IMPACT: BEHAVIORAL HEALTH OF CHILDREN AND FAMILIES IN THE CHILD WELFARE SYSTEM

2. IMPACT: BEHAVIORAL HEALTH OF CHILDREN AND FAMILIES IN THE CHILD WELFARE SYSTEM Pamela S. Hyde, J.D. SAMHSA Administrator HHS Psychotropics Summit Washington, DC • August 27, 2012

3. CHALLENGES • Six million children (9 percent) live with at least one parent who abuses alcohol or other drugs • > 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

4. 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

5. 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-thirdscored 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

6. 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

7. PSYCHOTROPICS: BALANCED APPROACH

8. 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

9. 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

10. 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