Lectures effective mental health intervention for youth
Lecture 1: introduction
1.1 introduction
Disorders often develop in childhood, so it is very important to be an expert that
makes thoughtful decisions regarding these psychopathological problems.
CBT: cognitive behavioral therapy is one of the effective mental health
interventions. In this course we are the diagnostic assessors, not therapeutic.
Dutch youth care system: since 2015 we have a new child and youth act which
states that children are the responsibility 393 local municipality’s (gemeentes),
first it was the responsibility of the 12 provinces. The goal of this is to reduce the
amount of children in specialized care and to increase prevention and use the
social network to support youth (civil society) but does not work, no decrease
in specialized care.
To be able to provide effective mental health care, evidence-based practice is
necessary.
Triad of evidence-based practice: by integrating three different aspects of
knowledge.
1. best scientific evidence
2. Clinical experience
3. Patient preferences
Scientific knowledge on interventions can be described by the 5 W’s. What
Works for Whom, when and why.
1. What causes psychopathology and what mechanisms influence its
development? To answer this question knowledge of developmental
psychopathology, but also psychodiagnostic assessment is necessary.
2. Can you use treatment to tackle these mechanisms, and if so, what is the
best treatment to choose? Knowledge of effectiveness but also matched to
individual and his/her context.
Interventions have to be evidence based because they can be harmful if it is not
tested properly. The intervention should not be based on a simple problem
solution approach, looking at a group instead of individuals and intuition.
1.2. Assessment for intervention
Psychodiagnostic assessment: assessment for intervention model (Pameijer)
is the model where this course is based on (handelingsgerichte diagnostiek).
A label is not an explanation, it is a description of the current problem. For
example: ADHD does not explain hyperactivity. The explanations are different for
different children with the same label.
Diagnostic cycle: finding explanatory factors for the behavior: to understand
factors that can be changed to help the child. Multiple factors are involved, and
these factors also influence each other. In this master the development sequence
is important (what develops first).
Carr:
, Predisposing factors: predispose to develop problems (e.g. difficult
temperament)
Precipitating factors: trigger the onset or marked exacerbation (e.g.
changing school)
Maintaining factors: perpetuate once developed (e.g. poor social
network)
Protective factors (e.g. positive personality traits such as emotional
stability) prevent further deterioration and have implications for prognosis
and response to treatment. A lot of protective factor may have a better
prognosis.
Different factors are in line with the diathesis-stress model: vulnerability
model: indicates which factors play a role in the onset of a particular mental
disorder: on the one hand and individual has a certain vulnerability and on the
other hand environmental factors (sources of stress) play a role.
Developed as an explanation for the onset of psychotic episodes in
schizophrenia which indicates that an explanatory factor or a risk factor does not
have to be a cause.
Treatment system as maintaining factor is if parents deny the problem or
treatment. Treatment system as a protective factor, the child accepts that there
is a problem and the treatment plan.
Case Bill:
- Predisposing: temperament, family
- Precipitating factor: fathers’ incarceration
- Maintaining factor: coercive interaction with mother
Left is first in time right is later in time. Double arrow is mutual interaction. There
is also a distinction in child and environmental factors. There are also interactions
between these factors (difficult temperament influences difficult family
environment transactional approach).
Explanations for certain behaviors are specific for individuals in a specific
situation. Risks may be explanation, but they do not have to be the cause.
, Searching for mechanisms are important because they create an opportunity to
break patterns and negative cycles. Importance of mechanisms:
- Need to know these to understand the problems and know the target for
intervention.
- 1 mechanism can play a role in several kinds of problems (so 1 factor can
explain several clusters)
- This can also explain high co-morbidity (eg. Focus on negative aspects in
anxiety and depressive complaints).
- Mechanisms can be hard to prove BUT often a reasonable case can be made
based on literature and experimental influence of presumed mechanisms.
Intervention strategies are based on:
Scientific knowledge (5w’s) what is happening
Try to influence the mechanisms of cause and maintaining factors factors
Are causes a transaction between several factors? Then your intervention
strategy should take this into account mechanisms
Intervention strategy does not need to be of the same nature as the cause
-> nature does not imply mediation and nurture does not imply BPT
intervention
Remove factor of. Compensate with something else (strengthening
protective factors.
1.3. Judgement
Putting someone’s development in an understandable diagram is a challenge, but
under the contains of money and time the risk for biases and errors rises. There
are systematic errors in interpreting research results, classification and choice of
treatment. To prevent these errors, you have to be aware of the most frequent
reasons for poor judgement:
1. Confirmation bias: you search for what you want to see. Means that we
pay attention to the information that confirms our convictions and ignore
evidence that contradicts them (for example confirming provisional
diagnosis).
2. Hindsight/‘I knew it all along’ bias: the tendency to doubt someone’s
decision after the event and to think that you saw it coming.
3. Availability bias: if for example ADHD is a lot in the media we have this
idea in our heads and apply it to a lot of people. The problem with this is
the information that is most readily available (comes most easily to mind)
is used. What is readily available to you is arbitrary arbitrary information
is used instead of facts subjective (non-objective) judgement.
4. Representativeness heuristic: when we make decisions based on
representativeness, we may be likely to make more errors by
overestimating the likelihood that something will occur, just because an
event or object is representative does not mean its occurrence is more
probable. We often compare 1 client with another instead of following the
criteria because it is too time consuming. This causes over diagnosing.
5. Anchoring bias: insufficient departure from the initial value; judgement
anchored to the first piece of information received, how arbitrary it may
be.
6. Framing: the way in which a problem is presented (for example a request
for help) determines how we think about the problem. (saying someone is
boyish is less problematic than when you say someone is hyperactive).
