Helping Children Cope With Fear & Anxiety
Whether tragic events touch your family personally or are brought into your home via newspapers and television, you can help children cope with the anxiety that violence, death and disasters can cause.
The Caring for Every Child's Mental Health Campaign offers these pointers for parents and other caregivers:
Encourage children to ask questions. Listen to what they say. Provide comfort and assurance that address their specific fears. It's okay to admit you can't answer all of their questions.
Talk on their level. Communicate with your children in a way they can understand. Don't get too technical or complicated.
Be honest. Tell them exactly what has happened. For example, don't say that someone who has died has "gone to sleep;" children may become afraid of going to bed.
Find out what frightens them. Encourage your children to talk about fears they may have. They may worry that someone will harm them at school or that someone will try to hurt you.
Focus on the positive. Reinforce the fact that most people are kind and caring. Remind your child of the heroic actions taken by ordinary people to help victims of tragedy.
Pay attention. Your children's play and drawings may give you a glimpse into their questions or concerns. Ask them to tell you what is going on in the game or the picture. It's an opportunity to clarify any misconceptions, answer questions and give reassurance.
Develop a plan. Establish a family emergency plan for the future, such as a meeting place where everyone should gather if something unexpected happens in your family or neighborhood. It can help you and your child feel safer.
If you are concerned about your child's reaction to stress or trauma, call your physician or a community mental health center.
To learn more about children's mental health:
Call toll-free: 1.800.789.2647
(TDD): 301.443.9006
Web site: mentalhealth.samhsa.gov/child
Comprehensive Community Mental Health Services
for Children and Their Families Program
Child, Adolescent and Family Branch
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
March 02, 2010
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 28, 2010
Disaster Crisis Counseling Program
Crisis Counseling Programs for the Rural Community
Disaster Crisis Counseling Program
The Nature of Disasters
Definition of a Federal Disaster Declaration
The Federal Emergency Management Agency (FEMA) provides supplemental funding to States for short-term crisis counseling projects to assist survivors/victims of Presidentially declared major disasters. FEMA supplements, but does not supplant, mental health services traditionally provided by State and local mental health agencies. The Crisis Counseling Assistance and Training Program (commonly referred to as the Crisis Counseling Program) was first authorized by the U.S. Congress under the Disaster Relief Act of 1974 (Public Law 93-288) and later modified by the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (Public Law 100-707). FEMA is responsible for administering the disaster assistance programs of the Stafford Act, including Federal assistance for crisis counseling services.
A major disaster, as defined by the Stafford Act, is any natural catastrophe, or regardless of cause, any fire, flood, or explosion, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance to supplement efforts and available resources of States, local government, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused by the disaster.
Disaster Types
Different types of disasters covered by the Stafford Act that may impact rural areas include: hurricane, tornado, storm, high water, wind driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought, fire, flood, or explosion. Disasters also differ by a number of characteristics including the following:
Origin of disaster (natural versus human-caused)
Length of warning time
Intensity of the event
Extent of property damage
Number of persons impacted
Number of injuries and deaths
Dynamics of the recovery period
Each type of disaster has its own unique pattern of destruction and characteristics that affect the emotional response of disaster victims (NIMH, 1983):
Flood disasters can result in long incident periods and the evacuation of whole communities.
Earthquakes strike without warning and after shocks intensify fright and despair.
Tornadoes randomly choose their victims, skipping one house and striking the next.
Hurricanes can be unpredictable and suddenly change course causing the evacuation of large areas.
Disasters may be classified as either natural or human-caused. The following chart describes the different characteristics of natural and human-caused disasters. Blame is a characteristic that differs significantly for natural and human-caused disasters. Disaster survivors of human-caused disasters may blame and feel anger toward individuals, groups, or organizations they believe caused or contributed to the disaster. In contrast, survivors of natural disasters may blame and feel anger toward themselves, believe it is "God's Will" or a punishment. Survivors of natural disasters may project their anger onto caretakers, disaster workers, or others (CMHS, 1996).
