None of us come in neat little packages. As humans, we are complex and don’t often fit into one category or another. The same can be said about how we are described and labelled when we come into a behavioral health treatment setting, and the range of challenges we may face.
In clinical settings, it is not uncommon for children and youth to present with many challenges at the same time. An elementary-school age child may have witnessed family violence, seem sad, and get into trouble at school for not following directions. A high school student may be feeling anxious and depressed, have thoughts of suicide, and show angry outbursts at home. A young adult beginning college may feel lonely and depressed, and be drinking alcohol excessively.
The question for us as providers is to help determine, with our clients, what the most pressing needs are. If treatment is needed, what might the priorities be? How can we help make that determination?
One approach is to consider functional impairment as a way to guide decision making. What are the behaviors, symptoms, or challenges that are getting in the way of success in everyday life? Areas that can be affected include getting along with others, attending school or work, performing at school or work, enjoying leisure activities (things we like to do for fun or enjoyment) or tasks of daily living like bathing, eating, and dressing? Knowing what areas are most impacted can help set targets for support or treatment.
Another approach is to identify which problems, that if addressed, would have the most impact on the widest range of challenges, both now and in the future. For example, research by Khrista Boylan, Jeffrey Burke, and others has shown that high levels of oppositional behavior in children can persist over time and can increase the risk for mental health problems later in adolescence. Thus, intervening early to address significant oppositional behaviors in childhood could improve current functioning as well as prevent future challenges.
Regardless of the approach taken, determining the best targets for treatment is a decision best made by youth and families in close collaboration with a care provider. Having a shared vision of what the problem is, how to go about treating it, and what the desired outcomes are lies at the heart of effective intervention.