Download Day 2: Plenary II Students` Mental Health

Addressing Students’ Mental Health Needs To
Improve School Climate and Academic Performance
NDTAC National Conference – June 22, 2016
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What We Will Cover
• Students’ mental health needs
– Overview of students’ mental health needs
(co-occurring disorders, trauma, and suicide)
– Connection to school climate and educational
achievement
• What can be done
– Federal and State initiatives and resources related to
prevention, intervention, and treatment
• Q&A
• Charge for the breakout session
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2016 NDTAC National Conference
Northwestern Juvenile Project:
Detention and Beyond
Karen M. Abram, PhD
Health Disparities & Public Policy
Department of Psychiatry and Behavioral Sciences
Feinberg School of Medicine
Northwestern University
Faculty
Linda A. Teplin, PhD (PI)
Karen Abram, Ph.D.
Leah Welty, Ph.D.
Jessica Jakubowski, Ph.D.
1-Day Count of Juvenile Offenders in
Custody, 1991-2013 (in 1,000s)
120
105
107
104
97
100
92
93
87
80
76
79
71
61
60
54
40
20
0
1991
1993
1995
1997
1999
2001
2003
2006
2007
2010
2011
2013
Percentage of Juvenile Court Cases that
Involve Females , 1985-2013
50%
40%
30%
20%
10%
0%
1985
1988
1991
1994
1997
2000
2003
2006
2009
2012
Why Study Detained Youth?
Disproportionate Minority Confinement
100%
80%
60%
40%
39.7%
20%
34.8%
% of African Americans
in US population (13%)
0%
% of AA's, Youth in Corrections
% of AA's, Adults in Prisons and Jails
Methods
• Stratified random sample, N=1829
• Sampled from Cook County Detention Center,
1995-1998
• Re-interviewed in community or corrections
• Array of measures
• State of the art locating
Northwestern Juvenile Project
Participation Rates
Wave
Original
Sample
n
3 year
3½ year
4 year
4½ year
6 year
8 year
10 year
11 year
12 year
13 year
14 year
15 year
16 year
1829
997
997
1829
1829
1829
800
800
1829
800
1829
1829
1829
Interviews
Completed*
97.5%
95.5%
93.1%
91.5%
84.2%
82.3%
85.5%
87.4%
87.8%
87.1%
84.1%
83.6%
81.6%
*Of those still living at the time their follow-up was due
During Detention
Mental Health Needs
Mood Disorders
Depression: sadness, tearfulness, diminished capacity to enjoy pleasurable
activities, irritability, and physical symptoms such as decreased appetite,
sleep disturbances, and fatigue
– Major depression: 5 or more symptoms during the same 2 week period
– Dysthymic disorder: persistent, chronic depression
Mania: abnormally, persistently elevated, expansive or irritable mood;
decreased need for sleep, increased energy, behaving strangely in the
classroom, impulsivity, being more talkative, excessive involvement in
pleasurable activities
– Manic episode: symptoms present for most of the day, nearly every day,
for a period of at least 1 week
– Bipolar disorder: alternates between depression and mania
Anxiety Disorders
e.g., Panic, Generalized Anxiety, Posttraumatic Stress
–
–
–
–
–
–
Feeling nervous or “on edge”
Unfounded or unrealistic fears
Trouble separating from parents
Sleep disturbance
Obsessive thoughts and/or compulsive behaviors
Trembling, sweating, shortness of breath, stomachaches,
headaches, muscle tension, and/or other physical symptoms
Anxiety is excessive or persists beyond developmentally
appropriate periods
Symptoms are persistent for 6 months or more
Disruptive Behavioral Disorders
• Conditions involving problems in the selfcontrol of emotions and behaviors
• Behaviors that:
– violate the rights of others
– or get youth into trouble
– e.g., aggression, destruction of property
• At least 4 symptoms last at least 6 months
Prevalence of Psychiatric Disorders at the
Baseline Interview
(N=1,829)
19
Mood
28
21
Anxiety
31
41
Behavioral
46
51
Substance Use
Males
Females
47
66
Any Disorder
74
0
20
40
60
80
100
Prevalence of Psychiatric Disorders
Among Males, Baseline
19
Mood
22
14
21
Anxiety
26
14
40
Behavioral
43
60
49
Substance Use
55
63
65
Any Disorder
70
82
0
20
African American
40
60
80
Hispanic
non-Hispanic white
100
Prevalence of Psychiatric Disorders
Among Females, Baseline
26
Mood
29
23
31
Anxiety
33
30
39
