Transcript Chapter_10_Counselin..._and_Adolescents

Counseling Children
and Adolescents
ECG 558
Chapter 10
Counseling At-Risk Children
and Adolescents
Introduction
Changing socioeconomic factors have
changed family environments in recent
years
 Poverty, economic instability, marital
transitions, social changes, new
technologies & violence have influenced
children/adolescents
 Challenges faced by today’s youth are as
great as ever before
 Fewer adults function as role models &
support systems
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Poverty as a Major Risk Factor
Poverty is related to poor physical health, low
educational attainment, and psychological disorders
 Four factors contribute to increased poverty among
children: decreased economic growth; changes in
employment structure; cut in government benefits for
children; increase in single-parent families
 Poverty experienced at younger age has greater
negative effects than at older age
 Poverty rates for ethnic minority children are higher
than for Caucasian children
 Effects of poverty are multifaceted (less access to
services, more health problems, more family
dysfunction)
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Socializing Systems:
Family Context
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Children are greatly influenced
Characteristics of healthy families: open system,
adaptive, flexible
Parental Divorce & Family Blending
Domestic violence
Child sexual abuse
Parenting Behavior
 Permissiveness
vs. restrictiveness
 Hostility vs.warmth
 Anxious/emotional involvement vs calm
detachment dimensions
Two Issues in the Family Context
I.
II.
Changing family structure
*divorce rates are rising
*blended families are a reality for many children
*working parents place extra caretaking responsibilities on
children
Dysfunctional families
*dysfunction in families is stressful for all members and can
cause disorders
*family environments that put children at risk are:
a. Violence in the home
b. Child Abuse
c. Neglect
d. Homicide
e. Sexual abuse
Socializing Systems: Peer Context
Peer influence
 Drug use
 Peer group interventions
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 Cooperative
learning groups
 Drawback – peers teach & reinforce deviance
behavior = negative peer effects
Socializing Systems:
School Context
Healthy school environments consist of:
1. Strong leadership
2. Collaboration
3. Sense of fairness and respect
4. Discipline
5. Community support
6. Academic curriculum
Socializing Systems
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School Context
Community support is important
 Constrained by deficient social capital
 School structure, size & philosophy influence
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School Dropout
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Low academic motivation, history of problems with
authority, frequent absences, pregnancy/ marriage,
working, family conflict, drug abuse, minority status,
2 years behind
School Violence
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Increased incidents
Fighting/intimidation
Weapons
The School Context
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Strong correlations between school difficulties and the
development of serious problems
Schools can reduce risk and promote positive adjustment
for all students
Schools should promote positive peer interactions
School size, structure, and philosophy have influence on
learning environment and at-risk students
Adolescence oftentimes brings on more school problems
(for instance, truancy, reduced motivation)
Gender role socialization may contribute to problems for
girls in schools
School dropout is higher for the students already at risk
Rising school violence
A Framework for
Prevention and Intervention
Factors contributing to mental health
problems in youth are diverse
 Families, schools, communities, and
society contribute to these problems and
help maintain them
 J. J. McWhirter et al. (2007) proposed a
comprehensive prevention/intervention
framework (At-risk, Approach, & Context
Continuums)
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At-Risk Continuum
The degree to which youth are at risk for serious
behaviors and problems
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Minimal = favorable demographics
Remote = less favorable demographics
High = negative demographics
Imminent = Negative demographics yet
have developed “gateway behaviors”
Highest = engaged in serious problem
behaviors, or depressed/suicidal
Approach Continuum
Appropriate types of prevention/intervention for
various levels of risk
 Universal = appropriate for all ages, not just the
at-risk children; preventive
 Selected = aim at those who share some
circumstances/experiences Ex: Head start
 Booster Sessions = review/reinforce components
of universal & selected approaches
 Indicated treatment approaches = used w/kids
at imminent risk for serious problem behaviors
 Second-chance Programs = used w/kids who
have engaged in severe problem behaviors
Contexts Continuum
Includes early involvement (family,school,society/
community) in broad-based prevention/intervention
 Family context – provide culturally appropriate
family-strengthening opportunities promoting
interaction/communication/health-care/ parent
training/ family counseling/ special programs
 School-based - early compensatory programs,
after school care, generic programs infused in
the curriculum, second chance, school-based
programs,etc
 Society/Community – improved economic
conditions, housing, childcare, job opportunities
etc
Depression:
Incidence and Characteristics
Adult depression differs from depression in
childhood and adolescence
 Dysthymia-chronic sense of dysphoria that is
