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Advancing Children’s Behavioral Health and Well Being:
Things to ConsiderLarke Nahme Huang, Ph.D.
Senior Advisor, Children Youth and FamiliesAdministrator’s Office of Policy Planning and Innovation
Children’s Mental Health Research and Policy Conference
March 6, 2013Tampa, Florida
A Public Health/Developmental Framework for SAMHSA
• Moving from a Services Administration to a Public Health Agency
• Re‐Balancing Across Promotion‐Prevention‐ Early Identification and Intervention ‐
Treatment and Recovery/Resiliency• Across the Life‐Span
Current Drivers
• Health Reform: Enacting Provisions of the Affordable Care Act
– Secretarial Reports re National Strategies: Quality, Prevention, Disparities, etc.
• Sandy Hook Elementary School Tragedy: – Focus on Mental Health
• Budget Challenges– Sequestration
http://www.whitehouse.gov/sites/default/files/omb/assets/legislativ
e_reports/fy13ombjcsequestrationreport.pdf
– Continuing Resolution – March 27, 2013
“Now is the Time” The President’s Plan Following Sandy Hook
Includes:1.
Closing background check
loopholes to keep guns out of
dangerous hands;2.
Banning military‐style assault
weapons and high‐capacity
magazines, and taking other
common‐sense steps to reduce
gun violence;3.
Making schools safer; and
4.
Increasing access to mental
health services.
“President’s plan to protect our
children and our communities by
reducing gun violence”WH.gov/Now‐is‐the‐Time
SAMHSA: Response to Sandy Hook
• Reach 750,000 young people through programs to identify mental health disorders early and connect to
treatment– Provide Mental Health First Aid Training for School
Personnel– School districts work with law enforcement, mental health
agencies and local organizations to assure students with MEB issues are referred and access services
• Innovative State‐based strategies to support young people in transition with MH/SA issues
– 16‐25 year olds at high risk for mental/substance use disorders and suicide, but least likely to seek help
Sandy Hook Response (cont)
• Workforce Development– Train > 5,000 additional mental health professionals to serve
emerging adults • National Dialogue on Mental and Emotional Health of
Young People– Change the conversation re Mental Health/Conditions and
Disorders– Engage all parts of community to reduce negative attitudes
re mental disorders, to recognize the warning signs and enhance access to supports and care.
(Administrator Pam Hyde, Congressional Testimony, January 14, 2013)
Sandy Hook Tragedy and Impact on Mental Health
• State budgets: 2009‐2012 ~ $4.3B slashed in mental health spending, but now…..
• Minn: legislators seeking $$ for MH treatments programs in schools
• PA: effort to reclaim $84M that was cut• VA: proposing $$ for training on Mental Health First Aid for
teachers and first responders• WIS Gov: proposed ~$30M boost to MH funding• CO Gov: proposed $18M for MH crisis hotline, walk‐in centers
and housing vouchers for MI• Opportunity for “good”
and “bad”
policy re mental health
The Secretary’s Action Plan to Reduce Racial and Ethnic Health Disparities
• Goal: Assess and heighten the
impact of all HHS policies,
programs, processes, and
resource decisions to reduce
health disparities. • HHS leadership will assure that:
Program grantees, as applicable,
will be required to submit health
disparity impact statements as
part of their grant applications.
Such statements can inform
future HHS investments and
policy goals…..
SAMHSA’s Approach to the Secretarial Priority re Disparity Impact Statements in Grants
Three‐prong Approach:1. Measure Development
– Using existing grant data (GPRA) to determine subpopulation disparities in Access, Service Use and Outcomes
2. Quality Improvement framework – CLAS Standards (Culturally Linguistically Appropriate Services, HHS)– Outreach/engagement, retention; workforce strategies
3. Operational changes in SAMHSA’s grant‐making – new language in RFAs (“Appendix J”), – review criteria; Terms and Conditions, – TA to grant project officers, etc.
