Transitions of Life, Family, and Community

Change is a natural part of life; it is something that we all go through at various points in our lives. Some changes are expected, and others come unexpectedly.

• Change can be particularly difficult to accept when it happens suddenly and without warning.
• Even changes we plan for and desire can create immense stress and trigger complicated feelings.

Adjust means the act or process of adapting to new conditions.

• Many times, we are expected to adjust too quickly to change.
• Having to adjust, especially too quickly, can create stress.
• Sometimes that stress can feel overwhelming and can cause problems.

There are several different transitional situations that are especially difficult to adjust to and that may cause stress:

• Death and loss. See Chapter D-22: Grief.
• Chronic conditions such as illness, injury, or disability.
• Divorce or the creation of a blended family.
• Parental incarceration.
• Substance abuse by a parent, child, or other loved one.
• Pregnancy and birth.
• Family reunification.
• Moving to another residence.
• Changing schools or graduating from school.
• Changing or losing a job.
• Problems with peers (for example, bullying). See Chapter D-14: Victims of Bullying.

Changes can impact an individual, a family, or a community.

People, especially children and vulnerable adults, are better prepared to cope with changes when their loved ones:

• Take time to prepare them for change.
• Practice good communication and talks with each other about the change.
• Spend more time together to support each other through the change.

Consider how the changes in your client's life are affecting her right now. Explore how she feels about these changes and transitions; do not rely on your own assumptions about whether or not she is struggling.

• The significance of any transition is based on the individual’s perception of that event.
• What may seem very important to a child may not seem important to an adult and vice-versa.

Symptoms related to adjustment issues often are similar to symptoms of depression or anxiety.

• However, with adjustment issues, the symptoms usually resolve once the person adapts to the new situation.
• See Chapter D-8: Mood Disorders (Depression & Bipolar) or Chapter D-9: Anxiety and Worry.

Support the client's development of coping skills so she can effectively manage the transition she is experiencing.

Provide safety and consistency for the client during the times that you are working together, and help connect her with safe and reliable family members, elders, community members, or pets.

Younger children are generally more susceptible to adjustment issues because they tend to have fewer coping skills than older children or adults. However, young children may also be protected from stress because they can't as fully assess how serious a change is or how it will affect them.

Children who are struggling with transitional issues need someone to listen to them. A child in need of services may have a family that is unaware, unsupportive or unwilling to seek services.

Children who have experienced repeated trauma are at greater risk of having adjustment issues, even if the trauma was not recent.

• If the child has experienced past abuse or a traumatic experience, see Chapter D-4: Past Abuse and Neglect or Chapter D-5: Trauma and Posttraumatic Stress.

Sometimes an individual struggling with adjustment or transition may be in danger of suicide or harmful behaviors.

People who are struggling with adjustment or transition may use substances as a way to cope with the stress.

• See Chapter D-2: Substance Use and Abuse.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs )that are current or updated before getting information about the client from other sources.

Client history related to recent life changes or changes in behavior.

Treatment Plan, including a history of presenting problem and recommended course of treatment.Reviewthe DSM-5 for criteria on Adjustment Disorder.

General concerns

• Recent life changes
• Exposure to trauma
• Exposure to abuse of others
• Being abused in the present or past
• Alcohol or drug abuse in the home
• Multiple environmental or relational problems

Emotional

• Sadness
• Hopelessness
• Anger
• Lack of enjoyment
• Crying spells
• Nervousness, anxiety, and/or worry
• Trouble sleeping
• Trouble concentrating
• Feeling overwhelmed
• Thoughts of suicide
• Bedwetting (see Chapter D-28: Urinary Accidents (Enuresis) )

Behavioral

• Fights with peers or family members
• Ignores important tasks like chores or homework
• Avoids family and friends
• Performs poorly at work or school
• Skips work or school
• Vandalizes property

General concerns

• Have you been through any recent changes or transitions?
  • Death and loss. See Chapter D-22: Grief.
  • Chronic conditions such as illness, injury, or disability.
  • Divorce or the creation of a blended family.
  • Parental incarceration.
  • Substance abuse by a parent, child, or other loved one.
  • Pregnancy and birth.
  • Family reunification.
  • Moving to another residence.
  • Changing schools or graduating from school.
  • Changing or losing a job.
  • Problems with peers (for example, bullying). See Chapter D-14: Victims of Bullying.

Emotional

• Do you feel sad or hopeless?
• Have you felt irritable or angry lately?
• Do you become easily frustrated?
• Have you stopped doing things you used to enjoy?
• Have you withdrawn from family and friends?
• Do you get overwhelmed easily?
• Have you had any thoughts of suicide?

Behavioral

• Have you had trouble sleeping?
• Do you have trouble concentrating?
• Have you been getting into fights with others?
• Do you ignore important tasks, such as chores or homework?
• Do you avoided family and/or friends?
• Have you ever used alcohol or drugs?
• Have you been performing poorly at work or school?
• Have you skipped work or school?
• Have you vandalized any property?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Both personal and community-wide transitions can be very stressful. During these periods, individuals may believe that they will never regain a sense of "normal" or feel stable again. When you are working with people who are struggling with a transition, first try to validate their perspective. Being heard and feeling understood can be extremely helpful for people dealing with stress. Next, help them identify what in their life is causing so much strain, no matter how trivial it may seem. After identifying the factors that are causing the distress, encourage them to seek healthy coping strategies. Specifically, you may consider:

• Cultural activities, such as:
  • Pow wows, dancing, storytelling, talking circles, culture camps, or potlatches.
  • Sports activities, hunting, and gathering.
  • Native Youth Olympics.
• Identifying personal, family, and community values.
• Developing a sense of belonging and giving back to the community;

During times of stress, people may have less time or energy to engage in strategies they usually use to maintain stability, like healthy eating, exercising, and/or spending time with friends. It is particularly important during stressful times that people still make efforts to do the things in their lives that help them feel good.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.