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Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention National Association of County Behavioral Health And Developmental Disabilities Directors Washington DC March 4, 2011 A Public Health Approach to Children’s Behavioral Health at the Center’s for Disease Control and Prevention (CDC) National Center on Birth Defects and Developmental Disabilities Division of Human Development and Disability

Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

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Page 1: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Ruth Perou, PhD

Child Development Studies TeamDivision of Human Development and Disability

National Center on Birth Defects and Developmental Disabilities

Centers for Disease Control and Prevention National Association of County Behavioral Health And Developmental Disabilities Directors

Washington DCMarch 4, 2011

A Public Health Approach to Children’s Behavioral Health at the Center’s for Disease Control

and Prevention (CDC)

National Center on Birth Defects and Developmental Disabilities

Division of Human Development and Disability

Page 2: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

States with Significant (p < .05) Increases in Parent-reported ADHD

Diagnosis (2003-2007)

Note: There was a statistical trend in the rates in MD, AL, & NE (.05<=p<= .1).

Page 3: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

SSNR SurveillanceSSNR Surveillance• National Survey

of Children’s Exposure to Violence (NatSCEV)

• ~70 screener items• Broad range of victimizations• Caregiver report: age 0-9 years

Youth self-report: age 10-17 yrs• 4,549 participants

• 34 SSNR items added

Page 4: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

The Public Health Model

Define the problem

Identify risk and protective factors

Develop and test prevention strategies

Assure widespread

adoption

Prevention

Page 5: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Sample CDC Child-Family Prevention Programs

• Project Choices• Project Connect• Learn the Signs. Act Early• Legacy for ChildrenTM

Page 6: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Learn the Signs. Act Early.Builds on familiar experiences of parents, such as monitoring their child’s growth

Aims to educate parents, health care professionals, and childcare providers about child development

Encourages early screening and intervention—strategies that hold the most promise for affected children and their families

Page 7: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

7

Learn the Signs Resource Kits

www.cdc.gov/actearlywww.cdc.gov/actearly

Page 8: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Legacy for ChildrenTM

Improve outcomes for children in poverty by promoting positive parenting

Legacy mechanisms:– Mother-Child Interaction– Enhancing parental self efficacy– Promoting a sense of community

Evaluation– Preliminary analysis are promising

– 17% INT children had fewer behavioral challenges– 20% INT children had higher cognitive scores

– Longitudinal evaluation in progress– Feasibility study in progress - Collaboration with ACF

Implementation Resources for Communities

Page 9: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

The Public Health Model

Define the problem

Identify risk and protective factors

Develop and test prevention strategies

Assure widespread

adoption

Evaluation Feedback throughout process

Page 10: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Evaluation

• Evaluation feedback at every step• Program Evaluation

– the goal of rigorous evaluation is to rule out alternative explanations (aka “threats to internal validity”) for observed outcomes

– Technology Enhancements to Parenting Programs

– Improving Training of Home Visitation Programs

Page 11: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Triple P: Population-based Approach

Everybody

All Families in a Specific Setting

Families at Risk

Media Campaign

Brief Consultationsin PrimaryCare Settings

ParentingSkillsTraining

Intensive Counseling

Families in Crisis

Page 12: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Public Health Leadership for the Prevention of Child Maltreatment

(PHL) Initiative

Supporting state public health agency efforts in primary prevention of child

maltreatment

Page 13: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

PHL Purpose To raise awareness

about child maltreatment prevention as a public health issue.

To identify ways to support, improve, and expand child maltreatment prevention efforts in public health agencies.

Page 14: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Health Department Role

Page 15: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

IndividualRelationshipCommunitySocietal

Examples • Parent Training

Examples • Home visitation •Legacy for ChildrenTM

• Project Choices

Examples• Parents Matter Program•School Connectedness•MH Consultation

Examples• Maternity/Paternity Leave

Examples of Public Health Relevant Approaches to Child Behavioral Health Across the Social Ecological Model

Page 16: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you!Points of Contact:

Ruth Perou, [email protected]

National Center on Birth Defects and Developmental Disabilities

Place Descriptor Here

Page 17: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

Autism and Developmental Disabilities Monitoring

(ADDM) Network– Collaborative effort to estimate prevalence

of ASDs in multiple areas of US

– Provide data to • Characterize the ASD population• Describe variation by subgroups and over time• Evaluate methodologic factors which may influence

estimates• Inform hypotheses on potential risk factors

Page 18: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities
Page 19: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

UCLA KABC IQ at 3 Years of Age

Intervention Comparison

IF = Intellectual Functioning

50% 30%

Page 20: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

UM DECA: Meeting Referral Criteria at 2 Years• 17% fewer intervention children fell 2 SDs

above the mean for behavioral problems• Comparison children had 78% greater odds of

meeting referral criteria for behavioral problems

36

52.542.5

0102030405060708090

100

Behav Probs*

% >= 2 SDs from

Mean

Int Comp Total

Page 21: Ruth Perou, PhD Child Development Studies Team Division of Human Development and Disability National Center on Birth Defects and Developmental Disabilities

WA

MT

OR

NV

CAUT

AZNM

CO

ID

WY

ND

SD

MN

IANE

KS

TX

FL

MS

LA

ALGA

SC

NC

VA

ME

NY

MI

WI

OK

MO

AR

TN

KY

IL IN

MI

OH

WV

DC

MD

DE

NJ

VT

RI

CT

NH

MA

AK

HI

PA

% of children aged 4-17 years currently taking medication for ADHD by state: United States,

2007

7.6%-9.5%

5.9%-7.5%

4.7%-5.8%

3.7%-4.7%

1.2%-3.6%