical than the public health model when dealing with preventive behavioral health services.
The continuum of health care model is drawn from a 1994 report of the Institute of Medicine (IOM) (Mrazek & Haggerty, eds., 1994), as originally proposed by Gordon (1983). It differs from the public health model in that it covers the full range of preventive, treatment, and maintenance services. There are three types of preventive services in the IOM model—universal, selective, and indicated. These do not correspond to the primary, secondary, and tertiary services in the public health model. Screening and follow-up preventive behavioral services correspond to secondary prevention within the public health model. Other preventive behavioral services, including most community-based services, correspond to primary or tertiary prevention.
Figure 1. Continuum of Health Care
Source: Reprinted with permission from Reducing Risks for Mental Disorders. Copyright 1994 by the National Academy of Sciences, Courtesy of the National Academy Press, Washington, DC.
In the IOM model, a “universal” preventive measure is an intervention that is applicable to or useful for everyone in the general population, such as all enrollees in a managed care organization. A “selective” preventive measure is desirable only when an individual is a member of a subgroup with above-average risk. An “indicated” preventive measure applies to persons who are found to manifest a risk factor that puts them at high risk (Mrazek & Haggerty, eds., 1994). All these categories describe individuals who have not been diagnosed with a disease.
Universal interventions, on a per-client basis, are relatively inexpensive services offered to the entire population of a lifestage group. They are conducted as a primary prevention or screening to identify sub-populations and individuals who need more intensive screening, preventive, or therapeutic services. A clinical example would be the provision of prenatal care as a universal service for all pregnant women. A behavioral health example would be the use of a simple screening protocol to identify depression in all adult patients at all primary care visits.
Selective interventions are more intensive services offered to subpopulations identified as having more risk factors than the general population, based on their age, gender, genetic history, condition, or situation. For example, more intensive breast cancer screening is provided for women with a family history of breast cancer. A behavioral health example would be offering smoking cessation programming to all smokers.
Indicated interventions are based on higher probability of developing a disease. They provide an intensive level of service to persons at extremely high risk or who already show asymptomatic, clinical, or demonstrable abnormality, but do not meet diagnostic criteria levels yet. Case management and intensive in-home assessment, health education, and counseling are examples of indicated interventions (Mrazek & Haggerty, eds., 1994).
Sometimes a universal service is a screening procedure provided to all, or a primary prevention procedure such as vaccinations for children. The selective service involves diagnostic procedures to confirm or deny a diagnosis, and the indicated service involves much more intensive, individualized services for those at highest risk.
The efficacy and cost-efficiency of preventive services depend on the entire array of universal, selective, and indicated service components. They also depend on the ability of the health care system to target and limit the more costly indicated interventions to those who could most benefit from them.
Appendix C to this report provides a more detailed presentation of the following policy, management, planning, and evaluation issues:
Translation of preventive behavioral research into health care practice
Assessment of the need for preventive services
Assessment of the efficacy of preventive services
Infrastructure and service components for preventive services
“General” vs. “Targeted” Services
Within this monograph, services are also classified into one of two categories, “general” and “targeted,” depending on the evidence base and the nature of the service. Those designated as “general” are supported by the evidence base as being appropriate for universal implementation by all health care systems. Services that are classified here as “targeted” appear to be appropriate for selected populations (e.g., selective or indicated populations if applying the IOM model), or they have a developing research base that is promising. “Targeted” services might also be social or educational interventions that could be provided by nonmedical staff to secure educational and social benefits.
C. Clinical vs. Community Preventive Services
Most preventive behavioral services are delivered in school and community settings, not health care settings (Schinke, Brounstein, & Gardner, 2002; DHHS, 1999). In a 1998 review of indicated preventive behavioral services for children and adolescents, Durlak and Wells (1997) used meta-analysis to review 177 programs—73 percent were in a school setting, compared with 23 percent that were mainly in medical settings. In a similar review published 1 year later by the same authors (Durlak & Wells, 1998), none of the programs was in a medical setting.
This report has been prepared to summarize and analyze the most promising preventive interventions (based on rigorous research studies) for consideration by health care organizations. Only interventions deliverable by health care systems are reviewed in this report. Most community preventive services are oriented toward school-age children, adolescents, and young adults—age groups with relatively low exposure to health care delivery settings. Such services generally are provided by and through schools and community organizations.
Health care settings, however, are effective in reaching pregnant women, infants, adults with major chronic medical illnesses, and those in need of surgical procedures. For example, these settings provide a place to address the behavioral needs of these patients through behavioral screening and preventive services, with follow-up in prescribed regimens of care. In this way, clinical preventive services for depression and substance abuse can reduce emergency room use and hospitalization (Olfson, Sing, & Schlesinger, 1999). Psychoeducational services also can speed recovery of postsurgical patients (Egbert, Battit, Welch, & Bartlett, 1964; Mumford, Schlesinger, & Glass, 1982).
It may not be incumbent upon health care delivery systems to provide highly specialized social and educational support services (Devine, O’Connor, Cook, Wenk, & Curtin, 1988), but health care delivery systems do have a role to play. Through their mental health and social work staff, they maintain working relationships with communitybased, social service, educational, and even correctional agencies to ensure they meet the needs of members of the health care delivery system.
D. Health Care Delivery System Provision of Preventive Behavioral Services
The need for behavioral services is substantial. Many who could benefit from treatment for these disorders do not receive care (Woodward et al., 1997; Harwood, Sullivan, & Malhorta, 2001).
Some of the lack of development of behavioral health services within health care delivery systems may be owing to the perception that mental health and substance use disorder services may be “softer” and therefore less effective than conventional medical therapy. However, the efficacy and cost-efficiency of these services is well established and has been recommended by multiple national organizations since at least the early 1990s (U.S. Preventive Services Task Force [USPSTF], 1996, 2002a, 2003).