Lecture 1: introduction
1.1 introduction
Disorders often develop in childhood, so it is very important to be an expert that
makes thoughtful decisions regarding these psychopathological problems.
CBT: cognitive behavioral therapy is one of the effective mental health
interventions. In this course we are the diagnostic assessors, not therapeutic.
Dutch youth care system: since 2015 we have a new child and youth act which
states that children are the responsibility 393 local municipality’s (gemeentes),
first it was the responsibility of the 12 provinces. The goal of this is to reduce the
amount of children in specialized care and to increase prevention and use the
social network to support youth (civil society) but does not work, no decrease
in specialized care.
To be able to provide effective mental health care, evidence-based practice is
necessary.
Triad of evidence-based practice: by integrating three different aspects of
knowledge.
1. best scientific evidence
2. Clinical experience
3. Patient preferences
Scientific knowledge on interventions can be described by the 5 W’s. What
Works for Whom, when and why.
1. What causes psychopathology and what mechanisms influence its
development? To answer this question knowledge of developmental
psychopathology, but also psychodiagnostic assessment is necessary.
2. Can you use treatment to tackle these mechanisms, and if so, what is the
best treatment to choose? Knowledge of effectiveness but also matched to
individual and his/her context.
Interventions have to be evidence based because they can be harmful if it is not
tested properly. The intervention should not be based on a simple problem
solution approach, looking at a group instead of individuals and intuition.
1.2. Assessment for intervention
Psychodiagnostic assessment: assessment for intervention model (Pameijer)
is the model where this course is based on (handelingsgerichte diagnostiek).
A label is not an explanation, it is a description of the current problem. For
example: ADHD does not explain hyperactivity. The explanations are different for
different children with the same label.
Diagnostic cycle: finding explanatory factors for the behavior: to understand
factors that can be changed to help the child. Multiple factors are involved, and
these factors also influence each other. In this master the development sequence
is important (what develops first).
Carr:
, Predisposing factors: predispose to develop problems (e.g. difficult
temperament)
Precipitating factors: trigger the onset or marked exacerbation (e.g.
changing school)
Maintaining factors: perpetuate once developed (e.g. poor social
network)
Protective factors (e.g. positive personality traits such as emotional
stability) prevent further deterioration and have implications for prognosis
and response to treatment. A lot of protective factor may have a better
prognosis.
Different factors are in line with the diathesis-stress model: vulnerability
model: indicates which factors play a role in the onset of a particular mental
disorder: on the one hand and individual has a certain vulnerability and on the
other hand environmental factors (sources of stress) play a role.
Developed as an explanation for the onset of psychotic episodes in
schizophrenia which indicates that an explanatory factor or a risk factor does not
have to be a cause.
Treatment system as maintaining factor is if parents deny the problem or
treatment. Treatment system as a protective factor, the child accepts that there
is a problem and the treatment plan.
Case Bill:
- Predisposing: temperament, family
- Precipitating factor: fathers’ incarceration
- Maintaining factor: coercive interaction with mother
Left is first in time right is later in time. Double arrow is mutual interaction. There
is also a distinction in child and environmental factors. There are also interactions
between these factors (difficult temperament influences difficult family
environment transactional approach).
Explanations for certain behaviors are specific for individuals in a specific
situation. Risks may be explanation, but they do not have to be the cause.
, Searching for mechanisms are important because they create an opportunity to
break patterns and negative cycles. Importance of mechanisms:
- Need to know these to understand the problems and know the target for
intervention.
- 1 mechanism can play a role in several kinds of problems (so 1 factor can
explain several clusters)
- This can also explain high co-morbidity (eg. Focus on negative aspects in
anxiety and depressive complaints).
- Mechanisms can be hard to prove BUT often a reasonable case can be made
based on literature and experimental influence of presumed mechanisms.
Intervention strategies are based on:
Scientific knowledge (5w’s) what is happening
Try to influence the mechanisms of cause and maintaining factors factors
Are causes a transaction between several factors? Then your intervention
strategy should take this into account mechanisms
Intervention strategy does not need to be of the same nature as the cause
-> nature does not imply mediation and nurture does not imply BPT
intervention
Remove factor of. Compensate with something else (strengthening
protective factors.
1.3. Judgement
Putting someone’s development in an understandable diagram is a challenge, but
under the contains of money and time the risk for biases and errors rises. There
are systematic errors in interpreting research results, classification and choice of
treatment. To prevent these errors, you have to be aware of the most frequent
reasons for poor judgement:
1. Confirmation bias: you search for what you want to see. Means that we
pay attention to the information that confirms our convictions and ignore
evidence that contradicts them (for example confirming provisional
diagnosis).
2. Hindsight/‘I knew it all along’ bias: the tendency to doubt someone’s
decision after the event and to think that you saw it coming.
3. Availability bias: if for example ADHD is a lot in the media we have this
idea in our heads and apply it to a lot of people. The problem with this is
the information that is most readily available (comes most easily to mind)
is used. What is readily available to you is arbitrary arbitrary information
is used instead of facts subjective (non-objective) judgement.
4. Representativeness heuristic: when we make decisions based on
representativeness, we may be likely to make more errors by
overestimating the likelihood that something will occur, just because an
event or object is representative does not mean its occurrence is more
probable. We often compare 1 client with another instead of following the
criteria because it is too time consuming. This causes over diagnosing.
5. Anchoring bias: insufficient departure from the initial value; judgement
anchored to the first piece of information received, how arbitrary it may
be.
6. Framing: the way in which a problem is presented (for example a request
for help) determines how we think about the problem. (saying someone is
boyish is less problematic than when you say someone is hyperactive).
