Child death cases are obviously tragic, but we need to let fact overrule emotion

In announcing the arrest Wednesday of a suspect in the killing of 10-year-old Anthony Avalos, Los Angeles County Sheriff Jim McDonnell said that reports of the boy’s injuries were “grossly overstated” and that detectives did not find cigarette burns on his body, contrary to earlier reports. “What you’ve heard there is not accurate based on what our detectives have seen,” he said.

It’s tempting to respond, “So what? The young boy was killed, and that’s what matters.” And indeed, that is the essential issue. But how did it happen, and when, and what signals were missed in the months before, and by whom? These questions are central to understanding not only who bears criminal responsibility, but how policies and practices failed, if they did, and how to improve them. The facts matter, and should not be overruled by emotion.

An L.A. County official reportedly said Anthony “came out as gay” in the weeks before his death, and that remark has become a persistent line in news reports. It is important. LGBTQ kids are overrepresented among youth in foster care, in part because of rejection by their families. They often are the targets of violence by family members or even strangers when their sexual orientation is revealed. In the murder trial of Isauro Aguirre, the boyfriend of the mother of slain 8-year-old Gabriel Fernandez, homophobia emerged in testimony as one possible motivating factor in the 2013 killing. There are, at least on the surface, eerie parallels between the deaths of Gabriel and Anthony.

But so far, the publicly reported evidence that Anthony “came out” is sketchy. One Department of Children and Family Services official said Anthony “said he liked boys.” Another department official said the boy’s statement was that he liked boys as well as girls. Is it “coming out” for a 10-year-old to say he likes boys and girls? It’s not impossible. There may well be additional evidence that he “came out,” or that an adult in the house believed he did and responded violently, but no such information has yet been released.

Enter the Fray: First takes on the news of the minute from L.A. Times Opinion »

Much anger has been directed at the Department of Children and Family Services, whose social workers respond to allegations of child abuse and neglect. There have been calls for firing and for criminally prosecuting county personnel, and the calls are given added resonance by the impending criminal trial of social workers and their supervisors in the Gabriel Fernandez case.

It is certainly possible that county workers failed, or even that some might be held criminally liable. Yet the information released so far is that the 12 complaints of abuse and neglect of Anthony were received years ago and that workers responded to them; and that there were no such complaints received in the last two years. Complaints about general neglect were confirmed, as was an allegation of sexual abuse several years ago. Complaints about other forms of physical abuse were not. None of that disproves failure on the part of county workers. It’s too early. We don’t yet know, and likely will not for quite some time. The Board of Supervisors, understandably angry and frustrated, reasonably called for a status report in 45 days. Even then, not every question will be answered.

The case is agonizing. After the death of Gabriel, the county convened a blue-ribbon panel to study the child welfare system and make recommendations for improvements; it hired 2,600 additional child welfare workers to reduce caseload size; and it established an Office of Child Protection to increase accountability and improve coordination among agencies. There should have been no way a similar death could occur under similar circumstances, but here it is — same general part of the county, a boy of close to the same age, an accused boyfriend of an allegedly neglectful mother, assertions of homophobia.

There have been calls for legislation, but to require what, exactly, that is not already required? In social media and in the news there have been demands for heads to roll, but whose, and for what reasons? It is exceedingly difficult, in the wake of the death of an innocent child, presumably at the hands of an adult, to take a breath and allow time to sort through the facts. But that — along with grief for the loss of life and determination not to permit yet another recurrence — is what is needed.

http://www.latimes.com/opinion/editorials/la-ed-anthony-avalos-20180629-story.html

