Bipolar Workshop Handbook 2

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  Bipolar assessment and Therapeutic Genogram Design
  Workshop Handbook
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  Christine L. Wirsing
  Capella University
  June 2007
  
  This workshop project is dedicatedto every family dealing with a child diagnosed with bipolar disorder with the hope that they can receive the help and guidance needed that will open a pathway toward a brighter, hope-filled future.
  CONTENTS
  TOC o " 1-4" " FrontMatter Title,8"u09a1 PAGEREF _Toc169288337 h 1
  Introduction PAGEREF _Toc169288338 h 1
  Background PAGEREF _Toc169288339 h 2
  The Bipolar Journey PAGEREF _Toc169288340 h 3
  A Family Focus Perspective PAGEREF _Toc169288341 h 3
  Family Focus Model (Hyde, 2001) PAGEREF _Toc169288342 h 4
  Workshop Goals PAGEREF _Toc169288343 h 5
  Obstacles to Accommodations PAGEREF _Toc169288344 h 6
  Impact PAGEREF _Toc169288345 h 6
  Multicultural Fact Sheet Handout Feel free to print, copy, and distribute these freely, as long as you leave the names and email addresses of the creators of the resources on them (EdChange 2001) PAGEREF _Toc169288346 h 7
  Accommodation Exercise:It Just Makes Sense PAGEREF _Toc169288347 h 8
  A Closer Look at the Individualized Education Plan (IEP): School and Family PAGEREF _Toc169288348 h 9
  Do's and Don'ts Handout (Burke, 2006) PAGEREF _Toc169288349 h 10
  Pet Scan Handout PAGEREF _Toc169288350 h 12
  The Social Network GenogramA Quick and Easy Way to Assess and Monitor Progress PAGEREF _Toc169288351 h 13
  Critical transition periods can be identified PAGEREF _Toc169288352 h 13
  Special ConsiderationsGrief, Respect, and Learning PAGEREF _Toc169288353 h 14
  Grief PAGEREF _Toc169288354 h 14
  Respect PAGEREF _Toc169288355 h 14
  Learning PAGEREF _Toc169288356 h 15
  Conclusion PAGEREF _Toc169288357 h 16
  A Note about the IEP PAGEREF _Toc169288358 h 17
  A copy of portions of the standard IEP, which is age-appropriate and relevant for accommodations for high school teenagers (Foltz, 2006) is provided with expressed permission (Bassc, 2007)in this handbook as a sample to guide you and/or your students family through the IEP process. PAGEREF _Toc169288359 h 17
  References PAGEREF _Toc169288360 h 18
  Appendix ASample IEP Form G1 (BASC, 2007) PAGEREF _Toc169288361 h 20
  Author Note PAGEREF _Toc169288362 h 21
  Welcome
  Welcome to the Bipolar Assessment and Therapeutic Genogram Design Workshop. Although this workshop addresses school counselors, it also targets anyone who is instrumental with preparing Individual Education Plans (IEPs) for students diagnosed with bipolar disorder. Special services directors, teacher, psychologists, mental health counselors, school social workers, school nurses, and family members will all benefit from this workshop and handbook.
  Sixteen years ago, while living in Italy, my ex-husband and I adopted our daughter from Romania at the age of two weeks. Up until the age of 10, she was healthy and happy. After developing serious gastrointestinal problems while living in Iceland, she and I were medically evacuated back to the states for treatment. While on the flight, she started the first day of her first menstrual cycle, which made matters even worse. By the time we landed, three days later via the Azores, D.C. and St. Louis, she had lost a significant amount of hair, was still unable to eat or drink without throwing up, and had to be pushed in a wheelchair because she was in so much pain she was unable to stand or walk.
  During all of this time, getting homework done, making up tests, numerous absences, and detentions were all also part of the journey. We were forced to begin a new family journey, a new medical journey, and a new academic journey simultaneously. This is like trying to get to Disneyland, CA locked in a car starting from NY, stopping at every school and hospital on the way, with all of your financial, physical, mental, and emotional assets as your only fuel. During this trip you have a child who is in pain, cutting herself, screaming, hitting, and threatening to either kill you or kill herself. Every place you stop along the way is a different doctor, different test, different diagnosis, different counselor, different education plan, different medication, and different set of problems to deal with such as medication reactions, increased psychotic episodes, hallucinations, and destruction.
  With all of this, the toughest, most painful, most isolating and most devastating, is the loss of friends and extended family support. Just about everything else in life must be sacrificed in order for this journey to take place. Often these sacrifices can include a job, church, sports, eating out or any kind of social activity due to the related panic and anxiety. Once I stepped out of the house for a 10-minute drive to collect myself after an intense rage episode only to come home to find my neighbor and two policemen in my house because my daughter had set a fire in the living room.
