Crisis Response Resources for Schools

Tragic Event Resources for
Schools/Educational Settings and Parents
Helpful Tools:
Crisis Line
Description: The Crisis Line is available 24 hours a day, seven days a week to anyone
experiencing a mental health crisis. Serving Maricopa County and parts of Pinal County
(ZIP Codes 85120, 85140, 85142 and 85143).
Toll free: (800) 631-1314
Local: (602) 222-9444
TTY/TDD toll free: (800) 327-9254
TTY/TDD local: (602) 274-3360
For emergency situations always call 9-1-1
Partnership Hotline between Magellan Health Services and ADHS/DBHS
Description: The Arizona Department of Health Services (ADHS)/Division of Behavioral
Health Services (DBHS) and Magellan Health Services of Arizona have set up a 24hour toll-free hotline to help citizens process feelings of grief, sorrow and depression.
The hotline is staffed by behavioral health professionals to offer counseling services to
people outside Pima County. Arizona residents can call the hotline to connect with crisis
response professionals who specialize in behavioral health. This information and more
can be found on the ADHS/DBHS website.
Phone Number: 1-800-203-CARES (1-800-203-2273)
Mental Illness on Campus What You Can Do to Help
Description: Tips on how to identify a person in trouble and what you can do to help.
http://www.nami.org/Template.cfm?Section=Mental_Illness_Fact_Sheets&Template=/C
ontentManagement/ContentDisplay.cfm&ContentID=85780
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The following are attached documents:
1. Crisis card
Description: Crisis Response Network provides crisis services for central
Arizona. Services include phone intervention and mobile crisis teams.
2. Mental Illness on Campus What You Can Do to Help
Description: Tips on how to identify a person in trouble and what you can do to
help.
http://www.nami.org/Template.cfm?Section=Mental_Illness_Fact_Sheets&Templ
ate=/ContentManagement/ContentDisplay.cfm&ContentID=85780
3. Magellan Bookmark
Description: Bookmark provides a brief description of Magellan Health Services.
Bookmark also contains Member Services and crisis contact information.
4. Safe Talk, Suicide Talk, and ASIST training
Description: Document describing training to learn how to provide practical help
to persons with thoughts of suicide. Website link to Achieve training website.
5. La Voz Spread – English Version
Description: Article was featured in La Voz newspaper. Article highlights
mental/behavioral health topics such as, crisis, accessing services, and signs
and symptoms.
6. La Voz Spread – Spanish Version
Description: Article was featured in La Voz newspaper. Article highlights
mental/behavioral health topics such as, crisis, accessing services, and signs
and symptoms
7. Handout: Tips on Calling an Agency for Mental/Behavioral Health Services
Description: Document provides support and guidance to someone who is calling
about mental/behavioral health services.
8. Arizona Response to Intervention
Description: School achievement and success require that students be provided
both academic and behavioral systems of support. A comprehensive system of
behavioral supports ensures that students are ready and able to learn by creating
environments conducive to learning and by addressing barriers to learning that
students experience.
Link: https://www.azed.gov/azrti/SystemofBehavioralSupports/RTISBS_FNL3.pdf
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9. School Safety: What Schools Can Do
Description: A safe school is one that is free from violent and criminal behaviors
and allows staff, students and community members to feel connected to the
school and able to participate in its major functions – teaching and learning. Link
also provides numerous references to examples, studies, and supportive
documents.
Link:
https://www.azed.gov/sa/health/downloads/What_Schools_Can_Do__4_.pdf
10. Guide: Mental Health Crisis Planning for Families and Educators
Description: Guide for parents to “Learn to Recognize, Manage, Prevent and
Plan for Your Child’s Mental Health Crisis.”
11. Photonovela – English Version
Description: Created by youth to help identify when someone might need help
and how to access services.
English version:
http://www.magellanofaz.com/media/120454/fotonovela!%20englishversion_final.
pdf
12. Photonovela – Spanish Version
Description: Created by youth to help identify when someone might need help
and how to access services.
Spanish version:
http://www.magellanofaz.com/media/120458/fotonovela!%20spanish_version_fin
al.pdf
13. Children and Tragedy Factsheet
Description: Factsheet with tips on what to look for while helping children recover
from a tragic event.
14. Common Responses to Traumatic Events Factsheet
Description: Factsheet with tips on some common reactions and signs/symtoms
of trauma that may present themselves after traumatic events.
15. Coping with Children’s Reactions Factsheet
Description: Factsheet with adviced to parents on how to cope with children’s
reactions after a disaster.
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16. Overcoming Your Fears and Anxiety Factsheet
Description: Factsheet with tips on what individuals can do to overcome feelings
of anxietey.
17. Post-trauma Do’s and Don’ts Factsheet
Description: Factsheet with tips on what to do and not do after a traumatic event.
18. Teenage Grieving Factsheet
Description: Factsheet with tips on common reactions of teenagers who are
grieving.
19. Tragedy Aftermath – Taking Care of Yourself Factsheet
Description: Factsheet with tips on what common responses to a disaster and
helpful tips on how to deal with them.
The following are resources available on line:
1. How to Get Care through Magellan Health Services of Arizona/How to Refer
to Mental Health Services
Description: Magellan of Arizona's website provides people with additional
information about how to access mental health services.
Link: http://www.magellanofaz.com/mypage-en/program--services/how-to-getcare.aspx
2. Arizona State Legislature
Description: Use this web site as a tool to track pending legislation, plus locate
and contact individual legislators, and stay up-to-date on current issues. For an
overview of the legislative process in Arizona, please feel free to explore this web
site.
Link: http://www.azleg.gov/
3. How Do I Find or Contact my Legislator
Description: Search for local legislator by address and zip code
Link: http://www.azleg.gov/alisStaticPages/HowToContactMember.asp
4. National Center for Crisis Management
Description: Site provides downloadable crisis documents to aid a school in the
development of a crisis response plan.
Link: http://www.schoolcrisisresponse.com/download.htm
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5. Title: Mental Health America - Tips for Educators, Students and Parents
(after the Virginia Tech Tragedy)
Link: http://www.nmha.org/go/coping-virginia-tech
6. Title: National Alliance on Mental Illness (NAMI) - The Virginia Tech
Tragedy- Distinguishing Mental Illness from Violence
Link:
http://www.nami.org/Template.cfm?Section=April6&Template=/ContentManagem
ent/ContentDisplay.cfm&ContentID=45403
The Crisis Line is available 24 hours a day, seven days a
week to anyone experiencing a mental health crisis.
Crisis Line
Serving Maricopa County and parts of Pinal County
(ZIP Codes 85120, 85140, 85142 and 85143)
Toll free: (800) 631-1314
Local: (602) 222-9444
TTY/TDD toll free: (800) 327-9254
TTY/TDD local: (602) 274-3360
For emergency situations always call 9-1-1.
¿Qué es Magellan de Arizona?
Magellan Health Services de Arizona es la Autoridad
Regional de Salud Mental del centro de Arizona,
que incluye todo el Condado de Maricopa y parte
del Condado Pinal. Los fondos para proporcionar los
servicios se obtienen a través de un contrato con el
Departamento de Servicios de Salud/la División de
Servicios de Salud Mental de Arizona y el Sistema de
Contención de Costos de Atención de Salud de Arizona.
¿Cómo presta los servicios Magellan de Arizona?
Magellan de Arizona maneja un sistema integral de
Organizaciones de Red de Proveedores (PNO, por
sus siglas en inglés) y Proveedores de Servicios
Calificados (QSP, por sus siglas en inglés), que brindan
una gran variedad de servicios para la salud mental y
el tratamiento de abuso de sustancias para residentes
elegibles dentro del Condado Maricopa y partes del
Condado Pinal. Magellan contrata a los proveedores
teniendo en cuenta los valores de las elecciones de los
individuos que reciben servicios, la diversidad cultural, y
la recuperación y el restablecimiento de los adultos, los
niños y sus familias. Para obtener una lista completa de
las agencias de proveedores, visite www.MagellanofAZ.
com/Directory.
¿Cómo recibo los servicios?
Después de la inscripción, usted deberá elegir una
PNO o un QSP según sus necesidades individuales. Su
proveedor le asignará un representante de salud mental
que le asistirá en la coordinación de su atención. Para
dar inicio al proceso de inscripción o para obtener más
información, comuníquese con Servicios para Miembros
de Magellan al (800) 564-5465 o a nuestra línea TTY al
(800) 424-9831.
S
Magellan de Arizona
(800) 564-5465 TTY (800) 424-9831
www.MagellanofAZ.com
Si está en crisis, puede encontrar ayuda. Llame a la Línea
de Crisis del Condado Maricopa al (800) 631-1314 o al TTY al
(800) 327-9254. Para emergencias, siempre llame al 9-1-1.
Who is Magellan of Arizona?
Magellan Health Services of Arizona is the Regional
Behavioral Health Authority for central Arizona, which
includes all of Maricopa County and part of Pinal County.
Funds for services are provided through a contract with
the Arizona Department of Health Services/Division
of Behavioral Health Services (ADHS/DBHS) and the
Arizona Health Care Cost Containment System (AHCCCS).
How does Magellan of Arizona deliver services?
Magellan of Arizona manages a comprehensive
system of provider network organizations (PNO) and
qualified service providers (QSP) who deliver a variety
of behavioral health services such as medication,
substance abuse treatment, crisis assistance and other
support services for qualifying residents of Maricopa
County and parts of Pinal County. Magellan contracts
with providers around the values of service recipient
choice, cultural diversity, and recovery and resiliency
for adults, children, and their families. For a complete
list of provider agencies, visit www.MagellanofAZ.com/
Directory.
How do I get services?
After enrollment you will choose a PNO or QSP
depending on your individual needs. Your provider will
assign you a behavioral health representative who
will assist you in coordinating your care. To begin the
enrollment process or for more information, contact
Magellan Member Services at (800) 564-5465 or our
TTY line at (800) 424-9831.
Magellan of Arizona
(800) 564-5465 TTY (800) 424-9831
www.MagellanofAZ.com
If you are in a crisis, help is available! Call the Crisis Line
at (800) 631-1314 or TTY at (800) 327-9254. For emergencies,
always call 9-1-1.
22084
Mental Illness on Campus ~ What You Can Do to Help
Times of anxiety and feeling down are common experiences in college, but did
you know that they may be part of a treatable mental health condition? The latest
research reports that feeling depressed to the point where students have trouble
functioning impacts about 40% of students—while 15% have a serious clinical
depression. Suicide is a serious problem in college---about 1,100 lives a year are
lost to this largely preventable outcome.
The 2005 National College Health Assessment (NCHA), a survey of nearly
17,000 college students conducted by the American College Health Association,
revealed that 25% reported they “felt so depressed it was difficult to function”
three to eight times during the past year and 21% reported they “seriously
considered suicide” one or more times during the past year. In the NCHA survey,
students also ranked depression as one of the top ten impediments to academic
performance.
While colleges and universities have a role in ensuring the health and safety of
people on campus, students themselves are often the first to recognize when a
problem might exist and are likely the first to be able to engage before the
condition becomes a more serious issue.
How can you tell if a Person is in Trouble?
• Take conversations about suicide or homicide very seriously. A person
who jokes about suicide or homicide may be struggling with a deeper
sense of hopelessness. Most people who commit suicide have told
someone, often in the days preceding the event.
• Sleep problems are often a symptom of more serious health problems.
Roommates who have big changes in sleep patterns may be at risk for
psychiatric illnesses. For example, if a person who usually sleeps ten
hours, midnight to 10 am, suddenly begins waking up at 5 am and acts
agitated or begins pacing, this could be a sign that they may be
experiencing a deeper problem that should be addressed.
• Bulimia and Anorexia are eating disorders that often co-occur with
anxiety and depression. Behaviors such as patterns of binge-eating,
recurrent inappropriate behavior to control one’s weight, self-induced
vomiting,
excessive exercise, expressions of an intense fear of gaining weight, or an
ongoing preoccupation with weight and food despite being may be signs
of a more serious psychiatric illness that needs medical attention.
• Alcohol and drug use compound all risk. Alcohol risk is higher in
sororities and fraternities, but the risk remains for most college students as
alcohol is often a part of acceptable campus social life. Guns are very high
risk in combination with alcohol and other drugs; these two in combination
are very dangerous.
• Be aware of expectable life stresses. Relationship breakups, future
career stress, exam pressure, peer pressure and judgment, loneliness,
financial stress, and even graduation can compound all other risks.
• Be mindful of other possible, less expectable but very real stresses--for
instance the realization that one may be gay, that one is being bullied or
discriminated against, the death of a parent of grandparent, or divorce can
compound self harm risk.
What to do if you suspect a person is in trouble or at risk.
• Follow your instincts. People have been wired for Millennia to detect
unusual or risky social situations, and your instincts can be a key to
helping someone get the help they need. If you feel sad around the
person, remember feelings can be contagious, and you may be sensing
their own internal despair. If you want to avoid the person, note that, too.
Do not hesitate to tell someone in authority on campus about your
concerns.
• Don't worry alone. If you live in on-campus housing, start with your
Residential Assistant/Advisor who can offer more information and
resources or will often know the best approach and services available to
you. You can also go to the Campus Counseling Center for information
and assistance about what is available on your campus community.
• If you feel you can, approach the person with concern, not judgment.
Easy comments such as “I sense you are (sad, troubled) etc.” can begin a
discussion and possibly invite the person to talk about what they are
experiencing. Gently suggest they get help, offer to go with them if you
feel comfortable with that. However, safety should always come first—
yours.
• Offer information on college mental health services. Don’t be afraid to
use them as they help people every day deal with the stresses of college
life.
• Offer information on web sites that might be helpful. Students rely on
networking and the Internet as primary information sources. NAMI has a
“NAMI on Campus” section at www.nami.org/namioncampus that also
features discussion group networking options that may offer the person
support and information to help them manage their own situations.
Additionally, there are over 1,100 local NAMI affiliates in communities
across the country. Visit www.nami.org to Find Support that is the most
convenient.
• Meetings and groups can offer hope and support to students. There are
often dozens of campus student groups operating all days of the week,
including support and networking groups for mental illness and stress
management. Find out what may be available and encourage the person
to attend. If you feel comfortable, offer to go to a first meeting with the
person, or find another person who might offer to make the meeting more
inviting.
• Be gentle with yourself. Even the best doctor cannot predict all bad
outcomes. People sometimes hide their feelings and behavior to avoid
consequences. Remember that you are ultimately only responsible for
your own behavior.
Reviewed by Ken Duckworth, M.D., 2007
Permission is granted for this fact sheet to be reproduced in its entirety, but the NAMI name, service mark,
and contact information must be included.
NAMI on Campus – 3803 N. Fairfax Drive, Suite 100, Arlington, VA 22203, Ph: 703-524-7600,
Email: [email protected],
Website: www.nami.org/oncampus
4. Safe Talk, Suicide Talk, ASIST and Mental Health First Aid trainings
Description: Please go to the website listed below for a full list of training. In
particular:

ASIST – Applied Suicide Intervention Skills Training
Purpose: The goal of this two-day, highly interactive, practical, practiceoriented workshop is to provide skills to all individuals to apply first-aid
suicide intervention in times of individual and family crises.
Training Highlights:
- Reduce fears about “suicide”.
- Increase knowledge for utilization in effective intervention.
- Increase competence and confidence in suicide first-aid skills.
- Develop practical intervention skills to effectively deal with
suicidal situations.
- Understand that suicide is a preventable problem.

Safe Talk, Suicide Talk - In only a few hours, you will learn how to
provide practical help to persons with thoughts of suicide. Expect to leave
safeTalk more willing and able to perform an important helping role for
persons with thoughts of suicide.
How does safeTalk help prevent suicide?
- SafeTalk prepares you to be a suicide alert helper. You are
aware that opportunities to help a person with thoughts of
suicide are sometimes missed, dismissed and avoided. You
want persons with thoughts to invite your help. You know the
TALK steps (Tell, Ask, Listen and KeepSafe) and can activate a
suicide alert. As part of the KeepSafe step, you connect persons
with thoughts to persons trained in suicide intervention. Helpers
trained in suicide intervention complete the helping process or
connect the person with more specialized help.
Why use safeTalk to learn to become alert?
- A carefully crafted set of helping steps and the use of creative
educational processes make it possible for you and up to 30
others in your community to leave safeTALK willing and able to
be suicide alert helpers. safeTALK is the result of some twenty
years of work at learning how to develop useful suicide
prevention abilities in a short program.

