Post on 03-Jan-2016
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Breaking the Disability- Breaking the Disability- Poverty CyclePoverty Cycle
Early Intervention in Behavioral Health Care
An Integrated, Family-Centered An Integrated, Family-Centered Approach to Working with High-Risk Approach to Working with High-Risk PopulationsPopulations
Work undertaken at the Center for Mental Health, Inc in Washington, D.C. between 1990-2006
Presented at the Invitation of Karen Burt, M.D., Director of Integrative Health -- to the Family Practice Residents, Tuesday March 24, 2009 – by Johanna Ferman, M.D., Medical Director, Adult System of Care, Mental Health Division, DHS
Prognosis & The Fault Line
The Fault Line:
Untreated Addiction and Mental IllnessCMH
CourtsCriminal Justice
Dysfunctional School System
Institutionalization Of Children &
Adults
Domestic Violence
Broken Child
Welfare System
Crisis and Emergency Room Visits
PovertyNeo-Natology and High Risk Infants Homelessness
Prognosis and The ElephantPrognosis and The Elephant
Learning Disabilities
Out of home
placementSocial
Emotional Developmental
Delays
UntreatedAddiction & mental
Illness
Disruption of familyas “developmental”
environment
“In utero” exposure to alcohol and drugs – multiple sequelae
Soc/Emotional Difficulties
Depression, Aggression
School failure- Drop out
Early Pregnancy
Gang activity
Use of alcohol/drugs to
Medicate underlyingproblems
CMH
CycleCycleofof
Disability Disability Poverty &Poverty &
HopelessnessHopelessness
“…to break the cycle of disability, poverty and
hopelessness due to untreated mental illness and
addiction...”
Mission at CMHMission at CMH
Target Population: AdultsTarget Population: Adults
Dual Dx MI/SA(10 yrs+) and SPMIDissociative DisordersPTSDMultiple Axis III
High-risk
-- Social-emotional skills gap
Is this familiar?
CMH
Target Population: ChildrenTarget Population: Children Birth through 21 Family history of MI and
addiction In utero/later exposure Developmental Delays
Speech, language, motor S-E
Loss, trauma, abuse Also familiar?
CMH
Child & Family
Mental Health
Substance Abuse
Intake
Evaluation
& Treatment
Testing
Planning
Case Mgmt..
Case Management Services
Physical Medicine Psychiatry
BusinessesUnions
GrassrootsCommunity
Agencies Primary healthcare
PublicHousing
JuvenileJustice
Child Welfare
Schools
Social-emotional skillsFood/clothingTransportationPre-Vocational preparation and job placement
CMH
CMH’s Family Health Model: A Developmental
Paradigm
IINTEGRATED NTEGRATED SSERVICESERVICES
• Evaln and Rx Plng• Reduce barriers to care• Drug/alc testing;
sobriety plan• Health training and
linkage; Prenatal • Grp,ind, fam therapies• Medicn mangt• Daily living skills
including s-e skills • Building community
• Milieu/member council
• Case management• Parenting skills• Arts/music/dance/writing• Linkages, legal,
AA/NA/Churches• Graduation Planning• Spiritual component
CMH
CMH
Sample Mean of Family Treatment Goal Attainment
Site 1 Site 2 Site 3 CMH
University of Illinois Outcome Study (1996-2000)
Women MH Consumers & Their Children
What did we learn from this What did we learn from this integrative work?integrative work?
• Family as central to support• S-e skills, groups
• Engagement• Early intervention
• Public health• UC Davis and other centers
Integrate • MH/SA/H• Intensity of each drives setting
CCC -- Strengths to build on:- CCC -- Strengths to build on:-
o Family Practice Addiction Serviceso A Magnet for Change
Integrative Medicine: EDAPT Groups Front end
IMPACT C-L work
CCRMC Ambulatory care
RxM