Behavioral Health Protocol

Behavioral Health Service Providers, including behavioral health professionals, behavioral health technicians and behavioral health paraprofessionals, should be advocates for victims and children. As such, they may provide primary therapeutic intervention, support to families, information, and be a source of referral for child abuse allegations because of their contact with children and their families. A primary concern of the behavioral health providers is to prevent re-victimization of the child. The provider may hear the initial disclosure, either directly from the victim or indirectly from a third person. Since reporting of child abuse is mandatory for behavioral health service providers, it is incumbent upon the provider to be familiar with current theory and research on child physical and sexual abuse. The Arizona mandatory reporting Law, A.R.S. §13-3620 (see Appendix A), requires that behavioral health and social service professionals, providers and other persons having responsibility for the care or treatment of children who “reasonably believe” that a child has been abused or neglected, are mandated to report the matter immediately. "Reasonable Grounds" for reporting means if there are any facts from which one could reasonably conclude that a child has been abused or neglected, the person knowing those facts is required to immediately report those facts to the appropriate authorities. When in doubt, make the report. Abuse and neglect reports should be made to both the Child Abuse Hotline 1-888-SOS-CHILD and to local law enforcement by dialing 911. The statute also states that anyone who reports a case of suspected child abuse is immune from liability in any civil or criminal proceeding resulting from the report unless the reporter has been charged with or is suspected of committing the abuse, or is acting with malice. Behavioral health service providers are responsible for maintaining current awareness of any statutory changes that may occur in the reporting law. Every behavioral health service agency needs to establish a procedure for following the mandatory reporting law. Every behavioral health service provider should be familiar with the specific reporting requirements as defined by the professional standards of his/her governing board. This Protocol provides guidelines as to how behavioral health provider or other person responsible for the care or treatment of children can best fulfill their legal and professional mandates, while working in conjunction with the agencies responsible for the investigation of child abuse cases. I. Agency Responsibilities A. Behavioral health agencies should provide support and assistance to the person who received the initial disclosure through the child abuse reporting process. Please note that in all cases the person receiving the information will be solely responsible for all steps of reporting described herein, and in Section IV of this document, REPORTING AND TRAINING RESPONSIBILTIES, Mandatory Reporting Guidelines. October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 26 B. Behavioral health service agencies should authorize yearly training on child abuse recognition and reporting for their entire staff. C. Behavioral health service agencies should adopt a standardized child abuse reporting form to be utilized for the mandatory written report (See Appendix N for exemplar). Agencies may adopt the sample provided or may create a form that provides the necessary information. II. Receiving the Initial Disclosure A. When it appears that a child is disclosing information about possible abuse, the person receiving such information should listen and ask no leading question. If the child does not spontaneously provide the information, only the following questions should be asked: What happened? Who did it? Where did it happen? B. The person receiving the information should ask no further questions. If the child has spontaneously answered any of the three questions, do not ask that question again. Record verbatim the statements made by the child or reporter in written form. Video/audio recording is not recommended. Any record you make including electronic, written, photo or video record must be preserved and may be subpoenaed. C. Once the initial disclosure has been made, only the forensic interviewer should conduct any further questioning or interviewing of the child. Further questioning may create additional trauma for the child. It may also impede, impair, hinder, interfere with or defeat future prosecution. There is a child advocacy center available where victim interview that meet the requirements of both criminal and DCS investigations are conducted by specially trained interviewers. (See Section III of this document). These interviews are video and/or audio recorded and become forensic evidence. This reduces the need for repeated interviews of the child victim. D. Inappropriate response to disclosure of abuse or neglect poses one of the greatest risks of trauma to the disclosing child. Do not make promises to the child or the nonoffending parent that cannot be guaranteed. For example, do not tell the child: "This does not have to be reported to the authorities"; "you won't have to testify"; "no one will go to jail"; etc. III. Reporting Child Abuse: When a behavioral health provider or other person required to report has reasonable grounds to believe that a minor has been the victim of abuse, he/she should: 1. If the non-offending parent or caretaker is aware of the disclosure and appears to be appropriately supportive, consideration should be given to encouraging the nonoffending parent or caretaker to immediately make the report to law enforcement and DCS while in the presence of the therapist. 1. The behavioral health service provider or other person required to report should request that he/she is identified in any report made by the reporting parent or caretaker. 2. If a behavioral health service provider or other person required to report believes the victim or other children in the home continue to be at risk, he/she should make October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 27 a second report to DCS. 3. Regardless of the non-offending parent or caretaker’s willingness or ability to report, the behavioral health provider still has the responsibility of making the reports to the appropriate law enforcement agency and to DCS immediately. B. Report the suspected abuse immediately to the Child Abuse Hotline and the law enforcement agency in the jurisdiction where the offense took place. C. Document the report information on a state/and or agency approved reporting form. Per A.R.S. §13-3620 (See Appendix A), a copy of the reporting form should be transmitted to DCS within 72 hours of making the initial report. If available, the forms should be faxed to DCS. The fax number for reporting to DCS should be requested from the Hotline Worker to whom the report is made. If fax is not immediately available, the reporting form should be mailed to Department of Child Safety, P.O. Box 44240, Phoenix, AZ 85064-4240. D. The behavioral health service provider and/or Agency should maintain the original copy of the written report and records regularly maintained, which should be kept in the client's file, in accordance with the requirements for preservation of a minor’s records as provided by Arizona regulations. E. Notify an Agency Supervisor, if applicable and immediately available, of the disclosure. Never delay making a report pending discussion with or approval of a Supervisor or other Agency resource. If there are questions as to whether information received constitutes abuse and should be reported, or whether the report should be made to DCS and/or law enforcement in the jurisdiction where the suspected abuse took place, contact the Child Abuse Hotline at 1-888-SOS-CHILD (or 1-888-767- 2445) and they may provide advice. The person receiving the information is solely responsible for reporting to DCS and the appropriate law enforcement agency. IV. Behavioral Health Service Provider's Responsibilities: The behavioral health service provider's primary goal is to facilitate healing in the child who has been victimized. This may include working with family members to negotiate changes in the child's environment, and assisting the family in aligning with the victim to provide emotional support and protection, and assisting in minimizing secondary trauma during the legal process. A. In this role, the behavioral health service provider should delay primary trauma intervention until after the forensic interview and investigation has been completed by the appropriate agency. In the interim, supportive therapy should be provided. Examples of supportive therapy include: 1. Encouraging the child's parent or caretaker not to allow contact between the victim and alleged offender. 2. Taking appropriate steps to ensure the safety of other children in the home. 3. Stabilizing the victim's environment by supporting removal of the alleged offender. B. Behavioral health service providers, who prefer not to work with child abuse victims, or lack expertise in this area, may also contact the Pima County Attorney's Victim Services Division to seek referrals to behavioral health professionals who specialize in working with child abuse victims. October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 28 C. During treatment, if the child or other person discloses further information regarding the abuse, the behavioral health service provider should document the information in direct quotes and promptly report this information to law enforcement and DCS. D. In accordance with A.R. S. §13-3620 (See Appendix A), mandated reporters, including behavioral health service provider, may be requested to release records to DCS and/or law enforcement. Offender treatment records may also be obtained pursuant to A.R.S. §13¬3620 in any civil, criminal, or administrative proceeding or investigation conducted by DCS or law enforcement in which a child's neglect, dependency, abuse or abandonment is an issue. Thus, written records should be complete, concise, clear and factual. A behavioral health service provider who has any questions regarding the release, or requested release, of records should contact the Special Victims Unit of the Pima County Attorney's office. E. Behavioral health service providers should not disclose facts regarding the allegations to the offender, victim, non-offending parent, caretakers or family members prior to the forensic investigation. Explain to the non-offending parent, caretaker or other family members that the facts of the alleged abuse should not be discussed until after the investigative interview is completed by law enforcement/ DCS. Behavioral health service providers should educate the parent/caretaker that the child may need to talk. Parent/caretakers should listen, be supportive of the child, and seek support from the treatment provider during this time. F. Behavioral health service providers involved in the treatment of various parties (i.e., victim, offender, non-offending parents and siblings) should collaborate with each other to support effective treatment. G. Behavioral health service providers should maintain appropriate boundaries in their work with the child and family members. 1. The victim should have a separate behavioral health service provider from the alleged offender. 2. The "no contact" rules between offender and victim should be followed consistently. 3. The victim's behavioral health service provider should not have direct contact with the alleged offender. Communication should be limited to communication between the victim's and the alleged offender's respective behavioral health service providers. 4. The victim's behavioral health service provider should familiarize her/himself with the Adult and Juvenile Probation Department's special conditions of probation for sex offenders. H. Behavioral health service providers should provide support to the child victim through the legal process, as appropriate. In cases where prosecution occurs, a Victim Services Advocate may be assigned. The role of the Advocate includes providing information about the criminal justice system and victim's rights; notification of court dates; visiting a courtroom with the victim; and being a support person during interviews, depositions, and/or court sessions. The behavioral health service provider should provide emotional support to the victim during this process in conjunction with the preparation done by the Victim Services Advocate. October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 29 I. The behavioral health service provider or other person required to report should be prepared to be called as a witness, although this will not always be necessary. This may be done by interview, deposition and/or appearance in court. These persons should be aware that there may be legal limitations regarding the content and scope of their testimony, and should contact the assigned County Attorney concerning any questions regarding requests for interviews, depositions or court appearances. V. Behavioral Health Information Sharing Disclosures may be made to law enforcement, DES and other authorities during the course of an investigation as required or permitted by law.

