Children’s Mental Health in New York State

1. Children’s Mental Health in New York State CMHP Workgroups Meeting Monday, December 17, 2007 David Woodlock Deputy Commissioner

2. Informing our work on the Children’s Mental Health Plan National Statistics and Research on Children’s Mental Health

3. Children’s Mental Health at a National Level • 1 out of 10 children have a serious emotional disturbance • Only 30% of children age 14 and older with emotional disturbance graduate with a standard high school diploma • Among all disabilities, emotional disturbance was associated with the highest rate of school dropout • Suicide is the 3rd leading cause of death among children and adolescents

4. Children in Foster Care • Northwest Foster Care Alumni Study, released by Casey Family Programs • examined the long term effects of foster care on adults who were now between and twenty and thirty-three years of age. • 54% of those formerly served in foster care had a Axis I diagnosis of major mental illness by the time that they reached 24 years of age • the rate for individuals formerly with the foster care system, with PTSD was double that of returning United States combat veterans.

5. The Health and Social Impact of Growing Up with Adverse Childhood Experiences • ACE Study (Robert Anda) • ACE’s disrupt neurodevelopment and have lasting effect on brain structure and function • Abuse, neglect, witnessing domestic violence, growing up with alcohol or substance abuse, mental illness, parental discord or crime in the home.

6. The Health and Social Impact of Growing Up with Adverse Childhood Experiences • ACE Study (Robert Anda) • ACE’s are common • More than 1 in 10 had 5 or more ACE’s • As the ACE’s score increases, so does the risk of numerous health and social problems • Teen pregnancy, smoking, alcohol abuse, risky sexual behavior, substance abuse, mental illness, risk of revictimization, poor work performance

7. The Health and Social Impact of Growing Up with Adverse Childhood Experiences • ACE Study (Robert Anda) • ACE Study calls for an integrated, rather than separate or categorical perspective of the origins of health and social problems throughout the lifespan • Earlier and improved treatment of exposed children and their caretakers

8. Informing our work on the Children’s Mental Health Plan Perspectives on the Evolution of Children’s Mental Health

9. Milestones in the Movement Towards Evidence Based Practice • With Jane Knitzer’s Unclaimed Children, released in 1982, the children’s mental health was awakened to the need to be much more community based. • The advent of CASSP leads to major change in the service system structure and processes. • Solidified family involvement • Large-scale expansion of community based services such as case management, family support, single points of access, etc. • Coordinated Children’s Services Initiative

10. Milestones in the Movement Towards Evidence Based Practice – Past 20 Years Systems Reform Service Providers - Focused on values and structures of CASSP • Full participation of Families • Comprehensive Array of Services • Individualized Treatment • Interagency Coordination • Case Management • Early Identification and Intervention Quality Reform Researchers – Major breakthroughs in identifying treatments that are most likely to improve mental health functioning. • NIMH Triples Funding • Evidence Based Practice • Entry into Policy “Winds Of Change” G A P

11. Milestones in the Movement Towards Evidence Based Practice – Past 20 Years Systems Reform Service Providers - Focused on values and structures of CASSP • Full participation of Families • Comprehensive Array of Services • Individualized Treatment • Interagency Coordination • Case Management • Early Identification and Intervention Highly efficient, equivocal treatments =

12. Milestones in the Movement Towards Evidence Based Practice – Past 20 Years Quality Reform Researchers – Major breakthroughs in identifying treatments that are most likely to improve mental health functioning. • NIMH Triples Funding • Evidence Based Practice • Entry into Policy “Winds Of Change” Effective Treatment, Yet Gains are Not Sustainable =

13. Informing our work on the Children’s Mental Health Plan Trends in New York State Children’s Mental Health

14. Restraints in RTF have been Reduced by 38% since 2004

15. Between 2000 and 2007: • RTF Waitlist Reduced by 136% in the Past 7 years • RTF Wait Time has been reduced by 50%

17. 2004-05 Increased Census – CNY (Syracuse) Hospital Closure 2006-07 Trend Decreasing

18. Total Bed Days For Children and Adolescents Across All Settings Decreased between 2004-05 and 2006-07 by 12%

19. Medicaid Inpatient Bed Days • Children 12 and under = Down 18% • Adolescents 13-18 years = Down 9%

20. Environmental Changes and Trends • Overall Trends • Value of Family Support and Family Driven Services • Early Identification and Intervention in Natural Settings for Kids and their Families • Continued Support for Clinically Complex Children • Developmental Skills Framework

21. Environmental Changes and Trends • New York State Service Trends • Inpatient • Bed Days Decreasing • Smaller General Hospital Programs Closing (LI and CNY) • CNY Increase in State-Operated Capacity • RTF • Stable Length of Stay • Gender flexibility in Unit Design • Looking at bed distribution vs. need (i.e. Lower Hudson River/NYC Area) • Restraint decreasing significantly • Facing significant capitol needs

22. Environmental Changes and Trends • New York State Service Trends • Residential • Resolve Utilization + Other Issues for FBT • Full Implementation of CR Model Enhancements • Release of CR RFP’s for Unallocated Resources • Bed Development Very Slow • Building Bridges in New York State • SPOA • Continue to Strengthen Accountability • Movement Towards Standard Set of Functions