The 1994 IOM report was titled Reducing Risks for Mental Disorders—Frontiers for Preventive Intervention Research (Mrazek & Haggerty, eds., 1994). A 1998 follow-up report, Preventing Mental Health and Substance Abuse Problems in Managed Care Settings (Mrazek, 1998), was completed in collaboration with the National Mental Health Association (NMHA). This report recommended widespread implementation of primary preventive programming to address five problem areas within health care systems:
Prevention of initial onset of unipolar major depression across the life span
Prevention of low birthweight and prevention of child maltreatment in children from birth to 2 years of age whose mothers are identified as being at high risk
Prevention of alcohol or drug abuse in children who have an alcohol- or drugabusing parent
Prevention of mental health problems in physically ill patients (comorbidity prevention)
Prevention of conduct disorders in young children
The 1999 Surgeon General Report was titled Mental Health: A Report of the Surgeon General (DHHS, 1999). Although the major focus of this report was care and management of mental disorders, all major preventive services were included.
SAMHSA published two recent prevention-related health care reports. The 2000 literature review titled Preventive Interventions Under Managed Care (Dorfman, 2000) used broader definitions of “prevention” and “mental health services” and recommended six interventions for managed care plans:
Prenatal and infancy home visits
Targeted cessation education and counseling for smokers—especially those who are pregnant
Targeted short-term mental health therapy
Self-care education for adults
Presurgical educational intervention with adults
Brief counseling and advice to reduce alcohol use
This new literature review retains four of the above services and omits numbers three and four on short-term mental health therapy and self-care. The companion document published in 2002 was titled Estimating the Cost of Preventive Services in Mental Health and Substance Abuse Under Managed Care (Broskowski & Smith, 2002). This report provided cost data for each of the services recommended in the 2000 literature review. It also featured, for each set of recommended services, a range of costs and options based on case mix and private versus public insurance coverage. It estimated the cost to managed care organizations (MCOs) to implement recommendations for four possible scenarios ranging from most expensive to least expensive, given drivers such as enrollment mix, staffing, staff salaries, and fixed and variable expenses. This report did not consider savings in other health care expenses. Even with the most expensive of cost profiles, the report did conclude that all six services could be fully implemented at a marginal cost of less than a 1 percent increase in cost, per member per month.
During this period, SAMHSA and the National Committee on Quality Assurance (NCQA)–sponsored Health Employer Data Information Set (HEDIS) program have attempted to bring preventive behavioral services to the attention of the managed care community. In response to market pressures to demonstrate high scores on HEDIS measures, the managed care community has taken giant strides to improve the care of patients with depression and has taken steps to enhance member adherence to prescribed regimens of care for diabetes.
In 1998, SAMHSA’s Center for Substance Abuse Prevention created the National Registry of Effective Programs (NREP) as a resource to help professionals in the field become better consumers of prevention programs (Schinke et al., 2002). NREP reviews and screens evidence-based programs (conceptually sound and/or theoretically driven by risk and protective factors) that, through an expert consensus review of research, demonstrate scientifically defensible evidence. NREP initially focused on substance use prevention but has expanded to include mental health; co-occurring mental health and substance use disorders; adolescent substance use treatment; mental health promotion; and adult mental health treatment. Many programs focus on school and family, but increasingly, programs from community coalitions and environmental programs are being identified as well implemented, well evaluated, and effective.
NREP evaluates programs for substance abuse prevention and treatment, co-occuring disorders, and mental health treatment, promotion, and prevention. After receiving published and unpublished program materials from candidates, NREP reviewers, drawn from 80 experts in relevant fields, rate each program according to 18 criteria for methodological rigor, and they also score programs for adoptability and usefulness to communities (Schinke et al., 2002). Based on the overall scoring, NREP categorizes programs as Model Programs, Effective Programs, Promising Programs, or Programs with Insufficient Current Support. Those wishing to learn more about Model Programs can visit www.modelprograms.samhsa.gov. At this site, there is also a link providing detailed information about NREP and the process for submitting a program for NREP review.
Despite these efforts, behavioral services— both preventive and therapeutic—still are not adequately identified, provided, or arranged by primary care practitioners. They also are not adequately promoted by health care systems. Brief screening instruments for alcohol and drug problems, for example, have been available for a number of years but are not widely used by practicing physicians (Duszynski, Nieto, & Vanente, 1995; National Center on Addiction and Substance Abuse at Columbia University, 2000). In a 2002 review, Garnick et al. (2002) conducted a telephone survey covering 434 MCOs in 60 market areas nationwide and secured useful responses from 92 percent of them. Only 14.9 percent of MCOs required any alcohol, drug, or mental health screening by primary care practitioners. Slightly more than half distributed practice guidelines that addressed mental illness, and approximately one third distributed substance use disorder practice guidelines.
DHHS’s 2003 campaign, Steps to a Healthier U.S., focuses on chronic disease prevention and health promotion with the goals of decreasing both the prevalence of certain chronic diseases and the risk factors that allow conditions to develop. This initiative aims to bring together local coalitions to establish model programs and policies that foster health behavior changes, encourage healthier lifestyle choices, and reduce disparities in health care.
In early 2003, SAMHSA published a review of the delivery of behavioral services by managed care organizations, based on 1999 data. This report, The Provision of Mental Health Services in Managed Care Organizations (Horgan et al., 2003), showed substantial variability from plan to plan, as well as substantial variability among health maintenance organizations (HMOs), pointof- service (POS) plans, and preferred provider organizations (PPOs). All MCOs provided behavioral services, but these services usually had limits and copayments that were more restrictive than for comparable medical services. Fewer than 10 percent required screening for behavioral disorders in primary care settings (Horgan et al., 2003).