Natural vs. Human-Caused Disasters
Natural Human-Caused
Causes Forces of nature Human error, malfunctioning
Examples Earthquakes, hurricanes, floods Airplane crashes, major chemical leaks, nuclear reactor accidents
Blame No one Person, government, business
Scope Various locations Locations may be inaccessible to rescuers, unfamiliar to survivors, little advance warning
Post-disaster
Distress High Higher, often felt by family members not involved in actual disaster
Source: CMHS. Psychosocial Issues for Children and Families in Disasters. A Guide for the Primary Care Physician. Washington, D.C.: U.S. Department of Health and Human Services; Publication No. (SMA) 96-3077, 1996.
Definition of Crisis Counseling Services
The Crisis Counseling Program, as it has been supported in the past twenty-five years by the Federal government, provides for short-term interventions with individuals and groups experiencing psychological sequelae from Presidentially-declared disasters. This type of intervention involves classic counseling goals of helping people to understand their current situation and reactions, assisting in the review of their options, providing emotional support, and encouraging linkage with other resources and agencies who may assist the individual. The assistance is focused upon helping the person deal with the current situation in which they may find themselves.
It draws upon the assumption, until there are contradictory indications, that the individual can resume a productive and fulfilling life following the disaster experience if given support, assistance, and information at a time and in a manner appropriate to his or her experience, education, developmental stage, and ethnicity (CMHS, 1994.
The Emergency Services and Disaster Relief Branch (ESDRB) of the Center for Mental Health Services (CMHS) will provide technical assistance to states in developing a grant request.
The ESDRB can be reached by phone at (301) 443-4735.
The Crisis Counseling Program is unique in comparison to the mix of Federal programs made available through a Presidential disaster declaration. It is the one program for which virtually anyone qualifies and where the person affected by disaster does not have to recall numbers, estimate damages, or otherwise justify need. The program provides primary assistance in dealing with the emotional sequelae to disaster.
Robert T. Stafford Act
The Stafford Act authorizes the President to provide training and services to alleviate mental health problems caused or aggravated by declared disasters. The Crisis Counseling Program is designed to provide supplemental funding to States for short-term crisis counseling services and is implemented when creating such services are beyond the resources of the State or local providers, given a Presidential disaster declaration.
FEMA may fund two separate portions of the Crisis Counseling Program: Immediate Services (IS) and Regular Services (RS). The IS grant enables the State and its local agency to respond to the immediate mental health needs with crisis counseling services. IS can be funded for up to sixty days after the Presidential declaration. If an RS application has been submitted, the program period for the immediate services may be extended thirty days and additional funding may be awarded. FEMA may approve a longer extension, if the review process of the regular program application exceeds thirty days. Costs incurred from the date of the incident to the date of declaration may be reimbursable under the immediate services program. The RS provides up to nine months of crisis counseling services, community outreach, and consultation and education services to people affected by the disaster. Funding for RS is separate from IS. The State may apply for either or both portions of the Crisis Counseling Program.
Application for IS funding must be completed within fourteen days of the disaster declaration. The application must contain a disaster description, needs assessment, program plan, budget, and budget narrative. The needs assessment is based on the needs of the affected communities and the ability of the current mental health system to respond to those needs. A State must demonstrate that State and local resources are insufficient to provide adequate services.
Differences Between Disaster Mental Health and Traditional Mental Health Programs
Disaster Crisis Counseling Programs are a departure from traditional mental health practice in many ways. The program is designed to address incident specific stress reactions, rather than ongoing or developmental mental health needs (CMHS, 1994). Programs must be structured and implemented according to Federally established guidelines and for a specific period. Emphasis is on serving individuals, families, and groups of people - all of whom share a devastating event that most likely changed the face of their entire community.
