Tuesday, May 17, 2016

Get Off the Sidewalk

So many times in our lives we are told to appreciate what we have and to be grateful and while that is somewhat true, it is important to understand that unhappiness exists for a reason.

If we encountered a fish lying peacefully on the ground while suffocating, we would know there was something desperately wrong with that picture. Fish need water. A fish without water should not be content.

Over the past few months I have learned that you can appreciate what you have while aching for what is still missing. The fish can appreciate being alive while understanding that without water it will soon die. We can be grateful for a place to sleep while knowing that if we do not eat we will starve to death. We can be grateful for snow and understand that we need clothing to keep us warm while enjoying it's presence. The presence of one does not negate the absence of the other.

Don't spend your time trying to make yourself feel happy about a situation that deep down you know isn't right. Maybe you aren't supposed to be happy with it. Maybe you are supposed to be doing something different. Maybe you are the fish lying on a sidewalk, it is time to get off.

Monday, May 09, 2016

Monsters Aren't Suddenly Sneaking Into Bathrooms

It seems everyone is in a tizzy these days over bathroom safty. Many are telling everyone to chill out, but I have to disagree. We do not need to chill out about bathroom safety, predators, or protecting children. What we absolutely must do is open our eyes to the real danger.

The danger does not lie with the transgender person just trying to use the bathroom...for the most part, sexual abuse isn't happening in a public restroom at all.

Statistics are very clear...It is heterosexual males who are the primary predators; and it isnt happening is some random place...

It is happening in your home.

It is happening at your child's friend's house.

It is happening at school or church in the hands of someone you trust.

The real danger is not an unknown monster trying to sneak into a bathroom...

They are the male neighbor who is always so helpful with your little ones.

They are the teacher who keeps them after school.

They are the favorite uncle.

They are the older cousin who always wants to play hide and seek.

They are family.

They are friends.

They are people you see everyday. People who have earned your trust.

I say that as a victim. I say that as a mama to many victims over the years. Predators exist in your trust and thrive on your ability to be misdirected. 

While you are busy hunting down the transgender person trying to use the restroom you are missing the real monsters hiding in plain sight.

I'm begging you to stop, not just because I call many in the LGBTQ+ community friends; but because I have been the one who's innocence was lost while people were monster hunting.

See Me

I watched an episode of Grey's Anatomy once that stays in my mind. There was this guy in ICU. When they brought in his wife and she saw his condition, she froze. The man she was looking at was nothing like the man she knew as her husband.

The doctor looks at her and says, "I know all you see now is damage and machines, but he's still there."


The Dr. said exactly what I most times want to scream! I know when you look at me, all you see is damage, but I'm still here. I'm still here. I am the same one who once made you laugh and smile. I am the one who organizes her food before she eats it and startles when you walk into a room. I am the one who writes sad stories but is always hopeful. I am the dreamer, the lover, the compassionate one who cries over hairless dogs and people I'll never meet. I am here.

