Author Archive: Aaron Garth

Mental state exam for youth workers: Thought process and content

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So we are a little over half way in this series. We have been developing an understanding of the core components of a mental state exam so that we can support our young people as best we can. This week I was speaking with a youth worker in one of Victoria’s largest Christian denominations about a mental health conference he was at. I was reminded about how important it is for all youth workers to have a strong understanding of mental health. So far we have discussed how a young persons appearance, behaviour, speech and language, and their mood and affect can provide indicators as to their mental state. Today we discuss how a young persons thought content can provide insight into their current mental health status.
 
A prime example of maladaptive thought content and process
 

Thought process

A young person’s thought process can tell you a lot about them. The quantity, tempo and form of thought are keys to understanding the process. A persons thought process can’t be directly observed. It can only be described by or inferred from a young persons speech. Some people may experience their thoughts coming so rapid that their speech seems incoherent. Alternatively an individual may have inhibited thinking, in which thoughts seem to progress slowly with few associations. Are they all over the place or are they clear and consistent. do they have few thoughts or do they keep returning to the same thoughts.
 
Does the young person include a great deal of irrelevant detail or make frequent diversions, but remains focused on the broad topic. Flight of ideas is typical of mania. On the other hand, young people with depression may have slow or inhibited thinking. Poverty of thought is one of the symptoms of schizophrenia, and may also be a feature of severe depression.

Thought content

When we think of thought content we would describe a young persons delusions, overvalued ideas, obsessions, phobias or preoccupations. To draw out any abnormalities of thought content we need to explore a young persons thoughts in an open-ended conversational manner with regard to their intensity, salience, the emotions associated with the thoughts, the extent to which the thoughts are experienced as one’s own and under one’s control, and the degree of belief or conviction associated with the thoughts.

A delusion is a core feature of psychotic disorders. A young persons delusions may be described as persecutory or paranoid, delusions of reference, grandiose, erotomanic, delusional jealousy or delusional misidentification. Delusions may be mood-congruent (the delusional content is in keeping with the mood), or mood-incongruent (delusional content not in keeping with the mood).  An overvalued idea is a false belief that is held with conviction but not with delusional intensity. Hypochondriasis is an overvalued idea that one is suffering from an illness and people with anorexia nervosa may have an overvalued idea of being overweight.

Preoccupations are thoughts which are not fixed, false or intrusive, but have an undue prominence in the person’s mind. Clinically significant preoccupations would include thoughts of suicide, homicidal thoughts, suspicious or fearful beliefs associated with certain personality disorders, depressive beliefs (for example that one is unloved or a failure), or some types of anxiety and depression. A Mental State Exam contributes to risk assessments of young people by including a thorough exploration of any suicidal or hostile thought content. Assessment of suicide risk includes detailed questioning about the nature of the person’s suicidal thoughts, belief about death, reasons for living, and whether the person has made any specific plans to end his or her life.
 
Stay tuned next week for part six: Perception

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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Youth work in the education system: where theory and practice collide.

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Last week we spoke about the need for youth workers in the education system to have good relationships. This week we look at the need for a good understanding of theory…youth work and educational.

In youth work we study youth development, theories of participation and many others that help us to work with young people in every situation we find ourselves in. Our theories often focus on the strengths of our young people to overcome the adversities they face. We develop our working styles around the strengths of our young people to provide a solid foundation to build relationship and work towards the future. Teachers also use their theory base to work on developing young people.

Youth work in the schooling system
 
One of the most common theories that teachers use is called scaffolding. Scaffolding was developed by Russian Psychologist Lev Vygotsky in the early years of last century. Vygotsky believed that all understanding is built on the previous learnings of a person. That a process must be undertaken to build new knowledge on top of old knowledge in the same way we build a scaffold. Vygotsky also believed in the Zone of Proximal Development. A space between what a young person can do by themselves and what they could do with the help of an adult. These two theories have permeated educational systems throughout the world for over forty years.
 
