CT Insider article 9/12/22

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Like much of the country, Connecticut faces what advocates call a children’s mental health crisis, exacerbated by the disruptions of the COVID-19 pandemic the past two and a half years. Those who work in children's mental health describe an untenable status quo in which more and more kids, like Arianna, face serious behavioral challenges, requiring treatment that often isn’t available in a system that’s stretched far too thin.

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While state lawmakers sought to address these issues through a sweeping children’s mental health bill during this year’s legislative session, many of the new programs are still months away, and the needs on the ground remain substantial.

August 30, 2022 - New York Times podcast

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Young people In the United States are facing a new set of risks. Why has the situation caught so many people off guard?

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In decades past, the public health risks teenagers in the United States faced were different. They were externalized risks that were happening in the physical world. Now, a new set of risks has emerged.

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In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. And suicide rates, which had been stable from 2000 to 2007 among this group, leaped nearly 60 percent by 2018.

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This podcast explores why this mental health crisis has become so widespread, and why many people have been unprepared to handle it.

NY Times article.

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Increasingly, anxious and depressed teens are using multiple, powerful psychiatric drugs, many of them untested in adolescents or for use in tandem.

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Psychiatrists and other clinicians emphasize that psychiatric drugs, properly prescribed, can be vital in stabilizing adolescents and saving the lives of suicidal teens. But, these experts caution, such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in.

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These drugs, generally intended for short-term use, are sometimes prescribed for years, even though they can have severe side effects — including psychotic episodes, suicidal behavior, weight gain and interference with reproductive development, according to a recent study published in Frontiers in Psychiatry.

988 has been designated as the new three-digit dialing code that will route callers to the National Suicide Prevention Lifeline (now known as the 988 Suicide & Crisis Lifeline), and is now active across the United States.

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When people call, text, or chat 988, they will be connected to trained counselors that are part of the existing Lifeline network. These trained counselors will listen, understand how their problems are affecting them, provide support, and connect them to resources if necessary.

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The previous Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis.

The Lifeline’s network of over 200 crisis centers has been in operation since 2005, and has been proven to be effective. It’s the counselors at these local crisis centers who answer the contacts the Lifeline receives every day. Numerous studies have shown that callers feel less suicidal, less depressed, less overwhelmed and more hopeful after speaking with a Lifeline counselor. 

KEN BURNS PRESENTS HIDING IN PLAIN SIGHT: YOUTH MENTAL ILLNESS A FILM BY ERIK EWERS AND CHRISTOPHER LOREN EWERS. A documentary about the mental health crisis among youth in America. Streaming on PBS.

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HIDING IN PLAIN SIGHT: YOUTH MENTAL ILLNESS features first-person accounts from more than 20 young people, ranging in age from 11 to 27, who live with mental health conditions, as well as parents, teachers, friends, healthcare providers in their lives, and independent mental health experts.  

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Related: Youth Mental Health Resources
In support of Hiding in Plain Sight: Youth Mental Illness, WETA Washington, D.C., the flagship public media station in the nation’s capital, launched Well Beings Youth Mental Health Project, a major public media multi-platform project to address mental health conditions.

With inpatient psychiatric services in short supply, adolescents are spending days, even weeks, in hospital emergency departments awaiting the help they desperately need.

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Mental health disorders are surging among adolescents: In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.

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​Nationally, the number of residential treatment facilities for people under the age of 18 fell to 592 in 2020 from 848 in 2012, a 30 percent decline, according to the most recent federal government survey. The decline is partly a result of well-intentioned policy changes that did not foresee a surge in mental-health cases. Social-distancing rules and labor shortages during the pandemic have eliminated additional treatment centers and beds, experts say.

American adolescence is undergoing a drastic change. Three decades ago, the gravest public health threats to teenagers in the United States came from binge drinking, drunken driving, teenage pregnancy and smoking. These have since fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders.

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In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.

"Overall, More than one in three high school students (37.1%) experienced poor mental health during the COVID-19 pandemic. In addition, 44.2% of students experienced persistent feelings of sadness or hopelessness, almost 20% seriously considered suicide, and 9.0% attempted suicide during the 12 months before the survey.