Jessica Lynn 

Sunday, May 01, 2016

Minority Victims of Placement Instability in the Foster Care System

Minority Victims of Placement Instability in the Child Welfare System
          Placement instability transcends culture, country, and systems of care with the only consistent mitigating factor being race (Tregeagle & Hamill, 2011). Foster, Hillemeier, and Bai (2011) found that black children represented 34% of the children in the foster care system despite the fact that they represent only 15% of the general population though the reasons are not entirely known. Not only are Black children over represented in the foster care population, they are moved more frequently than their White counterparts irrespective of any other factors (Foster et al., 2011). The foster care system is well known to fail the children that it serves, further exacerbating the fact that the Black children who are overrepresented pay more than other groups of children.
The Disparity of the Numbers of Minority Children in Foster Care
          The Child Welfare Information Gateway (2015) gives an overview of the children in foster care in 2013 produced from information taken from the Adoption and Foster Care Analysis and Reporting System (AFCARS). While only 5.91% of children in the United States ever enter the foster care system, statistics show that of the over four hundred thousand children in foster care, Black and Native American children are at a higher risk of placement than their white counterparts at 11.53% and 15.44% respectively (Wildeman & Emanuel, 2014). Overall, 57% of children in the foster care system are children of color (Bell, 2007).
          Children in the foster care system fair significantly worse than children who remain out of the system, with Black males showing the most disastrous effects of a failing system: 54% experience significant mental health issues, 55% are likely to drop out of high school, only 3% actually graduate from college, and 28% reported being arrested before the age of 21 (Bell, 2007).
            Data from the National Child Abuse and Neglect Data System (NCANDS) and Adoption and Foster Care Analysis and Reporting System (AFCARS) was analyzed to determine the disproportionality of the decision-making and outcomes between whites, Hispanics, blacks, Asian Americans/native Hawaiians and Pacific Islanders, and American Indians/Native Americans/Alaskan Natives (Hill, 2007).  The average amount of time in foster care overall is 13.5 months, but children of color typically spend more time and have three or more placement changes compared to their white counterparts (Child Welfare Information Gateway, 2015). Hill (2007) found that there was little difference between the county, state, and national levels when it came to racial and ethnic disproportionality with the exception of Hispanics on the state and county level where they are twice as likely as other groups to be placed into foster care though they were less likely to be investigated or substantiated. Further research found that this disparity is likely due to illegal immigration and parents being returned home or the child being sent here as a minor (Austin, 2006).
          The disparity in statistics related to race does not end with foster care placement but carry over into the exit from foster care. Only 51% of the children who exited foster care in 2013 were reunited with their parents or primary caretaker, the rest were either adopted (21%), emancipated (10%), sent to live with another relative (8%), sent to live with a non-related guardian (7%), or other outcomes such as being transferred to another agency, running away, or death (2%) (Child Welfare Information Gateway, 2015).
Foster care statistics verses the general population for both black and white
          There are some studies that suggest that there are more Black children in the foster care system because there is a higher prevalence of abuse and neglect within the black community though there are other studies that state that black families are targeted more than white families so they appear to have higher rates of abuse and neglect (Foster et al., 2011).
            Data collected from the National Survey of Child and Adolescent Well Being (NSCAW) found that children of different races were treated very differently resulting in different outcomes and attributes those differences to racial bias of child welfare personnel (Foster et al., 2011). Another stunning finding by Foster et al. is that the Adoption and Safe Families Act of 1997 (ASFA) that set expedited time limits on terminating parental rights and finding permanency for children in foster care has actually caused a great deal of harm to black families. Unfortunately, it is well known that statistically black people are more likely to be arrested, convicted, and spend time in jail than their white counterparts for the same crimes (Hill, 2007). When children are removed, white families are able to avoid the jail time or have a short jail stay and be quickly reunified with their children. The ASFA’s expedited timeframe does not give black families the time they need to get through the training, treatment, or jail time required by the courts before their rights are terminated (Foster et al., 2011).
Foster et al. (2011) point to a need for more equity in permanency across racial lines in the child welfare system as well as a need fore more empirically based research that is race/ethnicity specific concerning the causes of placement instability.
The Cycle and Why it Matters
            The continued lack of permanency leads to an increased risk of educational and mental health issues that then increase the likelihood that the child’s placement will be unstable. This is a vicious cycle with disastrous effects for the child, their families (biological, foster, and adoptive), and society at large. Placement instability is the factor Stott considers to be the highest contributing factor to the negative impact foster care has on the developing child or adolescent (Stott, 2012).