CRISIS COUNSELING PROGRAM
Immediate Services
Application due in fourteen days
Sixty-day program
Extension if RS is applied for
Regular Services
Apply within sixty days of declaration
Nine month program
Applications must include
Disaster description
Needs Assessment
Program Plan
Budget
Budget narrative
for more information click below
crisis counseling ceus
Outreach and crisis counseling activities are the core of the Crisis Counseling Program and create a unique set of challenges. Disaster crisis counseling requires breaking out of traditional ways of identifying people in need of services, providing access to those services, maintaining documentation, and determining effectiveness. Mental health professionals will work hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors/victims of the disaster in ways that may be foreign to their clinical training. This publication will focus on the implementation of appropriate crisis counseling services for rural communities across the United States.
Disaster Crisis Counseling Program
The Nature of Disasters
Definition of a Federal Disaster Declaration
The Federal Emergency Management Agency (FEMA) provides supplemental funding to States for short-term crisis counseling projects to assist survivors/victims of Presidentially declared major disasters. FEMA supplements, but does not supplant, mental health services traditionally provided by State and local mental health agencies. The Crisis Counseling Assistance and Training Program (commonly referred to as the Crisis Counseling Program) was first authorized by the U.S. Congress under the Disaster Relief Act of 1974 (Public Law 93-288) and later modified by the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (Public Law 100-707). FEMA is responsible for administering the disaster assistance programs of the Stafford Act, including Federal assistance for crisis counseling services.
A major disaster, as defined by the Stafford Act, is any natural catastrophe, or regardless of cause, any fire, flood, or explosion, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance to supplement efforts and available resources of States, local government, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused by the disaster.
Disaster Types
Different types of disasters covered by the Stafford Act that may impact rural areas include: hurricane, tornado, storm, high water, wind driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought, fire, flood, or explosion. Disasters also differ by a number of characteristics including the following:
Origin of disaster (natural versus human-caused)
Length of warning time
Intensity of the event
Extent of property damage
Number of persons impacted
Number of injuries and deaths
Dynamics of the recovery period
Each type of disaster has its own unique pattern of destruction and characteristics that affect the emotional response of disaster victims (NIMH, 1983):
Flood disasters can result in long incident periods and the evacuation of whole communities.
Earthquakes strike without warning and after shocks intensify fright and despair.
Tornadoes randomly choose their victims, skipping one house and striking the next.
Hurricanes can be unpredictable and suddenly change course causing the evacuation of large areas.
Disasters may be classified as either natural or human-caused. The following chart describes the different characteristics of natural and human-caused disasters. Blame is a characteristic that differs significantly for natural and human-caused disasters. Disaster survivors of human-caused disasters may blame and feel anger toward individuals, groups, or organizations they believe caused or contributed to the disaster. In contrast, survivors of natural disasters may blame and feel anger toward themselves, believe it is "God's Will" or a punishment. Survivors of natural disasters may project their anger onto caretakers, disaster workers, or others (CMHS, 1996).
Natural vs. Human-Caused Disasters
Natural Human-Caused
Causes Forces of nature Human error, malfunctioning
Examples Earthquakes, hurricanes, floods Airplane crashes, major chemical leaks, nuclear reactor accidents
Blame No one Person, government, business
Scope Various locations Locations may be inaccessible to rescuers, unfamiliar to survivors, little advance warning
Post-disaster
Distress High Higher, often felt by family members not involved in actual disaster
Source: CMHS. Psychosocial Issues for Children and Families in Disasters. A Guide for the Primary Care Physician. Washington, D.C.: U.S. Department of Health and Human Services; Publication No. (SMA) 96-3077, 1996.
Definition of Crisis Counseling Services
The Crisis Counseling Program, as it has been supported in the past twenty-five years by the Federal government, provides for short-term interventions with individuals and groups experiencing psychological sequelae from Presidentially-declared disasters. This type of intervention involves classic counseling goals of helping people to understand their current situation and reactions, assisting in the review of their options, providing emotional support, and encouraging linkage with other resources and agencies who may assist the individual. The assistance is focused upon helping the person deal with the current situation in which they may find themselves.
