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The System of Care is beneficial for those children who are lacking the resources to help them with their mental health disorder. Helping these children receive the services that they so desperately need. This program focuses on the distribution of the mental health services to these children and adolescents. Including the organization and collaboration of different services that are offered to those who are being affected ruthlessly and faced with acute or long-lasting disorders. These disorders often fall under the Seriously Emotionally Disturbed criteria. The mental health problem that will be acknowledged is; Reactive Attachment Disorder (RAD). This is a disorder that is formed from the constant child abuse and neglect. Child abuse and neglect affect so many children and youths resulting in injuries from physical to emotional, and mental trauma.
Reactive Attachment Disorder is an outcome that is caused by physical and mental suffering. This is a disorder that becomes a probable as a result from abuse that is experienced before the age of 5 years-old (Hornor, G., 2008). This disorder is a direct link from the lack of attachment between the caregiver and the child. These children who are diagnosed with this disorder are portrayed as failure to begin or reply in developmentally proper social connections, displayed by extremely reserved, alert or exceedingly unsure and inconsistent responses. These children dodge, and resist comfort or can display a cold alertness. They have appeared to either be incapable to or have tremendous trouble creating interactions and relationships with others (Hornor, G., 2008). Adolescents that are diagnosed with RAD can meet the criteria for Seriously Emotionally Disturbed. This disorder has exhibited the characteristics that are needed to be met over a long period of time and adversely affects daily living. With this disorder, there will be a treatment with the approach of the Systems of Care. This is including an assessment of the strengths and the problem. Then with the creation of a treatment plan to provide the potential services specifically for the presented family and child.
Systems of Care
The System of Care becomes essential for providing care for children who are suffering from severe mental health disorder. This concept can be described as being a system that organizes a combination of various community-based services (Stroul, B., Blau, G., & Friedman, R., 2010). The Systems of Care contains three core standards being community-based, family-driven, and youth-center, and culturally and linguistically knowledgeable. The terms that were originally used were child-centered and family-focused. This was updated to incorporate the parts each member in families played with recognizing who makes the decisions. A strengths-based approach is guided within this program for both family and child. This program is provided to those children who are in need and are seen as a priority due to them meeting the criteria for Seriously Emotionally Disturbed. They become a priority due to not having adequate access to care because of external influences such as socioeconomic status, child welfare, juvenile justice, special education, substance abuse, and many more (Chenven, M., 2010).
This system offers care for youths who are at risk and are suffering from a mental disorder. This support includes a well-defined style to interfering and providing the treatment. Providing the need for organizing services to address the demands of the child and their family. These organizations are meant to be within a community context to work together as a team with the family and their child (Chenven, M., 2010). The organizations that offer services for these families are often in collaboration with each other to ensure the best support. Demonstrating the idea of flexibility within this System of Care is to ensure these families and children can receive services. This is to help increase the number of children obtaining services. As well as, assist in possibly gaining confidence around their mental health disorder. This is to help these adolescences regularly attend school without the worry of their health. Providing individualized mental health services that fit the child or youth developmentally and with the specific needs of the family. The services or organizations offered will have the capacity to track, monitor, and help them manage helpfulness, and create their goals (Stroul, B., Blau, G., & Friedman, R., 2010). These are all to incorporate both the family, and the child to specialize the treatment and services.
A mental health problem that affects youth
Reactive Attachment Disorder is an attachment disorder that is not as frequent as other disorders that impact children. It has been shown that this disorder is not as common in the general population among youth than with those who were in foster care due to negligence and abuse. This disorder is exhibited in 1% of the general population of children, but 38 % of those children who were placed in foster care (Bosmans, G., Spilt, J., Vervoort, E., & Verschueren, K., 2018). Children who are presenting symptoms of RAD were being emotionally reserved towards their caregiver. Unsuitable persistent social and or emotional reactions are often shown throughout their responsiveness in a situation (Bosmans, G., Spilt, J., Vervoort, E., & Verschueren, K., 2018). These children have a hard time exhibiting a limited positive effect and can have a phase where they will display unexplained arousal. The unexplained arousal can occur during non-threatening contact with caregivers. The concerning behaviors also include lack of pursuing comfort when ill, sick, hurt, or scared, immediate interaction with strangers with no caution, difficult peer relations, and greater anger (Hornor, G., 2008).
Children who experience Reactive Attachment Disorder were exposed to a form of constant child abuse and or neglect from caregivers over a long period of time. They have experienced an unpredictable, unresponsive caregiver, and a lack of support (Hornor, G., 2008). Creating the idea for these children that they are unable to seek comfort from any form of adults. As well as lacking the inability to seek out adults for support when they are presented with any forms of stressors in an effort to obtain comfort. These children are left with the concept that adult caregivers are not trustworthy and undependable or unsupportive. Children with RAD have great difficulty in forming relationships with others. Those who were placed into the foster care, more than 90% of these adolescences have formerly been mistreated, abuse, and or abandoned (Hornor, G., 2008). Increase the risk of developing this disorder because of the instability and inconsistently from potential caregivers. This mental health disorder can affect any children and adolescence from any background as it only reflects on the concept of attachment. Whether they are able to receive the basic fundamental needs to develop properly.