            The reason that it is so significant is because it is so prevalent in the foster care system. Stott (2012) interviewed former foster children concerning their placement stability, drug use, and sexual behaviors. Participants reported that they changed placements every six months, with 19.3% having moved more than 12 times (Stott, 2012). Children are taken from unstable and disruptive home settings only to be placed into a system that is unstable and placements that disrupt.
            Localio, Luan, O'Reilly, and Rubin (2007) analyzed data from the NSCAW to determine if the problems children have upon entering foster care effect placement stability or if placement instability impacts children in a way that increases their risk for behavioral problems later. In a study of 5501 children from the NSCAW system, it was found that placement stability was strongly positively correlated with positive behavioral outcomes and that 51% of unstable children experienced abnormal behavioral outcomes (Localio et al., 2007). Most importantly Localio et al found that regardless of how the child came into care, the most important factor in determining how the child turned out was placement stability with children who failed to find placement stability being at a 63% higher risk of behavioral problems than children who achieved stability in foster care. The instability of foster care placements exacerbates the issues and creates new issues for children already at risk for mental health issues (Stott, 2012).
          Stott (2012) found that in spite of being removed from high risk environments and provided mental health and case management services adolescents who were in foster care were no better off than those children who were left in the home, and in fact they may even be worse off even into adulthood. Many of the participants in Stott’s (2012) study reported feeling hopelessness and depression. These children subsequently used drugs or sex to self medicate with oftentimes very serious consequences (Stott, 2012).
          Finally, Wildemen and Emanuel (2014) found that two-thirds of the children are placed into care due to some form of maltreatment. When children enter care they are told that they are going to be taken care of and have their needs met, yet that is not what they experience which is perhaps why placement instability is so detrimental. Ward (2009) found that the instability experienced by children in the foster care system is simply a repeat of the instability they experienced in their birth families home and thus reinforces their negative belief systems.
Exacerbating Factors in Placement Instability
           There are multiple factors that can make the situation for Black children in foster care worse. Racism and cultural differences create special circumstances that make Black children in America particularly vulnerable to placement disruption and the multitude of problems that brings. There is an extreme lack of minority foster and adoptive parents leading to children being placed in homes that are not familiar with their culture. This leads to misunderstanding and conflict that leads to an increase in the child’s behavioral issues and eventual placement disruption.  
Black in America Means Special Needs
          Bell (2007) found that black foster children suffer differently from their white counterparts in three specific ways: they experience racism still present in our society, they have little guidance and support that is appropriate, and finally they do not have a positive connection to or appreciation of their culture and heritage.
            While there are some state specific differences, in general, to be considered a special needs child in the area of adoption in the United States a child must: Have experienced some form of abuse or maltreatment, have physical or emotional disabilities, be older than one year, be members of a sibling group, be non-white (Schweiger & Obrien, 2005). “Be non-white”, it is most telling of the racism and discrimination that still exists in our country that a child, regardless of any other factors, in many states is considered special needs simply for not being white.
            Children considered special needs have a high number of adoption disruptions, averaging between 10-15% (Schweiger & Obrien, 2005). Adoption disruption is linked to many factors but the common thread weaved between them lies in the focus of the human services agencies. Currently all efforts go towards reunification with the biological family or in recruitment of new foster and adoptive families but fail to provide post adoption services. This lack of support leaves families unable to care for the most vulnerable of children. If the focus was shifted to be more encompassing of the entire process then it is hoped that the adoption disruption rate would drop and that children would achieve placement stability (Schweiger & Obrien, 2005).
Cultural Differences
            Anderson and Linares (2012) found that cultural factors influenced a child’s psychological adjustment in foster care. The development of a positive ethnic identity is important to that psychological adjustment, but ethnic dissimilarity due to foster care placement makes that difficult leading to social isolation, depression, and loneliness (Anderson & Linares, 2012). In fact, after removal from their homes over half of the children ended up meeting the criteria for separation anxiety disorder and have a higher risk of behavioral problems, disruptive behaviors, internalizing disorders, and delayed development (Anderson & Linares, 2012). The lack of psychological adjustment appears to be related to isolation from family and cultural norms as well as the social instability that occurs when a child enters a home with a different cultural background (Anderson & Linares, 2012).
            When the caregivers were of a different culture, particularly when they used a different language, the children had significant conduct problems, which appeared to be exacerbated by the fact that biological and foster parents had difficulty working together through language and culture barriers (Anderson & Linares, 2012). This is because one of the primary tasks of foster parents is to work with the biological parents to teach them the necessary skills so that they may be able to effectively parent their children. Foster parents also work with biological parents to advocate for the needs of the child, but when cultural differences lead to differing opinions on what the child needs, the situation becomes triangulated and the child loses. This becomes incredibly difficult when the ethnic background, culture, language and parenting practices are different.