https://www.pcao.pima.gov/documents/2014_Child_Abuse_Protocol%20Final.pdf

Child Abuse Registry; Records

SB1118 - 441R - I Ver
Reference Title: child abuse registry; records
AN ACT
AMENDING SECTION 8-804, ARIZONA REVISED STATUTES; MAKING AN
APPROPRIATION; RELATING TO PROTECTIVE SERVICES.
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 8-804, Arizona Revised Statutes, is amended to read:
8-804 . Central registry; notification; removal of name
A. The department of economic security shall maintain a central registry of reports, investigations and
evaluations made under this article. The registry shall contain the information furnished by protective
services workers throughout the state. The department shall incorporate duplicate reports on the same
incident in the original report and shall not classify duplicate reports as new reports.
B. Except as provided in subsection C, reports shall be kept in the central registry until the child
concerned reaches the age of eighteen years.
C. The department shall purge identifying information annually from the central registry that
pertains to reports received by the department after June 30, 1987 if no subsequent reports have
been received by the department on that child, family or alleged abuser if any of the following is
true:
1. After an investigation the report has been found invalid and two years have passed since the
department received the report.
2. A report has not been investigated and five years have passed since the department received the
report.
3. After an investigation the report has been found undetermined and five years have passed since
the department received the report.
4. A referral has been made to the family builders pilot program and five years have passed since the
report was received by the department.
B. THE DEPARTMENT SHALL KEEP ALL SUBSTANTIATED REPORTS IN THE CENTRAL
REGISTRY FOR TWENTY-FIVE YEARS AFTER THE DATE OF THE REPORT. THE
DEPARTMENT SHALL PURGE ALL OTHER REPORTS AND THE RECORDS AND FILES
RELATED TO THESE REPORTS THREE YEARS AFTER THE DATE OF THE REPORT IF
THE DEPARTMENT HAS NOT RECEIVED A SUBSEQUENT REPORT ON THE CHILD,
FAMILY OR ALLEGED ABUSER.
C. A PERSON WHO IS THE SUBJECT OF A SUBSTANTIATED CHILD PROTECTIVE
SERVICES REPORT KEPT IN THE CENTRAL REGISTRY MAY REQUEST THE
DEPARTMENT TO PURGE THE REPORT THREE YEARS AFTER THE DATE OF THE
REPORT IF THE DEPARTMENT HAS NOT RECEIVED A SUBSEQUENT REPORT ON THE
CHILD, FAMILY OR ALLEGED ABUSER.
D. WITHIN THIRTY DAYS AFTER THE DEPARTMENT RECEIVES A REQUEST TO
PURGE A SUBSTANTIATED REPORT PURSUANT TO SUBSECTION C, THE
ADMINISTRATIVE OFFICE OF APPEALS SHALL REVIEW THE REQUEST, THE REPORT
AND ANY OTHER EVIDENCE PRESENTED BY THE REQUESTER TO DETERMINE IF
THERE ARE CIRCUMSTANCES THAT WARRANT REMOVAL OF THE REPORT FROM
THE CENTRAL REGISTRY INCLUDING:
1. INVESTIGATIVE FINDINGS CLASSIFIED AS MINOR OR POTENTIAL ABUSE.
2. THE AGE OF THE CHILD.
3. IF THERE WAS INTENT TO HARM THE CHILD.
4. A WRITTEN STATEMENT FROM A THERAPIST VERIFYING THAT THE PERSON
WHO IS THE SUBJECT OF THE REPORT PARTICIPATED IN SERVICES AND IS NO
LONGER A THREAT TO ANY MINOR PERSON.
E. ON COMPLETION OF THE REVIEW THE ADMINISTRATIVE LAW JUDGE SHALL
DETERMINE IF PROBABLE CAUSE EXISTS TO REMOVE THE REPORT FROM THE
CENTRAL REGISTRY. IF THE ADMINISTRATIVE LAW JUDGE FINDS THAT PROBABLE
CAUSE EXISTS, THE ADMINISTRATIVE LAW JUDGE SHALL ORDER THE
DEPARTMENT TO REMOVE THE REPORT FROM THE CENTRAL REGISTRY.
F. THE DEPARTMENT SHALL NOTIFY THE REQUESTER WHEN THE REPORT IS
REMOVED FROM THE CENTRAL REGISTRY.
D. G. Any person who was the subject of a child protective services investigation may request
confirmation that the department has purged information about the person in accordance with
subsection C PURSUANT TO SUBSECTION B . On receipt of this request , the department shall
provide the person with written confirmation that the department has no record containing identifying
information about that person , and, if available, the date that the department purged the identifying
information .
Sec. 2. Appropriation; purpose; exemption
A. The sum of $175,000 is appropriated from the state general fund to the department of economic
security in fiscal year 1999-2000 for the purpose of maintaining the central registry established by
section 8-804, Arizona Revised Statutes.
B. The appropriation made in subsection A of this section is exempt from the provisions of section 35-
190, Arizona Revised Statutes, relating to lapsing of appropriations.

Has your name been added to a child abuse list?
Note: In the U.S. if you’ve been investigated by CPS you’ve probably had your name added to a “child
abuse index” listing that will prevent you from holding certain types of jobs, even if you were innocent
of the charges. The person who wrote the posting I’m reprinting below is in Canada. I feel this is an
important issue for many of us and so I requested to move this posting from our message board to here
on the front page of the site. You can discuss this issue with the person who wrote the following by
using this link: Abuse Registry should be under Review. (forum registration required) – ljm
By ‘Frustrated':
Most of our names are put on Abuse Registry and we did not have any Criminal
Background or no Convictions. We didn’t even go to Court. No Criminal Charges.
And yet our names are on Abuse Registry? I assumed it was only for the Convicted who
were already tried in Criminal Courts. Boy was I wrong. It is typically ANYONE can be
put on Abuse Registry who had CPS Cases previously and who were founded, substanited,
or indicated.
Should it be under review and should be reformed?
Yes.
We should go to our Consitiuents, Congressmen, and Senators and write letters to them,
telling them of our stories and our names were put on Abuse Registry. And make them
change the Laws, to have the Abuse Registry ONLY for CONVICTED Criminals and
Convicted Abusers that were already declared guilty in Criminal Courts in the peers of their
jury.
Everyone should WRITE A LETTER explaining to Senators and Congressmen that this is a
Problem. An innocent, law abiding, voting Citizen with no Criminal Background was being
put on the Registry without due process????? Shocked.
Please everybody, write a letter to Senators and Congressmen pleading that this is unjust
(unjustice) on the public. We never gotten to see the Criminal Courts. Even my Criminal
Case was thrown out and dismissed and our names are still on there regardless of what CPS
say? Who is ABOVE THE LAW>? CPS?
This is an OUTRAGE! It is like putting a Judge on Abuse Registry. Is that even right? It is
like putting Paris Hilton on Abuse Registry just because of her DUI? It is like putting
putting a Priest on it, OH wait a minute, let’s rewind, they had court for supposed sexual
abuse. Never mind. How about Children? 15 or 16 who become a first time parent gets put
on Abuse Registry. They can’t even finish High School. Rolling Eyes
Come on Let’s be real. Registries as I assumed, same as Sex Offender Registries FOR
CONVICTED. Should be treated as the same…CONVICTED ABUSERS who have
already been tried in Criminal Courts and was declared Guilty of his peers of the jury.
Why put law abiding, normal parents who never saw the steps of the Courthouse being put
on it for?
Why are the Parents were not or never was criminally or formally charged for any crimes if
anything at all????
Let’s change its Laws and Reform it. If CPS wants private registry, they should keep it to
themselves, and not made to the Public. Just CPS for their own imaginary bogus made ups
cases.
Let’s bring Justice back and let’s do it right.

