Nashville Community Health Needs for Children and Youth, 0-24

1. Nashville Community Health Needs for Children and Youth, 0-24 GOAL 6Children and Youth are Mentally Well

2. Participants of the 2006 Mayor’s Youth Summit identified 3 strategies for the Mental Health Subcommittee. INITIAL FOCUS • Promote awareness and a full range of mental health and substance abuse services along the continuum of care. • Professional development across sectors. • Community awareness and decreasing the stigma • Increase early identification of student issue. • Increase access to a full array of behavioral health services. FUTURE FOCUS • Provide mental health and substance abuse screening to all children and youth. • Implement a treatment matching approach for children and youth who need services.

3. Prevalence of Youth Mental Illness • One in 5 youth suffer from mental health issues and 1 in 10 from serious emotional disturbance. • Half of all mental illness begins by age 14. • Only about 20% of youths in need of services receive them. • Youth experiencing poverty and other negative environments are at higher risk for mental health issues. • More than half of youth experiencing mental illness also suffer from a substance use disorder. • Underage and excessive drinking has been noted to be the nation’s number one drug problem.

4. Biology Genetics Chemical imbalances in the body Central nervous system damage Environment Environmental toxins, such as lead Community violence Child abuse and neglect Chronic poverty Loss of relationships through divorce, death, etc. Peer pressure Negative school cultures There are many factors that contribute to or exacerbate behavioral health issues.

5. Negative Consequences Associated with Mental Illness • Bullying and violence • Substance use/abuse • Teen pregnancy and increased STDs • Academic failure and school dropout • Poorer physical health • Injuries and death • Suicide • Child abuse and neglect • Unemployment

6. Davidson County and MNPS Data • Metro Nashville Public Schools (MNPS) includes over 72,000 students and is the 49th largest in the nation. • MNPS students are more often minorities: • 48% African American • 36% Caucasian • 12% Hispanic • 4% other • MNPS’ ELL program has doubled in the past 5 years with over 7,000 students (10%). • Over 60% of students receive free or reduced-price lunch. • 65% of students graduated on-time in 2005-06. (an improvement of about 10% in 4 years).

7. Davidson County and MNPS Data • Tennessee ranks 46th in the US in overall child well-being. • Davidson County has among highest rates in the state for high school dropout, suspensions, child abuse, economic deprivation, teen pregnancy & juvenile court referrals. • Truancy filings grew by 900% from 2000 to 2004. • School referrals to juvenile court tripled between 2000 and 2004. • 38% increase in dependency/neglect filings. • Increased referrals for alcohol and drug related charges. • 2005 YRBS survey data show 25% of students drank before age 13 and 42% drank in the past 30 days.

8. School-Based Services in MNPS • MNPS contracts with community agencies to support 14 school-based mental health clinics, several Pre-K programs as well as therapy and case management programs. • STARS provides prevention and early intervention services through student assistance programs in approximately 30 middle and high schools. • Several agencies such as Oasis, Centerstone, Domestic Violence Intervention Center, Vanderbilt, among others provide universal and indicated prevention services. • MNPS provides services to students meeting eligibility for special education services (e.g., 504, IDEA).

9. Community-Based Services in Davidson County • Community mental health centers such as Centerstone, Vanderbilt, and Mental Health Cooperative Private agencies and counselors. • Oasis Center: Shelter and mental health counseling • Bradford, Cumberland Heights, and others targeting substance use issues. • Family and Children’s Services. • Tennessee Voices for Children: Respite services, parent support, and advocacy. • Services, outreach, and training through Metro Health Department as well as TN Department of Mental Health and Developmental Disabilities.

10. Current Service System Issues • Multiple barriers to accessing community-based services, e.g.: • Capacity (waiting lists) • Shortage of Child Psychiatrists • Parental and youth engagement and voice • Transportation • Insurance and cost • Stigma • Culture and language • Few school-based intervention and treatment services. • Inadequate collaboration across youth-serving sectors, e.g., schools, mental health, juvenile justice. • Over reliance on inpatient care due to lack of community alternative to traditional outpatient counseling. • Inadequate behavioral health training for primary care providers. • Educators not trained or equipped to identify and adequately refer students with behavioral health issues.

11. Anticipated Progress Over the Next 2-5 Years • Advocacy for state and local policies mandating improvements in prevention, early intervention, and treatment services for youth. • Increased collaboration across sectors. • Subcommittee proposal for a DOE planning and infrastructure building grant for integrating schools and mental health systems. • Plan to evaluate the network over time to assess impact of Alignment Nashville and similar community collaborations. • Increased innovative effective school-based intervention and treatment services. • Improved access to all types of services. • More appropriate strength-based services based on individual and family needs. • Innovative and more effective methods to effectively engage youth and their families and incorporate their viewpoints.

12. References • Annie Casey Foundation, 2006. • Califano, 2003. • Costello et al., 2003. • DHHS, 1999. • Kataoka, Zhang & Wells, 2002. • Kessler et al., 2005. • TCCY, 2005. • TN Council of Juvenile & Family Court Judges, 2004. • US Public Health Service, 2000.