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In addition to providing youths with access to needed mental health care, comprehensive approaches that promote help-seeking behaviors, connections to trusted adults and supportive peers, and engagement in community activities have been shown to have many benefits including improved feelings of connectedness, better mental health, reduced risk for suicide, reduced prevalence of health risk behaviors, and better academic achievement."

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CDC Summary can be found here: https://www.cdc.gov/healthyyouth/data/abes.htm

CDC data and report can be found here: https://www.cdc.gov/mmwr/volumes/71/su/pdfs/su7103a1-a5-H.pdf

From brain architecture to toxic stress to serve and return, The Brain Architects, a new podcast from the Center on the Developing Child at Harvard University, focuses on the specific, practical questions that often arise for parents and caregivers during the critically important period of early childhood.

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Bringing together experts and practitioners from pediatrics, social services, and education, among other disciplines, the podcast gathers many different voices that aren’t always speaking directly to each other. And, by answering questions such as, “What does toxic stress actually look like in the day-to-day?” and “How can I make sure I’m building my child’s brain?”, The Brain Architects can help all of us can use the science of child development to improve the lives of the children we interact with every day.

The U.S. Surgeon General issued an urgent Public Health Advisory regarding children’s mental health. The advisory is a response to nationwide concerns about increases in children’s mental health challenges, and directly addresses the bombardment of negative messaging children are exposed to through social media, the pervasive systemic concerns regarding climate change, income inequality, and racial injustice, and the dramatic changes to children’s lives created by COVID-19. As the Surgeon General’s report states, “[t]he pandemic era’s unfathomable number of deaths, pervasive sense of fear, economic instability, and forced physical distancing from loved ones, friends, and communities have exacerbated the unprecedented stresses young people already faced.”

The Report outlines a number of recommendations for parents, schools, policy-makers, funders, and healthcare professionals to address the current public health crisis for children, emphasizing that “[e]nsuring healthy children and families will take an all-of society effort, including policy, institutional, and individual changes in how we view and prioritize mental health… Our obligation to act is not just medical—it’s moral.”

Includes resources such as 24/7 hotlines, nonprofit treatment agencies, in-school and peer support, etc.

Also includes link to services in nearby towns at: The Hub: Behavioral Health Action Organization for Southwestern CT

Hartford Courant article regarding the surge of children brought to the Connecticut Children’s emergency department due to mental health crises, increasing once again since the beginning of the school year. 

Six months ago, pediatric mental health providers, who reported that they were already severely overburdened, warned that they expected to see an even greater surge in demand for care in the fall, as children returned to school. For many children, the profound disruptions of the COVID-19 pandemic — from remote learning to reduced social contact — significantly exacerbated, or led to the emergence of, experiences of anxiety and depression. And while for some children, this fall offered a return to the familiar routines of in-person learning, for others, it brought yet another destabilizing change.

As the coronavirus pandemic subsides, children in Connecticut are struggling with anxiety and depression. But mental health providers say they can’t handle the growing demand for services

Online Resource from the American Academy of Child & Adolescent Psychiatry (AACAP), Facts for Families Guide. AACAP's Facts for Families provide concise and up-to-date information on issues that affect children, teenagers, and their families.

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AACAP's website contains many other resources as well, such as their Youth Resources, Resource Libraries, and Gender and Sexuality Resources.

CT Mirror Article

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As the pandemic has dragged into its second year, health care providers are reporting a growing crisis in children’s behavioral health care. Increasing numbers of school-aged children are showing up at Connecticut emergency departments — many of them suicidal, out of control, or with hard-to-treat eating disorders — leading to an overflow of young patients in emergency departments with limited bed space and a long wait for inpatient or community-based care elsewhere, hospital officials said.

Recommendation from a CAC volunteer: "Excellent book about a family, schizophrenia, trauma, treatments, and family dynamics."

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The heartrending story of a midcentury American family with twelve children, six of them diagnosed with schizophrenia, that became science’s great hope in the quest to understand the disease.
 