  I began my work on my MA in mental health counseling to help me to become a better therapeutic parent. What I have learned along the way is that a workshop like this one may very well make a difference for a lot people in more ways than any of us can imagine.
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  Introduction
  The adolescent years is a difficult time filled with numerous transformations that the family encounters, endures, and establishes (Carter & McGoldrick, 1989/2005). These transformations are magnified when bipolar disorder is part of the family environment. This workshop/handbook is not so much about bringing you the latest and the greatest scientific or academic breakthroughs. Its about taking what many of you already know and already have the skills to carryout and applying it from a family focused assessment and management therapeutic perspective (Hyde, 2001). This handbook is simply a way of packaging it all into a very easy-to-use plan to help these young students, families, and school staff work together more easily and effectively.
  This workshop/handbook is about equipping you, motivating you, and encouraging you, to take a closer look at the lives involved at all of those IEP meetings to see if there is a place, somewhere, somehow for you to make a difference for some young student to work toward a better future that might include a high school diploma, a college degree, and an overall healthier and happier quality of life along with their family.
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  Background
  
  The stressful transformations that families with adolescents undergo are centered on the development of the adolescent yet influence the entire family system (Carter & McGoldrick, 1989/2005). Issues such as physical, sexual and emotional changes alongside gender identity of the adolescent engage every aspect of the family structure as roles adapt with the increasing independence of the adolescent (Carter & McGoldrick, 1989/2005). When therapeutic interventions are necessitated by a chronic illness such as bipolar disorder, it is important for the adolescent to have a supportive network, which includes their school, in cooperation with the parents and professionals (Carter & McGoldrick, 1989/2005). As you are aware, an important tool used in schools for students with special needs is the Individual Education Plan (IEP). With training augmentation, you can further utilize the IEP to assist students with bipolar disorder and their families by becoming a well-informed advocate and gaining the cooperation of the school staff and teachers.
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  The Bipolar Journey
  Illness:
  Depression
  Mania
  Self harm
  Rage attacks
  Homicide
  Suicide
  Psychotic episodes
  Hallucinations
  Family dysfunction
  Social networks
  Destruction
  Family system
  Activities
  Work
  Home
  Doctors/referrals
  Counselors
  Medical/Lab testing
  School
  Homework
  Makeup tests
  Absences
  Detentions
  A Family Focus PerspectiveCounselorSchoolFamilyDysfunctionMedicalTestsDoctorsIllness
  Family Focus Model (Hyde, 2001)
  As a mom, I know firsthand how difficult the journey to an accurate diagnosis can be. In general, things start off with a magnification of what can be described as normal teenage behavior. However, once things escalate, depression becomes apparent, self-harm becomes an issue, and suicide becomes a realistic possibility. It becomes time to start the long journey of doctors, counselors, and psychiatrists in pursuit of an accurate diagnosis before any appropriate treatment can begin.
  And there is an emphasis on the time to start here. It took five very long, very painful, and very frightful years before our daughter was diagnosed with bipolar disorder. The diagnosis is very important, but, in essence, it is simply a guide to another line of medications and possible treatments. Of course, all the while, school and education, although extremely important, become enormous burdens to surmount because of the specific problems and needs of the student.
  The need for each of you to participate in this workshop,enhance your professional skills regarding the importance of working collaboratively with your students and their families (Carter & McGoldrick, 1989/2005), and the effective use of the IEP(Chengappa & Williams, 2005) is very important for the academic success and future for the student, the students family and the school.
  Workshop Goals
  Provide evidenced-based psychoeducation
  When working from a family-focused perspective there are three important areas to consider (Hyde, 2001):
  
  • Psycho-education (Hyde, 2001).
• 2. Communication enhancement (Hyde, 2001).

3. Problem-solving training (Hyde, 2001).NOTE: This model appears to be culturally limited (Hyde, 2001) and is best suited for middle to upper middle class families.
