instructions for completing this self instructional packet ...dbhdduniversity.com/files/sip...

Instructions for Completing this Self Instructional Packet (SIP):

Read through this self instructional packet. As you read, make note of any questions you

have. When completed, you will:

• Go over your questions with your supervisor;

• Obtain a copy of the “Introduction to Behavioral Health & Developmental Disabilities

Knowledge Check” from your supervisor and complete it; and,

• Go over the Knowledge Check with your supervisor.

Introduction to Behavioral Health & Developmental Disabilities

This presentation gives a high level overview of the individuals we serve. This includes

people who have Behavioral Health needs and people with Developmental Disabilities.

Even if your hospital does not have developmental disability units, you will encounter

some individuals with intellectual and developmental disabilities in your hospital’s units. It

should help you to know about these individuals.

Proceed to the next slide.

1

These are the Subject Matter Experts who were involved in creating this session.

Proceed to the next slide and the session objectives.

2

By the end of this session, you will be able to:

• Describe the behavioral characteristics, symptoms, treatments and/or supports for

the types of individuals that enter the hospitals

‒ People with Mental Illness

‒ People with Mental Illness and Co-Occurring Addictive Diseases

‒ People with Developmental Disabilities

Proceed to the next slide and more detail around the three types of individuals that we

serve.

3

As you already have seen from the objectives, we serve three types of individuals.

The first group we will look at is “Individuals with Mental Illness.” Mental disorders are

abnormalities in the way individuals think, feel or experience moods. These disorders

have an effect on the many parts of the person’s life, such as how they make friends,

deal with stress, plan activities, and live in their communities.

The second type includes individuals who are not only dealing with Mental Illness, but

in addition to that, they have what we call a co-occurring addictive disease or

disorder. Some examples of co-occurring disorders are:

• Drug Addiction

• Alcohol Abuse

The third type of individual we serve are people who have Developmental

Disabilities. These individuals have limitations in intellectual functioning and in

adaptive behavior.

For all three of these, we will review behavioral characteristics associated with each

one, symptoms and supports used.

Proceed to the next slide and Topic 1.

4

A diagnosis of Mental Illness itself does not reflect the full picture of a person.

It is important for direct care staff to understand what the terms mean, and how they

should be used.

Also remember that recovery involves:

• Viewing psychiatric disorders as only one aspect of a person.

• Concentrating on developing a positive and holistic relationship and getting to know

the person as a way to understand what the person’s strengths, interests and

desires are as he or she continues to be in control of his/her life.

Proceed to the next slide which outlines the direction of Topic 1.

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Topic 1, “Individuals with Mental Illness” will focus on the four key areas noted on the

slide.

Move on to the next slide.

When you think of Mental Illness, what come to your mind?

Take a minute to write down a couple thoughts in the space below.

Then, move onto the next slide and an introduction to the definition of Mental Illness.

7

The National Alliance on Mental Illness (NAMI) defines mental illness as medical

conditions that disrupt a person's thinking, feeling, mood, ability to relate to

others and daily functioning. Just as diabetes is a disorder of the pancreas, mental

illnesses are medical conditions that often result in a diminished capacity for

coping with the ordinary demands of life.

If you remember nothing else, remember that mental illness is a MEDICAL

CONDITION, just like diabetes is a disorder of the pancreas OR arthritis is a disorder

of the joints. Mental illness diminishes a person’s ability to cope with everyday life.

Proceed to the next slide to review a couple more definitions.

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9

Review two additional definitions on the slide.

Scientists do not yet understand why some people have symptoms of mental illness,

and others do not, and we cannot predict who will have a mild illness and who will

have a severe, reoccurring one (CMHS EBP Toolkits, 2003).

It is important to note that medical and/or substance use conditions can mimic or

mask mental illness and these may need to be ruled out.

These disorders can affect the way people think and how they experience feelings or

moods.

These symptoms tend to last only while the person is under the influence of drugs or

during an illness such as a brain tumor or infection.

Now that you have looked at some definitions of Mental Illness, let’s go over some

statistics and demographics of Mental Illness.

Transition to next slide, “Who Has Mental Illness?”

Read the statistics on the slide making note of the underlined portions.

Move on to the next slide and learn about five of the most common types of Mental

Illness.

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This presentation will cover FIVE of the most common major disorders. They are:

• Schizophrenia

• Bipolar Disorder

• Major Depression

• Post Traumatic Stress Disorder

• Borderline Personality Disorder

Mental conditions are illnesses that change the way a person:

• Experiences life, and,

• Thinks and how they experience feelings or moods.

According to the Surgeon General’s report, all of human behavior is mediated by the

brain…that is the behaviors and symptoms that are seen are a result of brain

functions. (adapted, Putnam and Huckshorn).

