Therapeutic Interventions

Describe the child's symptoms of depression and their effects on the family. (1, 2)

Arrange for the child to obtain a complete physical and psychological evaluation of the depth and causes for depression. (3, 4)

1. Meet with the parents to gather a family history and review their observations of the child's symptoms of depression and how this is affecting the family.

2. Gain permission from the parents to contact the school to acquire any information relevant to their child's symptoms of depression and how these symptoms have affected school adjustment.

3. Assign the parents to schedule a physical and neurological examination by the child's physician to rule out physical causes of the child's symptoms of depression.

4. Instruct the parents to arrange for a complete psychological evaluation of the child with a private therapist, mental

3. Review various treatment options for childhood depression and select a course of action to pursue.

4. Gain a deeper understanding of depression, its causes, and treatment strategies by joining a support group, reading recommended literature, or viewing tapes about depression. (7, 8)

5. Teach the child to replace distorted, negative perceptions that contribute to health clinic, or a psychiatric hospital.

5. Review treatment options with the parents (e.g., no intervention, behavioral interventions, cognitive therapy, medication, hospitalization) and help them determine an initial plan based on the following considerations: (1) The age of the child, (2) the severity of the illness, (3) existing comorbid conditions, and (4) parents and child's attitude toward medication.

6. Encourage the parents to obtain treatment for the existing depression of the child and other family members immediately and to remain alert to future episodes after the current problem has been successfully treated.

7. Direct the parents to informational resources offering best practice interventions and treatments for childhood and adolescent depression (e.g., American Academy of Child and Adolescent Psychiatry, www.aacap.org, Child and Adolescent Bipolar Foundation, www.bpkids.org, or the National Mental Health Association, www.nmha.org).

8. Assign the parents to read literature which describes depression, it's causes and coping strategies (e.g., Survival Guide to Childhood Depression by Dubuque or 'HelpMe I'm Sad'by Fassler and Dumas).

9. Assign the parents to assist the child in identifying and eliminating negative thoughts the depression with positive, realistic thoughts. (9, 10)

6. Engage the child in age-appropriate, creative, or enjoyable activities and/or social events. (11, 12)

7. Examine all relationships in the child's life to determine factors contributing to the depression. (13, 14)

and replacing them with positive perceptions (or ask them to complete with their child the "Creating Positive Self Talk" activity from the Parenting Skills Homework Planner by Knapp).

10. Instruct the parents to engage in mutual story telling with their child by letting the child initiate a story and using parental input to guide the script toward a positive or an optimistic conclusion.

11. Advise the parents to insist that the depressed child participate in activities and social events on a daily basis and to make privileges desired by the child contingent upon engagement in these activities.

12. Assign the parents to enroll the child in age-appropriate activity groups to counter the tendency to perseverate about feelings of hopelessness.

13. Assign the parents to create a list of all the relationships in the child's life and rate each one as a positive, negative, or neutral influence on the child; instruct the parents to seek input from the child and to be especially alert to relationships which are manipulative, controlling, or abusive in nature.

14. Instruct the parents to promote positive relationships and eliminate or manage negative relationships in the child's life (or ask them to complete the "Managing Positive and

Encourage the child to actively participate in school and school-sponsored activities. (15, 16, 17)

9. Spend time alone with the depressed child's siblings to promote their self-esteem and reinforce their attempts to cope with their depressed sibling. (18, 19)

10. Commit to collaborate with all family members to help the child overcome his/her depression. (20)

Negative Relationships" activity from the Parenting Skills Homework Planner by Knapp).

15. Instruct the parents to insist on regular school attendance and to strongly encourage and support the child's participation in school-related programs and activities.

16. Assign the parents to meet with the school social worker or counselor to enlist counseling support for the child and explore the child's participation in focused counseling groups at school.

17. Instruct the parents to meet with the school psychologist and other educational staff to explore the possibility of a learning disability or other identifiable problems that may be contributing to the child's depression and may qualify the child for special education or other academic accommodations.

18. Encourage the parents to remain sensitive and empathetic to the needs of the depressed child's siblings and to schedule time for interaction and activities several times per week.

19. Meet with the child siblings to evaluate their feelings and frustrations of living with a depressed sister or brother and role play methods of engaging their sibling in positive interactions.

