Terry R. JOnes

Report
OHIO JUSTICE ALLIANCE FOR COMMUNITY
CORRECTIONS ANNUAL CONFERENCE
OCTOBER 11, 2013
Terry R. Jones, Bureau Chief
Ohio Department of Mental Health and Addiction Services
Bureau of Families and Children
1
CHILDHOOD TRAUMA
“Simply removing a child from a dangerous environment will
not by itself undo the serious consequences or reverse the
negative impacts of early fear learning. There is no doubt that
children in harm’s way should be removed from a dangerous
situation. However, simply moving a child out of immediate
danger does not in itself reverse or eliminate the way that he or
she has learned to be fearful. The child’s memory retains those
learned links, and such thoughts and memories are sufficient to
elicit ongoing fear and make a child anxious.”
National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved
fromwww.developingchild.harvard.edu.
2
CHILDHOOD TRAUMA
• Between 60% and 90% of children and adolescents
presenting for outpatient mental health treatment have
been exposed to trauma (Lang JM, Ford JD, Fitzgerald
MM.).
• Most have multiple experiences of trauma (Muesser et
al., 1998)
• As many as 1 in 3 girls and 1 in 6 boys are sexually
abused in childhood; 20% of all women have at last 1
incestuous experience before age 18.
3
CHILDHOOD TRAUMA
• Between 1/3 and 2/3 of known sexual assault victims are age 15 or
younger (median age 9.6 years for girls and 9.9 years for boys)
• Per capita rates of rape/sexual assault are highest among persons
aged 16-19, low income persons, urban residents, people with
disabilities, and those served in the criminal justice system.
• Sexually abused boys are more reluctant to report abuse than girls,
especially when perpetrator is family.
• Boys and men often “act out” through their own aggressiveness and
violence. More abused males than females go on to sexually abuse
others.
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CHILDHOOD TRAUMA
• In pediatric clinical samples, high levels of
traumatic stress have been found in
approximately 90% of children who are sexually
abused, 75% of those exposed to school violence,
50% of those physically abused, and 35% of
children exposed to community violence.
Hamblen J, Barnett E. PTSD in children and adolescents. 2011).
5
CHILDHOOD TRAUMA IN OHIO
Every 9 1/2 minutes, an Ohio child is abused or
neglected. In 2000, there were 54,084 substantiated
or indicated cases of abuse and neglect in Ohio.
Closer Look: Our Kids. Ohio Legal Rights Service, 2000.
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CHILDHOOD TRAUMA IN OHIO
Facility administrators reported that 70% 90% of children in Ohio’s residential
treatment facilities are victims of violence.
Closer Look: Our Kids. Ohio Legal Rights Service, 2000.
7
COST ESTIMATES OF CHILD MALTREATMENT
•
United States- in 2007 dollars
•
Direct costs-$33 Billion
•
Indirect costs-$71 Billion
•
Total annual costs-$104 Billion (Wang & Holton-Economic Impact Study, Prevent
Child Abuse America,2007)
•
Ohio-in 2007 dollars
•
Direct costs-$290 Million
•
Indirect costs-$2.1 Billion
•
Total annual costs-$3 Billion (Preventing Family Violence, Anthem Foundation of
Ohio, 2007)
8
PREVALENCE OF TRAUMA
• Boys who experience or witness violence are 1000 times more likely to
commit violence than those who do not.
• 66% of those in SA treatment report childhood abuse or neglect.
• 80% of those in psychiatric hospitals experienced physical or sexual abuse
as children.
• 90% of those diagnosed with BPD or DID were victims of violence.
Anne Jennings. What Can Happen to Abused Children When They Grow Up- If No One Notices,
Listens, or Helps? January 2001.
9
CHILDHOOD TRAUMA
Research indicates that children and adolescents from
minority backgrounds are at increased risk for trauma
exposure and development of Posttraumatic Stress
Disorder (PTSD). For example, African American,
American Indian, and Latin American children are
overrepresented in reported cases of child maltreatment,
and in foster care.
Department of Health and Human Services, Administration for Children and Families (2002).
