NAMI Basics Education Program

The fundamentals of caring for you, your family and your child with mental illness

Companion Power Point Presentation2008

Class 1 Agenda

• Welcome• Introductions to NAMI• Introduction to Teachers• Introduction to NAMI Basics

evaluation• Introduction to the NAMI

Basics program• Participant Introductions• Welcome to Holland• This is the illness your family

has to live with• Adjourn

NAMI Basics Evaluation Duke University: Dr. Barbara Burns Columbia University: Dr. Kimberly Hoagwood

University of Louisiana: Dr. Catherine Estis

• Goal: Offer course to more parents/caregivers free of charge– Demonstrate effectiveness

• What do participants learn?• Impact on family

– Measure• Before/after/3 month follow up

– Forms • Informed consent• 4 brief questionnaires

– Participation in the study is not required to take the course

– Questions?

NAMI• National Alliance on Mental Illness

– NAMI Tennessee, 45 affiliates– NAMI Robertson County

• Support group to start in January

• Founded in 1979• Nation’s largest grassroots mental

health organization• Mission

– Improve lives of adults and children with mental illness

– And their families– Support, Education, Advocacy, Research

• Membership– $25.00 family, three level membership– $3.00 open door, three level membership– Membership not required, but helps

NAMI be the nation’s voice on mental illness

NAMI Basics• For Families, other direct caregivers of

children/youth• Child diagnosed, or might have:

– Mental illness, or – Emotional disturbance

• Goals:– Give information to help caregivers– Help caregivers cope with traumatic

impact of mental illness on entire family– Decision tools to help you get care for

your child– Help you care for yourself and the rest of

the family

• Handout #1: NAMI Basics Principles

Discussion

• How do you feel about the idea that mental illnesses are brain disorders?– Physical illnesses– Like diabetes or heart conditions– It’s not your fault– But, you can take action to improve

• Resiliency • Recovery

Class Introductions

• Your name• Your occupation• Age & diagnosis of your child(ren)• Your relationship to child

– Parent, grandparent, foster-parent..

• Most pressing issue– 50 words or less

• What you hope to get from this class

Stigma & Mental Illness• Not casserole illnesses• Families, neighbors & friends don’t

know what to say– Avoid us

• Stigma is a mark of shame– Tipper Gore: “The last great stigma of the

20th century is the stigma of mental illness.”

• NAMI is erasing stigma & discrimination against individuals & families

• Pride in family resiliency– Child’s successes despite challenges

• Handout #2: Stigma & Mental Illness• Handout #3: The Facts

Discussion

• Why does society keep blaming families?

• Think of a time when you felt blamed for your child’s problems with mental illness

• What was that like?

Welcome to Holland• Handout #4: Welcome to Holland• Typical vs. Atypical• There is no “normal” child• Our children’s brain disorders are

“invisible”• Public sees behavior, not disability

– Blame adds to family burden

• Handout #5: Mental Illness as a Catastrophic Event

• But, our families have strength…• Handout #6: Predictable Stages of

Emotional Reactions Among Family Members Dealing with Mental Illness

Catastrophic StressorsClass 1: Chart 1

• An unanticipated event

• No time to prepare for it

• No previous experience about how to handle it

• Has a high emotional impact

• Involves threat or danger to self or others

Predictable Stages of Emotional Reactions

Class 1: Chart 2

Stage 1: Dealing with the Catastrophic Event

Stage 2: Learning to Cope: “going through the mill”

Stage 3: Moving into Advocacy: “CHARGE”

Every reaction is normalOnce you know where you are, then you can determine what you need.

Discussion: What do you think about the “Predictable Stages?”

