This clinician encouraged the client to process what coping skills have and have not worked with regard to managing sadness and encouraged the client to verbalize if he would be interested in attending a support group for individuals who have lost a child as a means to address the sadness related to the death of his daughter medications errors pictures generic sustiva 600mg fast delivery. This clinician encouraged the client to review his safety plan to ensure that the client is clear regarding steps he can take if he feels he needs assistance between sessions and reviewed the various coping skills that can decrease depressive symptoms such as going for a walk medications used to treat adhd quality 200mg sustiva, attending his psychiatry appointments regularly and asking for support when it is needed medications jamaica cheap 200 mg sustiva visa. R: Client reported that his weekend was "okay" but stated that he did not really go anywhere as planned because he "just did not feel like it" treatment yeast infection male 200mg sustiva with mastercard. The client reported that his depression was currently at a 5 and that he just wishes that people could understand him. Clinician struggled to verbalize what coping skills help him and continued to state that all he needed was "time" to get over his sadness. Client reported that he would be willing to attend a support group for people who have lost a child and stated that he planned to attend next week. The client reviewed his safety plan and agreed to follow the steps necessary to request support if needed. P: Clinician will continue to meet with the client 2x per week to assist him with developing and utilizing coping strategies to assist him with decreasing depressive symptoms and isolation. He was able to report that the extra support he has been receiving from his foster parents over the past month has been helpful and that sometimes he needs to be reminded of his goals. Each individual present reported that the client has been better able to manage his feelings of frustration in the school and home setting and discussed community resources they feel may be of additional support to the client. Interventions refer to what the practitioner will do in order to assist client with meeting their objective and life goals. Medi-Cal refers to Medicaid program in California from which reimbursements for medically necessary services are received. Mental Health Service Procedure refers to program-specific procedure used in progress notes to inform what services were provided by practitioner. Objectives refer to the smaller accomplishments/steps the client makes in order to achieve their life goals. Service activities may include but are not limited to assessment, plan development, therapy, rehabilitation and collateral. The services may include evaluation of the need for medication, evaluation of clinical effectiveness and side effects, the obtaining of informed consent, medication education and plan development related to the delivery of the service and/or assessment of the beneficiary. Service activities may include but are not limited to assessment, collateral and therapy. Crisis intervention is distinguished from crisis stabilization by being delivered by providers who are not eligible to deliver crisis stabilization or who are eligible, but deliver the service at a site other than a provider site that has been certified by the department or a Mental Health Plan to provide crisis stabilization. Action Button Definitions: Renew - Extends the date of authorization by one year from the date the plan is finalized. Other reasons may include updating a provider or staff name, or adding achievement dates. Add Objective /Intervention - To add objective(s)/intervention(s) to an existing finalized plan. Every program must have an intervention(s) that corresponds to one or more objectives, and the provider/program name in the intervention must match the provider/program name on your service notes or else you will not be able to finalize or bill for them. In the "Authorization" section of the plan you must scroll down the list of names to identify and forward the plan to your Supervisor. The "edit" action also allows adding an achievement date to an intervention without creating a new C. Your individual program may use forms in addition to the ones listed here and they may be located in alternative Drives or files specific to your program workflow. Francis Hospital Mills Peninsula Health Services John Muir Behavioral Health Center Aurora Hospital * Within 30 days of discharge for up to 3 non-consecutive 30 day periods. We are committed to assisting urban youth to become healthy and productive adults. Together with community partners, the Center conducts research to identify the needs and strengths of young people, and evaluates and assists programs to promote the health and wellbeing of young people. We would also like to thank the Charles Crane Family Foundation and the Shapiro Family Foundation for their support for the Guide. Members of the scientific Advisory Board the Scientific Advisory Board provided insight and information in their professional review of the chapters. CatherineBradshaw,PhD Assistant Professor, Department of Mental Health, Associate Director, Johns Hopkins Center for the Prevention of Youth Violence, Johns Hopkins Bloomberg School