Determinants of Health
Source: Robert Wood Johnson Foundation Commission to Build a Healthier America, www.commisiononhealth.org
Strategies to Consider
• Assertively use new and emerging data,
knowledge and information;
• Strengthen research‐practice‐policy partnerships• Systematically use grant programs as “learning
laboratories”• Move findings, lessons learned into practice and
policy with ongoing feedback loops• Identify and partner with potential “host”
systems
where children and families are
Data Efforts and Partnerships
• CDC MMWR (Morbidity Mortality Weekly Report) on Children’s Mental Health Surveillance, May 2013 –
Informed by multiple federal surveys• National Survey of Children’s Health (HRSA & CDC) State
based variability re Medication Treatment for ADHD – ranged from 33% Nevada to 79% Mississippi
• The New Adolescents: An Analysis of Health Conditions, Behaviors, Risks and Access to Services Among
Emerging Young Adults
‐
“adrift in perfect storm of health risks”
(Lawrence Neinstein, USC, 2013)
Major Depressive Episode & Treatment by Age
Slide Prepared by Mike Dennis,Ph.D., Chestnut Health Systems
Major Depressive Episode & Treatment by Gender
Slide Prepared by Mike Dennis, PhD., Chestnut Health Systems
Major Depressive Episode & Treatment by Race
Slide Prepared by Mike Dennis, Ph.D., Chestnut Health Systems
Substance Use Disorder & Treatment by Age
Slide Prepared by Mike Dennis, Ph.D., Chestnut Health Systems
Substance Use Disorder & Treatment by Race
Slide Prepared by Mike Dennis,Ph.D., Chestnut Health Systems
Unmet Need for Mental Health Treatment by 3 Months
Slide Prepared by Mike Dennis, Ph.D., Chestnut Health Systems
Scaling Up Systems of Care: CMHI Planning and Implementation Grants
To improve the behavioral health outcomes of children and youth with
serious emotional disturbances and their families: • State Grants to support state‐wide expansion and implementation
• Planning Grants (1‐year)• Implementation Grants ( 4‐Year)
• Support the provision of mental health and related recovery supports and
services• Plan and implement systemic changes in policy, financing, services and
supports, training and workforce development, • Sustain the system of care approach including through linkages with
health reform opportunities.
Scaling Up Systems of Care:
• Renewed emphasis on States– State Grants; SOC Language in 2014‐2015 Block Grant Application
• Opportunities in Health Reform– Essential Health Benefits– Alignment with Health Homes/ Care Management Entities
• CMS Informational Bulletins– EPSDT– Children’s Mental Health/Home and Community‐based Services
• State Directors’
Letters: Children’s Mental Health, Child Welfare Administrators, Medicaid Directors
– Childhood Trauma; Psychotropic Medications
Scaling Up: State Adolescent Substance Abuse Treatment Enhancement & Dissemination Grants
To improve treatment for adolescents: •development of a Learning Laboratory
with collaborating State‐
local
community based treatment provider sites. •Improvements in State level
infrastructure through workforce
development, financial planning, licensure and certification•Improvement of Site level
infrastructure through implementation of
Evidence Based Practice (EBP) related to assessment and treatment and
monitoring client
level change
Builds on: •Previous grant programs on adolescent SA treatment and Continuing
Care that generated best/evidence‐based practices for adolescents•Builds on cohort of 16 State Adolescent State Coordinator Grants
Scaling Up: Adolescent Substance Abuse Intervention/Treatment
• Support NASADAD Convening Adolescent SA State Coordinators on Monthly Basis
• NASADAD and SA Coordinators developing State Adolescent Substance Abuse Treatment Guidelines
• Builds on Adolescent SA Treatment Grants• Adolescent Substance Abuse Treatment ‐
Technical
Experts Panel Consensus Report (2013)• Health Reform: Essential Health Benefits include
category of Substance Abuse
Early Childhood Systems
• Child Care and Development Block Grant Fund $5.2 billion; 2.5 million children served
• Head Start $7.9 Billion; 1,141,876 children enrolled
(Early Head Start set‐aside ~ 130,000 birth‐
3yr olds; 14,000 pregnant women)
• Home Visiting $1.5 billion investment over 5 years (FY 2010‐2014)
• Race to the Top Early Learning Grants Competitive grants to States that with innovative and comprehensive
early education reform.
How can we best introduce and incorporate essentials of children’s mental health?
Universal Selected Indicated• Early social/emotional child development• Impact of trauma in early childhood• “Healthy and Safe Environments”
–
emotionally safety
• Mental Health Consultation• Screening, assessments and referrals –
child, family and
practitioners• Parenting – national initiative• Systems of Care/ Wraparound Approaches
Child Welfare System
• Child Trauma Collaborations (ACYF, CMS, SAMHSA) increase number of trauma‐exposed children in child welfare who receive the
right services at the right time to improve social‐emotional well‐being.
