Inside or Outside our Circle:Inside or Outside our Circle:Do Mental Health Concerns Do Mental Health Concerns

Affect our Outcomes?Affect our Outcomes?

CityMatCH Expedition 2004 Conference

September 13, 2004

The Engagement ParadigmThe Engagement Paradigm

Establish CommunityShare ContextExchange ContentDiscuss and DeliberateConsensus – or New ContextExpand Community

MCH Outcomes and Mental MCH Outcomes and Mental Health Outcomes?Health Outcomes?

A Common Language (?)A Common Language (?)

Developmental HealthBehavioral HealthMental HealthSubstance UseConduct Disorder

Traditional Maternal and Child Traditional Maternal and Child Health PopulationsHealth Populations

WomenPregnant WomenInfantsChildrenAdolescentsAdults

Tools and Strategies: Tools and Strategies: Identification and TreatmentIdentification and Treatment

Screening Case FindingDiagnosis ICD-9 DSM IVRTreatment Support Therapy Medication

Youth Risk Behavior Surveillance Survey: 1999Youth Risk Behavior Surveillance Survey: 1999Sadness and Suicide Ideation and AttemptsSadness and Suicide Ideation and Attempts

Felt sad or hopeless almost every day for >2 weeks preceding survey and stopped usual activities 28.3%

Seriously considered attempting suicide in 12 months preceding survey 19.3%

Attempted suicide > 1 time 8.3%

Suicide attempt requiring treatment (injury, poisoning, overdose) 2.6%

Youth Risk Behavior Surveillance Survey: 1999Youth Risk Behavior Surveillance Survey: 1999Substance UseSubstance Use

Used alcohol (ever) 81.0%

>1 drink alcohol on >1 day of 30 days preceding survey 50.0%

>5 drinks of alcohol on >1 day 31.5%

Used marijuana > 1 time 26.7%

Used methamphetamine (ever) 9.1%

Child and Adolescent Mental HealthChild and Adolescent Mental HealthPrevalence, Persistence, and Diagnosis:1Prevalence, Persistence, and Diagnosis:1

Anxiety Disorders 13.0%Mood Disorders 6.2%Disruptive Disorders 10.3%Substance Use Disorders 2.0%

* Six month (current) Prevalence, age 9-17

Child and Adolescent Mental HealthChild and Adolescent Mental HealthPrevalence, Persistence, and Diagnosis: 2Prevalence, Persistence, and Diagnosis: 2

Any Disorder 21%Significant Functional Impairment 11%Extreme Functional Impairment 5%

Child and Adolescent Mental HealthChild and Adolescent Mental Health“Derailment”“Derailment”

Expelled from SchoolDrop Out of SchoolBecome PregnantBe Convicted of a CrimeBegin Using Alcohol or Other Drugs

Child and Adolescent Mental HealthChild and Adolescent Mental Health“Derailment”“Derailment”

Few or no Mental Health Problems 0.5%

Mild Problems 4.3%Severe Emotional Disturbance

22.3%

Child and Adolescent Mental HealthChild and Adolescent Mental HealthPrevalence, Persistence, Diagnosis andPrevalence, Persistence, Diagnosis and TreatmenTreatmentt

Received any MH Services 40%

Received MH Services from School Counselor 75%

Received MH Services from MH Specialist 12%

Received MH Services from Primary Care 6%

Child and Adolescent Mental HealthChild and Adolescent Mental HealthPrevalence, Persistence, Diagnosis andPrevalence, Persistence, Diagnosis and TreatmenTreatmentt

MH Diagnosis and saw MH

Specialist 20%

Parental Recognition and saw MH Specialist 40%

Evidence Based PracticeEvidence Based Practice

Best PracticeBest Practice

Promising PracticesPromising Practices

School Based ClinicsExpanded School Mental HealthPrimary Care/Mental Health

Co-location/IntegrationCollaborative Practice ArrangementsYouth Development Programs/Initiatives

Promising PracticePromising PracticeExpanded School Mental HealthExpanded School Mental Health

Focused EvaluationReferralsTracking of ReferralsPreventive ServicesFull Range of Treatment Services

Promising PracticePromising PracticeYouth Development Programs/Initiatives: 1Youth Development Programs/Initiatives: 1

Goals: promote positive development even when seeking to prevent problem behaviors

Competence Confidence Connections Character Caring and Compassion

Promising PracticePromising PracticeYouth Development Programs/Initiatives:2Youth 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

Promising PracticesPromising Practices

EPSDT (with developmental/behavioral tools/checklists)

Bright Futures Mental HealthBrief Motivational TherapyBrief Interventional TherapyCognitive Behavioral TherapyMedication

Resources/ReferencesResources/References

Mental Health: A Report of the Surgeon General http://www.mentalhealth.org/cmhs/surgeongeneral/surgeongeneralrpt.asp

Youth Risk Behavior Surveillance Surveywww.cdc.gov/HealthyYouth/YRBS

Bright Futures Mental Healthwww.brightfutures.org

Center for School Mental Health Assistancewww.csmha.umaryland.edu

The Prevention Researcherwww.TPRonline.org

Evidence Based Practichttp://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/default.asp.