Mental Health First Aid - Mental Health First Aid is the initial help given
to a person showing symptoms of mental illness or in a mental health
crisis until appropriate professional, peer or family support can be
engaged. In the 12-hour, two-day course, Mental Health First Aid training
teaches people a five-step action plan to help someone in a mental health
crisis or someone showing symptoms of mental illness. To help
remember the steps, course participants learn a mnemonic, A-L-G-E-E:
- A: Assess for risk of suicide or harm.
- L: Listen non-judgmentally.
- G: Give reassurance and information.
- E: Encourage appropriate professional help.
- E: Encourage self-help and other support strategies.
In central Arizona, Mental Health First Aid trainers have reached more than 500
community members since the statewide initiative launched in spring 2011.
Those who are interested in becoming trained in Mental Health First Aid should
visit the Arizona Department of Health Services website dedicated to this
initiative implementation, http://www.azdhs.gov/bhs/mhfa.htm. The website
contains additional information on the program and a list of upcoming training
sessions and contact information for instructors if anyone wants to host the
training for their group or organization.
Mental Health First Aid USA is disseminated by the National Council for
Community Behavioral Healthcare, the Maryland Department of Health and
Mental Hygiene, and the Missouri Department of Mental Health. To learn more
about the Mental Health First Aid program, visit www.MentalHealthFirstAid.org.
Sign up for these FREE trainings at the Achieve website: https://magellan.learn.com/az
Magellan Health Services de Arizona
está dedicada a fortalecer el sistema de salud
mental del centro de Arizona.
Verdades Sobre …
La Salud Mental
Aproximadamente uno de cada cinco adultos
mayor de
tiene un desorden de salud
mental diagnosticable.
18
Mayo es el Mes de la Concientización
dedicada a fortalecer el sistema de salud
mental del centro de Arizona. Un sistema,
de la Salud Mental, una excelente
que además de brindar esperanza, recursos
oportunidad para aprender más sobre
y recuperación a aquellos en nuestro
las enfermedades mentales y dónde
cuidado, facilita el acceso de servicios a
solicitar ayuda. Es un periodo en el que
las comunidades más vulnerables elegibles
profesionales, organizaciones, escuelas,
para tratamiento de salud mental.
comunidades, hospitales y medios de
comunicación unen esfuerzos para crear
En Magellan de Arizona creemos que
conciencia sobre la importancia de la salud
las personas que reciben servicios de
mental y reducir el estigma que impide que
salud mental deben recibirlos de manera
las personas reciban la ayuda profesional
respetuosa basado en sus preferencias
que requieren. Para Magellan de Arizona,
individuales, valores, necesidades, idioma
esta labor es de todos los días tomando
de preferencia y creencias culturales. Para
en cuenta que en Estados Unidos, uno de
lograr esto, apoyamos a nuestro personal
Richard Clarke
Presidente, Magellan de Arizona
cada cuatro adultos y uno de cada cinco
y red de proveedores para aseguranos de
niños es afectado por una enfermedad mental sin importar proporcionar un servicio culturalmente competente. De esta
raza, nivel de educación o estatus socioeconómico.
manera, construimos relaciones más estrechas con la gente
La falta de acceso a los servicios de salud mental y la comunidad que servimos, proporcionamos un mejor
continúa siendo un problema serio entre las minorías en servicio y ayudamos a fortalecer la comunidad del centro de
todo Estados Unidos. Si bien la falta de seguro médico Arizona en general.
juega un papel importante en el acceso a los servicios de Como parte de nuestro esfuerzo por facilitar el acceso de
salud, las creencias culturales, la falta de información y servicios de salud mental a las comunidades más vulnerables,
entendimiento de las enfermedades mentales también son Magellan ha recopilado esta serie de información y recursos
barreras claves que impiden que las personas se atiendan.
de salud mental para ayudarle a entender mejor la causa y
De acuerdo a la Asociación Americana de Psiquiatría, “Los síntomas de las enfermedades mentales y donde pedir ayuda.
Hispanos o Latinos suelen tener diferentes percepciones al La mayoría de la información contenida en estas páginas
solicitar servicios de salud mental y sentirse estigmatizados fue extraída de documentos del Instituto Nacional de Salud
por hacerlo. Por ejemplo, algunos tienden a confundir la Mental (NIMH por sus siglas en inglés) y del Departamento
depresión con el nerviosismo, cansancio o inclusive hasta de Salud y Servicios Humanos (DHHS por sus siglas en
un malestar físico creyendo que se trata de algo temporal o inglés), quienes autorizan y fomentan la reproducción de
pasajero. Como resultado, las personas afectadas por una sus publicaciones para mejorar la salud pública.
enfermedad mental pueden no reconocer los síntomas como Por favor tome tiempo suficiente para revisar y compartir
tales y que requieren la atención de un especialista en salud esta información con sus seres queridos. Si usted o alguien
mental.” Si bien muchas de las barreras que impiden que que conoce requieren de servicios de salud mental o contra
los hispanos soliciten tratamiento son comunes entre otros el abuso de sustancias, comuníquese con Magellan de
grupos étnicos, la Asociación Americana de Psiquiatría Arizona llamando al (800) 564-5465. Magellan de Arizona
señala que los hispanos utilizan los servicios de salud y nuestros proveedores brindan a las personas elegibles
mental mucho menos que otros grupos étnicos.
para AHCCCS y a sus familiares, una voz en el proceso de
Como la Autoridad Regional de Salud Mental en el estado recuperación y la oportunidad de elegir dónde y cuándo
(RBHA por sus siglas en inglés), Magellan de Arizona está solicitar ayuda.
(National Institute of Mental Health)
Las enfermedades mentales son más comunes
que el cáncer, la diabetes o las enfermedades
cardiacas. (American Surgeons General’s Report)
Las enfermedades mentales afectan a
cualquier persona, independientemente de
su edad, estatus económico, raza, religión o
cultura. Las enfermedades mentales afectan
tanto a hombres como mujeres.
(National Alliance for the Mentally Ill)
Las enfermedades mentales suelen
desarrollarse durante la adolescencia y
juventud. Sin embargo, estas pueden presentarse
a cualquier edad. Los jóvenes y personas de la
tercera edad están más propensos a padecerlas.
(National Alliance for the Mentally Ill)
4
10
de las
causas principales de
incapacidad (años perdidos de productividad) en
Estados Unidos y otros países desarrollados
son las enfermedades mentales, las cuales
incluyen depresión crónica, trastorno bipolar,
esquizofrenia, y el trastorno obsesivocompulsivo. Muchas personas sufren más de
una enfermedad mental en algún momento de
su vida. (National Institute of Mental Health)
Con tratamiento y cuidado apropiado,
70 - 90%
entre el
de las personas
con enfermedades mentales logran reducir los
síntomas de manera significante y tener una
mejor calidad de vida.
(National Alliance for the Mentally Ill)
2/3
Más de
de las personas con
enfermedades mentales en Estados Unidos
viven en la comunidad y mantienen vidas
productivas. (National Mental Health Association)
Los Hombres y la Depresión
Instituto Nacional de Salud Mental
Señales y Síntomas • Sentimientos de tristeza, ansiedad, irritabilidad o sentirse “vacío”
• Pérdida de interés en el trabajo, la familia y actividades que antes disfrutaba incluyendo el sexo
• Problemas de concentración o mala memoria
• Dormir o comer demasiado o poco
• Pensamientos suicidas o intentos de suicidio
• Síntomas físicos persistentes tales como dolores de cabeza, trastornos digestivos y dolores crónicos que no responden a tratamientos • Problemas para cumplir con sus responsabilidades
La Buena Salud Mental
No Tiene Edad
Departamento de Salud y Servicios Humanos
Una mente sana es tan importante como un cuerpo sano.
El tener buena salud mental no significa que usted nunca se
sentirá triste, solo o abatido. Pero cuando estos sentimientos
trastornan su vida o permanecen en su ser por mucho tiempo,
puede ser que haya un problema más grande.
Sentimientos inusuales de tristeza o depresión pueden
ocurrir cuando tiene que mudarse de su hogar; sus seres
queridos se enferman o fallecen, tiene que depender de otros
para ir a lugares o para hacer cosas simples que usted solía
hacer por sí mismo o sus problemas de salud física parecen
abrumadores.
Si su depresión o los cambios en su comportamiento duran
más de dos semanas, hable con su médico u otro profesional
que provee cuidados de salud. Explíqueles exactamente cómo
usted se está sintiendo y aclare que es diferente de cómo usted
solía sentirse. Ellos pueden diagnosticar algún problema y
sugerir opciones de tratamiento. Comparta sus sentimientos
con un amigo, algún miembro de la familia o con un consejero
espiritual. A veces estas personas pueden distinguir cambios
que usted no nota.
Si usted o alguien que conoce requieren de servicios de
salud mental o contra el abuso de sustancias, comuníquese
con Magellan de Arizona llamando al (800) 564-5465. Los
servicios de Magellan están disponibles para niños y adultos y
son cubiertos por Medicaid o AHCCCS/KidsCare.
Además de sentimientos de depresión, algunos de los
siguientes cambios en el comportamiento pueden sugerir
la existencia de otros problemas emocionales:
• Afectarse o disgustarse fácilmente
• Falta de energía para hacer las cosas que quiere hacer
o las cosas que solía hacer
• Cambios en sus hábitos de dormir
• Creciente falta de memoria
• Llorar mucho
• Pasar mucho tiempo solo • Perderse con frecuencia
• Sentirse con miedo a las cosas
• Cambios en sus hábitos de comer
• Tener problemas con el manejo de dinero
• Creer que no puede hacer algo útil, algo que valga la pena
• Sentirse confundido
• Sentirse desalentado o abrumado
• Pensar que no vale la pena vivir la vida
• Pensar en hacerse daño a sí mismo
La depresión es un trastorno médico serio para el cual existe
tratamiento. Es una enfermedad cerebral que puede afectar
a cualquiera incluyendo a los hombres. Tan solo en Estados
Unidos más de seis (6) millones de hombres padecen de
depresión cada año.
Sea ejecutivo, empleado en construcción, escritor, policía,
estudiante, rico o pobre, con muchos seres queridos a su lado o
esté solo, no está inmune a sufrir depresión. Sin embargo, algunos
factores como antecedentes de depresión en la familia, problemas
de estrés, pérdida de un ser querido o alguna enfermedad crónica,
pueden hacerle aún más vulnerable a padecer de depresión.
Tanto los hombres como las mujeres pueden padecer de
este trastorno. Sin embargo, los hombres suelen manifestarlo
de manera diferente. Los hombres por lo general se quejan de
fatiga, irritabilidad, pérdida de interés en el trabajo o pasatiempos
favoritos y problemas de sueño, y no se quejan tanto de otros
síntomas como sentimientos de tristeza, falta de auto estima y
culpabilidad excesiva. Si bien las mujeres con depresión tienden
a cometer más intentos de suicidio, los hombres tienen mayor
probabilidad de morir por suicidio. Por ello y muchas más razones
es importante aprender a reconocer los síntomas y buscar ayuda
profesional.
Tenga presente que no todas las personas que sufren depresión
manifiestan todos los síntomas. Algunos tienen pocos síntomas,
mientras que otros pueden tener muchos. La severidad de los
síntomas varía de una persona a otra y también puede variar con
el transcurso del tiempo.
Investigaciones y hallazgos clínicos revelan que los hombres y las
mujeres hablan distinto o en el caso de lo hombres, sencillamente
no hablan sobre los síntomas de la depresión. Muchos no aceptan
que tienen un problema de depresión, se reúsan hablar de cómo
se sienten y pedir ayuda influenciados por sus creencias culturales
u origen étnico. Por ejemplo, el rol tradicional del hombre en la
comunidad Latina puede contribuir a que el hombre se reúse ha
expresar sus sentimientos sobre la depresión.
En lugar de reconocer sus síntomas, pedir ayuda o
solicitar el tratamiento apropiado, los hombres con depresión
independientemente de su origen étnico pueden recurrir al alcohol
o las drogas cuando están deprimidos, frustrados, desanimados,
enojados, irritados y algunas veces violentamente abusivos.
Algunos hombres enfrentan la depresión dedicándose de manera
compulsiva a su trabajo, tratando de ocultar la depresión a sí
mismos, la familia y los amigos; otros hombres pueden responder
a la depresión mostrando comportamiento temerario, es decir
arriesgándose y poniéndose en situaciones peligrosas.
La depresión al igual que otros trastornos emocionales no
conoce género, nacionalidad, diferencias étnicas o culturales. Sin
tratamiento, la depresión puede llevar a problemas personales,
familiares y financieros.
Afortunadamente, la depresión como la mayoría de las
enfermedades mentales es una enfermedad real para la que existe
un tratamiento. Con un diagnóstico y tratamiento apropiado, la
mayoría de las personas pueden y suelen recuperarse.
Trastornos de Ansiedad
Instituto Nacional de Salud Mental
Los trastornos de ansiedad afectan
aproximadamente a 40 millones de adultos
estadounidenses de 18 años de edad o más
(aproximadamente 18%) cada año, llenando
a las personas de miedo e incertidumbre.
A diferencia de la ansiedad relativamente
leve y transitoria causada por un evento
estresante (tal como hablar en público o
la primera cita amorosa), los trastornos de
ansiedad duran por lo menos seis meses y
pueden empeorar si no se tratan.
Los trastornos de ansiedad son
clasificados y divididos en diferentes tipos
y categorías como el trastorno de pánico,
el trastorno de estrés postraumático, el
trastorno obsesivo-compulsivo y trastorno
de ansiedad generalizada. Cada trastorno
de ansiedad tiene diferentes síntomas, pero
todos los síntomas se agrupan alrededor de
un temor o pavor irracional y excesivo.
Si bien es perfectamente normal
preocuparse por la salud, el dinero o
problemas familiares, las personas con
trastornos de ansiedad pasan el día llenas
de preocupaciones y tensiones exageradas
por éstos y otros motivos todo el tiempo,
incluso cuando hay poco o nada que
las provoque. En ocasiones, el simple
pensamiento de cómo afrontar el día les
produce ansiedad.
Los trastornos de ansiedad suelen
desarrollarse gradualmente y puede
comenzar en cualquier punto del ciclo de
vida, aunque los años de mayor riesgo son
aquellos entre la infancia y la mediana edad.
Los síntomas pueden mejorar o empeorar
con el tiempo, y generalmente empeorar en
momentos de estrés.
Las personas con trastornos de
ansiedad pueden visitar a su médico varias
veces antes de descubrir que tienen este
trastorno. Pueden pedirle a su doctor
ayuda con dolores de cabeza o problemas
para dormir, los cuales pueden ser
síntomas de un trastorno de ansiedad, pero
no siempre reciben la ayuda que necesitan
inmediatamente. Puede tomar tiempo para
que un doctor determine que una persona
cuenta con un trastorno de ansiedad y no
algo más.
Los trastornos de ansiedad suelen ser
acompañados por otras enfermedades
físicas o mentales incluyendo el abuso de
sustancias lo que puede hacer más difícil
detectar los síntomas y empeorarlos. En
algunos casos, estas otras enfermedades
necesitan ser tratadas antes que la persona
responda favorablemente al tratamiento
para el trastorno de ansiedad.
Hoy en día existen tratamientos
Magellan Health Services de Arizona, Inc. es la Autoridad Regional de Salud Mental del condado Maricopa y partes
del condado Pinal. Los fondos para servicios son proporcionados por contrato con el Departamento de Servicios de
Salud de Arizona/División de Servicios de Salud Mental de Arizona y el Sistema de Contención de Costos de Cuidado
de Salud del Estado de Arizona (AHCCCS).
Señales y Síntomas
•Se preocupa demasiado por las actividades de cada día
•Se preocupa mucho más de lo que debería
•Tienen problemas para concentrarse
•Se sobresalta con facilidad
•Insomnio, despierta con frecuencia y no se puede relajar
•Tienen dolor de cabeza, muscular, estomacal o dolores inexplicables
•Temblores o tics (movimiento nervioso)
•Está irritable, suda mucho y se marea o le falta el aire
•Tiene que ir al baño seguido
efectivos para los trastornos de ansiedad
y se continúa descubriendo nuevos
tratamientos que permiten a las personas
vivir vidas productivas. Si cree que usted o
alguien que conoce padece un trastorno de
ansiedad, busque información y ayuda lo
antes posible.
Déficit de Atención e Hiperactividad
(ADHD)
diagnosticados y recibir
tratamiento es mucho
menor ya que a los padres
se les dificulta reconocer
los síntomas por diversos
factores culturales.
Instituto Nacional de Salud Mental
El Déficit de Atención e Hiperactividad o
Attention-Deficit/Hyperactivity
Disorder (ADHD por sus siglas en
inglés) es un trastorno común en la
infancia y puede afectar a los niños de
distintas maneras. El ADHD hace que ¿Qué causa el ADHD?
a un niño le sea difícil concentrarse y Nadie lo sabe con
prestar atención. Algunos niños pueden seguridad. Algunos estudios
ser hiperactivos o tener
problemas para tener
Señales y Síntomas
paciencia. El ADHD
Falta de Atención
puede hacer que a un
Se distrae fácilmente, se le olvidan las
niño le resulte difícil
cosas o detalles, constantemente cambia
desempeñarse bien en la
de una actividad a otra y se le dificulta
escuela o comportarse en
seguir instrucciones
su casa.
Hiperactividad
Diversos estudios han
Habla demasiado, corre por todos lados, toca y
demostrado que en los
juega con todo lo que ve, constantemente está
últimos años alrededor
en movimiento o tiene dificultad para realizar
de uno de cada 10 niños
actividades tranquilas
en los Estados Unidos ha
Impulsividad
sido diagnosticado con
Se muestra impaciente la mayor parte del
ADHD.
Investigadores
tiempo, hace comentarios inapropiados,
expresa sus emociones y actúa sin importarle las
del Centro para el
consecuencias
Control y Prevención
de
Enfermedades
encontraron que del
2007 al 2009, nueve por ciento de sugieren que los genes juegan un papel
los niños entre los 5 a 17 años fueron importante pero al igual que otras
diagnosticados con este trastorno enfermedades, el ADHD probablemente
comparado al 7 por ciento entre 1998 y se debe a la combinación de varios
el año 2000.
factores. Además de la genética, los
Además de esto, algunos estudios investigadores analizan actualmente
sugieren que aunque los niños Latinos cómo factores ambientales, algún daño
tienen un alto riesgo de desarrollar cerebral, la nutrición y el entorno social
ADHD, la probabilidad de ser pudieran contribuir al desarrollo de
¿Qué son los medicamentos
siquiátricos y paraqué
se recomiendan?
ADHD.
Instituto Nacional de Salud Mental
Sobre las señales y síntomas
Aunque es perfectamente normal
que los niños se distraigan, sean
hiperactivos y hasta impulsivos algunas
veces, para los niños con ADHD este
tipo de conductas son más severas y
frecuentes. Para ser diagnosticado con
este tipo de trastorno, el menor tiene
que presentar los síntomas por lo menos
durante seis meses y ser más comunes
que en cualquier niño de su edad.
Si detecta que su niño presenta uno
que otro síntoma de vez en cuando,
probablemente no es ADHD. Sin
embargo, si manifiesta varios de los
síntomas la mayor parte del tiempo,
ya sea en casa, la escuela o al jugar, es
recomendable atender este asunto.
Mente Sana en Cuerpo Sano
Relación entre su salud física y su salud mental
Dra. Maritza Irizarry
Sunshine Pediatrics
las enfermedades mentales reside en
que la mayoría del tiempo no queremos
aceptar que sufrimos estas condiciones
y si reconocemos los síntomas, nos
reusamos a buscar ayuda por temor o
vergüenza sin imaginar que la relación
entre la salud física y la salud mental
es fundamental para nuestra salud y
bienestar en general.
Enfermedades mentales ocasionadas
por enfermedades físicas
Muchas veces no nos damos cuenta
cómo nuestra salud mental y nuestras
emociones afectan todo lo que hacemos,
cómo nos comportamos y hasta nuestra
salud física. Si bien es importante
cuidar nuestro cuerpo y las funciones
de nuestro organismo, es igualmente
importante, reconocer las señales de
alerta que pudieran implicar la necesidad
de una evaluación mental o psicológica
sea para nosotros como padres o para
nuestros hijos. Recordemos que la
dificultad principal en el diagnóstico de
A través de los años hemos visto que
pacientes con enfermedades crónicas,
como diabetes y asma, sufren trastornos
mentales como depresión y ansiedad. Se
estima que hasta un tercio de las personas
con síntomas graves de una condición
médica experimentan depresión. No
obstante, tanto los pacientes como sus
familiares generalmente ignoran los