Behavioral
57
62
42
Substance Use
52
62
71
Any Disorder
76
86
0
20
African American
40
60
Hispanic
80
non-Hispanic white
100
Comorbid Types of Disorder Among Males
None of the
Listed
Disorders
34.8%
14.6%
Substance 49.8%
1.4%
3.2%
ADHD/
Behavioral 41.7%
16.4%
6.7%
6.9%
1.1%
1.2%
2.0%
4.3%
0.7%
1.6%
Affective 17.9%
1.0%
2.1%
2.1%
Anxiety
21.1%
17
Comorbid Types of Disorder Among Females
None of the
Listed
Disorders
27.2%
Substance 44.5%
2.0%
1.2%
2.2%
3.9%
2.3%
7.6%
6.7%
4.8%
ADHD/
Behavioral 46.3%
2.0%
4.9%
2.9%
Affective
26.4%
2.6%
6.0%
Anxiety
31.5%
18
Suicidal Ideation
Suicidal Ideation: Thoughts of suicide that can range in
severity from a vague wish to be dead to active suicidal
ideation with a specific plan and intent
Specific Warning Signs
• A previous suicide attempt
• Current talk of suicide or making a plan
• Strong wish to die or a preoccupation with death
• Giving away prized possessions
• Signs of depression, such as moodiness, hopelessness, withdrawal
• Increased alcohol and/or other drug use
• Hinting at not being around in the future or saying good-bye
http://www.yspp.org/about_suicide/
warning_signs.htm
Suicidal Ideation and Behavior Among
Females, Baseline
Ever Felt Life Was
Hopeless
52
46
41
Thought About
Death (Past 2
Weeks)
26
13
19
Thought About
Suicide (Past 2
Weeks)
17
4
7
Specific Suicide
Plan
15
9
10
Ever Attempted
Suicide
32
43
22
Attempted Suicide
(Past 6 Months)
12
8
8
0
20
African American
40
60
Hispanic
80
non-Hispanic white
100
Suicidal Ideation and Behavior Among
Males, Baseline
Ever Felt Life Was
Hopeless
38
43
35
Thought About
Death (Past 2
Weeks)
22
16
20
Thought About
Suicide (Past 2
Weeks)
5
9
3
Specific Suicide
Plan
7
7
5
Ever Attempted
Suicide
9
18
9
5
6
2
Attempted Suicide
(Past 6 Months)
0
20
African American
40
60
80
Hispanic
non-Hispanic white
100
What % of males and females received needed
mental health treatment?
100%
80%
60%
Female
41%
Male
40%
20%
13%
0%
Treated
Prevalence of Childhood Maltreatment
Among Juvenile Detainees
Moderate Physical Abuse
Severe Physical Abuse
Females
Males
Sexual Abuse
0
20
40
60
80
100
Prevalence of Childhood Maltreatment:
Self-Report vs. Record
100
80
Self-Report
60
Record
40
Self-Report
or Record
20
0
Severe Physical Abuse
Sexual Abuse
Trauma
Children and adolescents experience trauma under two different sets of circumstances.
Some types of traumatic events involve (1) experiencing a serious injury to yourself or witnessing a serious injury to or the death of someone else, (2) facing imminent threats of serious injury or death to yourself or others, or (3) experiencing a violation of personal physical integrity. These experiences usually call forth overwhelming feelings of terror, horror, or helplessness. Because these events occur at a particular time and place and are usually short-lived, we refer to them as acute traumatic events. These kinds of traumatic events include the following:
•School shootings
•Gang-related violence in the community
•Terrorist attacks
•Natural disasters (for example, earthquakes, floods, or hurricanes)
•Serious accidents (for example, car or motorcycle crashes)
•Sudden or violent loss of a loved one
•Physical or sexual assault (for example, being beaten, shot, or raped)
In other cases, exposure to trauma can occur repeatedly over long periods of time. These experiences call forth a range of responses, including intense feelings of fear, loss of trust in others, decreased sense of personal safety, guilt, and shame. We call these kinds of trauma chronic traumatic situations. These kinds of traumatic situations include the following:
•Some forms of physical abuse
•Long-standing sexual abuse
•Domestic violence
•Wars and other forms of political violence
Trauma
Acute traumatic events:
• Experiencing a serious injury or witnessing a serious injury to
or the death of someone else; facing imminent threats of
serious injury or death to oneself or others; experiencing a
violation of personal physical integrity
• Typically evokes overwhelming feelings of terror, horror, or
helplessness
Prolonged trauma exposure, e.g., ongoing abuse, domestic
violence, war.
