1. Wisconsin Council of Administrators of Special Education May 4 th, 2016

2. Wisconsin Data Themes What is the prevalence of children’s mental health issues? What are some of the risk factors that contribute to mental health difficulties? Using the available data, where do we see serious concerns? Where do we have opportunities to shift our perspective? What kind of disparities do we see? What strengths can we build on?

3. Prevalence CDC and Prevention, “Mental Health Surveillance Among Children—United States, 2005-2011.” May 17, 2013, 62(02): 1-35. SAMHSA URS Table 1: Number of Children with SED, age 9 to 17, by state, 2013.

4. Almost half (46%) of Wisconsin’s children have experienced any adversity Risk Factor: Adversity Sacks, V., Murphey, D., & Moore, K. (2014) Adverse Childhood Experiences: National and State Level Prevalence. Child Trends Publication, 2014-28.

5. 5 Risk Factor: Poverty

6. Image from Child Abuse and Neglect Prevention Board, WI ACE Brief Risk Factor: Parental Capacity

7. Concern: Suicide Rates

8. Concern: Hospitalization Rates Rate of hospitalizing in a state facility is 4.5 times the national average and the highest in the Midwest. Refers to hospitalizations in public facilities. 2012 SAMHSA URS table for Wisconsin. “Access Domain: Persons Served in State Psychiatric Hospitals by Age and Gender, FY 2012”.

9. Concern: Psychotropic Drug Patterns among Children / Youth on Medicaid 7 out of 10 young people prescribed a psychotropic drug in 2013 had no therapy Younger kids (0-12) on psychotropic drugs were the least likely to have therapy 2013 Medicaid outpatient and professional claims data (fee for service and HMO).

10. Concern: Suspension Rates Wisconsin Individual Student Enrollment System (ISES).

11. Disparities: Suicide Risk 11 Wisconsin’s Black youth suicide attempt rate is 82% higher than the national average. LGBT, Hispanic, and Black youth are at the highest risk of attempting suicide. CDC Youth Online High School Youth Risk Behavioral Surveillance System, 2013.

12. MENTAL HEALTH Suicide risk during past 12 months among Wisconsin high school students by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 12

13. Disparities: Out-of-Home Placement American Indian children are at the highest risk of being placed in foster care and are almost seven times more likely to be in out-of-home care than their White peers. DCF’s 2012, “Annual Report on Out-of-Home Care.” Overall number of children in each racial group based on 2012 Wisconsin figures from Annie E. Casey Kids Count Data Center

14. 14 Disparities: Juvenile Justice

15. MENTAL HEALTH Protective factors among Wisconsin high school students by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 15

16. Strengths: The Good News… Wisconsin is better than the national average when it comes to… …insuring kids …identifying kids with emotional distress (EBD) in schools …poverty rates (lower than national average) …having safe, strong neighborhoods with good schools (61% of youth) …positive home environments for children (33% of youth)

17. Strengths: Recognition that Early Relationships Matter Home visiting programs Pyramid Model for developing social and emotional skills University of Wisconsin’s Infant Mental Health certification YoungStar Statewide 4K Wisconsin Healthiest Family Initiative Fostering Futures

18. Strength: Trauma-Informed Care Paper Tigers Trailer http://acestoohigh.com/2014/12/02/paper-tigers-trailer-a-peek-into- documentary-about-lincoln-high-school/ Resilient: The School Discipline Revolution https://www.youtube.com/watch?v=K6xRtNGjN3I Menominee Nation's Path to Health Heals Invisible Wounds: 2015 RWJF Culture of Health Prize http://www.rwjf.org/en/library/articles-and-news/2015/10/coh-prize- menominee-wi.html DPI: Creating Trauma-Sensitive Schools to Improve Learning: http://dpi.wi.gov/sspw/mental-health/trauma http://dpi.wi.gov/sspw/mental-health/trauma

19. Wisconsin Office of Children’s Mental Health Website http://children.wi.gov

20. Mental Health Legislation: 2013 ACT 20 $ 1.3 m to develop peer-run respite services $12.5 m. to increase forensic treatment services at the two state mental health institutes $250,000 for grants to counties to provide crisis intervention training to law enforcement mental health mobile crisis units grants for primary care and psychiatrists to work in underserved areas employment programs for people with mental health issues

21. Mental Health Initiatives for Children and Youth $10.2 m. Expand regional Comprehensive Community Services $3.75 m. Expand Coordinated Service Teams for children with serious emotional disturbances $524,000 Allow psychotherapy services in the home (DHS 35 certified clinics) $535,400 Create Office of Children’s Mental Health.

23. SHIFT Our Perspective: Innovation From illness to adaptation From primarily a clinical approach to a public health approach From families as receivers to families as leaders From a programs approach to a systems approach

24. Adaptation “Early experiences are biologically embedded in the development of the brain and other organ systems leaving a lifelong impact on learning, behavior and both physical and mental health.” Harvard Center on the Developing Child PET scans show marked differences in the brain architec­ ture of a nurtured brain (left) and an abused brain (right).

25. Safe, Stable, Nurturing, Informed Families Knowledgeable Lawmakers Trauma-Informed Care Understand basic trauma & ACEs information Recognize triggers Recognize signs of emotional dysregulation Learn basic self- regulation and de- escalation skills Approach others from a frame of cultural competence Shift your perspective from “what’s wrong with that person?” to “what might have happened to that person?” Mental Health Providers Mental Health Coaches and Organizational Consultants Youth and Parent Peer Specialists Student Support Services Skilled Child Serving Workforce ACEs, TIC and a Public Health Approach

27. Building Adult Capabilities to Improve Child Outcomes: Theory of Change https://www.youtube.com/watch?v=urU-a_FsS5Y

28. Systems Approach to Change and Families as Leaders ______________________________________________________________________ ___________________________________

29. Collective Impact

30. Systems Approach to Change

31. Trauma- Informed State Training for Law Enforcement Social Determinants of Health Early Childhood Comprehensive Systems Compassionate Schools Training Trauma Project TIC Shift Your Perspective Trauma Transformation in Juvenile Corrections Fostering Futures Example: Trauma-Informed Care

32. Collective Impact Parent and Youth Partners The OCMH believes that lasting improvement to child-serving systems such as mental health services, child welfare, and juvenile justice, will occur when policies and programs are driven by parents and youth who have experienced the ins and outs of these systems

33. Systems Approach: Leading Together DHS Family Organizations DPI OCMH DCF

34. Meaningful Family Involvement Wisconsin Department of Public Instruction State Management Team – Safe Schools Health Students Project AWARE Parent Advisory Workgroup to School Based Mental Health Race to the Top Endless Possibilities Conference WSPEI (WI Statewide Parent & Educator Initiative) FACETS (WI Family Assistance Center for Education, Training and Support)

35. 2015 OCMH Report: Appendices Collective Impact Partners’ Language Guide State Agencies and Tribal Financial Tables Children’s Mental Health Collective Impact Recommendations TIC and EBP County and Tribal Activity Table System Collaboration Table Crisis Related Information – Emergency Detention FAQs – Crisis Workgroup Summary and Recommendations – Crisis Response Continuum of Services http://children.wi.gov/Documents/OCMH%202015%20An nual%20Report%20to%20Legislature.pdf

36. Contact Information Elizabeth Hudson, LCSW Director, Wisconsin Office of Children’s Mental Health 1 W. Wilson Street, Room 656 Madison, WI 53703-0309 Phone: 608-266-2771 Website: http://children.wi.govhttp://children.wi.gov Staff Directory: http://children.wi.gov/Pages/ContactUs/ContactUs.aspx