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2. 2 BEHAVIORAL HEALTH OF PARENTS/CAREGIVERS: IMPACT ON CHILDREN IN CHILD WELFARE SYSTEM Pamela S. Hyde, J.D. SAMHSA Administrator Regional Partnership Grantee Kickoff Meeting Washington, DC January 23, 2013

3. 3 SAMHSA’S VISION  A nation that acts on the knowledge that: Behavioral health is essential to health Prevention works Treatment is effective People recover A nation/community free of substance abuse and mental illness and fully capable of addressing behavioral health issues that arise from events or physical conditions

4. 4 IMPACT: CHILD MALTREATMENT AND BEHAVIORAL HEALTH  Child Maltreatment 2010: Data from the National Child Abuse and Neglect Data System estimates 695,000 children were found to be victims of child maltreatment (754,000 incidents) 23 percent of children age < 17 who have experienced maltreatment have behavior problems requiring clinical intervention 35 percent of children age < 17 who have experienced maltreatment demonstrate clinical-level problems w/social skills – more than twice the rate of the general population

5. 5 IMPACT: PARENTS WITH SUDs  ~ Six million children (9 percent) live w/at least one parent w/SUD 1/3 of child welfare cases in which child remained in parent’s custody 2/3 of cases in which the child was removed 10 to 15 percent: infants exposed to substances during pregnancy  Majority of parents entering publicly-funded SA Tx are parents of minor-age children 59 percent: Had a child  age 18 22 percent: Had a child removed by CPS 10 percent: Lost parental rights once child was removed

6. 6 FOSTER CARE AND BEHAVIORAL HEATLH  Clinical-level behavior problems are ~3 x as common among foster care youth as general population  Among children who enter foster care, ~ ⅓ scored in clinical range for behavior problems on Child Behavior Checklist  Children in foster care more likely to have a MH diagnosis than other children  Foster youth between 14 and 17: 63 percent met criteria for at least one MH diagnosis at some point in life

7. 7 IMPACT: CHILDREN AND TRAUMA  > 6 in 10 U.S. youth have been exposed to violence in past year; nearly 1 in 10 injured  Trauma disrupts normal development, has lasting impact, and becomes intergenerational Brain development, cognitive growth, and learning Emotional self-regulation Attachment to caregivers and social-emotional development  Predisposes children to subsequent psychiatric problems Adverse Childhood Experiences (ACEs) potentially explain 32.4 percent of M/SUDs in adulthood ¼ of adult mental disorders start by age 14; ½ by age 25

8. 8 REPORTED PREVALENCE OF TRAUMA IN BH  43 – 80 percent: Individuals in psychiatric hospitals have experienced physical or sexual abuse  51 – 90 percent: Public mental health clients exposed to trauma  >70 percent: Adolescents in SU Tx had history of trauma exposure  Majority of adults and children in inpatient psychiatric and substance use disorder treatment settings have trauma histories

9. 9 INTERGENERATIONAL  Many women w/SUDs experienced physical or sexual victimization in childhood or in adulthood and suffer from trauma  Alcohol or drug use may be a form of self-medication for people w/trauma or mental health disorders  ⅔ adults in SUD Tx report being victims of child abuse and neglect  Women w/SUDs more likely to report a history of childhood abuse

10. 10 Prevalence of serious MH conditions among 18 to 25 year olds is ~ double general population Suicide 3 rd leading cause of death among all 15-24 year olds Higher Needs Higher Risks Lower Help- Seeking Behavior TRANSITION AGE YOUTH TOUGH REALITIES – YOUNG PEOPLE DIE

11. 11 TREATMENT IS EFFECTIVE  Need to ↑ understanding effective treatments exist for BH problems and trauma symptoms common among children in child welfare system  Need to promote ↑ use of evidence-based screening, assessment, and treatment  Need to ensure appropriate use of psychotropic medications while ↑ availability of evidence-based psychosocial treatments  Need to ↑ access to non-pharmaceutical treatment to ↓ potential for over-reliance on psychotropic medication as a first-line treatment strategy

12. 12 BUILDING ON LESSONS LEARNED RPGs PAST 5 YEARS  Project leadership: Engaging and sustaining partners in the process  Identifying opportunities for change: Be problem focused and data driven  Establishing shared outcomes and joint accountability  Implementing and sustaining system-level changes

13. 13 EXPAND YOUR RESOURCES → EXPAND YOUR REACH  National Center on Substance Abuse and Child Welfare: Improving systems and practice for families w/SUDs who are involved in the child welfare and family judicial systems  National Child Traumatic Stress Network: ↑ standard of care and improve access to services for traumatized children, their families, and communities  National Center for Trauma Informed Care: ↑ awareness of trauma-informed care and promote implementation of trauma-informed practices in programs/services  BRSS TACS: T/TA to States, providers, and systems to ↑ adoption and implementation of recovery supports (e.g., peer-operated services, shared decision making, supported employment) for people w/BH problems  NREPP: Searchable online registry of 260 + interventions supporting MH promotion, SA prevention, and MH/SA Tx

14. 14 SHAPING THE FUTURE TOGETHER BUIDLING ON THE FACTS  BH is a public health issue, not a social issue  BH problems lead to premature death and disability  BH problems impose steep human and economic costs  BH impacts physical health  Government policies often inappropriately treat BH as optional/extra  Many M/SUDs can be prevented  Early intervention can reduce impact of BH problems  Treatment works, but is inaccessible for many  Treatment needs to be about families  BH is community health - it affects everyone