Symptoms of Mental Illness

• Handout #7: Double edged sword of mental illness

• Positive: Traumatic changes in child’s behavior

• Negative: Traumatic losses due to brain disorder

• Self-Care is essential• Put your own mask on first

– Then you can help your child

• Handout #8: Course Syllabus

Class 2 Agenda

• Human Development

• The Biology of Mental Illness

• Getting an Accurate Diagnosis

• Overview of some of the illnesses

• Adjourn

Human Development• Freud, Erickson, Piaget, Koplewicz

– Children develop in stages– One stage must be completed before the

next can begin• Handout #1: Theories of Development• Freud: Child’s development depends on

interaction with parents (mother). – Must achieve one stage before the next

• Erickson: Lifelong human development• Piaget: Brain helps navigate stages• Handout 2: Koplewicz- children go through

similar stages at different rates• Where your child is in developmental process

– What your child is working on

• Brain Development: conception – 3yrs, fastest brain development

Brain CellClass 2: Handout # 3

The Human BrainClass 2: Handout # 4

The Limbic SystemClass 2: Handout # 5

ADHD & ADD• Core symptoms for >6 months:

– Inattention• Can’t pay attention to details• Avoid, dislike activities that require attention• Distractible, forgetful, careless, disorganized• Do not finish schoolwork

– Hyperactivity & Impulsivity• Agitation, fidgeting, squirming• Interrupts, speaks out of turn• “On the go,” acts as if driven• Intrudes on others, escalates when reprimanded

– Combined type– Low frustration tolerance

• Symptoms have persisted since early childhood• Something was “off” from the beginning• Describe child as “never slowing down”• May misread the child as bad or stupid, wonder

why the child is always in trouble in school

Major Depression• Core symptom is not sadness, but irritability

and aggressiveness– Extreme irritability, aggressiveness– Angry all the time, sullen, – Physical complaints, headaches, stomachaches– Drop in grades, won’t do homework– Negative self-judgment, hypersensitive to criticism– Overreact to disappointment, frustration– Unable to have fun, withdraw– Lethargic, doesn’t care– Sleep and appetite, too much or too little– May have hallucination, delusion, paranoia

• Observations from Home– Nothing pleases the child– Child is no fun to live with– Observe that child “’puts on a good face” in public– Worst symptoms at home

Depression in Teens

• Twice as many girls as boys• May mask with high performance or by

“hiding” at school or home– Sad, hopeless, empty– Sensitive, overreact to rejection, criticism,

disappointment– Grouchy, sulky– Lethargic, no energy, sleepy

• OR can’t control hyperactivity– Restless, aggressive, antisocial

• High risk of substance abuse– Think they are different, no one

understands• Stop caring about appearance• Thoughts of death

• Increased risk of suicide– 3rd leading cause of death ages 15 - 19

Bipolar Disorder

• Strong family history of bipolar• Extreme mood swings, may be rapid• Mania

– Hair trigger arousal, set off by slightest thing– Irritable, oppositional, negative behavior– Rage usually controlled at school– Hyperactive, distractible, inattentive– Grandiose behavior– Hypersexual activities & comments– Sensitivity to heat– Craving for carbohydrates– Psychotic episodes; delusions, hallucinations

• Depression• Observations from home

– Child “always different,” ragged sleep cycles, nightmares

– Severe separation anxiety– Sleep disturbance– Extreme physical sensitivity– Child worse at home than at school

Bipolar in Teens• Manic

– Insomnia, active late at night– “Gonna do” many things, unrealistic expectations– Rapid, insistent speech– All or nothing thinking– Spending sprees– Reckless driving, DUI, car accidents– Hyper-sexuality, no regard for consequences– Lying, cutting class, sneaking out at night to party– Psychotic; delusions (may have romantic

delusions), hallucinations

• Depression– Crying, gloom & doom thinking– Moodiness, irritable– Fatigue, oversleeping, no energy– Insecurity, low self-esteem– School avoidance, plays sick, physical complaints– Isolation, pushes people away– Suicidal thoughts, attempts

Oppositional Defiant Disorder& Conduct Disorder

• ODD– Negative, hostile, defiant– Persistent arguing, belligerent, stubborn– Intense rigidity, inflexibility– Touchy , resentful

• CD– Aggression, cruelty to people & animals– Destructiveness– Deceitfulness– Disobedience– Lack of remorse