Another SAMHSA report, also published early in 2003, offers some insight into discrepancies in coverage, comparing medical to behavioral services and discrepancies in policy and coverage, comparing therapeutic to preventive services. This report, titled Medical Necessity in Private Health Plans: Implications for Behavioral Health Care (Rosenbaum, Kamoie, Mauery, & Walitt, 2003), noted that services are covered by health insurance plans only if they are considered a “medical necessity.” The term medical necessity was defined differently for different services within each health plan, with due consideration given for each of the following five domains:
Contractual scope—whether the contract provides any coverage for certain procedures and treatments, such as preventive and maintenance treatments that are not necessary to restore a patient to “normal functioning.” This dimension preempts any other coverage decision.
Standards of practice—whether the treatment (as judged by the health plan) accords with professional standards of practice.
Patient safety and setting—whether the treatment will be delivered in the safest and least intrusive manner.
Medical service—whether the treatment is considered medical as opposed to social or nonmedical.
Cost—whether the treatment is considered cost-effective by the insurer (Rosenbaum et al., 2003).
The medical necessity report noted that Federal or State regulation is limited in covering how health insurance plans define medical necessity (Rosenbaum et al., 2003). This SAMHSA update is intended to build upon the reports noted above to further enhance implementation of preventive behavioral services in health care settings.
Two well-known models of preventive services are used when referring to behavioral programming for public health or mental health promotion and substance use prevention. They are reviewed briefly here.
for more information on this topic click link below
substance abuse ceus continuing education
The Public Health Model
Public health traditionally defines preventive services as “primary,” “secondary,” or “tertiary.” Primary preventive services, such as immunizations and programs related to tobacco, diet, and exercise, are intended to intervene before the onset of illness to prevent biologic onset of illness. Secondary preventive services include screening to detect disease before it becomes symptomatic, coupled with follow-up to arrest or eliminate the disease. The Pap test and mammography are medical examples of secondary prevention. Tertiary prevention refers to prevention of complications in persons known to be ill. Prevention of stroke through effective treatment of hypertension is an example of tertiary prevention. Much of disease management is tertiary prevention. In the public health model, the three levels of prevention are separate and distinct.
The Continuum of Health Care Model According to the Institute of Medicine (IOM)
When dealing with substance use and other behavioral disorders in clinical settings, the levels of prevention are less distinct than with physical illnesses. The tasks of identifying risk factors and detecting earlystage disease are usually accomplished by patient or family interview. Initial management of both risk and early stage disease is often conducted via patient and family counseling by the primary care provider. Thus, the continuum of the health care model is more practical than the public health model when dealing with preventive behavioral health services.
The continuum of health care model is drawn from a 1994 report of the Institute of Medicine (IOM) (Mrazek & Haggerty, eds., 1994), as originally proposed by Gordon (1983). It differs from the public health model in that it covers the full range of preventive, treatment, and maintenance services. There are three types of preventive services in the IOM model—universal, selective, and indicated. These do not correspond to the primary, secondary, and tertiary services in the public health model. Screening and follow-up preventive behavioral services correspond to secondary prevention within the public health model. Other preventive behavioral services, including most community-based services, correspond to primary or tertiary prevention.
Figure 1. Continuum of Health Care
Source: Reprinted with permission from Reducing Risks for Mental Disorders. Copyright 1994 by the National Academy of Sciences, Courtesy of the National Academy Press, Washington, DC.
In the IOM model, a “universal” preventive measure is an intervention that is applicable to or useful for everyone in the general population, such as all enrollees in a managed care organization. A “selective” preventive measure is desirable only when an individual is a member of a subgroup with above-average risk. An “indicated” preventive measure applies to persons who are found to manifest a risk factor that puts them at high risk (Mrazek & Haggerty, eds., 1994). All these categories describe individuals who have not been diagnosed with a disease.
Universal interventions, on a per-client basis, are relatively inexpensive services offered to the entire population of a lifestage group. They are conducted as a primary prevention or screening to identify sub-populations and individuals who need more intensive screening, preventive, or therapeutic services. A clinical example would be the provision of prenatal care as a universal service for all pregnant women. A behavioral health example would be the use of a simple screening protocol to identify depression in all adult patients at all primary care visits.
Selective interventions are more intensive services offered to subpopulations identified as having more risk factors than the general population, based on their age, gender, genetic history, condition, or situation. For example, more intensive breast cancer screening is provided for women with a family history of breast cancer. A behavioral health example would be offering smoking cessation programming to all smokers.
Indicated interventions are based on higher probability of developing a disease. They provide an intensive level of service to persons at extremely high risk or who already show asymptomatic, clinical, or demonstrable abnormality, but do not meet diagnostic criteria levels yet. Case management and intensive in-home assessment, health education, and counseling are examples of indicated interventions (Mrazek & Haggerty, eds., 1994).
Sometimes a universal service is a screening procedure provided to all, or a primary prevention procedure such as vaccinations for children. The selective service involves diagnostic procedures to confirm or deny a diagnosis, and the indicated service involves much more intensive, individualized services for those at highest risk.
The efficacy and cost-efficiency of preventive services depend on the entire array of universal, selective, and indicated service components. They also depend on the ability of the health care system to target and limit the more costly indicated interventions to those who could most benefit from them.
