Lets Solve Georgias Child and Adolescent Mental Health

Let’s Solve Georgia’s Child and Adolescent Mental Health Crisis Erica F. Sitkoff, Ph. D. Policy and Outreach Director Polly Mc. Kinney, Advocacy Director 11 -29 -16

Facts • 20 % of Georgia’s children and adolescents need behavioral health services. Only 20 % receive them. • 25, 350 Georgia children had a substantiated incident of abuse or neglect. (Kids Count) • 82, 029 Georgia school age children reported considering harming themselves in the past 12 months. 50, 381 did. (GA Student Health Survey) 1

Facts • 57, 677 Georgia school age children reported seriously considering suicide in the past 12 months. 27, 014 attempted. (GA Student Health Survey) • 8 was the age of the youngest child to commit suicide in Georgia • Behavioral health is the number one concern of child care providers 2

Recommendations • Create a comprehensive three-year state plan for child and adolescent behavioral health. • Engage all stakeholders. • Focus on workforce, access and transitions between systems. 3

Recommendations • Work to make sure it moves from a strategic conversation to an actionable plan. • Prioritize actions to ensure an immediate impact that instills hope for further change. • Implement it. 4

Broad Government Support • Children’s Mental Health Study Committee (House) • Youth Mental Health, and Substance Use Disorders Study Committee (Senate) • Health, Education and School-Based Health Centers Study Committee (House) • Governor’s Education Reform Commission • 2015 Child Welfare Reform Council Report • State agency strategic discussions • Interagency Directors Team 5

8 Components • ACCESS: IDENTIFYING AND SCALING EFFECTIVE PROGRAMS Which programs are effective and how do we expand them? • WORKFORCE DEVELOPMENT What workforce development strategies do we need? • FISCAL SUSTAINABILITY How do we achieve fiscal sustainability (beyond grants) for programs that are effective? • CROSS-SYSTEMS COORDINATION/ SYSTEMS OF CARE How do we maximize current resources to improve continuity of care across systems (and children of different ages)? 6

8 Components • IDENTIFYING and TREATING NEEDS EARLY How do we develop a coordinated screening and a “warm hand off” system that identifies and treats needs early? • POSITIVE CULTURE OF AWARENESS and PREVENTION What is needed to create a positive culture of awareness and prevention in child serving systems? • EVALUATION and CONTINUOUS IMPROVEMENT What oversight council, data and system is needed monitor what’s working, what’s missing, what’s not working and what’s possible? • CHANGING SOCIETAL CULTURE WITH EFFECTIVE COMMUNICATION AND ADVOCACY How can the stakeholders change culture, find buy-in and support for change? 7

Scaling Effective Programs Which programs are effective and how do we expand them? • Identify the preliminary outcomes of pilot and small-scale programs - Are they scalable? • Develop an asset map of successful programs (e. g. school-based health programs, tele-health systems, mental health consultation, private/public partnerships) • Identify the funding streams • Identify the funding barriers • Identify the policy, logistical or other barriers • Identify cultural barriers 8

Workforce Development What workforce development strategies do we need? • Partner with higher education institutions to increase the number of new licensed professionals practicing • Develop a cross agency and private/public coordinated approach to trainings to develop specialized skills • Retain professionals in Georgia 9

Workforce Development • Loan forgiveness • Determine effective use of certified versus licensed professionals to expand workforce capacity • Expand the reach of existing licensed professionals • Support programs that supervise 10 professionals working toward their license

Fiscal Sustainability How do we achieve fiscal sustainability (beyond grants) for programs that are effective? • Analysis of current payment mechanisms • Enable children 0 -5 to meet Medical Necessity criteria without a DSM diagnosis • Improve implementation of Medicaid services 11

Fiscal Sustainability • Braid and blend federal funding streams • Maximize the reach of licensed professionals through consultation and telehealth • Ensure that all children eligible for public health insurance remain insured – o 166, 000 children in 12 Georgia are uninsured

Cross System Coordination/System of Care How do we maximize current resources to improve continuity of care across systems (and children of different ages)? • Adopt Systems of Care principles • Expand Georgia APEX (or similar approaches) to early childhood centers and Head Start • Expand School-based health to Pre-K, child care centers, Head Start, middle schools and high schools 13

Cross System Coordination/System of Care • Ensure providers have the medical history to treat new patients • Use telehealth to improve continuity of care and minimize trauma for children in out of home placements • Improve social emotional learning (SEL) supports for in-person family visitation • Strengthen communication and supports between IDT, Regional Interagency Planning Teams and Local Interagency Planning Teams 14

Identifying and Treating Needs Early How do we develop a coordinated screening and a “warm hand off” system that identifies and treats needs early? • Coordinate the strategy, resources and activities to identify children with special needs • Use screening data effectively to access services • Use Positive Behavioral Intervention and Supports (PBIS) implementation in childcare centers • Implement pilot programs for mental health consultation in child care centers and pediatric offices for early childhood mental health 15 • Expand the use of Parent Child Interaction

Culture of Awareness & Prevention What is needed to create a positive culture of awareness and prevention in child serving systems? • SEL curricula for Early Learning, Pre. K 12 • PBIS in Early Learning Centers and all K-12 • Full-time School Climate Specialists at each RESA 16

Culture of Awareness & Prevention • Training on trauma and brain development • Training on child abuse/neglect/ sexual abuse • Increase funding for and quality of Outof-School Time supports – e. g. , afterschool programs, DBHDD club houses, summer learning and nutrition) 17

Evaluation and Improvement What oversight council, data and system is needed monitor what’s working, missing, not working and possible? • Establish a standing advisory group, such as a Child and Adolescent Behavioral Health Reform Council • Institute an evaluation framework to evaluate annual progress • Include both access and quality metrics. • IDT Systems of Care goals and work are incorporated into larger efforts. • Examine current policies for effective support of systems of care • Public and private providers 18 • Collect core process, utilization and outcome

Communication and Advocacy How can the stakeholders change culture, find buy-in and support for change? • Develop three to four key messages about how to identify behavioral health issues, access help, and support others. • Develop culturally appropriate (targeted) messaging about the “normalcy” of seeking support. • Develop unlikely champions in the business, political and lead policy sectors for promoting change. • Develop a coordinated state behavioral health communications plan 19 and metrics.

Remember: Facts • 20 % of Georgia’s children and adolescents need behavioral health services. Only 20 % receive them. • 25, 350 Georgia children had a substantiated incident of abuse or neglect. (Kids Count) • 82, 029 Georgia school age children reported considering harming themselves in the past 12 months. 50, 381 did. (GA Student Health Survey) 20

Remember: Facts • 57, 677 Georgia school age children reported seriously considering suicide in the past 12 months. 27, 014 attempted. (GA Student Health Survey) • 8 was the age of the youngest child to commit suicide in Georgia • Behavioral health is the number one concern of child care providers 21

Recommendations • Create a comprehensive three-year state plan for child and adolescent behavioral health. • Engage all stakeholders. • Focus on workforce, access and transitions between systems. 22

Recommendations • Work to make sure it moves from a strategic conversation to an actionable plan. • Prioritize actions to ensure an immediate impact that instills hope for further change. • Implement it. 23

Thank You! For more info: efenersitkoff@georgiavoices. org pmckinney@georgiavoices. org www. georgiavoices. org