• Observations from Home– Angry with child who doesn’t obey– Shocked, embarrassed by child’s behavior– Overwhelmed by criticism– Many school suspensions– Can’t take the child anywhere

ODD & CD in Teens

• When not treated early, ODD & CD worsens in teens– Truancy, school failure, expulsion– Reckless, accident prone– Low self-esteem covered by

cockiness.– Substance abuse– Serious harm to others: bullying,

physical abuse, rape– Encounters with criminal justice

system

Anxiety Disorder• Most common childhood mental illnesses• Separation Anxiety (panic disorder)

– Intense anxiety at separation from parents – Worry that parents will die– Refusal to sleep alone, will not go to sleepovers– Plays sick to avoid school

• Overanxious Disorder (GAD)– Overall worries– Dread of making mistakes, perfectionist– Too serious, tense, unsure, can’t take criticism– Deaf to reassurance

• Avoidant Disorder (social phobia)– Acute shyness– Restriction of social contacts to family– Fear of being singled out, evaluated, called on– Phobic about specific situations

• Observations from home– Concern over repeated school absences– Meltdowns occur when activities are forced– Catch 22: accommodating child’s fears risks school

failure, yet so does sending child to school

Anxiety Disorders in Teens

• Panic Disorder– Heart pounding, chest pain, shortness of

breath– Sweating, trembling– Feeling of choking, nausea, dizziness– Fear of dying, losing control, “going crazy”

• Social Phobia– Fear of specific social situations– Dread of humiliation, embarrassment– Avoidance of feared situations

• Social Phobia (generalized)– Fears most situations– Inability to start conversations– Fear of participating in small groups– Fear of talking to authorities

Obsessive Compulsive Disorder (OCD)

• Almost as common as ADHD• Twice as many boys as girls• Obsessions

– Fear of contamination (germs)– Fear of danger to self/others (fire, death, illness)– Fixation on lucky/unlucky numbers– Need for symmetry/exactness– Excessive doubts– Forbidden, aggressive, perverse thoughts

• Compulsions– Ritual handwashing, showering, grooming, cleaning– Repetitive counting, touching, going in/out,

writing/erase/re-writing– Continuous checking, questioning, hoarding

• Observations from home– Family must cooperate with rituals to avoid tantrums – Child too exhausted to play or join family activities– Bewildered & angry at child’s inability to control

behaviors– Compulsions swamp home life, more subdued in public

Childhood Onset Schizophrenia

• Rare, 1 in 40,000• Slow emergence of psychotic symptoms

– Early inhibition, withdrawal, sensitivity– Problems with conduct– Anxious, disruptive in social situations– Poor motivation and follow-through– School failure, special ed required– Inability to make friends, disinterested– Confusion about what is real, hears voices,

delusions – Little emotion shown, speaks rarely, – Inappropriate emotion– Infrequent eye contact/body language

• Observations from home– Child hears voices saying bad things about him– Stares at things that aren’t there– Child not interested in making friends– Odd behaviors pervasive in all parts of child’s life– Child appears “blank,” delays answering

questions, asks for statements to be repeated.

Schizophrenia• Onset late teens• More common, 1 in 100• Prodromal

– Uncontrollable crying not linked with source of sadness– Agitation, weight loss, lack of attention to hygiene– Withdrawal, isolation, grades drop– Odd sensory experiences, odd beliefs & rituals– Feelings of cosmic importance, intensely religious– Suspicious, feeling of being watched, disliked

• Acute “Positive” symptoms– Delusions & hallucinations– Grossly disorganized behavior, bizarre actions– Bizarre body postures, pacing, rocking, grimacing

• Residual “Negative” symptoms– Blunted emotional responses– Lack of motivation, no goal directed activities– Inability to relate to others– Lack of insight that one is ill– Poverty of speech, brief responses

• Observations from home– High functioning teenager falls apart, unrecognizable– Family engulfed in fear and panic, something is very

wrong

Class 3 Agenda

• Telling Our Stories

• Treatment Options Available

• The Medication Dilemma

• Adjourn

Telling Our StoriesClass 3: Chart 1

• Child’s name and age

• Child’s diagnosis/diagnoses

• How old was the child when symptoms began?