Reactive Attachment Disorder is in direct relations to the Attachment Theory. RAD is the understanding that these children and adolescents do not have a secure attachment. Children are expected to develop a secure attachment with caregivers who are understanding and sympathetic to their needs within the first few years (Hornor, G., 2008). However, if these children are not being presented with these characteristics in their caregiver, this then increase the risk to develop an insecure attachment. With the caregiver not being able to respond to the child’s stressors and help with regulation. Attachment is established within the first few years of life and the attachment style shows a few years later (Hornor, G., 2008). This is then demonstrated when the child either utilizes or does not utilize the caregiver as a form of a secure base. The idea of a secure base comes from the children looking back before exploring, stranger and separation anxiety. RAD affects these children negatively later in life with their incapability to have positive relationships and able to preserve them. The negative affect also embraces their inability to form a sense of self or direct their own emotional and behavioral reaction. A form of serious social deprivation is associated and in order to be qualified for this disorder there is a need for the lack or emotionally removed from adults. Thus, in turn, affecting their overall potential ability to form relationships and trust others (Hornor, G., 2008). There are long-term consequences if this disorder is not recognized prematurely and does not receive treatment earlier on. These children will develop Conduct Disorder, Oppositional Defiant Disorder, and Adult Antisocial Personality Disorder.
Seriously Emotionally Disturbed is defined by Substance Abuse & Mental Health Service Administration (SAMHSA). Someone who meets the criteria for SED is someone from birth up to 18-years-old who presently or at any other time throughout the earlier year, have been diagnosed with a disorder (Green, J. G., Alegría, M., Kessler, R. C., McLaughlin, K. A., Gruber, M. J., Sampson, N. A., & Zaslavsky, A. M., 2015). This diagnosed disorder can be mental, emotional, and behavior disorder for over a long period of time in order to meet the criteria for SED. SED describes that meeting the criteria results in functional impairment which restricts and or constraint child’s functioning in family, school, and or community (Green, J. G., Alegría, M., Kessler, R. C., McLaughlin, K. A., Gruber, M. J., Sampson, N. A., & Zaslavsky, A. M., 2015). These children often have problems in several areas of functioning, disruptive behaviors in school, may meet for more than one diagnosis, and often apart of more than one service. These are children who are overrepresented in the foster care and have been abused or neglected. Recognizing that these mental, behavioral, and emotional disorders have an adverse impact on these children’s daily life in every part. When children and adolescents meet these criteria and have been diagnosed with a disorder they become qualified for many forms of federally financed community-based amenities.
Reactive Attachment Disorder meets the criteria for Seriously Emotionally Disturbed due to the huge impact that this disorder has on these individuals. These children and youth have been diagnosed with this disorder can be described as having a harder time forming relationships among other adults. This is due to the previous trauma experienced in their early years of life. Children are learning about trust and reliability during their first few years of life. The trauma is a form that was persistent over a long period of time to inflict this kind of adverse effect on these children and adolescence. Which meets the persistent features and the recurrent aspect of the Serious Emotional Disturbance. Thus, affecting these children’s outcome later in life with relations and having the ability to succeed. Creating interference with the child’s ability to function within the family because of the concept of family has been altered with the abuse that was inflicted on these children. The family is no longer a safe and secure place and consequently the development of an insecure attachment style. This affects their ability to understand stranger and separation anxiety. They have impairment on what a secure attachment figure is and that not all adults are the same. Which in then affects the community and the school activities because they do not have the same engagement levels as other youths.
Intervene using Systems of Care
Assessing the potential client using the Systems of Care perspective requires tools to help provide an understanding of the client. Working with a client, understanding more of a holistic view on multiple levels. Where the child or client is having difficulty in and how their development went. Getting a Bio-Psycho-Social on the client to view each part and function of their life to help assist in their intervention. Assessment of the client is to be engaging with the family cultural considerate. Being culturally aware of the family and the client acknowledges that every family has different opinions on mental health, family roles, child roles, and on how to intervene. This is to help provide the best possible support in order to achieve positive outcomes. Some of the tools that can possibly be utilized when assessing the client are the Child and Adolescent Functional Assessment Scale (Francis, S. E., Ebesutani, C., & Chorpita, B. F., 2012). This is to help identify the scale of these adolescences SED scores across the disorders with their internalizing disorders and externalizing. This is used when measuring across various settings to help identify the amount of deficiency in functioning. This scale’s strength is distinguishing between the existence and absence of any mental disorders within the children and adolescence. These scores form this scale to help differentiate among who does and does not receive services from different programs (Francis, S. E., Ebesutani, C., & Chorpita, B. F., 2012). The Child and Adolescent Functional Assessment Scale is more of a holistic view, but it allows for a specific attention on the areas of critical need within the client.
