Mental state exam for youth workers: Mood and Affect.

So far in this series we have been developing an understanding of the core components of a mental state exam. So far we have discussed how a young persons appearance, behaviour, speech and language can provide indicators as to their mental state. Today we discuss how a young persons mood and affect can provide insight into their current mental health status.
 

Mood

Mood is described using a young person’s own words. Happy, sad, angry, elated, anxious or apathetic. Many young people may be unable to describe their subjective mood state. Throughout my career I have seen a marked decrease in emotional intelligence in our society. It may take some work to flesh out how a young person feels. There are a number of resources to help young people to articulate their emotions, my personal favourites are mood dudes and the stones. In essence Mood is how young people see themselves in their own opinion.
Emotional intelligence in a squeeze ball
 
The key to remember about mood is that it is subjective. The young person is the master of their own emotional state. Only they truly know what is going on inside.
 

Affect

Affect is noted by us when we observe the apparent emotion conveyed by the person’s nonverbal behaviour. Affect may be described as appropriate or inappropriate behaviour to the current situation, and as congruent or incongruent with their thought content. For example, a young person who shows a neutral affect when describing a very distressing experience such as family violence would be described as showing incongruent affect, which might suggest PTSD. The intensity of the young persons affect may be conveyed as normal, blunted, exaggerated, flat, heightened or overly dramatic.
 
A flat or blunted affect can be associated with schizophrenia, depression or post-traumatic stress disorder. Heightened affect might suggest mania, excitement or anxiety and an overly dramatic or exaggerated affect might suggest certain personality disorders. A young person may show a full range of affect, or a wide range of emotional expression during your assessment. They may move from heightened to blunted or they may only show a single affect.
 
The key to remember about affect is that it is objective. It is what you observe about a young person. The key here is to be clear about what you are observing and why you believe it means what you believe. For example, “Aaron appeared sad. He spoke slowly, kept eye contact on the ground and cried“.
 
Stay tuned next week as we discuss part five: Thought process and content.

Youth work in the education system

In the early days of my career I had the privileged of being a youth worker that went into our local high school. I was employed by my local church as a schools worker and spent much of my time running lunchtime programs. I spent much of my time building relationships with teachers, support staff and principals. I was in a lucky position. Many of my friends across the world had many more restrictions placed on them when working with and in schools.

One of the subjects in my Bachelor Degree was youth work and the schooling system in the course I learnt a lot about the way education has been framed through history and how it is placed in the current context. I also learnt that to be effective in the system that sometimes you had to work around the system. Honestly, it was one of my least favoured subjects. It really did not teach me how to work in the schooling system.

As youth workers we are guests in the education system. We are seen as providers of non-formal education… life skills and the like. When young people come to us they are not getting a qualification or an understanding of the three R’s (does that mean teachers can’t spell???). Instead we look after the other stuff. We develop the personal.

It is a sacred spot to work in the education system and we must honour the opportunity. The only way it can work is if the relationships are solid.

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Why youth ministers need to embrace youth work practices: Youth ministry in the 21st century.

A while back I was reading a blog post by Mark Oestreicher, A youth pastor from the USA. In it he states that youth pastors need a title change. They should be known as youth workers. This comment made me both uncomfortable and elated at the same time. Uncomfortable as it brings youth ministry into a realm that took me over a decade to learn and thousands of dollars in university subjects without the need for them to gain training or experience. Elated because the more complex society becomes the more the average youth pastor will experience issues which they traditionally have not been trained for… and youth worker brings with it a sense of training. It does make us ask questions about our identity.
 
I have recently had conversations with youth minister friends of mine who disagrees with Mark. They believed that the average church youth ministry did not regularly come across young people experiencing issues such as homelessness, substance misuse and family violence. They believed that the closest that a youth minister comes to doing youth work is program development and perhaps mentoring. My colleague and I had a long conversation and suffice it to say I disagree.

My first sermon December 2004
 
A number of years ago I had a similar conversation with the leading youth minister at one of the largest denominations in Victoria. In the conversation he said that the average church did not want their young people exposed to poor, homeless or prisoners. Guys I am sorry but the bible that I read said that was exactly who we were supposed to hang out with. This conversation is one of the reasons I moved from traditional youth ministry to youth work.
 