“Signs” of mental conditions, in this context, are defined as those behaviors that

another person can see and directly observe and symptoms are what assist staff to

know what the diagnosis is and what treatment to provide.

“Symptoms” relate to those thoughts, feelings, moods, and perceptions that are

experienced by a person themselves, that may or may not be observable my others.

They are directly related to brain functioning. Finally, mental disorders present

differently, depending on the individual’s personal characteristics (age, sex, race,

culture, etc).

Proceed to the next slide. It emphasizes the importance of treating all individuals with

dignity and respect.

12

Regardless of diagnosis……We owe all of the individuals……

• Dignity and Respect;

• To be addressed in “Person First” language;

• Individualized care and treatment; and,

• Involvement in their own recovery.

Mental Illness does not discriminate. It affects people of all economic and cultural

backgrounds. Let’s take a quick look at some faces and/or names you may recognize

that struggled with Mental Illness.

Review Slides 13-16. They illustrate some well-known people who have been

diagnosed with Mental Illness.

When done reviewing the slide material, proceed to the next slide.

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14


15

When done reviewing the slide material, proceed to the next slide which introduces

the five most common mental disorders focused on in this presentation.

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There are five most common major disorders. You will spend a few minutes on each

of these gaining a high level exposure to them. Let’s start with Schizophrenia.


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Schizophrenia is the most widely misunderstood mental condition. It is also known as a

thought disorder, often mistakenly characterized as a “split personality”. It is often used

to describe someone who is supporting two different concepts.

Schizophrenia is characterized by profound disruption in cognition and emotion. An

individual with schizophrenia may have serious problems with:

• Language and talking;

• What they are thinking about; and,

• How the view things around them.

They may experience psychosis at least part of the time which may result in strange

behaviors. (Behavioral Health Technician Study Guide, Putnam and Huckshorn, in press).

They can be unresponsive and withdrawn.

Refer to the second bullet on the slide.

It affects about 1 in every 100 persons and it occurs in every country, every culture, every

racial group, and in every income level.

Proceed to next slide, “Schizophrenia Characteristics.”

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Review the characteristics of Schizophrenia listed on the slide.

Move onto next slide which contains additional characteristics.

Review additional characteristics noted on this slide.

Schizophrenia is NOT split personality or multiple personality and it is NOT caused by

childhood experiences, poor parenting or lack of willpower.

Additional facts include:

• There are some Old Theories… well researched and discarded that thought

Schizophrenia was caused by:

− Parenting,

− Drug abuse

− Poverty,

− Weak character

• Now experts believe this biological vulnerability is caused by:

− Imbalance of chemicals; and,

− Neuro-transmitters in the brain & environmental stressors

(CMHS EBP Toolkit, 2003)

…..And the symptoms are not identical for each person. Let’s look at what those

symptoms can include.

Move onto the next slide.

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The symptoms of schizophrenia are often divided into two types; POSITIVE and

NEGATIVE.

Positive symptoms are disturbances that are “added” to the person’s personality. The

term positive is somewhat misleading because it does not describe condition that is good

for the person. Instead, positive means that the person is experiencing symptoms that are

obvious and of concern. The person may have serious problems with language and

talking, what they are thinking about, how they view things around them and how they view

themselves. (Huckshorn and Putnam)

They include: hallucinations (false perceptions); delusions (false beliefs); cognitive

difficulties (memory, concentration, and abstract reasoning); a decline in social or

occupational functioning; and becoming disorganized or even catatonic.

Negative symptoms are capabilities that are “lost” from the person’s personality.

They are less visible behaviors including a lack of energy, motivation, pleasure, and/or

not being able to express emotions. They can be accompanied with feeling sad at

times. (CMHS EBP Toolkits, 2003)

Negative symptoms of a thought disorder are just as difficult for the person as

positive symptoms are. Family, friends and staff sometimes do not understand that the

“lack of motivation” or follow-through on tasks is not out of laziness or not caring but in fact

a behavior that is part of the illness.

Scientists believe that it may take a few minutes longer to think and answer a question…or

maybe his/her language and communication centers have been affected…

Sometimes people have trouble putting feelings into words, have difficulty with

conversations…or perhaps his/her sensory systems have been affected….

Individuals can present as overwhelmed…oversensitive to touch, texture. Proceed to next

slide.

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Hallucinations may occur through any human sensory mechanism such as hearing,

sight, taste, smell, touch.

Delusions are strongly held false beliefs that are very real to the person even

when there is evidence that contradicts them.

The person may think that the television is sending messages, or think they are being

chased by the police or think they are going to be harmed by some group. The facts

do not support these beliefs, but they are strongly held. The person may giggle or

make faces inappropriately and act inappropriately in social situations. The behaviors

are very odd and can be observed in many situations in the treatment settings.

