Breaking the Disability- Poverty Cycle Early Intervention in Behavioral Health Care

An Integrated, Family-Centered Approach to Working with High-Risk Populations Work undertaken at the Center for Mental Health, Inc in Washington, D.C. between Presented at the Invitation of Karen Burt, M.D., Director of Integrative Health -- to the Family Practice Residents, Tuesday March 24, 2009 – by Johanna Ferman, M.D., Medical Director, Adult System of Care, Mental Health Division, DHS

Prognosis & The Fault Line The Fault Line: Untreated Addiction and Mental Illness CMH Courts Criminal Justice Dysfunctional School System Institutionalization Of Children & Adults Domestic Violence Broken Child Welfare System Crisis and Emergency Room Visits PovertyNeo-Natology and High Risk Infants Homelessness Prognosis and The Elephant

Learning Disabilities Out of home placement Social Emotional Developmental Delays Untreated Addiction & mental Illness Disruption of family as “developmental” environment “ In utero” exposure to alcohol and drugs – multiple sequelae Soc/Emotional Difficulties Depression, Aggression School failure- Drop out Early Pregnancy Gang activity Use of alcohol/drugs to Medicate underlying problems CMH Cycle of Disability Poverty & Hopelessness

“…to break the cycle of disability, poverty and hopelessness due to untreated mental illness and addiction...” Mission at CMH

Target Population: Adults  Dual Dx MI/SA(10 yrs+) and SPMI  Dissociative Disorders  PTSD  Multiple Axis III High-risk -- Social-emotional skills gap Is this familiar? CMH

Target Population: Children  Birth through 21  Family history of MI and addiction  In utero/later exposure  Developmental Delays  Speech, language, motor  S-E  Loss, trauma, abuse  Also familiar? CMH

Child & Family Mental Health Substance Abuse Intake Evaluation & Treatment Testing Planning Case Mgmt.. Case Management Services Physical Medicine Psychiatry Businesses Unions Grassroots Community Agencies Primary healthcare Public Housing Juvenile Justice Child Welfare Schools Social-emotional skills Food/clothing Transportation Pre-Vocational preparation and job placement CMH CMH’s Family Health Model: A Developmental Paradigm Family Health Model

I NTEGRATED S ERVICES Evaln and Rx Plng Reduce barriers to care Drug/alc testing; sobriety plan Health training and linkage; Prenatal Grp,ind, fam therapies Medicn mangt Daily living skills including s-e skills Building community Milieu/member council Case management Parenting skills Arts/music/dance/writing Linkages, legal, AA/NA/Churches Graduation Planning Spiritual component CMH

Sample Mean of Family Treatment Goal Attainment Site 1Site 2Site 3CMH University of Illinois Outcome Study ( ) Women MH Consumers & Their Children Outcome data: Changing Prognosis

What did we learn from this integrative work? Family as central to support S-e skills, groups Engagement Early intervention Public health UC Davis and other centers Integrate MH/SA/H Intensity of each drives setting

CCC -- Strengths to build on:- o Family Practice Addiction Services o A Magnet for Change Integrative Medicine: EDAPT Groups Front end IMPACT C-L work CCRMC Ambulatory care RxM

Questions