1、A Public Health Approach to Childrens Mental Health at the Centers for Disease Control and Prevention (CDC),Ruth Perou, Team Lead CDC Child Development Studies Team (Special thank you to Dr. Lara Robinson, CDC Child Development and Dr. James Mercy, CDC Division of Violence Prevention) Georgetown Uni
2、versity National Technical Assistance Center for Childrens Mental Health Meeting, Thursday, Feb. 18, 2010,“The findings and conclusions in this presentation are those of the author and do not necessarily represent the OFFICIAL POSITION of the Centers for Disease Control and Prevention.”,CDC MissionC
3、ollaborating to create the expertise, information, and tools that people and communities need to protect their health through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.CDC seeks to accomplish its mission by working with partners throughou
4、t the nation and the world to Monitor health Detect and investigate health problems Conduct research to enhance prevention Develop and advocate sound public health policies Implement prevention strategies Promote healthy behaviors Foster safe and healthful environments Provide leadership and trainin
5、g,Public Health Approach,What is Public Health?,Population approach Community as client Proactive and preventative Health protection & promotion Research/evaluation, policies, capacity building, and services MultidisciplinaryEcological Holistic,The Public Health Model2,Adapted from Mercy et al. (199
6、3),8,Impact of Childrens Mental Health,Around 1 in 5 young people (14-20%) have a current disorder Estimated $247 billion in annual treatment and productivity costs Significant other costs education, justice, health care, social welfare costs to the individual and family,From IOM (2009). Preventing
7、Mental, Emotional, and Behavioral Disorders,Childrens Early Brain Development Shapes Lifelong Health,Origins of chronic adult disease are often found among developmental & biological processes occurring during the early years Because brain circuits stabilize over time, the energy costs of altering c
8、ircuits (and therefore behavior) increase as the brain matures,ACE Study: Major Findings,Alcoholism and alcohol abuse Chronic obstructive pulmonary disease (COPD) Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease (IHD),Liver disease Risk for intimate partn
9、er violence Multiple sexual partners Sexually transmitted diseases (STDs) Smoking Suicide attempts Unintended pregnancies,Increases in ACE score associated with increased risk for the following health problems:,Early Adverse Exposures,Social, Emotional, &,Cognitive Impairment,Adoption of,Health-risk
10、 Behaviors,Disease, Disability, and Social Problems,Early Death,ACE Study Conceptual Framework: Whole Life Perspective,DeathBirth,Prevention Science & Child Wellbeing3-4,Prevention efforts aim to increase protective factors & reduce risk factors Risk & Protective factors Are often non-specific Are c
11、orrelated & cumulative Change with development Exist in multiple contexts Key to the success of intervention and prevention efforts,Mental Health Intervention Spectrum4,Health promotion- “enhance individuals ability to achieve developmentally appropriate task & a positive sense of self-esteem, maste
12、ry, well being, & social inclusion, strengthen ability to cope with adversity” Universal prevention- entire population eligible Selective prevention- above average risk group Indicated prevention- high risk, signs or systems but subclinical,Mental Health Intervention Spectrum,Treatment- reduce the l
13、ength of time the disorder exists and reduce co-morbidity Intervention Maintenance- supportive, instructional, or pharmacological long-term support to reduce disability,15,Prevention AND Promotion,From IOM (2009). Preventing Mental, Emotional, and Behavioral Disorders,Health Promotion,Universal Prev
14、ention,Selective Intervention,Indicated Prevention,Treatment/ Intervention,Level of Prevention & Associated Risk Level,High RiskLow Risk,Prevention among High-risk Individuals,Special efforts for indicated populations,Probability of Adverse Exposures,Intervening in Selected populations,Universal Pre
15、vention Approach,Shift entire population to the left,Probability of Adverse Exposure,The Public Health Model,Epidemiology,Some Examples of CDC Child/Family Epidemiology,ADHD PLAY Study Pregnancy Risk Assessment Monitoring System Autism & Developmental Disabilities Monitoring Network Early Hearing &
16、Detection Intervention Adverse Childhood Experiences Study (ACE) Childhood Lead Level Surveillance Meta-analysis of Parent Training Programs,Interactive data access tools on CDC website,National Survey of Childrens Health Data Resource Center Health Data Interactive (http:/www.cdc.gov/nchs/hdi.htm)
17、VitalStats Healthy People Data2010 NCHS Surveys Measures Catalog: Child and Adolescent Mental Health Youth Risk Behavior Surveillance System WISQARS (http:/www.cdc.gov/injury/wisqars/index.html) National Violent Death Reporting System (NVDRS),The Public Health Model,Prevention,Sample CDC Child-Famil
