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Ruth Perou, PhD
Child Development Studies TeamDivision of Human Development and Disability
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention National Association of County Behavioral Health And Developmental Disabilities Directors
Washington DCMarch 4, 2011
A Public Health Approach to Children’s Behavioral Health at the Center’s for Disease Control
and Prevention (CDC)
National Center on Birth Defects and Developmental Disabilities
Division of Human Development and Disability
States with Significant (p < .05) Increases in Parent-reported ADHD
Diagnosis (2003-2007)
Note: There was a statistical trend in the rates in MD, AL, & NE (.05<=p<= .1).
SSNR SurveillanceSSNR Surveillance• National Survey
of Children’s Exposure to Violence (NatSCEV)
• ~70 screener items• Broad range of victimizations• Caregiver report: age 0-9 years
Youth self-report: age 10-17 yrs• 4,549 participants
• 34 SSNR items added
The Public Health Model
Define the problem
Identify risk and protective factors
Develop and test prevention strategies
Assure widespread
adoption
Prevention
Sample CDC Child-Family Prevention Programs
• Project Choices• Project Connect• Learn the Signs. Act Early• Legacy for ChildrenTM
Learn the Signs. Act Early.Builds on familiar experiences of parents, such as monitoring their child’s growth
Aims to educate parents, health care professionals, and childcare providers about child development
Encourages early screening and intervention—strategies that hold the most promise for affected children and their families
7
Learn the Signs Resource Kits
www.cdc.gov/actearlywww.cdc.gov/actearly
Legacy for ChildrenTM
Improve outcomes for children in poverty by promoting positive parenting
Legacy mechanisms:– Mother-Child Interaction– Enhancing parental self efficacy– Promoting a sense of community
Evaluation– Preliminary analysis are promising
– 17% INT children had fewer behavioral challenges– 20% INT children had higher cognitive scores
– Longitudinal evaluation in progress– Feasibility study in progress - Collaboration with ACF
Implementation Resources for Communities
The Public Health Model
Define the problem
Identify risk and protective factors
Develop and test prevention strategies
Assure widespread
adoption
Evaluation Feedback throughout process
Evaluation
• Evaluation feedback at every step• Program Evaluation
– the goal of rigorous evaluation is to rule out alternative explanations (aka “threats to internal validity”) for observed outcomes
– Technology Enhancements to Parenting Programs
– Improving Training of Home Visitation Programs
Triple P: Population-based Approach
Everybody
All Families in a Specific Setting
Families at Risk
Media Campaign
Brief Consultationsin PrimaryCare Settings
ParentingSkillsTraining
Intensive Counseling
Families in Crisis
Public Health Leadership for the Prevention of Child Maltreatment
(PHL) Initiative
Supporting state public health agency efforts in primary prevention of child
maltreatment
PHL Purpose To raise awareness
about child maltreatment prevention as a public health issue.
To identify ways to support, improve, and expand child maltreatment prevention efforts in public health agencies.
Health Department Role
IndividualRelationshipCommunitySocietal
Examples • Parent Training
Examples • Home visitation •Legacy for ChildrenTM
• Project Choices
Examples• Parents Matter Program•School Connectedness•MH Consultation
Examples• Maternity/Paternity Leave
Examples of Public Health Relevant Approaches to Child Behavioral Health Across the Social Ecological Model
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Thank you!Points of Contact:
Ruth Perou, [email protected]
National Center on Birth Defects and Developmental Disabilities
Place Descriptor Here
Autism and Developmental Disabilities Monitoring
(ADDM) Network– Collaborative effort to estimate prevalence
of ASDs in multiple areas of US
– Provide data to • Characterize the ASD population• Describe variation by subgroups and over time• Evaluate methodologic factors which may influence
estimates• Inform hypotheses on potential risk factors
UCLA KABC IQ at 3 Years of Age
Intervention Comparison
IF = Intellectual Functioning
50% 30%
UM DECA: Meeting Referral Criteria at 2 Years• 17% fewer intervention children fell 2 SDs
above the mean for behavioral problems• Comparison children had 78% greater odds of
meeting referral criteria for behavioral problems
36
52.542.5
0102030405060708090
100
Behav Probs*
% >= 2 SDs from
Mean
Int Comp Total
WA
MT
OR
NV
CAUT
AZNM
CO
ID
WY
ND
SD
MN
IANE
KS
TX
FL
MS
LA
ALGA
SC
NC
VA
ME
NY
MI
WI
OK
MO
AR
TN
KY
IL IN
MI
OH
WV
DC
MD
DE
NJ
VT
RI
CT
NH
MA
AK
HI
PA
% of children aged 4-17 years currently taking medication for ADHD by state: United States,
2007
7.6%-9.5%
5.9%-7.5%
4.7%-5.8%
3.7%-4.7%
1.2%-3.6%