Appendix C to this report provides a more detailed presentation of the following policy, management, planning, and evaluation issues:
Translation of preventive behavioral research into health care practice
Assessment of the need for preventive services
Assessment of the efficacy of preventive services
Infrastructure and service components for preventive services
“General” vs. “Targeted” Services
Within this monograph, services are also classified into one of two categories, “general” and “targeted,” depending on the evidence base and the nature of the service. Those designated as “general” are supported by the evidence base as being appropriate for universal implementation by all health care systems. Services that are classified here as “targeted” appear to be appropriate for selected populations (e.g., selective or indicated populations if applying the IOM model), or they have a developing research base that is promising. “Targeted” services might also be social or educational interventions that could be provided by nonmedical staff to secure educational and social benefits.
C. Clinical vs. Community Preventive Services
Most preventive behavioral services are delivered in school and community settings, not health care settings (Schinke, Brounstein, & Gardner, 2002; DHHS, 1999). In a 1998 review of indicated preventive behavioral services for children and adolescents, Durlak and Wells (1997) used meta-analysis to review 177 programs—73 percent were in a school setting, compared with 23 percent that were mainly in medical settings. In a similar review published 1 year later by the same authors (Durlak & Wells, 1998), none of the programs was in a medical setting.
This report has been prepared to summarize and analyze the most promising preventive interventions (based on rigorous research studies) for consideration by health care organizations. Only interventions deliverable by health care systems are reviewed in this report. Most community preventive services are oriented toward school-age children, adolescents, and young adults—age groups with relatively low exposure to health care delivery settings. Such services generally are provided by and through schools and community organizations.
Health care settings, however, are effective in reaching pregnant women, infants, adults with major chronic medical illnesses, and those in need of surgical procedures. For example, these settings provide a place to address the behavioral needs of these patients through behavioral screening and preventive services, with follow-up in prescribed regimens of care. In this way, clinical preventive services for depression and substance abuse can reduce emergency room use and hospitalization (Olfson, Sing, & Schlesinger, 1999). Psychoeducational services also can speed recovery of postsurgical patients (Egbert, Battit, Welch, & Bartlett, 1964; Mumford, Schlesinger, & Glass, 1982).
It may not be incumbent upon health care delivery systems to provide highly specialized social and educational support services (Devine, O’Connor, Cook, Wenk, & Curtin, 1988), but health care delivery systems do have a role to play. Through their mental health and social work staff, they maintain working relationships with communitybased, social service, educational, and even correctional agencies to ensure they meet the needs of members of the health care delivery system.
D. Health Care Delivery System Provision of Preventive Behavioral Services
The need for behavioral services is substantial. Many who could benefit from treatment for these disorders do not receive care (Woodward et al., 1997; Harwood, Sullivan, & Malhorta, 2001).
Some of the lack of development of behavioral health services within health care delivery systems may be owing to the perception that mental health and substance use disorder services may be “softer” and therefore less effective than conventional medical therapy. However, the efficacy and cost-efficiency of these services is well established and has been recommended by multiple national organizations since at least the early 1990s (U.S. Preventive Services Task Force [USPSTF], 1996, 2002a, 2003).
The 1994 IOM report was titled Reducing Risks for Mental Disorders—Frontiers for Preventive Intervention Research (Mrazek & Haggerty, eds., 1994). A 1998 follow-up report, Preventing Mental Health and Substance Abuse Problems in Managed Care Settings (Mrazek, 1998), was completed in collaboration with the National Mental Health Association (NMHA). This report recommended widespread implementation of primary preventive programming to address five problem areas within health care systems:
Prevention of initial onset of unipolar major depression across the life span
Prevention of low birthweight and prevention of child maltreatment in children from birth to 2 years of age whose mothers are identified as being at high risk
Prevention of alcohol or drug abuse in children who have an alcohol- or drugabusing parent
Prevention of mental health problems in physically ill patients (comorbidity prevention)
Prevention of conduct disorders in young children
The 1999 Surgeon General Report was titled Mental Health: A Report of the Surgeon General (DHHS, 1999). Although the major focus of this report was care and management of mental disorders, all major preventive services were included.
SAMHSA published two recent prevention-related health care reports. The 2000 literature review titled Preventive Interventions Under Managed Care (Dorfman, 2000) used broader definitions of “prevention” and “mental health services” and recommended six interventions for managed care plans:
Prenatal and infancy home visits
Targeted cessation education and counseling for smokers—especially those who are pregnant
Targeted short-term mental health therapy
Self-care education for adults
Presurgical educational intervention with adults
Brief counseling and advice to reduce alcohol use
This new literature review retains four of the above services and omits numbers three and four on short-term mental health therapy and self-care. The companion document published in 2002 was titled Estimating the Cost of Preventive Services in Mental Health and Substance Abuse Under Managed Care (Broskowski & Smith, 2002). This report provided cost data for each of the services recommended in the 2000 literature review. It also featured, for each set of recommended services, a range of costs and options based on case mix and private versus public insurance coverage. It estimated the cost to managed care organizations (MCOs) to implement recommendations for four possible scenarios ranging from most expensive to least expensive, given drivers such as enrollment mix, staffing, staff salaries, and fixed and variable expenses. This report did not consider savings in other health care expenses. Even with the most expensive of cost profiles, the report did conclude that all six services could be fully implemented at a marginal cost of less than a 1 percent increase in cost, per member per month.
During this period, SAMHSA and the National Committee on Quality Assurance (NCQA)–sponsored Health Employer Data Information Set (HEDIS) program have attempted to bring preventive behavioral services to the attention of the managed care community. In response to market pressures to demonstrate high scores on HEDIS measures, the managed care community has taken giant strides to improve the care of patients with depression and has taken steps to enhance member adherence to prescribed regimens of care for diabetes.