It draws upon the assumption, until there are contradictory indications, that the individual can resume a productive and fulfilling life following the disaster experience if given support, assistance, and information at a time and in a manner appropriate to his or her experience, education, developmental stage, and ethnicity (CMHS, 1994.
The Emergency Services and Disaster Relief Branch (ESDRB) of the Center for Mental Health Services (CMHS) will provide technical assistance to states in developing a grant request.
The ESDRB can be reached by phone at (301) 443-4735.
The Crisis Counseling Program is unique in comparison to the mix of Federal programs made available through a Presidential disaster declaration. It is the one program for which virtually anyone qualifies and where the person affected by disaster does not have to recall numbers, estimate damages, or otherwise justify need. The program provides primary assistance in dealing with the emotional sequelae to disaster.
Robert T. Stafford Act
The Stafford Act authorizes the President to provide training and services to alleviate mental health problems caused or aggravated by declared disasters. The Crisis Counseling Program is designed to provide supplemental funding to States for short-term crisis counseling services and is implemented when creating such services are beyond the resources of the State or local providers, given a Presidential disaster declaration.
FEMA may fund two separate portions of the Crisis Counseling Program: Immediate Services (IS) and Regular Services (RS). The IS grant enables the State and its local agency to respond to the immediate mental health needs with crisis counseling services. IS can be funded for up to sixty days after the Presidential declaration. If an RS application has been submitted, the program period for the immediate services may be extended thirty days and additional funding may be awarded. FEMA may approve a longer extension, if the review process of the regular program application exceeds thirty days. Costs incurred from the date of the incident to the date of declaration may be reimbursable under the immediate services program. The RS provides up to nine months of crisis counseling services, community outreach, and consultation and education services to people affected by the disaster. Funding for RS is separate from IS. The State may apply for either or both portions of the Crisis Counseling Program.
Application for IS funding must be completed within fourteen days of the disaster declaration. The application must contain a disaster description, needs assessment, program plan, budget, and budget narrative. The needs assessment is based on the needs of the affected communities and the ability of the current mental health system to respond to those needs. A State must demonstrate that State and local resources are insufficient to provide adequate services.
Differences Between Disaster Mental Health and Traditional Mental Health Programs
Disaster Crisis Counseling Programs are a departure from traditional mental health practice in many ways. The program is designed to address incident specific stress reactions, rather than ongoing or developmental mental health needs (CMHS, 1994). Programs must be structured and implemented according to Federally established guidelines and for a specific period. Emphasis is on serving individuals, families, and groups of people - all of whom share a devastating event that most likely changed the face of their entire community.
CRISIS COUNSELING PROGRAM
Immediate Services
Application due in fourteen days
Sixty-day program
Extension if RS is applied for
Regular Services
Apply within sixty days of declaration
Nine month program
Applications must include
Disaster description
Needs Assessment
Program Plan
Budget
Budget narrative
for more information click below
crisis counseling ceus
Outreach and crisis counseling activities are the core of the Crisis Counseling Program and create a unique set of challenges. Disaster crisis counseling requires breaking out of traditional ways of identifying people in need of services, providing access to those services, maintaining documentation, and determining effectiveness. Mental health professionals will work hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors/victims of the disaster in ways that may be foreign to their clinical training. This publication will focus on the implementation of appropriate crisis counseling services for rural communities across the United States.
After The Disaster: A Children’s Mental Health Checklist
After The Disaster: A Children’s Mental Health Checklist
Disasters can be particularly traumatic to children. Sometimes, it can be difficult to determine the extent of the psychological trauma, and whether or not professional mental health services are indicated. This checklist is one way to assess a child’s mental health status.
Add up the pluses and minuses to obtain a final score. If the child scores more than 35, it is suggested you seek a mental health consultation.
Has the child had more than one major stress within a year BEFORE this disaster, such as a death in the family, a molestation, a major physical illness or divorce? If yes: +5
Does the child have a network of supportive, caring persons who continue to relate to him daily? If yes: -10
Has the child had to move out of his house because of the disaster? If yes: +5
Was there reliable housing within one week of the earthquake with resumption of the usual household members living together? If yes: -10
Is the child showing severe disobedience or delinquency? If yes: +5
Is the child showing any of the following as NEW behaviors for more than three weeks after the disaster?