 Child Abuse Registry Info 

Parents with Mental Health Issues

I’m a parent and I have mental health problems and/or a personality disorder. Can a social worker take my children away? “Don’t ever let anyone tell you that your mental health challenges make you a weak person or a bad parent. Living and surviving and managing with all that stress and noise in your head requires strength, more strength than many other people will ever even have to find from within themselves. You are strong. Very strong indeed” Debbie, aged 35, living with her four children and with lifelong schizoaffective disorder Historically, there has been stigma and prejudice associated with parenting whilst living with a mental health challenge or personality difficulty. In the past, individuals who had or had been diagnosed with problems with their mental health were at unjustified risk of having their children taken from them. However, from the very beginning of disability rights legislation in the 1990s, mental health conditions have been recognised as disabilities. Therefore, people with mental health conditions have gained the right to protection from discrimination and parents with mental health conditions have gained the entitlement to support from Adult Services in their parenting role. Therefore, the courts should never allow a Social Worker to remove a child from a parent simply because the parent has mental health difficulties. Instead, Children’s Services would need to provide the court with evidence to demonstrate one or more of the following scenarios; The mental health difficulties of the parent are of such severity that the parent cannot safely look after their child, even with the supervision of family members and/or the support of professional agencies, and that the parent is likely to have these difficulties for the foreseeable future. For example, Katie is suffering from psychosis, holds the resulting belief that she needs to add bleach to her son Liam’s baby formula and does not appear to understand why giving Liam bleach is harmful to him. Children’s Services would need to prove to the court that there was nothing Katie’s husband Rob or any professional could reasonably do to prevent Katie from feeding Liam with bleach before the court would allow a Social Worker to take Liam into care. The parent is not engaging with the mental health treatment or social support necessary to enable them to safely look after their children. For example, single mother Shenaz is very depressed and struggling to keep the house clean, get her daughters Amira and Aisha dressed and ready for school and doesn’t want to take anti-depressants or have counselling and refuses to accept help from her ex or her sisters. Children’s Services would need to prove to the court that they had done everything possible to encourage Shenaz to accept help before the court would allow a Social Worker to place Amira and Aisha with their father or aunt. The mental health difficulties of the pregnant woman involve a lifestyle so chaotic, risky or unpredictable that it is reasonable to believe that the newborn baby would be exposed to an unacceptable level of risk. For example, Shannon is six months pregnant and constantly moving between squats comprised of people who grow and use cannabis, a substance which Shannon uses to self-medicate against the voices she hears. Children’s Services would need to prove to the court that Shannon would be highly likely to try and raise her as-yet-unborn child surrounded by drugs and drug users, and thus at extreme risk of cot death, abuse and neglect. Mental health advocacy services are experienced at helping parents to articulate and to explain to professionals their difficulties, and are skilled at helping parents to locate and request the help they need. Therefore, if a parent with current or historic mental health difficulties is able to explain and understand their difficulties and to explain the support they need, they should not find themselves in danger of losing their children. However, this advice can be problematic for people in the following situations I have a diagnosis of personality disorder. Can a social worker take my children away? You may also be interested in this post about personality disorder. Personality disorder is a contentious and disputed diagnosis, and one which can be used in different ways or mean different things to different professionals. Most people with a diagnosis of personality disorder have had difficulties for a long time, and most find that mental health services have not been able to help them. Therefore, people with diagnoses of personality disorder can find it difficult to access or engage with the sort of help they need. Professionals – including doctors and social workers – can sometimes find people with a diagnosis of personality disorder confusing or intimidating, and difficult to help. Many people with a diagnosis of personality disorder manage well as parents. However, some parents with diagnoses of personality disorder do need some help. Most people with a diagnosis of personality disorder have a history of childhood abuse or neglect, and some may therefore need guidance in understanding how to keep their own children safe and cared for. Many people with a diagnosis of personality disorder struggle to manage relationships and emotions, and some may therefore need support in responding to the behaviour of their children. Some people with a diagnosis of personality disorder cope with stress in self-destructive ways such as by self-harm, substance abuse, eating problems or sexual risk-taking, and these people may need help in ensuring that their children are not affected by their behaviour. It is this latter category – those parents who are harming themselves, and whose children are witnessing them harming themselves or whose unborn children are affected by them harming themselves – who are most likely to attract the concern of professionals. However, before allowing a Social Worker to remove a child from a parent with a personality disorder, the court must ensure that everything possible has been done to help and support the parent. In the past, personality disorders were regarded as ‘untreatable’ and some people with diagnoses of personality disorder may still be told they are ‘untreatable’: however, this attitude is now recognised as discriminatory and does not remove from statutory services the legal obligation to try and help. There is help and support available for people with diagnoses of personality disorder: treatments such as mentalisation-based therapy (MBT), dialectic behaviour therapy (DBT), cognitive analytic therapy (CAT) and therapeutic communities have been demonstrated as reasonably effective. Therefore, unless a person with a diagnosis of personality disorder is refusing all help, their Social Worker must do everything possible to find them the support they need before considering whether to take their children away. The medication I’ve been given means that I sleep so soundly I don’t wake up if the baby needs me in the night – and I’m a single parent. Can the Social Worker take my children away? Excessive sleepiness is a well-known side-effect of much psychotrophic medication, particularly the older antipsychotics. When prescribing, psychiatrists should be willing to take lifestyle factors such as the possible need for waking quickly into account – for most people, there will be alternative forms of medication to try. When a physically-disabled single parent needs support at night, Adult Services should provide and fund a carer or personal assistant. Parents who have a similar need due to medication should therefore have a similar entitlement. Therefore, the court would insist that Adult Services provide the help parent needs as an alternative to removing the children. In practice, however, single parents with both physical and mental health disabilities often have to work quite hard to access and secure funding for such levels of help. Advocacy services such as those run by Mind and Rethink can be very effective. I know I need therapy to be a good enough parent, but my Social Worker says the waiting lists mean that I won’t even get an assessment for another six months and that even then I mightn’t get any help because I’m too unwell or live too far away. Can the Social Worker take