Task Force on Involuntary Examination of Minors

1. Task Force on Involuntary Examination of Minors Children and Youth: Acute Crisis and Behavioral Health September 28, 2017

2. Acute Crisis and Behavioral Health Overview • National Trends • Prevalence: Anxiety and depression among children and teens • Florida Trends • 2017 Kids Count Data Book • Florida Youth Survey 3. Contributing Factors 4. Task Force Discussion

3. Acute Crisis and Behavioral Health National Trends - Prevalence National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults (Study: American Academy of Pediatrics, Nov. 2017) • Objective: examine national trends in 12-month prevalence of major depressive episodes (MDEs) in adolescents/young adults between 2005 -2014 • Study Methods • Data drawn from National Surveys on Drug Use and Health (NSDUH) between 2005 – 2014 (SAMHSA) • NSDUH is an annual cross-sectional survey of US population in all 50 states – noninstitutionalized population aged 12 and older • Interview/Self-report of 176,245 adolescents between 2005 – 2014 • 12-month and lifetime MDEs were assessed using a structured interview based on Diagnostic Statistical Manual of Mental Disorders (Fourth Edition)

4. Acute Crisis and Behavioral Health National Trends - Prevalence Results • Prevalence of teens who reported major a depressive episode (MDE) in the previous 12 months increased from 8.7% in 2005 to 11.5% in 2014 (Gradual increase in later years from 2010 on) • The increase was larger and statistically significant only in ages 12 – 20 • No significant increase noted in substance abuse/disorders • In comparison to teens without MDE, those with MDE included: • a disproportionate number of older teens; • nonstudents and unemployed; • from households with no or a single parent; and • teens with substance use disorders

5. Acute Crisis and Behavioral Health National Trends - Prevalence Results Cont. • Mental health care contacts did not change over time; however, the use of specialty mental health care providers increased in teens and young adults • Specialty mental health care includes: private mental health care settings, inpatient and day treatment settings, and prescribed medications • Inpatient treatment was most prominent in 2014 • The proportion of teens with 12-month MDE who received mental health counseling/treatment in the past 12 months of their depression did not significantly change over the 2005 to 2014 period • Most of the increases in the use of services were limited to 2011 and after

6. Acute Crisis and Behavioral Health National Trends - Prevalence Summary/Considerations • Each year, almost 1 in 11 teens and young adults have a MDE • Sociodemographic and household factors previously associated with adverse mental health outcomes in teens (single parent homes or income) did not account for the increasing trend in depression • Trends were different among boys and girls • Aligns with past studies and recent data: larger increase in depressive symptoms in girls (2X that of boys) in more recent years - increased suicide among girls and young women • Teen girls may have been exposed to a greater degree of depression risk factors in recent years: • Cyberbullying may have increased more among girls than boys • As compared to boys, girls use mobile phones with texting applications more frequently and intensely

7. Acute Crisis and Behavioral Health National Trends – Prevalence Summary/Considerations Considering the growing prevalence of MDE in the 12 – 20 age group, stable treatment rates translate into a growing number of depressed teens who are untreated Primary care settings are an opportunity to screen for and treat depression (and other mental health conditions) among children and teens – promoted by the American Academy of Pediatrics Task Force on Mental Health Outreach efforts, prevention, early detection and treatment of depression and other common mental health conditions in the 12 – 20 age group - focus for public mental health, schools, colleges, health care providers

8. Acute Crisis and Behavioral Health National Trends – Prevalence Additional Prevalence Data • National Institute of Mental Health • 20% of all youth ages 13 – 18 live with a mental health condition • 11% of youth have a mood disorder • 10% have a behavior or conduct disorder • 8% have an anxiety disorder • 50% of all lifetime cases of mental illness begin by age 14 and 74% by age 24 • The average delay between the onset of symptoms and intervention is 8 – 10 years • Suicide is the 3rd leading cause of death in youth ages 10 – 24 • Anxiety and depression in high school kids have been on the rise since 2012 after several years of stability - cuts across all demographics (suburban/urban/rural), those who are college bound and those who aren’t

9. Acute Crisis and Behavioral Health Florida Trends 2017 Florida Kids Count • Overall Child Well-Being (2017) - Florida ranks 40th • Comprised index of combined data across four domains: Economic Well-Being, Education, Health, Family and Community • Economic Well-Being (2017) - Florida ranks 45th • Children living in households with high housing cost burden (2015) = 40% • 1 – 3% Improvement from 2010 – 2015 • Children in poverty (2015) = 23% • Children whose parents lack secure employment (2015) = 31% • Teens not in school and not in work (2015) = 8%

10. Acute Crisis and Behavioral Health Florida Trends Florida Kids Count 2017 • Education (2017) - Florida ranks 31st • Young children not in school: 2013 – 2015 = 50% • 4th graders proficient in math, reading - no number and not included • Health (2017) - Florida ranks 44th • Low birth weight babies (2015) = 8.6% • Children without health insurance (2015) = 7% • Teens who abuse alcohol or drugs (2015) = 6% • Children without health insurance: 36% • 49% improvement from 2010 – 2015