• Psychotropic Medications (ACYF, CMS, SAMHSA) State Directors Letter, State Directors Summit, GAO Report
• Treatment Foster Care Technical Experts Panel (ACYF, CMS, SAMHSA)
• The National Center on Substance Abuse and Child Welfare‐
SAMHSA IAA with ACYF; shared center
• Regional Partnership Grants ACF Grant, SAMHSA TA via NCSACW
Attorney General’s Defending Childhood Initiative
• Connections with Law Enforcement and the Juvenile Justice System (judges, family and youth courts,
detention, etc.)• Children Exposed to Violence
Grants and task force• National Forum on Youth Violence Prevention
Place‐based, Mayor‐led 10 cities initiative• School to Prison Pipeline
School Discipline Consensus Project• Children of Incarcerated Parents
>1.7M children; increased risk of extreme poverty, exposure to substance abuse, home instability, etc.
U.S.D.A.: Women Infants and Children Nutrition Program (WIC)
• Rates of depression and depressive symptoms among low‐
income mothers, nearly double general population (12‐27%
current; 43% lifetime)• Is a concern in Head Start, SNAP, TANF, WIC – programs serving
economically disadvantaged families• Depression interferes with parenting; imposes risks for healthy
child development; associated with depression in children (IOM
Report, 2009)• WIC: new guidance for WIC workers re screening and referral to
supports/services• WIC: During Fiscal Year 2011, the number of women, infants,
and children receiving WIC benefits each month averaged
almost 9 million participants per month; WIC touches about 50%
of all babies born
SAMHSA’s Framework re Trauma and a Trauma‐Informed Approach
Trauma: Individual trauma results from an • Event, series of events, or set of circumstances that is• Experienced
by an individual as physically and/or emotionally harmful or
threatening and that has lasting adverse • Effects
on the individual’s functioning and/or physical, social, emotional, or
spiritual well‐being
Trauma‐Informed Approach: A program, organization or system • Realizes and is aware of the widespread impact of trauma and understands
potential paths for recovery; • Recognizes
the signs and symptoms of trauma in clients, families, staff, and others
involved with the system; • Refrains from
retraumatization;• Responds
by fully integrating knowledge about trauma into policies, procedures,
practices and interventions, and settings.
Principles and Suggested Guidance for a Trauma Informed Approach
Responding to IOM’s Preventing Mental, Emotional, and Behavioral Disorders Among Young People
• SAMHSA’s 2012 7‐State Policy Academy on Preventing Mental and
Substance Use Disorders in Children and Youth
• Office of Adolescent Health Science to Service Symposium: Advancing the
Prevention of Mental, Emotional, and Behavioral Disorders in Adolescence
• SAMHSA/NIDA Implementation Team • Building a Shared Prevention
Infrastructure
States’
Challenges and Key Areas of Focus
Challenges• Addressing the risk factors or the
conditions?• Identifying, building, or using
existing infrastructure?• Paying for individual or
community/population
prevention?• Finding shared platforms for
prevention that can
service/support multiple types of
preventable conditions (e.g.
obesity, teen pregnancy,
depression, suicide, alcohol use,
etc.)
Key Topics• Providing training in evidence‐
based suicide prevention to
reduce risk factors and promote
positive and protective factors in
youth and their families • Identifying / developing
epidemiological and other
planning data to support an
integrated prevention system • Screening for and addressing
trauma in the lives of young
children• Developing MEB screening
guidelines for primary care for
youth ages 13 to 21
Positive Indicators of Child Well‐being
•SENSE OF PURPOSE• Believing one’s life is meaningfully
connected to a larger picture
SELF‐MANAGEMENTAge-appropriate autonomy, emotional self-regulation, persistence, constructive time use
AGENCYPlanfulness, resourcefulness, positive risk-taking, realistic goal-setting, motivation
SENSE OF PURPOSEBelieving one’s life is meaningfully connected to a larger picture
CONFIDENCEPositive identity and self-worth
SOCIAL INTELLIGENCECommunication, cooperation, conflict-resolution skills, trust, intimacy
ENVIRONMENTAL
AWARENESS & BEHAVIORKnowledge, positive behaviors
RISK MANAGEMENT SKILLSSkills and knowledge to avoid drug and alcohol use and risky sex
CRITICAL THINKINGEvaluation/analytical/problem- solving skills
KNOWLEDGE OF
ESSENTIAL LIFE SKILLSFinancial management, decision- making skills, home maintenance, etc.
POSITIVE RELATIONSHIPS
WITH PEERS, SIBLINGS,
FAMILY, ETC.Warmth, closeness, communication, support, positive advice
Adapted from: Lippman, LH; Moore, KA & McIntosh, H. (2011). Positive indicators of child well-being: A conceptual framework, measures, and methodological issues. Applied Research in Quality of Life. Accessed on August 16, 2011. http://www.springerlink.com.proxy.uchicago.edu/content/tr32721263478297/.
CONNECTION TO
CULTURE