Possible Solutions
            When placement instability is not related to bureaucracy, having a committed caregiver becomes the single most important factor (Localio, Luan, O'Reilly, and Rubin, 2007). When looking at reasons that children were moved, a caregiver’s commitment to permanence lead to a 93% rate of stability when compared to only 42% for children who’s caregivers were not committed to their permanence (Koh, Rolock, Cross & Eblen-Manning, 2014)). Relative caregivers also show a higher commitment to stability than those who are unrelated with 67% (Koh et al., 2014). Finding caregivers who are committed to caring for children and giving them the proper tools to handle the needs of the children they are for is the number one way to improve placement stability outside of administrative failures.
Stoping the Problem Before it Starts
            Since the highest risk of entering foster care occurs before the age of one, Wildeman and Emanuel (2014) suggest that one possible solution might be to provide additional support to pregnant women and new mothers in order to reduce the number of foster care placements. If a family in crisis is provided with wrap around services designed to teach them effective parenting skills, coping skills, and life skills then the need for foster care placement will be lessoned (Wildeman & Emanuel, 2014).
            Increasing access to community services and programs can also help prevent children from coming into the foster care system. This can occur through referrals from teachers, social workers, and others in the community who encounter a family who might benefit from such interventions (Wildeman & Emanuel, 2014). In this way families can get the help they need instead of entering a system that has clearly demonstrated its lack of ability to actually help children.
Addressing Administrative Failures
Localio et al. (2007) found that over 70% of the moves that occurred in the foster care system were administrative in nature. Of all the many problems that plague the foster care system; this one is the most simple to solve as it is not based on a child’s behavior, parent’s improvement, or even the availability of acceptable placements, but rather the conscious efforts of those in charge to make decisions in the best interest of the child. If the moves have not been made due to a child’s behavior but to poor business practices, those practices can be changed, thus improving the lives of the children whose lives they so drastically affect.
Stott (2012) suggests many options for improving the way caseworkers handle a child being moved such as: Delaying a move until the end of a school year, prepare the child better before he or she is moved, allow the child to visit the new school and placement prior to the move, allow the child to remain in contact with people from the previous placement, and allow the child to be more involved in the decision making process.
It is important to note that there may be times when moving a child is in the child’s best interest. Tregeagle and Hamill (2011) report that under the following conditions a move should be considered positive: When they are being reunited with their siblings, to be moved to a home that better meets their needs, or because a relative has been found to keep them. However, even in those cases, the timing of the moves needs to be done in the least disruptive way as possible.
Ward (2009) posits that better planning both before and after a child is moved as well as increased resources for the people caring for the children would the amount of instability children experience and the detrimental effects it has on their long-term adjustment and development.
Currently the United States ranks twenty out of twenty-one in the life and well-being of its youth as rated by the United Nations and UNICEF that examined factors such as “poverty, deprivation, education, health, relationships, and risky behavior” (Bell, 2007, p.151). The Alliance for Racial Equity (ARE) has been working to improve the status of the United States most vulnerable children through addressing six crucial areas: Policy change and finance reform, research, evaluation, and data driven decision making, creating youth, parent, and community partnership, building public will and strategic communications, training human service employees, and implementing site based practice change (Bell, 2007).
While the prevention of abuse and neglect is the first and most effective way to prevent ever having to deal with the nightmare that is the child welfare system in the United States, it is not always possible. While foster care has the potential to be helpful, it’s many pitfalls leave children oftentimes far worse than those left in the home, excluding of course those more severe cases of abuse or neglect (Bass, Shields & Berman, 2004).
Bass, Shields and Berman (2004) highlight the fact that the foster care system should enhance the lives of the children and families it serves not diminish them.  Aside from the prevention of children entering the system, some simple changes to the foster care system and the way black children in particular are handled can improve the lives of the children it is supposed to protect. First of all, the individual needs of the child must be accounted for (Bass et al., 2004). The children must first be placed in homes that are culturally aware with parents who are committed to stability. From there the caregivers must be provided with the support and services necessary to meet the child’s needs. Moves must be made only in the best interest of the child and even then only if carefully planned. Finally, every effort must be made for reunification with the parents or relatives as statistically that has the highest rate of stability (Bell, 2007). There is hope for improvement through education and understanding.