Nightly states of terror? +5
Waking from dreams confused or in a sweat? +5
Difficulty concentrating? +5
Extreme irritability? +5
Loss of previous achievements in toilet or speech? +5
Onset of stuttering or lisping? +5
Persistent severe anxiety or phobias? +5
Obstinacy? +5
New or exaggerated fears? +5
Rituals or compulsions? +5
Severe clinging to adults? +5
Inability to fall asleep or stay asleep? +5
Startling at any reminder of the disaster? +5
Loss of ambition for the future? +5
Loss of pleasure in usual activities? +5
Loss of curiosity? +5
Persistent sadness or crying? +5
Persistent headaches or stomach aches? +5
Hypochondria? +5
Has anyone in the child’s immediate family been killed or severely injured in the disaster (including severe injury to the child)? +15
Note: Preoccupation with death, unusual accident proneness or suicidal threats are reasons for immediate consultations. It is also recommended that any child who has been seriously injured or who has lost a parent, sibling or caregiver by death, have a psychological evaluation and/or brief therapy.
Note: This checklist was developed under the auspices of Project COPE, a federal funded (FEMA) crisis counseling program activated in Santa Cruz, California, in response to the October 17, 1989 Loma Prieta Earthquake. The project provided individual, family and group counseling, agency debriefing services and a school intervention program. Over the course of 16 months, the project provided services to more than 25,000 individuals. Peter J. Spofford, M.S. served as Project COPE Director.
Disasters can be particularly traumatic to children. Sometimes, it can be difficult to determine the extent of the psychological trauma, and whether or not professional mental health services are indicated. This checklist is one way to assess a child’s mental health status.
Add up the pluses and minuses to obtain a final score. If the child scores more than 35, it is suggested you seek a mental health consultation.
Has the child had more than one major stress within a year BEFORE this disaster, such as a death in the family, a molestation, a major physical illness or divorce? If yes: +5
Does the child have a network of supportive, caring persons who continue to relate to him daily? If yes: -10
Has the child had to move out of his house because of the disaster? If yes: +5
Was there reliable housing within one week of the earthquake with resumption of the usual household members living together? If yes: -10
Is the child showing severe disobedience or delinquency? If yes: +5
Is the child showing any of the following as NEW behaviors for more than three weeks after the disaster?
Nightly states of terror? +5
Waking from dreams confused or in a sweat? +5
Difficulty concentrating? +5
Extreme irritability? +5
Loss of previous achievements in toilet or speech? +5
Onset of stuttering or lisping? +5
Persistent severe anxiety or phobias? +5
Obstinacy? +5
New or exaggerated fears? +5
Rituals or compulsions? +5
Severe clinging to adults? +5
Inability to fall asleep or stay asleep? +5
Startling at any reminder of the disaster? +5
Loss of ambition for the future? +5
Loss of pleasure in usual activities? +5
Loss of curiosity? +5
Persistent sadness or crying? +5
Persistent headaches or stomach aches? +5
Hypochondria? +5
Has anyone in the child’s immediate family been killed or severely injured in the disaster (including severe injury to the child)? +15
Note: Preoccupation with death, unusual accident proneness or suicidal threats are reasons for immediate consultations. It is also recommended that any child who has been seriously injured or who has lost a parent, sibling or caregiver by death, have a psychological evaluation and/or brief therapy.
Note: This checklist was developed under the auspices of Project COPE, a federal funded (FEMA) crisis counseling program activated in Santa Cruz, California, in response to the October 17, 1989 Loma Prieta Earthquake. The project provided individual, family and group counseling, agency debriefing services and a school intervention program. Over the course of 16 months, the project provided services to more than 25,000 individuals. Peter J. Spofford, M.S. served as Project COPE Director.
