Gene Griffin, J.D., Ph.D.

December 01, 2011

1. Prevalence of Mental Illness in Older Youth in Child Welfare 2. A Transition Program for Youth moving from Child Welfare to Adult Mental Health Services 3. Older Youth, Trauma and Mental Illness

Diagnosis Major Depression Conduct/Oppositional ADHD

PTSD Mania

Percentage in the Past Year 18% 17% 10%

8% 6%

McMillen et al., 2005, Journal of the American Academy of Child and Adolescent Psychiatry

Issue (2005): Illinois Child WelfareOlder youth with major mental health issues stayed in high end residential placements until they aged out. Then, as young adults, they were referred to the Division of Mental Health, which often refused to take the referral and only had limited community based services.

Child Welfare felt that Mental Health was not interested in youth Mental Health felt that Child Welfare was doing a last minute dump of non-mentally ill youth Only precedent- a previous agreement between Child Welfare and Developmental Disabilities wherein DCFS paid DD several million dollars in advance to assess and place aging out wards with DD. Unfortunately, the money was gone, and DCFS felt it did not get as many youth placed as DD had agreed to

DCFS and Mental Health (Adult) formed a joint committee to review clinical applications of 17 year olds with major mental illness for a transitional living program DCFS presented cases; mutual agreement as to mental illness and likely need for longterm care Two private agencies that already had contracts with DCFS and DMH created transitional living group homes for mentally ill young adults

Overlapping Jurisdiction DMH (adult) system responsible when MI youth turns 18; DCFS could keep custody until 21; Provider, DCFS and DMH participate in ongoing staffings DCFS agreed to pay completely for the transitional living program Youth transitions to DMH community programs when clinically appropriate or by age 21

Written up as an Interagency Agreement Funding- No new money required DMH did not pick up costs of transitional program DCFS was actually saving money because the per diem for transitional living programs was less than the per diem for the high end residential programs Youth actually get continuity of care and true transition to adult system

In four years, 112 referrals made 60 youth accepted. 45 referrals already in the program 7 youth transitioned into the adult mental health system The downstate facility has 16 funded beds. The Chicago facility has 17 beds. Referrals who are not accepted into the program continue to receive recommendations for alternative placement.

Child TraumaThe experience of an event by a person that is emotionally painful or distressful which often results in lasting mental and physical effects. Event Experience Effect

C o m p l e x i t y

Symptom Constellations Individual Symptoms Events

Trauma

Overlapping Symptoms 1. Bipolar Disorder hyperarousal and other anxiety symptoms mimicking hypomania; traumatic reenactment mimicking aggressive or hypersexual behavior; and maladaptive attempts at cognitive coping mimicking pseudo-manic statements restless, hyperactive, disorganized, and/or agitated activity; difficulty sleeping, poor concentration, and hypervigilant motor activity a predominance of angry outbursts and irritability striking anxiety and psychological and physiologic distress upon exposure to trauma reminders and avoidance of talking about the trauma

Trauma Child Trauma

2. Attention Deficit / Hyperactivity Disorder

Child Trauma

3. Oppositional Defiant Disorder 4. Panic Disorder

Child Trauma Child Trauma

Overlapping Symptoms 5. Anxiety Disorder, including Social Anxiety, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, or Phobia 6. Major Depressive Disorder avoidance of feared stimuli, physiologic and psychological hyperarousal upon exposure to feared stimuli, sleep problems, hypervigilance, and increased startle reaction self-injurious behaviors as avoidant coping with trauma reminders, social withdrawal, affective numbing, and/or sleep difficulties drugs and/or alcohol used to numb or avoid trauma reminders severely agitated, hypervigilance, flashbacks, sleep disturbance, numbing, and/or social withdrawal, unusual perceptions, impairment of sensorium and fluctuating levels of consciousness

Trauma Child Trauma

Child Trauma

7. Substance Abuse Disorder 8. Psychotic Disorder

Child Trauma Child Trauma

Age 0 6 yo 7 13 yo 13 16 yo 17+ yo Sex Female Male

N (14,103) 8,452 2,799 2,459 393

% 59.93 19.85 17.44 2.79

6,942 7,149

49.27 50.73

Race
African American Non-Hispanic White Hispanic Other 6,519 6,513 786 79 46.91 46.87 5.66 0.57

