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BEHAVIORAL HEALTH OF PARENTS/CAREGIVERS: IMPACT ON

CHILDREN IN CHILD WELFARE SYSTEMPamela S. Hyde, J.D.

SAMHSA Administrator

Regional Partnership GranteeKickoff Meeting

Washington, DC • January 23, 2013

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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

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IMPACT: CHILD MALTREATMENT AND BEHAVIORAL HEALTH

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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IMPACT: PARENTS WITH SUDs

~Six million children (9 percent) live w/at least one parent w/SUD• 1/3 of child welfare cases in which child remained in parent’s

custody• 2/3 of cases in which the child was removed• 10 to 15 percent: infants exposed to substances during

pregnancyMajority of parents entering publicly-funded SA Tx are parents of

minor-age children• 59 percent: Had a child age 18• 22 percent: Had a child removed by CPS• 10 percent: Lost parental rights once child was removed

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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, ~⅓ scored in clinical range for behavior problems on Child Behavior Checklist

Children in foster care 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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IMPACT: CHILDREN AND TRAUMA

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

Trauma disrupts normal development, has lasting impact, and becomes intergenerational• Brain development, cognitive growth, and learning• Emotional self-regulation• Attachment to caregivers and social-emotional development

Predisposes children to subsequent psychiatric problems• 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

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REPORTED PREVALENCE OF TRAUMA IN BH

43 – 80 percent: Individuals in psychiatric hospitals have experienced physical or sexual abuse

51 – 90 percent: Public mental health clients exposed to trauma

>70 percent: Adolescents in SU Tx had history of trauma exposure

Majority of adults and children in inpatient psychiatric and substance use disorder treatment settings have trauma histories

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INTERGENERATIONAL

Many women w/SUDs experienced physical or sexual victimization in childhood or in adulthood and suffer from trauma

Alcohol or drug use may be a form of self-medication for people w/trauma or mental health disorders

⅔ adults in SUD Tx report being victims of child abuse and neglect

Women w/SUDs more likely to report a history of childhood abuse

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TRANSITION AGE YOUTHTOUGH REALITIES – YOUNG PEOPLE DIE

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TREATMENT IS EFFECTIVE

Need to ↑ understanding effective treatments exist for BH problems and trauma symptoms common among children in child welfare system

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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BUILDING ON LESSONS LEARNEDRPGs PAST 5 YEARS

Project leadership: Engaging and sustaining partners in the process

Identifying opportunities for change: Be problem focused and data driven

Establishing shared outcomes and joint accountability

Implementing and sustaining system-level changes

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EXPAND YOUR RESOURCES → EXPAND YOUR REACH

National Center on Substance Abuse and Child Welfare: Improving systems and practice for families w/SUDs who are involved in the child welfare and family judicial systems

National Child Traumatic Stress Network: ↑ standard of care and improve access to services for traumatized children, their families, and communities

National Center for Trauma Informed Care: ↑ awareness of trauma-informed care and promote implementation of trauma-informed practices in programs/services

BRSS TACS: T/TA to States, providers, and systems to ↑ adoption and implementation of recovery supports (e.g., peer-operated services, shared decision making, supported employment) for people w/BH problems

NREPP: Searchable online registry of 260+ interventions supporting MH promotion, SA prevention, and MH/SA Tx

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SHAPING THE FUTURE TOGETHERBUIDLING ON THE FACTS

BH is a public health issue, not a social issueBH problems lead to premature death and disabilityBH problems impose steep human and economic costsBH impacts physical healthGovernment policies often inappropriately treat BH as optional/extra Many M/SUDs can be preventedEarly intervention can reduce impact of BH problemsTreatment works, but is inaccessible for manyTreatment needs to be about familiesBH is community health - it affects everyone