(Maternal) and Child Mental Health (MCMH)Windows of opportunity to

promote healthy development & mental health from birth to 24

Cecilia Breinbauer, MD, MPH

Clinician (Chile)

PAHO

IADB

ICDL

UNICEF

Infancy & Early Childhood

Childhood

Adolescence

Young adults

Lessons learned & opportunities

Pan American Health Organization (PAHO) Adolescent Health (2001-2004) Lessons Learned

•  Knowledge is not enough •  Multilevel interventions •  Developmental stages, Very

Young Adolescents (VYAs) •  Adolescent needs &

WANTS >> Youth participation - advocacy

Pan American Health Organization (PAHO)

Child Health (2004-2005) Lessons Learned •  Community organization •  Knowledge is not enough…

–  Maternal depresion? –  Domestic violence? –  Alcoholism, poverty... –  Social determinants of health

•  Early Child Development (ECD) advocacy –  Care for Child Development

(CCD) “IMCI”

Inter-American Development Bank (IADB)Chile, Nicaragua, Honduras (2005-2006)

Prevalence of developmental delays

Cost-effectiveness of ECD interventions •  No comparable costs •  No comparable outcome

measures •  Duplication of programs

and lack of coordination between sectors: –  Health –  Education –  Social protection

•  “No data, no problem, no action”

•  Complexities and tensions of measuring developmental delays at the population level

INEQUITY Measuring child developmental delays through

household surveys (Chile, 2006)

http://myslide.es/documents/ii-encuesta-de-calidad-de-vida-y-salud-2006.html

Interdisciplinary Council on Developmental and Learning Disorders (ICDL) (Stanley Greenspan)

The power of online education

Moving from the medical model to the social model of disability

•  Neurodiversity movement •  “toxic stress”, stigma &

disability

•  Ph.D. Infancy and Early Childhood Mental Health and Developmental Disorders

•  Training of trainer certificate in “Floortime”

Non-profit management, strategic planning, governance

UnicefAffordable

Programs & interventions

Evidence

Human Rights

We must use evidence aligned with human rights conventions Ø CRC (children) Ø CRPD (children with

disabilities) Ø CEDAW (women & girls) Ø CAT (torture or

degrading treatment)

http://www.ohchr.org/EN/ProfessionalInterest/Pages/CoreInstruments.aspx

PAHO

IADB

ICDL

UNICEF Infancy & Early Childhood

Childhood

Adolescence

Young adults

MCMH: Windows of opportunity to promote healthy development & mental health from birth to 24

UN Sustainable Development Goals 2015-2030

From MDGs

•  Focus on reducing child (MDG4) and maternal mortality (MDG5)

To SDGs

•  “Ensure healthy lives and promote wellbeing for all at all ages” (SDG3) –  Proposed Target 3.4. “By 2030,

reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”

https://sustainabledevelopment.un.org/topics

From MCH to MCMH “Mental and behavioral disorders” are the leading cause of years lived with disability

Parents Teachers

GBD attributable to “mental and behavioral disorders”

20 disorders: •  Mayor depressive disorder and dysthymia •  Bipolar disorder and cyclothymic disorder •  All anxiety disorders •  Childhood behavioral disorders (ADHD, conduct

disorders, ASD), intellectual disability •  Substance use disorders, alcohol dependence and

FAS, illicit drug use disorders •  Eating disorders (anorexia, bulimia)

Infancy

Childhood Adolescence

Whiteford H. et al (2013). GBD attributable to mental and substance use disorders: findings from the GBD Study 2010. Lancet, 382

MCMH Momentum and Opportunities

EDUCATION HEALTH

•  No health without perinatal mental Health (Lancet 2014)

•  WISH Report 2015

Supporting Policies

Perinatal-First 1,000 days

Transition to school

Transition to adolescence

Transition to adulthood

Windows of Opportunity Young People (0-24)

Nature Brain development

Strengths & Weaknesses

Nurture Stress & Opportunities

Home, School, Community

Transformation video Health & Human Services, King County

http://www.kingcounty.gov/elected/executive/health-human-services-transformation.aspx

UW Global Health •  Global WACh

–  Peru, Caribbean, Kenya

•  IHME: Population level indicators of Child Development & Mental Health, correlations

•  Mentoring MPH students UW Psychiatry •  MCMH

Promoting healthy development & mental health from birth to 24

Infancy & Early Childhood

Childhood

Adolescence

Young adults

Current work

a stronger Collaboration

Children’s MH

Parents’ MH

CMH

ECD

MMH

MCMH

Building from areas of expertise

UW MCMH

Cross-sectorial Collaboration

Children’s MH

Parents’ MH

CMH

ECD

MMH

MCMH

Interdisciplinary

UW MCMH

Health + Education + Welfare + Housing + Labor + …..

Shared Vision: We believe there is no health without mental health and we envision a world where every parent and child experience warm, intimate and continuous healthy relationships Shared Mission: Inform, support and shape maternal and child [health care] systems through innovative interventions that promote and improve the mental health and emotional well-being of all mothers, infants, children, adolescents and their families. Shared Values: Accessible, affordable and high quality maternal and child mental health services, interdisciplinary collaboration on evidence based care and research, cultural relevance and diversity, meeting each dyad at their individual level of need (stepped care intervention), collaborative model of care, active involvement of caregivers and teachers, embracing rights of children and adults with disabilities

UW MCMH work in progress towards strengthening

collaborations

All children have within them the potential to be great kids. It's our job to create a great world where this potential can flourish -  Stanley Greenspan, Great Kids, 2007 with Bernard Levy (Founding members of ZTT,1977)

Collective mission

Infancy

Childhood

Adolescence