That being said, a number of my youth ministry colleagues would also gawk at this vision of youth ministry. They spend their time with young people in detention centres, running advocacy campaigns and feeding the hungry. Many of the youth ministers deal with family breakdown, issues of homelessness and provide outreach in their community. In Melbourne though it seems the average youth ministry course has not prepared them to do this. They have had to learn on the fly and live by faith.

Leading a camp for children of prisoners in 2007

 

The 21st century youth minister needs to embrace their call and learn some youth work. The average church youth worker could do with a good dose of youth work theory. Perhaps a bit on youth participation and engagement or a bit of outreach and relationship building. They could do with a good dose of practice wisdom in drug and alcohol, program development and mental health. If church based youth workers are serious about being a resource in their community, schools and churches then its time to come into the 21st century. Young people are not turning to their minister for support any more because the average youth minister is not there, willing to step into the breach or trained to do it.

Youth Ministry in the 21st century is now and will become more challenging into the future. It is the person who recognises now the need for ongoing professional development and further training that will become the ultimate youth worker. This means that  bible colleges have a responsibility to teach their students more than before about young people and youth ministry students have a responsibility to seek out more about young people and how to work with them. Youth ministers must become more… they must become youth workers.
 

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Motivation Monday: Ideas for the Ultimate Youth Worker

American composer John Milton Cage is quoted as saying “I can’t understand why people are frightened by new ideas. I’m frightened by old ones”.

What old ideas about youth work or the youth sector frighten you? What holds us back? What would you change about our current situation?

What new ideas make you thrive? What ideas scare others?

How will your ideas change the world?

What can youth worker’s learn from ANZAC day?

Today Australians throughout the world stop to pay tribute and remember those who lost their lives in World War One and subsequent conflicts. We remember that these young men and women fought for the cause of freedom and lost their lives to help us live the lives we live today. Their sacrifices will never be forgotten. Lest we forget.

As a youth worker I was reflecting recently on the role of youth workers during both world wars. In many ways it was the height of youth clubs. Whether groups like Boy Scouts, the Hitler Youth or the Boys Brigade they all had a surge during those world conflicts. In most cases the youth workers who were involved sought to bring the best in their young people to the fore through skill building and service. However, they also became recruiters for military service.

Youth workers even today find themselves in this role. How many young people have joined military service instead of going to jail after a well meaning youth justice officer persuades a judge that this would be a good option? How many young people have met recruiters in their schools after the welfare team set up a careers day?

Military service is not a bad thing at all. In fact I know many young people who without the military would have ended up in really bad places. The question for youth worker’s is about transparency and role power. There were a number of youth workers on all sides of the wars who used their influence and role power to insight young people to join up and train with malice in their hearts. There were a majority Who supported young people to join up for the cause of freedom and peace. The difference was transparency and use of their role.

Today we are less likely to see a world war than in years gone by. However we are still recruiting young people to fight in conflicts throughout the world. As a youth worker we have a lot of power and influence over young people. We must make sure that our actions are clear and transparent and bring about good.

What do you think???

Mental State Exam for youth workers: Speech and language.

Over the past few weeks we have been developing an understanding of the components of a mental state exam. So far we have discussed how a young persons appearance and behaviour can provide indicators as to their mental state. Today we look at how a young persons speech can provide insight into their current mental health.
 
A young persons speech is assessed by observing their spontaneous speech, and also by using structured tests of specific language functions. during this time we are focussed on the production of speech rather than the content of speech, which we will address under thought form and thought content in weeks to come. When observing the young persons spontaneous speech, a youth worker should note and comment on paralinguistic features such as the loudness, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate, spontaneity and latency of speech.
 
A structured assessment by a qualified speech pathologist is a great tool for diagnosing serious difficulties in speech however a basic screening can be performed by an aware youth worker. An assessment of speech includes an assessment of expressive language by asking the young persons to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests form part of the mini-mental state examination. In practice, the structured assessment of receptive and expressive language is often reported under cognition which we will discuss in a coming cast.
 
Language assessment will allow you to recognise young people presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism or Asperger syndrome may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person’s words) and palilalia (repetition of the subject’s own words) can be heard by young people with autism, schizophrenia or Alzheimer’s disease. A young person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them.
 
Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner.
 
If you know a speech pathologist or have the opportunity to do some training with one, do it! Aside from appearance speech is one of the most observable ways to notice a persons mental state.
 