• Can lead to intense feelings of fear, loss of trust in others,
decreased sense of personal safety, guilt, and shame.
http://www.nctsn.org/content/defining-traumaand-child-traumatic-stress
Symptoms of Child Traumatic Stress and PTSD
•
•
•
Intrusion
Recurrent, involuntary, intrusive memories; traumatic nightmares; flashbacks;
intense or prolonged distress after exposure to traumatic reminders; marked
physiologic reactivity (e.g., increased heart rate) after exposure to trauma-related
stimuli
Avoidance
Persistent avoidance of distressing trauma-related stimuli after the event
Negative Alterations in Cognitions and Mood
Inability to recall key features of the traumatic event; persistent, negative beliefs and
expectations about self and the world; persistent distorted blame of self or others;
persistent negative trauma-related emotions; markedly diminished interest in activities;
feeling alienated from others; inability to experience positive emotions; "time skew"
(younger children); "omen formation“ (younger children); posttraumatic play
(compulsively repeating some aspect of trauma and does not relieve anxiety)
•
Alterations in Arousal and Reactivity
Irritable or aggressive behavior; self-destructive or reckless behavior;
hypervigilance; exaggerated startle response; problems in concentration; sleep
disturbance
Prevalence of Traumatic Experiences among Detained Youth
Sexual Assault
30
2
Bad Accident
22
34
Attacked/ Severely
Beaten
31
36
Thought Would Die
49
54
Threatened with
Weapon
47
59
Witnessed Severe
Violence
64
75
Ever Traumatized
84
93
0
20
Females
40
60
80
100
Males
Abram et al ., 2004, AGP
Proportion of Sample by IQ (KBIT)
Above Average
100%
Average
80%
Below Average
60%
40%
77%
Below
Average
Well Below Average
20%
Lower Extreme
0%
IQ Category
Lansing et al., J. of Cor. Hlth Care, April, 2014
After Detention
Prevalence of Any Juvenile or Adult Incarceration
After
Baseline*
%
0
20
40
60
80
Total
87
Male
All
94
Males
Female
Females
100
74
African American
98
Hispanic
Males
95
Non-Hispanic White
83
African American
79
Hispanic
Females
Non-Hispanic White
72
56
* Until October 2013; includes juvenile detention, juvenile prison, adult jail, and adult prison .
Prevalence of Any Adult Incarceration After Baseline*
%
0
10
20
30
40
50
60
70
88
Male All
Female
Males
90
75
Total
51
94
African American
89
Males
Hispanic
73
Non-Hispanic White
Females
80
58
African American
41
Females
Hispanic
Non-Hispanic White
* Until October 2013; includes adult jail and adult prison.
33
100
Delinquents: Cause of Death,
Ages 15-29 by Gender
100%
Other, 5%
Homicide: Other, 5%
}
Motor Vehicle, 1%
Drug Overdose, 1%
Suicide, 2%
Other, 30%
Motor Vehicle, 9%
50%
Drug Overdose, 15%
Homicide: Firearm,
86%
Suicide, 4%
Homicide: Other, 13%
Homicide: Firearm,
28%
0%
Delinquent Males
Delinquent Females
Teplin at al., 2014, Pediatrics
Cause of Death: Males Ages 15-29*
100%
Other, 5%
Homicide: Other, 5%
}
Motor Vehicle, 1%
Drug Overdose, 1%
Suicide, 2%
Other, 25%
Motor Vehicle, 13%
50%
Drug Overdose, 5%
Suicide, 4%
Homicide: Other, 4%
Homicide: Firearm,
85%
Homicide: Firearm,
49%
0%
Delinquent Males
General Population Males
*Standardized on Cook County Juvenile Temporary Detention Center population
Teplin at al., 2014, Pediatrics
Lifetime Prevalence
Substance Use Disorder
By 12 years after baseline:
• 90% had had any substance use disorder
– 77% had had an alcohol use disorder
– 83% had had a marijuana use disorder
– 22% had had an other drug use disorder
Size of Social Support Network
8 Years after Detention
x = 1.8
%
Preliminary Data
Positive Outcome Domains
•
•
•
•
•
•
•
•
Educational Attainment
Gainful Activity
Interpersonal Functioning
Parenting Responsibility
Residential Independence
Mental Health
