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

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

3. MCH Outcomes and Mental Health Outcomes?

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

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

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

7. 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%

8. 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%

9. 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

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

11. 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

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

13. 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%

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

15. Evidence Based Practice Best Practice

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

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

18. 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

19. 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

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

21. Resources/References Mental Health: A Report of the Surgeon General http://www.mentalhealth.org/cmhs/surgeongeneral/surgeongeneralrpt.asp Youth Risk Behavior Surveillance Survey www.cdc.gov/HealthyYouth/YRBS Bright Futures Mental Health www.brightfutures.org Center for School Mental Health Assistance www.csmha.umaryland.edu The Prevention Researcher www.TPRonline.org Evidence Based Practic http://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/default.asp.