23. Environmental Changes and Trends • New York State Service Trends • Treatment • Early Identification and Effective Treatment (Clinic-Plus Implementation and Expansion) • Outpatient Restructuring Project - Clinic • Day Treatment • Family Support • Strategies to Meet Increasing, Diverse Need for Family Support • More Opportunities for Youth Voice • Waiver • Release of New Guidance Document • Collaboration with and Adaptation to the B2H

24. Environmental Changes and Trends • New York State Service Trends • Collaboration Across Agencies • Child by Child – Family by Family Approach • New Indices – New Commitments • MH/MR Collaboration Initiative with DDSO’s and Field Offices • Children’s Cabinet • Commissioner Meeting December 19th-20th • Growing Awareness of the Effects of Culture on Engagement and Genuine Access to Services

25. Informing our work on the Children’s Mental Health Plan Achieving the Promise Implementation

26. Child and Family Clinic-Plus • Current provider plans target up to 246,000 screenings statewide • Most screenings (189,000) will occur in schools • Nearly 25,000 will target children in early childhood centers • Over 20,000 target children in preventive settings • Nearly 12,000 in primary care practices

27. Child and Family Clinic-Plus • The following have made a commitment to partner with Clinic-Plus providers: • 135 school districts Upstate and on Long Island • 191 schools in NYC • 53 early childhood centers in NYC • 38 preventive programs in NYC • 7 primary care practices in Upstate and Long Island

28. Child and Family Clinic-PlusNext Steps • Engagement • Family Support • Support Providers in Service Transformation • Learning Collaboratives • Ensure Quality • Public Education – Screening as a loving thing to do for your child

29. Rural TelepsychiatryStatus 11/6/07 Sites already established but no activity in 2007 Sites already established and activity in2007 Sites with new equipment 2007 and have utilized consultation 2007 new equipment but no activity Eligible Sites ? 1 2 1 9 2 2 Equipment d/c 5/07

30. Children’s Rural Telepsychiatry: Next Steps • Continued Relationship Building with Dr. Perkins and Child Psychiatry Team • Working with the Conference of Local Mental Hygiene Directors • Understand and Resolve Implementation Issues • Connect with Larger STEPS Plan

31. Evidence Based Treatment Dissemination Center • In 2006-07, EBTDC trained over 425 clinicians and supervisors in Cognitive Behavioral Therapy for Depressive Symptoms and Trauma Focused Cognitive Behavioral Therapy • Clinical consultation was provided: • Group format of no more than 12 clinicians & supervisors • Conference calling twice per month for 1.5 hours for 1 year.

32. Evidence Based Treatment Dissemination Center Lessons Learned: • In 2008-09 training will focus on 1 or 2 new treatment models • Survey of field on next topic (N=200 surveys): • Training in Disruptive Behavior Disorders, ADHD and Family Therapy were most prominent • ADHD most common diagnosis (by far) • EBTDC Scientific Advisory Board to meet in January 2008 to recommend training for Disruptive Behaviors • Training in new treatment will begin in June 2008

36. Waiver Outcomes • Effectiveness of a Children’s Home and Community Based Services Waiver ProgramPsychiatric Quarterly (2007) • Study of St.Luke’s (NYC) waiver program indicated: • The Waiver appears to be a clinically and cost effective way of maintaining children in their community. • “The waiver successfully maintained 81% of its children in the community during an average period of 12 months, while children on the wait list were maintained at only a 30% rate for a substantially shorter (three and one-half months) period.”

37. Informing our work on the Children’s Mental Health Plan Children’s Mental Health Planning Themes

38. Collective Responsibility All child-serving systems work towards supporting and addressing children’s social and emotional development. A wide array of professionals, paraprofessionals, parents and youth are involved in promoting children’s emotional wellness.

39. Broadening the Definition of Children’s Mental Health Children’s mental health is: • Social emotional development • Youth development • Screening and early identification • Treatment • Family support • Community supports and skill building Leading to the development of resilient young people

40. Continuing Trends from the Achieving the Promise Initiative • Continued momentum towards evidence based treatment • Normalizing early identification of mental health issues and ensuring access and engagement in treatment • Balancing resource allocation between early identification and high need children and families • Driving new skills and needs for workforce • Efforts to reduce stigma continue

41. Sustaining Trends in Inpatient, Residential and High-End Services • Continued support for effective local care planning structures • Continuous improvement in treatment quality • Access to services when needed • Continued focus on integration of family support • Accountability

42. Continued need for Systems Collaboration • Primary Care: Antipsychotic medications cause weight gain and diabetes • Education: Significant impact of emotional wellbeing on academic success • Juvenile Justice: Approximately one out of five (20%) youth in the JJ system has a serious mental disorder • Foster Care: Anywhere from 40 to 85% of kids in foster care have mental health disorders

43. [We] speak for those children who cannot speak for themselves, children who have absolutely nothing but their courage and their smiles, their wits and their dreams. Every child has the right to health, to tenderness, to life. - Audrey Hepburn

44. “One act of beneficence, one act of real usefulness, is worth all the abstract sentiment in the world.” -Anne Frank