Promoting Youth as Problem Trainee Handouts September, 2003
_______________________________________________________________________Not for delivery or reproduction without permission of the University of Denver Institute for Families. Contact Linda Metsger, at 303 871-2910 or at ifduonline.org
Handout 1 8:30 – 9:00 Welcome, Overview and Introductions 9:00-9:20 What Do You Know 9:20 -10:30 What the Professionals Say 10:30-10:45 10:45- 11:15 Youth and Adult Perspectives 11:15 – 12:00 Youth Views: The Digital Stories 12:00 – 1:00 1:00 - 1:45 How Youth Use Help
1:45- 2:15 Finding and Using Resources 2:15 – 2:30 2:30 – 3:45 Promoting Youth as Problem Solvers 3:45-4:30 Exercise, Evaluation and Wrap-up
Handout 2 Competencies and Objectives Competency 1
Able to identify common issues of concern related to mental health and substance use from the perspectives of both adults and youth.
Able to identify resources for mental health and substance abuse issues.
Able to use youth development principles to help youth use resources, make decisions, and deal effectively with mental health and substance use issues.
Handout 3 What Do We Know about Youth Mental Health and Substance Use
The U.S. Department of Health and Human Services conducts a periodic, national household survey on drugs and alcohol. Recent findings* indicate what trends over the last 10-15 years among teenagers (12-17): 1.
_____ a decrease in alcohol use _____ an increase in alcohol use _____ little or no change
_____ youth begin drinking at earlier ages than they used to _____ the age of first drink hasn’t changed much over time _____ youth begin drinking somewhat later than they used to
_____ youth who drink don’t use drugs more than other youth _____ youth who drink use drugs less than other youth _____ youth who drink use more drugs than other youth
Among the 35% of 17 year olds who are current drinkers, what percent report binge drinking (5 or more drinks 1-4 times) or heavy drinking (5 or more drinks per occasion on 5 or more days) in the last 30 days
5. Which ethnic group has the highest rate of problem drinking among older
6. Which of the following problem behaviors are self-reported as highly
associated with binge and heavy drinkers among teenagers (meaning they
are at least twice as likely to report this than teenagers who drink less or don’t drink at all)? (Check all that apply)
____ Physically attacking others ____ Arrested _____ Driving under the influence of drugs or alcohol
7. Many studies have shown a high correlation between youth drinking and
mental health issues. Do you think youth who are heavy and binge drinkers are aware of the symptoms of mental health issues in themselves?
What is the relationship between drinking by age 14 and later use of alcohol?+ ____ No significant relationship between early drinking and later
____ More likely to have substance abuse problem than those who
What estimated percentage of all adolescents (not just those in foster care) have emotional problems serious enough to warrant a diagnosis?#
____ 6-7 % ____ 13-14% ____ 20-21% ____ over 25%
Depression is the most common diagnosed mental health concerns among adolescents.#
Estimated percentage of juveniles in Colorado youth corrections custody with serious emotional disturbance is
____24% *Janet Greenblatt, “Patterns of Alcohol Use Among Adolescents and Associations with Emotional and Behavioral Problems: National Clearinghouse for Alcohol and Drug Information, March , 2000 + Grant and Dawson, 1977 # Maurice Blackman, “You Asked about Adolescent Depression” Canadian Journal of CME, May 1995 ^ Colorado DYS data from 1999
Handout 4 Some Mental Health Concerns Among Youth Post Traumatic Stress Disorder (PTSD) Source:
David Barlow (ed) Clinical Handbook of Psychological Disorders, 2nd Edition, Guilford Press, New York, 1993
Re-experiencing previous trauma, e.g., flashbacks, generalized terror or fear, anxiety Avoidance through denial, minimization, numbing, or by avoiding thinking or talking about event and/or staying away from reminders such places and objects and people associated with the traumatic event(s). Numbing response may be seen as stupor, derealization, depersonalization, feeling detached. Increased arousal such as hyper-vigilance, difficulty concentrating, difficulty falling or staying asleep , exaggerated startle response, irritability and outbursts of anger.
abuse, neglect leading to traumatic incidents, witnessing violence, or being threatened.