síntomas de la depresión pensando que el
sentirse deprimido es normal para alguien
que esta luchando con una enfermedad
seria y crónica. Sin embargo, la depresión
causada por la enfermedad
crónica puede agravar el
Enfermedades Crónicas Ligadas a la Depresión
problema especialmente si
• De las personas que sufren un ataque cardiaco
la enfermedad causa dolor y
entre el 40% - 65% también padece depresión
fatiga, o limita la capacidad
• Enfermedad de Parkinson 40%
de la persona para interactuar
con los demás.
• Esclerosis Múltiple 40%
• Derrame Cerebral, 10 – 27%
• Cáncer 25%
• Diabetes 25%
• Síndrome de Dolor Crónico 30%-54%
La obesidad y la depresión
La obesidad es un problema
de salud creciente, que
además de predisponer a
trastornos mentales produce
Cuándo Solicitar
Ayuda Profesional
Si ha hecho lo posible por mejorar su salud mental y emocional y no logra
sentirse bien, entonces es momento de buscar ayuda especializada. Las
recomendaciones de un profesional dedicado podrían motivarlo a realizar cosas
que quizá no podría hacer por usted mismo.
Señales de alerta que pudieran requerir
atención inmediata:
» Sentir que no vale la pena seguir viviendo
» Pensar constantemente en la muerte, tener ideas suicidas o
planificar como suicidarse
» Tomar riesgos que ponen en peligro su vida y la de otros
a su alrededor
» Pensar en lastimarse, lastimar a otros, destruir cosas o en
cometer un crímen
Departamento de Salud y Servicios Humanos (DHHS, por sus siglas en inglés)
muchas complicaciones, problemas
cardíacos, metabólicos y alteración
en la salud en general. Al igual que las
enfermedades crónicas, la obesidad
ha sido relacionada también con el
desarrollo de depresión y problemas
de ansiedad. No podemos precisar qué
ocurre primero, si el trastorno mental o
el aumento de peso. Generalmente esto
depende de factores personales. Lo que
sí sabemos es que hay factores genéticos
que predisponen tanto al desarrollo de
obesidad como a trastornos mentales.
Se estima que alrededor de un 61% de
los estadounidenses tienen problemas
de sobrepeso o son obesos. Encuestas
indican que uno de cada cinco adultos
mayores de 30 años se considera obeso.
Independientemente de lo que suceda
primero, la clave es reconocer que si
está luchando contra una enfermedad
crónica o problema de sobrepeso y está
sufriendo depresión o algún problema de
ansiedad por ello, consulte de inmediato
con su médico. De esta manera se
buscará un tratamiento que trate ambas
condiciones de manera simultánea,
como un programa para perder peso
que incorpore asesoría psicológica, por
ejemplo.
Recuerde que en el caso de la salud
mental existen agencias en el Valle,
donde puede dirigirse sin necesidad de
ser referido por su doctor, como por
ejemplo Magellan de Arizona, llamando
al 1-800-564-5465 donde se le
atenderá en español si es necesario.
Los medicamentos siquiátricos pueden ser una parte
efectiva de tratamiento de enfermedades mentales como
la esquizofrenia, depresión, bipolaridad, trastornos de
ansiedad y déficit de atención e hiperactividad. En ocasiones
los medicamentos son combinados con tratamiento como
la psicoterapia. Con la ayuda de estos medicamentos
muchas personas con enfermedades mentales pueden
vivir vidas productivas. Sin ellos, algunas personas podrían
experimentar síntomas mas graves hasta incapacitarlas.
¿Cómo se utilizan dichos medicamentos? Los medicamentos siquiátricos son utilizados en el
tratamiento de enfermedades mentales. Si bien no curan
la enfermedad, ayudan a reducir o eliminar los síntomas
problemáticos y mejorar el funcionamiento diario de las
personas con desórdenes siquiátricos. La efectividad de los
medicamentos varía en cada organismo. Algunas personas
obtienen excelentes resultados y los requieren solo poco
tiempo. Por ejemplo, una persona que sufre depresión puede
sentirse mucho mejor después de tomar medicamentos por
unos meses y no necesitarlos jamás. Sin embargo, personas
con problemas de esquizofrenia, bipolaridad, depresión o
ansiedad crónica quizá requieran consumir medicamentos
por más tiempo.
¿Qué debo preguntar a mi doctor si me receta algún
medicamento psiquiátrico?
Usted y su familia pueden ayudar a su doctor a encontrar
el medicamento ideal para usted. El doctor debe conocer su
historial médico, enfermedades prevalentes en su familia, si
padece algún tipo de alergia, si está con otros medicamentos,
suplementos alimenticios o hierbas medicinales y otra
información sobre su salud en general. Después de tomar
el medicamento notifique a su doctor como
se siente, si experimenta algún efecto
secundario o cualquier otra
inquietud que tenga
sobre el medicamento.
Preguntas que usted o algún familiar
debería hacer a su médico al recetarle algún
medicamento
¿Cuál es el nombre del medicamento?
¿Para qué es el medicamento?
¿Cómo y cuando debe tomarlo?
¿Qué cantidad debe tomar?
¿Qué debe hacer en caso de olvidar tomarlo?
¿Cómo y cuándo debe dejar de tomarlo?
¿Si tendrá algún tipo de reacción con cualquier otro
medicamento que este tomando?
¿Si es necesario evitar algún tipo de bebida o alimento
mientras consume el medicamento?
¿Si debe tomarse antes o después de ingerir algún tipo
de alimento?
¿Si es seguro consumir alcohol mientras tome ese
medicamento?
¿Cuáles son los efectos secundarios y qué hacer en caso
de experimentarlos?
¿Dónde puedo conseguir ayuda?
Si usted o alguien que conoce requiere servicios de salud mental o contra el abuso de
sustancias, comuníquese con Magellan de Arizona llamando al (800) 564-5465 o
TTY (800) 424-9831. Los servicios de Magellan están disponibles tanto para niños
como adultos y son cubiertos por Medicaid o AHCCCS/KidsCare.
Para mayor información de cómo solicitar AHCCCS, los requisitos de elegibilidad/
ingresos, recursos, reglas de participación para los programas y lugares donde puede
someter una solicitud en persona, comuníquese al 602-417-4000.
Magellan de Arizona cuenta con personal que habla español para responder a sus
llamadas y preguntas. Por favor comuníquese con Magellan para aprender más sobre los
recursos disponibles para el cuidado de la salud mental o contra el abuso de sustancias
en el centro de Arizona.
Magellan lo conectará con el
Servicios de salud mental cubiertos por AHCCCS
proveedor de servicios en su
• Evaluación y tratamiento
área que más le convenga.
• Servicios de salud mental y abuso de sustancias Si usted o algún familiar
• Diagnóstico, terapia y consejería experimenta una crisis, y
• Administración de casos
requiere apoyo psicológico,
• Transporte
comuníquese con la Red
• Servicios en localidades y medicamentos
de Respuesta en Casos de
Crisis. La Línea de Respuesta
en Casos de Crisis es gratuita y está disponible las 24 horas del día, los siete días de
la semana para cualquier persona que experimenta una crisis de salud mental en el
condado Maricopa y partes del condado Pinal. Para emergencias, llame siempre al 9-1-1.
¡La información es poder!
Si usted o alguien que conoce, fue diagnosticado con una
enfermedad mental recientemente y le gustaría aprender más
sobre su condición para ayudar en el proceso de recuperación,
las siguientes agencias pueden enviar por correo material
impreso sobre las enfermedades mentales más comunes a
personas con acceso limitado a Internet o computadora.
www.samhsa.gov • 1-877-726-4727
www.nimh.nih.gov • 1-866-615-6464
Depression and Bipolar Support Alliance www.dbsalliance.org • 1-800-826-3632 www.cdc.gov • 1-800-232-4636
www.healthyminds.org • 1-888-357-7924
www.nami.org • 1 (800) 950-NAMI
www.familyinvolvementcenter.org
602-288-0155
Fast Facts About...
Magellan Health Services of Arizona
is dedicated to a strong behavioral health care
delivery system for central Arizona.
Mental Health
18+
About one in five adults
has a
diagnosable mental disorder. (National Institute
of Mental Health)
in our care, as well as access to services
Dear Readers,
to under served populations eligible for
I wanted to reach out with a message
mental health care.
of hope and recovery for those you love
At Magellan of Arizona we believe
that might be living with a mental illness.
that all behavioral health care recipients
It can be anything from depression or
must receive effective treatment in a
schizophrenia to uncontrollable rage or
manner that is respectful of individual
abuse of drugs or alcohol. Mental illness
preferences, needs and values and
does not discriminate. In any given year,
compatible with their preferred language
one in four adults and one in five children
and cultural beliefs. To accomplish
in the U.S. is affected by a mental illness
this, we support our staff and network
regardless or race, level of education or
providers to ensure delivery of culturally
socioeconomic status.
competent care. By doing so, we are
Lack of access to mental health services
Richard Clarke, Ph.D., CEO,
building stronger relationships with the
continues to be a serious problem among Magellan Health Services of Arizona
people and the community we serve,
minority populations across the U.S.
providing better care and ultimately, help
While lack of insurance plays a huge
role in accessing health care, cultural beliefs and lack of strengthening central Arizona’s community as a whole.
understanding of mental illness are also significant barriers As part of our ongoing effort to facilitate access to mental
to care.
health care to vulnerable populations, Magellan has compiled
According to the American Psychiatric Association, this comprehensive review of mental health information to
“Hispanics/Latinos often have different attitudes about help you better understand the cause and symptoms of
accessing mental health services, and may feel highly mental illness and when and where to seek professional
stigmatized for doing so. For example, Hispanics/ Latinos help. Most of the information included on these pages
often mistake depression for nervousness, tiredness, or was retrieved from documents by the National Institute
even a physical ailment, and may see it as something that of Mental Health and the U.S. Department of Health and
is temporary. Affected individuals may not recognize their Human Services, which fully authorize and encourage the
symptoms as those that require the attention of mental reproduction of their publications in an effort to improve
health specialists.” Although many of the barriers that public health.
deter minorities from accessing treatment are true for all Please take the time to review this handout and share
populations, the American Psychiatric Association indicates the information with people you know. If the possibility of
that Hispanic Americans use mental-health services far less mental illness or substance abuse is a concern for you or
than other ethnic and racial groups.
someone you care about please call Magellan of Arizona at
As the Regional Behavioral Health Authority (RBHA) for (866) 564-5465. Magellan of Arizona and our provider
Maricopa County and part of Pinal County, Magellan Health partners give AHCCCS eligible individuals and their families
Services of Arizona is dedicated to a strong behavioral health a voice in the recovery process and choice to seek care when
care delivery system for central Arizona. A system of care and where they need it.
that not only provides hope, resources and recovery to those
Mental illnesses are more common than cancer,
diabetes, or heart disease. (U.S. Surgeon General’s
Report)
Mental illnesses can affect persons of any
age, income, race, religion, or culture. Mental
Illnesses affect both males and females.
(National Alliance for the Mentally Ill)
Mental illnesses often appear for the first time
during adolescence and young adulthood.
While they can occur at any age, the young
and the old are especially vulnerable. (National
Alliance for the Mentally Ill)
of the 10 leading causes of disability
4
(lost years of productive life) in the United
States and other developed countries are
mental disorders, which include major
depression, bipolar disorder, schizophrenia,
and obsessive-compulsive disorder. Many
persons suffer from more than one mental
disorders at any given time. (National Institute of
Mental Health)
With proper care and treatment, between
70 - 90%
of persons with mental
illnesses experience a significant reduction
of symptoms and an improved quality of life.
(National Alliance for the Mentally Ill)
2/3
More than
of Americans who have a
mental illness live in the community and
lead productive lives. (National Mental Health
Association)
Men & Depression
National Institute of Mental Health
Signs and Symptoms of Depression in Men
•
•
•
•
•
•
•
•
Good Mental
Health is Ageless
U.S. Department of Health
and Human Services
A healthy mind is as important as a healthy body. Being in
good mental health doesn’t mean that you’ll never feel sad,
lonely, or ‘down.’ But when these feelings disrupt your life or
go on too long, there may be a bigger problem.
Unusual feelings of sadness or depression can happen
when you have to move from your home; people you love
get sick or die; if you have to depend on others to get around
even to do the simple things you used to do yourself or when
physical health problems seem overwhelming.
If depression or other changes in your behavior last longer
than two weeks, talk with your doctor or other health care
professional. Tell them exactly how you’re feeling, and let
them know how this is different from the way you used to feel.
They can check for any problems you may be having, and can
discuss treatment options with you. Share your feelings with
a friend, family member or spiritual advisor. These people can
sometimes notice changes that you might not see.
If you or someone you know needs mental health or
substance abuse services, contact Magellan of Arizona at
(800) 564-5465 or TTY (800) 424-9831. Magellan’s
services are available for children and adults and are covered
by Medicaid or AHCCCS/KidsCare.
In addition to feelings of depression, some of the
following changes in behavior may suggest other
emotional problems:
• Being easily upset
• Changing sleep habits
• Increasing forgetfulness
• Being afraid of things
• Changes in eating habits
• Neglecting housework
• Crying a lot
• Being confused
• Getting lost a lot
• Having trouble managing money
• Not having the energy to do the things
you want to do, or used to do
• Believing that you can’t do anything worthwhile
• Staying alone a lot of the time
• Spending little or no time with friends
• Feeling hopeless or overwhelmed
• Thinking life isn’t worth living
• Thinking about hurting yourself
Feeling sad or “empty,” hopeless, irritable, anxious, angry
or very tired
Loss of interest in work, family, or once-pleasurable
activities, including sex
Not being able to concentrate or remember details
Not being able to sleep, or sleeping too much
Overeating, or not wanting to eat at all
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems
Inability to meet the responsibilities of work, caring for
family, or other important activities
Depression is a serious but treatable medical condition —
a brain disease — that can strike anyone, including men. In
America alone, more than six (6) million men experience
depression each year.
Whether you’re a company executive, a construction worker,
a writer, a police officer, or a student; whether you are rich or
poor; surrounded by loved ones or alone; you are not immune
to depression. Some factors, however, such as family history,
undue stress, the loss of a loved one, or serious illnesses can
make you more vulnerable.
Both men and women are affected by depression. But men
can experience it differently than women. Men may be more
likely to feel very tired and irritable, and lose interest in their
work, family, or hobbies. They may be more likely to have
difficulty sleeping than women who have depression. And
although women with depression are more likely to attempt
suicide, men are more likely to die by suicide. For this and many
other reasons, it’s important to recognize the symptoms and
seek professional help.
Keep in mind that not everyone who is depressed experiences
every symptom. Some people experience only a few symptoms;
some people suffer many. The severity of symptoms varies
among individuals and also over time.
Research and clinical findings show that women and men
may talk differently — or in the case of men, not talk — about
the symptoms of depression. Many men do not recognize,
acknowledge, or seek help for their depression. They may be
reluctant to talk about how they are feeling based on cultural
beliefs or ethnic origin. For instance, traditional gender
roles in the Latino community may further contribute to an
unwillingness to talk about feelings of depression.
Men with depression, regardless of ethnic background,
may be more likely to turn to alcohol or drugs, or to become
frustrated, angry or irritable instead of acknowledging their
feelings and asking for help. Some men may throw themselves
compulsively into their work or hobbies, attempting to hide their
depression from themselves, family, and friends; other men
may respond to depression by engaging in reckless behavior.
Depression and other mood disorders cross all national,
cultural, ethnic, and gender boundaries. If left untreated,
depression can lead to personal, family, and financial
difficulties.
Fortunately, depression, like most mental disorders is a real
and treatable illness. With appropriate diagnosis and treatment
most people can and do recover. The darkness disappears; hope
for the future returns, and energy and interest in life becomes
stronger than ever.
Anxiety Disorders
National Institute of Mental Health
Anxiety Disorders affect about 40
million American adults age 18 years and
older (about 18%) in a given year, causing
them to be filled with fearfulness and
uncertainty. Unlike the relatively mild, brief
anxiety caused by a stressful event (such as
speaking in public or a first date), anxiety
disorders can last at least six (6) months
and can get worse if they are not treated.
Anxiety disorders are classified and
divided into different types or categories
such as panic disorder, post-traumatic stress
disorder, obsessive compulsive disorder
and general anxiety disorder. Each anxiety
disorder has different symptoms, but all
the symptoms cluster around excessive,
irrational fear and dread.
Although it is perfectly normal to worry
about things like health, money, or family
problems, people with anxiety disorders
are extremely worried about these and
many other things at all times, even when
there is little or no reason to worry about
them. They are very anxious about just
getting through the day. They think things
will always go badly. At times, worrying
keeps people with anxiety disorders from
doing everyday tasks.
Anxiety disorders tend to develop
slowly. They often start during the teen
years or young adulthood. Symptoms may
get better or worse at different times, and
often are worse during times of stress.
People with anxiety disorders may visit a
doctor many times before they find out they
have this disorder. They ask their doctors to
help them with headaches or trouble falling
asleep, which can be symptoms of anxiety
disorders, but they don’t always get the help
they need right away. It may take doctors
some time to be sure that a person has an
anxiety disorder instead of something else.
Anxiety disorders commonly occur
along with other mental or physical
illnesses, including alcohol or substance
abuse, which may mask anxiety symptoms
or make them worse. In some cases, these
other illnesses need to be treated before a
person will respond to treatment for the
anxiety disorder.
Effective therapies for anxiety
disorders are available, and research is
Magellan Health Services of Arizona, Inc. is the Regional Behavioral Health Authority for Maricopa County and Parts
of Pinal County. Funds for services are provided through a contract with the Arizona Department of Health Services/
Division of Behavioral Health Services and the Arizona Health Care Cost Containment System (AHCCCS).
Signs and Symptoms
• Worrying very much about everyday things
• Trouble controlling their constant worries
• Hard time concentrating
• Easily startled
• Trouble falling asleep or staying asleep
• Feeling tired all the time
• Headaches, muscle aches, stomach aches,
or unexplained pains
• Have a hard time swallowing
• Tremble or twitch
• Irritable, sweat a lot, and feeling
light-headed or out of breath
• Have to go to the bathroom a lot
uncovering new treatments that can help
most people with anxiety disorders lead
productive, fulfilling lives. If you think you
have an anxiety disorder, you should seek
information and treatment right away.
Attention-Deficit/Hyperactivity
Disorder (ADHD)
National Institute of Mental Health
