Supervision

 Consultants in their first year  The transfer to consultancy  Management Skill  I want them to be able to supervise others  I want them to stay in the service  Identification of gaps  Not paid; no time allocation  Mentoring

Supervision

 Professional Hierarchical  Cross professional for special purposes or on special request  Peer group (cross team)  Personal Appraisal (Service based)

On Prevention

Primary Prevention Evidence

 Durlak & Wells in 1997 reviewed 1200 primary prevention programs of which 77 met a stringent 54 standards for meta-analysis.

 Average effect size was between 0.2 and 0.9

 Better than most of the work on heart disease  Better than results from antidepressant studies  At least as good as composite results for MST

Universal Work

EVIDENCE

INFANCY Improved maternal diet and reduced smoking during pregnancy led to fewer pre-term deliveries, higher birth weight babies and less child abuse Olds et al 1988

1958 British Cohort health at age 33

Significant Latent Factors (Early life 0-7 yrs)  Birth weight and height age 7 (as ratio of adult height)  Whether read to.

 Social & emotional status age 7 (assessed by school teachers, how well they adjusted to school) Source: Clyde Hertzman

‘Sensitive periods’ in early brain development Binocular vision Central auditory Habitual ways of responding Language Emotional control High Symbol Peer social skills Relative quantity Low 0 1 2 3 Years 4 5 6 7

Breakfast and Annual Changes in Test Scores

10 5 0 0.6

1.4

2.2

-1.0

-0.2

Reading -5 0.7

1.1

1.5

1.9

2.4

0.5

1.0

1.5

2.0

2.5

Language Mathematics -10 48 55 62 69 76 48 55 62 69 76 Percent who ate breakfast Source: California Healthy Kids Survey & STAR data files.

48 55 62 69 76

EVIDENCE

SCHOOL AGE CHILDREN Increased resilience and connectedness to the school led to 50 point reduction in suicidal thinking Resnick, Blum et al, 1997 Because of the trajectory from thinking through planning to attempts, we can assume this reduction will have long term benefit

Selective Work

COPMI Qualitative Studies

 “Family-centered, strengths-based approaches were identified across program directors as critical to intervention success.” Hinden, Nicholson et al, Uni Massachusetts, 2006

Hinden et al., 2002 (Child Outcomes)

 Child outcomes included achieving developmental milestones, enhanced school readiness, improved child behavior and emotional adjustment, and improved school attendance.

 For those programs engaged in political advocacy and social marketing, increased public awareness, decreased stigma, and increased funding opportunities reflected positive outcomes.

PATS Evaluation, 2005

 Structured questionnaire follow-up study over 3 years  PATS participants reported significant reductions in depressive symptoms (60% pre intervention, 38% 12 months later), risk of homelessness (44% pre-intervention, 17% 12 months later) and stigma (30% pre intervention, 15% 12 months later) after their involvement in the program. http://www.rch.org.au/emplibrary/pats/PATS_FinalEvaluationReport_Dec 2005.pdf

Indicated Work

MST: Meta-Analysis of Programs

 8 programs met criteria  At follow up:  fewer arrests  less time in institutions  lower self reported delinquency  No differences for behaviour, parental mental health, family functioning and relationships, risk of incarceration, and peer relationships.

Bruce, J., 2002. Evidence Based Mental Health. 5:4.

MST

 Costs may be up to $30,000 per family  RESULTS  A number of randomised controlled trials with chronic juvenile offenders  Reduces re-arrest by 25 - 70%  Reduces out-of-home placement by 47 - 64% in long-term follow-up Juvenile Forensic Evaluation Resource Centre, 2000

Can Trajectories be Averted?

Longitudinal study of 909 students up to 17 years of age:  More types of trajectories than expected   < 6% followed trajectory of chronic antisocial behaviour Disruptive preschool children are at higher risk of following trajectories of frequent antisocial behaviour  Intensive intervention between 7- 9 yrs of (parent training, social skills training), changed long term developmental trajectories of physical aggression, vandalism, and theft for disruptive kindergarten boys in low socio-economic areas.

Lacourse et al., 2002

Thinking through to the Future

So what should we be thinking about?

 It is likely that Australia will have to confront the economic realities, and this may make social exclusion worse  Despite the percentage reduction overall in young people over the next 20 years, more of them may react to stress with mental health problems  We need to consider every scrap of evidence that allows us to put in place preventive strategies along the trajectory of young life  We need to ‘proof’ our children against stress

So what should we be thinking about?

 We do need to grab as much as we can of the available new monies for mental health services.

 However, the increased demands are at this time likely to drown services capacity  We must collaborate to present to Bureaucracies what is most likely to work in prevention  A major part of this may be to revisit the first 3 years of a child’s life and promote the primary relationships - perhaps through such simple things as reading.

A Couple of Elegant Tiered Partnerships

Bayside Ei Program

Universal Program

20 weeks (2 terms) of in school, class teacher managed, AUSSIE OPTIMISM Program based on an Australianisation of the work of Seligman (Optimistic Child), and his team - Jaycox, Gillham et al.

Selective Program

IF a young person scores over 30 on the CES-D (>2SD greater than mean) and the SDQ also scores over 20, THEN We discuss with school personnel and further assessment occurs with the MINI Kid and either set up a program in the school or refer direct to CYMHS

CadetLiFe

Australian Defence Force Cadets (n=22,000)  UNIVERSAL CD based program using elements adapted from LiFe, the national MHPPEi documents, Aussie Optimism,

Mind Matters

, and available research  A ‘Pathways to Care’ program acknowledging national resources (eg Kid’s Helpline, Reach Out) and possible local service access.

 Access to Reach Out On Line (ROC!)

USAF Suicides by year

A Changed World

Youth Suicides 1968-2005

Australian Suicide Rates 15-24 yrs, per 100,000 (ABS) 35 30 25 20 15 10 5 0 1968 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 2000 2002 2004

Mobile Phone Ownership

(Australian Bureau of Statistics, 2006)

100 90 80 70 60 50 40 30 20 10 0 1990 1995 1999 2005

Mobile Phone Ownership in Young People

(Roy Morgan Research 2006)

100 80 60 40 Boys Girls 20 0 Seven Nine Eleven Thirteen

Battling the forces of Darkness

Consumerism creates Public health challenges for us QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.

The Centre for MHPPEi

Minister of Health Director of Mental Health Mental Health Statewide Network Mental Health Interdepartmental Committee MHPPEi Working Group Steering Committee Infant Psychiatry Hub Director Centre for MHPPEi Centre for MHPPEi Innovative technologies Advisory Board Suicide Prevention

Possibilities for the Centre

 Placement at a Major Health Centre (eg RBH) (adv. Infrastructure)  Placement in the Community (eg Nundah) (adv. Links with NGOs and Community)  Placement across Institutions (ie Uni plus Health Service) (adv. ?Kudos plus academic input)