Anderson, M., & Linares, O. L. (2012). The role of cultural dissimilarity factors on child adjustment following foster placement. Children and Youth Services Review, 34(4), 597-601. doi:10.1016/j.childyouth.2011.11.016 
Austin, L. (2006). Immigrant children and families in the foster care system. The Connection, 22 (3), 6-13. Retrieved from http://www.lisetteaustin.com/pdfs/CASA%20Immigrant%20Children.pdf
Bass, S., Shields, M.K., & Behrman, R.E. (2004). Children, families, and foster care: Analysis and recommendations. The Future of Children, 14 (1). Retrieved from http://www.princeton.edu/futureofchildren/publications/journals/article/index.xml?journalid=40&articleid=132&sectionid=866
Child Welfare Information Gateway. (2015). Foster care statistics 2013 [Brochure]. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pubPDFs/foster.pdf
Foster, M. E., Hillemeier, M. M., & Bai, Y. (2011). Explaining the disparity in placement instability among African-American and White children in child welfare: A blinder-oaxaca decomposition. Children and Youth Services Review, 33(1), 118-125. doi:doi:10.1016/j.childyouth.2010.08.021
Hill, R. B. (2007). An analysis of racial/ethnic disproportionality and disparity at the national, state, and county levels. Casey-CSSP Alliance for Racial Equity in Child Welfare. Retrieved from http://s3.amazonaws.com/zanran_storage/www.cssp.org/ContentPages/869228046.pdf 
Koh, E., Rolock, N., Cross, T.P., Eblen-manning, J. (2014). What explains instability in foster care? comparision of a matched sample of children with stable and unstable placements. Children and Youth Services Review, 37, 36-45. doi: 10.1016/j.childyouth.2013.12.007
Localio, R. A., Luan, X., O'Reilly, A. L., & Rubin, D. M. (2007). The impact of placement stability on behavioral well being for children in foster care. Pediatrics, 119(2), 336-344. doi:10.1542/peds.2006-1995
Schweiger, W. K., & O'Brien, M. (2005). Special needs adoption: An ecological systems approach. Family Relations, 54(4), 512-522. Retrieved from http://www.jstor.org/stable/40005304
Stott, T. (2012). Placement instability and risky behaviors of youth aging out of foster care. Child & Adolescent Social Work Journal, 29(1), 61-83. doi:http://dx.doi.org/10.1007/s10560-011-0247-8
Tregeagle, S., & Hamill, R. (2011). Can stability in out-of-home care be improved? an analysis of unplanned and planned placement changes in foster care. Children Australia , 36(2), 74-80. doi:http://dx.doi.org/10.1375/jcas.36.2.74 
Ward, H. (2009). Patterns of instability: Moves within the care system, their reasons, contexts and consequences. The International Association of Outcome-Based Evaluation and Research in Family and Children's Services: Research from Around the World, 31(10), 1113-1118. doi:10.1016/j.childyouth.2009.07.009  

