Strong Foundations: Getting oriented to children's behavioral health in Georgia
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This document provides an overview of behavioral health among youth in Georgia. It discusses that behavioral health encompasses both mental health and substance use disorders. Nearly half of US youth experience a behavioral health condition, and among Georgia youth, nearly 1 in 10 have been diagnosed with a behavioral health condition. The most prevalent conditions among Georgia youth are substance use disorders, anxiety, and depression. A variety of social factors can influence behavioral health, such as adverse childhood experiences, poverty, and access to healthcare and education. Over half of Georgia children have experienced at least one adverse childhood experience.
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Strong Foundations: Getting oriented to children's behavioral health in Georgia
- 1. Getting oriented to children’s behavioral health in Georgia Laura Colbert, MPH, MCHES May 15, 2018
- 2. Behavioral health is more than mental health Mental illness Substance use disorders Co-occurring • Depression • Anxiety disorders • Schizophrenia or other psychoses • PTSD • Attention hyperactive disorder (ADHD) • Etc.
- 3. Childhood & adolescence are key time periods • BH conditions emerge early • Often at times of transition, stress 75% by age 24 50% by age 14
- 4. Among U.S. youth: Almost half (46.3%) have ever experienced a BH condition (ages 13-17) ages 8-15 experience a MH disorder in a 12- month period (1.4%) ages 12-17 experience co- occurring disorders 13.1% 340,000
- 5. Among Georgia youth: Nearly 1 in 10 have 1+ diagnosed BH condition (ages 2-17) Have 2+ conditions BH conditions become more prevalent for older youth*: 44% 14.1% Of those: *ages 12-17
- 6. Most prevalent conditions among Georgia youth Substance use** • Marijuana (6.4%) • Tobacco products (5.8%) • Binge alcohol (3.8%) **ages 12-17 Mental health conditions* • Anxiety (25.1%) • Depression (12.1%) • Attention hyperactive disorder (9.0%) *ages 13-18
- 8. Factors influencing behavioral health Biological PsychologicalSocial Behavioral health
- 9. The social determinants of health “The circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness.” --World Health Organization
- 10. The social determinants of health • Adverse childhood experiences (ACEs) • Access to health care • Access to & quality of education • Unemployment & job security • Poverty & income inequality • Food insecurity • Housing issues • Discrimination
- 11. 13.60% 9.20% Children living in households that make ≤100% FPL Children living in households that make 100-199% FPL Percent of children who have a behavioral health diagnosis The role of the social determinants of health ≤ $20,780 for a family of 3 $20,781—$41,352 for a family of 3
- 12. A focus on adverse childhood experiences (ACEs) 51.20% 26.80% 26.80% ACEs A stressful or traumatic event that occurs before the age of 18 that a person remembers as an adult Children in Georgia with ACEs No ACEs 1 ACE 2+ ACEs
- 13. 41.6% 53.0% 57.0% White Latino Black Percent of children by race who experience ACEs Disparities in ACEs among Georgia children
- 14. Access to behavioral health services
- 15. Pathways to children’s BH services Children covered by GA Families Medicaid Foster children covered by GA Families 360 & CMO’s provider directory DCH, Medicaid Children with disabilities covered by SSI Medicaid Children who are uninsured & Georgia Crisis & Access Line DBHDD, Medicaid Children covered by PeachCare for Kids CMO’s provider directory DCH, Children’s Health Insurance Program Children covered by private health insurance Insurer’s provider directory Private health insurance company How to find available services Payer
- 16. Sources • 3: National Alliance for Mental Illness, Mental Health Facts: Children & Teens • 4: Merikangas KR, He J-p, Burstein M, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry. 2010;49(10):980-989 Kessler RC, Avenevoli S, Costello EJ, et al. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of general psychiatry. 2012;69(4):372- 380. • 5: National Survey of Children’s Mental Health. Georgia vs. Nationwide Mental and Emotional Well-Being Profile, 2007. Child and Adolescent Health Measurement Initiative (CAHMI) Data Resource Center (DRC) website. http://www.childhealthdata.org Listed in by slide number
- 17. Sources • 6: National Institute of Mental Health (https://www.nimh.nih.gov/health/statistics/prevalence/index.shtml) National Survey on Drug Use & Health 2015-2016 (https://www.samhsa.gov/data/sites/default/files/NSDUHsaePercents2016/NSDUHsae Percents2016.pdf) • 10: National Survey of Children’s Mental Health. Georgia vs. Nationwide Mental and Emotional Well-Being Profile, 2007. Child and Adolescent Health Measurement Initiative (CAHMI) Data Resource Center (DRC) website. http://www.childhealthdata.org • 11: National Survey of Children's Health, Georgia vs. Nationwide Mental and Emotional Well-Being Profile. 2007. CAHMI DRC http://www.childhealthdata.org. • 12: National Survey of Children's Health. Data query on Adverse Family Experiences Nationwide & Georgia. CAHMI DRC. 2011/2012; http://www.childhealthdata.org. Listed in by slide number
Notas do Editor
- Thank you very much. Another round of applause for Ms. Harrison. Show of hands: how many people here today would consider themselves proficient or expert in the area of children’s BH? I am relatively new to the in-depth examination of children’s behavioral health, and do not consider myself an expert. I am learning, along with the rest of the GHF staff. That said, I’m going to provide some background information on BH generally, what Georgia’s landscape looks like, and how young Georgians generally access care when needed. My goal is to give us all a common starting point and some shared understanding so that we can benefit as much as possible from the speakers that follow me this morning.
