Psychotic Disorders in Children and Youth
OPTIMAL OUTCOME OF TREATMENT
The child/youth and family learns to manage the illness through developing an awareness of the illness, and acquires skills to overcome or accommodate to symptom fluctuations. The child/youth develops age appropriate living, educational and social skills, and interacts and functions appropriately within the family. The family experiences a sense of emotionally rewarding interactions and stability while simultaneously accommodating for the child's illness with minimal need for support or treatment.
ASSESSMENT GUIDELINES (See Assessment Guidelines for Children/Youth)
All staff should provide services which are perceived as non-threatening and affirming of the child/youth's rights and personhood. The assessment should be provided in a manner which does not attribute blame to families. Staff should provide the services needed with sensitivity and patience with the child/youth and family.
1. While the primary source of information in this diagnosis is the observation of the child/youth, it is important that parents/care givers be consulted during the assessment process. They are a critical source of information. Collateral sources of information may include school, significant others, and care givers.
2. Children/youth with psychotic disorders should be carefully triaged to establish the immediacy of need for center services. This should include evaluation of possible danger to self or others, and need for involuntary hospitalization or out of home placement.
3. Children/youth with Psychotic Disorders should be assessed for the need for a neurological, psychiatric, and medical evaluation.
4. Assessment of the family system is a critical component in determining appropriate treatment.
TREATMENT GUIDELINES (See Treatment Guidelines for Children/Youth)
1. Treatment of the family system is essential with particular emphasis on techniques that will modify any destructive patterns that have developed.
2. Psychoeducational information should be provided for family members. Receptiveness of the family to such information provides additional information as to the family dynamics and should be considered in treatment planning. The family should be helped to the understanding and acceptance that the child's illness will not disappear, but symptoms can be managed and controlled.
3. Family support, including respite services for the primary care giver, are critical areas to be addressed in treatment planning.
3.1 Respite, as defined in the Mental Health Services Manual: Children's Services Section, is preventative in nature and, therefore, is appropriate for children and youth who are not determined to be "in crisis."
3.2 Family support in the form of assertive case management should address crisis needs as well as other temporary options, i.e., kinship-care, day treatment, partial hospitalization, therapeutic foster care.
3.3 Families, Agencies, and Communities Together (FACT) Local Interagency Councils (LIC's) may provide valuable resources.
4. Collaborative exchanges of information from all agencies or individuals involved with the child/youth is essential in evaluating the efficacy of treatment, e.g., parents, care givers, teachers, respite care providers, case managers, etc.
5. Medication is critical in the treatment of psychotic disorders. Medication arrangements should be made in accordance with the child/youth's assessed needs. Medical staff have primary responsibility to obtain informed consent from the parent(s)/legal guardians (See HB 213, Treatment and Commitment of Mentally Ill Children), and periodically review medication with the child/youth and family. Therapists should also review medication use with the child/youth and family and refer concerns to the medical staff as indicated.
5.1 Under the provisions of HB 213, Treatment and Commitment of Mentally Ill Children, if either the parent or child disagrees with that treatment, a due process proceeding shall be held in compliance with the procedures established.
6. Family should be made aware of support groups and other community resources.
7. A crisis plan should be developed for each child and family to address the cyclical nature of this illness.
THESE GUIDELINES HAVE BEEN
DEVELOPED BY:
THE UTAH PREFERRED PRACTICE CONSENSUS PANEL
UNDER THE AUSPICES OF THE UTAH
DIVISION OF MENTAL HEALTH
APPROVED SEPTEMBER 20, 1996