Proceed to next slide which addresses different types of Schizophrenia.

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There are several types of Schizophrenia and .

They are:

Paranoid Schizophrenia -- extremely suspicious, persecuted, or grandiose, or

experiences a combination of these emotions.

Disorganized Schizophrenia -- often incoherent in speech and thought, but may not

have delusions.

Catatonic Schizophrenia -- withdrawn, mute, negative and often assumes very

unusual body positions.

Residual Schizophrenia -- no longer experiencing delusions or hallucinations, but

has no motivation or interest in life.

Schizoaffective Disorder--symptoms of both schizophrenia and a major mood

disorder such as depression.

The final information I want to go over regarding this disorder is the medication used

to treat it. Medication along with other forms of treatment and peer support can

be very effective to assist people in their recovery from schizophrenia. We will follow

up with more information on recovery in another presentation during NEO.

Transition to the final slide focused on Schizophrenia. It covers “Antipsychotic

Drugs”.

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The new generation of antipsychotic medications help people with schizophrenia to

live fulfilling lives. They help to reduce the biochemical imbalances that cause

schizophrenia and decrease the likelihood of relapse. Like all medications, however,

anti-psychotic medications should be taken only under the supervision of a mental

health professional.

There are two major types of antipsychotic medications:

Traditional (Conventional/Typical) antipsychotics effectively control the “positive”

symptoms such as hallucinations, delusions, and confusion of schizophrenia.

New Generation (also called Atypical) antipsychotics treat both the positive and

negative symptoms of schizophrenia, often with fewer side effects.

Side Effects are common with antipsychotic drugs. They range from mild side

effects such as dry mouth, blurred vision, constipation, drowsiness and dizziness

which usually disappear after a few weeks to more serious side effects such as

trouble with muscle control, pacing, tremors and facial ticks. The newer generation of

drugs have fewer side effects.

We are about to move to the next category of Mental Illness…..Bipolar Disorder.

Transition to the next Mental Illness diagnosis which is Bipolar Disorder.

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Bipolar disorder is also known as manic depression.

• It is an illness involving one or more episodes of serious mania and

depression. The illness causes a person’s mood to swing from excessively “high”

and/or irritable to sad and hopeless, with periods of a normal mood in between.

• More than 2 million Americans suffer from bipolar disorder.

• It typically begins in adolescence or early adulthood and continues

throughout life. It is often not recognized as an illness and people who have it

may suffer needlessly for years.

• It can be extremely distressing and disruptive for those who have this disease,

their spouses, family members, friends and employers.

• Although there is no known cure, bipolar disorder is treatable, and recovery is

possible. Individuals with bipolar disorder have successful relationships and

meaningful jobs.

• The combination of medications and psychotherapy helps the vast majority of

people return to productive, fulfilling lives.

• “Bipolar disorder is treatable, and recovery is possible.”

• Bipolar Disorder is no one’s fault.

Proceed to next slide.

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People have experienced mood disorders for at least as long as they have been able

to record their experiences.

One of the earliest terms for depression “melancholy” literally meaning “black bile”

dates back to Hippocrates. Within the past 40 years or so, researchers have had the

means to study the changes in cognition and brain functioning.

Scientists believe symptoms are caused by a chemical imbalance in brain

chemistry and that this happens before birth.

Symptoms typically emerge either in the teens or young adulthood or later

when people are in their late 30’s or 40’s.

Some people have a mild form of this condition; others may require multiple

hospitalizations (CMHS EBP Toolkits, 2003)

Proceed to next slide, “Symptoms and Characteristics.”

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Some people with bipolar disorder experience severe depression, then normal mood,

then hypo-mania or mania, then normal mood, then depression again. Others can

experience any combination of these states, including never having depression or

severe mania.

Hypo-mania and mania are words used to describe these states of “well being” or

“elation” with reports of the following symptoms: feelings of extreme happiness,

excitement, irritability, being unrealistically self-confident, having bad judgment,

sleeping less and being over-active, talking a lot, racing thoughts, and/or being

distracted easily. [hypo-mania is at a less extreme level than full mania.]

People who have experienced depression report the following symptoms: Sad mood,

low energy, eating differently (too little or too much), sleeping differently (too little or

too much), suicidal signs etc.

(CMHS EBP Toolkits, 2003)

More information on symptoms of a person experiencing mania follows on the next

slide.

Transition to next two slides.

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Bipolar disorder is often difficult to recognize and diagnose.

It causes a person to have a high level of energy, unrealistically expansive

thoughts or ideas, and impulsive or reckless behavior. These symptoms may feel

good to a person, which may lead to denial that there is a problem or anything is

wrong.