Conduct Disorder Source:
“Facts for Families #33, American Academy of Child and Adolescent Psychiatry, January, 2000
behavioral and emotional problems in children
and youth involving behaving in socially unacceptable ways, including one or more of the following:
¾ Aggression to people or animals ¾ Destruction of property ¾ Deceitfulness ¾ Stealing ¾ Violating rules
Many have co-existing conditions such as mood disorders, anxiety, PTSD, substance abuse, ADHD, or thought disorders.
Possible factors include child abuse, other types of traumatic life events, brain damage, school failure, or genetic vulnerability.
Oppositional Defiant Disorder Source:
Disorder Information Sheets, PyschNet-UK
Pattern of uncooperative, defiant and hostile behavior toward authority figures that does not involve major antisocial violations but is beyond typical age-stage behaviors and lead to impairment in functioning.
Factors may include traumatic or upsetting life events or genetic predisposition. Children and youth diagnosed this way have a higher rate of family history of disruptive behavior disorders, substance-use disorders or mood disorders.
David Barlow (ed) Clinical Handbook of Psychological Disorders, 2nd Edition, Guilford Press, New York, 1993
Depression” Sex Roles: A Journal of Research, July, 1999
A mood disorder characterized by sadness, helplessness (more in females), hopelessness, withdrawal, irritability, lethargy, and/or sleep disturbances. Females twice as likely as males to be diagnosed as depressed in adolescence. They tend to experience “interpersonal depressive style”: fear of abandonment, helplessness, chronic feelings of incompetence and low self-esteem. Adolescent males are more likely to experience “self-criticism depressive style and externalizing disorders”, meaning they also self-criticize but act out their depression aggressively.
Possible factors include traumatic or upsetting life events or brain biochemistry imbalances.
Bipolar Affective Disorder
James Chandler, “Bipolar Affective Disorder (Manic Depressive Disorder) in Children and Adolescents”
A mood disorder in which there is a swing (cycling) from feeling up (mania) to down (depression). Moods may be primarily up or down or both equally. The ups and downs are often characterized by the following behaviors:
¾ Inflated self-esteem, grandiosity ¾ Decreased need for sleep ¾ Increased talkativeness, feeling pressure to keep
¾ Racing thoughts, flight of ideas ¾ Distractability ¾ Increased, incessant activity ¾ Risk taking for pleasure experiences
¾ Lethargy ¾ Withdrawl ¾ Sadness ¾ Sleep disturbances
Half of adults had onset before age 17. In adolescents it is more common in males but this reverses by adulthood. Rapid cycling is more common in younger people.
mania (e.g., steroids). Some people (including children and youth) who are misdiagnosed as depressed and given antidepressants develop mania. In rare cases infections and hyperthyroidism can cause mania. Street drug highs can be mistakenly diagnosed as mania. Some children and youth who have a bipolar condition are misdiagnosed as Oppositional Defiant Disorder or Conduct Disorder. Bipolar disorder can mimic ADHD, when in fact some have both disorders. Nearly all children and youth with bipolar disorder also have ADHD (but not the reverse).
Borderline Personality Disorder
David Barlow (ed) Clinical Handbook of Psychological Disorders, 2nd Edition, Guilford Press, New York, 1993
A pervasive pattern of instability and dys-regulation across emotional, behavioral, cognitive and interpersonal domains. An inability to regulate/modulate emotional reactions. More common in females both in adolescence and adulthood. Common symptoms:
¾ Emotional responses are highly reactive ¾ Episodic depression, anxiety, irritability, and anger ¾ Extreme impulsivity ¾ Self-destructive (high incidence of suicide
¾ Brief (and non-psychotic) dissociation and
delusion (goes away when stress is reduced)
¾ Difficult, chaotic and intense relationships with
others; often “split” helpers and other people in life between the good and bad, reversing these periodically
There is a high incidence of childhood sexual abuse reported by people with this diagnosis. Other traumatic early childhood life events may also lead to inability to regulate/modulate emotions.