Wildeman, C., & Emanuel, N. (2014). Cumulative risks of foster care placement by age 18 for U.S children, 2000-2001.  PLoS One, 9(3). doi:http://dx.doi.org/10.1371/journal.pone.0092785

The Need for Advocacy for Adolescents with Mental Illness

The Need for Advocacy for Adolescents with Mental Illness
          Despite the fact that mental illness is one of the top five causes of morbidity, mortality, and disability for adolescents, those suffering from mental illness continue to go without the treatment they so desperately need (Dolan, Fine, & The Committee On Pediatric Emergency Medicine, 2011). Adolescents have special needs that are specific to their age group that are not easily understood by the general public. In addition to that there is a lack of recognition of adolescent mental health needs that leads to under identification (Jenson et al., 2011). Because adolescents do not have a voice and are dependent on others for their care, it is vital that they have an advocate (Hohenhaus, 2005). A mental health advocate can be the bridge over the mental health care gap so many adolescents fall into.
Overview of Adolescent Mental Illness
          In order to understand why having an advocate is necessary, it is important to understand the prevalence and complex needs of adolescents with mental illness. In adolescence neural pathways and behavioral patterns are created that will last throughout their lifetime (Adolescence is a transitional time when new attitudes, issues, and behaviors are explored (Martin, 2014). While this exploration is necessary, it also a stressful time for adolescents.
          Martin (2014) cites abstract reasoning as the primary issue that complicates the mental health treatment of adolescents. Being able to think abstractly is a necessary step towards becoming an adult but adolescents do not yet have the maturity to either ask the right questions, or misuse the existence of grey areas to support negative thoughts and behaviors. While this time period is one of exploration and sorting out how they feel and believe about the world around them, for an adolescent with mental health issues, this can create serious problems (Martin, 2014).
          Dolan, Fine, and The Committee on Pediatric Emergency Medicine (2011) report that twenty one percent of children in between the ages of 9-17 have a diagnosable mental illness or substance disorder and that ten percent of children in the United States currently suffer from mental illness.  Sadly, Only a third of those adolescents who are identified to have mental illness receive treatment (Merikangas et al., 2011, abstract). Adolescents who suffered with attention deficit/hyperactivity disorder (ADHD) and those who have more severe forms of mental illness are more likely to receive treatment than those with milder forms of mental illness or those with “anxiety, eating, or substance abuse disorders” (Merikangas, et al., 2011, abstract).
            Adolescent suicide is the forth-leading cause of death for 10-14 year olds with more than half of adolescents overall experiencing suicidal thoughts (Dolan, Fine, & The Committee on Pediatric Emergency Medicine, 2011). It must be noted that were early screening tools used and proper treatment available, suicide would not so frequently be the outcome. If only a third of adolescents are getting treatment, two thirds are left suffering alone.
          There is clearly a gap between the needs of adolescents suffering from mental illness and the treatment options available. Living with mental illness is possible; adolescents just need assistance learning how to live and the tools necessary to navigate their illness. Advocacy is the key to bridging that gap so that adolescents can reach a place of health and wholeness.
What Does an Advocate Look Like?
          An advocate can be a parent, concerned family member or other adult, educational or medical providers, or others within a community who see a need and want to find ways to meet that need (NAMI, 2015). While training could be vital in preparing an advocate for the task at hand, the most important feature of an advocate is the desire to help those who are suffering overcome the barriers to treatment. A passion for change is necessary when dealing with such a fragmented and broken system. Advocating for adolescents with mental illness is no easy task and will require creativity, tenacity, and concern. Advocacy is a world in which it is easy to get discouraged, but the payoffs are tremendous for both the advocate and those they help.
          As of now, there are not any nationally recognized standards or ways a person can become an advocate (Torrey, 2011). Because there are not any nationally recognized standards as with other professions and roles, becoming an advocate varies greatly on the type of organization and setting a person chooses to advocate. There is currently an effort by the Alliance of Professional Health Advocates (APHA) and others to develop a nationally recognized program for advocacy certification (Torrey, 2013). This program is just in the beginning phase though it is a step in the right direction for establishing national credentials for advocates. Until such time as a national program is developed, those interested in advocacy have to research local resources to advocate and participate in whatever training that specific agency requires. For example, the National Alliance on Mental Illness [NAMI] offers training and resources on advocacy for those with mental illness. Advocates in the NAMI organization can be involved in multiple types of advocacy projects from individual advocacy to political action to help make changes on a national level (NAMI, 2015)
Barriers to Effective Treatment and Proposed Solutions
Stigma and Skepticism
          There are many barriers to the effective treatment of adolescents with mental illness. Mental illness generally has negative connotations that lead to negative attitudes and beliefs about the person who is suffering. The greatest barrier appears to be the stigma associated with having mental illness as it prevents adolescents or their families from seeking treatment in the first place (Cowan, 2014).