my children away? It can be very difficult for parents with mental health difficulties and personality disorder diagnoses to find and receive the support they need. Waiting lists often exceed the government’s 18 week target and parents can feel very frightened and isolated in the meantime, which may increase the level of risk of harm or neglect they pose to their children. However, Children’s Services should never consider removing children simply because of the difficulties in accessing help for the parent. The courts should ensure that this will not happen. National mental health charities and local advocacy groups can also be useful in helping parents to find the help they need within a reasonable time-frame – such organisations can often be more aware of available resources than social workers or psychiatrists. I know I could manage with the children if I had daily visits from a support worker, weekly counselling and 24/7 access to the Crisis Team. My Social Worker agrees, but says that there’s not enough funding within the system available to give me that much help. Can they take my children simply because it’s cheaper than giving me the help I need? This is a scenario which should never arise. However, given the current budget cuts within the public sector, all local authorities are under pressure to save money, if only in the short term. Ultimately, the courts make decisions based upon the best interests of the child rather than on the financial convenience of the professionals involved. It would therefore be very difficult for Children’s Services to persuade a court to allow Social Workers to remove children simply to avoid the expense of supporting a parent. Parents who are struggling to obtain the help they need often benefit from a good solicitor and the support of advocacy services. See for example, the advocacy services run by Mind and Rethink which can be very effective. I have problems other than with my mental health. Sometimes I fall over and wet myself due to seizures I have, but the Social Worker think it happens because I’m drunk even though the doctor I saw at A&E last year could tell it was a medical problem. Can the Social Worker take my children for being drunk, even though I don’t even drink? People who have mental health problems often find that any unexplained physical symptoms will be attributed to their mental health or behaviour: this is known as ‘diagnostic overshadowing’, and is very common. Furthermore, Children’s Services and the NHS do not always share information as effectively as necessary, and records and letters can be inaccurate, worsening the problem. The Patient Advice and Liaison Service (PALS) are generally very good at ensuring that doctors provide Social Workers with all the information they need. If Children’s Services were to make a court application on the basis of inaccurate information, the solicitor of the parent should successfully be able to highlight and challenge any errors. When I am most distressed, I can find it hard to talk to people or to explain what is wrong. I’ve tried to write things down, but I’m not very good at reading and writing and I don’t always understand what professionals say or write. This means that the Social Worker sometimes thinks that I’m not cooperating – can they take my children away? Many people who have both mental health problems and difficulties with communication or literacy find that the anxiety, stress and confusion associated with their mental health can make it especially hard to explain to professionals what is wrong and to understand what they are being told to do. All professionals – and especially Social Workers – should be trained in working with and communicating with people with range of needs and difficulties. However, advocacy services can be helpful, especially when parents have additional learning difficulties. The Social Worker told me that she ‘doesn’t believe in people with schizophrenia being allowed to be parents’. Can she take my children away? As explained above, this opinion is discriminatory, and to act on it would be illegal. Social workers and other professionals may believe in many things and may hold a range of personal opinions. However, the law does not give professionals the authority to act on the basis of their individual views. Before a Social Worker is able to apply to the court for the removal of children, both the Social Worker and his/her manager will need to agree that the children should be removed, and the solicitor employed by the local authority will need to agree that there is a reasonable chance that the court will agree with them. No local authority solicitor would advise Children’s Services to initiate court action based simply upon such views expressed by one individual Social Worker. I’ve read some things online about Social Workers. I now realise that Children’s Services have hidden a camera in my daughter’s teddy, and I know that the way the Social Worker dyed her hair last week means that they’re going to take my daughter. Is this true? Certainly, there are some frightening things written online. Many of these appear to have been written by people who suffer the unusual or scary thoughts often associated with diagnoses of paranoia, some personality disorders or psychosis. If a parent is frightened by their thoughts or beliefs, and if the parent is finding it hard to get these thoughts or beliefs out of their head, he or she may be experiencing a deterioration of their mental health. Parents with a diagnosis of schizophrenia, bipolar disorder or personality disorder sometimes hear persecuting voices that others cannot hear, and these voices can include those of authority figures such as Social Workers and psychiatrists. Looking after children whilst experiencing such intense distress would be hard for any parent with or without mental health difficulties. The best thing a parent can do in this situation is therefore just to ask for help from a mental health professional or a trusted friend. I know that I need help in looking after my children and my partner does help – he’s a great dad and does everything for them. However, he beats me regularly and I’m scared to tell anyone because I know he’ll convince them that it’s just my mental health making me imagine the beatings… even if I do leave, I know he’d get full custody of the children and ban me from seeing them because I know I couldn’t look after them on my own. If I ask for help, can a Social Worker take my children away? This is probably one of the most difficult scenario for a parent with a mental health problem or personality disorder diagnosis. The Women’s Aid website provides some thoughtful and realistic advice here. Parents who find themselves in this very vulnerable position would do best to approach Children’s Services and mental health support via the support of an independent domestic violence advocate, who will help the Social Worker to understand what is happening and what will help. Some women’s refuges have intensive support available to mothers with specific mental health needs, and some refuges can allow women to stay for up to five years. However, the mother will need legal advice and representation to protect themselves from their abusive ex-partner, which is currently available free of charge to all domestic violence victims through legal aid. You might also find it helpful to visit our section on domestic violence and abuse. I’m on my own with the children all week and I’m hearing voices telling me to kill myself and I’m having thoughts of doing frightening things. I want to phone 999 and ask for help – but will a Social Worker come and take the children away? If the suicidal or severely distressed parent has no adult family members or friends around to help, it is possible that the children may be taken into temporary local authority care in order for the parent to receive the urgent help that s/he needs. Children’s Services should make a priority of initiating any longer-term support necessary to support the parent to care for children in the future. Therefore, the parent should never be afraid of asking for help in a crisis or emergency. PLEASE if you are feeling suicidal and you haven’t got anyone else you want to talk to, call the Samaritans. http://childprotectionresource.online/reporting-post-natal-depression/