Handout 5 Diagnoses of Substance Problems Typology
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IVR) addresses “Substance Use Disorders” in two major categories: “Substance Dependence” and “Substance Abuse”. Substance Dependence: “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.” Three or more of the following diagnostic criteria must be present: 1. Tolerance:
Need for more of the substance to get high or getting less high on the same amount
Experiences withdrawal symptoms consistent with the particular substance or takes the same or a closely related substance to avoid withdrawal.
Person wants to or tries to cut down or stop using the substance
Lots of time involved in obtaining, using and recovering from use of the substance
Substance use interferes with life activities
Substance use continues even when health problems arise that are related to substance use.
Substance Abuse: “a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.” There is recurrent use and one or more of the following has occurred within a 12 month period: 1. Failure to fulfill major obligations (failing school)
2. Use occurs in situations which could be hazardous (e.g., driving) 3. Legal problems (e.g., arrests for substance-related disorderly conduct) 4. Social or interpersonal problems (e.g., arguments with parents about drug
The Use, Misuse and Abuse Typology
Another typology is that of “Use, Misuse” and Abuse” (Gary Fisher and Thomas Harrison, Substance abuse: Information for School Counselors, Social Workers, Therapists, and Counselors, Allyn and Bacon, 1997) Use
Ingesting alcohol or other drugs without negative effects
Using alcohol or other drugs with negative consequences
Continued use of alcohol or other drugs despite negative consequences.
Addiction Compulsive use of alcohol or other drugs with negative
Handout 6 Drug Classification
Source: Gary Fisher and Thomas Harrison, Substance abuse: Information for School Counselors, Social Workers, Therapists, and Counselors, Allyn and Bacon, 1997 Central Nervous System Depressants Effects:
Low doses: relaxation and calmness, muscle relaxation, disinhibition, anxiety reduction. Impaired judgment and reflexes. Lowered pulse rate and blood pressure. Higher doses: sedation, drowsiness, slurred speech, staggering, sleep and coma
Alcohol Prescribed and over the counter drugs for anxiety, sleep disturbance, seizure control, colds, allergies and coughs.
Barbiturates: Seconal (reds, red devils) Nembutal
Valium Librium Dalmane Halcion Xanax Ativan
Cold medicines with alcohol, scopolamine or antihistamines
Central Nervous System Stimulants Effects: Sense of euphoria, self-confidence, psychomotor stimulation,
alertness, mood elevation. Suppress appetite and combat fatigue. Eventually tremors, sweating, flushing, rapid heart beat, anxiety, insomnia, paranoia, convulsions, heart attack, stroke. No satiation point so use can quickly escalate.
Hallucinogens Effects: Altered state of consciousness (perceptions of visual, auditory,
Increased awareness of inner thoughts and impulses Rise in pulse and blood pressure With PCP, may be increased suggestibility, delusions and depersonalization. Flashbacks for many years
Cannobinols Effects: Euphoria
Dilated eyes, reduced intraocular pressure
marijuana (grass, pot, weed, joint, reefer, dubie)
Inhalants and Volatile Hydrocarbons Effects: Reduced
Nitrates – altered consciousness and increased sexual pleasure
Loss of consciousness and death due to lack of oxygen
Damage to liver, kidneys, brain and lung
Butyl and isobutyl (locker room, rush, bolt, quick silver, zoom)
Anabolic Steroids Effects: Build muscle and body mass
Contra-acts blood anemia and endometriosis.
in males: atrophy of testicles, impaired sperm production, infertility, early baldness, acne and enlarged breasts. in females: facial and body hair
Types: All are synthetic drugs resembling testosterone
For animals but used illicitly by humans:
Handout 7 Drugs Used in Treatment of Mental Disorders Disorder Drugs Desired
Schizophrenia and other Major tranquilizers
Handout 8 Signs of Adolescent Substance Abuse Change in behavior
Music and dress associated with drug users
More money and resources Appearing high Former friends are worried, angry at youth
Derrick will be 18 in two months. He is living now in a Residential Treatment Center (RTC) and is preparing to transition to an apartment where two youth who left the RTC several months ago now live. He will continue to participate in the county’s Transition and Independent Living program including attending counseling sessions. He is studying for the GED and hopes to enroll in a truck driving school. He plans to continue working at the fast food restaurant where he has been employed for four months.
