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OHIO JUSTICE ALLIANCE FOR COMMUNITY CORRECTIONS ANNUAL Conference october 11, 2013

OHIO JUSTICE ALLIANCE FOR COMMUNITY CORRECTIONS ANNUAL Conference october 11, 2013. Terry R. Jones, Bureau Chief Ohio Department of Mental Health and Addiction Services Bureau of Families and Children. Childhood Trauma.

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OHIO JUSTICE ALLIANCE FOR COMMUNITY CORRECTIONS ANNUAL Conference october 11, 2013

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  1. OHIO JUSTICE ALLIANCE FOR COMMUNITY CORRECTIONS ANNUAL Conferenceoctober 11, 2013 Terry R. Jones, Bureau Chief Ohio Department of Mental Health and Addiction Services Bureau of Families and Children

  2. Childhood Trauma “Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the negative impacts of early fear learning. There is no doubt that children in harm’s way should be removed from a dangerous situation. However, simply moving a child out of immediate danger does not in itself reverse or eliminate the way that he or she has learned to be fearful. The child’s memory retains those learned links, and such thoughts and memories are sufficient to elicit ongoing fear and make a child anxious.” National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved fromwww.developingchild.harvard.edu.

  3. Childhood Trauma • Between 60% and 90% of children and adolescents presenting for outpatient mental health treatment have been exposed to trauma (Lang JM, Ford JD, Fitzgerald MM.). • Most have multiple experiences of trauma (Muesser et al., 1998) • As many as 1 in 3 girls and 1 in 6 boys are sexually abused in childhood; 20% of all women have at last 1 incestuous experience before age 18.

  4. Childhood Trauma • Between 1/3 and 2/3 of known sexual assault victims are age 15 or younger (median age 9.6 years for girls and 9.9 years for boys) • Per capita rates of rape/sexual assault are highest among persons aged 16-19, low income persons, urban residents, people with disabilities, and those served in the criminal justice system. • Sexually abused boys are more reluctant to report abuse than girls, especially when perpetrator is family. • Boys and men often “act out” through their own aggressiveness and violence. More abused males than females go on to sexually abuse others.

  5. Childhood Trauma • In pediatric clinical samples, high levels of traumatic stress have been found in approximately 90% of children who are sexually abused, 75% of those exposed to school violence, 50% of those physically abused, and 35% of children exposed to community violence. Hamblen J, Barnett E. PTSD in children and adolescents. 2011).

  6. Childhood Trauma in Ohio Every 9 1/2 minutes, an Ohio child is abused or neglected. In 2000, there were 54,084 substantiated or indicated cases of abuse and neglect in Ohio. Closer Look: Our Kids. Ohio Legal Rights Service, 2000.

  7. Childhood Trauma in Ohio Facility administrators reported that 70% - 90% of children in Ohio’s residential treatment facilities are victims of violence. Closer Look: Our Kids. Ohio Legal Rights Service, 2000.

  8. Cost Estimates of Child Maltreatment • United States- in 2007 dollars • Direct costs-$33 Billion • Indirect costs-$71 Billion • Total annual costs-$104 Billion (Wang & Holton-Economic Impact Study, Prevent Child Abuse America,2007) • Ohio-in 2007 dollars • Direct costs-$290 Million • Indirect costs-$2.1 Billion • Total annual costs-$3 Billion (Preventing Family Violence, Anthem Foundation of Ohio, 2007)

  9. Prevalence of Trauma • Boys who experience or witness violence are 1000 times more likely to commit violence than those who do not. • 66% of those in SA treatment report childhood abuse or neglect. • 80% of those in psychiatric hospitals experienced physical or sexual abuse as children. • 90% of those diagnosed with BPD or DID were victims of violence. Anne Jennings. What Can Happen to Abused Children When They Grow Up- If No One Notices, Listens, or Helps? January 2001.

  10. Childhood Trauma Research indicates that children and adolescents from minority backgrounds are at increased risk for trauma exposure and development of Posttraumatic Stress Disorder (PTSD). For example, African American, American Indian, and Latin American children are overrepresented in reported cases of child maltreatment, and in foster care. Department of Health and Human Services, Administration for Children and Families (2002).

  11. Childhood Trauma Although child trauma is a significant and pervasive mental health condition, it is potentially one of the most treatable—a remarkable development, considering that no empirically supported treatments for child trauma existed before the late 1990s.

  12. Childhood Trauma The National Child Traumatic Stress Network (NCTSN) suggests that trauma treatment may also build resilience, indicating that “children who receive timely and appropriate treatment may not only recover, but gain the tools and capacity to cope more successfully with future stress” National Child Traumatic Stress Network. Changing the course of children's lives. 2011.

  13. DSM-V and Trauma Proposed changes to the DSM-V overlap with the achievements of the NCTSN and underscore increased recognition of trauma’s impact on mental health. Recommendationsinclude relocating trauma-related disorders from Anxiety Disorders into a new primary category, encompassing Acute Stress Disorder, Post-Traumatic Stress Disorder, and Trauma- or Stressor-Related Disorder Not Elsewhere Classified.

  14. Childhood Trauma: Past STATE Efforts Through Ohio’s Transformative State Incentive Grant (TSIG) the Ohio Department of Mental Health created a Childhood Trauma Task Force strategic plan focused on: 1) Public Awareness and Education; 2) Screening and Assessment; 3) Evidence–Based Training; 4) Data Collection and Analysis.