of Public Health RobertCrosnoe,PhD Associate Professor, Department of Sociology & Population Research Center, University of Texas at Austin JacindaDariotis,PhD Assistant Scientist, Center for Adolescent Health, Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health NikeeaC. Russell,PhD Professor & Director, Frances McClelland Institute for Children, Youth & Families, Norton School of Family & Consumer Sciences, University of Arizona FreyaL. But make room on the bookshelf, because the time has come with the release of the Teen Years Explained: A Guide to Healthy Adolescent Development. By compiling in plain English the science behind adolescence, the authors have produced a comprehensive yet accessible resource that 1) explains, without oversimplifying, the complex processes of development; 2) challenges and empowers adults to invest more attention, more time, and more resources in adolescents as they transition to adulthood; and 3) gives youthdevelopment professionals the knowledge they need to ensure that healthy adolescent development is an explicit goal of their work. Everything from basic social development theory to cutting-edge neuroscience is packed into this guide, making it a useful reminder of some key principles underlying the youth development movement and a resource for adults who find themselves helping teens navigate a world that likely feels different from the one they grew up in. At the Forum for Youth Investment, we are committed to supporting leaders who are working on youth issues. One thing we try to do is meet people where they are, but quickly help them see a bolder path. Simple catchphrases often help us do that, and three in particular are reinforced by this guide. Ensuring teenagers enter adulthood addiction-free, without dropping out of school, and with no arrest record is a short-sighted goal that reflects low expectations. Embracing adolescence as a time of opportunity is difficult, given the real risks associated with this period and the unacceptable numbers of young people who are, in fact, dangerously disconnected. Yet reframing development as a positive, normative process is critical if parents, professionals, and institutions are to support, socialize, challenge, and instruct. The scientific evidence now firmly supports the notion that, while development unfolds across different domains, developmental processes are inextricably intertwined. Behavioral health affects learning; cognitive development affects behavioral health; civic engagement influences identity development. By describing and knitting together the processes that unfold across developmental domains and coming back to themes such as the importance of positive relationships, the Guide reminds readers that effective practitioners-whether employed in after-school programs, teen centers, schools, courts, camps, or hospitals-understand the basics of adolescent development and its implications for creating supportive learning environments where teens can thrive. Young people move in and out of numerous settings every day-familial, institutional, informal, virtual. The range of environments they encounter grows with the increasing autonomy of adolescence. The Guide challenges us to remember that while we will not and should not always have control over adolescents, we can, in fact, shape many of the settings where they spend time. Creating contexts that nurture growth and minimize risk requires the kind of working knowledge of adolescent development that this guide offers. We need youth-centered, not system-centered, approaches the vast majority of policy and practice conversations about youth well-being taking place across the country focuses on systems. Increasingly, conversations are taking place across multiple systems: How can juvenile justice and child welfare work together better to support transitioning youth How can schools and community-based organizations work together to reduce the dropout rate While these attempts to work across systems are promising, most are still system-centered conversations. As a result, they are organized around and constrained by expertise and assumptions about systems, as opposed to expertise and assumptions about young people and their developmental needs. Over the years, the Forum for Youth Investment has moved away from leading with terms like "adolescent development" and "youth development. Stating that we wanted to help leaders leverage the considerable financial and human resources spent addressing specific problems. If we are serious about changing the odds for young people-about ensuring that they are indeed ready for college, work, and life-then it is our responsibility as practitioners, advocates, and policy-makers to use the information in this guide to check our assumptions, allocate our resources, and rethink our approaches.