less intense than depression
 Signs = frequent physical complaints-headaches,
stomaches, muscle aches, fatigue-, school
absence or poor performance, running away,
outburst of anger, irritability or crying, boredom,
lack of interest, alcohol or substance abuse,
heightened social sensitivity, difficulty in
friendships, fear of death; Also associated with
anxiety, disruptive behaviors, substance-abuse,
diabetes, increased suicide risk
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Depressive Disorders
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Incidence and Characteristics (cont)
Depression affects approximately 30% of
adolescents
Depression affects approximately 2-5% of
children
Females are twice as likely as males to express
depression
Depression is not a developmental “phase”
Both the developmental process as well as the
psychological, social, and biological components
of depression need to be taken into
consideration
Depression:
Treatment
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Take cultural factors into account
Counselors need to use developmentally
appropriate interventions
Preventative, community-based programs that
promote healthy families
School-based training/educational/topic specific
Cognitive-behavioral therapy is most effective
Antidepressant medications/ psycho social
interventions
Combination of CBT & medications
Suicide
Incidence and Characteristics
Suicide is the third leading cause of death – ages 10-24
Leading cause of the death of Gay and Lesbian
adolescents
 American Indians have the highest suicide rate among
ethnic minority adolescents
 Hispanic adolescents are more likely for suicide than
European American or African American
 Females are 3 times more likely than males to attempt;
males are 5 times more likely to complete suicide
 Depression, difficult adjustments, emotional
ambivalence, anger, ineffective communication, and
stressful living conditions contribute to suicidal ideation
 Loneliness, impulsivity, risk-taking, low self-esteem,
faulty thinking patterns also associated with higher
suicide risk
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Suicide:
Assessment
Multifaceted approach necessary
 Clinical interview - helpful in assessing risk
 Risk factors include: family history of
suicide, previous suicide attempts,
substance abuse, anxiety, hopelessness/
depression, current family problems, other
current stressors
 Self-report measures
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Suicide:
Prevention/Intervention
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Focus on underlying environmental and interpersonal characteristics
associated with suicide(depression, lack of social support, poor
problem-solving skills, & hopelessness)
School setting is a good place for primary prevention
Offer family support programs (Family Resource Center)
Early intervention should minimize frequency and severity of suicidal
ideation
Suicide screenings
Establishment of interdisciplinary crisis teams (teachers, school
counselors, parents, nurses, community)
McWhirter et al. (2007): use of four-step model for managing a
suicide crisis
1. assess lethality
 2. written agreement & emergency phone
 3. monitor and track client’s behavior for 1-3 days
 4. inform the child’s parents
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Substance Abuse
Incidence and Characteristics
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Pathological use of a substance that causes
significant impairment in functioning
Statistics - p. 349 in text
Drugs most used by adolescents in US – Alcohol,
Tobacco, & Marijuana
Substance Abuse:
Risk Factors
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Individual Factors- aggressiveness, neg moods,
withdrawal, mental health issues, withdrawal,
impulsivity, conduct disorders, ADHD, depression,
learning disorders
Peer Factors–association w/drug abusers
Family Factors – Older sibling abuses, high family
conflict, poor parenting practices,
School Factors – academic failure, subsequent dropout, inappropriate classroom behavior, aggression
toward others, etc
Community Factors – poverty, lax drug laws/abuse,
Substance Abuse
Prevention and Treatment
Preventive interventions typically occur in
school settings and may be universal,
selected or indicated interventions
 Schools mostly use information-based
preventive interventions
 Treatment occurs most often outside the
school setting
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Substance Abuse
Prevention and Treatment
Outside Interventions
 Treatment sites
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Outpatient
Day treatment
Inpatient & Residential
Types of treatment
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12-step program
Cognitive behavioral-based interventions
Family-based interventions
Therapeutic communities
Substance Abuse
Prevention and Treatment
School-Based Interventions
 Student Assistance Programs (SAP)
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Only available in some school sites
Students are aware that substance abuse
disclosure can lead to negative consequences
rather than support (Zero tolerance policies)
 Motivational Interviewing
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Work with Student’s resistance rather than against it
Listen for challenges the student is currently facing
(school disciplinary consequences, problems at home,
Use skills of reflection to communicate understanding
Summary
Counseling process with children and
adolescents in crisis is complex
 Need for comprehensive interventions
 Knowledge of community and school
programs and resources
 Advocacy for broader social and policy
change
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