          Henderson, Evans-Lacko, and Thornicroft (2013) report that over seventy percent of those with mental illness do not pursue adequate treatment due to the fear of being discriminated against. Being afraid of stigma is a very real fear as three out of four people with mental illness experience stigma (Government Of Western Australia Mental Health Commission [GWAMHC] (2010).
          Adolescents already struggling with their identity and issues such as depression and anxiety could easily be overwhelmed the discrimination associated with being labeled mentally ill. Unlike physical illnesses, those who suffer from mental illness are seen as less socially desirable and have difficulty in relationships, educational and job settings, and the community at large (Henderson et al., 2013). It is easily understood why an adolescent would choose to suffer in silence rather than add the weight of stigmatization as well.
          Stigma not only affects the initial decision to pursue treatment, but also at institutional and community levels (Henderson, Evans-Lacko, & Thornicroft, 2013). Those with mental illness are generally socially outcast and therefore not involved in the decision making process for policies and procedures that inevitably affect them. This group of adolescents is either without a voice, or their voice is dismissed due to the belief that because they have mental illness they are incapable of being a productive member of society (GWAMHC, 2010). Stigma also leads to a lack of support for the family as they are viewed with suspicion and malice. Those who are stigmatized have “experiences and feelings of shame, blame, hopelessness, and distress” (GWAMHC, 2010).
          Another barrier to treatment is skepticism as it leads people to reject those things they do not understand (Cowan, 2014). The behaviors exhibited by the mentally ill are oftentimes seen as attention seeking rather than the presentation of mental illness. This is further complicated by a general lack of understand about what mental illness looks like in adolescents as well as how the treatment for adolescents is different.
          Martin (2014) reports that adolescents are oftentimes seen as unruly and rebellious and while this is at times true, symptoms of mental illness could be mistaken for rebellion causing the adolescent to be denied care. People do not see the suffering of having a mental illness as a real problem so they don’t take adolescent who seek help seriously (Cowan, 2014).
          The Christian community is notorious for ignoring the importance of mental health issues and even persecuting those with mental illness. Menzie (2014) reports that rather than understanding that they live in a fallen world where illness exists, they attribute mental illness to a lack of faith, the result of sin, or spiritual attacks.  This is sadly supported by many scriptures such as Philippians 4:6 that says, “Do not be anxious about anything” or Romans 12:12 which says, “Rejoice in hope, be patient in tribulation, be in constant prayer” (New International Version). The misguided translation is that is they will just trust God or just pray those with mental illness will be fine. What they fail to recognize is that Jesus himself experienced every human emotion. When people talk about Jesus they forget about the Jesus who overturned tables in anger, lonely Jesus who begged for His disciples to stay up with Him while He prayed, or even desperate Jesus who asked why God had forsaken Him. Having emotions or distressing thoughts, even overpowering emotions and thoughts are no more sin than having a cold.
          Overcoming stigma and skepticism. Knowledge is power and in no other circumstance is that true. Hohenhaus (2005) reports that educating others about adolescent mental illness and how it affects the adolescent, their family, the community, and society at large is the most important thing an advocate can do. As adolescents, their caregivers, and others receive training in mental health related issues, a veil is lifted making it less likely for symptoms to be seen in a negative fashion and or ignored.
          Within the Christian community advocates can educate members about the causes and symptoms of mental illness while pointing to scriptures that point to compassion, advocacy, and hope. Jesus came to heal the broken hearted, to comfort them, to shine a light into their darkness.
          This student posits that advocates can hold classes or trainings in the community to help members understand what mental illness is, what it looks like, and how it can be treated. Churches, schools, and mental health centers would be excellent locations to hold such classes. The Internet is also a very effective tool at reaching the masses. An advocate could create informational websites with links to resources important in in mental illness. Websites could also include message boards so that adolescents or their families could communicate with people who have similar experiences though this student recommends such a website be heavily monitored to prevent exploitation or bullying. 
Lack of Organization, Effective Screening, and Quality Measures
          Once a parent or caregiver recognizes the need for treatment, they are likely to find an inadequate system that is difficult to navigate and seemingly impossible to find hope in. Mental health treatment has been absent from most organized efforts to improve and measure the quality of care (Pincus, Spaeth-Rublee, & Watkins, 2011). This lack of organization and accountability leads to system devoid of effectiveness.