In 1998, SAMHSA’s Center for Substance Abuse Prevention created the National Registry of Effective Programs (NREP) as a resource to help professionals in the field become better consumers of prevention programs (Schinke et al., 2002). NREP reviews and screens evidence-based programs (conceptually sound and/or theoretically driven by risk and protective factors) that, through an expert consensus review of research, demonstrate scientifically defensible evidence. NREP initially focused on substance use prevention but has expanded to include mental health; co-occurring mental health and substance use disorders; adolescent substance use treatment; mental health promotion; and adult mental health treatment. Many programs focus on school and family, but increasingly, programs from community coalitions and environmental programs are being identified as well implemented, well evaluated, and effective.
NREP evaluates programs for substance abuse prevention and treatment, co-occuring disorders, and mental health treatment, promotion, and prevention. After receiving published and unpublished program materials from candidates, NREP reviewers, drawn from 80 experts in relevant fields, rate each program according to 18 criteria for methodological rigor, and they also score programs for adoptability and usefulness to communities (Schinke et al., 2002). Based on the overall scoring, NREP categorizes programs as Model Programs, Effective Programs, Promising Programs, or Programs with Insufficient Current Support. Those wishing to learn more about Model Programs can visit www.modelprograms.samhsa.gov. At this site, there is also a link providing detailed information about NREP and the process for submitting a program for NREP review.
Despite these efforts, behavioral services— both preventive and therapeutic—still are not adequately identified, provided, or arranged by primary care practitioners. They also are not adequately promoted by health care systems. Brief screening instruments for alcohol and drug problems, for example, have been available for a number of years but are not widely used by practicing physicians (Duszynski, Nieto, & Vanente, 1995; National Center on Addiction and Substance Abuse at Columbia University, 2000). In a 2002 review, Garnick et al. (2002) conducted a telephone survey covering 434 MCOs in 60 market areas nationwide and secured useful responses from 92 percent of them. Only 14.9 percent of MCOs required any alcohol, drug, or mental health screening by primary care practitioners. Slightly more than half distributed practice guidelines that addressed mental illness, and approximately one third distributed substance use disorder practice guidelines.
DHHS’s 2003 campaign, Steps to a Healthier U.S., focuses on chronic disease prevention and health promotion with the goals of decreasing both the prevalence of certain chronic diseases and the risk factors that allow conditions to develop. This initiative aims to bring together local coalitions to establish model programs and policies that foster health behavior changes, encourage healthier lifestyle choices, and reduce disparities in health care.
In early 2003, SAMHSA published a review of the delivery of behavioral services by managed care organizations, based on 1999 data. This report, The Provision of Mental Health Services in Managed Care Organizations (Horgan et al., 2003), showed substantial variability from plan to plan, as well as substantial variability among health maintenance organizations (HMOs), pointof- service (POS) plans, and preferred provider organizations (PPOs). All MCOs provided behavioral services, but these services usually had limits and copayments that were more restrictive than for comparable medical services. Fewer than 10 percent required screening for behavioral disorders in primary care settings (Horgan et al., 2003).
Another SAMHSA report, also published early in 2003, offers some insight into discrepancies in coverage, comparing medical to behavioral services and discrepancies in policy and coverage, comparing therapeutic to preventive services. This report, titled Medical Necessity in Private Health Plans: Implications for Behavioral Health Care (Rosenbaum, Kamoie, Mauery, & Walitt, 2003), noted that services are covered by health insurance plans only if they are considered a “medical necessity.” The term medical necessity was defined differently for different services within each health plan, with due consideration given for each of the following five domains:
Contractual scope—whether the contract provides any coverage for certain procedures and treatments, such as preventive and maintenance treatments that are not necessary to restore a patient to “normal functioning.” This dimension preempts any other coverage decision.
Standards of practice—whether the treatment (as judged by the health plan) accords with professional standards of practice.
Patient safety and setting—whether the treatment will be delivered in the safest and least intrusive manner.
Medical service—whether the treatment is considered medical as opposed to social or nonmedical.
Cost—whether the treatment is considered cost-effective by the insurer (Rosenbaum et al., 2003).
The medical necessity report noted that Federal or State regulation is limited in covering how health insurance plans define medical necessity (Rosenbaum et al., 2003). This SAMHSA update is intended to build upon the reports noted above to further enhance implementation of preventive behavioral services in health care settings.
February 13, 2010
CEU Training Video for MFTs, LCSWs, LPCs, Social Workers and Counselors
Click link below for ceus video training
Continuing Education CEU Training Video for MFTs, LCSWs, LPCs, Social Workers and Counselors
Approved in many states including California BBS, Florida, New Jersey, New York, Texas, Hawaii, Nevada and Ohio.
Continuing Education CEU Training Video for MFTs, LCSWs, LPCs, Social Workers and Counselors
Approved in many states including California BBS, Florida, New Jersey, New York, Texas, Hawaii, Nevada and Ohio.