The Connecticut Children’s Health Brief series provides data-driven findings and recommendations to inform best practice and policy to strengthen families and promote optimal outcomes for all children. The series features work from Connecticut Children’s researchers, clinicians and program leaders that addresses the medical, social, environmental, and behavioral factors that directly impact child health, development and well-being. This work has the potential to have a broad and lasting influence on critical contemporary issues in children’s health such as obesity, asthma, sexually transmitted diseases, behavioral health disorders, and child abuse. It also serves to inform policy, advance equity and reduce disparities.

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Questions about the Connecticut Children’s Health Brief series can be directed to HealthBrief@connecticutchildrens.org.

Hartford Courant article on 1/16/21

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As the coronavirus pandemic drags on, doctors and other mental health professionals worry about the impacts of prolonged isolation and stress on children and teens, including an increased risk of suicide.

In Jennifer Cohen Harper’s newest release, Thank You Mind: Understanding My Big Feelings On Tricky Days, she helps children learn how awareness, self-compassion and positive self-talk can be powerful tools even on their trickiest days. It also includes meaningful tips for caregivers to support kids as they navigate their big feelings. 

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Childhood is filled with intense emotions. And it should be. But when kids are overwhelmed by tricky emotions, they sometimes try to push them away or become reactive. By exploring a wide range of emotions—anger, joy, sadness, awe, and more—children can discover how their mind can help them make sense of their emotional experiences.

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“With Thank You Mind, Jenn Cohen Harper brings kids (and their adults) on another empowering journey through our daily emotional landscapes, and all the challenges and joys along the way.” -- Chris Willard, PsyD, author of Breathing Makes it Better and Growing Up Mindful

Koleen Kerski from Birth to Three, who presented at CAC's 11/16/20 in-service, followed up with this information regarding infant mental health/social-emotional support. Click the link above to access the November 2020 report: Supporting Social-Emotional and Mental Health Needs of Young Children Through Part C Early Intervention: RESULTS OF A 50-STATE SURVEY

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This report examines features of states’ Part C Early Intervention (EI) programs that help them identify and serve infants and toddlers with social-emotional (SE) delays and mental health conditions. A 50-state survey conducted by the National Center for Children in Poverty (NCCP) and Georgetown University Center for Children and Families (CCF) asked state Part C Coordinators about their programs’ policies and procedures related to screening, evaluation, eligibility, services, and financing that affect the program’s capacity to meet the SE needs of infants and toddlers.

The Child & Family Guidance Center: The State of Connecticut's Suicide Advisory Board recently released a Public Health Alert on teen suicide and the impact of these uncertain times: “Tragically, in the past four weeks Connecticut has lost four young teens to suicide. We share this alert so that during these uncertain times youth collectively receive increased support, and so adults understand that right now youth are: 1) Struggling with feelings of uncertainty, 2) Feeling isolated and lonely 3) Experiencing losses and grief 4) Needing increased mental health support 5) Impacted by world events.”

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The Child & Family Guidance Center's Mobile Crisis Intervention Services (MCIS) clinicians are on the front lines, providing emergency support to Fairfield County youth in psychiatric distress. Our clinicians, in MCIS and in all our Behavioral Health programs, are here to help.

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If you think your child needs an emergency mental health assessment, call Connecticut's 2-1-1 line — available 24 hours a day, seven days a week. If you are concerned about your child's behavior call us directly at [tel://(203) 394-6529](203) 394-6529.

From CT Public Radio: The repercussions of being homeless as a child younger than 6 can be lifelong, and the strain often shows in their speech, behavior, development and health, according to child-care workers and experts.

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They may be nonverbal, or act out. They’re often sick, but may not have a pediatrician. They may not even know how to brush their teeth. “The impact on these young children is gigantic,” said Darcy Lowell, chief executive of Child First. Based in Trumbull, the agency provides counseling and practical help to families in their homes, and in homeless and domestic violence shelters. 

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Now, the state, children’s advocates and housing organizations are participating in an initiative that focuses specifically on pregnant women and children under 6 who are homeless or housing unstable. The three-year, $1 million collaborative intends to prevent homelessness and collect data, with the hope of avoiding lifelong problems and costly remedies.

