How to Talk So Mental Health Will Listen Shaping Supports to

How to Talk So Mental
Health Will Listen
Shaping Supports to
Fit the Person
Jeff Sneddon, LCSW
Introduction
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Who am I and why am I here?
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Context of Presentation

Review Some Facts
Agenda
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What is currently in our bag of Tricks
The Why’s and How’s of Mental Health
Assessments
Diagnostic Process and Difficulties
What is Therapy, What do we Want, and
What do we do?
Working with insurance, CCO’s
Open discussion and problem solving
Evaluation
What is currently in our bag of
tricks: Objectives

Review the critical components of Case
Management Services that we have at our
disposal for use in referring individuals for
Behavioral Health Services and Advocacy.
What is currently in our bag of
tricks?
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American with Disabilities Act
◦ Title II Section 201-204
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Rehabilitation Act
◦ Section 504
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Oregon Revised Statutes
◦ ORS 659A.103 and 659A.142
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Oregon Administrative Rules
◦ 309-011-0070 thru 309-011-0095
Person Centered Planning and Referral
Process
 Development and Monitoring of Plans of
Care.
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Bag-O-Tricks: ADA

An individual with a disability who, with or
without reasonable modifications to rules,
policies, or practices…, meets the essential
eligibility requirements for the receipt of
services or participation in programs or
activities provided by a public entity shall by
reason of such disability be excluded from
participation in or be denied the benefits
of…
Bag-O-Tricks: ORS
It is the public policy of Oregon to
guarantee individuals the fullest possible
participation in the social and economic life
of the state…to participate in and receive
the benefits of the services, programs, and
activities of state government…without
discrimination on the basis of disability; and
 It is unlawful practice to exclude from
participation in or deny the benefits of the
services programs or activities or to make
any distinction, discrimination, or restriction
because of a disability.

Bag-O-Tricks: Rehab Act

Agencies that receive Federal financial
assistance can not deny individuals the
opportunity to participate in or benefit from
programs, services or other benefits.
Bag-O-Tricks: Person Centered
Planning and Referral Process
Person Centered Planning looks at an
individuals wants, needs, and desires
systemically with input from families,
friends, and paid care givers.
 Address unmet needs and make referrals to
resources to secure unmet needs.
 Ability to provide critical information to
resources to assist in accessing services
and supports.

Bag-O-Tricks: Plans of Care
Case Managers/Personal Agents assist in
the development of plans of care and
individualized measurable goals to meet an
agreed upon outcome.
 Case Mangers/Personal Agents Monitor the
plans of care to and continue to address
any unmet needs or provide guidance for
revision.
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Assessments: Objectives
Understand what a Bio-Psycho-Social
Assessment includes.
 Know how to prepare ourselves to be able to
assist with providing assistance and support to
our consumers.
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Bio-Psycho-Social Assessment
Important basic questions to know:
 What is the primary concern?
 How long has this been occurring?
 How often does this happen?
 Has there been a recent significant change
 or event?
 Are there any other behaviors of concern?
 Are there any medical conditions or
medications?
 What is the developmental and social history?
Bio-Psychosocial Assessment
Domains
Identification
and Chief Complaint
Biological
Psychological
Social
Environmental
Risk
Factors
Mental Status Examination
Clinical Formulation
Diagnosis
Recommendations for intervention
Diagnositics: Objectives
Increase our understanding of the diagnostic
process.
 Understand how modifications can be made to
criteria.

Using the DSM
Three factors when using the DSM
1. It only describes particular conditions – it
does not provide intervention strategies
2. There can be some tendency to focus on
the individual pathology instead of on a
client’s interaction with the environment
3. Third reason for wariness when using the
DSM concerns imperfections in its
categories – individuals and their behaviors
are complex and difficult to place in neat,
compact categories.
16 Major Diagnostic Classes
1.
2.
3.
4.
5.
6.
7.
8.
Disorders Usually first Diagnosed in
Infancy, Childhood or Adolescence
Dementia, Alzheimer, and other Cognitive
Disorders
Substance Related Disorders
Schizophrenia and other Psychotic
Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
16 Major Diagnostic Classes ctd.
9.
10.
11.
12.
13.
14.
15.
16.
Dissociative Disorders
Sexual Disorders
Eating Disorders
Sleep Disorders
Impulse Control Disorders
Adjustment Disorders
Personality Disorders
Mental Disorders Due to a General Medical
Condition not Elsewhere Classified
Multi-Axial Classification System
Axis I: Clinical Disorders
 Axis II : Personality Disorders & Intellectual
Disability
 Axis III : Current general medical conditions
 Axis IV : Psychosocial stressors
 Axis V : Global Assessment of Functioning
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Diagnostic Complications
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Diagnostic Overshadowing
Intellectual Distortion
Psychosocial Masking
Cognitive Disintegration
Baseline Exaggeration
Diagnostic Overshadowing
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A phenomenon where clinicians attribute
behavior to the developmental disability and not
to a co-existing mental illness symptom.
◦ An individual with profound ID believes that they
can drive a car.
Intellectual Distortion

Concrete thinking and impaired communication
result in poor communication about their own
experience (Sovner, 1986).
◦ Individual describes self as ‘scared’ instead
of ‘mad’ because of poor verbal skills.
Psychosocial Masking

Impoverished social skills and life experiences
result in unsophisticated presentation of a
disorder or misdiagnosis of unusual behaviour
as a psychiatric disorder (Sovner, 1986).
◦ Giggling and silliness is misdiagnosed as psychosis.
Cognitive Disintegration

Bizarre behavior is presented in response
to minor stressors that could be
misdiagnosed as a psychiatric disorder
(Sovner, 1986).
◦ A client is highly disruptive and complains a
lot after a preferred staff member leaves, but
is diagnosed with schizophrenia.
Baseline Exaggeration

Prior to the onset of a disorder there are high
levels of unusual behaviors, making it difficult to
recognize the onset of a new disorder (Sovner,
1986).
◦ A person who already had poor social skills and
was withdrawn becomes more so and begins to
experience other signs and symptoms of
depression. This is missed because staff reports
are inaccurate and staff turn-over means that noone is aware of the overall change in the person’s
functioning.
Putting it all together
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Present a solid case for treatment
Discuss the ramifications of the lack of
treatment
Benefit vs Accommodation
Inquire about specialization and ask for a
referral
Sell yourself, MH does not like to do CM
Discuss how you can facilitate a IDT to
support the clinical work
Literature is one sided
Developmentally appropriate services
Helpful Links:
Child Development Institute:
http://childdevelopmentinfo.com/
 Online Mendelian Inheritance in Man:
http://omim.org/
 AAIDD Reading Room:
http://www.aaidd.org
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Evaluation and Goodbye
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Jeff Sneddon, LCSW
jsneddon@co.linn.or.us