January 24, 2010
Continuing Education CEUs for MFTs and LCSWs
Spousal and Partner Abuse. Doemstic Violence CEUs for MFTs and LCSWs
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
Course Objectives: Click here for full course text
1. Learn definition and distinguish between types of abuse
2. Become familiar with relevant facts and statistics
3. Identify spousal/partner abuse symptoms
4. Evaluate the effects of spousal/ partner abuse
5. Identify same gender abuse dynamics
6. Become familiar with relevant cultural factors
7. Learn the national domestic violence applicable laws
8. Become familiar with resources and referrals
Table of Contents: Click here for full course text1. Definitions and Types of Abuse
2. Facts and Statistics
3. Symptoms and Effects
4. Domestic Violence and the Law
5. Evaluation, Intervention and Treatment
6. Resources and Referrals
7. References
1. Definitions and Types of Abuse
Domestic violence and emotional abuse is characterized by physically and/or psychologically dominating behaviors used by a perpetrator to control the victim. Partners may be married or unmarried; heterosexual, or homosexual; living together, separated or dating. Domestic violence occurs in all cultures; people of all races, ethnicities, religions, sexes and classes can be perpetrators of domestic violence. Domestic violence is also known as domestic abuse, spousal abuse, or intimate partner violence. Domestic violence is perpetrated by both men and women. Domestic abuse is any form of abuse that occurs between and among persons related by affection, kinship, or trust. It can occur with youth, adults or elders of all ages and walks of life. The perpetrator often will use fear and intimidation as a method of control. The perpetrator may also threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence. Domestic abuse is intentionally trying to control another person. The abuser intentionally uses verbal, nonverbal, or physical methods to gain control over the other person. Domestic abuse includes:
• Physical abuse
• Sexual abuse or sexual assault
• Verbal abuse
• Emotional Abuse
• Financial abuse
• Neglect
• Ritual abuse
• Spiritual abuse
• Criminal harassment
• Stalking, and Cyber stalking
(Stark, E., A. Flitcraft, 1996. Women at Risk: Domestic Violence and Women's Health. Sage).
There are many considerations in evaluating abuse including:
• Mode: physical, psychological, sexual and/or social.
• Frequency: on/off, occasional and chronic.
• Severity: in terms of both psychological or physical harm and the need for treatment.
• Transitory or permanent injury: mild, moderate, severe and up to homicide.
An area of the domestic violence field that is often overlooked is passive abuse leading to violence. Passive abuse is covert, subtle and veiled. This includes victimization, procrastination, forgetfulness, ambiguity, neglect, spiritual and intellectual abuse.
Increased recognition of domestic violence began during the women's movement. Awareness regarding domestic violence varies among different countries. Only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or more than 10% of the U.S. population.
There is increasing awareness and advocacy for men victimized by women. In a report on violence related injuries by the US Department of justice (USDOJ August 1997) hospital emergency room visits related to domestic violence revealed that physically abused men represent just under one-sixth of the total patients admitted to hospital reporting domestic violence as the cause of their injuries. The report reveals that significantly more men than women did not disclose the identity of their attacker. This is likely due to shame, stigma, and embarrassment associated with men victimized by women.
According to a July 2000 Centers for Disease Control Report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence
Physical Abuse
Physical abuse is characterized by aggressive behavior that may result in the victim sustaining injury. Physical abuse attacks are used by the perpetrator to control the victim. The abuse is rarely a single incident and typically forms identifiable patterns that may repeat more and more quickly, and which may become increasingly violent.
Physical abuse can include:
• assault with a weapon
• biting, pinching
• burning
• choking
• kicking, pushing, throwing or shaking
• slapping, hitting, tripping, grabbing or punching
• tying down or otherwise restraining or confining
• homicide
Sexual Abuse and Assault
Sexual abuse and assault includes any non-consensual sexual activity ranging from harassment, unwanted sexual touching, to rape. Sexual harassment is characterized by ridiculing another person to try to limit their sexuality or reproductive choices, while sexual exploitation could involve forcing someone to participate in pornographic film-making. Examples of sexual abuse include fondling of genitals, penetration, incest, rape, sodomy, indecent exposure, forced prostitution, forced production of pornographic materials (Verbal/ Emotional/ Psychological Abuse
Abbott, Pamela and Emma Williamson, 1999.. "Women, Health and Domestic Violence". Journal of Gender Studies).
Domestic violence is not only physical and sexual violence but also psychological. Psychological violence can be defined as intense and repetitive degradation, creating isolation, and controlling the actions or behaviors of the spouse through intimidation or manipulation to the detriment of the individual. Emotional and psychological abuse sometimes involves tactics to undermine an individual's self-confidence and sense of self-worth, such as yelling, mocking, insulting, threatening, using abusive language, humiliating, harassing and degrading. It can also include deprivation of emotional care, and isolating the individual being targeted (Five Year State Master Plan for the Prevention of and Service for Domestic Violence." Utah State Department of Human Services, January 1994).
Financial/Economic Abuse
Financial abuse occurs when one individual attempts to take total or partial control of another's finances, inheritance or employment income. It may include denying access to one's own financial records and knowledge about personal investments, income or debt, or preventing a partner from engaging in activities that would lead to financial independence.
Financial or economic abuse includes:
• withholding economic resources such as money or credit cards
• stealing from or defrauding a partner of money or assets
• exploiting the partner's resources for personal gain
• withholding physical resources such as food, clothes, necessary medications, or shelter from a partner
• preventing a partner from working or choosing an occupation
Ritual Abuse
Ritual abuse is defined as a combination of severe physical, sexual, psychological and spiritual abuses used systematically and in combination with symbols, ceremonies and/or group activities that have a religious, magical or supernatural connotation. Victims are terrorized into silence by repetitive torture and abuse over time and indoctrinated into the beliefs and practices of the cult or group. Ritual abuse may also be linked to Satanism or devil worship.
Spiritual Abuse
Spiritual abuse may include:
• using the partner's religious or spiritual beliefs to manipulate them
• preventing the partner from practicing their religious or spiritual beliefs
• ridiculing the other person's religious or spiritual beliefs
• forcing the children to be reared in a faith that the partner has not agreed to
Spiritual and religious abuse is also abuse done in the name of, brought on by, or attributed to a belief system of the abuser, or abuse from a religious leader. This can include Priests, Ministers, cult members, family members, or anyone abusing in the name of a deity or perceived deity. Spiritual or religious abuse can find its way into every religion and belief system that exists. It may encompass many other forms of abuse, especially physical, sexual, emotional, psychological and financial (Warshaw, C. (1993). "Limitations of the Medical Model in the Care of Battered Women". in Bart, P., E. Moran. Violence Against Women: The Bloody Footprints. Sage).