• What were the symptoms?

• How is the child doing now? In school? At home?

• How are YOU right now? Where are you on the Stages chart?

Getting Treatment• Request: Minimize provider “bashing” • Disclaimer: We discuss general terms,

cannot suggest specific treatment, • Step 1: Pediatrician

– May refer to mental health– Offer to treat child, including medication– Refer to school counselor

• Handout #1: Value of Early Identification• Step 2: Contact community mental health agency

• Handout #2: Mental Health Professionals– Talk to others regarding who to see, providers,

clergy, families– May have a waiting list, pediatrician in the interim

• Step 3: Evaluation is the treatment foundation

• Handout #3: Psychiatric Evaluation• YOU are the CEO of your child’s care

Discussion• What was the process like getting

treatment for your child?– Was there a downside when you got the

evaluation?– What was the hardest part of the

evaluation for you?– How did you feel when you heard the

diagnosis?

• Handout #4: Bio-psycho-social dimensions

Treatment Options• Outpatient: Child lives at home, goes

for appointments• Inpatient: Child goes to hospital or

residential treatment– When child poses risk to self/others

• Day treatment/partial hospitalization:– Child at home for night, but in program all

day• Once level of treatment is decided,

treatment is recommended– Treatment plan– You and your child should be part of your

child’s treatment planning– Outcomes:

• Symptom reduction, improved school attendance, family relationships, decreased involvement with the law, substance abuse

• Prevent need for more restrictive service, decrease hospitalization or out-of-home placement

Discussion

• Tell us about your experience so far with navigating mental health treatment options.

Medication• Ground rule #1:

– We won’t be playing doctor

• Ground rule #2: – We will discuss general questions only.

• Medication types have increased due to ability to study neurotransmitters & activity in the synapses

Class 3 Handout # 7 Two neurons in synaptic

contact

Psychiatric Medication and Children

• Few pharmacology studies on children, no long term studies

• FDA approval is difficult, clinical literature builds case for “off label” use

• Handout #11: FDA meds approved for Children and Youth

• Black Box Warning: May cause serious adverse effects– FDA requires black box warning on

antidepressants increased risk of suicide– Does not mean medication caused behavior– BUT needs monitoring to catch suicidality early

Risks of Anti-Depressants• Suicidal thoughts are part of depression• 2 phase response to anti-depressants

– Initial lift in energy before mood lifts– “Energized state of despair,” increased suicide risk

• Did anti-depressant cause suicidal thinking– Or was it part of the illness?– Either way, we must watch our kids closely during

medication change

• Since 2007, when black box warning issued– Decreased prescription of anti-depressants– Increased depression in children & teens– Increased suicide rates in children & teens

• NAMI favors: – Informed consent of risks/benefits of treatment – Vs. risks of no treatment. – Careful monitoring, – Comprehensive treatment.

Discussion

• What is your experience with deciding to use or not use medication with your child?

• Handout #12: Classes of psychotropic medication

• Handout #13: Parents’ Top Ten How to make sure your child gets the best possible treatment

• More tip sheets in resource section• Name one thing you will do to take care of

yourself this week

Class 4 Agenda

• Family Burden

• Communication Skills

• Problem Solving Skills

• Tips for Handling Difficult Behavior in Children

• Crisis Preparation and Responses

• Adjourn

Family Burden• Dealing with a child’s mental illness affects

the well-being of the entire family– Family feels alone, shunned– Handout #1: Minimizing negative impact on other

family members • Improving skills for difficult situations

– Reduces family turmoil due to mental illness

• Roles of other family members change– Other children may resent & blame the ill child– Parents may resent each other, especially about

how to handle child’s mental illness

• We cannot sacrifice the rest of the family to take care of the ill child– Handout #2: Minimizing Negative Impact on

Family Members

Discussion

• How has it been for you? – caring for your child with mental

illness – while also living the rest of your

life?

• How have your other children handled the challenge?