10
CHILDHOOD TRAUMA
Although child trauma is a significant and
pervasive mental health condition, it is potentially
one of the most treatable—a remarkable
development, considering that no empirically
supported treatments for child trauma existed
before the late 1990s.
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CHILDHOOD TRAUMA
The National Child Traumatic Stress Network (NCTSN)
suggests that trauma treatment may also build resilience,
indicating that “children who receive timely and appropriate
treatment may not only recover, but gain the tools and
capacity to cope more successfully with future stress”
National Child Traumatic Stress Network. Changing the course of children's lives. 2011.
12
DSM-V AND TRAUMA
Proposed changes to the DSM-V overlap with the
achievements of the NCTSN and underscore increased
recognition of trauma’s impact on mental health.
Recommendations include relocating trauma-related
disorders from Anxiety Disorders into a new primary
category, encompassing Acute Stress Disorder, PostTraumatic Stress Disorder, and Trauma- or StressorRelated Disorder Not Elsewhere Classified.
13
CHILDHOOD TRAUMA: PAST STATE EFFORTS
Through Ohio’s Transformative State Incentive Grant (TSIG) the Ohio Department of
Mental Health created a Childhood Trauma Task Force strategic plan focused on:
1)
Public Awareness and Education;
2) Screening and Assessment;
3) Evidence–Based Training;
4) Data Collection and Analysis.
14
CHILDHOOD TRAUMA: PAST EFFORTS
•Presented on Trauma Informed Care (TIC) and the landmark Adverse Childhood Experiences
(ACE) Study.
• Trained 200 clinicians in Trauma Focused-Cognitive Behavioral Therapy (TF–CBT) during Fall
2010.
• Trained 100 public child welfare agency staff on Trauma-Informed Child Welfare.
• Developed a TF–CBT and Child Welfare workshop presented jointly to mental health and child
welfare professionals and foster parents.
• Developed and disseminated Trauma Informed Best Practices and Protocols for Ohio’s domestic
violence programs.
•Governor’s Executive Order 2009-13S banning prone restraint and limiting physical restraints in all
state systems.
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AND THEN….
• The TSIG GRANT ENDED………
16
AND SO…WHAT HAVE YOU DONE LATELY?
• Elevation of Medicaid match responsibility to the state level.
• Created a predictable and sustainable future for local board
systems. Will free-up an estimated $70 million annually ($105
million for the FY 14-15 biennium) in local board spending.
• Focuses local efforts on unmet needs, trauma initiatives,
transitional age housing, employment, transportation, or
addressing waiting lists.
17
AND SO…WHAT HAVE YOU DONE LATELY?
TARGETED INVESTMENTS….
• Governor Kasich’s Jobs Budget increased state funding for
mental health by 5.7% ($26.8 million) over two years, reversing
a downward trend since 2008 in which state funding was
reduced by 19.5% ($112.4 million).
• $5 million investment targeted at youth and young adults with
intensive needs
• Additional investment in both mental health and addiction in the
mid-biennium review for a total of $6 million
18
AND SO…WHAT HAVE YOU DONE LATELY?
• Proposal to extend Medicaid benefits to 138% of Federal Poverty Level.
• Offering coverage for 366,000 individuals, many of them children, estimated
to enroll– effective Jan. 1, 2014.
• Serving more Ohioans at no extra cost to Ohio.
• Transition age youth in danger of losing services when entering adulthood.
ENGAGE Grant funded in July, 2013.
19
AND SO…WHAT HAVE YOU DONE LATELY?
ODMH staff participated on the Ohio Interagency Task
Force on MH/JJ which recommended the following:
• Development of a “PRTF” (Psychiatric Residential
Treatment Facility) or similar model, designed to offer
intense, focused mental health treatment to youth
committed to ODYS to promote a successful return of
youth to their community most of whom have
experienced trauma.
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AND SO…WHAT HAVE YOU DONE LATELY?
• Developed Medicaid health homes for individuals with
SED/SPMI.
• Approximately 14,000 clients enrolled in Phase I,
scheduled to go statewide January 1, 2014
21
AND SO…WHAT HAVE YOU DONE LATELY?