The most common causes of obstruction are prostatic hypertrophy symptoms 7 days before period generic 600mg sustiva otc, cancer of the prostate or cervix medicine norco generic sustiva 600 mg free shipping, or retroperitoneal disorders 86 treatment ideas practical strategies 600 mg sustiva. In addition medications like zovirax and valtrex discount 200mg sustiva otc, kidney stones, blood, fungal infection, and bladder malignancy may result in obstruction. The clinician should become familiar with the most common causes, in order to prevent avoidable worsening of the course of chronic kidney disease. Further limiting the comparability of the results across the studies is the wide variation in the selection of analytic techniques and presentation of data. A major limitation of this guideline is its failure to provide a semi-quantitative assessment of the relationships between the factors assessed and the outcomes of rate of progression or risk for kidney failure. This review of these studies does not provide a conclusive answer to the causes underlying the more rapid rate of progression or increased risk for kidney failure. Stratification 229 There is a broad range of factors that are associated with more rapid decline in kidney function, some of which are amenable to interventions. Certain patient groups, defined by either type of kidney disease, clinical, gender, racial, or age characteristics, are at greater risk for progression of kidney disease-this denotes the need to increase awareness among patients and providers about proper care and the need to institute interventions to attempt to slow progression. It is thus critical to educate patients and providers regarding the risk factors and to facilitate providing aggressive interventions where indicated. This may require changing the policies of care providers and payers regarding frequency of follow-up and payment for medications. However, there are certain factors whose impact has not been conclusively determined, such as dietary protein intake, hyperlipidemia, and anemia and their treatment. Many of the conclusions regarding the impact of factors unrelated to intervention, such as age, gender, race, and cause of kidney disease, come from ``small' interventional trials. Similarly, in the case of the impact of blood pressure control, conclusions largely come from the observations that patients with lower blood pressures have improved outcomes. Alternatively, a sufficiently large prospective interventional trial could achieve a similar goal. In the kidney, these changes may lead to increased trafficking of plasma proteins across the glomerular membrane and to the appearance of protein in the urine. The presence of urinary protein not only heralds the onset of diabetic kidney disease, but it may contribute to the glomerular and tubulointerstitial damage that ultimately leads to diabetic glomerulosclerosis. It highlights the strong relationship between progressive diabetic kidney disease and the development of other diabetic complications and emphasizes the importance of monitoring and treating diabetic chronic kidney disease patients for these other complications. Microalbuminuria is present when the albumin excretion rate is 30 to 300 mg/24 hours (20 to 200 g/min) or the albumin-to-creatinine ratio is 30 to 300 mg/ g. Thus, macroalbuminuria and proteinuria may be relatively equivalent measures of urinary protein excretion (see Guideline 5). Nevertheless, differences in methods of measurement and the lack of standardized definitions or terminology often make comparisons between studies difficult. Definitions of Diabetic Complications Other Than Chronic Kidney Disease Cardiovascular disease. Cardiovascular disease is not a specific complication of diabetes per se, since it occurs frequently in nondiabetic individuals. Stratification 231 lar disease in diabetic patients and may accelerate the process of atherosclerosis. For the purposes of this guideline, cardiovascular disease refers to coronary heart disease, cerebrovascular disease, peripheral vascular disease, congestive heart failure, and left ventricular hypertrophy. The American Diabetes Association provides clinical practice recommendations for screening and treatment of cardiovascular disease in diabetes526 which are available on the Internet ( On the other hand, cardiovascular disease itself may increase the level of urinary albumin/protein. Thus, the extent to which chronic diabetic glomerulosclerosis is an independent risk factor for the development of cardiovascular disease may be difficult to determine with certainty, especially in congestive heart failure, without demonstrating diabetic kidney damage at the tissue level. The earliest change of diabetic retinopathy that can be seen with the ophthalmoscope is the retinal microaneurysm. Growth of abnormal blood vessels and fibrous tissue that extends from the retinal surface or optic nerve characterizes the proliferative stage of diabetic retinopathy. With experience, these changes can be identified readily by direct ophthalmoscopy, preferably through dilated pupils. Stereoscopic fundus photographs, however, produce a more reliable and reproducible assessment of diabetic retinopathy. The Airlie House Classification scheme, or a modification of this scheme, is commonly used to classify the level of retinopathy in epidemiological studies; the more severely involved eye is used for classification. The American Diabetes Association provides clinical practice recommendations for screening and treatment of diabetic retinopathy. Some studies performed retinal photographs (from 2 to 7 fields, depending on the study) and others relied on ophthalmoscopic examinations through dilated pupils. Moreover, retinopathy was graded by the Airlie House Classification scheme (or a modification of this scheme) in some studies and by less precisely defined clinical