Abstaining from Substance Abuse
Desistance from Criminal Activity
Preliminary Data
Positive Outcomes, 12 Years After Baseline:
Gender Differences
Females
Males
54
52
Educational Attainment
Gainful Activity
39 * *
20
Criminal Desistance
68 *
27
Residential Independence
38
Interpersonal Functioning
36
37
Parenting Responsibility
67 *
*
*
84
24
Mental Health
52
61 *
*
*
*
54
53
Abstaining from Substance Abuse
0
20
40
60
%
80
100
Preliminary Data
Positive Outcomes, 12 Years After Baseline:
Racial/Ethnic Differences Among Males
Non-Hispanic White
Hispanic
African American
Educational Attainment
74 W > AA, H
50
51
Gainful Activity
16
Criminal Desistance
51 W > H > AA
29
44
28
26
Residential Independence
35
Interpersonal Functioning
49
42
19
56
44
36
37
Parenting Responsibility
W > AA, H
W > AA
W > AA, H
47
W > AA
54
50
52
Mental Health
37
Abstaining from Substance Abuse
0
20
56 AA, H > W
53
40
60
%
80
100
Preliminary Data
Positive Outcomes, 12 Years After Baseline:
Racial/Ethnic Differences Among Females
Non-Hispanic White
Hispanic
African American
Educational Attainment
52
68
56
W > AA
37
42
38
Gainful Activity
62
Criminal Desistance
67
73
68
69
66
Residential Independence
Interpersonal Functioning
33
59
38
W > AA, H
82
85
85
Parenting Responsibility
48
Mental Health
61 AA > W
63
52
53
Abstaining from Substance Abuse
0
20
40
61
60
%
80
100
Preliminary Data
Highest Level of Educational Attainment, 12
Years After Detention: Gender Differences
Females
Males
5
4
Postsecondary
F>M
7
Vocational/technical
5
21
High school
12
19
GED
31
48
48
Less than high school/GED
0
10
20
30
40
50
%
60
70
80
90
100
Highest Level of Educational Attainment, 12 Years
After Detention:
Racial/Ethnic Differences Among Females
non-Hispanic white
Postsecondary
2
Hispanic
African American
11
6
6
7
7
Vocational/technical
19
High school
24
21
GED
18
24
W >AA
32
32
Less than high school/GED
0
10
20
30
44
40
48
50
%
60
70
80
90
100
Highest Level of Educational Attainment, 12 Years
After Detention:
Racial/Ethnic Differences Among Males
non-Hispanic white
Postsecondary
3
4
Hispanic
African American
6
W >AA, H
Vocational/technical
5
5
High school
7
11
14
20
W >AA, H
GED
29
31
39
27
Less than high school/GED
0
10
20
49
49
30
40
50
%
60
70
80
90
100
Employment Status, 12 Years After Detention:
Gender Differences
Females
Males
61
Not employed
71
10
Employed part-time
9
F>M
28
Employed full-time
20
0
10
20
30
40
50
%
60
70
80
90
100
Employment Status, 12 Years After Detention:
Racial/Ethnic Differences Among Females
non-Hispanic white
Hispanic
African American
48
Not employed
56
63
20
Employed half-time
11
10
W >AA
32
Employed full-time
33
28
0
10
20
30
40
50
%
60
70
80
90
100
Employment Status, 12 Years After Detention:
Racial/Ethnic Differences Among Males
non-Hispanic white
Hispanic
African American
40
Not employed
53
77
13
Employed half-time
14
7
W > H > AA
46
Employed full-time
33
16
0
10
20
30
40
50
%
60
70
80
90
100
Funding Agencies
National Institute on Drug Abuse
Office of Juvenile Justice and Delinquency Prevention
Office of Behavioral and Social Sciences Research
Centers for Disease Control and Prevention
National Institute on Alcohol Abuse and Alcoholism
NIH Center on Minority Health and Health Disparities National Institute
of Mental Health
Center for Substance Abuse Prevention
Center for Mental Health Services
Center for Substance Abuse Treatment
NIH Office of Research on Women’s Health
NIH Office of Rare Diseases
Department of Labor
Department of Housing and Urban Development
Robert Wood Johnson Foundation
William T. Grant Foundation
Q&A
48
Breakout Sessions
Group A: Salmon Community (200 A/B)
Group B: Gold Community (4117/4118)
Group C: Teal Community (200 C)
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