An Overview of Mental Health and Children Abram Rosenblatt, Ph.D. University of California, San Francisco

Prevalence Rates by Functional Impairment Overall Prevalence:21% Mental Disorder & Significant Functional Impairment: 11% Mental Disorder & Extreme Functional Impairment: 5%

Median Rates of Prevalence of Disorder by Age Across Existing Studies Pre-School8% Pre-Adolescent12% Adolescent15% Wider Age Ranges18%

Risk Factors for Mental Disorders Poverty Physical Problems Intellectual Disabilities Low Birth Weight Family History of Mental & Addictive Disorders Caregiver Separation Abuse or Neglect

Access Annual Prevalence of Mental/Addictive Disorders and Services for Children 11% Diagnosis and No Treatment (11%) 5%** 3%** 0.6 %** 0.5 %** 4%** 7%** 0.3 %** 0.8 %** **For those who use more than one sector of the service system, preferential assignment is to the most specialized level of mental health treatment in the system. Source: Shaffer et al., 1996 Percent of Population (21%) With Mental/Addictive Disorders (in one year) Percent of Population (21%) Receiving Mental Health Services (in one year) Percent of Population Receiving Specialty Care (8%) Percent of Population Receiving General Medical Care (1%) Percent of Population Receiving School Services (11%) Percent of Population Receiving Other Human Services and Voluntary Support (1%)

Treatment for Mental Disorders: Practice Level Psychotherapy Average treated individual was better adjusted after treatment than 79% of those not treated The magnitude of the effects closely parallels those obtained with adults Treatment differences favor behavioral rather than non- behavioral techniques

Title? Support for the efficacy of outpatient psychotherapy interventions provided to children presenting with specific mental health problems and behavioral disorders. The effectiveness of psychotherapy when provided in community settings to children is much less well understood or documented Review: 9 studies of treated children in a non- research clinical setting- little to no positive effect.

Medication CategoryIndicationShort-Term Efficacy Long-Term Efficacy Short-Term Safety Long-Term Safety Rank StimulantsADHDABAA1 Selective Serotonin Reuptake Inhibitors Major Depression OCD Anxiety Disorders BACBAC CCCCCC AACAAC CCCCCC 2 Central Adrenergic Agonists Tourette syndrome ADHD BCBC CCCC BCBC CCCC 3 Valproate and Carbamazepine Bipolar disorders Aggressive conduct CCCC CCCC AAAA AAAA 4 Tricyclic Antidepressants Major depression ADHD CBCB CCCC BBBB BBBB 5 BenzodiazepinesAnxiety DisordersCCCC6 AntipsychoticsChildhood schizophrenia and psychoses Tourette syndrome BABA CCCC CBCB BBBB 7 LithiumBipolar disorders Aggressive conduct BBBB CCCC BCBC CCCC 8 Level of Supporting Data Figure: Grading the Level of Evidence for Efficacy of Psychotropic Drugs in Children Key: A= > 2 randomized controlled trials (RCTs). B= At least 1 RCT C= Clinical opinion, case reports, and uncontrolled trials.Source: Jensen et al., 1999

Effectiveness of Program Level Interventions Positive Outcomes: Home Based Services (especially Multi-Systemic Therapy) Therapeutic Foster Care Some Case Management Outpatient: –Psychosocial treatments focusing on problem solving –Parent management training –Child-Parent interpersonal skill strengthening Encouraging: Wraparound Process

Outcomes of Systems of Care Research: Findings by Research Design Clinical Status Functional Status Life Satisfaction Safety/ Welfare Cost/ Utilization Post Only Pre-Post Time Series NECGD Experiment = + == Positive + Same = Negative -

Conclusions: Mental disorders among children are a significant public health problem Access to services is a significant problem Promising and growing research on the efficacy of services in research settings Limited research on the effectiveness of services in community settings