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Opportunity to reduce number of youth in jail population: Estimated 60% have diagnosable mental disorders (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.

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Opportunity to reduce number of youth in jail population: Estimated 60% have diagnosable mental disorders (1)

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  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 It’s 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 parent’s past history of suffering childhood trauma, increases a child’s at risk status Family or community violence Infant’s exposure to trauma or ongoing stressful environments: An infant’s 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 Children’s 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 andClinical 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 children’s 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 6:1, ff.

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