SupervisionConsultants in their first yearThe transfer to consultancyManagement SkillI want them to be able to supervise

othersI want them to stay in the serviceIdentification of gapsNot paid; no time allocationMentoring

Supervision

Professional HierarchicalCross professional for special

purposes or on special requestPeer group (cross team)Personal Appraisal (Service based)

On Prevention

Primary Prevention Evidence

Durlak & Wells in 1997 reviewed 1200 primary prevention programs of which 77 met a stringent 54 standards for meta-analysis.

Average effect size was between 0.2 and 0.9 Better than most of the work on heart disease Better than results from antidepressant studies At least as good as composite results for MST

Universal Work

EVIDENCE

INFANCYImproved maternal diet and reduced

smoking during pregnancy led to fewer pre-term deliveries, higher birth weight babies and less child abuse

Olds et al 1988

1958 British Cohort health at age 33

Significant Latent Factors (Early life 0-7 yrs)

Birth weight and height age 7 (as ratio of adult height)

Whether read to.Social & emotional status age 7

(assessed by school teachers, how well they adjusted to school)

Source: Clyde HertzmanSource: Clyde Hertzman

‘Sensitive periods’ in early brain development

Binocular vision

0 1 2 3 7654

High

Low

Years

Habitual ways of respondingLanguageEmotional

controlSymbolPeer social

skillsRelative quantity

Central auditory system

Breakfast and Annual Changes in Test Scores

-1.0-0.2

0.61.4

2.2

0.71.1

1.51.9

2.4

0.51.0

1.52.0

2.5

Reading Language Mathematics

Percent who ate breakfast

-10

-5

0

5

10

Cha

nge

in S

AT

-9 (

NP

R)

48 55 62 69 76 48 55 62 69 76 48 55 62 69 76

Source: California Healthy Kids Survey & STAR data files.

EVIDENCE

SCHOOL AGE CHILDRENIncreased resilience and connectedness to

the school led to 50 point reduction in suicidal thinking

Resnick, Blum et al, 1997

Because of the trajectory from thinking through planning to attempts, we can assume this reduction will have long term benefit

Selective Work

COPMI Qualitative Studies

“Family-centered, strengths-based approaches were identified across program directors as critical to intervention success.”

Hinden, Nicholson et al, Uni Massachusetts, 2006

Hinden et al., 2002(Child Outcomes)

Child outcomes included achieving developmental milestones, enhanced school readiness, improved child behavior and emotional adjustment, and improved school attendance.

For those programs engaged in political advocacy and social marketing, increased public awareness, decreased stigma, and increased funding opportunities reflected positive outcomes.

PATS Evaluation, 2005

Structured questionnaire follow-up study over 3 years

PATS participants reported significant reductions in depressive symptoms (60% pre-intervention, 38% 12 months later), risk of homelessness (44% pre-intervention, 17% 12 months later) and stigma (30% pre-intervention, 15% 12 months later) after their involvement in the program.

http://www.rch.org.au/emplibrary/pats/PATS_FinalEvaluationReport_Dec2005.pdf

Indicated Work

MST: Meta-Analysis of Programs

8 programs met criteria At follow up:

fewer arrests less time in institutions lower self reported delinquency No differences for behaviour, parental

mental health, family functioning and relationships, risk of incarceration, and peer relationships.

Bruce, J., 2002. Evidence Based Mental Health. 5:4.

MST

Costs may be up to $30,000 per family RESULTS

A number of randomised controlled trials with chronic juvenile offenders

Reduces re-arrest by 25 - 70% Reduces out-of-home placement by 47 -

64% in long-term follow-upJuvenile Forensic Evaluation Resource Centre,

2000

Can Trajectories be Averted?Longitudinal study of 909 students up to 17 years

of age: More types of trajectories than expected < 6% followed trajectory of chronic antisocial

behaviour Disruptive preschool children are at higher risk of

following trajectories of frequent antisocial behaviour

Intensive intervention between 7- 9 yrs of (parent training, social skills training), changed long term developmental trajectories of physical aggression, vandalism, and theft for disruptive kindergarten boys in low socio-economic areas.

Lacourse et al., 2002

Thinking through to the Future

So what should we be thinking about?

It is likely that Australia will have to confront the economic realities, and this may make social exclusion worse

Despite the percentage reduction overall in young people over the next 20 years, more of them may react to stress with mental health problems

We need to consider every scrap of evidence that allows us to put in place preventive strategies along the trajectory of young life

We need to ‘proof’ our children against stress

We do need to grab as much as we can of the available new monies for mental health services.

However, the increased demands are at this time likely to drown services capacity

We must collaborate to present to Bureaucracies what is most likely to work in prevention

A major part of this may be to revisit the first 3 years of a child’s life and promote the primary relationships - perhaps through such simple things as reading.

So what should we be thinking about?

A Couple of Elegant Tiered Partnerships

Bayside Ei ProgramUniversal Program20 weeks (2 terms) of in school, class teacher

managed, AUSSIE OPTIMISMProgram based on an Australianisation of the work of Seligman (Optimistic

Child), and his team - Jaycox, Gillham et al.

Selective ProgramIF a young person scores over 30 on the CES-D

(>2SD greater than mean) and the SDQ also scores over 20, THEN

We discuss with school personnel and further assessment occurs with the MINI Kid and either set up a program in the school or refer direct to CYMHS

CadetLiFeAustralian Defence Force Cadets

(n=22,000)UNIVERSAL CD based program using

elements adapted from LiFe, the national MHPPEi documents, Aussie Optimism, Mind Matters, and available research

A ‘Pathways to Care’ program acknowledging national resources (eg Kid’s Helpline, Reach Out) and possible local service access.

Access to Reach Out On Line (ROC!)

USAF Suicides by year

A Changed WorldA Changed World

Youth Suicides 1968-2005

Australian Suicide Rates15-24 yrs, per 100,000 (ABS)

0

5

10

15

20

25

30

35

1968 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 2000 2002 2004

Mobile Phone Ownership (Australian Bureau of Statistics,

2006)

0102030405060708090

100

1990 1995 1999 2005

Mobile Phone Ownership in Young People (Roy Morgan Research 2006)

0

20

40

60

80

100

Seven Nine Eleven Thirteen

Boys

Girls

Battling the forces of Darkness

Consumerism creates Public health challenges for us QuickTime™ and a

TIFF (Uncompressed) decompressorare needed to see this picture.

The Centre for MHPPEi

Steering Committee

MHPPEi Working Group

Infant Psychiatry Hub Innovative technologies Suicide Prevention

Centre for MHPPEi Advisory Board

Director Centre for MHPPEi

Mental Health Statewide Network

Director of Mental Health Mental Health Interdepartmental Committee

Minister of Health

Possibilities for the Centre

Placement at a Major Health Centre (eg RBH) (adv. Infrastructure)

Placement in the Community (eg Nundah) (adv. Links with NGOs and Community)

Placement across Institutions (ie Uni plus Health Service) (adv. ?Kudos plus academic input)