          Dolan, Fine, and The Committee On Pediatric Emergency Medicine (2011) cite an inadequate or non-existent screening process that is caused by a lack of education and training. There does not appear to be a set standard in how to screen for, identify, or treat those adolescents with mental illness. For the most part the adolescent or their caregiver are at the mercy of whatever provider they come across and that specific person’s level of understanding and knowledge as well as their wiliness to get involved. Throughout childhood children are screened for multiple types of physical illness, it seems to reason that the implementation of a broad based mental health screening tools would be a positive step. In fact, according to Berger-Jenkins, McCord, Gallaher, and Olfson (2012) the providers who implemented a mental health screening tool in the pediatric office saw that parents were more open to discussing mental health problems and that attention to mental health problems by clinicians was increased. Despite this increase in attention, referrals did not increase so the system was not overburdened (Berger-Jenkins et al., 2012)
          The American Psychological Association [APA] (n.d.) cites a lack of coordination, inconsistency in policy and procedures, and a lack of funding as the cause for the lack of identification of adolescent mental health needs. The mental health systems fragmentation makes continuity of care borderline impossible resulting in many adolescents suffering needlessly.
          Overcoming the lack of organization, effective screening, and quality measures. In 2010 the U.S Department of Health and Human Services (HHS) was tasked with the development of a National Quality Strategy (NQS) by the Patient Protection and Affordable Care Act (ACA). The ACA’s purpose was to assist people in finding affordable, safe, and effective healthcare (Substance Abuse And Mental Health Services Administration [SAMHSA], 2014). While the ACA was a step in the right direction, and included stipulations for behavioral and mental health, its implementation in the mental health field has been sporadic at best (Pincus, Spaeth-Rublee, & Watkins, 2011).
          Understanding the unique needs that mental heal encompasses, the SAMHSA (2014) used the NQS to create a framework for measuring the effectiveness of treatment and treatment outcome measures within the mental health field called the National Behavioral Health Quality Framework (NBHQF). The goal of the NBHQF is to provide “a mechanism to examine and prioritize quality prevention, treatment, and recovery elements at the payer/system/plan, provider/practitioner, and patient/population levels” (SAMHSA, 2014).
          Advocates wishing to become involved in changing the mental health system so that the needs of adolescents are met could become involved with the implementation of the standards laid out in the NBHQF through working directly with agencies or their governing authorities. According to the SAMHSA (2014) there is not a cohesive method for measuring treatment outcomes. Advocates could help in the creation of outcome measures to determine the effectiveness of various forms of treatment or even to examine the provider performance. Now is a great opportunity to become involved in an up and coming field that is much needed and long awaited.
Lack of Training and Time
          The mental health system is overwhelmed in general making it even less likely to be able to handle the specific needs of any one group, especially one that does not have a voice such as the adolescent (Hohenhaus, 2005). There are simply not enough people educated in adolescent mental illness to identify or treat those who are in need of help. Sadly many professionals and community members do not even recognize the need for specialized training. Most people consider adolescents to be “little adults” rather than recognizing they have unique needs (Hohenhaus, 2005).
          Even when a provider recognizes the need, the limited amount of professionals to support them leaves them overburdened.  There are simply too many adolescents with too many needs and everyone suffers. Providers are left without the time necessary to effectively intervene; this is true of teachers, counselors, medical providers, and other concerned community members (Hohenhaus, 2005).
          Overcoming the lack of training and time. Dolan, Fine, and The Committee on Pediatric Emergency medicine (2011) advocate for the training of social workers, physicians, and community mental health workers in the intricacies of treating adolescents with mental illness. Training should start first with how to identify those who have unmet mental health needs, according to Jensen et al. (2011) this is best accomplished by developing a brief and easily understood method with scientifically designed warning signs. Providers should be trained in use of such a screening tool so they are better able to utilize their time. Currently mental health issues are generally dealt with on a crisis basis, which takes significantly more time and energy for all involved. Having an organized method for identifying problems before they turn into a crisis will lesson time providers are stuck dealing with a crisis.
          Adolescents with mental illness and their families are currently suffering needlessly due to a fragmented and inadequate system. The treatment of mental illness involves a multi-systemic approach but at this time, there is no central piece coordinating treatment so that there is continuity of care. A mental health advocate can be the difference between wellness and another child being lost forever to suicide or other serious mental illness. The mental health advocate can collaborate with the adolescent, their caregivers, teachers, doctors, therapists, and others in the community to ensure that their needs are met in a way that facilitates healing and growth. The system is overburdened dealing with the crisis situations caused by adolescent mental illness. As advocates become more involved crisis can be circumvented and lesson that burden.

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You Want Her Whole

You want her whole. Trust me. For when she finds her muchness; when she gathers all the pieces of herself, all the pieces you have broke...