Improve student academic support
Improve school attendance
Enhance level of knowledge and skill with IEP accommodations/supportive services
Decrease the amount of time needed for IEP meetings
Increase student participation and treatment adherence
Improve overall school, student, and family satisfaction
Learn effective coping strategies and techniques for recurrent episodes
Obstacles to Accommodations
Chengappa and Williams (2005) interviewed US and UK based psychiatrists seeking what they perceived as barriers to effective management of bipolar disorder. This study demonstrates that education for these students, their parents, and their schools is the foremost important dynamic that can bring about improvement (Chengappa & Williams, 2005). The article states that both US and UK psychiatrists reported the need for the improvement of therapeutic agents that can be tolerated well and be effective throughout all intervals of the illness. Additional significant difficulties reported as barriers were poor adherence to treatment, substance use/abuse, problematic diagnoses, and lack of stabilization. It is clear that these doctors share the same goal as most families of reducing the occurrence of relapse and providing a swift response to relapse episodes. The study is not age-specific and is limited by self-reporting, but is useful for validating the importance the role education plays in a family system therapeutic intervention approach.
Impact
As you will see in the following fact sheet, bipolar disorder does not discriminate against age, culture, or gender. Also, the depression associated with bipolar disorder has a global impact on disability. This workshop handbook can be used to help fulfill the need to utilize those in distinctive roles such as school counselors and social workers through education and advocacy as part of an extensive therapeutic management plan to help adolescents diagnosed with bipolar and their families across the globe.
-153478759125Multicultural Fact Sheet Handout Feel free to print, copy, and distribute these freely, as long as you leave the names and email addresses of the creators of the resources on them (EdChange 2001)
Accommodation Exercise:It Just Makes Sense
To help you to understand, explain, and address stigma issues with other students in relation to students receiving special treatment from faculty (Padron, 2006), you are being asked to complete a short assignment during which anxiety-provoking noises will be introduced, and your legs will be tied together while you wear glasses to blur your vision. This exercise is designed to simulate the discomfort students experience from both bipolar and medication reactions during class. This exercise is designed to promote understanding of the need for appropriate accommodations in school (Chengappa & Williams, 2005).
When we think of certain sensory words such as blurry, hyper, and sick, we may not experience these feelings the same as others do (Bartoshuk, Fast, & Snyder 2005).
Practicing appropriate behavior over and over (rehearsal) can lead to long-term stress reduction and prevent/eliminate coping strategies that may be maladaptive (Rohrmann, Netter, 2002).
This exercise will help you to keep in mind the possible variants between experience and expression (Bartoshuk, Fast, & Snyder 2005).The student with bipolar disorder will be subjected to these and other similar sensory experiences during school, and it is clear that we can take advantage of the opportunities the IEP provides to address these sensory issues in such a way that will decrease maladaptive behaviors, increase appropriate coping skills, (Rohrmann, Netter, 2002) thereby improving school attendance and academic performance.

A Closer Look at the Individualized Education Plan (IEP): School and Family
Working Together
Help overcome stigma
Increase understanding of basis for accommodations
Improve academic response to medication reactions
Application of social network genograms
Collaborate with doctors/school nurses
Family Considerations:
Keeping student alive
Health & wellbeing
Normalized life
Education
Inclusion
Accommodations
Informed & aware staff
Communication
Discipline
High school diploma
College & Career
Independence
Do's and Don'ts Handout (Burke, 2006)
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Pet Scan Handout
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The Social Network GenogramA Quick and Easy Way to Assess and Monitor Progress
The application of a social network Genogram, which represents the student and family in their particular family life cycle stage (Carter & McGoldrick, 1989/2005), can be an easy and manageable means of incorporating present student/family challenges to facilitate preparation for the students future life course in a more proactive manner (Carter & McGoldrick, 1989/2005).
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Critical transition periods can be identified
Relapse episodes can be identified and perhaps avoided
School and family adaptability can be periodically examined (Carter & McGoldrick, 1989/2005).
Special ConsiderationsGrief, Respect, and Learning
In recognizing that bipolar is a serious chronic brain disorder that cannot be cured (Hyde, 2001), school counselors and social workers can better serve the students needs by learning, accepting, and cooperating with each students treatment objectives (Hyde, 2001). Often the student is in need of acquiring new coping skills to perform satisfactorily in school with a new understanding of his/her self identity (Hyde, 2001). Being able to ascertain the specific needs of the student suffering with bipolar disorder and applying age-appropriate solutions (Foltz, 2006) in school in cooperation with the students social network is the driving force that will create greater hopes for success for the student, family, and school (Stein, Mann, & Hunt, 2007).
Grief
There is a perplexing and chronic experience of grief for the student that should be recognized (Hyde, 2001). In addition to the stormy symptoms of bipolar, problems with possible legal issues, and dealing with numerous medical professionals, the student endures losing friendships, hopes and dreams no longer within reach, self-control, and sense of self (Hyde, 2001). Failure to recognize and work with the students grief can lead to setbacks in the students academic progress as well as his/her overall treatment regime (Hyde, 2001).