Another reason bipolar disorder is difficult to diagnose is that its symptoms may appear

to be part of another illness or attributed to other problems such as substance abuse,

poor school performance, or trouble in the workplace.

Symptoms of mania

Excessive energy, activity, restlessness, racing thoughts and rapid talking

Extreme “high” or euphoric feelings -- a person may feel “on top of the world” and

nothing, including bad news or tragic events, can change this “happiness.”

Easily irritated or distracted.

Decreased need for sleep – an individual may last for days with little or no sleep

without feeling tired.

Persons with mood disorders often have problems sleeping or sleeping too much;

changes in how much and how frequently they eat or problems with concentration,

memory, and a general feeling that life is hard and not fun.

They may talk very fast and excitedly but not make good sense as they talk (incoherent).

The person may not continue to work and may experience serious problems socially.

Proceed to next slide and continue discussing “Symptoms and Characteristics.”

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Individuals diagnosed with Bipolar may possess:

Unrealistic beliefs in one’s ability and powers -- a person may experience feelings

of exaggerated confidence or unwarranted optimism. This can lead to over ambitious

work plans and the belief that nothing can stop him or her from accomplishing any

task.

Uncharacteristically poor judgment -- a person may make poor decisions which

may lead to unrealistic involvement in activities, meetings and deadlines, reckless

driving, spending sprees and foolish business ventures.

Sustained period of behavior that is different from usual-- a person may dress

and/or act differently than he or she usually does, become a collector of various

items, become indifferent to personal grooming, become obsessed with writing, or

experience delusions.

Unusual sexual drive

Abuse of drugs, particularly cocaine, alcohol or sleeping medications

Provocative, intrusive, or aggressive behavior -- a person may become enraged

or paranoid if his or her grand ideas are stopped or excessive social plans are

refused.

Proceed to next slide which discusses Treatments.

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Treatment is critical for recovery. A combination of medication, professional help

and support from family, friends and peers help individuals with bipolar disorder

stabilize their emotions and behavior.

Most people with bipolar disorder can be treated with medication. A common

medication, Lithium, is effective in controlling mania in 60% of individuals with

bipolar disorder however, it has a very narrow therapeutic window. This requires

frequent monitoring of blood levels which can be an issue with individuals who are not

compliant with medications and treatment. In addition, benzodiazepines are

sometimes prescribed for insomnia and thyroid medication can also be helpful.

It is suggested that those with bipolar disorder receive guidance, education and

support from a mental health professional to help deal with personal relationships,

maintain a healthy self-image and ensure compliance with his or her treatment.

Support and self-help groups are also an invaluable resource for learning coping

skills, feeling acceptance and avoiding social isolation. Friends and family should join

a support group to better understand the illness so that they can continue to offer

encouragement and support to their loves ones.

We are about to move to the next category of Mental Illness….Major Depression.

Transition to the next slide and the third diagnosis Mental Illness diagnosis, Major

Depression.

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Best looked at on a continuum, major depression ranges from mild to severe

symptoms and affects people similarly, across the world.

It is the most common serious mental condition

Affects more than 19 million Americans each year.

• Can:

‒ Complicate other medical conditions.

‒ Be serious enough to lead to suicide.

• Includes having one or more episodes lasting at least 2 weeks where there is

a very sad mood or the loss of interest in regular activities or interests

It is also important to know that depression symptoms can occur in any of the mental

illnesses that people experience and that, often, people need to be treated for both

their primary illness as well as depression itself. The good news is there are effective

treatments for all kinds of depression.

People with depression, similar to all the other mental conditions, can learn to

manage their own illnesses and lead productive lives.

The more people understand about their illness and take an active role in treatment,

the better they will feel and be able to recover.

Proceed to next slide and go over the symptoms.

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Potential symptoms of depression include:

• Sad mood, “feeling dark, down all the time”

• Change in appetite

• Feeling tired, having low or no energy

• Feeling helpless, hopeless, or worthless

• Suicidal thoughts or actions

• Concentration problems

Other symptoms are sleeping little or more than usual, feeling guilty or responsible for

things that are not your fault or that you have no control over,

Again, everyone is different and will experience depressive symptoms differently.

Often people who are depressed think they caused this and are embarrassed. Other

times people are irritable and angry way beyond what is actually happening to them.

Some clinicians have described depression as ‘anger turned inward,’ and often

people have very good reasons to be angry about things that have happened to them.

Issues such as child abuse, neglect, trauma, negative life experiences, serious

medical illness, natural disasters and other events can lead to unresolved and

unexpressed anger and hopelessness and may lead to depression.

Move on to next slide, "Suicidal Thought or Intentions".

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Read the passage on the slide. It represents the thoughts of a depressed person who

experienced suicidal thoughts or intentions.