Derrick has been in and out of foster care several times in his life. At age 6 he was removed for neglect because his single mother was taking drugs and not supervising him. His life-long difficulties in school first surfaced during this foster care stay and he was diagnosed as ADHD. He was prescribed Ritalin which the foster parents said helped him. He returned home after his mother completed in-patient substance abuse treatment and had been clean for 4 months. He continued to have problems at school but his mother refused to give him Ritalin, saying she felt it was poisoning him. When Derrick was 12, his mother was incarcerated for forgery and Derrick lived in foster care for 6 months until his mother was released and he was returned to her. During this time Derrick’s difficulties at school escalated and he was diagnosed as Oppositional Defiant Disorder. He was treated in individual therapy for three months and put back on the Ritalin; his behavior improved somewhat. He says that when he returned home he stopped taking the Ritalin for good. At age 16 Derrick was placed for a third time due to conflict with his mother and to his arrest for possession of marijuana and stealing a car. He had dropped out of school. A substance assessment at that time indicated that Derrick had been using marijuana since age 12 and that his current pattern was to smoke two-three times daily. He acknowledged a pattern of binge drinking, i.e., getting drunk once a week, sometimes to the point of passing out. He said he drank only beer. His mother said that his room constantly
smelled of pot and that she knows he drinks to a dangerous level because she has found him passed out in the front yard on several occasions. During the past 14 months in the RTC, Derrick has undergone the substance abuse treatment program provided by the RTC and is believed to have remained substance free except for a week seven months ago when he ran and admitted to binge drinking and smoking dope. He still refuses to take Ritalin, saying he doesn’t care whether or not he has a hard time paying attention, its just no big deal, he can make himself concentrate as long as he has to in order to get through school. The teachers at the on grounds school say that he struggles with attention issues but is able to get through the school day and complete most of his school work. They wish he would take the Ritalin because they feel it would help him get over the hurdle of passing the GED.
When he ran seven months ago, Derrick was picked up after some youth called the police. They told the police that Derrick was drunk and high and threatening to kill himself. Derrick was hospitalized before returning to the RTC. He was diagnosed with depression and prescribed Zoloft. However, over the next month he became increasingly agitated and slept little. He cut on himself and was re-hospitalized. He was then diagnosed as Bipolar and put on Lithium. His mother’s description of his father (whose whereabouts have been unknown since Derrick’s birth) indicated to the psychiatrist that Derrick’s bipolar disorder is likely genetic. The psychiatrist explained that bipolar disorder, when misdiagnosed as depression and treated with anti-depressants, can sometimes lead to an escalation of symptoms in a person whose true illness is bipolar disorder. Since then Derrick has been relatively stabilized, although he is still sometimes oppositional, particularly about the meds, which he hates because they make him feel “blah”. RTC staff must watch Derrick closely when he takes the Lithium because he has attempted to “cheek” it several times. This is a major issue in the plans to move to the apartment. Derrick is saying “When I turn 18 and get out of here, you can’t make me take it. Why don’t you just let me try getting along without these meds?! I’ll be ok. You all think you know what’s best for me but you don’t!”