20. Brainstorm with the couple or the single parent methods of enlisting the support of the noncustodial or estranged

11. Engage in relationship counseling and couple-centered activities to strengthen the marital bond. (21, 22, 23)

12. Identify and replace any depressive, negative cognitions and distorted perceptions that may be affecting the emotional well-being of the child with depression and other family members. (24, 25)

13. Identify the negative consequences of financial instability on family functioning. (26)

14. Increase family income through employment and/or community agency assistance. (27, 28)

parent, or blended and extended family members in supporting the family's plan to treat the child's depression.

21. Enlist the parent's commitment to support one another and avoid any manipulation or triangulation that may be contributing to the child's depression.

22. Explore with the couple how the child's depression is affecting their relationship and assist them in brainstorming methods of remaining loving and supportive toward one another.

23. Assign the parents to schedule "couple-time" daily for personal communication and weekly for activities of mutual interest.

24. Review with the parents their own history of depression and mental illness and refer them to a mental health professional for evaluation and treatment if there is any indication of psychopathology.

25. Explore with the parents any of their negative perceptions or attitudes that are contributing to the child's depression and brainstorm with the parents methods of modeling a more positive attitude.

26. Explore with the parents the effects of poverty on the family and the child (e.g., lack of nutritional meals or appropriate clothing, frequent geographic moves).

27. Help the parents develop a plan for obtaining consistent employment and needed economic assistance and

15. Establish safe and stable housing for the family. (29, 30)

16. Reassure the child about personal security, express an awareness of and empathy for the child's fears, and commit to maintaining a supportive and loving relationship. (31, 32)

17. Seek treatment for alcohol and drug dependency. (33, 34, 35)

services; note any roadblocks to achieving these goals.

28. Refer the family to agencies that provide social, financial, and economic services and help the family apply for these services.

29. Assign the parents to assess their current housing and neighborhood in terms of safety, stability, and suitability and determine if poor and unsafe living conditions are contributing to family volatility and the child's depression.

30. Assist the parents in enlisting the help of community agencies (e.g., Habitat for Humanity, www.habitat.org, Department of Housing and Urban Development programs: (800) 569-4287) in finding safe and suitable housing.

31. Assign the parents to read How to Talk so Kids Will Listen and Listen so Kids Will Talk (Faber and Mazlish) to assist in opening the lines of positive communication with the child.

32. Instruct the parents to schedule a daily time for actively listening to the child, offering reassurance about personal security and expressing an awareness of and empathy for the feelings of fear, helplessness, and hopelessness.

33. Instruct the parent with a chemical dependence problem to participate in substance abuse treatment program and to commit to the long-term termination of any abuse of substances.

18. Utilize discipline strategies that teach responsibility and self-reliance. (36, 37)

19. Impl ement regul arly scheduled family meetings to promote expression of feelings and family cohesion. (38)

20. Increase and record the frequency of verbalizing affirmations to all the children in the family. (39)

34. Direct the parents to require drug and alcohol testing if there is a suspicion that the depressed child is using restricted substances.

35. Instruct the parents to enroll the child in a rehabilitation program if there is evidence that the child is using alcohol or drugs.

36. Assign the parents to help the child develop responsible behavior by implementing the four steps to teaching responsibility: (1) assign chores and tasks to the child; (2) expect some noncompliance, (3) issue a logical consequence for the noncompliance, and (4) give the same task again to check for learning (see Parenting with Love and Logic by Cline and

37. Instruct the parents to use controlled choices (e.g., homework before or after dinner, ride or walk to school) to shape behavior, promote decision-making abilities, and encourage feelings of empowerment in the depressed child.

38. Instruct the parents to schedule regular family meetings to promote family cohesion and to encourage each child to participate in the plans for family functioning and the resolution of family problems.

39. Teach the parents the therapeutic advantages of giving frequent affirmations to the all children in the family (e.g., enhances

21. Teach the children problemsolving skills. (40)

self-esteem, expresses encouragement, builds self-confidence) and brainstorm statements of recognition that could be directed toward the child.

40. Instruct the parents to help the child deal with personal problems using a problemsolving approach that offers support and guidance but leaves the major responsibility for resolution with the child (e.g., listen with empathy, ask for permission to share ideas for resolution, brainstorm possible solutions, allow the child to determine how he/she will handle the situation).

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