What Causes ADHD?
Scientists are not sure
what causes ADHD,
although many studies
suggest that genes play a
large role. Like many other
illnesses, ADHD probably
results from a combination
Attention
deficit
hyperactivity
disorder (ADHD) is one of the most
common childhood disorders and
can continue through adolescence
and adulthood making it difficult for
people to inhibit their spontaneous
responses—responses that can
involve everything from
movement to speech to
attentiveness.
In recent years,
Signs and Symptoms
studies have shown
Inattention
that nearly 1 in 10
Easily distracted, misses details, forgets
U.S. kids have been
things, frequently switches from one
diagnosed with ADHD.
activity to another, and has trouble
Researchers from the
following instructions
U.S. Centers for Disease
Hyperactivity
Control and Prevention
Talk nonstop, dash around, touching or playing
found that between
with anything and everything in sight, constantly
in motion, difficulty doing quiet tasks or
2007 and 2009, an
activities
average of 9% of children
Impulsivity
between the ages of 5
Very impatient, blurt out inappropriate
and 17 were diagnosed
comments, show emotions without restraint,
with the disorder. This
and act without regard for consequences
compared with just
under 7% between 1998
and 2000.
In addition, limited
available research suggests that Latino of factors. In addition to genetics,
children are at a great or greater risk researchers are looking at possible
for developing ADHD, although they environmental factors, and are studying
are much less likely to be identified by how brain injuries, nutrition, and the
their parents as displaying problematic social environment might contribute to
behavior and subsequently are less ADHD.
likely to receive proper assessment and
treatment due to several practical and About Warning Signs
Although it is normal for all children to
cultural factors.
be inattentive, hyperactive, or impulsive
sometimes, for children with ADHD,
these behaviors are more severe and
occur more often. To be diagnosed
with the disorder, a child must have
symptoms for 6 or more months and
to a degree that is greater than other
children of the same age.
If you spot just a few signs, or
the symptoms appear only in some
situations, it’s probably not ADHD.
On the other hand, if your child shows
a number of ADD/ADHD signs and
symptoms that are present across all
situations—at home, at school, and at
play—it’s time to take a closer look.
ADHD can lead to problems at home
and school, and affect your child’s ability
to learn and get along with others. It’s
important for you as a parent to be able
to spot the signs and symptoms, and
get help if you see them in your child.
Healthy Minds, Healthy Bodies
The relationship between our physical health and our mental health
People refuse to accept they have such
conditions. Even when symptoms are
present, shame and fear keeps a lot of
individuals from seeking help. However,
the relationship between our physical
health and our mental health is vital to
our emotional well-being and overall
health.
Dr. Maritza Irizarry
Sunshine Pediatrics
Often we forget how our mental health
and our emotions affect everything we
do, from the way we act to our physical
health. Although it’s important to take
care of our bodies, it’s also important to
be able to recognize the warning signs
that could imply the need of a mental or
psychological evaluation, either for us as
parents or for our children. Mental illness
often goes under-diagnosed and under
treated, primarily because of stigma.
Mental Illness caused by
Chronic Illness
Throughout the years, we’ve seen how
patients with chronic illnesses such as
diabetes and asthma suffer from mental
illnesses like anxiety and depression. It is
estimated that one third of people with
chronic illnesses in the U.S. experience
depression. Yet, some of these individuals
along with family members ignore the
symptoms of depression thinking it’s
perfectly normal to feel that way. If
untreated, depression could make health
problems worse, especially if individuals
dealing with a chronic illness are
experiencing pain, fatigue, or difficulty
interacting with others.
Chronic Conditions and their Link to Depression:
• Of those who experience a heart attack,
40%-65% also experience depression
• Coronary artery disease (without heart attack): 18%-20%
• Parkinson’s disease: 40%
• Multiple sclerosis: 40%
• Cancer: 25%
• Diabetes: 25%
• Chronic pain syndrome: 30%-54%
Obesity and
Depression
Obesity is a growing
health problem in
the U.S. In fact, it is
estimated that about
61% of Americans are
overweight or obese.
National polls indicate
that one in five adults 30
years or older considers
When to seek
Professional Help
themselves obese. Obesity cannot only
lead to chronic health conditions such as
heart and metabolic problems, but it has
also been linked to the development of
mental illnesses, such as anxiety disorders
and depression. We cannot determine
which occurs first, the mental disorder or
the weight gain—this probably depends
on personal factors. However, we do
know genetic factors put an individual at
a higher risk of developing obesity and
mental health disorders.
Regardless of what comes first, the
key to a healthy lifestyle is recognizing
the signs and symptoms associated
with a chronic illness, weight gain and
mental illnesses (like anxiety disorder or
depression). Take charge of your health
and inform your doctor immediately if
you experience any of these symptoms.
By doing this, your doctor can help you
find a treatment option that meets your
physical and mental health needs. For
instance, your doctor may recommend
participating in a weight loss program
that utilizes psychological support.
Remember that there are agencies
in the Valley where you can get mental
health services without a referral from
your doctor. Magellan Health Services of
Arizona offers help in Spanish at (800)
564-5465.
Overcoming stigma and expressing to
your doctor how you feel without fear of
being judged or criticized is key in helping
you find the right treatment options that
allow you to have a healthy mind and a
healthy body.
What are psychiatric
medications and
who gets them?
National Institute of Mental Health
Psychiatric medications are used to treat the symptoms
of mental disorders such as schizophrenia, depression,
bipolar disorder (sometimes called manic-depressive
illness), anxiety disorders, and attention deficit-hyperactivity
disorder (ADHD). Sometimes medications are used with
other treatments such as psychotherapy. Many people with
mental disorders live fulfilling lives with the help of these
medications. Without them, people with mental disorders
might suffer serious and disabling symptoms.
How are medications used to treat mental disorders?
Medications treat the symptoms of mental disorders. They
cannot cure the disorder, but they make people feel better so
they can function. Medications work differently for different
people. Some people get great results from medications and
only need them for a short time. For example, a person with
depression may feel much better after taking a medication
for a few months, and may never need it again. People with
disorders like schizophrenia or bipolar disorder, or people
who have long-term or severe depression or anxiety may
need to take medication for a much longer time.
What should I ask my doctor if I am prescribed a
psychiatric medication?
You and your family can help your doctor find the right
medications for you. The doctor needs to know your medical
history; family history; information about allergies; other
medications, supplements or herbal remedies you take; and
other details about your overall health.
After taking the medication for
a short time, tell your doctor how
you feel, if you are having
side effects, and any
concerns you
have about the
medicine.
Things you or a family member should ask
your doctor when a medication is prescribed:
What is the name of the medication?
What is the medication supposed to do?
How and when should I take it?
How much should I take?
What should I do if I miss a dose?
When and how should I stop taking it?
Will it interact with other medications I take?
Do I need to avoid any types of food or drink while taking the medication? What should I avoid?
Should it be taken with or without food?
Is it safe to drink alcohol while taking
this medication?
What are the side effects? What should I do if I
experience them?
Is the Patient Package medicine available?
Where Can I Get Help?
If you or someone you know needs mental or substance abuse services, contact
Magellan of Arizona at (800) 564-5465 or TTY (800) 424-9831. Magellan’s services
are available for children and adults and are covered by Medicaid or AHCCCS.
If you’ve made consistent efforts to improve your mental and emotional health
and you still don’t feel good – then it’s time to seek professional help. Because
we are so socially attuned, input from a knowledgeable, caring professional can
motivate us to do things for ourselves that we were not able to do on our own.
Red flag feelings and behaviors that may require
immediate attention
» You feel like life is not worth living anymore
» You think a lot about dying, have thoughts of suicide, or have planned how to kill yourself
» You are taking lots of risks that are endangering your life and/or the lives of others
» You feel like hurting yourself, hurting others, destroying property
or committing a crime
Reprinted with permission from the U.S. Department of Health and Human Services (DHHS)
For more information on how to apply for AHCCCS or questions regarding eligibility,
income, resources, program participation rules, or the nearest branch to apply in
person, please call (602) 417-4000.
Magellan of Arizona has English and Spanish speaking staff available to answer your
calls and questions. Please contact Magellan of Arizona to find out more about mental
health and substance abuse
resources available to you.
Mental Health Services covered by AHCCCS
Magellan will connect you
• Evaluation and treatment
to a service provider that
• Services for mental disorders and substance abuse
best fits your needs and is in
your area.
• Diagnosis, therapy and counseling
If you or a member of
• Case management
your family is in crisis,
• Transportation
call the Maricopa Crisis
• Services in facilities and medication
Response Network at
(800) 631-1314 or TTY
(800) 327-9254 for immediate help. The Maricopa Crisis Response Network is
available 24 hours a day, seven days of week to assist anyone experiencing a mental
health crisis in Maricopa County. For emergencies always call 9-1-1.
Knowledge is Power
If you or someone you know was recently diagnosed with
a mental illness or substance abuse disorder and wish to
learn more about their condition to help with their recovery
process, the following agencies can mail printed materials
about the most common mental illnesses to individuals with
limited access to the Internet or a computer.
www.samhsa.gov • 1-877-726-4727
www.nimh.nih.gov • 1-866-615-6464
Depression and Bipolar Support Alliance www.dbsalliance.org • 1-800-826-3632 www.cdc.gov • 1-800-232-4636
www.healthyminds.org • 1-888-357-7924
www.nami.org • 1 (800) 950-NAMI
www.familyinvolvementcenter.org
602-288-0155
TIPS ON CALLING AN AGENCY FOR
MENTAL/BEHAVIORAL HEALTH SERVICES
Step 1:
Pick an agency you would like to call from the
attached list.
Step 2:
Pick up the phone and dial the number.
Step 3:
Let the person on the phone know that you want to
know more about their services.
Step 4:
Ask if they have (whatever type of help you need)
services.
Step 5:
Ask about how much the services cost. Ask if they
have a sliding fee scale (where you only pay what you
can afford).
Step 6:
If they offer the services you need, ask to make an
appointment.
Step 7:
Verify the time and day of appointment, the name of
the person you will meet, and the address of where the
appointment will be held.
Step 8:
Ask any other questions you may have then thank the
person for helping you.
AZ Response to Intervention (RTI)
System of Behavioral Supports
Overview School achievement and success require that students be provided both academic and
behavioral systems of support. A comprehensive system of behavioral supports ensures that
students are ready and able to learn by creating environments conducive to learning and by
addressing barriers to learning that students experience.
Response to Intervention (RTI) is a problem-solving model that utilizes prevention logic as its
basis; that is, the proactive implementation of strategies at the school level, classroom level
and/or student level prior to the development of academic or behavior problems. An effective
system of behavioral supports will decrease the development of new problem behaviors and
prevent the worsening of existing problem behaviors.
The tiered levels within the RTI model provide for a continuum of behavioral supports for
students. All students are provided the Universal Level (Tier 1) supports; approximately 80
percent of students will perform well under these conditions. Approximately 15 percent of
students, those with more risk for problem behavior, will require Targeted Level (Tier 2)
supports directed to the specific needs of the individual or small group of students. The
remaining five percent of students that have already displayed problem behaviors require
Intensive Level (Tier 3) supports.
A primary component of a comprehensive system of behavioral supports includes the teaching
of pro-social behavior skills needed to facilitated learning. At each level, pro-social skills are
taught, monitored and acknowledged. Commonly addressed skills include the meeting of
school behavior rules and expectations, communication skills, self control, responsibility and
empathy. Support strategies also include the redesigning of environments to eliminate routines
and physical arrangements that maintain problem behaviors and the involvement of families in
efforts.
A comprehensive system of behavioral supports utilizes data-based decision making and a
continuous improvement process in which teams regularly, systematically, and honestly
evaluate outcomes and areas for improvement. Success relies upon professional development
that builds knowledge and skill in district and school personnel and facilitates the change
process throughout the organization.
This document describes in more detail the following components of a system of behavioral
supports:
• Data-Based Decision Making
• Curriculum, Instruction and Strategies
• Professional Development
Data‐Based Decisions Data-based decision making is the collection, management, analysis, and utilization of relevant
data to make informed decisions. This process is utilized at the school, classroom and student
levels within a system of behavioral supports. It therefore guides the necessary system
changes as well as student interventions.
1
Key features of effective data-based decision making processes include: data are accurate,
valid and easy to collect; data are presented in user-friendly format (e.g., graph format); data
are available when decisions need to be made; data collection staff understand the value of
their work (how the information is used in decision making); the leadership team is trained in
collecting and using data; and a team approach is used for decision making. Data-based
decision making also requires the development of procedures that ensure proper analysis as to
whether gains are being achieved and the actions that should occur next. (Sugai 2007)
The process of implementing a system of behavioral supports begins with a school-wide needs
assessment involving analysis of disciplinary, safety and climate data from multiple sources.
This process aids the school (and district) in setting goals and creating action plans. These data
sources are also used to determine appropriate strategies and programs for prevention and
intervention, measure progress toward goals, and evaluate the effectiveness of the strategies.
A system of behavioral supports utilizes a continuous improvement process, such as the US
Department of Education’s Principles of Effectiveness, illustrated below.
Needs
Assessment
Evaluation
of
Outcomes
Measurable
Goals &
Objectives
ResearchBased
Strategies
This process is also utilized for small groups of students and individual students receiving
Targeted and Intensive Levels of supports.
The primary sources of data needed for implementing a system of behavioral supports include
the following:
Universal Level (Tier 1)
• School safety and disciplinary incident data in aggregate by student, location, time of
day, referring individual, and grade level
• Disciplinary action information in aggregate, including detentions, suspensions, and
expulsions, as well as corrective actions taken, such as behavior intervention groups
• Attendance data, dropout data and causal factors in aggregate
• Student survey information (anonymous and in aggregate) capturing high risk behavior
and school safety and climate perceptions
• Staff and parent survey information (anonymous and in aggregate) capturing school
safety and climate perceptions
• School health office data in aggregate
• Process data for evaluating the fidelity of implementation of the Universal system
2
Targeted Level (Tier 2)
• School safety and disciplinary incident data by student
• Individual and/or group data related to the Target Level intervention
• Social competency rating scales
• Teacher observation data
• Process data for evaluating the fidelity of implementation of interventions
Intensive Level (Tier 3)
• Functional Behavior Assessment
• Individual student data related to the Intensive Level intervention
• Process data for evaluating the fidelity of implementation of interventions
Additional information from parents and guardians, behavioral health agencies, social service
agencies, juvenile justice, or law enforcement may be necessary for a correct summation of the
conditions impacting student learning.
Curriculum, Instruction and Strategies Curriculum within the comprehensive system of behavioral supports focuses on the pro-social
skills students need to be ready and able to learn. Instruction focuses on how these skills are
taught. The pro-social skills to be taught are determined by the needs of the student population
but commonly include: meeting behavior rules and expectations, communication skills, self
control, responsibility and empathy. Support strategies also include the redesigning of
environments to eliminate routines and physical arrangements that maintain problem behaviors
and the involvement of families in efforts.
The diagram below shows the curricula and other supports most commonly utilized within the
three-tier framework. Intensive Level of Supports (Few students, high‐risk) Tier 3 Intensive Level Tier 2 Targeted Level (some students, at‐risk) Tier 1 Universal Level (all students) •
•
•
•
•
Intensive academic support Intensive social skills teaching Individual behavior management plans Family involvement Multi‐agency collaboration (wrap‐
around)services Alternatives to suspensions and expulsions Community and service learning •
•
Targeted Level of Supports •
Increased academic support •
Increased and targeted social skills teaching •
Increased monitoring and reinforcement systems •
Self management techniques •
Family involvement •
Mentoring programs •
Alternatives to suspensions and expulsions •
Community and service learning Universal Level of Supports •
School behavior expectations instruction •
Universal social skills training •
Active supervision and monitoring •
Positive reinforcement systems •
Firm, fair, and corrective discipline •
Effective classroom management 3
•
Improved environmental arrangements •
Family involvement Sprague, J. (Revised 2007). Effective Strategies for Creating Safer Schools and Communities - Creating
Schoolwide Prevention and Intervention Strategies, Hamilton Fish Institute on School and Community
Violence & Northwest Regional Educational Laboratory.
Horner, R.H., & Supai, G. (2005). School-wide positive behavior support: An alternative approach to
discipline in schools, in Bambara, L. & Kern, L. (Eds.) Positive Behavior Support, 359-390, NY: Guildford
Press.
Professional Development Professional development is a key component to implementing an effective system of
behavioral supports that ensures that students are ready and able to learn. Success is largely
dependent upon utilization of qualified and experienced professionals to lead district and school
teams through the change process and development of knowledge and skills in the following
areas:
Context Standards