Stay tuned next week for part four: Mood and Affect.
 

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Guest post on drownthenoise.wordpress.com/

Our guest post is being published on Neels Redelinghuys’ Blog today – it’s an open look at the situations that shape a youth worker through their career. Feel free to post in the comments about how witty, insightful and amazing it is!!!

If you’ve come to Ultimate Youth Worker after already reading the post on http://drownthenoise.wordpress.com/  WELCOME!!! We hope you found it witty, insightful and amazing too!

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The need to network: Collaboration for effective youthwork.

Its National Youth Week here in Australia and we are ramping things up at Ultimate Youth Worker. This week Our Director of Operations had the privilege of hosting a forum for The Youth Affairs Council of Victoria. The forum focused on how youth workers can best provide opportunities for engagement and participation for young people. During this session on of the gaps that was identified in the local area was the lack of communication and networking between service providers.
 
 
Youth participation and engagement is our core business as youth worker’s. However, to be most effective we need to know what is going on in our area and who is doing it! A dozen youth workers from eight youth service providers spoke about the need for there to be more opportunities for them to meet each other and speak about the things that are going on in their area. Many spoke of their networking with each other on an ad hoc basis. Most knew of each others organisation. No one knew everyone or the programs which they ran. The networks were pretty much in disarray.
 
As the session progressed the youth workers began to get to know each other. They worked out what each other did and what programs they ran. They began asking each other more pointed questions. In all they got to know each other better. As we were finishing up it was a great thing to see all the youth workers exchanging numbers and working out times to meet again. Networking is an extremely useful and enjoyable experience but one we as youth workers struggle to do.
 
 
Whatever situation you find yourself in currently, you can always build your network. It doesn’t take going to a seminar or a training session. All you need to do is stick out your hand and say hi to another person. In youth work we need to have great networks as it sets us up to collaborate with other organisations to provide the best service possible to our young people. In the current landscape of service cuts and funding constrictions it is the service providers with the best networks that are moving ahead in leaps and bounds where others are flailing.
 
The difference between a good youth worker and an Ultimate Youth Worker can often be their network and collaborations.
 

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Mental State Exam for youth workers: Behaviour.

“Oh Behave!” Austin Powers knew all to well that we toe a fine line as humans when it comes to ‘normal’ human behaviour. When we are doing a mental state exam we are observing the fine line between what our clinical brothers and sisters would call ‘normal’ and ‘abnormal’. Behaviour is an interesting phenomenon for youth workers to observe. It requires us to use our powers of observation and our own self reflection (apparently youth workers can be a little abnormal!) to determine whether a person is doing alright. We need to observe whether the young person is acting in a similar way to how they act most of the time or differently. Whether they are acting similar to their peers or completely different. Behaviour requires us to have an understanding of normal behaviour and abnormal behaviour.
 
Normal day or abnormal behaviour?
 

Movements

Tremors, shakes, tics, involuntary movements may indicate a neurological disorder, or they could be the side effects of antipsychotic medication, schizophrenia or drug abuse. If your young person is showing these types of movements it may be normal for them or it might be abnormal. It may be something serious like a neurological disorder or it may just be the effects of the drugs they have used. Your ability to observe this behaviour and refer them out to more specialised support will be key.
 
This also goes if they are hyperactive, rocking, gesturing wildly, fidgeting or unable to sit still. This may mean they are delirious or manic, or it might just mean they are excited or full of beans. Only your keen observation of their movements and your deep relationship will tell you if something is out of the ordinary or ‘abnormal’.

Level of activity and arousal

A persons level of activity and arousal may also provide insight into their mental state. Are they hyperactive (high action) or lethargic (low action)? An increase in arousal and movement (hyperactivity) which might reflect mania or delirium. An inability to sit still might represent akathisia, a side effect of antipsychotic medication. Similarly a decrease in arousal and movement (akinesia or stupor) might indicate depression or a medical condition such as dementia or delirium.
 
Of course if you are over aroused and hyperactive you may just be having a birthday, bar mitzvah or a wedding. You may be on a camp and really excited. If your young people are lethargic it may just be the last day of camp, the end of a boring group session or a distressing break-up with a cherished boyfriend. Your keen understanding of your young people will help you to know whether or not it was the red cordial or sad movie that is making your young person behave differently or whether it is something else more insidious.