criteria in others. Beyond methodological issues, the absence of retinopathy in some subjects with elevated albuminuria/proteinuria may reflect the presence of nondiabetic kidney disease, particularly in older type 2 diabetic patients. These factors undoubtedly contributed, at least in part, to the reported variability of the association between retinopathy and albuminuria/proteinuria. Diabetic neuropathy is perhaps one of the most difficult complications of diabetes to measure. Although 60% to 70% of people with either type of diabetes are affected, many investigators in the past used non-standardized methods for measuring neuropathy. The lack of standardized nomenclature and criteria for diabetic neuropathy 232 Part 7. Accordingly, studies examining the relationship between the level of urinary albumin/protein and diabetic neuropathy often yielded confusing and conflicting results. In 1988, a joint conference of the American Diabetes Association and the American Academy of Neurology adopted standardized nomenclature and criteria for the diagnosis of neuropathy in diabetes. Subclinical neuropathy is defined as an abnormal electrodiagnostic test, quantitative sensory threshold, or autonomic function test in the absence of clinical signs and symptoms. Clinical neuropathy is defined as an abnormal test associated with clinical signs and/or symptoms. The American Diabetes Association provides clinical practice recommendations for screening and treatment of diabetic neuropathy. Since reviews often reported the associations qualitatively, individual studies were included to provide quantitative estimates of the association. Reference was also made to individual studies of nonCaucasian patients, since many reviews reported only results from studies in Caucasians. Given the low rate or absence of type 1 diabetes in many non-Caucasians, the impact of ethnicity on the relationship between proteinuria and other diabetic complications was examined only in those with type 2 diabetes. Cardiovascular disease is related to the level of proteinuria or albuminuria in diabetic kidney disease (Table 127 and Figs 51 and 52) (R, C). Increased cardiovascular mortality was linked with elevated urinary albumin excretion in type 2 diabetes in 1984578,579 and with type 1 diabetes in 1987. Crude association of microalbuminuria and cardiovascular morbidity or mortality in type 2 diabetes. The results are presented with (total) and without (subtotal) the study that included subjects with clinical proteinuria. The association between diabetic kidney disease and cardiovascular disease is generally considered stronger in type 2 than in type 1 diabetes at all levels of albuminuria/ proteinuria, due in large part to the older age of the type 2 diabetic patients. These results may be influenced by the racial/ethnic mix of the sample cohort, since some populations included in the cohort with high rates of type 2 diabetes, such as the Pima Indians, have lower rates of cardiovascular disease than Caucasians with type 2 diabetes. In this review, patients with microalbuminuria had an overall crude odds ratio for cardiovascular morbidity and mortality of 2. Retinopathy is related to the level of proteinuria or albuminuria in diabetic kidney disease (Table 128) (R, C). Review articles evaluated for this guideline included patients from clinic and population-based studies of type 1 and type 2 diabetes. Stratification 235 quently,603,604 particularly in type 2 diabetes, because of the coexistence of nondiabetic kidney disease. Nevertheless, the incidence of proliferative retinopathy increases dramatically with the development of elevated urinary albumin/protein excretion. Less is known about the strength of the association between urinary albumin/protein excretion and neuropathy than about the other complications of type 1 and type 2 diabetes. The review articles evaluated for this guideline comment briefly that some studies found a relationship whereas others did not.
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We are also developing plans for a new Institute for Urban Population Health medicine chest 600mg sustiva free shipping, a collaboration with local partners to bring about transformational change to health in local communities symptoms 0f low sodium purchase 200mg sustiva amex. We want to achieve a measurable improvement and impact on health gain and local management of physical and mental health problems through new evidence based interventions symptoms 2 cheap sustiva 600mg mastercard. We are proud of our ability to control information systems for the purpose of data creation symptoms 5 weeks 3 days discount sustiva 600 mg without a prescription, curation and analysis, with strong and transparent information governance processes throughout. We have developed a clear strategy and action plan to maintain and develop leadership in the field of informatics. Systems have been developed to enable electronic healthcare records to be shared across our partner organisations and with other healthcare organisations. We are working with patients to make electronic patient information available in an anonymised format between partner trusts, primary care and social care. Together we have a powerful information resource for both practitioners and researchers. Services are provided for people living in Croydon, Lambeth, Lewisham