HD 410 Unit 2
Ventura County System of Care
-Clearly defined target population -System-wide goal of locally based treatment to preserve family unity -Commitment to developing collaborative programs of services and standards tailored to individual needs of children and their families -Continuum of service options that cross agency boundaries -Mechanism for system evaluation -More children were served, especially those from ethnic minority backgrounds -Fewer youth required placement in state hospitals or residential treatment centers -Project netted a substantial savings to the state -Model expanded to whole state in 2001
The Willie M. Program
-Guaranteed individualized treatment in the least restrictive setting, based on child's needs rather than availability of service providers -Cooperative arrangements among the multiple agencies -Wraparound case management -Individual habilitation plan based on an assessment of both risk and protective factors -Protective factors, such as reading skills, relationships with adults, social skills, positive beliefs and attitudes, and involvement in community activities were strengthened -Parental and caretaker positive discipline skills were strengthened -Participants attended school more often and had fewer arrests -Program was successful and expensive
Strategies for Policy Reform
-Integrate mental health services into key child-serving agencies -Identify malleable risk and protective factors -Provide evidence-based interventions to reduce risk and strengthen protective factors -Provide developmentally and culturally appropriate and sequenced service sufficiently early in childhood to disrupt negative developmental trajectories
Serious Emotional Disturbances (SED) Rates
22.2% lifetime prevalence of SED among adolescents 5.7% prevalence in school populations Children suffering from SED are more likely to be male, low-income, and from a racial/ethnic minority group
Statistics in Child Welfare
About 3.4 million referrals for alleged maltreatment were reported to U.S. child protection services in 2012 In 2012, about 399,546 children were in out-of-home protective placements in foster care and nonfamily settings In 2012, 748,000 children were served by child welfare agencies
Protective Factors Related to Academic Success - Individual
Adequate level of intelligence Ability to work collaboratively Capacity to focus in face of distraction High socio-emotional functioning Ability to adapt to change Effective communication skills Ability to use humor to de-escalate situations Good social skills Positive outlook Involvement in extra-curricular activities
Common Childhood Mental Health Disorders
Anxiety disorders Social anxiety disorder Separation anxiety disorder Generalized anxiety disorder Post traumatic stress disorder Depression Conduct disorder Oppositional defiant disorder Attention deficit and hyperactivity disorder Eating disorders Anorexia nervosa Bulimia nervosa Childhood schizophrenia
The Child and Adolescent Service System Program (CASSP)
CASSP focused on the needs of children with SED by providing financial incentives to states to develop systems of care to serve these children
Four Assumptions of CASSP
Children and adolescents with serious emotional disorders are found in all of the nation's public health, mental health, education, juvenile justice, and child welfare systems Most children and adolescents with serious problems are served in more than one of these agencies at the same time Regardless of the agencies with which children are affiliated, the mental health needs of children have been overlooked and have not been addressed appropriately Few states have planning mechanisms to identify children and adolescents who are served across multiple systems
Systems of Care
Community-based, child-centered, family-focused, and culturally competent approach to integrating services Full range of services, including mental health, substance abuse, health, social, educational, and vocational services Flexibility enough to tailor services to the specific needs of the child and family
Effects of Maltreatment
Delayed physical growth Neurological damage Mental/emotional/psychological problems such as violent behavior, depression, and PTSD Substance abuse Eating disorders Obesity Suicide Sexual promiscuity
Essentials for Childhood
Developed by the Centers for Disease Control and Prevention (CDC) Provides a roadmap for states and communities to cultivate "safe, stable, and nurturing relationships and environments" for children Focuses on changing social norms and public policies to reflect the importance of healthy child development using the best available information
Recent Policy Themes
Early childhood education -Preschool for All program -Race to the Top School choice -Student Success Act -Strengthening America's Schools Act College and career readiness Standards and high-stakes assessments -Common core state standards
Promotive Interventions and Strategies
Establish positive behavioral and rigorous academic expectations for all students Make environmental arrangements and provide active supervision Apply consequences to encourage desired behavior and discourage undesirable behavior Develop school and community linkages Develop school and home linkages
Common Protective Factors for Child Maltreatment - Child Factors
Firstborn Healthy Multiple interests and hobbies Good-natured, precocious, mature, inquisitive, willing to take risks, optimistic, hopeful, altruistic, personable, independent Meets or exceeds age-appropriate developmental milestones High self-esteem, internal locus of control, ability to give and receive love Perceptive - quickly assesses dangerous situations and avoids harm Good interpersonal skills - able to create, develop, nurture, and maintain supportive relationships; assertive and articulate; good social skills; relates to both children and adults Well developed cognitive skills High academic achievement
Risk Factors for School Dropout and Academic Failure - Family
Frequent moves Early exposure to familial antisocial behavior Parent-child conflict Lack of connectedness with peers, family, school, and community
Fort Bragg Study
Implemented non-clinic-based services such as in-home crisis stabilization, afterschool group treatment, therapeutic foster care, and crisis management Demonstrated substantial system improvements including increased service capacity, enhanced collaboration among service agencies, reduced use of hospitals and residential treatment facilities Did not produce significant clinical outcomes with regard to alleviation of symptoms, increased functioning, or reduction of impairments
Trends in School Failure and Academic Achievement
In 2010, nearly 3.1 million children dropped out of school before earning a high school diploma
Risk Factors of Children with Serious Emotional Disturbance (SED)