February 27, 2010
Questions to Help Children Talk About a Disaster
Emergency Mental Health and Traumatic Stress
Tips for Teachers
Questions to Help Children Talk About a Disaster
Disasters hit children hard. It is difficult for them to understand and accept that there are events in their lives that cannot be predicted or controlled. Perhaps worst of all, we as adults cannot "fix" a disaster, solve it, or keep it from happening again.
As a classroom teacher, you can play an important role in the healing process of children who are affected by a disaster. One technique you can use to help children cope and heal is to assist them in expressing their experiences and feelings by talking. This technique works best when you use "open-ended" questions that require more than a "yes" or "no" answer. There are many leading questions you can use to encourage children to talk, such as:
Where were you and what were you doing when the disaster happened?
What was your first thought when it happened?
What did other people around you do during/after the disaster?
Was anyone you know hurt or killed?
Did/do you dream about the disaster?
What reminds you of the disaster?
What do you do differently since the disaster?
How do you feel now?
How have you gotten through rough times before?
What, if anything, would you do differently if this happened again?
As the children begin to open up, encourage various views. Acknowledge their experiences and reassure them that what they are feeling is "normal." Play a guiding role, rather than trying to control the discussions.
Allow children with low language skills, shyness, or discomfort to be silent. It might be helpful to encourage peer support for these children. If a child has limited English-language skills, consider asking for a translator to help the child express him/herself. Create an atmosphere in which a child can feel comfortable sharing experiences and feelings in any language. The goal of the process is to help children feel better. If any of your students show serious signs of distress, consult a school counselor or mental health professional.
Tips for Teachers
Questions to Help Children Talk About a Disaster
Disasters hit children hard. It is difficult for them to understand and accept that there are events in their lives that cannot be predicted or controlled. Perhaps worst of all, we as adults cannot "fix" a disaster, solve it, or keep it from happening again.
As a classroom teacher, you can play an important role in the healing process of children who are affected by a disaster. One technique you can use to help children cope and heal is to assist them in expressing their experiences and feelings by talking. This technique works best when you use "open-ended" questions that require more than a "yes" or "no" answer. There are many leading questions you can use to encourage children to talk, such as:
Where were you and what were you doing when the disaster happened?
What was your first thought when it happened?
What did other people around you do during/after the disaster?
Was anyone you know hurt or killed?
Did/do you dream about the disaster?
What reminds you of the disaster?
What do you do differently since the disaster?
How do you feel now?
How have you gotten through rough times before?
What, if anything, would you do differently if this happened again?
As the children begin to open up, encourage various views. Acknowledge their experiences and reassure them that what they are feeling is "normal." Play a guiding role, rather than trying to control the discussions.
Allow children with low language skills, shyness, or discomfort to be silent. It might be helpful to encourage peer support for these children. If a child has limited English-language skills, consider asking for a translator to help the child express him/herself. Create an atmosphere in which a child can feel comfortable sharing experiences and feelings in any language. The goal of the process is to help children feel better. If any of your students show serious signs of distress, consult a school counselor or mental health professional.
Disaster counseling
DISASTER COUNSELING SKILLS
Disaster counseling involves both listening and guiding. Survivors typically benefit from both talking about their disaster experiences and being assisted with problem-solving and referral to resources. The following section provides "nuts-and-bolts" suggestions for workers.
ESTABLISHING RAPPORT
Survivors respond when workers offer caring eye contact, a calm presence, and are able to listen with their hearts. Rapport refers to the feelings of interest and understanding that develop when genuine concern is shown. Conveying respect and being nonjudgmental are necessary ingredients for building rapport.
ACTIVE LISTENING
Workers listen most effectively when they take in information through their ears, eyes, and "extrasensory radar" to better understand the survivor's situation and needs. Some tips for listening are:
Allow silence - Silence gives the survivor time to reflect and become aware of feelings. Silence can prompt the survivor to elaborate. Simply "being with" the survivor and their experience is supportive.
