Children’s Policy Conference Keeping Kids Closer to Home Peter Selby, PhD -- February 24, 2016

Priorities for Children Texas children will receive effective mental health care as part of their overall health so they can reach their full potential. All Texas children will have access to the mental health services they need to succeed academically and develop into adults with families, homes, work, faith, and community. All Texas children will have a network of support that works together to address mental health needs without first having to be placed in juvenile detention or foster care. Slide 2

Mental Health and Texas Children One half of all mental illnesses begin by age 14. Each year, 175,000 Texas children suffer from severe mental health needs. Of those, 50% will drop out of high school, and they face double the risk for substance use as compared to children without such needs. Suicide is the second leading cause of death for young people ages 10 to 24; nearly one in seven Texas high school students makes a suicide plan. Slide 3

Mental Health and Texas Children Current public services: -Most people think about the Department of State Health Services (DSHS) when they think about the “Texas public mental health system” -DSHS served just over 47,000 children and adolescents in SFY million Texas children and adolescents in poverty have Medicaid -Medicaid served over 300,000 with behavioral health needs Despite the availability of Medicaid, too many Texas children first receive mental health services through foster care, juvenile justice or special education. Slide 4

Juvenile justice and child welfare children and youth 65% -70% in contact with the juvenile justice system have a diagnosable mental health disorder; Almost 1/3 have disorders serious enough to require immediate and significant treatment; 80% involved with child welfare have emotional or behavioral disorders; Most have experienced significant trauma; Removal from their homes and placement moves within the foster care system bring additional trauma. Slide 5

School to Prison Pipeline Increased risk for involvement with the juvenile and adult criminal justice systems as a result of educational practices implemented by school districts across the state and across the country. These practices include: “Zero tolerance policies” Police in schools School climate School responses to normal classroom misbehavior. Suspension from 9th grade triples the chances of incarceration and doubles chances of dropping out. Slide 6

Who is in the Pipeline? Racial minorities: African American students are 3.5 times more likely than their white classmates to be suspended or expelled for the same offense. Children with disabilities: Nearly 3/4 of students in special education are suspended or expelled, and “emotional disturbance” is among the most common underlying issues. While less than 10% of public school children have been identified as having disabilities that affect their ability to learn, these students make up 1/3 of youth in juvenile detention. Slide 7

How can we close the pipeline? Reducing use of suspension and expulsion is not simple (especially in light of pressure to meet accountability standards). Given the strong system of local control in Texas, school districts and administrators have tremendous power to make changes. With leadership from the top, school discipline can change from a system of punishment to a system of student development. Evidence-informed alternatives to exclusionary discipline can diminish the negative outcomes of harmful discipline policies, boost achievement, reduce misconduct, and maintain safe and healthy schools. Slide 8

Strategies for Action School-wide social and emotional support models that seek to improve the culture within an entire school. Examples include Positive Behavioral Interventions and Support (PBIS) and Safe and Responsive Schools (SRS). Programs that support educators with enhanced behavior management and student discipline. Approaches that change the way that schools respond to misbehavior. These approaches replace suspension with alternative responses or activities. (e.g., Restorative Justice) Community-partnered school mental health. Schools partner with health care systems to ensure access to health and mental health care for students who need it through school-based and school-linked health care delivery. Slide 9

Once children enter the system … Difficult to identify and treat children and youth in vulnerable settings like foster care, juvenile justice and even schools Too often, we over-serve some children and youth, including some with little or no mental health needs When we place youth in restrictive settings with more disturbed children, they get worse Slide 10

What does the research say? Children with even the most severe mental disorders often can live at home, and succeed in community settings like school. Ideally, supports and interventions … are designed around the goals of the family and child; are provided primarily in the family’s home and community; strengthen the family’s and child’s network of social support; are integrated with primary care; are available when needed, including after-school, in the evenings, and on weekends; and give children the opportunity to practice life skills and make positive choices while engaged in community activities. Slide 11

Effective strategies Restrictive does not equal intensive While necessary for some children and youth, restrictive options like RTCs and inpatient psychiatric are not effective for most children and may do more harm than good Research-supported interventions are primarily: community-based, restorative, skill building, family- centered and coordinated Effective interventions and systems are trauma informed Slide 12

Effective strategies … Whenever possible, the family should be full partners in all phases of planning and intervention. Whenever safe and appropriate, youth with mental health needs should be prevented from entering out of home placement or the juvenile justice system in the first place. For youth who do enter the system, the first option should be effective treatment within their families and community. For those few who require restrictive placement, it is important to ensure that they have access to effective services while in care to help them re-enter society successfully. Slide 13