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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