What is early-onset Bipolar Disorder?

Bipolar Disorder is a serious mental illness characterized by recurrent episodes of depression, mania, and/or mixed symptom states. These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning. Manic symptoms include: Severe changes in mood - either extremely irritable or overly silly and elated Overly-inflated self-esteem; grandiosity Increased energy Decreased need for sleep - able to go with very little or no sleep for days without tiring Increased talking - talks too much, too fast; changes topics too quickly; cannot be interrupted Distractibility - attention moves constantly from one thing to the next Hypersexuality - increased sexual thoughts, feelings, or behaviors; use of explicit sexual language Increased goal-directed activity of physical agitation Disregard of risk - excessive involvement in risky behaviors or activities. Depressive symptoms include: Persistent sad or irritable mood Loss of interest in activities once enjoyed Significant change in appetite or body weight Difficulty sleeping or oversleeping Physical agitation or slowing Loss of energy Feelings of worthlessness or inappropriate guilt Difficulty concentrating Recurrent thoughts of death or suicide Symptoms of mania and depression in children and adolescents may manifest themselves through a variety of different behaviors. When manic, children and adolescents, in contrast to adults, are more likely to be irritable or prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, muscle aches, stomachaches or tiredness, frequent absences from school or poor performance in school, talk of or efforts to run away from home, irritability, complaining, unexplained crying, social isolation, poor communication, and extreme sensitivity to rejection or failure. Other manifestations of manic and depressive states may include alcohol or substance abuse and difficulty with relationships. Existing evidence indicates that Bipolar Disorder beginning in childhood or early adolescence may be a different, possibly more severe, form of the illness than older adolescent- and adult-onset Bipolar Disorder. When the illness begins before or soon after puberty, it is often characterized by a continuous, rapid-cycling, irritable, and mixed symptom state that may co-occur with disruptive behavior disorders, particularly attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD), or may have features of these disorders as initial symptoms. In contrast, later adolescent- or adult-onset Bipolar Disorder tends to begin suddenly, often with a classic manic episode, and to have a more episodic pattern with relatively stable periods between episodes. There is also less co-occurring with ADHD or CD among those with later onset illness. A child or adolescent who appears to be depressed or exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in Bipolar Disorder, particularly if there is a family history of the illness. This evaluation is especially important since psychostimulant medications, often prescribed for ADHD, may worsen manic symptoms. There is also limited evidence suggesting that some of the symptoms of ADHD may be a forerunner of full-blown mania. Findings from an NIMH-supported study suggest that the illness may be at least as common among youths as among adults. In this study, one percent of adolescents ages 14-18 were found to have met criteria for Bipolar Disorder or cyclothymia, a similar but milder illness, in their lifetime. In addition, close to six percent of adolescents in the study had experienced a distinct period of abnormally and persistently elevated, expansive, or irritable mood even though they never met full criteria for Bipolar Disorder or cyclothymia. Compared to adolescents with a history of major depressive disorder and to a never-mentally-ill group, both the teens with Bipolar Disorder and those with subclinical symptoms had greater functional impairment and higher rates of co-occurring illnesses (especially anxiety and disruptive behavior disorders), suicide attempts, and mental health services utilization. The study highlights the need for improved recognition, treatment, and prevention of even the milder and subclinical cases of Bipolar Disorder in adolescence. Bipolar Disorder in Children and Teens Does your child go through intense mood changes? Does your child have extreme behavior changes? Does your child get much more excited and active than other kids his or her age? Do other people say your child is too excited or too moody? Do you notice he or she has highs and lows much more often than other children? Do these mood changes affect how your child acts at school or at home? Some children and teens with these symptoms may have bipolar disorder, a serious mental illness. This brochure will give you more information. What is bipolar disorder? Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or manic depression. Children with bipolar disorder go through unusual mood changes. Sometimes they feel very happy or “up,” and are much more energetic and active than usual, or than other kids their age. This is called a manic episode. Sometimes children with bipolar disorder feel very sad and “down,” and are much less active than usual. This is called depression or a depressive episode. Bipolar disorder is not the same as the normal ups and downs every kid goes through. Bipolar symptoms are more powerful than that. The mood swings are more extreme and are accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms are so strong, they can make it hard for a child to do well in school or get along with friends and family members. The illness can also be dangerous. Some young people with bipolar disorder try to hurt themselves or attempt suicide. Children and teens with bipolar disorder should get treatment. With help, they can manage their symptoms and lead successful lives. Who develops bipolar disorder? Anyone can develop bipolar disorder, including children and teens. However, most people with bipolar disorder develop it in their late teen or early adult years. The illness usually lasts a lifetime. Why does someone develop bipolar disorder? Doctors do not know what causes bipolar disorder, but several things may contribute to the illness. Family genes may be one factor because bipolar disorder sometimes runs in families. However, it is important to know that just because someone in your family has bipolar disorder, it does not mean other members of the family will have it as well. Another factor that may lead to bipolar disorder is the brain structure or the brain function of the person with the disorder. Scientists are finding out more about the disorder by studying it. This research may help doctors do a better job of treating people. Also, this research may help doctors to predict whether a person will get bipolar disorder. One day, doctors may be able to prevent the illness in some people. What are the symptoms of bipolar disorder? Bipolar “mood episodes” include unusual mood changes along with unusual sleep habits, activity levels, thoughts, or behavior. In a child, these mood and activity changes must be very different from their usual behavior and from the behavior of other children. A person with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Children and teens having a manic episode may: Feel very happy or act silly in a way that’s unusual for them and for other people their age Have a very short temper Talk really fast about a lot of different things Have trouble sleeping but not feel tired Have trouble staying focused Talk and think about sex more often Do risky things Children and teens having a depressive episode may: Feel very sad Complain about pain a lot, such as stomachaches and headaches Sleep too little or too much Feel guilty and worthless Eat too little or too much Have little energy and no interest in fun activities Think about death or suicide Can children and teens with bipolar disorder have other problems? Young people with bipolar disorder can have several problems at the same time. These include: Substance abuse. Both adults and kids with bipolar disorder are at risk of drinking or taking drugs. Attention deficit/hyperactivity disorder (ADHD). Children who have both bipolar disorder and ADHD may have trouble staying focused. Anxiety disorders, like separation anxiety. Sometimes behavior problems go along with mood episodes. Young people may take a lot of risks, such as driving too fast or spending too much money. Some young people with bipolar disorder think about suicide. Watch for any signs of suicidal thinking. Take these signs seriously and call your child’s doctor. How is bipolar disorder diagnosed? An experienced doctor will carefully examine your child. There are no blood tests or brain scans that can diagnose bipolar disorder. Instead, the doctor will ask questions about your child’s mood and sleeping patterns. The doctor will also ask about your child’s energy and behavior. Sometimes doctors need to know about medical problems in your family, such as depression or alcoholism. The doctor may use tests to see if something other than bipolar disorder is causing your child’s symptoms. How is bipolar disorder treated? Right now, there is no cure for bipolar disorder. Doctors often treat children who have the illness in much the same way they treat adults. Treatment can help control symptoms. Steady, dependable treatment works better than treatment that starts and stops. Treatment options include: Medication. There are several types of medication that can help. Children respond to medications in different ways, so the right type of medication depends on the child. Some children may need more than one type of medication because their symptoms are so complex. Sometimes they need to try different types of medicine to see which are best for them. Children should take the fewest number of medications and the smallest doses possible to help their symptoms. A good way to remember this is “start low, go slow.” Medications can cause side effects. Always tell your child’s doctor about any problems with side effects. Do not stop giving your child medication without a doctor’s help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse. Therapy. Different kinds of psychotherapy, or “talk” therapy, can help children with bipolar disorder. Therapy can help children change their behavior and manage their routines. It can also help young people get along better with family and friends. Sometimes therapy includes family members. What can children and teens expect from treatment? With treatment, children and teens with bipolar disorder can get better over time. It helps when doctors, parents, and young people work together. Sometimes a child’s bipolar disorder changes. When this happens, treatment needs to change too. For example, your child may need to try a different medication. The doctor may also recommend other treatment changes. Symptoms may come back after a while, and more adjustments may be needed. Treatment can take time, but sticking with it helps many children and teens have fewer bipolar symptoms. You can help treatment be more effective. Try keeping a chart of your child’s moods, behaviors, and sleep patterns. This is called a “daily life chart” or “mood chart.” It can help you and your child understand and track the illness. A chart can also help the doctor see whether treatment is working. How can I help my child or teen? Help begins with the right diagnosis and treatment. If you think your child may have bipolar disorder, make an appointment with your family doctor to talk about the symptoms you notice. If your child has bipolar disorder, here are some basic things you can do: Be patient. Encourage your child to talk, and listen to your child carefully. Be understanding about mood episodes. Help your child have fun. Help your child understand that treatment can make life better. How does bipolar disorder affect parents and family? Taking care of a child or teenager with bipolar disorder can be stressful for you, too. You have to cope with the mood swings and other problems, such as short tempers and risky activities. This can challenge any parent. Sometimes the stress can strain your relationships with other people, and you may miss work or lose free time. If you are taking care of a child with bipolar disorder, take care of yourself too. Find someone you can talk to about your feelings. Talk with the doctor about support groups for caregivers. If you keep your stress level down, you will do a better job. It might help your child get better too. Where do I go for help? If you’re not sure where to get help, call your family doctor. You can also check the phone book for mental health professionals. Hospital doctors can help in an emergency. Finally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area. You can find it here: https://findtreatment.samhsa.gov . I know someone who is in crisis. What do I do? If you know someone who might be thinking about hurting himself or herself or someone else, get help quickly. Do not leave the person alone. Call your doctor. Call 911 or go to the emergency room. Call National Suicide Prevention Lifeline, toll-free: 1-800-273-TALK (8255). The TTY number is 1-800-799-4TTY (4889). For more information on conditions that affect mental health, resources, and research, go to MentalHealth.gov at http://www.mentalhealth.gov , or the NIMH website at http://www.nimh.nih.gov. In addition, the National Library of Medicine’s MedlinePlus service has information on a wide variety of health topics, including conditions that affect mental health. National Institute of Mental Health Office of Science Policy, Planning, and Communications Science Writing, Press, and Dissemination Branch 6001 Executive Boulevard Room 6200, MSC 9663 Bethesda, MD 20892-9663 Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free TTY: 301-443-8431 or 1-866-415-8051 toll-free Fax: 301-443-4279 Email: nimhinfo@nih.gov Website: http://www.nimh.nih.gov U.S. Department of Health and Human Services National Institutes of Health National Institute of Mental Health NIH Publication No. QF 15-6380 Revised 2015 http://www.ryanlichtsangbipolarfoundation.org/site/c.ltJZJ8MMIsE/b.2107349/k.4471/What_is_earlyonset_Bipolar_Disorder.htm

What Every Parent Should Know Network

 What Every Parent Should Know Network 

Is your teen a narcissist?

Is Your Teen a Narcissist? Learn the Warning Signs and Treatment Options
Jul 13, 2014 | Terri DiMatteo | 17 Comments

Is your teen unhappy, lacking in close friends and totally self obsessed? Is this a normal developmental stage of adolescence or do these symptoms indicate narcissistic personality disorder (NPD)? How can you tell the difference?

Firstly, don’t panic! Many teens seem totally self obsessed at some stage and most simply grow-out of their behaviors. As time passes and teens mature – and as responsibilities increase – you may notice that the worrisome behaviors diminish. Perhaps you will observe the formation of healthy interpersonal relationships and behaviors which demonstrate increased awareness, empathy and compassion.