• Leadership - requires skillful school and district leaders who guide system
implementation and continuous improvement.
• Resources - requires resources to support adult learning and collaboration.
Process Standards:
• Data-Driven - uses data (student, teacher, classroom, school-wide) to determine
adult learning priorities, monitor progress, and help sustain continuous improvement.
• Research-Based - prepares educators to apply research to decision making.
• Design - uses strategies/interventions appropriate to the intended goal.
• Learning - applies knowledge about human learning and the change process.
• Collaboration/team building - provides educators with the knowledge and skills to
effectively communicate and collaborate.
• Evaluation - uses multiple sources of information to guide improvement and
demonstrate its impact.
• Long Term Focus – systems change takes time and perseverance (e.g., 3-4 years)
before some desired outcomes become evident.
Content Standards:
• Equity - prepares educators to demonstrate appreciation for all of their students by
establishing learning environments that are emotionally and physically safe and
communicating high expectations for academic achievement and quality
interpersonal relationships.
• Cultural Competence - provides educators with the knowledge and skills to
understand, communicate with, and effectively interact with people across cultures.
• Quality Teaching - deepens content knowledge; provides educators with researchbased instructional strategies to assist students in meeting rigorous academic
standards; and prepares them to use various types of classroom assessments
appropriately.
• Classroom Management and Behavioral Supports Strategies - provides educators
with research-based strategies that build the knowledge and skills needed to support
positive interaction, nurture students’ capacity for self-management, and develop
proactive and preventive management techniques.
• Child and Adolescent Development - deepens understanding of child and adolescent
development and of how to support growth in the cognitive, social, emotional, and
physical domains.
4
•
•
Data-Based Decision Making - provides educators with the knowledge and skills to
collect, manage, analyze, and utilize relevant data to make informed decisions at the
school, classroom, and student levels.
Family and Community Involvement - provides educators with knowledge and skills
to involve families and other stakeholders appropriately.
Based on the National Staff Development Council (NSDC) Standards for Staff Development, Revised
2001 and the Arizona School Evaluation Tool (AzSET), PBISAz, Revised 2007.
Web Resource List Positive Behavioral Interventions and Supports (PBIS) Basics
• OSEP Technical Assistance Center on Positive Behavioral Interventions & Supports
o Blueprint for SW-PBS Implementers
o PBIS Tools
o Training Resource
o User Resources
• PBISAz
o PBISAz Basics
o Downloads
• Minneapolis Public Schools Positive School Climate Tool Kit
Online Courses
• Florida’s Postitive Behavior Support Project
• Kansas Institute for Positive Behavior Support
Interventions/Resources
• Effective Educational Practices: Successful Schools
• Decision Support System for Youth Well Being
• Rhode Island Positive Behavioral Interventions & Supports
• Technical Assistance Center on Social Emotional Intervention (TACSEI) for Young
Children
• George Washington University Hamilton Fish Institute
Effective Program Strategies
• Center for the Study and Prevention of Violence – University of Colorado at Boulder:
Matrix of Programs
• Substance Abulse & Mental Health Services Administration (SAMHSA) – United States
Department of Health and Human Services
• Centers for Disease Control and Prevention (CDC) Education – Department of Health
and Human Services
• Protective Schools Model
• What Kids Need: Developmental Assets – Search Institute
5
School Safety: What Schools Can Do
A safe school is one that is free from violent and criminal behaviors and allows staff, students
and community members to feel connected to the school and able to participate in its major
functions – teaching and learning. Violent or criminal behaviors at school compromise the
learning environment and put health and safety in jeopardy. The question is often asked, “What
can we do to make our schools safer?” Unfortunately there is no simple solution to creating
safe environments or to prepare for all possible emergencies. However, the following is a list of
ten action items for schools to consider. Appropriate physical features, campus layout,
prevention programs, policies, and procedures of schools can minimize the impact of
disruptions and intrusions. Utilizing multidisciplinary teams to discuss safety issues based on
school and community needs unify efforts to support a safe learning environment. An attached
bibliography provides the research that supports the effectiveness of these action items.
1. Include safety in the district and school mission statements17,18,19
• Reference a safe environment that is conducive to learning in the district and school
mission statements
• Support the mission by dedicating resources to safety
2. Develop a Comprehensive School Safety Plan2, 6, 8, 9, 11, 14, 17, 18
• Form a multidisciplinary school safety committee of key personnel that meet
regularly to plan and implement prevention and safety efforts based upon data
• Utilize a comprehensive and standardized safety and discipline tracking and
reporting system
• Base the safety plan on a comprehensive needs assessment that includes incident
data, student prevalence data, crime statistics, and climate survey information
• Develop measurable goals and objectives for the plan
• Monitor data and evaluate programs and policies to ensure that goals and objectives
of the plan are met
• Share information with stakeholders
3. Ensure a Supportive Climate2, 6, 8, 13, 14, 17, 18, 21
• Make the campus welcoming to students, staff and visitors
• Ensure that students are engaged in school work that is challenging, informative and
rewarding
• Display diligent and impartial behavior when supervising students
• Respond to students in a caring and non-shaming manner
• Establish an engaging system of extracurricular programs and services
• Be proactive in connecting with students and parents
4. Implement Drug and Violence Prevention and Early Intervention Programs2, 3, 6, 16
• Target prevention efforts on the needs identified through a comprehensive needs
assessment (Item 2)
• Utilize research-based prevention curricula, programs and strategies that build
knowledge and skills and are likely to change behavior
• Emphasize school-wide (universal) approaches to prevention but also include
strategies for at-risk and high-risk students (select and targeted)
• Involve families and the community in drug and violence prevention trainings
• Reinforce pro-social behaviors through adult modeling
• Ensure prevention and intervention programs are sustained, coordinated, and
comprehensive
5. Utilize a Threat Assessment Protocoll7, 10, 18, 20, 22, 23
• Form a well-trained threat assessment team that convenes as needed
• Utilize the Arizona Threat Management Protocol or comparable protocol
• Develop the capacity to evaluate information that is useful in determining whether a
threat might materialize
• Share information regarding potentially dangerous conditions or people with
appropriate school personnel and service providers
• Identify and provide resources or referrals for students with behavioral health needs
6. Collaborate with Community Agencies6, 8 11, 15, 18, 21
• Develop written agreements with community agencies to provide for a continuum of
services for students and families
• Coordinate with law enforcement, including advance coordination on type of student
infractions that warrant their involvement and law enforcement access to students
• Coordinate with juvenile justice on the needs of students on probation and for
services for the general student population
• Screen students for mental health concerns and refer to behavior health providers for
services
• Coordinate with social service and health service providers for the health and wellbeing of the school community
• Coordinate for the provision of youth development programs, such as mentoring and
recreation
7. Screen and Monitor Employees19
• Conduct a thorough background check and fingerprint clearance of potential new
employees and volunteers that work directly with students but without certificated
supervision
• Establish job performance criteria and an equitable system of periodic observations
and evaluations
• Develop a system for recognizing and handling employees who are arrested for
criminal offenses
• Promptly remove staff who are incompetent or pose a risk to students
8. Secure the Campus2, 8, 9, 15, 17
• Conduct an annual school security site assessment that is based on Crime
Prevention Through Environmental Design (CPTED) concepts
• Utilize CPTED recommendations when possible
• Control access to the campus
• Ensure campus is clean and inviting
• If utilizing security technology, ensure that it’s use will improve needs identified in
your site assessment
9. Develop and Practice School Emergency Response Plans4, 5, 7, 8, 12
• Form a multidisciplinary emergency response team that includes first responders
• Develop a multi-hazards plan based on the Arizona School Emergency Response
Plan: Minimum Requirements and utilizes the state template
• Train school personnel and practice the plan school-wide
• Plan for the mental health needs of students and staff post-crisis so that learning can
resume as quickly as possible
10. Implement Effective Policies and Procedures8, 11, 18, 21
• Develop policies and procedures that are consistent with state and federal law
• Develop and consistently implement a school discipline code of student behavior that
supports and rewards pro-social behavior
• Train school personnel on policies and procedures including the need to take
immediate and appropriate action on all reports of alcohol and drug use or sales,
threats, bullying, weapon possession, or victimization
• Train students and inform parents on discipline and safety policies
• Utilize best practice approaches to safety situations which consider alternatives to
disciplinary approaches and identify and support behavioral health needs of students
• Incorporate Items 2 – 9 on this list into the school/district policies and procedures
Bibliography
1. Adelman, H. & Taylor, L. Safe and Secure: Guides to Creating Safer Schools, Guide 7:
Fostering, School, Family, and Community Involvement, Office of Juvenile Justice and
Delinquency Prevention, U.S. Department of Justice & Northwest Regional Educational
Laboratory, September 2002.
2. American Institute for Research & U.S. Department of Education (April 2000), Safeguarding
Our Children: An Action Guide – Implementing Early Warning, Timely Response, U.S.
Department of Education.
3. Arizona Department of Health Services, (2005), Framework for Prevention in Behavioral
Health, Phoenix, Arizona.
4. Arizona Department of Education & Arizona Division of Emergency Management,
Revised September (2006), Arizona School Emergency Response Plan: Minimum
Requirements.
5. Arizona Department of Education (2009) Arizona School Safety Program Operational Plan
Template.
6. Bosworth, K. Smith Endowed Chair in Prevention Education, Protective Schools: Linking
Drug Abuse Prevention with Student Success, University of Arizona, 2000.
7. Department of Education, Office of Safe and Drug-Free Schools (2003), Practical Information
on Crisis Planning: A Guide for Schools and Communities, Washington, D.C.
8. Department of Justice & Department of Education (October 1998), Annual Report on School
Safety, Bureau of Justice Statistics Clearinghouse.
9. http://www.teachsafeschools.org/seven-steps.html, Seven Steps to a Safer School.
10. Jimerson, S.R. Brock, S.E. Cowan, C.C. Threat Assessment: An Essential Component of a
Comprehensive Safe School Program, Student Counseling, October 2005.
11. Hutton, T. & Bailey, K. School Policies and Legal Issues Supporting Safe Schools, Effective
Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and
Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007.
12. Kutash, K. & Duchnowski, A. J. The Role of Mental Health Services in Promoting Safe and
Secure Schools, Effective Strategies for Creating Safer Schools, The Hamilton Fish Institute
on School and Community Violence & Northwest Regional Educational Laboratory,
Washington D.C. 2007.
13. Mayer, J. E. Creating a Safe and Welcoming School Environment, International Academy of
Education, International Bureau of Education, 2007.
14. North Central Regional Educational Laboratory (1996), Critical Issue: Developing and
Maintaining Safe Schools, Learning Point Associates.
15. Schneider, T. Ensuring Quality School Facilities and Security Technologies, Effective
Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and
Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007.
16. Sprague, J. Creating Schoolwide Prevention and Intervention Strategies. Effective
Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and
Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007.
17. Stephens, R. P. Congressional Statement, Hearing on Understanding Violent Children,
National School Safety Center, Westlake Village, California, April 28, 1998.
18. Stephens, R. P. Directors Message, National School Safety Center, Westlake Village,
California, 2008.
19. Stephens, R. P. Ten Steps to Safer Schools, National School Safety Center, Westlake
Village, California.
20. Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S: Health, Mental Health
and Safety Guidelines for Schools, American Academy of Pediatrics & National Association
of School Nurses, 2004.
21. U.S. Department of Education & U.S. Department of Justice, Office of Juvenile Justice and
Delinquency Prevention, (September 1996), Creating Safe and Drug-Free Schools – Action
Steps for Schools.
22. U.S. Secret Service & U.S. Department of Education (2002), Threat Assessment in School:
A Guide to Creating Safe School Climates.
23. Meehling, O. Threat Management Protocol, April, 2008.
Arizona Department of Education
School Safety and Prevention
www.ade.az.gov/sa/health
July 2008
Mental
Health Crisis
Planning
for Families
Learn to recognize,
manage, prevent and
plan for your child’s
mental health crisis
800 Transfer Road, Suite 31
St. Paul, MN 55114
Phone: 651-645-2948
Toll Free: 1-888-NAMI HELPS
Fax 651-645-7379
E-mail: [email protected]
Web: www.namihelps.org
Mental Health Crisis Planning for Families
Learn to Recognize, Manage, Prevent and Plan for Your Child’s Mental
Health Crisis
A mental health crisis is just as important to address as any other health
care crisis. It can be difficult to predict just when a crisis will happen,
and it can occur without warning. A crisis can occur even when a family has followed a crisis prevention plan and used techniques taught to
them by mental health professionals.
We all do the best we can with the information and resources we have
available at the time of the crisis. Some days we can handle more than
other days; this is normal and to be expected when raising a child with
challenging behaviors. You may need help when you have exhausted all
your tools or means of coping with the crisis.
This booklet will help you understand what can cause a crisis, the warning signs of a crisis, the strategies to help de-escalate a crisis, resources
that may be available and how to create a crisis plan. Information on
communication and advocacy skills for families is included along with
a sample crisis plan. The term child is used throughout the booklet and
refers to both children and adolescents.
RECOGNIZE
What is a mental health crisis?
Any situation in which the child’s behaviors puts them at risk of hurting
themselves or others and/or when the parent isn’t able to resolve the
situation with the skills and resources available.
What causes a mental health crisis?
Many things can lead to a mental health crisis. Increased stress,
changes in family situations, bullying at school or substance use may
trigger an increase in behaviors that lead to a mental health crisis.
Medical illnesses can also affect mental health and can lead to a crisis.
Any of these things can be difficult on someone, but they can be more
difficult for someone with a mental illness, especially a child who
probably doesn’t understand their illness and the symptoms which may
appear suddenly.
3
Here are some examples of situations or stressors that can trigger a
mental health crisis:
their stress level, etc. Families may want to keep a journal or calendar
documenting what preceded the behaviors that are of concern.
Home or Environmental Triggers
• Changes to family structure; parents separate, divorce or remarry
• Loss of any kind, family member or friend due to death or relocation
• Loss of family pet
• Transitions between mom’s and dad’s home
• Strained relationships with step-siblings / step-parents
• Changes in friendships
• Fights or arguments with siblings or friends
• Conflict or arguments with parents
Here are some warning signs of a mental health crisis:
School Triggers
• Worrying about tests and grades
• Overwhelmed by homework or projects
• Feeling singled out by peers or feelings of loneliness
• Pressures at school, transitions between classes and school activities
• Bullying at school
• Pressure by peers
• Suspensions, detentions or other discipline
• Use of seclusion or restraints
• Misunderstanding by teachers who may not understand that the
child’s behavior is a symptom of their mental illness.
Other Triggers
• Stops taking medication or misses a few doses.
• Starts new medication / new dosage of current medication
• Medication stops working
• Use of drugs or alcohol abuse
• Pending court dates
• Being in crowds / large groups of people
• Changes in relationship with boyfriend, girlfriend, partner
What are the warning signs of a mental health crisis?
Sometimes families or caregivers observe changes in a child’s behavior
that may indicate a crisis may be impending; while other times the crisis
occurs suddenly and without warning. You may be able to de-escalate
or prevent a crisis from happening by identifying the early changes in
your child’s behavior, an unusual reaction to daily tasks, an increase in
4
Inability to cope with daily tasks
• Doesn’t bathe, brush teeth, comb/brush hair
• Refuses to eat or eats too much
• Sleeps all day, refuses to get out of bed
• Doesn’t sleep
Rapid mood swings
• Increase in energy
• Inability to stay still, pacing
• Depressed mood
Increased agitation
• Makes verbal threats
• Violent out-of-control behavior
• Destroys property
• Cruel to animals
Displays abusive behavior
• Hurting other
• Cutting self
• Alcohol or substance abuse
Loses touch with reality (psychosis)
• Unable to recognize family or friends
• Confused thinking, strange ideas
• Thinking they are someone they are not
• Not understanding what people are saying
Isolation from school, family, friends
• No or little interest in extra-curricular activities
• Changes in friendships
• Stops attending school, stops doing homework
Unexplained physical symptoms
• Eyes or facial expressions look different
5
•
•
Increase in headaches, stomach aches
Complains they don’t feel well
•
•
•
Be patient and accepting
Announce actions before initiating them
Give them space, don’t make them feel trapped
MANAGE
What to do in a mental health crisis?
When a mental health crisis or behavioral emergency occurs, parents often don’t know what to do. A crisis can occur even when a
parent has used de-escalation techniques or other options to address the crisis. It’s often nobody’s fault. Children’s behaviors
and crisis situations can be unpredictable and occur without warning.
If you are worried that your child is in or nearing a crisis, you can
seek help in a number of ways. Before choosing which option to
pursue, assess the situation. Consider whether your child is in
danger of hurting themselves, others or property. Consider
whether you need emergency assistance, guidance or support.
De-Escalation Techniques
Children cannot always communicate their thoughts, feelings or
emotions clearly or understand what others are saying to them
during a crisis. As a parent it is important to empathize with your
child’s feelings, help de-escalate the crisis, and to assess the situation to determine if you need emergency assistance, guidance or
support. Seek outside resources or help when your actions are not
helping.
De-escalation techniques that may help resolve a crisis:
• Keep your voice calm
• Use short sentences
• Listen to their story
• Offer options instead of trying to take control