• On or before January 1, 2014 Intensive Home
Based Treatment (IHBT) shall be a Medicaid
reimbursed service; upon CMS (Centers for
Medicare and Medicaid Services) approval
training and technical assistance needed for the
expansion of IHBT shall be provided .
22
AND SO…WHAT HAVE YOU DONE LATELY?
• ODMH has replicated its successful Community
Linkages program for youth involved in the
juvenile justice system who have SED and may
have experienced trauma and their families to
facilitate the timely provision of community
mental health services and supports upon
release from ODYS.
23
AND SO…WHAT HAVE YOU DONE LATELY? HOUSE BILL 59
• Section 501.10. Screening Tool for High-Risk Youth Team Evaluation.
• OHT shall convene a team comprised of DYS, OMA, ODJFS, ODMHAS, and
the Dept. of Health.
• The team shall evaluate the feasibility of implementing a trauma screening
tool for high-risk youth and create a report outlining (a) the recommended
screening tool; (b) training in the administration of the recommended tool; (c)
screening protocols; (d) the persons to whom the tool should apply and (e)
implications for treatment. The report shall be completed by December 1,
2013, and shall be distributed to the Governor. First meeting occurred on
February 15, 2013
24
AND SO…WHAT HAVE YOU DONE LATELY?
• Other state/county initiatives: Ohio Governor’s
Task Force on Human Trafficking, AG Human
Trafficking Task Force, and FCCS-The Gateway
Call Project.
25
AND SO…WHAT HAVE YOU DONE LATELY?
• By June 30, 2015, ODMH in collaboration
with ODYS will select and implement a
statewide, culturally appropriate
standardized screening instrument specific
to mental health and trauma to be used at
the earliest contact points as youth enter
the juvenile justice system.
26
AND SO…WHAT HAVE YOU DONE LATELY?
• ODMH is currently working with other systems of care
(Child Welfare, DYS, DODD, Health, and Education) to
develop a universal screening tool based on
developmental age, nature of trauma exposure, culture
and service context to be administered at each point of
system entry. ODYS has received $82,500 in grant
funds for this initiative and will partner with ODMH and
other systems.
27
AND SO…WHAT HAVE YOU DONE LATELY?
• During FY14/15, the Ohio Department of
Mental Health will work with the Office of
Medical Assistance (OMA) on adding
Family Therapy services to our Medicaid
service array to support the provision of
behavioral health services to children,
youth and their families.
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AND SO…WHAT HAVE YOU DONE LATELY?
• Collaborated and funded upcoming trauma training for probationary and DYS
staff. They in turn will train their respective system staff.
• Scheduled trauma specific training to ODMH Regional Hospital staff and
DODD Developmental Center staff. All shifts will be trained.
• Initiated exploratory discussion with a CCOE to provide trauma specific
training/technical assistance statewide.
• ODMH/ODADAS recently conducted a statewide survey of 644 MH/AOD
providers to access capacity and needs of providers and local systems to
provide effective, evidence-based and trauma focused treatment.
• Allocated Block Grant dollars to fund trauma centered initiatives.
• Participated on the Department of Education’s Task Force on Seclusion and
Restraint.
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THE WORK HAS ONLY BEGUN: NEXT STEPS
•
Addressing trauma requires a comprehensive, multipronged human service
approach. This approach includes:
•
Increasing awareness across systems of the harmful short- and long-term
effects of trauma experiences in children;
•
Developing and implementing across systems effective preventive, treatment,
and resiliency support services that reflect the needs of diverse populations;
•
Building strong partnerships and networks to facilitate knowledge exchange and
systems development;
•
Providing training and tools to help systems identify trauma and intervene early;
and
•
Informing public policy that supports and guides these efforts.
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QUESTIONS/ANSWERS
Contact information:
Terry R. Jones, Bureau Chief
Bureau of Children and Families
Office of Wellness and Prevention
Ohio Department of Mental Health and Addiction Services
30 East Broad Street, Suite 851
Columbus, Ohio 43215
614-466-0111
[email protected]
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