Attend nonverbally - Eye contact, head nodding, caring facial expressions, and occasional "uh-huhs" let the survivor know that the worker is in tune with them.
Paraphrase - When the worker repeats portions of what the survivor has said, understanding, interest, and empathy are conveyed. Paraphrasing also checks for accuracy, clarifies misunderstandings, and lets the survivor know that he or she is being heard. Good lead-ins are: "So you are saying that . . . " or "I have heard you say that . . . "
Reflect feelings - The worker may notice that the survivor's tone of voice or nonverbal gestures suggests anger, sadness, or fear. Possible responses are, "You sound angry, scared etc., does that fit for you?" This helps the survivor identify and articulate his or her emotions.
Allow expression of emotions - Expressing intense emotions through tears or angry venting is an important part of healing; it often helps the survivor work through feelings so that he or she can better engage in constructive problem-solving. Workers should stay relaxed, breathe, and let the survivor know that it is OK to feel.
SOME DO'S AND DON'T'S
Do say:
These are normal reactions to a disaster.
It is understandable that you feel this way.
You are not going crazy.
It wasn't your fault, you did the best you could.
Things may never be the same, but they will get better, and you will feel better.
Don't say:
It could have been worse.
You can always get another pet/car/house.
It's best if you just stay busy.
I know just how you feel.
You need to get on with your life.
The human desire to try to fix the survivor's painful situation or make the survivor feel better often underlies the preceding "Don't say" list. However, as a result of receiving comments such as these, the survivor may feel discounted, not understood, or more alone. It is best when workers allow survivors their own experiences, feelings, and perspectives.
Disaster counseling involves both listening and guiding. Survivors typically benefit from both talking about their disaster experiences and being assisted with problem-solving and referral to resources. The following section provides "nuts-and-bolts" suggestions for workers.
ESTABLISHING RAPPORT
Survivors respond when workers offer caring eye contact, a calm presence, and are able to listen with their hearts. Rapport refers to the feelings of interest and understanding that develop when genuine concern is shown. Conveying respect and being nonjudgmental are necessary ingredients for building rapport.
ACTIVE LISTENING
Workers listen most effectively when they take in information through their ears, eyes, and "extrasensory radar" to better understand the survivor's situation and needs. Some tips for listening are:
Allow silence - Silence gives the survivor time to reflect and become aware of feelings. Silence can prompt the survivor to elaborate. Simply "being with" the survivor and their experience is supportive.
Attend nonverbally - Eye contact, head nodding, caring facial expressions, and occasional "uh-huhs" let the survivor know that the worker is in tune with them.
Paraphrase - When the worker repeats portions of what the survivor has said, understanding, interest, and empathy are conveyed. Paraphrasing also checks for accuracy, clarifies misunderstandings, and lets the survivor know that he or she is being heard. Good lead-ins are: "So you are saying that . . . " or "I have heard you say that . . . "
Reflect feelings - The worker may notice that the survivor's tone of voice or nonverbal gestures suggests anger, sadness, or fear. Possible responses are, "You sound angry, scared etc., does that fit for you?" This helps the survivor identify and articulate his or her emotions.
Allow expression of emotions - Expressing intense emotions through tears or angry venting is an important part of healing; it often helps the survivor work through feelings so that he or she can better engage in constructive problem-solving. Workers should stay relaxed, breathe, and let the survivor know that it is OK to feel.
SOME DO'S AND DON'T'S
Do say:
These are normal reactions to a disaster.
It is understandable that you feel this way.
You are not going crazy.
It wasn't your fault, you did the best you could.
Things may never be the same, but they will get better, and you will feel better.
Don't say:
It could have been worse.
You can always get another pet/car/house.
It's best if you just stay busy.
I know just how you feel.
You need to get on with your life.
The human desire to try to fix the survivor's painful situation or make the survivor feel better often underlies the preceding "Don't say" list. However, as a result of receiving comments such as these, the survivor may feel discounted, not understood, or more alone. It is best when workers allow survivors their own experiences, feelings, and perspectives.
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.
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