As you can hear in this passage, depression can run very deep in a person’s thoughts. It is

a serious public health problem.

All staff need to be aware of the risk factors that increase the possibility of a suicide

attempt.

Protective factors, such as effective and appropriate clinical care, easy access to care and

support from family, community health and mental health providers are essential in

ameliorating the potential for a completed suicide.

Certain questions need to be asked of anyone who appears depressed, hopeless,

helpless, powerless, or feels worthless. These kinds of “behaviors” can be observed by the

alert staff member. Staff should ask people what their plans are and inform supervisor and

Charge Nurse of their findings.

You need to be aware of Individuals who make statements such as “its no use”, “no one

will care if I die”, “my family will be better off without me”, “I just do not want to wake up

tomorrow…” Withdrawing from friends and family. All of these statements or behaviors

need to be assessed and discussed with the person.

Effective treatment options exist. Awareness of the signs and symptoms will assist you

with the proper intervention.

There are also observable risk factors that are key clues to someone’s suicidal tendency.

Proceed to the next slide, “Risk Factors Related to Suicidal Thoughts & Intentions.”

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Review the risk factors highlighted on the slide.

Move on to next slide, “The Causes of Depression.”

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Many things can contribute to clinical depression. For some people, a number of factors

seem to be involved, while for others a single factor can cause the

illness. Oftentimes, people become depressed for no apparent reason.

Highlight each cause listed on the slide using the information listed below.

Biological – People with depression typically have too little or too much of certain brain

chemicals, called “neurotransmitters.” Changes in these brain chemicals may cause or

contribute to clinical depression.

Cognitive – People with negative thinking patterns and low self-esteem are more likely to

develop clinical depression.

Gender – Women experience clinical depression at a rate that is nearly twice that of men.

(Ask class, why do women experience depression twice as much as men?) While the

reasons for this are still unclear, they may include the hormonal changes women go through

during menstruation, pregnancy, childbirth and menopause. Other reasons may include the

stress caused by the multiple responsibilities that women have. Also, men may not be as

willing to admit that they have feelings of depression.

Co-occurrence- clinical depression is more likely to occur along with certain illnesses, such

as heart disease, cancer, Parkinson’s disease, diabetes, Alzheimer’s disease and hormonal

disorders.

Medications – side effects of some medications can bring about depression

Genetic – a family history of clinical depression increases the risk for developing the illness.

Situational – difficult life events, including divorce, financial problems or the death of a

loved one can contribute to clinical depression.

Clinical depression is very treatable, with more than 80% of those who seek treatment

showing improvement. The next slide highlights some of those treatments.

36

Read through the treatment components mentioned.

Our next category is “Borderline Personality Disorder.”


Another set of disorders that is very important when discussing mental conditions include the personality disorders.

Personality disorders are patterns in the way that a person thinks about their life and environment.

The disorder and patterns are part of the person’s way of thinking and behaving. These beliefs are usually problematic and cause the individual difficulty when relating to others and functioning in their daily lives.

The behaviors of this disorder are characterized by intense and stormy relationships,

low self esteem, self-sabotaging acts, mood fluctuations and impulsivity.

The hallmark of BPD is severe difficulty regulating emotions. It is also known as

“emotional dysregulation”.

Proceed to the next slide. You will find facts that will help you put Borderline

Personality Disorder into perspective.

37

Review each statistic on the slide regarding BPD.

Move to the next slide, “Signs and Symptoms.”

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The behaviors described on this slide are some general patterns individuals with

Borderline Personality Disorder may exhibit. They may show self-harm, damaging

behavior, feelings of emptiness and lack of satisfaction.

People who have this disorder may practice self-damaging behaviors such as:

excessive spending, unsafe sex, substance abuse, reckless driving, binge eating or

suicidal, self-mutilating behaviors usually in response to perceived threats of rejection

or separation.

Relationships alternate between dependence and rejection.

On top of that, Personality Disorders are not easily treated. Borderline Personality Disorder (BPD) is one of the more serious disorders, due to its symptoms. One thing that is critical to understand is…… they are at high risk for lethal behaviors including violence, self destruction, self-abuse, legal problems and have frequent re-admissions.

With that said, individuals with BPD do benefit from trained, recovery team to work with them and to plan their care and recovery.

Go to next slide and review additional Signs and Symptoms.

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Additional signs and symptoms include:

• Intense affect manifested by outbursts of anger, hostility, depression and/or anxiety.

• Frequent displays of temper, constant anger, recurrent physical fights

• ”Splitting” behaviors usually manifested by pitting one person or group against

another (good guy vs. bad guy)

As you have seen with the other diseases we have covered, there are treatments for

this disorder as well.


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There is no one treatment that has emerged as a guaranteed treatment for BPD. A

combination of psychotherapy and medications seems to work best.

