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IMPACT: BEHAVIORAL HEALTH OF CHILDREN AND FAMILIES IN THE

CHILD WELFARE SYSTEMPamela S. Hyde, J.D.

SAMHSA Administrator

HHS Psychotropics Summit Washington, DC • August 27, 2012

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CHALLENGES

> 6 in 10 U.S. youth have been exposed to violence in past year; nearly 1 in 10 injured

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

Six million children (9 percent) live with at least one parent who abuses alcohol or other drugs

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CHILD WELFARE AND BEHAVIORAL HEALTH

Children in child welfare system have disproportionally high rates of social-emotional and behavioral health problems

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

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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, ~one-third scored in the clinical range for behavior problems on Child Behavior Checklist

Children in foster care are 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

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TREATMENT IS EFFECTIVE

Need to ↑ understanding effective treatments exist for BH problems and trauma symptoms common among children in foster care

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

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PSYCHOTROPICS: BALANCED APPROACH

HARMFUL BENEFICIAL

Appropriate Age

Used With Psychosocial

Interventions

Appropriate Use

Correct Medication, Dosage, and Monitoring

Too Young

Polypharmacy/No Coordination

Too Soon/At Intake

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SAMHSA’S WORK WITH AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY

Youth Voice Tip Sheet – Spearheaded by SAMHSA Child and Adolescent Psychiatry Fellow

Child and Adolescent Psychiatric Fellowship Program• Once a week, second-year resident comes to SAMHSA to work on policy

issues; 4 fellows over past 3 years

Assisted AACAP with creating “Guide for Community Child Serving Agencies on Psychotropic Medications for Children and Adolescents”

Expanded Work of Center for Health Care Strategies, Inc.

• Opportunity for 5 states to receive intensive TA on psychotropic medication use in foster children

• Expanding to learning community for all 50 states

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OPPORTUNITIES

SAMHSA Grant Announcements – Training and Capacity Building for Child Welfare Workers in Evidence-Based Trauma Interventions and Implementation• System of Care Expansion Implementation Cooperative Agreement grants• National Child Traumatic Stress Initiative grants

– National Center for Child Traumatic Stress – Treatment and Service Adaptation Centers – Community Treatment and Services Centers

New ACF Demonstration Grant: “Initiative to Improve Access to Needs-Driven, Evidence-Based/Evidence-informed Mental and Behavioral Health Services in Child Welfare” • Supports evidence-based or evidence-informed screening, assessment, case

planning, and service array reconfiguration practices

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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