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Download Day 2: Plenary II Students` Mental Health
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Addressing Students’ Mental Health Needs To Improve School Climate and Academic Performance NDTAC National Conference – June 22, 2016 1 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 2 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) 49