Based on an initial assessment using the Child and Adolescent Needs and Strengths (CANS)

Mental Health Symptoms Depression

% of Children 16.68

Attachment
Anger Control Attention / Impulse Anxiety Oppositional Affect Dysregulation Conduct Substance Abuse Behavioral Regression Eating Disturbance Psychosis Somatization

15.60
14.53 12.50 11.66 9.97 9.67 5.54 4.13 2.91 2.61 1.72 1.25

Potentially Traumatic Events Neglect Family Violence Traumatic Grief/Separation Physical Abuse Emotional Abuse Witness to Criminal Activity Medical Trauma Sexual Abuse Community Violence School Violence Natural Disaster

% 46.12 29.25 25.49 20.67 13.40 10.51 9.69 8.63 3.46 1.58 0.65

War Affected
Terrorism Affected

0.25
0.18

Trauma Symptoms Adjustment To Trauma Re-experiencing Avoidance Numbing Dissociation

% of Children 24.02 8.08 8.69 6.13 2.12

0 1 2 3 4 5 6 7 8 9

# of Significant Trauma Events (N) (N= 3412) (N= 4081) (N= 3039) (N= 1792) (N= 904) (N= 489) (N= 184) (N= 73) (N= 34) (N= 10)

Average # of Trauma Symptoms 0.06 0.23 0.49 0.91 1.23 1.63 1.93 2.25 2.85 2.80 2.33 5.00 Incident Rate Ratio= 1.410 0.41 0.70 1.17 1.82 2.42 3.00 3.67 4.51 5.53 6.30 9.33 12.94

Average # of Mental Health Symptoms

11* (N= 3) 13 (N= 17) (*no subjects with 10 or 12 trauma events; 65 subjects unavailable)

Incident Rate Ratio = 1.342

# of Trauma Symptoms 0 1 2 3 4

Average # of Mental Health Symptoms 0.51 2.04 3.06 3.53 4.64

7.73
Incident Rate Ratio = 1.74

# of Strengths 0 1 2 3 4 5 6 7 8

# of Trauma Symptoms 1.74 1.55 1.30 1.24 1.11 0.97 0.72 0.60 0.41

9
10

0.33
0.20 Incident Rate Ratio = 0.82

Child Trauma

06 years old

7 - 12 years old

13 17 years old

17+ years old

All Children

1a. Any Suspected Traumatic Event

93.15%

98.25%

97.93%

98.22%

95.14%

1b. Any Actionable Traumatic Event

69.90%

83.78%

84.38%

88.30%

75.69%

2. Any Trauma Symptom 3. Potential PTSD

15.32% 1.25%

42.34% 4.50%

51.24% 5.98%

57.51% 6.87%

28.12% 2.88%

1000 900 800 700 600

Trauma Constellations 757 951

500 400 300

281

Individual Symptoms Events

200 100
29

0
Any Event Significant Event Trauma Symptoms PTSD

A. Children in Child Welfare, Illinois

B. NO Symptoms

C. Trauma Symptoms Only

D. Mental Health Symptoms Only

E. BOTH Trauma and Mental Health Symptoms

0 6 Year Olds

68.02 %

11.76 %

7.11 %

13.12 %

7 12 Year Olds

33.45%

13.81%

13.56 %

39.18%

13 16 Year Olds

17.03%

6.93 %

21.92 %

54.13%

17 + Year Olds

16.25 %

6.00 %

15.75 %

62.00 %

All Youth

50.77 %

11.16 %

11.22 %

26.85%

A. Children in Child Welfare Custody

C. Trauma Symptoms

E. B O T H

D. Mental Health Symptoms

B. No Symptoms

A. 17+ year olds in Child Welfare

6%

62%

15.75%

B. No Symptoms 16.25%

(1) mental health assessments of all youth in child welfare include measures of traumatic events and trauma-related symptoms; (2) trauma-focused treatment begin when a youth in child welfare demonstrates a trauma-related symptom; and (3) a clinician not diagnose a youth in child welfare with a mental illness without first addressing the impact of trauma.