Another theorist who has permeated the education system is Ivan Ilich, an Austrian philosopher, Roman Catholic priest, and social commentator on areas such as medicine and education. In 1971 his book “Deschooling Society” gave a radical slap in the face to institutional education and how it has has limited the learnings of young people in society. Instead he posits self-directed learning as a better option.
 
A number of other theories permeate the education system and depending on where in the world you are will depend on the theory that is at the forefront of educational practice. Using the relationships you have made ask a teacher or principal to give you an overview of the theoretical approaches that they use. If you have an understanding of the theories which underpin their work then you can work with them to develop a model of practice in their school which works for both parties.
 
What theories do your schools use?
 

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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A new paradigm for world wide youth work

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For a long time now there has been a conversation going on in youth work. A professional/ para-professional dichotomy which many believe is subversive to the current push for professionalization. A conversation which preaches resistance to the neo-liberal free market push which seeks qualification over experience and cheap labour over appropriate supports.
 
The issue with requiring professionalism of a vocation is one which is being faced by social work in Australia and has been faced by psychologists. One of the issues which has and will continue to rear its head is if youth workers professionalise they will require higher pay. Higher pay in a free market means less workers. Less workers mean less appropriate service provision. Another issue is that of training and qualification. With over 75% of the current youth work employ holding a two year diploma or less where do we set the bar. The youth workers association in Victoria requires a bachelor degree for full membership. The Department of Human Services however only requires a Certificate IV for its youth work staff.
 
At Ultimate Youth Worker we believe that the professionalisation debate is currently doing more harm than good to youth work. In the storm and stress that is youth work we need all the boots on the ground that we can possibly muster. At Ultimate Youth Worker we see the current debate thinning out the herd. It makes qualifications the epitome of the profession and damns anyone else. Youth work throughout history has bucked the trends and required youth workers to think outside the square. The current push for professionalization places us firmly in the square.
 
Any dead fish can float with the current, It takes a live one to swim against it. We need a new paradigm to the idea of current professionalization ideology. We need well trained, well supported qualified youth workers! What we don’t need is a broad swathe approach to attaining this. We need a whole lot more practical wisdom in youth work. We need a whole lot more passion. We need a whole lot more accountability. What we do not need more of is control in the form of restricting sector size. We need to set ourselves apart from the pack.
 

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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First step of faith for Ultimate Youth Worker’s

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Welcome to another Monday Ultimate Youth Workers. I was recently read about the amazing work of Dr. Martin Luther King Jr. in the turbulent times of the 1960’s. There is something about a man who is thrown in to the deep end of such a massive issue that not only swims but tows a nation behind him. If that doesn’t motivate you nothing does.
 
One of Dr. King’s quotes that I read was, “Take the first step in faith. You don’t have to see the whole staircase, just take the first step”. Sometimes we don’t know what step two or three look like. We just have to take a leap. When Dr. King and the other brave residents who in 1955 Boycotted the Montgomery Bus for 385 days I am sure they didn’t think on day one that they would be there for over a year.
 
When Dr. King gave his “I have a dream” speech I don’t think that he saw the civil rights movement stalling after his death. I think he saw a moment in time where someone had to stand in the breach.
 
In his final days in 1968 Martin Luther King Jr. spoke with an authority and wisdom that some people say could only have come from a prophetic knowing that the end was near. Most of the time we do not know how our journey will end we just need to take the first step in faith and hope all will work itself out in the wash.
 
 
What is your first step in faith going to look like?

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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Mental state exam for youth workers: Mood and Affect.

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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.

Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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Youth work in the education system

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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.

What do you think? Leave us a comment below or post a comment on facebook and twitter.

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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

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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.
 

What do you think? Leave us a comment below or post a comment on facebook and twitter.

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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Motivation Monday: Ideas for the Ultimate Youth Worker

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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?

Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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What can youth worker’s learn from ANZAC day?

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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???

Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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Mental State Exam for youth workers: Speech and language.

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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.
 

You can also leave us a comment below or post a comment on facebook and twitter.

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Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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