• What about your job?• What about your personal life?

Communication Skills• Good communication is difficult

– Expressing what you want to say– So others understand what you mean– Understanding what others mean to say

• Add mental illness– Concentration problems– Information processing problems– Intense, unpredictable emotions

• Families living with mental illness – Extra need for good communication skills

• You cannot control what your child says• Or perceives you to say• You CAN control words and tone you use

• When parent communication changes – Child’s communication eventually follows

• Handout #3: Communication Guidelines

I-Statements• Handout 4: I-Statements• Specific, direct comments

– What you think, feel and want– You take responsibility– You say what you mean directly, but calmly– Calm facial expression & eye contact with child

• I feel _______________ (feeling)• When you __________________ (action)

I-StatementFollow-Up

• Invitation to come to a win-win solution:– Help me….– Lets work together on….– Process feelings with reflective response– Before problem solving

• As opposed to YOU Statements – Child feels accused & defensive

• I-statements – Focus on facts, no blaming– Parent expresses feelings– Don’t express doubt.– Say what you mean and mean what you

say.– Good for positive feedback & constructive

criticism

Reflective Response • Focus on feelings of other person

– Our children feel safe venting their feelings on us

– We need to talk to our children about their behavior, but also acknowledge their perception

– “Park” your feelings• Listen for your child’s perceptions & feelings

• Handout 5: Reflective Response1. Acknowledge child’s lived experience2. Validate that anyone with that experience

would feel the way they do3. Communicate that you understand what your

child believes and feels4. Do not correct your child until you have

reflected their perceptions & feelings

Collaborative Problem SolvingPlan B

Class 4: Chart 1

1. Empathy (plus reassurance)

2. Define the problem

3. Invitation

Typical view:

Children do well if they want to

CPS: Children do well if they can

Crisis Preparation & Response

• How to prepare for explosive episodes– Rages – Violent behavior– Psychotic episodes– Self-injurious behaviors, – Suicidal threats, gestures

• 10 Markers of Bipolar Rage– Rages most often occur at night– Rages roar out of nowhere at the drop of a hat– Rage takes a predictable course:

• Build-up• Explosion• Exhaustion

– Great volume of rage cannot be imitated– Gory thinking during rage– Child will destroy precious objects during– Child reports rage as sense of heat– Rage is felt as entity that takes over– Child not able of feeling satisfied– During rage, child is paranoid

Rage Escalation Phases• Dysphoric phase

– Everything annoys them• Provocative phase

– Child looking for a fight

• Explosive phase– Brain frontal lobes inoperative– Limbic brain takes over– Child catapulted into “anything goes”

• Handout 8: Survival Strategies for Managing Rage

• Handout 9: One Mother’s Story

• Regardless of type of violence, safety is always the priority

• Call for help when you need it

Self-Injury• May include:

– Carving, scratching, biting, branding, marking, picking at skin & hair, burning, cutting

• Variety of causes:– Mental illness– Risk-taking display– Expression of individuality– Attention seeking for desperation, anger– Suicidality

• For youth who cannot express emotion– Self-injury may relieve tension for some– Others feel hurt, angry, afraid, hateful

• What to do if your child self-injures– Do not ignore it– Talk with your child, – Use I-statements, reflective response & problem

solving– Watch your child for recurring signs

Suicide• Shockingly common

– 3rd leading cause of death ages 15 – 24– 6th leading cause of death ages 5 -14

• Handout 10: Suicide Myths & Facts• Handout 11: Warning Signs• What to do

– Ask your direct questions:“Are you thinking of killing yourself?”“How do you plan to do it?”

– If there is a plan, call for professional help• Youth Villages• May need hospitalization

– Often – not always – warning signs• Talking about death,

– “Will not be here any more”• Giving away prized possessions• Listening to music about death, • Writing about death • Grades drop• Withdrawal, isolation• Grooming deteriorates

Crisis Plan• Handout 12: Crisis SPIN

– Safety– Plan– Intervene– Negotiate

• Handout 13: Crisis Plan– Who needs to be involved– Steps to follow based on acuity– One place for child’s information: quick access– Once plan is developed

• Every family member reads it• Understands their part• Place it where it can easily be found

• Handout 14: Relapse Plan– Steps to take BEFORE symptoms get to crisis level

• Crisis and relapse plans to be developed when child is in good shape, – NOT during crisis

Discussion

• What are the first symptoms that let you know an episode is beginning for your child?