Systems of Care is a strength-based approach for the client. A Behavioral and Emotional Rating Scale will be utilized for children who are diagnosed with SED (Painter, K., 2012). This scale was intended to assist in the measurement of individual strengths of the children ages 5-18 years-old. It not only measures personal strengths, but as well as relational, family participation, intrapersonal, school performance, and effective strengths. There are multiple versions of this assessment where depending on the age of child they will complete a different version and for a version for the caregiver to complete the Behavioral and Emotional Rating Scale (Painter, K., 2012). This also provides a view into where the clients do not exceed in. Higher scores determine more developed personal strengths. If the client receives a lower score in an area of the assessment scale that can be viewed as in clinical range.
Creating a treatment plan using the Systems of Care states that youth with SED require and receive services from a variety of agencies that apply different eligibility criteria. Incorporating the principles and core values within the System of Care will be used to develop a treatment plan. The core values are being child-centered, family-focused, personalized and community-based, culturally competent, and evidence-based. The core values and principles are along the same practice. There is the idea of working in a partnership and team-based. These all become essential when seeking to provide all-around support. Youth can benefit from this approach from the different services and engaging not only the youth but their families as their partners in care.
Creating this treatment plan, the client would be asked to identify their hopes from these sessions and then base it around what the client needs are. If the client states what they would like to work on, then there will have the increased potential for engagement throughout sessions and more of a chance for positive outcomes. Being client-centered is critical to provide the specific services. Throughout this process, the family will be involved in the treatment process. This is to recognize that the family is central to the care of these children and the families become an equal part in services that are being provided to the child. Including, providing the family and a choice in helping the client. In addition to getting their perceptive on services or the clients’ strengths. These then create the idea of being a team based from the family’s perceptive and the official support services. Influencing a collaboration and working cooperatively among all the different supporters. This treatment becomes distinctively formed for the child from different aspects of their disorder and the environment. This treatment will include having services for both the child and the family.
The System of Care provides opportunities for children who may not originally be offered services after being diagnosed. Being able to provide needed services to children who are diagnosed with a disorder which in turn is affecting their everyday life becomes crucial. Focusing on how mental health services were being provided to these youths and in what ways can they positively change. Identifying community-based programs to offer various services to meet all of the different children’s needs and their challenges. Creating the ability to make the connection and help coordinate different networks to assist in providing the highest achievable services to the family and child. These children are often struggling with Serious Emotional Disturbance Disorders and demand the additional support all around in their life. The disorder that they have been diagnosed with affect multiple areas of their daily lives and results in functional impairment. These disorders are often limiting the child’s ability to exceed without the additional support and services. Reactive Attachment Disorder is one that can be put under Serious Emotional Disturbance. This is a disorder that makes it difficult for these children and youth to develop an attachment to other adults in their lives. They are described as having an insecure attachment style and is usually caused by a continuous trauma such as abuse and neglect in all forms. Reactive Attachment Disorder causes lack of social connections, inappropriate reaction to a social situation, lack of stranger awareness and or separation awareness. With the help of the Systems of Care approach, these children who are diagnosed with such a severe diagnosis can be provided with valuable treatment and services to help work with the clients and the family.
- Bosmans, G., Spilt, J., Vervoort, E., & Verschueren, K. (2018). Inhibited symptoms of reactive attachment disorder: Links with working models of significant others and the self. Attachment & human development, 1-15.
- Chenven, M. (2010). Community systems of care for children’s mental health. Child and Adolescent Psychiatric Clinics of North America, 19(1), 163-174.
- Francis, S. E., Ebesutani, C., & Chorpita, B. F. (2012). Differences in levels of functional impairment and rates of serious emotional disturbance between youth with internalizing and externalizing disorders when using the CAFAS or GAF to assess functional impairment. Journal of Emotional and Behavioral Disorders, 20(4), 226-240. doi:http://dx.doi.org/10.1177/1063426610387607
- Green, J. G., Alegría, M., Kessler, R. C., McLaughlin, K. A., Gruber, M. J., Sampson, N. A., & Zaslavsky, A. M. (2015). Neighborhood sociodemographic predictors of serious emotional disturbance (SED) in schools: demonstrating a small area estimation method in the national comorbidity survey (NCS-A) adolescent supplement. Administration and Policy in Mental Health and Mental Health Services Research, 42(1), 111-120.
- Green, J. G., Xuan, Z., Kwong, L., Hoagwood, K., & Leaf, P. J. (2016). School referral patterns among adolescents with serious emotional disturbance enrolled in systems of care. Journal of child and family studies, 25(1), 290-298.
- Hornor, G. (2008). Reactive attachment disorder. Journal of Pediatric Health Care, 22(4), 234-239.
- Painter, K. (2012). Outcomes for youth with severe emotional disturbance: A repeated measures longitudinal study of a wraparound approach of service delivery in systems of care. Child Youth Care Forum, 41, 407-425.
- Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.
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