At this in-service we learned about the wide range of programs and resources offered by CFGC and how to access them for our clients).

• Brochure (in English) on Care Coordination, a family focused program that uses the Wraparound team model to provide families with Help, Healing, and Hope for a better future

• Brochure (in Spanish) - same as above but in Spanish

• Care Coordination Referral Form

Some of the programs offered by CFGC include: 

• Community Support for Families

• Multi Systemic Therapy (MST) (in home intensive therapeutic program for adolescents and their families)

• Adolescent Substance Abuse Program

• Functional Family Therapy Program (short-term, intensive intervention program designed for families with 11- to 18-year-old youth who have been referred for behavioral or emotional problems by the juvenile justice, mental health, school, or child welfare systems)

• Outpatient Behavioral Health

• Emergency Mobile Crisis Services

If you think any of these programs might be appropriate for a child in your case, please discuss with your Program Director.

Teen Instagram sensation and author of Light Filters In @poeticpoison returns with a second collection of short, powerful poems about love, forgiveness, self-discovery, and what it’s like living after a hard-fought battle with depression, in the vein of poetry collections like Milk and Honey and the princess saves herself in this one.

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Materials from CAC Inservice on 4/24/19 featuring Deidre Romeo, Program Manager, and Betsie Bergman, Team Lead, from St. Vincent's Behavioral Health Outpatient Services.

PDF includes:

• St. Vincent's Behavioral Heath Services at-a-glance handout

• St. Vincent's Behavioral Heath Adolescent Intensive Outpatient Program (IOP) overview

• Reference list of 2019 Mental Health & Substance Use Public & Nonprofit Resources, Greenwich-Stamford-Norwalk areas

• Contact information for Deidre and Betsie

New York Times article by Concepción de León

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Lett me know if any of these sound familiar: Boys don’t cry. We don’t air family business. You have to be strong. Turn to God.

These refrains... are just some of the responses that people dealing with mental health challenges in Latino communities have come to know well. Going to therapy or struggling with mental illness can be viewed as a sign of weakness or that you’re “crazy.” Combine this with unequal access to mental health services and quality health insurance, and it’s no wonder that Latinos, who are just as likely to suffer from a mental illness as whites, are half as likely to seek treatment.

By Terry DeMio, Cincinnati Enquirer

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A recent study shows that 53 percent of Ohio's children's services caseworkers have symptoms of post-traumatic stress disorder. That compares with national incidences that range from 35 percent to 75 percent of child-welfare staff.

A national research study is underway to help with the recruitment and retention of child-welfare staff nationwide. That's where the PTSD finding came from. The project is headed by the Quality Improvement Center for Workforce Development, which is partnering with the U.S. Health and Human Services' Children's Bureau in a five-year, federally funded project.

The OCA's report outlines concerns from state inspectors at the Department of Public Health and the Department of Social Services regarding a multiple suicidal incidents at the Solnit S. PRTF from November 2017 through July 2018: 7 suicide attempts and 1 suicide in June. DPH made multiple findings during this time that deficiencies at Solnit S. PRTF rose to the level of creating an "immediate jeopardy" of harm to children in the facility and that a mandated plan of correction was required to improve safety and treatment planning for residents.

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OCA's report examines the oversight structure for this state-run facility and other child-serving treatment programs. OCA concludes that the state lacks an effective and transparent framework for ensuring safe and high quality care at Solnit and at other child-serving treatment facilities, and OCA is recommending to the legislature that immediate steps be taken to revise state law, where applicable, to begin the process of creating a more transparent and accountable service delivery system for vulnerable children and their families. 

The Connecticut Coalition to End Homelessness and the Department of Mental Health and Addiction Services have teamed up to present a six webinar series "Meeting the Needs of Your Clients: Building Competencies in Mental Health and Addiction Services". The Utilizing DCF's Emergency Mobile Psychiatric Service (EMPS) Resources webinar is the fourth webinar of the series.

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The Presenter: Tim Marshall, LCSW, Director, Office of Community Mental Health, Department of Children and Families

Click Here for the powerpoint presentation.