  15. Childhood Trauma: Past Efforts •Presented on Trauma Informed Care (TIC) and the landmark Adverse Childhood Experiences (ACE) Study. • Trained 200 clinicians in Trauma Focused-Cognitive Behavioral Therapy (TF–CBT) during Fall 2010. • Trained 100 public child welfare agency staff on Trauma-Informed Child Welfare. • Developed a TF–CBT and Child Welfare workshop presented jointly to mental health and child welfare professionals and foster parents. • Developed and disseminated Trauma Informed Best Practices and Protocols for Ohio’s domestic violence programs. •Governor’s Executive Order 2009-13S banning prone restraint and limiting physical restraints in all state systems.

  16. And then…. • The TSIG GRANT ENDED………

  17. And So…What have you done lately? • Elevation of Medicaid match responsibility to the state level. • Created a predictable and sustainable future for local board systems. Will free-up an estimated $70 million annually ($105 million for the FY 14-15 biennium) in local board spending. • Focuses local efforts on unmet needs, trauma initiatives, transitional age housing, employment, transportation, or addressing waiting lists.

  18. And So…What have you done lately? Targeted Investments…. • Governor Kasich’s Jobs Budget increased state funding for mental health by 5.7% ($26.8 million) over two years, reversing a downward trend since 2008 in which state funding was reduced by 19.5% ($112.4 million). • $5 million investment targeted at youth and young adults with intensive needs • Additional investment in both mental health and addiction in the mid-biennium review for a total of $6 million

  19. And So…What have you done lately? • Proposal to extend Medicaid benefits to 138% of Federal Poverty Level. • Offering coverage for 366,000 individuals, many of them children, estimated to enroll– effective Jan. 1, 2014. • Serving more Ohioans at no extra cost to Ohio. • Transition age youth in danger of losing services when entering adulthood. ENGAGE Grant funded in July, 2013.

  20. And So…What have you done lately? ODMH staff participated on the Ohio Interagency Task Force on MH/JJ which recommended the following: • Development of a “PRTF” (Psychiatric Residential Treatment Facility) or similar model, designed to offer intense, focused mental health treatment to youth committed to ODYS to promote a successful return of youth to their community most of whom have experienced trauma.

  21. And So…What have you done lately? • Developed Medicaid health homes for individuals with SED/SPMI. • Approximately 14,000 clients enrolled in Phase I, scheduled to go statewide January 1, 2014

  22. And So…What have you done lately? • On or before January 1, 2014 Intensive Home Based Treatment (IHBT) shall be a Medicaid reimbursed service; upon CMS (Centers for Medicare and Medicaid Services) approval training and technical assistance needed for the expansion of IHBT shall be provided.

  23. And So…What have you done lately? • ODMH has replicated its successful Community Linkages program for youth involved in the juvenile justice system who have SED and may have experienced trauma and their families to facilitate the timely provision of community mental health services and supports upon release from ODYS.

  24. And So…What have you done lately? House Bill 59 • Section 501.10. Screening Tool for High-Risk Youth Team Evaluation. • OHT shall convene a team comprised of DYS, OMA, ODJFS, ODMHAS, and the Dept. of Health. • The team shall evaluate the feasibility of implementing a trauma screening tool for high-risk youth and create a report outlining (a) the recommended screening tool; (b) training in the administration of the recommended tool; (c) screening protocols; (d) the persons to whom the tool should apply and (e) implications for treatment. The report shall be completed by December 1, 2013, and shall be distributed to the Governor. First meeting occurred on February 15, 2013

  25. And So…What have you done lately? • Other state/county initiatives: Ohio Governor’s Task Force on Human Trafficking, AG Human Trafficking Task Force, and FCCS-The Gateway Call Project.

  26. And So…What have you done lately? • By June 30, 2015, ODMH in collaboration with ODYS will select and implement a statewide, culturally appropriate standardized screening instrument specific to mental health and trauma to be used at the earliest contact points as youth enter the juvenile justice system.

  27. And So…What have you done lately? • ODMH is currently working with other systems of care (Child Welfare, DYS, DODD, Health, and Education) to develop a universal screening tool based on developmental age, nature of trauma exposure, culture and service context to be administered at each point of system entry. ODYS has received $82,500 in grant funds for this initiative and will partner with ODMH and other systems.

  28. And So…What have you done lately? • During FY14/15, the Ohio Department of Mental Health will work with the Office of Medical Assistance (OMA) on adding Family Therapy services to our Medicaid service array to support the provision of behavioral health services to children, youth and their families.

  29. And So…What have you done lately? • Collaborated and funded upcoming trauma training for probationary and DYS staff. They in turn will train their respective system staff. • Scheduled trauma specific training to ODMH Regional Hospital staff and DODD Developmental Center staff. All shifts will be trained. • Initiated exploratory discussion with a CCOE to provide trauma specific training/technical assistance statewide. • ODMH/ODADAS recently conducted a statewide survey of 644 MH/AOD providers to access capacity and needs of providers and local systems to provide effective, evidence-based and trauma focused treatment. • Allocated Block Grant dollars to fund trauma centered initiatives. • Participated on the Department of Education’s Task Force on Seclusion and Restraint.

  30. The work has only begun: Next Steps • Addressing trauma requires a comprehensive, multipronged human service approach. This approach includes: • Increasing awareness across systems of the harmful short- and long-term effects of trauma experiences in children; • Developing and implementing across systems effective preventive, treatment, and resiliency support services that reflect the needs of diverse populations; • Building strong partnerships and networks to facilitate knowledge exchange and systems development; • Providing training and tools to help systems identify trauma and intervene early; and • Informing public policy that supports and guides these efforts.

  31. Questions/Answers Contact information: Terry R. Jones, Bureau Chief Bureau of Children and Families Office of Wellness and Prevention Ohio Department of Mental Health and Addiction Services 30 East Broad Street, Suite 851 Columbus, Ohio 43215 614-466-0111 Terry.Jones@mha.ohio.gov

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