ChildrensMentalHealthinTexas:RunningaDiagnosticTest May7,2009

For the future wellbeing of Texas, children must have what they need to develop and grow into successful adults.Unfortunately,manychildrenfaceunmetmentalhealthneeds.InconjunctionwithChildrensMental HealthAwarenessWeek, May310,2009,TexansCareForChildrenexaminedrecentindicatorsofchildrens mental health in Texas and the states performance in providing laws and services that address childrens mentalhealthneeds. Key: Topic Ensuringchildrenare emotionallyandsocially readytostartschool Status Comments Thepercentageofchildrenneedingtorepeatkindergarten,first, or second grade in Texas has climbed steadily this decade.i Repeating early grades is often a sign that emotional or behavioral problems are interfering with learning.ii Two out of three child care providers surveyed inTexasreport caring for children with a behavioral or emotional difficulty, and the majority have asked a parent to remove a child from their program and seen an increase in the number or severity of behavioral or emotional difficulties in recent years.iii Texas has someofthelowestchildcarestandardsandaccreditationrates inthecountry,ivmeaningmanykidsherespendtheyearswhen the most rapid brain development occurs in environments that maybeillequippedtofosterhealthydevelopment.v Sincethebeginningofthedecade,Texashasimproveditsratio ofstudentstomentalhealthprofessionalsinschools,andfewer counties today than 10 years ago have shortages of mental health professionals. Still, there are nearly 2,600 public school students to every one mental health professional in a school,vi andtwooutofeverythreecountiesinTexashavebeendeemed mental health professional shortage areas.vii Research to be publishedinthismonthsHealthAffairsfindslackofprovidersof mentalhealthservicesforchildrenandadearthofinsurancefor childrens mental health prevent many kids nationwide from gettingservicestheyneed. =healthy =needsimprovements =nearfailing =failing

Accesstomentalhealth professionals

Topic Investmentsinchildrens mentalhealthtreatment

Status

Comments Texasranks49thinthecountryinpercapitaspendingonmental health treatment.viii Among Texas kids with a diagnosed mental illness, serious emotional disturbance or at risk of being removed from their homes or classrooms for mental health reasons, only 18 percent receive the mental health treatment theyqualifyfor.ixTherearefrequentreportsoffamiliesturning theirchildrenovertothechildwelfareorjuvenilejusticesystem asmentalhealthprovidersoflastresort. FewerteensinTexasbetweentheagesof12and17areabusing alcohol and illegal drugs than their counterparts nationally.x However, only 44% of Texas incarcerated youth who need substance abuse treatment receive it.xi Substance abuse is higherinyouthwithmentalhealthchallenges,andisassociated withriskybehaviors.xii Roughly5outof100,000youth,ages1019,taketheirownlives. TexasteensuiciderateisslightlyabovetheU.S.average.xiii Texas uses only two of five recommended state strategies for addressingyoungchildrensbehavioralhealth.xiv

Keepingchildrensubstance abusefree

Preventingyouthsuicide

Supportforbestpracticesto supportemotionaland socialhealthinearly childhood Supportforbestpracticesin schoolagedchildrens mentalhealth

Texasusesonlythreeoffiverecommendedstatestrategiesfor addressingmentalhealthinschoolagedchildren.xv

Initiativestoimprove outcomesandaccountability inchildrensmentalhealth

Texas mental health infrastructure includes some recommended measures to improve data and analysis so that services to mental health patients can improve over time; the state also follows some, but not all, evidencebased best practicesinchildrensmentalhealth.xvi Texashasnottakenanystepsrecommendedinanationalreport to ensure childrens mental health providers and services can respond effectively to a population of children with diverse culturalandlinguisticneeds.xvii

Supportforbestpracticesto ensureculturallyand linguisticallyresponsive childrensmentalhealth services ConclusionandRecommendations:

When mental health needs in children go untreated, those children grow into adults whose problems are much more difficult and costly to solve. They become youth at risk of entering the juvenile justice system, parentsatriskofendangeringtheirownchildrenswellbeing,andadultscostingtaxpayersmorethroughlost productivity and increased criminal justice, health and social service expenses. By acting now to improve childrens mental health, Texas can prevent challenges that become more acute and more difficult to treat laterinlife.