• Ask how you can help your child
• You may want to avoid touching your child
• Remain calm, avoid overreacting
• Move slowly
• Don’t argue or shout
• Express support and concern
• Keep stimulation level low
• Avoid eye contact
6
If you haven’t been able to defuse the crisis yourself you may want to
seek additional help. Trained mental health professionals can assess a
child to determine the level of crisis intervention required and may refer
families to short-term crisis stabilization services or hospitalization if
appropriate. Often a trained mental health professional can help a family de-escalate a crisis before it occurs.
Remain as calm as possible and continue to seek guidance and support
until the crisis is resolved. Most importantly – safety first! In a crisis
situation, when in doubt, back off or get out.
Not in immediate danger
If you do not believe your child is in immediate danger, call a psychiatrist, clinic nurse, therapist, case manager or family physician that is
familiar with the child’s history. This professional can help assess the
situation and offer advice. The professional may be able to obtain an
appointment or may be able to admit the child to the hospital. If you
cannot reach someone and the situation is worsening, do not continue to
wait for a return call. Take another action, such as calling your county
mental health crisis team. If safety is a concern, call 911.
Mental Health Crisis Phone Lines and Crisis Response Teams
In Minnesota, each county has 24-hour access to mental health crisis
phone assistance for both adults and children. Some 24 hour phone
lines provide service to more than one county. These crisis lines are
answered by trained workers who assist callers with their mental health
crisis, make referrals, and contact emergency services, if necessary.
There is no charge for this service which is available to all persons in
Minnesota.
In addition to 24-hour crisis phone lines, some counties are also covered
by a mobile crisis response team. Some crisis teams cover more than
one county. All children’s mental health county crisis teams may provide short-term intervention and stabilization services for children between birth to 21 years of age that are experiencing an emotional or
behavioral crisis. A child does not have to have a mental health diagnosis to receive crisis services.
7
Crisis teams are available 24-hours a day, seven days a week, 365 days
a year to help de-escalate the immediate crisis. Crisis teams help families develop a plan to provide practical behavioral strategies to address
the short term needs of the child. They may assist the family in identifying the issues that led to the crisis and suggest ideas to avoid a crisis
in the future. Crisis teams will also help identify possible resources and
supports to help the child or family.
County mental health mobile crisis response teams are expected to be
mobile and meet families at their home, child’s school, community centers, library, clinic, anywhere the family feels most comfortable or
where the child is. They can also help families develop and write a
crisis plan, provide phone consultation and support, and help in nonurgent situations where their guidance can prevent a future crisis. Response times for mobile teams can vary depending on your location and
the location of the mobile team staff.
Crisis teams employ licensed mental health professionals and mental
health practitioners who have bachelors and master’s level training.
Each county mobile crisis team provides on-going training for staff and
when needed consultation with outside mental health professionals.
Counties vary in having staff who can speak languages other than English, but they all offer interpreter services. Families who need an interpreter may have to wait additional time to receive crisis services depending on the availability of interpreter services.
When you call your county mental health crisis team they will triage the
call to determine the level of crisis service needed. If the child is in
immediate danger to themselves or others, the crisis team will refer to
911 and have law enforcement respond. If the situation is non-urgent
the crisis team will assess the level of intervention required: information and referral, phone consultation, an emergency room visit or an
immediate site visit.
The crisis team will need to ask questions to determine how to best help
you and your child. They may ask you for your name, a phone number
to call in case you are disconnected, the nature of the problem, if safety
is a concern, if the child has hurt himself, what caused the crisis, the
child’s mental health or hospitalization history (if any), if you are currently using mental health resources and your medical insurance information. Crisis teams will respond and address the situation regardless if
someone has insurance. If you have insurance the crisis team will bill
8
your insurance company for services they provide. Families will not be
turned away or refused services for lack of insurance.
When crisis staff make a site visit expect them to conduct a safety assessment to determine if the child is at risk of harm. They may decide
to have law enforcement respond, that a child should be seen at the
nearest emergency room or to direct admit the child to the sub-acute
unit at Fairview Riverside for ongoing care and treatment. The crisis
team may do a diagnostic assessment and make on-going recommendations for crisis stabilization services.
Short-term interventions provided by the county crisis teams may include plans that help the family provide behavioral strategies to prevent
future crisis, identify short-term safety needs, referrals to mental health
providers and/or mental health agencies.
Stabilization services may be available for up to 14 days after crisis
intervention. Stabilization involves the development of a treatment plan
that is driven by the diagnostic assessment and the family’s need for
services. It must be medically necessary and must identify the emotional and behavioral concerns, goals and objectives. The treatment
plan will also identify who is responsible for the interventions and services, the frequency or service intensity needed and the desired outcomes.
Stabilization services may also include brief solution-focused strategies,
referrals to long-term care agencies, crisis psychiatric appointments,
coordinated crisis plans and a referral for the counties children’s mental
health case management services.
In Immediate Danger
If the situation is life-threatening or if serious property damage is occurring, call 911 and ask for law enforcement assistance. When you call
911, tell them your child is experiencing a mental health crisis and explain the nature of the emergency. Telling the law enforcement agency
that it is a crisis involving a child with a mental illness increases the
chance that they will send an officer trained to work with people with
mental illnesses. Be sure to tell them – if you know for certain –
whether your child has access to guns, knives or other weapons.
When providing information about a child in a mental health crisis,
always be very specific about the behaviors you are observing. Instead
9
of saying “my son is behaving strangely,” for example, you might say,
“My son hasn’t slept in three days, he hasn’t eaten anything substantive
in over five days, and he believes that the someone is talking to him
through his IPod.” Report any active psychotic behavior, huge changes
in behaviors (such as not leaving the house, not taking showers), threats
to other people and increase in manic behaviors or agitation (pacing,
irritability). You need to describe what is going on right now, not what
happened a year ago. Finally, in a crisis situation, remember: when in
doubt, back off or go out. Do not put yourself in harm’s way.
Law Enforcement Response
When the law enforcement officer arrives, provide them with as much
relevant and concise information about your child as you can, including
the child’s:
Diagnosis
Medications
Hospitalization history
Previous history of violence or criminal charges
If the child has no history of violent acts, be sure to point this out. Lay
out the facts efficiently and objectively, and the officer will decide the
course of action.
Remember once 911 has been called and the officer arrives on the
scene, you do not control the situation. Depending on the law enforcement officer involved, they may take your child to detention instead of
to a hospital emergency room. Law enforcement officers have broad
discretion in deciding whom to arrest, whom to hospitalize and who to
ignore. You can encourage and advocate for the law enforcement officer to view the situation as a mental health crisis. Be clear about what
you want to have happen without disrespecting the law enforcement
officer’s authority. But remember, once 911 is called and law enforcement officers arrive on the scene, they determine if a possible crime has
occurred and they have the power to arrest and take into custody a person that they suspect of committing a crime.
Law enforcement can (and often does) call the county mental health
crisis teams for assistance in children’s mental health crises. The crisis
team may assist police in deciding what options are available and appropriate for the child and their family. The crisis team may decide to
respond with law enforcement. The police may decide to transport the
10
child to the emergency room.
Some counties have CIT Officers. CIT stands for Crisis Intervention
Training. CIT officers are specially trained officers who have received
additional education and training to recognize and work with individuals who have a mental illness. CIT officers have a better understanding
that a child’s behaviors are the result of a mental illness and how to help
de-escalate the situation. They recognize that those with mental illnesses are sometimes in need of a specialized response.
Emergency Room
When you bring your child to the Emergency Room, it is important to
know it does not guarantee admission. The admission criteria vary and
are dependent on medical necessity as determined by a doctor. County
mental health crisis teams can assist with the triage process and refer a
child to the hospital for assessment. It may be easier to have your child
admitted to the hospital if the county crisis team makes the referral and
assists in the triage process. County mobile crisis teams do not typically transport children to emergency rooms; if transportation is needed
the crisis team may contact paramedics or law enforcement or request
that you provide transportation.
When families arrive at the emergency room they should be prepared to
wait several hours. You may want to bring a book, your child’s favorite
toy, IPod, game or activity if that helps the child stay calm. If parents
have developed a crisis kit they should bring a copy with them to the
emergency room or hospital. See page 16 of this booklet to learn about
crisis kits.
If your child is not admitted to the hospital and the situation changes
when you return home, don’t be afraid to call the crisis team back. The
crisis team will re-assess the situation and make recommendations or
referrals based on the current situation. Your child may meet the criteria for hospital admission later.
Emergency Holds (a term used under the commitment law)
Sometimes a person with a mental illness creates such a risk of injury
that he/she must be held in custody before a petition for commitment
can be filed or before the pre-petition screening team can review the
matter. In these cases an emergency hold can be placed to temporarily
confine the person in a secure facility like a hospital. Emergency holds
last for 72 hours each (not including weekends and holidays). An emer-
11
gency hold doesn't necessarily result in starting the commitment process it only serves as a way to assess the individual to determine if commitment is necessary.
You should know that the commitment law is for people ages 18 and
over. Minnesota laws are confusing about how commitment applies to
teenagers ages 16 and 17. Some counties apply the commitment law to
teenagers at these ages, providing all the due process requirements.
Other counties may allow parents to consent to treatment, use juvenile
courts or even use the CHIPS petitions for 16 or 17 year olds that are
refusing treatment. Because the practice varies so much, check with
your county.
PREVENT
It is possible for children who live with a mental illness to become ill
even when they are following their treatment plan; however, the best
way to prevent a crisis is to have a treatment plan that works and is followed. It is also important to understand that children change as their
brains mature and medications that were working can suddenly stop
working. Behaviors change. New behaviors occur. Parents can help
prevent a crisis by noting changes in behaviors. Parents may want to
document behaviors by keeping a journal, making notations on a calendar or listing common occurring behaviors. It is important to remember
to note changes and early warning signs because they might be an indicator that a crisis could occur.
In order to prevent a crisis, it’s also important to ask yourself:
• What situations have led to a crisis in the past?
• What has worked to help reduce my child’s stress or to avoid a conflict in the first place?
• What steps can I take to keep everyone safe and calm?
• Whom can I call for support in a crisis or to help calm the situation?
• Should I consider a medic alert tag or bracelet for my child?
• What skills could I or my child learn and practice to reduce the impact of future crisis?
• Have I developed a crisis intervention plan? Does it need to be updated?
• What can I do to reduce family stressors?
• Have I utilized all available resources?
LEAP Method
Dr. Xavier Amador, in his book, I am Not Sick, I Don’t Need Help, outlines a communication skill that can be used in times of crisis and as a
way of engaging your child in calming down during a crisis. It is called
the L.E.A.P. method. LEAP stands for Listen, Empathize, Agree, and
form a Partnership. It is a family-friendly version of a form of therapy
called Motivational Enhancement Therapy.
Listen – the goal is to listen to your child’s needs without making
judgment, to understand their point of view and to use reflective listening to state back to your child that you understand (not necessarily
agree) what they said or need.
Example: I heard you say that you are not going to take your
medication any more. I understand that your sister is being
annoying and you want to hit her. I see that you are very angry with me and hear that you don’t want to talk right now.
Empathize – if you want your child to consider your point of view, it
is necessary for you to understand theirs. This is not the same as agreeing with your child; it’s about empathizing with them about how they
feel.
Example: I would be upset too if my sister played my video
game without asking my permission. I would be mad if I got a
C- on my test after I studied two hours for the test.
Agree – find common areas on which both you and your child can
agree. Acknowledge that your child has personal choices and responsibility for the decisions he/she makes about their behaviors and the consequences of those choices.
Example: I heard you say that your sister is arguing with you
and I heard you say that you want to hit her. Of course, you
feel like hitting her, and I am glad you didn’t. Can you think of
other options?
Partner – form a partnership to achieve shared goals. This involves
you and your child developing an action plan to meet agreed-upon
goals.
Example: We both agree your sister is bothering you and she
12
13
shouldn’t play your video games without asking you first.
What can we do the next time she bothers you?
Collaborative Problem Solving
Dr. Ross Greene, in his book, The Explosive Child, outlines a collaborative problem solving (CPS) method in which the child and parent engage in finding mutually satisfactory solutions to a problem. The emphasis is on preventing problems before they occur by recognizing triggers that occur before the crisis. Dr. Greene believes that children do
as well as they can and teaches families to identify their child’s lagging
skills. Missing skills can be taught.
All parents need strategies to work with their child’s behavior. The
truth is, we need strategies to deal with problem behaviors. Fortunately,
missing skills can be taught even when they are difficult to learn. But
not overnight. The missing skills are what show up as “misbehavior.”
Our children don’t know how to do better. We have to teach them the
skills in ways that work for them.
In the CPS approach you “lend” your child your frontal lobe by breaking down the problem solving steps in a way that helps them do better
in the long run.
Dr. Greene has some innovative ideas about helping children with challenging behaviors and understands what gets in the way of appropriate
behavior. This book may be helpful for parents of children with persistent problem behaviors that don’t respond well to typical parenting
strategies or “rewards and punishment” behavioral approaches such as
sticker charts or time-outs.
PLAN
Learn to Create a Crisis Plan
Children can experience a mental health crisis even when their families
have utilized the best resources offered by mental health professionals,
the local school system, advocacy agencies and social service organizations. A crisis plan is a short-term written plan designed to address
behaviors and help prepare for a crisis. Preparing for a crisis is an individualized process. However, there are some common elements that
can be found in a good crisis prevention plan.
14
• Child’s Information – name and age of child, mental health diagnosis, medical history, list of child’s strengths and interests.
• Family Information – name of parents, step-parents, list of family
members who live in the home.
• Behaviors – things that trigger or antecedents (things that are present before the behavior occurs), a list of strategies that have worked in
the past, a list of what may escalate the child’s behavior, (such as actions or people that are likely to make the situation worse), a list of
what helps calm the child or reduces symptoms.
• Medication – name and type of medication, dosage, prescribing
physician’s name and phone number, pharmacy name and phone number, list of medications that have not worked in the past, and known
allergies.
• Treatment Choices – list of interventions or treatments that are
being used, list of interventions that have not worked in the past, treatments that should be avoided, list of treatment preferences.
• Professional Involvement - phone numbers of children’s crisis
team, family doctor, therapist, social worker, psychiatrist, and hospitals
with psychiatric units.
• Supports – adults the child has a trusting relationship with such as
neighbors, friends, family members, favorite teacher or counselor at
school, people at church or work acquaintances.
• Safety Concerns – access to guns, knifes or weapons, access to
medication: both prescription and over-the-counter, safety plan for siblings or other family members, emergency contact names and phone
numbers.
• Resources – advocacy organizations, support groups.
Developing a crisis plan involves active involvement of all team members, including involvement of the child when possible. A crisis plan
should be written down and distributed to all persons who may be involved in resolving a crisis. It should be updated whenever there is
change in the child’s diagnosis, medication, treatment or team members.
Remember:
• Talk with ALL family members and discuss “what to do, if this
were to happen.
• Contact your local police department; provide them with a copy of
15
the crisis plan.
• Create a safe environment by removing any and all weapons and
sharp objects.
• Lock up all medications; both over-the-counter and prescription
medications.
• Create a plan that keeps other family members safe, especially
younger children in the home.
• Know the number of your county mental health crisis team.
Be Organized
You will receive a lot of paper and information and documents at meetings. The number one thing to be is to be organized. Use a three-ring
binder, accordion file or manila folder to organize the paperwork, documents, medical history and progress notes. Organize the binder or accordion folder with divider tabs. It helps to have current information
about your child all in one place.
Create a Crisis Kit
Parents whose children experience frequent crises may benefit from
developing a crisis kit that includes their binder and a small tote bag or
