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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
CHALLENGES
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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
CHILD WELFARE AND
BEHAVIORAL HEALTH
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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
FOSTER CARE AND
BEHAVIORAL HEATLH
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Clinical-level behavior problems are ~3 x as common
among foster care youth as general population
Among children who enter foster care, ~one-third scored
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
TREATMENT IS EFFECTIVE
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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
PSYCHOTROPICS: BALANCED
APPROACH
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HARMFUL
BENEFICIAL
SAMHSA’S WORK WITH AMERICAN ACADEMY OF
CHILD AND ADOLESCENT PSYCHIATRY
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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
OPPORTUNITIES
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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
SAMHSA’S VISION
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A nation that acts on the knowledge that:
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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