An Overview of Mental Health and Children

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An Overview of Mental Health and Children

• Abram Rosenblatt, Ph.D.
• University of California, San Francisco

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Prevalence Rates by Functional Impairment
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Median Rates of Prevalence of Disorder by Age
Across Existing Studies
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Risk Factors for Mental Disorders

• Poverty
• Physical Problems
• Intellectual Disabilities
• Low Birth Weight
• Family History of Mental Addictive Disorders
• Caregiver Separation
• Abuse or Neglect

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AccessAnnual Prevalence of Mental/Addictive
Disorders and Services for Children
Percent of Population (21) With Mental/Addictive
Disorders (in one year)
Percent of Population (21) Receiving Mental
Health Services (in one year)
Percent of Population Receiving Specialty Care
(8)
3
Percent of Population Receiving General Medical
Care (1)
Diagnosis and No Treatment (11)
5
11
0.5
Percent of Population Receiving School Services
(11)
0.6
7
4
0.3
Percent of Population Receiving Other Human
Services and Voluntary Support (1)
0.8
For those who use more than one sector of the
service system, preferential assignment is to the
most specialized level of mental health treatment
in the system. Source Shaffer et al., 1996
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Treatment for Mental Disorders Practice Level

• Psychotherapy
• Average treated individual was better adjusted
  after treatment than 79 of those not treated
• The magnitude of the effects closely parallels
  those obtained with adults
• Treatment differences favor behavioral rather
  than non-behavioral techniques

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Title?

• Support for the efficacy of outpatient
  psychotherapy interventions provided to children
  presenting with specific mental health problems
  and behavioral disorders.
• The effectiveness of psychotherapy when provided
  in community settings to children is much less
  well understood or documented.
• 1995 Review 9 studies of treated children in a
  non-research clinical setting- little to no
  positive effect.

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Medication
Figure Grading the Level of Evidence for
Efficacy of Psychotropic Drugs in Children
Level of Supporting Data
Key A gt 2 randomized controlled trials (RCTs).
B At least 1 RCT C Clinical
opinion, case reports, and uncontrolled
trials. Source Jensen et al., 1999
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Effectiveness of Program Level Interventions

• Positive Outcomes
• Home Based Services (especially Multi-Systemic
  Therapy)
• Therapeutic Foster Care
• Some Case Management
• Outpatient
• Psychosocial treatments focusing on problem
  solving
• Parent management training
• Child-Parent interpersonal skill strengthening
• Encouraging Wraparound Process

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Outcomes of Systems of Care Research Findings
by Research Design
Clinical Status
Functional Status
Life Satisfaction
Safety/ Welfare
Cost/ Utilization

Post Only



Pre-Post





Time Series

-




NECGD
-
Experiment


Positive Same Negative -
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Conclusions

• Mental disorders among children are a significant
  public health problem
• Access to services is a significant problem
• Promising and growing research on the efficacy of
  services in research settings
• Limited research on the effectiveness of services
  in community settings