and Southwark and for patients from around the country who need specialist care. We provide assessment in the community, and treatment where patients can access talking therapies and social care for selfhelp and problem-solving to intensive day services. We also provide inpatient and outpatient services for people who need more intensive treatment and support. The aim was to challenge the myths, taboos and stigma around mental illness and its treatment in Britain today. Notwithstanding this change, the needs of patients and the commitment of clinicians, researchers and teachers to Mood, Anxiety and Personality Disorders endures. It is headed up by Professor Allan Young and coordinates our research in mood, bringing together many experts in this field. Affective disorders are projected to become the leading contributor to the global burden of disease by 2020, reflected in a notable expansion of mental health services for this target group. The programme provides world-class specialised graduate training in affective disorders, with a strong clinical element. A multidisciplinary approach is used, capitalising on the most recent findings from a range of disciplines including psychiatry, psychology, genetics, neuroscience, psychopharmacology, epidemiology and biostatistics. This includes specific cognitive-behavioural protocols for individuals with chronic fatigue syndrome, chronic pain, fibromyalgia, irritable bowel syndrome, diabetes and chronic obstructive pulmonary disease. It provides psychoeducation, relaxation skills, mindfulness techniques, pacing techniques, sleep hygiene techniques and depressive thinking selfmanagement techniques. People who attend may be on many medications, may feel isolated, be living on benefits and have lost their ability to work. This is an eight-week group programme aimed at helping patients to cope with their physical symptoms and associated stress, anxiety or depression. The group focuses on behaviour changes that lead to healthier habits and facilitates an average weight loss of 2. Personalised care was acceptable to people and those who received it reported less chest pain after six and 12 months. Depression was frequent, but anxiety was more common and increased the chances of both heart attacks and death. Further research is planned to more fully understand the links between anxiety, chest pain and heart disease 2 Whilst first-line psychological treatments are effective for nearly half of attenders, there remain a substantial number of patients who do not benefit. We have successfully recruited and assessed approximately 350 participants using the new Clinical Research Facility. Participants are approached before starting treatment and offered a baseline interview to be carried out while they are waiting. Consenting participants complete a diagnostic interview, are asked to give blood and hair samples for relevant biomarkers and complete psychological and social questionnaire measures. They then go on to complete their psychological therapy as offered by the Southwark Psychological Therapies Service. This will allow us to test for relationships between predictor variables and patient outcome measures, with the goal of basing future clinical decision-making on the individual needs of the patient in an evidencebased manner. Currently, there are no clear predictors of treatment outcomes for these patients. Here we report on the first year of recruitment and describe the characteristics of our sample to date. Approximately half (46%) were taking prescribed psychotropic medication (most frequently antidepressants). Our initial data also indicated that 16% met criteria for borderline personality disorder and 69% were at high risk of personality disorder. Over half of participants (55%) reported experiencing at least one stressful life event in the previous 12 months, whilst 67% reported experiencing at least one form of childhood trauma. Within this overall assessment, our research environment was given a 100% world-leading rating and the impact of our work was judged to be 100% world-leading or internationally excellent. Building on their success, we plan to hold regular seminars to foster ongoing communication of research needs and findings, and collaboration between clinicians and academics. Clinical Outcomes Clinical outcomes are measurable changes in the health or quality of life of patients that result from the care they have received. The constant review of clinical outcomes establishes standards against which we can continuously improve all aspects of clinical practice. Patients told us that one of the barriers to this was lack of clarity about how to make complaints. Figure 3 Showing the number of complaints over the last five years 124 98 84 102 121 Quality of care outcomes We aim to ensure that all patients get the most effective care in a timely and efficient manner. Level of complaints One of our priority areas has been to review the number of complaints. The service offers an integrated and culturallysensitive approach to treatment where patients are provided with a treatment programme tailored to their cultural and linguistic needs, as well as to the complexity of their symptoms. The aim is for patients to develop a sense of control and to support healthy boundary development. We achieve this through a variety of modalities of