Derrick is anxious to be living on his own. He is sick of the routines and rules of the RTC. He believes that he can pass his GED since he has come close to passing practice tests. He vacillates about his diagnosis of bipolar disorder. He says he has always heard from his mom that his dad would have highs and lows and maybe he is this way too. But, even if he is, he firmly believes the meds aren’t necessary and that he can do helpful things for himself if he gets depressed (exercise, spend time with friends, make himself be outgoing) or if he gets hyper or, as he says, manic (exercise, take a sleeping pill, and maybe even smoke a J again). He says “I know I shouldn’t be drinking, I get too wasted, but I can control smoking marijuana; I can keep it down to a once-in-a-while thing.” Derrick’s counselor at the RTC sat in on a meeting Derrick had with the psychiatrist who prescribed the Lithium. Both told Derrick that it is critical that he stay on this med because it is really helping him. They said that his transition to living on his own is going to be stressful and he needs to be feeling his best. However, in team meetings at the RTC several staff have argued that Derrick ought to be allowed to go off the Lithium while he is still in the RTC so that he can learn how he is affected. They say that everyone knows he is going to go off it first chance he gets and that he should do so while he is still living with people who can help him. Derrick’s mother, who comes for family therapy weekly at the RTC, says that generally she thinks most medication is “slow poison” and that over the long run it will harm Derrick’s body and maybe even his mind. She tells him that he needs to work on these alternative ways to manage his substance abuse and his mental health problems. She says she thinks it all goes back to his lousy childhood. She says she is sorry about that but she thinks Derrick can get past it by living a clean and active life. She says that when she was in substance treatment some of the patients tried Anabuse but she thinks they didn’t do so well, they just stayed addicted. She says that although she herself has had several relapses, these have been short-lived and she has never lost her job. She is determined to stay off substances by will power. QUESTIONS
o the diagnosis of bipolar disorder and how he can deal with
o the diagnosis of ADHD and how to best deal with it. o The diagnosis of substance abuse and how to best deal
¾ What are the professionals beliefs about Derrick’s various
diagnoses and how he can best handle them?
¾ What are the mother’s beliefs about Derrick’s various diagnoses
¾ What are some ways to address differences of opinion so as to be
Handout 10 How Youth Use Help A Youth Development Perspective
Youth use help in learning and achieving when 1.
They are involvement in planning and decision-making
There is a mentoring relationship in which they feel supported
Both the experiences for learning and the perspectives held by
the adults are normalizing for the youth.
They feel like they are being treated with respect
There are opportunities to practice and learn (sometimes
There are “if-then” rehearsals (thinking through the likely
consequences of various actions and planning with this in mind)
Setbacks are seen as learning opportunities
The youth has opportunities for new roles and responsibilities
They are guided to build on their strengths
Incremental progress is acknowledged and valued
Handout 11 Key Youth Developmental Characteristics Affecting How Youth Use Help
Peer oriented, desire to be accepted by peers
Rejection of adult and authority figure control
Handout 12 Resources for Supporting Transitioning Youth in Managing Their Substance Abuse and Mental Health Issues
Arturo is 18 years and 9 months. He has been in the Department’s custody for nearly two years. At the time he came into care two years ago, he had been released from a detention facility for having set a series of fires in alleys in his neighborhood – at that time he was placed in a Residential Treatment Center (RTC). While at the RTC he was diagnosed with depression and prescribed Wellbutrin. He participated in the Independent Living program and at 18 entered the Transition program in which he is getting financial support and continues to participate in Independent Living programming including individual and group counseling. Arturo lives with another youth in an apartment. He attends a trade school and has changed his focus recently from machinery repair to electronics. Arturo works 20 hours per week at a convenience store. Arturo had been in foster care in childhood from age 8-9 following sexual abuse by a live-in uncle and lack of protection by his mother due to her drug dependency. At age 9 a grandmother was located when she moved to this state from Mexico and she took custody. Arturo received treatment (both individual and group) for sexual abuse from age 8-10. At age 10 Arturo moved with his grandmother to another area of the state. In the 5 months that Arturo has been living in the apartment, the caseworker and Independent Living worker have become increasingly concerned about what they see as Arturo’s risky behavior. He laughingly talks about frequently setting small fires to relieve boredom and stress. He says these are always on the concrete patio and pose no danger. Arturo’s roommate says he thinks Arturo is weird about this fire stuff; he gets a big kick out of waving around burning objects: paper rolls, dry leaves, rope. Arturo says he thinks everyone is making something over nothing – this is just like a hobby, it calms him down, gets his mind off the stuff that is bugging him. He says that it has always been this way – the fires in the alley were just for fun; he was always careful. He says” I bet lots of people do little things like this, they just aren’t open about it. The world is full of closet deviants.”