• Remember the airplane:– Grab your oxygen mask first

• Then help your child– Embrace the situation as a mission,

• Not a burden– Become skillful at helping your child

through dire times– Never give up hope!

Class 5 Agenda

• Record Keeping

• Overview of the Mental Health System

• Overview of School System’s role

• Overview of Juvenile Justice system

• Introduction to Transition Issues

• Adjourn

Record Keeping• You are the primary advocate for your child,

the CEO of your child’s care.– Inform yourself of each system’s responsibilities

and resources– Be prepared with facts about your child

• Keep your own records• Simple is better. Just do it.

– 3 ring binder with dividers– Folders in an accordion file

• Section headings– Personal – Medical – School– Mental Health/Crisis/Relapse – Legal

• Each section– Official documents– Medication record– Conferences, prep, notes and follow-up– phone call logs, emails, letters

Record Keeping System• Handout 1: Record Keeping System• Handout 2: Portable Treatment Record • Handout 3 & 4: Sample forms

– Phone log– Phone/Meeting documentation

• Handout 5: Behavior Change Log– Note changes in your child as they occur

• Parental Record will:1. Decrease the chance of the same mistakes

happening twice.2. Decrease the time needed for a medical history

during intake. 1. Allows more time for the provider to actually

evaluate your child

3. Provide “proof” when necessary4. Be available to “grab & go” in a crisis

Mental Health System• Nationally, the mental health system does

not work well for children and adolescents.– Shortage of qualified personnel

• 2 systems: – Private:

• Paid by private health insurance or individual out of pocket

• Private providers have the right to refuse public health care clients or anyone who can’t pay fees

– Public:• Government (federal, state, local) or non-profits• May charge a sliding fee based on income• Public providers usually accept

– Medicaid (TennCare)– SCHIP (CoverKids)– Medicare

• Handout 6: Government Insurance Programs• Handout 7: Medicaid and SCHIP eligibility• Handout 8: Supplemental Security Income

SSI• Handout 9: Private Insurance

Mental Health Services

• Regional Mental Health Institutes (RMHI)– State hospitals

• Community Mental Health Centers• Handout 11: State Plan for Children’s Mental

Health Services– Vision: System of Care for Children and Youth– Some of these service types only exist in a few

locations

• Handout 12: Rights of Individuals Receiving Services

Patients’ Rights• Confidentiality:

– Illegal/unethical for mental health professionals – To share information about your child’s treatment– To even acknowledge that your child is receiving

services at the agency/facility– UNLESS you give written consent to release

information

• If you are concerned that your/ your child’s rights have been violated– Use grievance procedure provided by agency– Or contact Department of Mental Health and

Developmental Disabilities• 1-800-560-5767 • http://state.tn.us/mental/policy/oca1.html

– Contact TN Disability Law & Advocacy Center

School System• Children spend most of their waking hours at

school– They learn to navigate the world

• Rights provided by federal law– Americans with Disabilities Act (ADA)

• Handout 13: Education laws for children with disabilities– Individuals with Disabilities Education Act (IDEA)– Section 504, Rehabilitation Act– More information in Additional Resources– Unfunded mandates: Schools need to provide

services with no federal dollars

• Handout 14: Eligibility criteria IDEA vs. 504– 504: For child who needs minor accommodations– IDEA: For child who needs more extensive changes

and supports

• Handout 15: Emotional Disturbance (ED) criteria– Educational assessment, NOT medical diagnosis– Our children usually qualify as ED

• Also: learning disabled, autism

School System• When do you ask for help?