11. Acute Crisis and Behavioral Health Florida Trends Florida Kids Count 2017 Family and Community - Florida ranks 35th • Children in single parent families (2015) = 40% • Children in families where head of household lacks high school diploma (2015) = 12% • Children living in high poverty areas (2015) = 14% • Teen births per 100,000 (2015) = 21% The 2017 Kids Count Data Book can be found at the following link: http://www.floridakidscount.org/

12. Acute Crisis and Behavioral Health • The Youth Risk Behavior Surveillance System (YRBS) defines felt sad or hopeless as: "felt sad or hopeless almost every day for 2 or more weeks in a row so that they stopped doing some usual activities during the 12 months before the survey.“ • Data Source: Centers for Disease Control and Prevention. (2016): http://nccd.cdc.gov/YouthOnline/App/Default.aspx Florida Trends - Youth Risk Behavior Surveillance Survey

13. Acute Crisis and Behavioral Health Data Source: Centers for Disease Control and Prevention. (2016): http://nccd.cdc.gov/YouthOnline/App/Default.aspx Florida Trends - YRBSS

14. Acute Crisis and Behavioral Health Florida Trends 2016 Florida Youth Substance Abuse Survey • % of youth who reported engaging in delinquent behavior in the last 12 month: • Carrying a handgun = 5.3% (up from 3.9% in 2014) • Selling drugs = 4.2% (down from 5.6% in 2014) • % of youth involved in bullying behavior • Skipped school due to bullying = 7.9% • Was kicked or shoved in the past 30 days = 13% • Was taunted to teased in the past 30 days = 27.9% • Victim of cyber bullying in the past 30 days = 7.7% • Physically bullied by others in the past 30 days = 6.1% • Verbally bullied in the past 30 days = 12%

15. Acute Crisis and Behavioral Health Florida Trends 2016 Florida Youth Substance Abuse Survey – Risk factors • Percent of Students with Elevated Risk Factors - National normative sample • Middle school Risk Factor Average = 40% • High School = 45% • Overall = 43% • Percent of Percent of Students with Elevated Risk Factors – Florida • Middle school Risk Factor Average = 39% (decrease from 45% in 2004) • High School = 38 % (decrease from 45% in 2004) • Overall = NA • Note: Because risk is associated with negative behavioral outcomes, it is better to have lower risk factor scale scores, not higher. Conversely, because protective factors are associated with better student behavioral outcomes, it is better to have protective factor scale scores with high values.

16. Acute Crisis and Behavioral Health Florida Trends 2016 Florida Youth Substance Abuse Survey – Protective factors • Percent of Students with Elevated Protective Factors - National normative sample • Middle school Risk Factor Average = 56% • High School = 59% • Overall = 57% • Percent of Percent of Students with Protective Factors – Florida • Middle school Risk Factor Average = 52% (increase from 50% in 2004) • High School = 61% (increase from 57% in 2004) • Overall = NA • Data Source: Florida Youth Substance Abuse Survey (2016)/ Data Tables: http://www.myflfamilies.com/service-programs/substance-abuse/fysas/2016

17. Acute Crisis and Behavioral Health Contributing Factors – TIME Health • The number of distressed young people is on the rise – experts trying to determine how best to help • They are the post 911 generation • Raised in a era of economic insecurity • Never known a time when school shootings and terrorism where not the norm • Hit puberty when technology and social media where transforming society • Dr. Marion Underwood - UC Davis Study: Social media and teens • Studied what 13-year-olds (n=200) actually post and say on social media • There is no form line between their real and online worlds • Most young teens will experience bullying • Parental monitoring does make a difference – parents can buffer negative effects

18. Acute Crisis and Behavioral Health Contributing Factors - TIME Health • Ellen Chance, Co-president of Palm Beach Co. School Counselor Assoc. • Technology and online bulling is affecting kids as early as fifth grade • School counselors often administer standardized tests and have less time to deal with students mental health • “I couldn’t tell you how many students are being malicious to each other over Instagram and Snapchat.” • Dr. Janis Whitlock, Director - Cornell Research Program on Self-Injury and Recovery • “If you want to create an environment to churn out really angsty people, we’ve done it.” • teens are in a cauldron of stimulus they can’t get away from, don’t want to get away from, or don’t know how to get away from • Studies pretty consistently show that people who injure themselves do so to cope with anxiety or depression

19. Acute Crisis and Behavioral Health Contributing Factors - TIME Health • Fadi Haddad, psychiatrist: Children/adolescent psychiatric emergency department Bellevue Hospital/ NY City: • Every week, we have a girl who comes to the ER and some social-media rumor or incident that upsets her – then she cuts herself • Even very involved parents often unaware of how distressed their child is • Dr. Laura Prager: Director of Child Psychiatry Emergency Services at Mass. General Hospital: Article - Kids in Crisis: The View from the ER • Most common psychiatric problems seen in the ER: • behavioral dysregulation (out of control behavior), self-injurious behavior/suicide ideation or attempt • Socioeconomic stress • Lack of outpatient services is the single reason kids with psychiatric problems end up in the ER – because they don’t exist or insurance won’t cover

20. Acute Crisis and Behavioral Health Task Force Discussion