backpack with snacks, games, music or books that may help the child
when waiting for long periods of time.
•
•
•
•
•
•
This crisis tool kit should be kept in an easily accessible place in your
home or in your car. You may want to consider packing an emergency
bag that includes a change of clothes and basic hygiene supplies that
can be kept in your vehicle in case a crisis occurs.
ADVOCACY
Parenting a child with a mental illness can be overwhelming. It is not
easy to navigate the system or to obtain appropriate services for your
child. You may need help to learn how to advocate for your child.
Parents are their child’s best advocate. They know their child best and
most of the time know what they need, but not always how to ask first.
Learning to be an effective advocate and developing these skills takes
time.
You will be involved in many meetings concerning your child. These
meetings are especially stressful the first few times. The more meetings
you participate in the more comfortable and assertive you will feel and
you will feel more on an equal power footing with others in the room.
Recognize that your opinion matters and professionals want to hear
from you. Presenting yourself and ideas in the following ways will help
you gain credibility with professionals and can help you effectively
partner with mental health providers to help your child.
16
In your binder include the following:
•
Current diagnostic assessment
Copy of crisis plan
Documentation of phone calls and meetings
Hospitalization history
List of medications and dosages
Copies of all service plans, evaluations and progress notes including school IEP and 504 plans
Names and phone numbers of mental health professionals and mental health agencies working with your child
Take the binder with you to all meetings. It will help you keep track of
discussions, your child’s progress, what questions to ask at a meeting,
what actions have occurred or not occurred. Getting in the habit of
writing things down will result in long term benefits. If you have documentation then it is less “he said, I said” and more “this is what I have
in my notes of the conversation/email/text”.
When you are at a meeting prioritize what is important. Putting too
many concerns on the table can lead to confusion or a lack of focus. Go
to the meeting with a list of the three things you want to accomplish.
Having those items written down will help you remain focused. Clearly
state your expectations and ideas, provide facts and not much emotion.
Listen to what others are saying and take notes. Don’t be afraid to ask
questions if you don't understand what is being said. You may want to
bring a friend to help listen and take notes. Bringing cookies or a snack
can help break the tension and create a friendly atmosphere.
If you become overwhelmed don’t hesitate to ask for a break, or excuse
yourself to make a phone call or to use the restroom. Give yourself
time to gather your thoughts and gain focus. If you feel your objectives
cannot be met, try to negotiate and work towards a compromise. Be
17
willing to meet in the middle. Nothing is gained if all parties refuse to
listen and work towards a solution.
Speak in terms of what is best for your child, not what you want the
outcomes to be. Example: Johnny would really benefit from one to one
support at school.
Be Objective
As hard as it can be – these are our children after all - try to keep the
conversations and questions objective and unemotional. The more you
can stay objective and unemotional, the more control you can have in
the situation and the more you stay involved in the conversation and
decisions about your child.
Get Support
To be an effective advocate parents need support and need to take care
of themselves. You may want to join a support group. Support groups
give you a way to help you take care of yourself. At a support group
you meet with other parents with similar experiences and you benefit
from the support they give you. You gain knowledge and learn skills.
You also get a chance to support other parents by sharing your knowledge. By networking with other families, you create more support for
yourself and your child, increasing your child’s chances to receive appropriate services.
Be Effective
Parents should understand that good communication can help them receive appropriate services for their child. Good communication involves verbal and nonverbal language and listening skills. It is a twoway process, so you should be aware of how your words and actions
influence communication. By communicating well, you are ensuring
that the other person understands you and you understand them.
There are a number of skills that you can develop to enhance your ability to communicate well. This way you are tuned in not only to words,
but how they are said and the nonverbal behavior that accompanies
words.
Some of these non-verbal techniques are:
• use good eye contact
• concentrate on your tone of voice
• watch your nonverbal gestures and hand signals which can be misread
• Sit next to the most important person at the meeting
• Speak slowly and clearly
You can also develop a number of verbal skills that will ensure you
have understood what has been said and provide feedback to the other
person that you are listening. Some of these techniques are:
•
•
•
•
•
Paraphrasing - Put into your own words what the other person has
said. You do this by using fewer words and providing facts.
Reflective Listening - focuses on the feeling or emotion of what
has been said. You state back what you hear and see, taking note
of the nonverbal communication as well and the words that are
spoken.
Summarizing - you sum up what the other person has said. You do
this after a person has spoken for a long period of time.
Questioning - ask open-ended questions to clarify what has been
said.
I-Statements - start sentences with “I”. Here you take ownership
of what has been said and state back what you heard, “I heard you
say . . . is that correct?”
Listening is another part of the process that helps you advocate for your
child. It requires that we listen to the other person attentively without
letting our own thoughts and feelings interfere. Parents can increase
the chance that they will be heard by providing information about their
child that is current, in the here and now, instead of telling the whole
story. When information is kept to what is needed now and based on
facts, not feelings or emotions, you increase the chance of being heard.
Remember to keep an open mind and listen to what the other person has
said. They may have good ideas that you haven’t thought about.
Verbal and nonverbal communication work together to convey a message. You can improve your spoken communication by using nonverbal signals and gestures that reinforce and support what you are saying.
This can be especially useful when speaking to a large group of people.
18
19
Common Terms
CHILD Short-Term Crisis Intervention Plan
Child /Family Information:
Child’s Name:
Medications:
Mother’s Name:
D.O.B.
Dosage:
Phone(s)
Diagnosis(s)
Date of Plan:
Physician
Name / number
Pharmacy
Name / Number
Father’s
Name:
Phone(s)
Child - refers to both children and adolescents birth to age 18.
Parent - means the birth or adoptive parent of a minor. Parent also
means the child's legal guardian or any individual who has legal authority to make decisions and plans for the child.
Psychosis - loss of contact with reality: a psychiatric disorder such as
schizophrenia or mania that is marked by delusions, hallucinations, incoherence, and distorted perceptions of reality.
Federal Resources
Description of child/family strengths:
Description of immediate child/family needs:
Safety Concerns:
Treatment Choices:
Interventions preferred:
Interventions that have been used:
Interventions that should be avoided:
Professional involvement:
Psychiatrist Name /
Phone:
Therapist
Name /Phone:
School Contact / Phone:
Case Mgr
Name / Phone:
Crisis Team Phone:
Family Doctor
Name / Phone:
Hospital
Name /
Phone:
Other:
Supports to use in crisis resolution:
Name / Phone:
Name /Phone:
Name/Phone:
Name /
Phone:
Resources:
Advocacy Group:
20
Support Group:
MH Agency:
About our Children
www.aboutourkids.org
Bazelon Center for Mental Health law
www.bazelon.org
Child and Adolescent Bipolar Foundation
www.bpkids
Children with Attention Deficit Hyperactivity-Disorder
www.chadd.org
National Alliance on Mental Illness
www.nami.org
National Child Traumatic Stress Network Center
www.nctsn.org
National Federation of Families for Children’ Mental Health
www.ffcmh.org
National Institute of Mental Health
www.nimh.org
Office of Juvenile Justice and Delinquency Prevention
www.ojjdp.ncjrs.org
U.S. Department of Education
www.edu.org
Social Security Administration
www.ssa.gov
Substance Abuse Mental Health Services Administration
www.samsha.org
Other:
21
State Resources
Acronyms Used in Children’s Mental Health
Arc of Minnesota
www.arcmn.org
Minnesota Association for Children’s Mental Health
www.macmh.org
Minnesota Children’s Mental Health Division
www.dhs.state.mn.us/cmh
Minnesota Autism Society
www.ausm.org
Minnesota Children with Special Health Needs
www.health.state.mn.us/mcshn
www.health.state.mn.us/suicideprevention
Minnesota Council of Child Caring Agencies
www.mccca.org
Minnesota Department of Corrections
www.doc.state.mn.us
Minnesota Department of Education
www.education.state.mn.us
Minnesota Disability Law Center
www.mndlc.org
Minnesota Ombudsman for Developmental Disabilities
and Mental Health
www.ombudmhmr.state.mn.us
Minnesota Parent Leadership Network
www.mpln.org
National Alliance on Mental Illness of Minnesota
www.namihelps.org
Parent Advocacy Coalition for Educational Rights (PACER)
www.pacer.org
ADHD
ASFA
CAFAS
CHIPS
CMHA
CIT
CR
CTSS
DD/ED
DHS
DSM-IV
EBD
EBP
GAF
IEP
IIIP
ITP
MA
MRJPP
OHPP
PMAP
SED
SSI
TEFRA
VFCA
504 plan
Attention deficit / hyperactivity disorder
Adoption and Safe Families Act
Child and Adolescent Functioning
Assessment Score
Children in need of protection or services
Minnesota Comprehensive Children’s
Mental Health Act
Crisis Intervention Training
Custody relinquishment
Children’s therapeutic services and support
Developmental delay /
emotional disturbance
Department of Human Services
Diagnostic and Statistic Manual of Mental
Disorders
Emotional behavior disturbance
Evidence-based practices
Global Assessment of Functioning
Individualized education plan
Individualized interagency intervention plan
Individual treatment plan
Medical Assistance
Minnesota Rules of Juvenile Protection
Procedure
Out-of-home placement plan
Prepaid Medical Assistance Plan
Severe emotional disturbance
Social Security Income
Tax Equity and Fiscal Responsibility
Act of 1962
Voluntary foster care agreement
Section 504 of the Americans with
Disabilities Act
Funding for this booklet was provided in part by the Wasie Foundation
and by the Metro Children’s Crisis Service (MetrCCS) partnership, a
seven county, public-private partnership working to improve the children’s
mental health crisis sys tem through community based crisis intervention.
22
23
¿RECONOCES
ESTA
HISTORIA?
Traida a usted por
LOS HIJOS TAMBIEN RESIENTEN.
LAS ENFERMEDADES MENTALES Y EL ABUSO DE SUSTANCIAS AFECTAN
A PERSONAS DE CUALQUIER EDAD.
EL PEDIR AYUDA PROFESIONAL NO ES SEÑAL DE DEBILIDAD SINO DE
FORTALEZA.
LAS SALIDAS FACILES SON SIEMPRE LA PUERTA DE ENTRADA A
­PROBLEMAS MAS COMPLEJOS.
EL NO BUSCAR APOYO PROFESIONAL A TIEMPO PUEDE COMPLICAR
LAS COSAS.
LO MAS DIFICIL ES DAR SIEMPRE EL PRIMER PASO.
ARREPIENTETE DE NO HABER LLAMADO Y NO POR HABERLO
HECHO.
MAGELLAN DE ARIZONA ESTA AQUÍ PARA AYUDARTE.
MAGELLAN DE ARIZONA CUENTA CON PERSONAL QUE HABLA
ESPAÑOL Y CLINICAS POR TODO EL VALLE.
EL PERSONAL DE MAGELLAN ESTA AQUÍ PARA AYUDARTE.
LA RECUPERACION ES POSIBLE Y DEPENDE DE TI.
LA RECUPERACION Y RESISTENCIA VAN DE LA MANO Y TU ESFUERZO
NO ES EN VANO.
HAZ EL BIEN SIN MIRAR A QUIEN.
LOS SERVICIOS DE MAGELLAN ESTAN DISPONIBLES TANTO PARA
NIÑOS COMO PARA ADULTOS Y SON CUBIERTOS POR MEDICAID O
AHCCCS. MÁS DETALLES AL REVERSO.
Estimado lector,
¿Sabe usted cuántas personas a su alrededor padecen de una
enfermedad mental?
De acuerdo con el Instituto Nacional de Salud Mental,
cada año, uno de cada cuatro adultos en los Estados ­Unidos
experimenta un trastorno de salud mental. Además,
la ­inestabilidad económica, altas tazas de desempleo,
­ejecuciones hipotecarias y otras aflicciones financieras han
aumentado el número de personas sufriendo de altos niveles
de estrés y de enfermedades psicológicas. Las enfermedades
mentales pueden afectar a toda persona, a cualquier edad.
¡Necesitamos su ayuda!
Como la Autoridad Regional de Salud Mental del
­Condado de Maricopa, Magellan de Arizona entiende que
cuando una persona empieza a desarrollar síntomas de
una enfermedad mental, ésta y su familia con ­frecuencia
­acuden primero con sus amigos, vecinos o líderes
­religiosos para un consejo o ayuda.
¿Que puede hacer?
Por favor comparta esta fotonovela e información con sus
conocidos para ayudarlos a entender que el buscar ayuda
profesional no es una señal de debilidad, sino de fortaleza.
Si usted o alguna persona que conoce requieren de
­servicios de salud mental o contra el abuso de sustancias,
­comuníquese con Magellan de Arizona llamando al (800)
564-5465 o al TTY (800) 424-9831. Los servicios de
­Magellan están disponibles tanto para niños como para
adultos y son cubiertos por Medicaid o AHCCCS.
Acerca de AHCCCS
Para mayores informes sobre como solicitar AHCCCS,
los requisitos de elegibilidad/ingresos, recursos, reglas de
­participación en los programas o para la ubicación mas
cercana donde puede obtener y someter una solicitud de
AHCCCS en persona, por favor llame al (602) 417-4000.
Disponibilidad de Servicios
Magellan de Arizona cuenta con personal que habla
­Español para responder a sus llamadas y preguntas. Por
favor comuníquese con Magellan para aprender más
sobre los recursos disponibles para el cuidado de la salud
mental o contra el abuso de sustancias en el Condado
de ­Maricopa. Magellan le conectará con el proveedor de
­servicios en su área que más le convenga.
Línea de Crisis
Si usted o un familiar experimentan una crisis y ­requieren
de apoyo psicológico, comuníquese con la Línea para ­Casos
de Crisis del Condado de Maricopa disponible en ­Español,
­llamando al (800) 631-1314 o al TTY al (800) 327-9254.
La Línea para Casos de Crisis del Condado de Maricopa
es gratuita y está disponible las 24 horas del día, los siete
días de la semana, para cualquier persona que experimente
una crisis de salud mental en el Condado de Maricopa.
Para emergencias, siempre llame al 9-1-1.
Magellan Health Services de Arizona, Inc. es la Autoridad Regional de Salud Mental del
­Condado de Maricopa. Fondos para servicios son proporcionados por un contrato con el
­Departamento de Servicios de Salud de Arizona/División de Servicios de Salud Mental de Arizona
y el Sistema de Contención de Costos de Cuidado de Salud del Estado de Arizona (AHCCCS).
DO YOU
RECOGNIZE
THIS STORY?
Brought to you by
CHILDREN UNDERSTAND MORE THAN YOU THINK THEY DO.
MENTAL ILLNESSES AND SUBSTANCE ABUSE ISSUES AFFECT PEOPLE
REGARDLESS OF THEIR AGE.
GETTING PROFESSIONAL HELP IS NOT A SIGN OF WEAKNESS, BUT OF
STRENGTH.
EASY SOLUTIONS ARE THE GATEWAY TO LARGER PROBLEMS.
WITHOUT TIMELY PROFESSIONAL HELP THINGS CAN GET WORSE.
THE FIRST STEP IS ALWAYS THE HARDEST.
MAKE THE CALL, YOU WON’T REGRET IT.
MAGELLAN OF ARIZONA IS HERE TO HELP.
MAGELLAN OF ARIZONA HAS BILINGUAL STAFF AND MANY
­CLINICS ACROSS THE VALLEY.
MAGELLAN STAFF ARE HERE TO HELP YOU.
RECOVERY IS POSSIBLE AND DEPENDS ON YOU.
RECOVERY AND RESILIENCY GO HAND IN HAND AND YOUR EFFORTS
WILL PAY OFF IN THE END.
DON’T LET FEAR AND MISUNDERSTANDING KEEP YOU FROM
­GETTING THE HELP THAT YOU NEED.
MAGELLAN’S SERVICES ARE AVAILABLE FOR CHILDREN AND ADULTS
AND ARE COVERED BY MEDICAID/AHCCCS. SEE BELOW FOR MORE
INFORMATION.
Dear reader,
Do you know how many around you struggle with mental
health problems?
What you can do? Please share this information with anyone who might
need it to help them understand that seeking professional
According to the National Institute of Mental Health, one help is not a sign of weakness, but a sign of strength. out of every four adults in the United States ­experiences
a mental health issue in any given year. Furthermore, the
If you or anyone you know needs ­mental/behavioral health
current financial ­instability, increased unemployment
or substance abuse services, contact Magellan of Arizona
rates, foreclosures and other financial distress have led
at (800) 564-5465 or TTY (800) 424-9831. ­Magellan’s
services are available for children and adults and are
to more people suffering from higher levels of stress and
­psychological illness. Mental illness can strike anyone
­covered by Medicaid or AHCCCS (for those who qualify).
of any age, race/ethnicity or gender.
About AHCCCS
We need your help!
For more information on how to apply for AHCCCS
As the Regional Behavioral Health Authority (RBHA) for or questions regarding eligibility, income, resources,
Maricopa County, we at Magellan of Arizona ­understand
­program participation rules or the nearest branch to
that when someone begins developing the signs of ­mental apply in person, please call (602) 417-4000.
illness, they often turn first to their friends, family,
­neighbors or a faith leader for advice and help.
Service Availability Magellan of Arizona has bilingual ­speaking staff ­
available to answer your calls and questions. Please
­contact ­Magellan of Arizona to find out more about
mental/­behavioral health and substance abuse resources
­available in Maricopa County. Magellan will connect ­you
to a ­service provider that best fits your needs and is in
your area.
Crisis Line
If you or anyone you know is in crisis, please call the
­Maricopa Crisis Line at (800) 631-1314 or TTY (800)
327-9254 for immediate help. The Maricopa Crisis Line
is also available in Spanish, 24 hours a day, seven days
a week to anyone experiencing a mental health crisis in
Maricopa County. For emergencies ­always call 9-1-1.
Magellan Health Services of Arizona, Inc. is the Regional Behavioral Health Authority
for ­Maricopa County. Funds for services are provided through a contract with the Arizona
­Department of Health Services/Division of Behavioral Health Services and the Arizona Health
Care Cost Containment System (AHCCCS).
Children and Tragedy
Tragedy may strike quickly and without warning. These events can be frightening for adults, but they are traumatic
for children if they don’t know what to do. Children may become anxious, confused or frightened. It is important to
help them reduce their fears after a traumatic event.
Children and Their Response to Disaster 1
Children depend on daily routines. They wake up, eat breakfast, go to school and play with friends. When tragedies
interrupt this routine, children may become anxious. They'll look to you and other adults for help. How you react to
tragic events gives them clues on how to act. If you react with alarm, a child may become more scared.
Feelings of fear are healthy and natural for adults and children. But as an adult, you need to keep control of the situation.
Concentrate on your child’s emotional needs by asking what’s uppermost in his or her mind. Your response during
this time may have a lasting impact.
Be aware that following a tragic incident, children are most afraid that:
ƒ
ƒ
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The event will happen again.
Someone will be injured or killed.
They will be separated from the family.
They will be left alone.
Helping Children Recover from a Tragic Event
Keep the family together. Keep the family together as much as possible. Make children a part of what you are doing to
get the family back on its feet.
Calmly and firmly explain the situation. As best as you can, tell children what you know about the event and what efforts
are being undertaken in its aftermath.
Encourage children to talk. Let children talk about the tragedy and ask questions as much as they want. Encourage
children to describe what they’re feeling. Listen to what they say. If possible, include the entire family in the
discussion.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
1 Adapted from the Los Angeles City Fire Department at www.lafd.org/egindex.htm.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.
Common Responses to Traumatic Events
Trauma affects people in different ways. But there are some common reactions. The signs and symptoms may begin
right away. Or you may feel fine for days or even weeks and suddenly have a reaction. It is normal for people to feel
emotional “aftershocks” after a traumatic event. Some common responses are:
Physical Reactions


