Inside or Outside our Circle: Do Mental Health Concerns Affect our Outcomes? CityMatCH Expedition 2004 Conference September 13, 2004

The Engagement Paradigm Establish Community Share Context Exchange Content Discuss and Deliberate Consensus – or New Context Expand Community

MCH Outcomes and Mental Health Outcomes?

A Common Language (?) Developmental Health Behavioral Health Mental Health Substance Use Conduct Disorder

Traditional Maternal and Child Health Populations Women Pregnant Women Infants Children Adolescents Adults

Tools and Strategies: Identification and Treatment Screening Case Finding Diagnosis ICD-9 DSM IVR Treatment Support Therapy Medication

Youth Risk Behavior Surveillance Survey: 1999 Sadness and Suicide Ideation and Attempts Felt sad or hopeless almost every day for >2 weeks preceding survey and stopped usual activities28.3% Seriously considered attempting suicide in 12 months preceding survey19.3% Attempted suicide > 1 time 8.3% Suicide attempt requiring treatment (injury, poisoning, overdose) 2.6%

Youth Risk Behavior Surveillance Survey: 1999 Substance Use Used alcohol (ever)81.0% >1 drink alcohol on >1 day of 30 days preceding survey50.0% >5 drinks of alcohol on >1 day31.5% Used marijuana > 1 time26.7% Used methamphetamine (ever) 9.1%

Child and Adolescent Mental Health Prevalence, Persistence, and Diagnosis:1 Anxiety Disorders13.0% Mood Disorders 6.2% Disruptive Disorders10.3% Substance Use Disorders 2.0% * Six month (current) Prevalence, age 9-17

Child and Adolescent Mental Health Prevalence, Persistence, and Diagnosis: 2 Any Disorder21% Significant Functional Impairment11% Extreme Functional Impairment 5%

Child and Adolescent Mental Health “Derailment” Expelled from School Drop Out of School Become Pregnant Be Convicted of a Crime Begin Using Alcohol or Other Drugs

Child and Adolescent Mental Health “Derailment” Few or no Mental Health Problems 0.5% Mild Problems 4.3% Severe Emotional Disturbance22.3%

Child and Adolescent Mental Health Prevalence, Persistence, Diagnosis and Treatment Received any MH Services40% Received MH Services from School Counselor75% Received MH Services from MH Specialist12% Received MH Services from Primary Care 6%

Child and Adolescent Mental Health Prevalence, Persistence, Diagnosis and Treatment MH Diagnosis and saw MH Specialist 20% Parental Recognition and saw MH Specialist 40%

Evidence Based Practice Best Practice

Promising Practices School Based Clinics Expanded School Mental Health Primary Care/Mental Health Co- location/Integration Collaborative Practice Arrangements Youth Development Programs/Initiatives

Promising Practice Expanded School Mental Health Focused Evaluation Referrals Tracking of Referrals Preventive Services Full Range of Treatment Services

Promising Practice Youth Development Programs/Initiatives: 1 Goals: promote positive development even when seeking to prevent problem behaviors Competence Confidence Connections Character Caring and Compassion

Promising Practice Youth Development Programs/Initiatives:2 Atmosphere: youth as resource to be developed rather than problem to be managed Activities: formal and informal opportunities for youth to nurture interests and talents, practice new skills, and gain a sense of personal or group recognition

Promising Practices EPSDT (with developmental/behavioral tools/checklists) Bright Futures Mental Health Brief Motivational Therapy Brief Interventional Therapy Cognitive Behavioral Therapy Medication

Resources/References Mental Health: A Report of the Surgeon General Youth Risk Behavior Surveillance Survey Bright Futures Mental Health Center for School Mental Health Assistance The Prevention Researcher Evidence Based Practic