    In effect, these egotistical adolescent ‘narcissistic’ indicators may merely represent a developmental stage in a teen’s personal growth and maturity – and nothing more.

It should be pointed out that – contrary to popular notion -- those with NPD actually do not love and adore themselves excessively rather they are void of self-love and self-worth and can be dangerous to both themselves and others.

NPD is much darker:

    Those diagnosed with NPD often suffer depression, have thoughts of suicide, and exhibit a pattern of repeated failed interpersonal relationships. A swirl of trouble and high conflict at work and at school constantly surrounds them. 

Diagnosing Narcissist Personality Disorder

The DSM-IV-TR defines narcissistic personality disorder as:

    “An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation, and lack of empathy, usually beginning by early adulthood and present in various contexts.”1

A list of traits associated with NPD are listed below. In order for an individual to be diagnosed as NPD at least five (5) of the traits identified must be present.

    Is assuredly convinced that he or she is special, unique and can only interact and associate with other special, uniquely qualified or high-status people (or institutions).
    Insists on being treated with excessive adulation, admiration, attention and  affirmation.  Or, if not, then desires instead to be feared and viewed as infamous or notorious.
    Demonstrates a sense of grandiosity and self-importance (e.g., grossly exaggerates skills, accomplishments, talents, connections and personality traits to the point of lying; demands to be recognized as superior without demonstrating actual achievement to support the claim.)
    Exploits personal relationships focusing only on his or her own goals at the expense of others. 
    Demonstrates characteristics of at least one of the two narcissistic types: 'The Cerebral Narcissist' is driven with fantasies of boundless success, notoriety, tremendous power or omnipotence and incomparable brilliance. 'The Somatic Narcissist' is obsessed with his or her bodily beauty or sexual performance or ideal, everlasting, all-conquering love or passion.
    Believes he or she is “above the law” and all knowing (omnipresent). Behaves in a superior, invincible, immune way, and when questioned or frustrated by people he or she views as either inferior or unworthy – rages.
    The individual presents as arrogant and haughty, possessing a strong sense of entitlement and demanding full and unquestionable compliance with his or her unreasonable expectations for special favor and exemplary treatment.
    Possesses a severe lack of empathy. Cannot accept - or even acknowledge - the  needs, feelings, desires, choices, preferences or priorities of another.
    Demonstrates continuous examples of envy and jealously. Sets out to hurt and demolish the source of his or her frustration. Experiences paranoid delusions believing that others feel identically about him or her and will act in the same manner toward them.

To further determine whether or not an adolescent suffers NPD, consider these developmental and environmental factors, which are thought to contribute to NPD:

    Unreliable or unpredictable caregiving from parents
    Experiences in childhood, such as loss of a father figure
    Suffers severe childhood emotional abuse
    Excessively condescending or critical environment - Is overindulged and over-praised by her parents
    Possesses an oversensitive temperament from birth
    Learned manipulative behaviors as a way to get what she wanted

Note that chronic insomnia, over-work, ongoing exposure to high levels of stress, substance abuse, medical problems, and difficulties with family or other interpersonal relationships can exacerbate the symptoms of a personality disorder.
Treating Teen Narcissistic Personality Disorder

As teens are generally in a fragile mental state it makes it especially difficult to treat teens who suffer narcissistic personality disorder. Treatment attempts are often met with disdain making it impossible to develop the proper and necessary therapeutic therapist-client alliance. The teen’s own self-perception often interferes with this essential process.

    A therapeutic objective is to teach the teenager to value him or herself on a more realistic level and to adjust one's thinking about others' value in relation to his or her own. Exercises designed to assist the teen in developing empathy for others would be an aspect of treatment of this personality disorder.
    In general, medication is not part of the treatment plan, except in those cases where depression and anxiety emerge as the teen struggles to cope with his or her new reality of self.
    Group therapy (such as Dialectical Behavioral Therapy), somatic experiencing, anger management, sleep management, psycho-education and individual psychotherapies can help.
    Neuro-feedback techniques can also be utilized in conjunction with the other therapies.
    Holistic remedies such as yoga, meditation, acupuncture and massage therapy can support and enhance treatment and healing.
    Family therapy groups that incorporate family members and significant others into the therapeutic treatment plan are advantageous.

This combination of treatments can show good result in dealing with personality disorders.
Factors That Slow Recovery

Keep in mind, though, that:

    Narcissists rarely enter treatment and when they do they often view it as a ‘waste of time’. Depression – as well as substance abuse, specifically alcohol, marijuana or cocaine -- are prevalent among persons with this disorder and negatively impact psychological and medical treatment.
    Individuals with NPD typically have interpersonal problems with family, loved ones, classmates and co-workers – therefore, their impaired social support structure adds another layer of difficulty regarding their entrance into and continuation of treatment.
    NPD’s who are excessively impulsive or self-destructive will require more intensive therapy and resolution will come at a slower pace.

Friends and Family Can Accelerate Treatment

It may be very difficult and challenging for friends, family and loved ones to help and support because persons with NPD have great difficulties with interpersonal relationships.

    Family and friends can help by educating themselves about NPD in order to interact emphatically and with compassion for the person who has NPD.
    Family and friends are an indispensable resource when it comes to monitoring symptoms and watching for dangerous maladaptive behaviors.
    There are some treatment centers that specialize in working with individuals with NPD and friends and family can provide emotional support and financial resources.

The Prognosis

    NPD is generally a chronic life-long disturbance with periods of remission and exacerbation (worsening) dependent on changing life circumstances.
    Psychotherapy over time, coupled with sleep and stress management, and psycho-education, can address related problems.
    When a person with NPD develops depression or substance abuse, treatment becomes imperative.
    Clients who do receive effective treatment will experience significant improvement in their ability to function normally in their daily lives, with improvement in their interpersonal relationships.

References

    American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.

Terri DiMatteo Terri DiMatteo
Licensed Professional Counselor
Counselor/Therapist
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Drug Testing For CPS

1923 Testing for Substance Abuse
1923.1 Detection Periods for Substance Abuse

CPS June 2010

For detection periods, see Appendix 1922.1: Detection Periods for Abused Substances.
1923.2 Diluted Samples Obtained During Testing

CPS June 2010

A diluted sample indicates that a client drank a large amount of water at some time before the drug test.

When the lab indicates that a sample is diluted, the caseworker can take one the following actions to arrive at a conclusion about the client's use:

  •  Have the client retested

  •  Request a different type of testing, such as requesting a hair follicle test instead of a urine test

  •  Rely on credible evidence obtained through observation, information from collateral sources (such as a teacher, neighbor, or family doctor), and the case history
1923.3 Instant (Swab) Tests and Court Hearings

CPS June 2010

An instant test is a swabbing of a client's oral fluids. The test is performed by a caseworker to test for recent drug use. If possible, the test results are confirmed by a laboratory.