Eye contact

The eyes are the window to the soul they say, and never more so was this true than whilst doing a mental state exam. Does your young person make good eye contact with the floor? Can they look you in the eye? What happens when they are telling you porky pies??? A persons eye contact can say a lot about their mental state. It can tell you if they are lying. It can tell you if they are psychopathic. It can tell you if they are nervous, sad or depressed. Eye contact is one of the most important behavioural signposts for us as youth workers.
 
There are of course some caveats  to this. If your young persons culture frowns on eye contact for example the aboriginal population in Australia. A young person will not make too much eye contact with an adult out of respect. A young person with eye issues such as having a lazy eye may not seem to be making good eye contact, but it may just be your view.
 

There is a danger

Behaviour is difficult to observe objectively. Not Impossible, but difficult. Most of us observe others behaviour subjectively. We watch through the lens of what we find appropriate. In some cases this is not an issue. We see someone hit their child with a lump of wood, or a person overdosing or a young person in a relationship with a 40 year old and our observation is that this is abnormal. For the most part this is right. When we start to look at others behaviour we must think about what they are thinking when they do this. Most of us do not behave inappropriately on purpose… too often anyway. There is also a number of theories from a number of very noted behavioural theorists that can help us determine whether a person is normal or abnormal.
 
Aside from the clear observable issues like shakes, poor eye contact or hyperactivity some peoples behaviour can just be different to us. One of the best way we know of to observe and relate to a person on a behavioural level is DISC. Disc is a quadrant based behavioural analysis tool which can help you to determine if another person is nuts or just in a different quadrant than you. Since doing some training in DISC and using this to view peoples behaviour I have found that my mental state exams (as well as my general observations) have become more clear.
 
PS. If you observe something that seems out of the ordinary, try to explain what it is. For example, ‘John seemed depressed’, will not get you much help from a clinician. However, if you say, ‘John seemed depressed as he was making poor eye contact, was mumbling and wouldn’t finish sentences’, then you are more likely to elicit a response from clinicians.
 
We hope this helps. See you next week for part three, Speech.

 

 

Youth workers need to do more than just support young people.

As a youth worker I have worked in a number of settings. I have learnt new skills and tried new things. One thing however that has stayed the same through all of those settings is that youth work is not all I have done. I have been a plumber, a carpenter, a painter, an envelope stuffer, a mechanic, a teacher, a chef, a guitarist, an accountant and many others. For most of my job I do all this other stuff and use my youth work skills to engage with young people and expand our service.




MItchell Youth Centre
 
Some of these skills I have gained over my lifetime. Others I learnt on the go. All of them are secondary to my youth work, however without them I would be little more than a counsellor. Recently I have been developing a youth centre for a local council and it has meant a lot of non-youth work. I have painted, cut, built and sanded to my hearts content. One of my supervisors said to me recently that I needed to be more than a Coordinator of Youth Services. I needed to get my hands dirty. All he saw was my time with my staff and when i was at my desk.
 
When people only see our work in throughput numbers or KPI’s from a position description then these other skills don’t add into the equation. My supervisor didn’t see my networking, my painting or my building skills. He didn’t see the participation of the young people in the development of the centre. All he saw was that I wasn’t at my desk. I wasn’t doing paperwork or running another useless meeting. In his eyes I was not getting my hands dirty like some of my colleagues.
 
Never let a person say you are not doing youth work when you are using these secondary skill sets. Do not let appearances ruin your work. I have built stronger relationships with young people over the last month through building tables and painting walls than had been built previously in one on one meetings. I have better relationships with service providers because I took the time to have a coffee and talk about their cars, or house building or choice in music. Youth work is all about developing relationships. How we develop those relationships often come down to the secondary skills we have. Today’s neoliberal world does not care about this. They care about numbers. They see this as ‘support’.
 
We need to do more than just support young people. At least in the way governments and funding bodies ask us to. We must build deep relationships. It is through these relationships that we can do our best work, and these relationships are built on life and the skills we have picked up while living it. Those secondary skills are just as important, if not more so, than any counselling session or group work program. Building relationships with young people where they are at is what youth work prides itself on. But more often than not these days we are berated for doing this as it does not tick the numbers box. We must strive to be more than just another ‘support’ mechanism for our young people. We must do life with them.