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Sleeplessness.
Fatigue, hyperactivity or “nervous energy.”
Pain in the neck or back.
Headaches.
Heart pounding or chest pains.
Dizzy spells.
Appetite changes.
Emotional Reactions

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

Flashbacks or “reliving” the event.
Feeling jumpy or easily startled.
Feeling irritable.
Anger.
Feeling anxiety or feeling helpless.
Feeling vulnerable.
Usually, the signs and symptoms of trauma will lessen with time. If you are concerned about your reaction, note the
specific symptoms that worry you. For each symptom, note the:


Length—Trauma reactions should grow less intense and disappear within a few weeks.
Intensity—If the reaction interferes with your ability to live your life normally, you may want to seek help.
Tips for Coping after a Traumatic Event
The suggestions below will help you cope with a traumatic event:






Get physical exercise and relaxation to help relieve the stress.
Talk to people. Talk is the most healing medicine.
Spend time with others. Resist the tendency to be alone.
Allow yourself to feel bad. Share your feelings with others.
Keep a journal. Write your way through sleepless times.
Get plenty of rest and eat regular meals, even if you don’t feel like it.
Recurring thoughts, dreams or flashbacks are normal. They will decrease over time and become less painful.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.
Coping with Children’s Reactions
Fear is a normal reaction to any danger that threatens life or well-being. After a disaster, a child may be afraid of
recurrence of injury or death. He or she may also be afraid of being separated from family or of being left alone.
Parents sometimes do not recognize the emotional needs of the child once they are relieved that nothing “serious”
has happened to the family. A child who is afraid is very frightened. A first step for parents is to understand the
kinds of fear and anxiety a child experiences.
Advice to Parents
ƒ
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It is very important for the family to remain together.
The child needs reassurance from your words as well as actions.
Listen to what the child tells you about any fears.
Listen when the child tells you how he or she feels. Listen to what he or she thinks about what has happened.
Explain to the child, as well as you can, about the disaster and about the known facts. Again, listen carefully to
him or her.
Fears do not need to completely disrupt a child’s and family’s activities.
Settling Down
ƒ
ƒ
ƒ
Parents should show the child that they are maintaining control. They should be understanding, but firm and
supportive. Parents should make decisions for the child.
It is natural for a child to want to cling to or be close to the parents and for the parents to want to have the
child near them.
Parents should also be aware of their own fears and uncertainties and the effect these will have upon the child.
How Can Parents Recognize When To Get Professional Help?
It is time to get help for your child if:
ƒ A sleeping problem continues for more than a few weeks.
ƒ The clinging behavior does not diminish.
ƒ The fears become worse.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.
Overcoming Your Fears and Anxiety
Increased anxiety levels are normal during tragic events. There are ways to reduce the stress and keep normalcy in
our lives.
Anxiety can be a feeling of dread or fear over a real or imagined threat to your well-being. Some anxiety is normal.
Mild anxiety helps people complete tasks or practice speeches or presentations. Feeling anxious can alert you when
danger is present. But anxiety brought on by a tragic event can be overwhelming. It may get in the way of your daily
life. Here are some tips to help you overcome anxiety1:

Prepare for events. Get ready for events that may cause anxiety, such as speaking in front of a group or dealing
with an uncomfortable situation. Imagine yourself feeling calm, confident and in control.

Eat healthy foods. Eat at regular times. Don’t skip meals.

Limit caffeine. Too much caffeine can make you anxious. Drink decaf coffee, tea, colas or other sodas. Avoid
chocolate.

Avoid nicotine and alcohol. They contain chemicals that can cause anxiety.

Exercise regularly. Use relaxation exercises, such as deep breathing, visualization or meditation.

Don’t over-commit. Don’t try to do too much with too little time. This is a sure way to bring on anxiety.

Face your fears slowly and gradually. Face your fears a little bit at a time until you are ready to take on more.
Anxiety is a real feeling. With patience, you can conquer it.

Control the things you can. If you walk for exercise, continue to walk. You can change your walk to an inside
location, but continue your daily routine.

Limit viewing of television news. Tragic things feed news coverage. You don’t have to subject yourself or
your family to repeated doses of it. Tune in for updates. Limit your exposure if it makes you or your family
anxious.

Keep family members close by if it makes you feel better. Being cautious about personal safety is good. Try
not to overreact.

Do something for someone else. Take the focus off your worries. Do something nice for someone else. This
can improve our own frame of mind.

Volunteer. Contact schools, hospitals or volunteer groups. Ask how you can help. Take action to be part of the
solution. This is a helpful way to reduce your anxiety.

Talk to someone. If you feel overwhelmed by your emotions, talk with a friend, family member, doctor,
religious advisor or mental health professional.
_______________________________________
1
Adapted from the National Mental Health Association, Coping with Anxiety, at www.NMHA.org.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2002 Magellan Health Services, Inc.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2002 Magellan Health Services, Inc.
Do’s And Don’ts After a Trauma
People who have gone through a traumatic event often show changes in behavior. The information below may help
avoid a long-term reaction to stress.
Do’s

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
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Get enough rest.
Maintain a good diet and exercise program.
Find time and talk to friends and family about what happened.
Take time for relaxing activities.
Follow a familiar routine.
Spend time with family and friends.
Attend meetings about this traumatic event.
Create a calming place to escape to, either visually or literally.
Take one thing at a time.
Expect the experience to bother you.
Seek professional help if your symptoms continue for a long time.
Seek medical help if your physical symptoms worry you.
Don’ts

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Drink a lot of alcohol.
Use drugs or alcohol to numb consequences.
Withdraw from significant others.
Reduce relaxing activities.
Stay away from work.
Increase caffeine intake.
Look for easy answers.
Take on new major projects.
Pretend everything is OK.
Make major changes if you don’t need to.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.
Understanding the Teenage Grieving Process
Grief is an emotion that accompanies many types of loss. When a teenager grieves, it can complicate a difficult and
often confusing stage in his or her life. The following are common reactions of teenagers who are grieving.
Shock/Disbelief
Teenagers may show few signs of grieving at first. This form of denial is important for coping and should be
respected. In months to come, the numbness will fade. Your teen will need you more than ever.
Guilt
Most people who grieve feel guilt, including teenagers. Arguments or unfinished business are part of life, especially
during teen years. Because of this, teens often have extreme feelings of guilt. They feel responsible when there is a
death or separation of some sort. They may feel like they are at fault. They may feel there was something they could
have done to change the situation.
Anger
A teenager may feel abandoned after a death. Anger can become very powerful. It is important that teens have safe
and healthy options for expressing their anger. Some suggestions include throwing cotton balls at a wall or
screaming into a pillow.
Drugs/Alcohol
A grieving person is hurting. A natural response is to want to numb the pain. By drinking or using drugs, the person
avoids dealing with the grief. Grieving teens are at high risk for self-destructive behavior. It is important to be open
with teenagers. Let them know that masking their feelings or clouding their judgment will not change the situation.
It will only prolong the grieving process. Be aware of any changes in your teen’s behavior or attitude that may come
from drug or alcohol use.
Tears
Tears are natural and a necessary part of grief. If you do not see tears, do not assume they are not there. Many teens
grieve in private. If a teenager shares tears with you, be quiet and listen. Don’t try to fix the pain.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.
Tragedy Aftermath: Taking Care of Yourself
If you have just gone through the shock and pain of a tragedy, you may be very shaken for the next few days or
weeks. As the shock wears off, you will start to rebuild and put your life back together. You may experience many
different emotions at this time. For months after experiencing a tragedy, it is common to feel let down and
resentful.
Some common responses to a disaster include1:
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Irritability/Anger.
Sadness.
Fatigue.
Headaches or Nausea.
Loss of Appetite.
Hyperactivity.
Inability to Sleep.
Lack of Concentration.
Nightmares.
Increase in Alcohol or Drug Consumption.
Many people who have gone through a tragedy will have at least one of these responses. Accepting your feelings is
the first step in feeling better. Other helpful things to do include2:
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Talk about your experiences. Share your feelings rather than holding them in. This will help you feel better
about what happened.
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Pay attention to your health and diet, and get adequate sleep. Relaxation exercises may help if you have a
hard time sleeping.
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Prepare for future emergencies. This may help you feel less helpless and bring peace of mind.
Help Is Available
Call us using the phone number on your member identification card for more information, help and support. We
are here to help you get and stay well.
1
2
www.lafd.org/eqindex.htm
Ibid
Adapted with permission from the National Mental Health Association at www.nmha.org
This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician.
© 2001 Magellan Health Services, Inc.