Medications can reduce anxiety, depression, and impulsive behaviors.

The Treatment Team needs to work together to:

• Set realistic goals, use clear action words.

• Be aware of manipulative behaviors (flattery, seductiveness, guilt instilling).

• Provide clear, consistent boundaries & limits.

• Use clear straightforward communication.

• Be aware of therapeutic goals & boundaries of treatment.

• Avoid rejecting or rescuing.

• Assess for suicidal and self-mutilating behaviors, especially when under times of stress.

In addition…..

People diagnosed with BPD can idealize their caregivers and then demand a lot of their

time. This behavior can quickly change to criticism of staff that are “not there enough, do

not care enough, or do not give enough of themselves” and staff can quickly find

themselves the target of rage and punishment. (Horsfall et al, 2001)

Move to next slide and review specific treatments that are used in combination with the

therapy described here.

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Review the treatments highlighted on the slide.

• DBT stands for “Dialectual Behavioral Therapy. It is a therapy based on research

It’s main goal is to help a person create a “Life-worth-living” that, to the person,

seems impossible. The therapy is used to help people who have difficulty

managing their emotions and feel like their emotions are controlling their life. It

targets, first and foremost, the reduction of life-threatening and other out-of control

behaviors (such as severe drug addiction, eating disorders, interpersonal chaos,

inability to regulate extreme emotions).

‒ It then targets the reduction of emotional dysregulation and distress (quiet

desperation) that is so common in BPD.

‒ In addition, DBT helps persons deal with difficulties in interpersonal relationships,

living with a sense of emptiness or feeling confused about who they are. Other

behaviors addressed include impulsive behavior, fearful thinking and self-injury.

‒ Central components of DBT are the teaching and development of skills that the

individual can use independently to manage strong feelings and impulsive urges.

‒ The treatment uses group and individual sessions, homework as well as

telephone coaching, and the hard work often shows results.

Proceed to next slide, “Post Traumatic Stress Disorder”.

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Read the slide and definition.

PTSD has been around for a while. It is much more common than most clinicians

ever thought…Traumatic life experiences leading to the development of PTSD are

much more common than historically believed.

Decreased self esteem, loss of sustained beliefs about people or society,

hopelessness, a sense of being permanently damaged and difficulties in relationships

are typically observed. (Surgeon General’s report, 1999)

Recently, the issue of traumatic life events has become a national focus, especially in

mental health settings.

The fact is PTSD impacts several types of people in the population. While military is

probably the most well known, that is just one group that suffers from it.

Transition to next slide.

It is important to note before we go further that not all “traumatic” events meet the

clinical standards for trauma. The loss of a loved one or the limitations resulting from

an illness may cause trauma but the shock of such events is not in itself abnormal.

However, certain traumas or traumatic experience can be severe and can affect many

different people.

Rape survivors, survivors of natural disasters to military service men and women all

can develop PTSD.

Proceed to next slide and how PTSD appears in a person.

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PTSD can occur based on both an event that threatens injury to self or others and

the person’s response to those events that involves persistent fear, helplessness, or

horror.

The brain can be affected in such a way that makes the Individual feel like the event

is happening again and again.

Proceed to next slide, “Symptoms.”

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PTSD has several symptoms. They usually start to occur directly after a traumatic

event, but sometimes it may take months or years for them to show up. They may

also come and go over the course of many years.

Proceed to next slide and “Treatments.”

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There are two modes of treatment for PTSD ……Medications and Therapy.

• Psychotherapy

• Cognitive Behavior Therapy (CBT) employs tailored exposure to the traumatic event

through a memory or another form of exposure. By tolerating the exposure to the trauma,

the individual’s anxiety and symptoms can gradually reduce.

CBT has two different parts:

‒ A behavioral component (usually referred to as “exposure therapy”); and,

‒ A cognitive component that aims to correct distorted thoughts that can result in

shame and self-blame.

Move onto the next slide, “Trauma and Recovery - Interview with Adult Trauma Survivor “.

47

48

Read the interview with the Adult Survivor.

Active observing… basic attention to the person talking and validation goes a long

way in demonstrating our understanding.

(Adapted from Difficult Conversations: A workshop for Non-Clinician to become

Trauma-Informed)

Transition to last slide in this Topic 1, “Well-being and Recovery.”

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Wrap-up of Topic 1, Mental Illness

The ultimate goal of treating individuals……is to support them to improve their well-

being and quality of life through a process of “recovery”:

Recovery plays an important role in how we treat individuals. The concept of

“recovery” must guide any understanding of mental illness.

