Opportunity to reduce number of youth in jail population:

1
September 8, 2005 Presentation to California
Institute of Mental Health (CIMH) The case for
intervening early on with very young children and
their families Elizabeth W. Pfromm, MPA,
M.S. Executive Director of the Los Angeles Child
Guidance Clinic

• Opportunity to reduce number of youth in jail
  population
• Estimated 60 have diagnosable mental
  disorders (1)
• Estimated 50-90 of SED population have
  conduct disorders (2)
• 68 are minority youth (1)

2

• Webster-Stratton, among others, has
  demonstrated that
• conduct disorders can be identified in
  preschoolers and
• successfully treated (3)
• Offord et al 7-25 of young children meet
  diagnostic
• criteria for Oppositional Defiant Disorder

3

• Opportunity to intervene early on with children
  being expelled from preschools
• Its behavioral problems which cause these
  children to be
• expelled
• Prevalence rate for problem behaviors which
  place children
• age 5 and younger at risk, estimated at 10
• For economically disadvantaged as high as 27
  (Raver and
• Knitzer, 2002) (4)

4

• National study of expulsion rates of
  preschoolers
• (Gilliam, 2005) (5)
• 3.2 times higher than K-12 expulsion rates
• Appears that preschool expulsions reduced when
  teachers had
• access to mental health consultation
• Early behavioral problems correlated with
  early learning
• problems children at risk for future
  problems
• (e.g., substance dependency, school dropout,
  juvenile
• justice system involvement)

5

• Latest NIMH finding (6) half (50) of all
• lifetime cases of mental illness begin by
• age14, and that despite effective
  treatments,
• there are long delays sometimes decades
• between first onset of symptoms and when
• people seek and receive treatment.
• 75 of disorders begin by age 24

6

• Lerner Followed preschoolers for 11.5 years and
  found those who scored highest for behavioral
  problems had highest later need for psychiatric
  services (7).

7

• Rutter (8) Children with two or more risk
  factors compared to those with one or no risk
  factors, have much higher likelihood of future
  psychiatric impairment.
• Particularly Striking Those children with four
  risk factors are ten times as likely to
  experience future psychiatric impairment.

8
Risk Factors

• Poverty
• Poverty, combined with a parents past history
  of suffering
• childhood trauma, increases a childs at
  risk status
• Family or community violence
• Infants exposure to trauma or ongoing
  stressful
• environments
• An infants brain re-organizes its activity
  around survival needs
• as opposed to learning needs (Perry) (9 and
  10)

9
Risk Factors (continued)

• Parental mental health status
• Parental substance abuse
• Single parents who lack support systems,
• especially teenage parents
• Family isolation

10
References

• (1) Children with Emotional Disorders in the
  Juvenile Justice System.
• NMHA Program Policy, P-37, 2004.
• (2) Focal Point, A National Bulletin on Family
  Support and Childrens
• Mental Health. Spring, 1997, Vol. 11, No.
  1. Published by Portland State
• University, Research and Training Center,
  Regional Research Institute for
• Human Services.
• (3) Webster-Stratton, C. (1998). Preventing
  Conduct Problems in Head
• Start Children Strengthening Parenting
  Competencies. Journal of
• Consulting and Clinical Psychology, Vol.
  66, No. 5, pages 715-730.

11
References (continued)

• (4) Raver and Knitzer (2002). Ready to Enter
  What Research Tells
• Policymakers About Strategies to Promote
  Social and Emotional School
• Readiness Among Three- and Four-Year-Olds.
  National Center for Children in
• Poverty.
• (5) Gilliam, W.S., Ph.D. (2005).
  Pre-kindergarteners Left Behind Expulsion
• Rates in State Pre-kindergarten Systems.
  Yale University Child Study Center.
• (6) National Comorbidity Survey Replication
  (NCS-R), as referenced in
• NIMH Press Release (June 6, 2005) studies
  are published in Archives of
• General Psychiatry, Ronald Kessler, Ph.D.,
  et al. (June 6, 2005).
• (7) Lerner, J.A. et al (1985) Preschool
  Behavior Can Predict Future Psychiatric
• Disorders. Journal of the American Academy
  of Child Psychiatry, Vol. 24, No. 1,
• pages 42-48.

12
References (continued)

• (8) Rutter (1979). Protective factors in
  childrens responses to stress and
• disadvantage. M.W. Kent and J.E. Rolf
  (Eds). Primary Prevention of
• Psychopathology Social Competence in
  Children, pages 49-74.
• (9) Perry, B.D. et al (1995). Childhood
  Trauma, The Neurobiology of
• Adaptation, and Use-Dependent
  Development of the Brain How status
• become traits. Infant Mental Health
  Journal, 16, pages 271-291.
• (10) Perry, B.D. (1993). Neurodevelopment
  and the Neurophysiology of
• Trauma II Clinical Work Along the
  Alarm-Fear-Terror Continuance.
• The Advisor 61, ff.