Additionally, Arturo refuses to take the Wellbutrin except on his terms. He says that he can tell when he needs some – he starts getting moody and so he takes them for awhile and then he quits. He says he doesn’t believe that a steady dose is necessary – he thinks it’s a good drug but he can manage it himself. He sees his moodiness as “just normal, like all teenagers are and besides I’ve had a crappy life and its no wonder I get moody, it’s not an illness or anything.” His workers see him as increasingly depressed and frustrated. He tells his worker that he drinks two or three bottles of beer several evenings per week but never to the point of intoxication. His roommate confirms this. Arturo sees his problems in school as being a result of studying something he is uninterested in. He knows he has to be in school to get the particular type of financial assistance he is receiving but he doesn’t want to be in school. Arturo does not have a learning difference or ADHD and he has a normal range IQ. He passed his GED on the first try. Arturo doesn’t have any idea what he wants to do but he knows he isn’t interested in either of the things he has studied at the trade school. Recently he has wondered aloud about whether he ought to get on with a wildfire fighting crew. He has been surfing websites about wildfires and hotshot crews and talks knowledgably about the issues. He says with irony in his voice, “they ought to take me in a minute – I know more about fire than any recruit.”
Handout 14 Tiffany is 18 ½ and she has been living in the Benson foster care home since age 15. She entered foster care following her parents’ arrest for operating a meth lab and the death of her toddler sister from a meth lab explosion. Tiffany was traumatized by the event – she had, in her words, been obsessed about making sure her little sister did not get near the lab, which was in the garage. However, one day while Tiffany was lying on the couch listening to music on her headphones, her sister woke from a nap and wandered out to the garage. It is unclear what set off the explosion since no adults were present, however, the child died. Tiffany has been wracked by guilt, especially since her father blamed her for her sister’s death. She has been diagnosed at various times over the past 3 ½ years with PTSD and Generalized Anxiety Disorder. She says she thinks that she does have PTSD but that the best way to handle it is to think about happier things. She has been compliant with medications and is now doing fairly well on Paxil. Both she and the adults who work with her see her as highly emotionally dependent on the Bensons. She has resisted or in some way blocked efforts to move away from them. She will graduate from high school soon and wants to go to college. She would like to go to the community college near the Bensons and continue to live with them. The Bensons, who have done well with Tiffany, but never wanted to adopt her, are fine with this arrangement for only six more months. They have been planning to retire and move to a retirement community founded by their church and they have put this off because of Tiffany. They want to see Tiffany “on her own two feet.” They say they will always be available to her but they need to get on with their lives. Tiffany was in treatment for 1 ½ years for PTSD and anxiety at the mental health center. She refused psychotherapy after that time saying that the therapist just keeps bringing up the same things over and over. However, she is highly compliant about the Paxil. Once, when her prescription was low, she became very agitated about getting it refilled immediately. She keeps the meds bottle in the kitchen and asks the Bensons to watch her
taking it every day. She says she can manage it herself but she feels comforted by them watching her take it. Tiffany’s therapist feels like Tiffany shuts down in treatment, refusing to problem solve about current issues because she won’t address the fact that the Bensons are going to move. Tiffany has told the adults in her life that she feels like a brick wall comes up whenever she tries to look at her life beyond the time when the Bensons leave. She says she just is not ready to be planning for this and can everyone please just wait until she graduates from high school and gets settled into community college? When asked to envision her life in the future, Tiffany says she sees “a painting like the Norman Rockwell ones; it is of a bright white house and there is a picket fence around it. It has a painting studio and I am there painting big pictures, like of summer flowers. My husband will be nice to me and he will make enough money so I don’t have to work.” She loves now to draw and paint bright, reassuring pictures of children, animals and nature. She sees her doing this in her ideal future. She wants to study art in community college. Both she and the Bensons say that she is happiest and most content when she is drawing or painting.