treatment, using a tailor-made programme devised for each patient. They provide advice and brief treatment, including self-help therapy for people aged over-18 with depression or anxiety. A particular focus of the service is caring for people who are unemployed or who are at risk of losing their job. Description of service the anxiety care pathways cover numerous clinical pathways for different diagnoses of anxiety and related disorders, as well as complex co-morbid conditions in which anxiety forms a significant aspect. For the hoarding pathway, we are working with local authorities and others to establish a coordinated response, including seeking funds for specific new projects. For the agoraphobia pathway, we have established basic principles underpinning provision. The out-patient assessment and follow up service has continued to manage increasing demand offering a viable treatment option for many individuals with treatment resistant disorders. It provides an alternative treatment environment for those who do not require inpatient care, but will benefit from the residential treatment and support of a compassionate community. There was a mean overall improvement in YaleBrown Obsessive Compulsive Scale score of 17 (s. Residents are invited to complete a satisfaction survey at the end of their treatment. Residents were also asked whether they would recommend the unit and the mean recommendation score was 4. Residents were also invited to make comments as to ways in which the service could be improved. All the therapists, occupational therapists, assistant therapists and support staff work together as a seamless team. The therapist travelled to my home and helped me apply what I had learned in the unit.
When peers were present symptoms herpes sustiva 200mg without prescription, additional brain circuitry that processes rewards was also activated treatment molluscum contagiosum cheap 200mg sustiva overnight delivery, the building blocks of empathy emotional and social development in context Adolescents face an astonishing array of options in modern society-everything from choosing multiple sources of entertainment to deciding among alternative educational or vocational pathways medicine stone music festival discount sustiva 600mg without a prescription. Teenagers are confronted with more decisions treatment dvt cheap 200mg sustiva, and more complicated decisions, than their parents and grandparents faced, often in complex environments that trigger conflicting feelings and desires. Responsible decision-making involves generating, implementing, and evaluating ethical choices in a given situation. The choices ideally will benefit both the decision-maker and the well-being of others. The still-developing frontal lobes in the brain render adolescents vulnerable to making poor decisions; they can have trouble forming judgments when things are cloudy or uncertain. The Cognitive Development chapter gives strategies for helping young people with their decisionmaking skills. Empathy is the foundation of tolerance, compassion, and the ability to differentiate right from wrong. Empathy motivates teens and adults alike to care for those who are hurt or troubled. Ways you can help build empathy in an adolescent: Demonstrate tolerance and generosity in your thoughts, words, and actions. Actively participate in religious or social organizations that ask you to focus on issues larger than yourself. Fine-tune your own empathetic behaviors and act on your concerns to comfort others, so that teenagers can copy your actions. Teach empathy and awareness of others, such as helping youth understand on an emotional level the negative consequences of prejudice. Talk with a young person about how his or her own suffering can lead to compassion for other teens who experience suffering. By late adolescence and early adulthood, the cognitive control network matures, so that even among friends in a highpressure situation, the urge to take risks diminishes. Because heightened vulnerability to peer influence and risk-taking ap- pears to be a natural and normal part of neurobiological development, telling adolescents not to give in to peer influence may not be effective, especially during early adolescence. Instead, teens may be best protected from harm through limiting exposure to risky situations. Harm-reducing tactics include raising the price of cigarettes, rigorously policing the sale of alcohol to minors, placing restrictions on teen driving, and making reproductive health services more accessible to adolescents. Talk with young people about what distinguishes true friends from situational friends. They try to help and encourage you, and they stand by you when the other kids make fun of you or give you a hard time. A true friend does not judge you by the clothes you wear or how much expensive stuff you have, pressure you to go along with the crowd, make you do dangerous or illegal things, or leave you high and dry when things get rough. Find out what adolescents are interested in-computers, music, dance, poetry slams, sports, science fiction/fantasy-and help start a club, or get teens involved in existing organizations. Find role models for friendship Examples of good friendships abound in movies, books, and songs, and also in your community. Friendship could be the theme of a book club or a movie series in a