Special Forum: Rural Behavioral Health Wednesday, July 14, 2010 Washington DC

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Contact Information Karen Francis, Senior Research Analyst Technical Assistance Partnership Phone: Web: Joyce Sebian, Senior Policy Associate, National TA Center for Children’s Mental Health at Georgetown University Phone: Web:

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 3 10 Strategic Initiatives 1.Prevention of Substance Abuse and Mental Illness 2.Violence and Trauma 3.Military Families – Active, Guard, Reserve, and Veteran 4.Health Insurance Reform Implementation 5.Housing and Homelessness 6.Jobs and Economy 7. Health Information Technology for Behavioral Health Providers 8.Behavioral Health Workforce – In Primary and Specialty Care Settings 9.Data and Outcomes – Demonstrating Results 10. Public Awareness and Support

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Institute of Medicine Report: Preventing Mental, Emotional, and Behavioral Disorders Among Young People – Progress and Possibilities (2009) Call to Action  Risk factors are well established  Preventive interventions are available  First symptoms typically precede disorder by 2-4 years  Interventions before a disorder manifests itself offer best opportunity to protect young people  Such interventions can be integrated with routine health care and wellness promotion, as well as in schools, families, and communities  Mental health improvements also improve physical health

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 5 IOM Report 2009 Addressing Risk Factors  Risk factors come in clusters, associated with more than one disorder  Prevention requires attention to multiple risk factors ●Biological (family history) ●Psychosocial (family disruptions) ●Social (poverty, violence, safety in schools, access to health care)  Well-designed prevention interventions reduce a range of problems and disorders and are sustained over the long term

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 6 IOM Report 2009 Policy Implications  National leadership necessary  Inter-departmental strategy that identifies goals and coordinates use of resources on all levels – national, state, & local  State & local systems that support healthy development  Investment in prevention & promotion in mental health services and in school systems  Workforce training  Public education about risk factors  Equip young people “at risk” with skills & habits to live healthy, happy, and productive lives

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Practical Strategies to Address the Behavioral Health Needs of Children and Families in Rural America September 21-23, 2010 Renaissance Glendale Hotel; Glendale, AZ REGISTER NOW al_BH_Symposium_2010.html

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY A View of Rural America Alaska “lower 48” Adapted from WICHY- Mental Health Program

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Increasingly attracting retirees from the cities and others seeking a slower pace of life Increasingly attracting growing numbers of “new Americans” seeking job opportunities moving into rural communities. Continue to lack many of the public services and access to these services that are much more commonplace in metropolitan areas. Increased need for schools, jobs, and day care resulting from growing numbers of young families among minority populations Need a workforce that is comparably multi-cultural and multi-lingual From: Trend 5—Diversity Increases in Non-metro America, USDA, Economic Research Service, Feb Trends in Rural and Frontier America

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Mental Health Challenges in Rural Areas Family poverty is a risk factor for behavioral health concerns and increase the risk of child abuse and neglect. (DHHS 1999) Difficulties in access, availability and acceptability of mental health services are of increased concern in rural and frontier communities- New Freedom Commission Report- Rural Children are one of the groups least likely to have access to mental health services. (DHHS 2003, 2004). More than 90% of all psychologists and psychiatrists, and 80% of MSWs, work exclusively in metropolitan areas More than 60% of rural Americans live in mental health professional shortage areas More than 65% of rural Americans get their mental health care from their primary care provider The mental health crisis responder for most rural Americans is a law enforcement officer

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Incidence and prevalence rates of mental illness and substance abuse are comparable to urban residents, but they are less likely to have access to services or providers. Rural teens and rural older adults have a much higher rate of suicide than their urban peers. Programs to specifically train and promote the placement of rural mental health professionals are few in number, and those that do exist are not often located in rural areas. Rural residents are less likely to have health insurance with a mental health benefit. Other barriers include lack of transportation and social stigma. Mental Health in Rural & Frontier Communities

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Children in Rural Communities 60 million Americans live in rural and frontier areas. Nearly two-thirds of the counties in the United States are rural, Less than one-fifth of the U.S. child population lives in rural America. Of the 50 poorest counties in the country, 48 are located in rural America. (Kids Count data) Rural Children are more likely to live in poverty – US Economic Research Service- 21 % of rural children lived in poverty compared to 18% of non-rural children. – Rural Child Poverty rates are higher for all racial and ethnic groups except Asian Americans. (Rural Families Data Center 2004)

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 13 The Rural Web Portal: Healthy Children and Families Helping Communities to Enhance Social and Emotional Outcomes for Children and Families in Rural and Frontier Areas Official Launch - June 7, Public Health approach- children’s overall health and social/emotional wellbeing. Collaborative effort across technical assistance centers Fosters networking and information sharing across Grant programs – starting with SAMHSA/CMHS children’s grantees Technical assistance resource to rural and frontier communities An outcome of the National Plan for Rural Behavioral Health, Funded by the SAMHSA/Center for Mental Health Services.

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 14 Rural Portal: Healthy Children and Families Safe Schools/Healthy Students, Systems of Care, National Child Traumatic Stress, Youth Suicide Prevention & Early Intervention, Circles of Care, Statewide Family Networks, Youth Transition, Dialogue and discussion that can inform state and federal policies To provide a web portal that facilitates on-going dialogue about challenges, successes and best practices related to providing mental health services to children and families in rural areas A community of learners committed to children’s overall health and social/emotional wellbeing. Photo Credit- Nikkel Photo Credit- Kucik

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 15 Building a National Plan for Rural Behavioral Health Action Areas Action Area #1: Public Health Approaches to mental and behavioral health are implemented in rural and frontier areas. Action Area # 2: Research informs policy and practice regarding rural mental health/behavioral health services and supports. Action Area # 3: Disparities in financing behavioral health services and supports are reduced or eliminated in rural and frontier areas. Action Area # 4: Behavioral health and primary health care services and systems are integrated in rural and frontier areas. Action Area # 5: Recruitment, retention and the provision of a quality professional work environment results in a stable, highly qualified, culturally and linguistically competent behavioral health workforce in rural and frontier areas. Action Area # 6: Consumers, families and youth are employed as part of the mental and behavioral health workforce within rural and frontier communities. Action Area # 7: Children, youth and their families and consumers across the lifespan have access to a full continuum of quality mental and behavioral health services and supports within the community that are culturally and linguistically acceptable.

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY 16 Issues and Challenges: Rural and Frontier Communities F rom a Special Forum on Rural Behavioral Health Held at the 2006 Georgetown University Training Institutes Prepared by Joyce K. Sebian Stigma Workforce Shortages Public health approach: Systematic approaches Integrate behavioral health and primary health care Early Identification Family Driven Youth Guided Access to appropriate services Transportation Tribal Entities Custody relinquishment Family Support services

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Discussion Questions RECOMMENDATIONS FOR POLICY In your opinion, what are the three most important recommendations for policy to support effective practice and performance in relation to the topic of this Special Forum?

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Discussion Questions RECOMMENDATIONS FOR PRACTICE In your opinion, what are the three most important recommendations for practice to support effective practice and performance in relation to the topic of this Special Forum?

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Discussion Questions RECOMMENDATIONS FOR TECHNICAL ASSISTANCE In your opinion, what are the three most important recommendations for technical assistance to support effective practice and performance in relation to the topic of this Special Forum?

© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY Wrap Up Please join us at the Rural Symposium! Sept , 2010 Register Now Rural_BH_Symposium_2010.html