– Problems come up with your child’s school work or behavior

– When you notice a problem, it’s probably past time to ask for help

– School may contact you– Start with your child’s teacher – request a meeting

• Take your records & Parents and Teachers as Allies– Let teacher know you are willing to help them

learn to deal with your child– Teacher may need info on mental illness

• School may be reluctant to recognize child’s disability

• Scarce resources would be required to serve your child

• Best to collaborate, but if not…• Advocate – your child’s well-being is at stake

Special Education

• Handout 16: Special Education Process• Individualized Education Plan (IEP)

– Like a treatment plan for education– Developed during IEP meeting with:

• Child, parents, school personnel, others you invite

– IEP signed by you, child & school personnel• Keep a copy in your records• Track what is/is not implemented

• If you are not satisfied, forms on school’s website:– Process for re-determination– Process to file complaint

• You are not alone in this process: Help is available– NAMI – Tennessee Voices for Children

Discussion• What are your experiences with

the school system?• What has it been like for you as a

parent or caregiver?• Have you found a way to make

the system work for you and your child?

• Even if you do everything right, – No guarantees

• School is tough for our children• Self-esteem based on peer relationships• Children do not have power to change

schools – often must learn to cope• Handout 17: 10 tips for school parents

Juvenile Justice System

• If your child’s behavior brings them into contact with the law– Truant officers,– Juvenile court personnel, – Police, law enforcement– Youth detention centers

• Majority of children in Juvenile Justice facilities have diagnosable mental illness – TN, 53%– JJ system does not deliver MH services– We can hope JJ officials recognize mental illness

and refer to treatment– JJ personnel are stretched

• No time to learn• Not enough time to help our children

Juvenile Justice System

• Your child needs an advocate– Make sure the illness gets treated first– Then charges evaluated based on presence of MI– Judges are usually willing to work with parents

who are caring & involved– Having a mental illness is not an excuse to break

the law, but can be a factor in consequences

• Good record-keeping is invaluable!– Provide documentation to authorities– Educate authorities about your child’s illness– Work collaboratively

• If that doesn’t work…– Remember, you are not alone– Others can help you get what is needed– Call NAMI, TN Voices, or Disability Law &

Advocacy Center

Discussion• Have any of you had experience

with the juvenile justice system?• What has it been like for you?• What did you learn from the

experience that might help others?

Transition to Adulthood• Parental rights cease when child turns 18• Changes:

– Confidentiality changes at 18, • You are no longer included in treatment

– TN: Child can make own treatment decisions at 16– Medicaid (TennCare)– SCHIP (Cover Kids)– Educational service eligibility– Social Security benefits, child’s check comes

directly to them• SSI• Social Security Survivor benefits until age 22

– State custody: Ends at 19

Transition to Adulthood

• Going away to college, technical school, employment– Help your child obtain MH providers in

new location• Don’t leave it up to them

– Facilitate written referral and treatment summary

• Current to future providers– Encourage child to sign up with campus

office of disability• Once assessment is done,

– Help is easier to get if needed

– Consider natural social supports• Relatives• Friends• Clubs:

– What does your child like to do?• Faith community

Transition to Adulthood

• Recommended documents:– IDEA transition plan (age 14+)

• Help child develop skills needed in adulthood– HIPAA release (age 18)

• Signed by child • Necessary for you to get treatment information

– Advanced Directive (age 18)• TN: Declaration for Mental Health Treatment

– Wellness Recovery Action Plan (WRAP)– Crisis Plan

• Optional documents: • Mental Health Power of Attorney• Health Care Power of Attorney• Durable Power of Attorney (finances)• Conservatorship

– Only if child is very disabled– Incapable of self-care or make basic decisions

Next Week:Graduation!

• Guest Speakers: • NAMI Robertson County

– Debi Wheatley– Melanie Brander

• Self-Care strategies• Evaluation of Course

– “Take home message” sheets

• Certificates– Refreshments?– Celebration?

Class 6 Agenda

• Presentation by local experts

• Review of items identified as most pressing from Class 1

• Self-Care• Referral to ‘Graduate

School’• Course Evaluation• Diplomas• Adjourn