Part of recovery is learning about signs and symptoms, how to manage these, and

even recover in spite of reoccurring symptoms Experts, including people in

recovery, do not believe that a person’s “symptoms” must be eliminated for a person

to “recover” and, in fact, many people have learned to live with symptoms as part of

their recovery process (CMHS EBP Toolkits, 2003)

Move on to next slide and Topic 2: Individuals with Mental Illness and Co-Occurring

Addictive Diseases.

Many people in the hospital are Individuals with Mental Illness & Co-Occurring

Addictive Diseases. This also is known as “Dual Disorders” OR “Dual Diagnosis.”

Proceed to the next slide, “Dual Diagnosis – What is It?

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There are individuals who can sometimes not only have a diagnosis from one of the

categories we previously covered, but, on top of that, the individual has a substance

abuse issue.

Proceed to the next slide, “Co-Occurring Addictive Disorders Require Special

Attention.”

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Special attention is required for treating Co-Occurring Addictive Diseases.

Imagine the challenge of just dealing with a diagnosis of Mental Illness. Now, in

addition to that, you have to break the cycle of an addictive disease.

This requires special attention because of all the challenges the person is grappling

with.

Examples include:

• Stigma associated with both mental illness and substance abuse which can cause

shame and guilt.

• One disorder affects the Other

‒ Mental illness can trigger a person to use: and,

‒ Using can trigger the mental illness.

• Using drugs, when mentally ill…

‒ Worsens mental illness

‒ Inhibits recovery.

Move to the next slide and share some statistics regarding Dual Diagnosis.

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According to the National Institutes of Health……

• 85% of people with dual disorders have histories of abuse and/or neglect when they

were children or young adults.

• When treating these individuals, it is essential that we remember that more than

likely, they have histories of abuse/neglect.

Move to the next slide which highlights the remaining reasons special attention must

be given to this disorder.

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And finally…….

• Individuals with such histories tend to be more vulnerable to psychological injury,

and very often have much shame, guilt, and anger

• Feelings like shame, guilt, and anger are powerful triggers for people to use drugs

and alcohol, and so such feelings must be addressed in treatment.

Transition to next slide, Let’s look at “Treatment Guidelines.”

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Treatment Guidelines evolve around showing support to build trust. This leads to

greater acceptance of their disorder.

Transition to Topic 3, “Individuals with Developmental Disabilities”.

Move on to the third group that we serve in our facilities.

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The third group of individuals that we serve is Individuals with Developmental

Disabilities. This diagnosis is very different from Mental Illness in how it is caused,

symptoms and supports.

Proceed to the next slide, “Goal….Full Community Inclusion.”

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U.S. law recognizes policy that disability is a natural and normal part of the human experience

that does not diminish the rights of individuals with developmental disabilities to exert control

and choice over their own lives and to fully participate in and contribute to their communities

through full integration and inclusion in the mainstream.

Georgia is quickly moving to full community inclusion and self-determination of individuals with

developmental disabilities.

Move to the next set of slides that gives an overview of developmental disabilities.

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The American Association on Intellectual and Developmental Disabilities

(AAIDD)

States that Developmentally Disabled Individuals…..exhibit:

• Substantial limitations in present functioning.

• Deficits in “adaptive behavior” that appears during the developmental period.

3% of general population have some type of developmental disability.

Move on to the next slide and highlight some key facts about Developmental

Disabilities.

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It is important to know that Developmental Disabilities:

• Is NOT a medical or mental disorder.

• Affects important life skills (that many of us perform routinely and almost without

thinking each day).

• Describes lifelong disabilities associated with mental and physical limitations.(Their

ability to adapt to daily living).

Move to next slide and review two additional facts.

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Developmental Disabilities:

• Usually begins at birth or before the age of 21; and last…..

• Is a permanent condition.

Proceed to the next slide and continue the overview.

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Developmental Disabilities include intellectual disabilities, autism spectrum disorders,

Down syndrome, language and learning disorders, cerebral palsy, vision impairment,

and hearing loss.

It is characterized by two areas that are assessed. Those areas are:

• Limitations in Intellectual Functioning

• Adaptive Living Skills

Let’s look at what “Intellectual Functioning” means. Proceed to next slide.

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Limited intellectual functioning can be indicated by a score of 70 or lower on an IQ

test. Intellectual functioning refers to general mental capacity, such as learning,

reasoning, and problem solving.

The second characteristics looked at when assessing Developmental Disabilities is

deficiencies in Adaptive Skills.