Treating childhood trauma

Oprah Winfrey reports on how trauma plays a role in childhood development and what new methods are being used to help kids who have experienced it.

PowerPoint Presentation from CAC's 2/9/18 in-service on PTSD by Kat Lee, MA, CCLS, RDT with the Post Traumatic Stress Disorder (PTSD) Center.

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Related materials:

The CDC-Kaiser ACE Study: 

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being.

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"Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults," published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.

NYTimes Op-Ed by David Bornstein

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Over the past decade, Dr. Nadine Burke Harris, the founder of the Center for Youth Wellness, in Bayview Hunters Point, San Francisco, has emerged as one of the country’s strongest voices calling for a national public health campaign to raise awareness and a sense of urgency about the devastating and potentially lifelong health effects of childhood trauma.

Since the original research on adverse childhood experiences, known as the ACE Study, was published in 1998, a growing body of evidence has indicated that severe or prolonged levels of childhood adversity (often measured in terms of an “ACE score” ranging from 0 to 10) are far more common and harmful than has been appreciated. Dr. Burke Harris, a pediatrician, has led in developing methods to screen and treat children and families suffering health problems attributable to what is known as toxic stress.

Science has confirmed the damaging effects of trauma on a child's brain and the relevance and importance of good mental health. As a child's brain architecture is being built, early experiences and toxic environments are major determinants of the capacity of a child's later functioning. But as children grow, they encounter increasingly complex tasks and demands. Like the structure of a house, the brain needs to become functional in a variety of ways to accommodate new expectations and demands. The experiences and environments that adolescents have available to them become the building materials that allow them to adjust to new demands, to support new skills, and to become reliable members of society. Each year in the United States, more than 6 million referrals are made to the child welfare system and more than 600,000 of these children are determined to be substantiated victims of abuse or neglect.

NYTimes article by Nicholas Bakalarnor

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The daughters of women exposed to childhood trauma are at increased risk for serious psychiatric disorders, a new study concludes.

Dr. Nikolov's and Dr. Loftus's PowerPoint presentation, and the event page can be found here. 

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The seminar featured:  

• Sara Bartosz, Deputy Director of Litigation Strategy, Children’s Rights, NY

• Mirela Loftus, MD, PhD, Child and Adolescent Psychiatrist, Institute of Living, Hartford, CT

• Roumen Nikolov, MD, Medical Director, Albert J. Solnit Psychiatric Center, CT Department of Children and Families

Related articles:

• Psychotropic Medication and Children in Foster Care, ABA Center on Children and the Law, 2011

• California Moves to Stop Misuse of Psychiatric Meds in Foster Care, National Public Radio, 2015

This is a bulletin from the Child Welfare Information Gateway. Studies indicate when children feel unsafe or threatened, their brain development may be negatively impacted with long-lasting effects on their learning ability as well as their social, emotional, and behavioral development. Additionally, their risk for developing mental health disorders such as depression, posttraumatic stress, anxiety, bipolar disorder and others significantly increases. Child welfare professionals have an opportunity to identify this early
childhood trauma—either chronic or acute—and respond with early intervention that can offset the negative consequences.

From Sarah Eagan, State of CT Office of the Child Advocate:

In 2014, following a series of student suicides, Stamford Public Schools began looking at ways they could better support students' behavioral health and well being. 

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They contacted the Child Health and Development Institute of Connecticut (CHDI) to help review the district's strengths and areas of concern and began building a trauma-informed model for school mental health that is resulting in better outcomes for students. This Issue Brief explores the process, strategies and lessons learned by Stamford Public Schools which can help guide other districts seeking to improve their mental health services and supports.

From the Center for Children's Advocacy

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Like other online content, texts and images do not go away.  For teens who sext, there are legal,  emotional, educational and long-term career consequences.  There is enormous trauma for adolescents  whose privacy is violated.  The issues are complex, the images are permanent, and the consequences are real.  

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Click on the link above for the recorded webinar and CCA attorney Leon Smith's presentation, Sexting and Cyberbullying: What Does the Law Say? (once you land on the linked page, look in the middle of the page for links to the webinar recording and powerpoint presentation).