Using the Tests in Court

Before presenting the results of instant swab tests as evidence in court, the caseworker must obtain confirmation from a laboratory.
1923.4 Using Acceptable Contractors to Obtain Test Results

CPS June 2010

DFPS accepts lab test results from physicians, hospitals, the legal system (such as the adult probation department), and providers of substance abuse treatment in order to assess safety and to assess the need for services and treatment.
1923.5 Frequency of Random Substance Abuse Testing

CPS June 2010

In general, the caseworker may conduct random drug tests when substance abuse laboratory testing is allowed under 1920 Substance Abuse Testing; that is, when:

  •  a case is scheduled for closure;

  •  reunification of the child with his or her family is contemplated;

  •  there are changes in the parent's appearance, behavior, or affect;

  •  new information is received about possible substance abuse;

  •  the client has terminated substance abuse treatment;

  •  the client shows signs of returning to seeking and using drugs, including  associating with former friends and family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol;

  •  the client refuses to create a relapse safety plan (see 1966 Developing a Safety Plan in Case a Client Relapses);

  •  the client minimizes or denies seeking and using drugs seeking and after test results come back positive;

  •  there are signs that abstinence is being threatened; for example, when a client increases the amount of alcohol consumed or begins to smoke cigarettes frequently to relieve anxiety;

  •  the client has made minimal or no effort to mitigate the substance abuse related problems that led to abuse and neglect;

  •  the client is not involved in substance abuse treatment or aftercare, even though it was recommended; and

  •  the regional substance abuse specialist recommends testing.

Hair Follicle Testing

The caseworker determines the frequency with which random hair follicle testing may be conducted, by following regional protocols.
1923.6 Situations Not Appropriate for Drug Testing

CPS June 2010

It is not appropriate for a caseworker to arrange for drug testing when a parent is:

  •  actively involved in substance abuse treatment and the treatment provider conducts random testing that is based on laboratory confirmation.

  •  randomly tested by another entity, such as a probation department or drug court, and the test is confirmed by a laboratory. The caseworker must check into the frequency of testing by the other entity, before random testing is discontinued by CPS.
1923.7 Discontinuing Drug Testing

CPS June 2010

The caseworker must discuss with the supervisor and the client's treatment provider when contemplating discontinuing routine drug testing.

The discontinuation or modification of routine drug testing may be considered when:

  •  A parent does not exhibit substance seeking and using behaviors (for example, when associating with former friends or family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol); and

  •  The parent has a consistent pattern of negative tests results.
1923.8 Assessing Test Results or Accepting an Admission

CPS June 2010

Positive Result

The caseworker must assess a positive drug test result in relationship to the child's safety and risk. The result must be discussed with the parent in a timely manner.

If a parent with a positive drug result is not engaged in substance abuse treatment and is actively parenting a child, the caseworker refers the parent to:

  •  a provider of outreach, screening, assessment, and referral (OSAR) services or

  •  a provider of substance abuse treatment.

The threshold that makes a referral appropriate is based on the definition of a child not being safe. That is, a child is not safe when:

  •  threats or dangers exist in the family that are related to substance use;

  •  the child is vulnerable to such threats; and

  •  the parent who is using substances does not have sufficient protective capacities to manage or control threats.

Client Admission

A client's verbal or written admission is accepted as a positive result of drug use; however good casework practice calls for getting the client to sign a statement of use.

Testing to Rule Out Under-Reporting

If a client admits to drug use, is not engaged in treatment, and is actively parenting children, the caseworker may consider referring the client to a substance abuse provider for screening, assessment, or treatment.

Referral may be necessary because clients sometimes under-report drug use or do not admit to all of the substances that they have used.

Clients likewise may under-report:

  •  the frequency with which they use dugs,

  •  the quantity of drugs they use, and

  •  the amount of money they spend on the drugs.

Negative Result

When the result of a parent's drug test is negative, the caseworker:

  •  notifies the parent about the result in a timely manner; and

  •  encourages the parent's abstinence and provides positive feedback.

Refusal to Test

When testing is appropriate under 1920 Substance Abuse Testing, but the client refuses to take a drug test, the caseworker must document the refusal to be tested.

If a parent refuses to take a drug test or refuses to allow a child who is an alleged perpetrator to be tested, the caseworker consults with the supervisor in a staffing meeting. The supervisor may recommend legal intervention, if the evidence raises concern for the child's safety.

For cases under court jurisdiction, the caseworker must notify the judge and attorneys about the client's refusal to test.
1923.9 Documenting Prescribed Medicine Before Offering Drug Testing

CPS June 2010

When testing is appropriate under 1920 Substance Abuse Testing, the caseworker must document any prescribed medication that the client is taking.

The documentation may be made by:

  •  completing a regional form; or

  •  entering the details in the Contact Narrative in the IMPACT system.

The caseworker must share the information about the client's medication with the lab's medical review officer (MRO).
1924 Special Situations Related to Substance Abuse
1924.1 Methadone and Prescription Medication

CPS June 2010

Methadone

If the parent tests positive for methadone, the caseworker:

  •  obtains a release (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services) from the parent;

  •  verifies with the methadone clinic, that the parent has a prescription for methadone and is taking methadone as prescribed; and

  •  assesses the effect that the methadone dosage has on the parent's ability to provide consistent and safe supervision of the children.

Prescription Medicine

Similar to methadone, the caseworker must assess the effect that prescription medications have on a parent's ability to provide supervision and to keep children safe.

To determine whether the client is taking his or her medication as prescribed, the caseworker must check with the client's medical provider.

For the caseworker to obtain the information from the medical provider, the client needs to sign a consent-to-release form (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services).

If the client refuses to sign the release form, the caseworker consults with the supervisor about whether to request legal intervention.
1924.2 The Infectious Client

CPS June 2010

If the caseworker is concerned that a client may have an infectious disease, the caseworker, with the supervisor's approval, refers the client to a local drug-testing facility for a urine test in lieu of an oral test.

Testing Within 48 Hours

The client must be tested within 48 hours after the contact with the caseworker.
1924.3 Drug Use During a Parent-Child Visit or FGDM Conference

CPS June 2010

A court order supersedes the following DFPS policies.

Parent-Child Visit

If a parent appears to be under the influence of a controlled substance and or alcohol, the parent-child visit must not occur.

Family Group Decision Making (FGDM) Conferences

A parent or participant who is visibly intoxicated during a family group decision making (FGDM) conference, must be excused from the conference.

The caseworker does not administer an oral test during the FGDM conference. Any required testing occurs at the end of the meeting and preferably at a location away from the FGDM immediate site.

For policy on the testing of youth, see 1951 Children and Adolescents Who Smoke Marijuana, Use Other Drugs, or Drink Alcohol.

The existence of a positive drug result in the case record does not automatically exclude a parent from visiting with the child or attending a FGDM. The caseworker needs to weigh the benefits of the visit or attendance when confronted with a positive drug reading in the case record.

If the child will not be in danger, the visit or participation may be allowed.
1924.4 The Court Testimony of the Medical Review Officer

CPS June 2010

Because of the high costs, testimony provided by technicians, medical review officers (MRO), or other personnel employed by drug testing facilities is reserved for extreme circumstances; for example, parental termination hearings in substitute care cases when a judge requires testimony in person.

Alternatives to consider before requesting court room testimony from a representative of a drug testing laboratory include:

  •  depositions at locations near the drug testing laboratory; and

  •  testimony provided via teleconference.

If DFPS concludes that court room testimony is necessary from a representative of a drug testing laboratory, the DFPS region requiring the testimony:

  •  negotiates payment rates;

  •  negotiates travel expenses;

  •  renders payment for court-related services; and

  •  renders payment for testimony provided by a representative of a drug-testing laboratory.



https://www.dfps.state.tx.us/handbooks/CPS/Files/CPS_pg_1923.asp