Max is approaching his 18th birthday. Until recently he was living with his uncle and aunt who have been licensed to provide foster care to Max and his two younger sisters for the past 1 ½ years. The three children came into care because their grandmother, who raised them, had a stroke. Their mother had lived off and on with her mother, the children’s grandmother, since Max was born. None of the children’s fathers has been involved in their lives. Their mother is currently incarcerated for homicide, having stabbed the younger girl’s father during a fight nearly ten years ago. Last month Max was moved to a Residential Treatment Center (RTC) because he had been caught showing the younger girl pornography on the internet and it was determined this had been going on for almost two months. There were no allegations of touching but all of the adults involved felt he was grooming her. Since moving to the RTC Max has been evaluated and has been diagnosed with depression. He has been prescribed Wellbutrin and began taking it just a few days ago. He is frightened, sullen and irritable. He denies everything about the situation, saying his sister had been walking in on him when he was looking at porno and wouldn’t leave so he just let her stay and ignored her. He says that his aunt and uncle are prudes and they are using this as an excuse to get him out of the house and just keep the girls, who they like a lot better. He has been stonewalling in his therapy sessions, saying that they are just trying to get him to confess so they can jail him. He says he wouldn’t take the meds if he could get out of it. His therapist says that some of the testing (e.g. the Thematic Apperception Test – TAT) indicates there may be issues of childhood abuse, perhaps sexual, but is not sure. Max will not speak about his early life, saying the therapist will use whatever he says against him. Max’s legal situation is unclear. His case is being investigated and it is possible but unlikely that the DA will file charges against Max as an adult. Max says he isn’t talking to anybody about anything until that is known. Max had been planning to leave his aunt and uncle’s home when he turned 18. He has participated to some degree in the Independent Living classes
offered by his county Child Welfare Agency and the worker said he has been making some progress in some of the hard skill areas such as interviewing for jobs and managing his checkbook. However, she sees him as guarded and afraid of revealing too much of himself – even before the allegation. Max is unsure what he wants to do but is leaning towards going into the armed services. He likes the idea of being on his own, being treated like an adult. He is fearful that the allegation could interfere with this plan. Also, when he was prescribed Wellbutrin he became very angry, saying that the Army wouldn’t take him if they thought he was nuts. The RTC staff describe Max as a young person “on hold” – he seems to be paralyzed by events in his life now. They wonder how to “unlock” him.
Handout 16 Planning and Assessing Progress in the Context of Name of Youth____________________________ 1.
What do you view as the main issues related to mental health or
2. What effects do these issues have on the youth – particularly in relation
to how the youth is making his or her way in transitioning and learning independent living skills? Do you think the young person sees it the same way and if not, how?
What might be some ways to work with this youth to promote his/her ability to deal with mental health or substance abuse concerns? Use Handouts 10 and 11 as references – to what degree do your ideas utilize youth development principles and youth developmental characteristics?
Comments received from I&APs on the proposed Desert Star South Development (by 8 September 2010) ______________________________________________________________________________ From: Ranwedzi Mashudu [mailto:RanwedziM@dwa.gov.za] Sent: 08 September 2010 02:51 PM To: Lima Maartens Subject: RE: Re comment period for DSS Scoping Report Hi Lima Unfortunately there are still
A sociedade ainda faz uma grande cobrança em relação à maternidade, e isso, muitas vezes, gera ansiedade e angústia aos casais que não estão conseguindo engravidar. Nota-se que nos últimos anos têm ocorrido importantes mudanças nos hábitos e no estilo de vida das pessoas, que pode, de alguma forma, estar retardando e diﬁcultando a gestação. Alguns aspectos do dia-a-dia contribuem m