- I come from an education background, and one of the adult learning principals to start with broad topics that most attendees are familiar with, so bear with me while I spend one minute telling you all something you may already know. Behavioral health includes mental health, substance use behaviors, and the co-occurrence of both of those things. Mental health conditions span a range of diagnoses and symptoms, but some of the ones that we most commonly think of are listed here. A person does not need to have a diagnosis to have a mental health condition per se.
- We also know that BH conditions emerge early. Half of BH conditions begin by age 14 and 75% by age 24. These conditions will often appear at times of stress or transition. For example, as a young person transitions from high school to college, they may experience their first psychotic episode. Or a child who is moving between foster homes may experience anxiety. Because such a high proportion of BH conditions begin at these early ages, a focus on children’s BH is critical. Prevention and early intervention are key, especially as BH conditions are much more treatable in the early stages (similar to cancer or diabetes). When we talk about children’s BH, what is the scope of the problem?
- In the U.S.: Almost half of youth ages 13-17 have experienced any BH condition in their lifetimes (inclusive of substance use disorders and co-occurring disorders), and 21.4% have experienced a severe disorder in their lifetimes. In the last 12-month period, 13.1% have experienced a MH disorder of some kind. You can see here, that co-occurring disorders are more rare, although still impact a lot of young people across the country.
- Here in Georgia: 9.5% of Georgia children have at least one diagnosed BH condition, and of those 44% have 2 or more conditions. BH conditions become more prevalent as children develop, increasing from 9.5% to 14.1% for youth ages 12-17. This trend mirrors data nationwide.
- When we say Georgia youth have BH conditions, these are the most common for both MH & SUD. These are not the only, but rather the three that occur most often in each category.
- As we think about how to reduce those numbers/statistics, we want to consider the factors that influence BH. What determines if I am going to have an anxiety disorder or a psychosis as compared to someone else?
- As with all health conditions, BH is influenced by a multitude of factors, most of which can be lumped into these three categories: -Biological: your genetic make-up -Psychological: self-esteem, coping skills, chronic stress -Social: sometimes called environmental. Can include family and social support systems, but also includes systemic factors. Because I do not have a PhD and because the social influences on BH can be best influenced by public policy, we are going to focus on social factors this morning and how they contribute to children’s BH.
- The social factors that influence BH (and other kinds of health too) are called the social determinants of health. SDOH are the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness.
- The social determinants of health include all of these factors. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. People who experience poor social determinants of health have an increased risk for behavioral health conditions. (And the relationship is bi-directional, so that many people with BH disorders are also at risk for poor social determinants.) Racial and ethnic minorities, people with low incomes, those without health insurance or those who are underinsured, and people who experience one or more ACEs are at increased risk for mental health conditions.
- Here’s a specific example of how income can influence a child’s risk for BH conditions. In Georgia, about 566,000 chidren (23%) live in poverty. Those kids are more likely to have a BH diagnosis than children living just above the poverty line.
- Another social determinant of health is a child’s experience of adverse childhood experiences, also called ACEs. ACEs can include witnessing violence, being displaced by natural disaster or homelessness, abuse or neglect, or any other event that may cause trauma for a young person. You can see here that about ½ of Georgia children have ACEs, again raising their risk for poor BH.
- Consistent with national trends, white children in Georgia are less likely to have adverse childhood experiences (ACEs) compared to non-white children, such that 41.6% of white children are affected by ACEs compared to 57% of Black children and 53% of Latino children. This leaves children of color more vulnerable to poor BH.
- As we consider all of this, I want to leave you with one other piece of information. That is how children in Georgia access BH services. At GHF, we have historically done a lot of work around health insurance and the uninsured. We often think about health insurance coverage as a pathway to health services, and for chldren’s BH services, it’s really no different.
- A child’s coverage determines when and where they can find BH services and supports. With some help from DBHDD, we broke down the pathway to care for Georgia children by the types of coverage we have available in this state. Some of this is on the backside of the fact sheet in your folder, if you’d like a closer look at it. For those covered by Medicaid through a Care Mgmt Organization, they look to the CMO’s provider directory and Medicaid pays for that care. For young people with SSI Medicaid and those who are uninsured, they access care through DBHDD’s provider network, through GCAL, and DBHDD/Medicaid pays for the services. For me, this chart is helpful in understanding how public policy decisions do or can impact different populations of children. Ex: Georgia has a lot of choice and authority to make changes to Medicaid or within DBHDD, but little to no authority over employer-sponsored health plans which provide much of the private health coverage in the state. It’s also important to remember that children may receive services through two or more of these pathways as they and their families grow and experience life changes.
- I’m going to stop there for this morning and let Dante pick up with a discussion of Georgia’s system of care. Before I introduce him, I think I have time for 1-2 questions if you all have any.
- Introduce Dante. See bio.