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

States with Significant (p <.05) Increases in Parent-reported ADHD Diagnosis ( ) Note: There was a statistical trend in the rates in MD, AL, & NE (.05<=p<=.1).

SSNR 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 yrs 4,549 participants 34 SSNR items added

The Public Health Model Prevention

Sample CDC Child-Family Prevention Programs Project Choices Project Connect Learn the Signs. Act Early Legacy for Children TM

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

7 Learn the Signs Resource Kits

Legacy for Children TM 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

The Public Health Model Evaluation Feedback throughout process

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

Triple P: Population-based Approach Everybody All Families in a Specific Setting Families at Risk Media Campaign Brief Consultations in Primary Care Settings Parenting Skills Training Intensive Counseling Families in Crisis

Public Health Leadership for the Prevention of Child Maltreatment (PHL) Initiative Supporting state public health agency efforts in primary prevention of child maltreatment

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.

Health Department Role

IndividualRelationshipCommunitySocietal Examples Parent Training Examples Home visitation Legacy for Children TM 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

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: 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, PhD National Center on Birth Defects and Developmental Disabilities Place Descriptor Here

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

UCLA KABC IQ at 3 Years of Age InterventionComparison Mild MR Moderate MR Borderline IF IF = Intellectual Functioning Mild MR Moderate MR Borderline IF 50% 30%

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

WA MT OR NV CA UT AZ NM CO ID WY ND SD MN IA NE KS TX FL MS LA AL GA 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, %-9.5% 5.9%-7.5% 4.7%-5.8% 3.7%-4.7% 1.2%-3.6%