Harassment, Stalking and Cyberstalking
Stalking is harassment of or threatening another person, especially in a manner that physically or emotionally disturbs them. Stalking of an intimate partner can occur place during the relationship, with intense monitoring of the partner's activities, or it can take place after a partner or spouse has left the relationship. The stalker may be trying to get their partner back, or they may wish to harm their partner as punishment for their departure. Regardless of the motive, the victim fears for their safety. Stalking may occur at or near the victim's home, near or in their workplace, on the way to any destination, or on the internet (cyberstalking). Stalking can be on the phone, in person, or online. Stalkers sometimes do not reveal themselves, or they may just “show up” unexpectedly. Stalking is often unpredictable and dangerous. Stalkers may utilize threatening tactics including:
• “showing up” wherever the victim is located
• repeated phone calls (often hanging up)
• following the victim
• watching the victim from a hiding place
• sending the victim unwanted packages/gifts/letters
• monitoring the victim's phone calls
• monitoring the victim’s mail or internet use
• sifting through the victim's garbage
• contacting the victim's friends, family, co-workers, or neighbors to obtain information about the victim
• damaging the victim's property
• threatening to hurt the victim or the victim’s family, friends or pets
Cyberstalking is defined as utilizing the internet with the intention to harass and/or stalk another person. Cyberstalking is deliberate and persistent in nature. It may be an additional form of harassment, or the only method the perpetrator employs. The cyber stalker’s communication may be disturbing and inappropriate. Often, the more the victim protests or responds, the more rewarding the cyberstalker experiences the stalking. The best way to respond to a cyberstalker is not to respond. Cyberstalking may graduate to physical stalking, aggression, and violence.
Battering relationships are often characterized by cyclical phases, sometimes referred to as The Cycle of Violence. A period of peace and calm is followed by escalating tension. A woman might feel as though she were walking on eggshells. Minor incidents may occur that the woman tries to minimize or deny, sometimes by taking the blame.
When the tension becomes unmanageable, aggression occurs. The victim may be kicked, thrown against a wall, raped, threatened at gun or knife point, slapped, punched or subjected to any of the endless mental and physical abuses that batterers use to intimidate and control their partners.
This then leads to the honeymoon phase where the relationship appears to be stable, the abusive incident is forgotten, and there is no active abuse. Of course, the abuse process remains unresolved and it is only a matter of time until tension develops, which leads to another explosion of violence, and the cycle continues.
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
Course Objectives: Click here for full course text
1. Learn definition and distinguish between types of abuse
2. Become familiar with relevant facts and statistics
3. Identify spousal/partner abuse symptoms
4. Evaluate the effects of spousal/ partner abuse
5. Identify same gender abuse dynamics
6. Become familiar with relevant cultural factors
7. Learn the national domestic violence applicable laws
8. Become familiar with resources and referrals
Table of Contents: Click here for full course text1. Definitions and Types of Abuse
2. Facts and Statistics
3. Symptoms and Effects
4. Domestic Violence and the Law
5. Evaluation, Intervention and Treatment
6. Resources and Referrals
7. References
1. Definitions and Types of Abuse
Domestic violence and emotional abuse is characterized by physically and/or psychologically dominating behaviors used by a perpetrator to control the victim. Partners may be married or unmarried; heterosexual, or homosexual; living together, separated or dating. Domestic violence occurs in all cultures; people of all races, ethnicities, religions, sexes and classes can be perpetrators of domestic violence. Domestic violence is also known as domestic abuse, spousal abuse, or intimate partner violence. Domestic violence is perpetrated by both men and women. Domestic abuse is any form of abuse that occurs between and among persons related by affection, kinship, or trust. It can occur with youth, adults or elders of all ages and walks of life. The perpetrator often will use fear and intimidation as a method of control. The perpetrator may also threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence. Domestic abuse is intentionally trying to control another person. The abuser intentionally uses verbal, nonverbal, or physical methods to gain control over the other person. Domestic abuse includes:
• Physical abuse
• Sexual abuse or sexual assault
• Verbal abuse
• Emotional Abuse
• Financial abuse
• Neglect
• Ritual abuse
• Spiritual abuse
• Criminal harassment
• Stalking, and Cyber stalking
(Stark, E., A. Flitcraft, 1996. Women at Risk: Domestic Violence and Women's Health. Sage).
There are many considerations in evaluating abuse including:
• Mode: physical, psychological, sexual and/or social.
• Frequency: on/off, occasional and chronic.
• Severity: in terms of both psychological or physical harm and the need for treatment.
• Transitory or permanent injury: mild, moderate, severe and up to homicide.
An area of the domestic violence field that is often overlooked is passive abuse leading to violence. Passive abuse is covert, subtle and veiled. This includes victimization, procrastination, forgetfulness, ambiguity, neglect, spiritual and intellectual abuse.
Increased recognition of domestic violence began during the women's movement. Awareness regarding domestic violence varies among different countries. Only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or more than 10% of the U.S. population.
There is increasing awareness and advocacy for men victimized by women. In a report on violence related injuries by the US Department of justice (USDOJ August 1997) hospital emergency room visits related to domestic violence revealed that physically abused men represent just under one-sixth of the total patients admitted to hospital reporting domestic violence as the cause of their injuries. The report reveals that significantly more men than women did not disclose the identity of their attacker. This is likely due to shame, stigma, and embarrassment associated with men victimized by women.
According to a July 2000 Centers for Disease Control Report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence
Physical Abuse
Physical abuse is characterized by aggressive behavior that may result in the victim sustaining injury. Physical abuse attacks are used by the perpetrator to control the victim. The abuse is rarely a single incident and typically forms identifiable patterns that may repeat more and more quickly, and which may become increasingly violent.
