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DMH/DD/SAS Access to the Full Continuum of Services for Children and Adolescents with Substance DMH/DD/SAS Access to the Full Continuum of Services for Children and Adolescents with Substance Use and Mental Health Problems Flo Stein, Chief DMHDDSAS Youth Accountability Task Force April 22, 2010 11

n So how should an ideal system of care for children that addresses prevention, n So how should an ideal system of care for children that addresses prevention, treatment and recovery from substance use and/or mental health challenges be designed? 2

The North Carolina Child Plan To provide for children and families with substance use The North Carolina Child Plan To provide for children and families with substance use disorders or mental health needs services that are : l Delivered in the home and community in the least restrictive, most appropriate and consistent manner possible. l. A system of effective quality care. l Accessible, culturally appropriate treatment, intervention and prevention and recovery services. 3

NC System of Care n n n The plan for care for children’s services NC System of Care n n n The plan for care for children’s services in our state is based on the evidence based program known as the System Of Care (SOC). A system of care is a coordinated network of community –based services and supports that are organized to meet the challenges of children, youth and adolescents. Systems of Care was originally funded by the Center for Mental Health Services, SAMHSA. 4

Systems of Care n n n Families and youth work in partnership with public Systems of Care n n n Families and youth work in partnership with public and private organizations to design services and supports that are effective and that build on the strengths of the individual. Systems of Care is not a program –it is a philosophy of how care should be delivered. Each LME has a designated SOC Coordinator that works with providers and other agencies to conduct child and family team meetings for each child needing services. 5

Children with Mental Health Disorders n There an estimated 4. 5 to 6. 3 Children with Mental Health Disorders n There an estimated 4. 5 to 6. 3 million children and youth with mental health challenges in the US. About 2/3 of these young people do not receive the services they need 6

Adults and Children with MH Diagnosis Served in SFY 2009 n n n DMH/DD/SAS Adults and Children with MH Diagnosis Served in SFY 2009 n n n DMH/DD/SAS served a total of 229, 297 individuals with a diagnosis of mental health in SFY 2009 27 percent or 62, 000 were 17 years or younger About 1. 4 percent of children were served in hospitals or residential centers 7

Gender of Youth with MH Diagnosis Served in SFY 2009 n Males were disproportionately Gender of Youth with MH Diagnosis Served in SFY 2009 n Males were disproportionately represented 8

Race of Youth with MH Diagnosis Served in SFY 2009 9 Race of Youth with MH Diagnosis Served in SFY 2009 9

n Children with Substance Use Disorders n Adolescent alcohol and drug use occurs in n Children with Substance Use Disorders n Adolescent alcohol and drug use occurs in the context of rapid developmental change n Teens often use a greater number of or different types of drugs than adults, resulting in more complicated withdrawal or dependency patterns. 10

n Adolescents with alcohol and drug use problems are a heterogeneous group. They exhibit n Adolescents with alcohol and drug use problems are a heterogeneous group. They exhibit marked individual differences n The vulnerability, risk, resilience and protective factors associated with adolescent use problems have been identified 11

Initiation of Substance Abuse Behaviors Before Age 11 (Middle School) or Age 13 (HS) Initiation of Substance Abuse Behaviors Before Age 11 (Middle School) or Age 13 (HS) * Middle school initiation before age 11 yrs; * High school initiation before age 13 yrs Source: NC YRBS, 2007 12

Substance Abuse Behaviors among Youth in North Carolina (past 30 day use) Middle schools Substance Abuse Behaviors among Youth in North Carolina (past 30 day use) Middle schools students asked the question “ever had a drink other than a few sips” (33. 6%) , no comparable ‘past 30 day use’ data available through 2007 YRBS for middle school students. Source: NC YRBS, 2007 13

Illegal Drug Use Patterns Among Middle School Students (‘ever used’) Source: NC YRBS, 2007 Illegal Drug Use Patterns Among Middle School Students (‘ever used’) Source: NC YRBS, 2007 14

Illegal Drug Use Patterns Among High School Students (‘ever used’) Source: NC YRBS, 2007 Illegal Drug Use Patterns Among High School Students (‘ever used’) Source: NC YRBS, 2007 15

n A small but significant potion of adolescent who try alcohol or other drugs n A small but significant potion of adolescent who try alcohol or other drugs will develop substance use problems. Monitoring the Future indicates a majority of U. S. teenagers regardless of gender, or race/ethnicity is exposed to and uses alcohol and other drugs by the final year of high school 16

SA Prevention Need Among North Carolina Youth n Almost all of the 731, 632 SA Prevention Need Among North Carolina Youth n Almost all of the 731, 632 children and adolescents (12 -17 yrs old) of North Carolina need an ‘universal’ prevention program n Through the 2007 NC YRBS, 37. 7 % of 12 -17 yr old students reported as having consumed alcohol in the past 30 days n This estimate would place 275, 826 of North Carolina’s high school students in need of selective or indicated prevention programs. n Through Substance Abuse Block Grant and the SDFSCA grants approximately 10, 000 youth were served (SFY 2006 -07) 17

Treatment Need n Of the 731, 632 children and adolescents in North Carolina q Treatment Need n Of the 731, 632 children and adolescents in North Carolina q Based on national prevalence estimates, 54, 188 children and adolescents (12 -17 yrs) were in need of SA treatment services q Of this group of children and adolescents approximately 3279 or 6. 1 % received substance abuse treatment services Note: Estimates based on IPRS and Claims data, Estimates do not include prevention services 18

Adverse Consequences of Not Providing Prevention , Intervention and Treatment n n n n Adverse Consequences of Not Providing Prevention , Intervention and Treatment n n n n Fatal and non-fatal injuries related to motor vehicle accidents, suicides, homicides, violence and delinquency Severe Emotional Disorders Risky sexual practices Impulsivity, alienation, and psychological distress Neurological impairment Other medical complications Delayed in normal cognitive and social-emotional development 19

Family Factors n n n Family disorganization increases risk of adolescent health problems including Family Factors n n n Family disorganization increases risk of adolescent health problems including substance use disorders and mental health disorders. The family provides crucial background both genetically and environmentally. Children of parents with substance use disorders are at increased risk to develop substance use disorders themselves. Community disorganization increases risk 20

Resiliency Factors n n n Self-esteem Family connectedness or other trusted reliable adults Religiosity Resiliency Factors n n n Self-esteem Family connectedness or other trusted reliable adults Religiosity Other community supports Coping Skills Motivation for change 21

Youth with Distinctive Treatment Needs n n n n Youth in the Juvenile Justice Youth with Distinctive Treatment Needs n n n n Youth in the Juvenile Justice System. Homeless Youth with coexisting mental health disorders. Youth with chronic physical illness, especially pain related syndromes. Youth influenced by traumatic events. Gang involved youth. Youth with multiply deployed parents or siblings. 22

Essential Elements n n Assertive Outreach Progressive Assessment (GAIN-Global Appraisal of Individual Needs or Essential Elements n n Assertive Outreach Progressive Assessment (GAIN-Global Appraisal of Individual Needs or LOCUS) Availability of a comprehensive Continuum of Care Conducting Recovery Management Check Ups 23

Adolescent Specific Treatment Services n n n n Targeted sessions (anger, gender, culture) Focus Adolescent Specific Treatment Services n n n n Targeted sessions (anger, gender, culture) Focus on skill and competency acquisition Co-occurring services Family programming Education services Wrap around services and supports Health care Recreation and leisure skills and activities 24

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DMH/DD/SAS RECOVERY 27 DMH/DD/SAS RECOVERY 27