Respect
You are a caring professional who works with many students with limited time and resources. The more effectively and efficiently you can work with each of your students, the better for everyone. Your office may be the only place where these students can experience the level and degree of respect they need and deserve. Education, support, and consultation are all things you already provide for your students (Hyde, 2001). Working from the students social network genogram can help guide your focus in areas that can help postpone, decrease, and most importantly prevent episodic relapses (Hyde, 2001).
Your ability to distinguish the students personality traits from the symptoms of bipolar will be an important cornerstone of the mutual respect than can develop between you and your student. This is critical when seeking to avoid the reinforcement of dysfunctional behavior (Hyde, 2001). The student is expected to behave accordingly for numerous hours a day, five days a week, throughout the school year, year after year. Helping the student to work toward healthful changes,focusing less on deficits, and maintaining a supportive respect for the students chronic grief will lay the foundation for successful communication. This can lead to fewer absences, improved academic performance, and appropriate accommodations that will provide equal access for the student to attain a higher education (Padron, 2006).
Learning
An important part of the students academic success will be dependent upon the tracking and mapping of the course of the illness during school hours. Using the social network genogram is a quick and easy method of focusing on problems and solutions that will help the student avoid unnecessary risks that will lead to recurrence or relapse (Hyde, 2001).
Conclusion
Thank you for taking the time to participatein this workshop. It is my hope that this workshop/handbook will provide you with the tools to help you to better serve your student and your students family. By implementing the social network genogram you can easily make ongoing assessments to determine what aspects of the students education plan are working and which ones are not beneficial. Exploration and assessment of the students social network can provide a foundation from which you can provide psycho-education, improve communication, and become a more effective problem solver for your student, your students family, and your school.
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A Note about the IEP
A copy of portions of the standard IEP, which is age-appropriate and relevant for accommodations for high school teenagers (Foltz, 2006) is provided with expressed permission (Bassc, 2007)in this handbook as a sample to guide you and/or your students family through the IEP process.
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It is important to understand the unique qualities of the adolescent brain affected with bipolar disorder. (Malhi, Lagopoulos, Sachdev, Ivanovski, & Shnier, 2005).
References
BASSC. (2007). IEP form G1 (Version BASC IEP) [Online form]. Available from http://aweb.stclair.k12.il.us/bassc/1898/
Burke, T. (2006). A guide for teachers and administrators (1st ed., Vol. 1). Retrieved June 1, 2007, from CABF Web site: CABF_BPchildlearning.PDF
Carter, B., & McColdrick, M. (2005). The expanded family life cycle: Individual family, and social perspective (Third ed.). Boston: Pearson Education Company. (Original work published 1989)
Chengappa, R., & Williams, P. (2005). Barriers to the effective management of bipolar disorder: a survey of psychiatrists based in the UK and USA. Bipolar Disorders, 7(1), 38-42.
EdChange & multicultural pavilion. (2001). Did you know? (Version 1) [A fact sheet on psychological disabilities]. Available from http://www.mhhe.com/multicultural
Foltz, R. (2006). The mistreatment of mood disorders in youth. Ethical Human Psychology and Psychiatry, 8(2), 147-154. Retrieved June 1, 2007, from Capella University iGuide Online Library Web site: http://capella.edu
Hyde, J. (2001). Bipolar illness and the family. Psychiatric Quarterly, 72(2), 109-118. Retrieved June 8, 2007, from Capella University iGuide Online Library Web site: http://www.capella.edu
Malhi, G., Lagopoulos, J., Sachdev, P., Iva, B., & Shnier, R. (2005). An emotional Stroop functional MRI study of euthymic bipolar disorder. Bipolar Disorders, 7(5), 58-69. Retrieved June 1, 2007, from Capella University iGuide Online Library Web site: http://www.capella.edu
Padron, J. (2006). Experience with post-secondary education for individuals with severe mental illness. Psychiatric Rehabilitation Journal, 30(2), 147-149. Retrieved June 1, 2007, from Capella University iGuide Online Library Web site: http://www.capella.edu
Stein, C., Mann, L., & Hunt, M. (2007). Ever onward: The personal strivings of young adults coping with serious mental illness and the hopes of their parents. American Journal of Orthopsychiatry, 77(1), 104-112. Retrieved June 1, 2007, from Capella University iGuide Online Library Web site: http://www.capella.edu
NOTE: All photo images used in this handbook have been printed from royalty-free resources provided by Microsoftoffice.com.
Appendix ASample IEP Form G1 (BASC, 2007)
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37763889647 Author Note
Select this text and then begin typing your author note