Physical abuse can include:
• assault with a weapon
• biting, pinching
• burning
• choking
• kicking, pushing, throwing or shaking
• slapping, hitting, tripping, grabbing or punching
• tying down or otherwise restraining or confining
• homicide
Sexual Abuse and Assault
Sexual abuse and assault includes any non-consensual sexual activity ranging from harassment, unwanted sexual touching, to rape. Sexual harassment is characterized by ridiculing another person to try to limit their sexuality or reproductive choices, while sexual exploitation could involve forcing someone to participate in pornographic film-making. Examples of sexual abuse include fondling of genitals, penetration, incest, rape, sodomy, indecent exposure, forced prostitution, forced production of pornographic materials (Verbal/ Emotional/ Psychological Abuse
Abbott, Pamela and Emma Williamson, 1999.. "Women, Health and Domestic Violence". Journal of Gender Studies).
Domestic violence is not only physical and sexual violence but also psychological. Psychological violence can be defined as intense and repetitive degradation, creating isolation, and controlling the actions or behaviors of the spouse through intimidation or manipulation to the detriment of the individual. Emotional and psychological abuse sometimes involves tactics to undermine an individual's self-confidence and sense of self-worth, such as yelling, mocking, insulting, threatening, using abusive language, humiliating, harassing and degrading. It can also include deprivation of emotional care, and isolating the individual being targeted (Five Year State Master Plan for the Prevention of and Service for Domestic Violence." Utah State Department of Human Services, January 1994).
Financial/Economic Abuse
Financial abuse occurs when one individual attempts to take total or partial control of another's finances, inheritance or employment income. It may include denying access to one's own financial records and knowledge about personal investments, income or debt, or preventing a partner from engaging in activities that would lead to financial independence.
Financial or economic abuse includes:
• withholding economic resources such as money or credit cards
• stealing from or defrauding a partner of money or assets
• exploiting the partner's resources for personal gain
• withholding physical resources such as food, clothes, necessary medications, or shelter from a partner
• preventing a partner from working or choosing an occupation
Ritual Abuse
Ritual abuse is defined as a combination of severe physical, sexual, psychological and spiritual abuses used systematically and in combination with symbols, ceremonies and/or group activities that have a religious, magical or supernatural connotation. Victims are terrorized into silence by repetitive torture and abuse over time and indoctrinated into the beliefs and practices of the cult or group. Ritual abuse may also be linked to Satanism or devil worship.
Spiritual Abuse
Spiritual abuse may include:
• using the partner's religious or spiritual beliefs to manipulate them
• preventing the partner from practicing their religious or spiritual beliefs
• ridiculing the other person's religious or spiritual beliefs
• forcing the children to be reared in a faith that the partner has not agreed to
Spiritual and religious abuse is also abuse done in the name of, brought on by, or attributed to a belief system of the abuser, or abuse from a religious leader. This can include Priests, Ministers, cult members, family members, or anyone abusing in the name of a deity or perceived deity. Spiritual or religious abuse can find its way into every religion and belief system that exists. It may encompass many other forms of abuse, especially physical, sexual, emotional, psychological and financial (Warshaw, C. (1993). "Limitations of the Medical Model in the Care of Battered Women". in Bart, P., E. Moran. Violence Against Women: The Bloody Footprints. Sage).
Harassment, Stalking and Cyberstalking
Stalking is harassment of or threatening another person, especially in a manner that physically or emotionally disturbs them. Stalking of an intimate partner can occur place during the relationship, with intense monitoring of the partner's activities, or it can take place after a partner or spouse has left the relationship. The stalker may be trying to get their partner back, or they may wish to harm their partner as punishment for their departure. Regardless of the motive, the victim fears for their safety. Stalking may occur at or near the victim's home, near or in their workplace, on the way to any destination, or on the internet (cyberstalking). Stalking can be on the phone, in person, or online. Stalkers sometimes do not reveal themselves, or they may just “show up” unexpectedly. Stalking is often unpredictable and dangerous. Stalkers may utilize threatening tactics including:
• “showing up” wherever the victim is located
• repeated phone calls (often hanging up)
• following the victim
• watching the victim from a hiding place
• sending the victim unwanted packages/gifts/letters
• monitoring the victim's phone calls
• monitoring the victim’s mail or internet use
• sifting through the victim's garbage
• contacting the victim's friends, family, co-workers, or neighbors to obtain information about the victim
• damaging the victim's property
• threatening to hurt the victim or the victim’s family, friends or pets
Cyberstalking is defined as utilizing the internet with the intention to harass and/or stalk another person. Cyberstalking is deliberate and persistent in nature. It may be an additional form of harassment, or the only method the perpetrator employs. The cyber stalker’s communication may be disturbing and inappropriate. Often, the more the victim protests or responds, the more rewarding the cyberstalker experiences the stalking. The best way to respond to a cyberstalker is not to respond. Cyberstalking may graduate to physical stalking, aggression, and violence.
Battering relationships are often characterized by cyclical phases, sometimes referred to as The Cycle of Violence. A period of peace and calm is followed by escalating tension. A woman might feel as though she were walking on eggshells. Minor incidents may occur that the woman tries to minimize or deny, sometimes by taking the blame.
When the tension becomes unmanageable, aggression occurs. The victim may be kicked, thrown against a wall, raped, threatened at gun or knife point, slapped, punched or subjected to any of the endless mental and physical abuses that batterers use to intimidate and control their partners.
This then leads to the honeymoon phase where the relationship appears to be stable, the abusive incident is forgotten, and there is no active abuse. Of course, the abuse process remains unresolved and it is only a matter of time until tension develops, which leads to another explosion of violence, and the cycle continues.
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