youth program. Expose adolescents to real-life role models and then discuss what good friendships have in common. Community service also promotes the values of caring and kindness, and it helps adolescents develop a sense of empathy. Possible scenarios include what to say when someone asks, "Do you like my new haircut Stress the importance of boundaries, establishing limits, and respecting privacy and "alone time," which make friendships healthier and stronger in the long run. The early teen years are marked by rapid changes-physical, cognitive, and emotional. Young people also face changing relationships with peers, new demands at school, family tensions, and safety issues in their communities. The ways in which teens cope with these stressors can have significant short- and long-term consequences on their physical and emotional health. Difficulties in handling stress can lead to mental health problems, such as depression and anxiety disorders. Getting into a fight with a friend is stressful, but so is a passionate kiss and contemplating what might follow. The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. The hormones speed Y stress After-school or summer jobs Dating and friendships Pressure to wear certain types of clothing, jewelry, or hairstyles Pressure to be a particular size or body shape. Dealing with the physical and cognitive changes of puberty Family and peer conflicts Being bullied or exposed to violence or sexual harassment Crammed schedules, juggling school, sports, after-school activities, social life, and family obligations things that can cause youth School pressure and career decisions Pressure to experiment with drugs, alcohol, or sex up heart rate, breathing rate, blood pressure, and metabolism. This physical response to stress kicks in much more quickly in teens than in adults because the part of the brain that can calmly assess danger and call off the stress response, the prefrontal cortex, is not fully developed in adolescence. The stress response prepares a person to react quickly and perform well under pressure. The stress response can cause problems, however, when it overreacts or goes on for too long. The things that cause adolescents stress are often different from what stresses adults. Others are out there dancing their feet off, talking and laughing and hoping the music never stops. In between, you 38 the teen years explained may find a few kids pretending to be bored, hanging out with their friends, and maybe venturing onto the floor for a dance or two. It is best, whenever possible, to help teens address stressful situations immediately. Listen to them, be open, and realize that you can be supportive even if you cannot relate to what they are feeling. Tune in to your own levels of stress, since your overwhelmed feelings can be contagious. For chronic stress, parents or caring adults can help teens understand the cause of the stress and then identify and practice positive ways to manage the situation. It may be regarded as a regular-albeit nasty- part of growing up, but research has shown that bullying has far-reaching negative effects on adolescents. This all-too-common experience can lead to serious problems for young people at a critical time in their development, including poor mental health and dropping out of school. In a 2001 national survey of students in grades six to 10, 13 percent reported bullying others, 11 percent reported being the target of school bullies, and another 6 percent said they bullied others and were bullied themselves. Teen bullying appears to be much more common among younger teens than older teens. As teens grow older, they are less likely to bully others and to be the targets of bullies. Bullying involves a person or a group repeatedly trying to harm someone they see as weaker or more vulnerable. Bullying can involve direct attacks-hitting, threatening or intimidating, maliciously teasing and taunting, name-calling, making sexual remarks, sexual assault, and stealing or damaging belongings. Bullying can also involve the subtler, indirect attacks of rumor-mongering or encouraging others to snub someone. New technology, such as text messaging, instant messaging, social networking websites, and the easy filming and online posting of videos, has introduced a new form of intimidation- cyberbullying-which is widespread on the Internet. Debunking the myth of the bully the typical portrait of a young bully is someone who is insecure and seething with self-loathing. The latest research indicates the opposite is often true, that teen bullies-both boys and girls-tend to be confident, with high self-esteem and elevated social status among their peers. This can 40 the teen years explained taking the bark out of bullies Bullying should not be shrugged off as a normal rite of passage in adolescence. It is abusive behavior that is likely to create emotional and social problems during the teen years and later in life for both the victim and the aggressor. Here is how adults can help: SpeAk up after a teen tells you about being bullied at school or elsewhere. Speak to the parents or adults in charge if a teen is being harassed by a peer or social clique. Adolescents look to adults for cues as to how to act, so practice being caring and empathetic, and controlling your aggressions.
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