We can make Texas a place where children grow up with the support and encouragement they need to become healthy, wellrounded adults. Prevention is the key we must educate parents and other primary adults in childrens lives, and help them encourage childrens social and emotional development, resilience, selfesteem,andconfidence.Forchildrenneedingextrahelp,servicesmustbeavailabletohelpchildrenand theirfamiliesbesuccessful. WhatTexascandothismonthbeforethelegislativesessionends: Keepmoneyinthebudgetforextendingservicesforchildrenwithmentalhealthchallenges,using CommunityResourceCoordinationGroups,TexasIntegratedFundingInitiativesites,setasideofcrisis fundsforchildren,andincreasedreimbursementsformentalhealthprovidersservingchildreninthe CHIP and Medicaid programs, as proposed in Health and Human Services Commission Exceptional Items10and12inHB1(Pitts) EstablishanEarlyChildhoodBehavioralConsultantspilotprogramtoaddresstheneedsofchildren withbehavioralproblemsinearlychildhoodsettings,asproposedinSB1613(Lucio) Take steps to increase quality in early childhood environments by raising training requirements for childcareprovidersasproposedinSB1730(West),reducingchildteacherratiosinpreKprogramsas proposedinHB130(Patrick),SB21(Zaffirini),andHB1241(Villarreal),andgivingparentsinformation aboutchilddevelopment,asproposedinHB1240(Villarreal) Improve coordination and planning among childserving agencies so mental health is addressed most effectively, as HB 3259 (Naishtat) and SB 1646 (Van de Putte) would do in creating an inter agencyCouncilonChildrenandFamilies Take measures to ensure youth with unmet mental health challenges who are in or leaving the juvenile justice system can access services. SB 1286 (Royce) would improve continuity of these serviceswithinthesystemwhileHB4451(McReynolds)wouldseethatyouthcanaccesscommunity basedmentalhealthserviceswhentheyarenolongerincarcerated;HB1630(Naishtat)andSB2031 (Watson) would prevent juveniles who qualify for prescriptions and care through Medicaid or CHIP from facing gaps in their health insurance coverage; HB 1629 (Naishtat) and SB 1376 (Uresti) would helpensurefosteryouthinthejuvenilejusticesystemcanaccessmentalhealthtreatmentsandmore iftheyneedthem.

ForfurtherinformationandrecommendationsabouthowTexascanimprovechildrensmentalhealth,seethe 2009ChildrensCampaignReportatTexansCareForChildrenswebsite,www.texanscareforchildren.org.
iTexasEducationAgency,DivisionofAccountabilityResearch.ReportsandAbstracts:GradelevelRetentioninTexasPublicSchools." iiNationalAssociationofSchoolPsychologists."PositionStatementonStudentGradeRetentionandSocialPromotion."2003. iiiTexasAssociationofChildCareResourceandReferralAgenciesandtheRaisingTexasInitiative.2007.ExecutiveSummaryFindingsofSurveyofBehavioralandEmotionalDifficultiesinChildCare. ivNationalAssociationforChildCareResourceandReferralAgencies."ChildCareintheStateof:Texas."Annualpublication. vShonkoff,J.&Phillips,D.FromNeuronstoNeighborhoods:TheScienceofEarlyChildhoodDevelopment.Washington,D.C.:NationalAcademyPress.2000. viDatarepresentfulltimeequivalentpublicschoolemployeescodedasAssociatePsychologists,Psychologists,orSocialWorkersinTexasEducationAssociation(TEA)publication,StandardStaffFTEand SalaryReports.TexansCareForChildrencalculatedthenumberofstudentsforeveryonementalhealthprofessionalinthepublicschoolsystembydividingthetotalTexaspublicschoolenrollmentin TEAs"StandardEnrollmentReports"bythenumberofmentalhealthprofessionalsinTexaspublicschools. viiTexasDepartmentofStateHealthServices,MentalHealthStateHPSADesignations. viiiNationalAssociationofStateMentalHealthProgramDirectorsResearchInstitute,Inc."FundingSourcesandExpendituresofStateMentalHealthAgencies.Table1:SMHAMentalHealthActualDollar andPerCapitaExpendituresbyState. ixDataprovidedtoTexansCareForChildrenuponrequestbyAmandaBroden,TexasDepartmentofStateHealthServices(DSHS),Amanda.Broden@dshs.state.tx.us.February16,2006andSpring2008. xU.S.DepartmentofHealthandHumanServices(HHS),SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA),OfficeofAppliedStudies(OAS).StateEstimatesonSubstanceUsefrom theNationalSurveyonDrugUseandHealth. xiDataprovideduponrequestbyTexasYouthCommission(TYC),InformationResourcesDivision,Mark.Fortress@tyc.state.tx.us,2008. xiiNationalAdolescentHealthInformationCenter.TheMentalHealthofAdolescents:ANationalProfile,2008.SanFrancisco:UniversityofCaliforniaSanFrancisco,2008. xiiiCenterforDiseaseControlandPrevention(CDC).CDCWonderCompressedMortalityFile19992005. xivxviiCooper,J.UnclaimedChildrenRevisited:TheStatusofChildrensMentalHealthintheU.S.PresentationattheApril21,2009meetingoftheTexasChildrensMentalHealthForum.