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In addition to measuring an Individual’s intellectual functioning, Developmental Disabilities are also

characterized by limitations in adaptive skills, which covers three types of skills:

• Conceptual Skills - language and literacy; money, time, and number concepts; and self-direction

• Social Skills - Interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e.,

wariness), social problem solving, and the ability to follow rules, obey laws, and avoid being

victimized

• Practical Skills - activities of daily living (personal care), occupational skills, healthcare,

travel/transportation, schedules/routines, safety, use of money, use of the telephone

Starting on the right side of the slide and looking at these counter-clockwise, examples of Adaptive

Skills are”:

Learning - Need lots of repetition and multi-sensory experiences to learn basic skills

Self Care - May have problems with skills like dressing or brushing teeth

Receptive Language - Difficulty understanding language that is spoken

Expressive Language - May not talk at all for some time or may have limited speech

Mobility – Ability to walk without assistance or have the equipment need to move on their own

(Modified wheelchairs, hand splint).

Self-Direction – Not being able to process their thinking; Knowing intuitively how to carry out a task

(Example: Brushing teeth, environmental safety concerns such as looking both ways at a crosswalk)

Capacity for Independent Living - Running a household independently; Transportation logistics

getting from one place to another

Motor Skills - May affect both gross motor and fine motor skills

Social Skills - May avoid making eye contact; interacting with other

There are behavioral characteristics that are observable in Individuals with developmental disabilities.

Move on to the next slide

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Review behavioral characteristics.

An example of a challenging behavior is someone who picks at their skin and causes

a wound, or someone who yells out in a loud voice which disturbs other individuals.

An example of a challenging physical condition is someone who is unable to walk and

has to use a wheelchair.

Some individuals have fragile health in general.

People may be at high risk for abuse because they may not be able to verbalize when

they have a problem, and they are not physically able to get away from an abusive

person or situation. Some people may be at high risk because of their limited ability

to reason.

Move onto the next slide and go over some typical stereotypes.

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One of our goals is to get past these stereotypes and see the potential in our

individuals. They are quite capable of learning skills to live a healthy life. To

understand this, it is important to understand the main cause of developmental

disabilities.

Proceed to next slide.

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There are three known causes of developmental disabilities…Genetics OR your DNA

passed on by your parents……..Prenatal Circumstances……the health and well-

being of the mother……and Trauma that may occur to the child after birth. We will

look at each of these a little more now.

The next three slides look at each of these in a little more detail.

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Review the impact of genetics. Move to next slide.

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Prenatal Circumstances can impact developmental disabilities if the circumstances

include:

• Very Young Mothers

• Older mothers age 35 or older

• Infections

• Drugs

• Trauma

Move to next slide.

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Trauma after birth can cause Developmental Disabilities. Examples include:

• Shaken Baby Syndrome

• Head Trauma (Drowning/Lack of Oxygen)(before and after birth)

• Illnesses

• Unexplained (largest category)

With the causes known, let’s look at the types of measurement tools used to assess

this disability.

Move on to next slide.

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One of the main measurement methods to assess the severity of developmental

disabilities are IQ tests such as those listed on the slide.

Remember, intellectual functioning refers to a general mental capability. It involves

the ability to:

• Reason or plan

• Solve problems

• Think abstractly

• Comprehend complex ideas

• Learn quickly

• Learn from experience


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Even with reliable and accurate testing, you need to keep in mind……

• IQ tests are not a perfect way to measure intelligence.

• Every individual is a unique human being with varying degrees of ABILITY in

different areas.

• The purpose of tests and other assessment tools is to tailor supports and services

to assist the individual in his or her life.

• Individuals can improve their adaptive skills.

DBHDD staff that work with developmentally disabled individuals assist them to

move to community living.

Move to next slide.

Scales measure developmental performance.

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Say:

DBHDD’s Goal is to:

• Assist individuals with developmental disabilities:

‒ With life skills

‒ With increasing adaptive behaviors

• Support individuals to achieve full community inclusion

Full community inclusion means that people can live in their own homes, work, have

friends and live in the community of their choosing.

People with intellectual disabilities can and do lead satisfying lives.

Proceed to next slide. It illustrates how the hospital helps individuals with

developmental disabilities.

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The hospital provides support on a variety of levels. These services and supports are

tailored for EACH PERSON according to what they need.

The interdisciplinary team is critical to individualized supports and services. They

work to determine what needs to be done to help the individual reach his or her own

goals.

Proceed to the next slide, “Four-Step Active Treatment Plan.”

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The term “Active Treatment” is a term used to show that there are supports and

services being given to each person as they need them while the individual is in this

hospital’s services.

The treatment process is the same as any other individual in our units. Outside of the

condition, we treat these individuals exactly that same as our Individuals with Mental

Illness and/or Co-occurring Addictive Diseases.

1) Assess the individual’s capability.

• What the individual can and cannot do in all aspects of living.

2) Create Objectives

• List of specific steps that help achieve desired goals.

• Write the Individual Support Plan.

3) Implement Plan.

4) Review Plan annually or at any significant change.

Proceed to final slide.

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Take a moment to jot down any questions you have about this topic. Go over your

questions with your supervisor.

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