18、y Prevention Programs,Project Choices Project Connect Learn the Signs. Act Early Legacy for ChildrenTM,Learn the Signs. Act Early.,Builds on familiar experiences of parents, such as monitoring their childs growth Aims to educate parents, health care professionals, and childcare providers about child
19、 development Encourages early screening and interventionstrategies that hold the most promise for affected children and their families,25,Learn the Signs Resource Kits,www.cdc.gov/actearly,Legacy for ChildrenTM,Improve outcomes for children in poverty to promoting adaptive parenting Legacy mechanism
20、s: Mother-Child Interaction Enhancing parental self efficacy Promoting a sense of community Evaluation Preliminary analysis are promising Longitudinal evaluation in progress Resources,The Public Health Model,Evaluation Feedback throughout process,Evaluation,Evaluation feedback at every step Program
21、Evaluation the goal of rigorous evaluation is to rule out alternative explanations (aka “threats to internal validity”) for observed outcomes Technology Enhancements to Parenting Programs Improving Training of Home Visitation Programs,Ecological Model in Action: Triple P,Randomized population-level
22、trial Implemented Triple P in 9 counties in SC Train providers (n = 649) Conduct media campaign Results for Triple P counties: Smaller increases in substantiated child maltreatment cases Reductions in out of home placements Reductions in child hospitalizations and ER visits due to CM injuries,Triple
23、 P: Population-based Approach,EverybodyAll Families in a Specific SettingFamilies at Risk,Media CampaignBrief Consultations in Primary Care SettingsParenting Skills Training,Intensive Counseling,Families in Crisis,Individual,Relationship,Community,Societal,Examples Parent Training,Examples Home visi
24、tation Legacy for ChildrenTMProject Choices,ExamplesParents Matter Program School Connectedness MH Consultation,ExamplesMaternity/Paternity Leave,Examples of Public Health Relevant Approaches to Child Health Across the Social Ecological Model5,Thank you,CDC Resources,CDC Resources by Health Topic,As
25、thma http:/www.cdc.gov/asthma/default.htm Child Maltreatment www.cdc.gov/ncipc/dvp/CMP/default.htm Hammond, W. R.; Haegerich, T.M.; Saul, J. The public health approach to youth violence and child maltreatment prevention at the Centers for Disease Control and Prevention. Psychological Services. Vol 6
26、(4), Nov 2009, 253-263. Leeb, R. T., Paulozzi, L., Melanson, C., Simon, T., & Arias, I. (2008). Child maltreatment surveillance: Uniform definitions for public health and recommended data elements. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Con
27、trol.,Child Safety www.cdc.gov/safechild/ Community Guide for Preventive Services http:/www.thecommunityguide.org/ - Evidence-based recommendations for programs and policies to promote population health Community Health www.cdc.gov/CommunityHealthResources/ -On-line community health tool http:/www.c
28、dc.gov/healthycommunitiesprogram/tools/change.htm Developmental Disabilities Autism Spectrum Disorders (Act Early Campaign)(http:/www.cdc.gov/ncbddd/actearly/index.html) Cerebral Palsy/Hearing Loss/ Intellectual Disability/Vision Impairment (CDC) (http:/www.cdc.gov/ncbddd/dd/ Depression/Anxiety (Adu
29、lt) http:/www.cdc.gov/Features/Depression/ http:/www.cdc.gov/Features/dsBRFSSDepressionAnxiety/,Disaster Mental Health http:/www.bt.cdc.gov/mentalhealth/ Early Hearing 48(No. RR-11). http:/www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm An Evaluation Framework for Community Health Programs http:/www.
30、cdc.gov/eval/evalcbph.pdf Fetal Alcohol Syndrome http:/www.cdc.gov/ncbddd/fasd/index.html,Immunizations http:/www.cdc.gov/vaccines/spec-grps/parents.htm Learn the Signs. Act Early/Developmental Screening www.cdc.gov/ncbddd/actearly/ Lead Poisoningwww.cdc.gov/nceh/lead/ Mental Health/Behavioral (Chil
31、dren) ADHD (CDC, National Resource Center) (http:/www.cdc.gov/ncbddd/adhd/index.html) (http:/www.help4adhd.org/) Tourette Syndrome(http:/www.cdc.gov/ncbddd/tourette/default.htm) Youth (http:/www.cdc.gov/HealthyYouth/mentalhealth/publications.htm) Nutrition 1-26.,Oral Health http:/www.cdc.gov/OralHea
32、lth/topics/dental_sealant_programs.htm (school based sealant program & resources) Parenting www.cdc.gov/parents Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child P
33、sychology, 36, 567589. Refugee/Immigrant Health http:/www.cdc.gov/ncidod/dq/refugee/faq/faq.htm School Health http:/www.cdc.gov/HealthyYouth/ STD http:/www.cdc.gov/std/ http:/www.cdcnpin.org/parentsmatter/program.asp (Parents Matter! Program for preteens) Violence Prevention http:/www.cdc.gov/violenceprevention/index.html,Contact Information,Ruth Perou Child Development Studies Team Leader rpz4cdc.gov (404) 498-3005 Child Development Studies Team http:/www.cdc.gov/ncbddd/child/default.htm,
