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Filling critical need: Programs designed to help children, families to cope, thrive

Tribune-Democrat (Johnstown, PA) - 7/6/2014

July 06--JOHNSTOWN -- What often is written off as normal teenage rebellion or adolescent misbehavior may be a symptom of deeper issues.

Nearly half of all teens experience some diagnosable mental disorder while growing up.

About 1 in 5 will have bouts with severe disorders, the National Institute of Mental Health reports.

A battalion of mental health professionals and programs stand ready to help families facing mental health crises, but the forces are stretched thin by the growing need and funding cutbacks.

"There is definitely more of a need," said Randy Hay, administrator of Bedford-Somerset Mental Health-Mental Retardation Program.

"With the downturn of the economy, we are looking at more. There are issues in the schools that we didn't have before, and the funding is less."

Attention deficit hyperactivity disorder is the most prevalent, hitting nearly 6 million children, or 10 percent of the population from the ages of 3 to 17. ADHD is nearly three times more common in boys than in girls, the Centers for Disease Control and Prevention says.

Although not as common as ADHD, disorders on the autism spectrum gain a lot of attention because they can take more resources and usually require services for a lifetime.

Among the other disorder groups diagnosed in children and adolescents are mood, conduct, post-traumatic stress, eating, panic and anxiety disorders.

More serious adult mental health issues found in children include schizophrenia, depression and bipolar disorder.

Treatments often involve a combination of counseling and medication, said Dr. Anseruddin Mohammed, a psychiatrist with Conemaugh Counseling Services.

But parents are often the keys to helping children with behavioral health disorders, Mohammed said. Conemaugh Counseling, like virtually every program working with children and youth, stresses the importance of parental involvement with in-home services and family counseling.

"Parenting is one of the most important jobs there is, and we have absolutely no formal training for it," Mohammed said.

"Many parents have grown up in stressed-out families. Their parents have not set a good example for them."

'Parenting pyramid'

Mohammed recommends what is known as the "parenting pyramid" as the center of interaction with children. The pyramid model has a broad base encouraging parents to spend time interacting with children in a positive way, such as playing, talking, listening, reading and sharing empathy in stressful times.

Those are the most important aspects, Mohammed said.

Moving up the pyramid, parents are encouraged to provide encouragement through praise and reward for good behavior.

The next level focuses on setting limits and rules with consistent follow-through. Because it is represented higher on the pyramid, it is smaller, symbolizing restrained use, Mohammed said. The next level tells parents to ignore negative behavior as much as possible, and to try to distract disruptive children, redirecting their attention to more positive areas.

Finally, the top of the pyramid calls for punishment, or as Mohammed likes to call it, "consequences."

"Too many parents turn to 'time out' without giving their children enough time," Mohammed said. "This is about ignoring the bad behavior as much as we can and celebrating the good behavior."

Mohammed admits it can be a struggle. Parents are often dealing with their own stress and anxiety.

"They tell me, 'I have nothing good to say about my child,' " Mohammed said. "That's sad. Even if a child 90 percent of the time is acting out, there is still 10 percent they are going to be good.

"Focus on that 10 percent and praise him for being good that 10 percent."

Sometimes it takes convincing to get the parents involved, said Jill Surloff, clinical supervisor of Alternative Community Resource Program's school-based initiative.

"We offer family therapy in the schools and in the home," Surloff said. "We want a lot of parental involvement. It is always a struggle."

"You see more progress with the student if the parents are more vested in it," said Cathy Krinjeck, outpatient program director for ACRP.

'Emotional stability'

ACRP offers several options for parents, including parent-child interactive therapy. Using a two-way mirror, trained counselors watch parents interacting with their children, offering advice, encouragement and suggestions through ear buds.

Many behavioral issues are first identified in the classroom, so input from teachers and coaches often is crucial to a proper diagnosis, said Dr. Aileen Oandasan, a child and adolescent psychiatrist with Conemaugh Counseling.

"Many times a learning problem also has a mental health component," Oandasan said.

"We help them find a more optimal placement for the child, but the schools are in charge of academic placement and special education services."

If the behavior becomes a threat to the child's safety or to the safety of other students, Oandasan said, it may become necessary to remove the child from the classroom and place him or her in a partial hospitalization day program or residential treatment facility.

She said this area does not have any residential facilities for children, so it requires families to travel.

Oandasan would like to see more options for residential treatment.

But removing a child from the home and school should be a last resort, and ACRP's mission is to prevent that by offering a variety of options, such as the school-based program now in several counties.

"The school-based program was developed first because access to services is very hard for working parents and parents without transportation to get the students to one of our clinics," Surloff said.

The program started in the Greater Johnstown School District in 2005. Today all Cambria County school districts, along with several parochial schools and a vo-tech school, participate.

The effort has grown to include school districts in surrounding counties, serving more than 600 students last year.

"I think it speaks volumes that we are growing because it is such a great program," Krinjeck said. "This is really working out well. Emotional stability creates academic success."

The ACRP leaders admit they can't do it alone. Teachers play an important role in helping children use the coping and socialization skills they are learning from the counselors.

"It takes a lot of cooperation on the teachers' part," Surloff said.

Teachers can help troubled students recognize their negative behavior and substitute positive behavior, such as communicating, writing in journals and other creative coping mechanisms.

Randy Griffith covers health care for The Tribune-Democrat. Follow him on Twitter @photogriffer57.

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