Inadequate social skills Poor academic performance Family violence Alcohol and drug abuse Mental illness
Common Risk Factors for Child Maltreatment - Parental Factors
Insecure attachment with own parents Lack of trust/ insecurity Childhood history of maltreatment Single parent without support/live-in partner Social isolation Poor impulse control/Low frustration tolerance Depression//anxiety/Substance abuse Negative attitudes and attributions about child's behavior Inaccurate knowledge and expectations about child development
Key Issue in Child Welfare
Lack of common procedures for describing and classifying child maltreatment: The definitions of abuse and neglect vary across states
Risk Factors for School Dropout and Academic Failure - School
Large size Limited resources High staff turnover Inconsistent classroom management practices Negative school and classroom climate School violence Overcrowding High student to teacher ratios Insufficient curricular and course relevance Weak, inconsistent adult leadership Poor building design Over-reliance on physical security measures
Student-Specific Risk Factors Associated with Dropout and Academic Failure
Low academic achievement Student misbehavior Suspensions and expulsions Negative narrative comments in school records Frequent referrals for in- and out-of-school problems Number of elementary schools attended Early involvement in the juvenile justice system Low school engagement
Common Risk Factors for Child Maltreatment - Community/Social/Environmental Factors
Low socioeconomic status of neighborhood Stressful life events Lack of access to medical care, health insurance, inadequate child care, and social services Parental unemployment; homelessness Social isolation/lack of social support Exposure to racism/discrimination
Difficulties with SOC
Management is time-consuming, cumbersome, and often inefficient Turf issues Budgeting process may not be open to public for review and comment Difficult to implement
Risk Factors for Child Maltreatment- Family Factors
Parental unemployment Separation/divorce, especially high conflict divorce High general stress level Lack of grandparent as caretaker Low socioeconomic status 4 or more children in family Rural residence
Risk Factors for School Dropout and Academic Failure - Individual
Poor learning-related social skills Substance use Pregnancy Limited intelligence Disabled Minority status Special education status Inability to read by the fourth grade
Protective Factors Related to Academic Success - School
Positive and safe environment High academic and social expectations Positive relationship with teachers School bonding Positive and open school climate Positive ratings for overall educational performance
Common Protective Factors for Child Maltreatment - Community/Social/Environmental Factors
Positive peer relationships Extended family in close proximity Good schools - close relationships with teachers Reliance on informal networks of family, friends, and community leaders for advice
Risk Factors for School Dropout and Academic Failure - Neighborhood
Poverty Low percentage of affluent neighbors
Common Risk Factors for Child Maltreatment - Child Factors
Premature birth Difficult temperament Physical/cognitive/emotional disability; chronic or serious illness Childhood trauma Older than 2 years of age Antisocial peer group Child aggression, behavior problems, attention deficits
Child Welfare Service Goals
Protect children from harm Preserve existing family units Promote children's development into adults who can live independently and contribute to their communities
Competitive grant programs funded under the American Recovery and Reinvestment Act
Race to the Top Investing in Innovation
Targeted Interventions and Strategies
Redistribution of tax dollars to support schools in low-income neighborhoods Early identification and intervention at the point of school entry Targeted and intensive strategies to integrate education policy
Common Protective Factors for Child Maltreatment - Parental/Family Factors
Structure - rules and household responsibilities for all members Open exchange and expression of feelings Good supervision and monitoring of children Warm and supportive relationships Parental agreement on family values and morals Mutually satisfying relationships Four or fewer children spaced at least two years apart Middle to upper level SES Nurturing relationships with extended family Positive social network support Capacity to meet emotional needs of infants and children
Home-Visitation Programs
The Nurse-Family Partnership (NFP) -A home-visiting model provided to first-time at-risk mothers beginning prenatally with visits by nurses and continuing until the child's second birthday Attachment and Biobehavioral Catch-up (ABC) -A home-visiting model that has demonstrated impacts on stress neurobiology and behavior regulation in young foster children The Maternal, Infant, and Early Child Home Visiting program authorized by the Patient Protection and Affordable Care Act in 2008 provided five years of funding for state grants to expand home visiting services
Transforming Mental Health Through the Affordable Care Act
Three themes that may improve the accessibility and quality of services for children: -Parity of physical and mental health -The focus on prevention and early intervention -The integration of physical and behavioral health care
Evidence-Based Care
Well-established treatment is one that has been shown to be superior to either a placebo or other treatment Probably efficacious treatment is shown only as superior to outcomes of either a waiting list condition or a no-treatment control group
Transforming Mental Health in Early Childhood
focus needs to be on- -The parent-child relationship -Helping parents learn about child development and the importance of providing a nurturing environment
Protective Factors Against Child and Adolescent Mental Health Disorders
individual level: good social skills academic achievement easy going temperament, good problem solving skills familial level: parental monitoring good communication and cohesion extra-familial level: presence of nurturing/caring adults opportunities and support for achievement
Risk Factors for Child and Adolescent Mental Health Disorders
individual: genetic vulnerability victim of physical/sexual abuse poor self esteem difficult temperament chronic childhood illness or developmental delay race/ethnicity as they lead to poverty levels previous diagnosis of mental health disorder girls-depression, eating disorders boys- conduct disorder, adhd familial: low SES multiple moves parental substance abuse parental mental illness poor maternal bonding or attachment poor parenting skills four or more siblings extra-familial level: frequent violence high stress rejection by peers social isolation
