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Washington Lawyer: When the Kids Are Not All Right

September 1, 2015

The September issue of Washington Lawyer includes an in-depth feature on children’s access to mental health care, including a focus on Children’s Law Center and our work on children’s mental health and trauma. An excerpt below:

D.C. Report Card

While mental health care for children is an issue across the country, there is some good news for the District of Columbia, according to Sandalow, whose organization, the CLC, grades the District each year on how it is working to meet the mental health needs of its low-income youth.

In its 2015 report, the CLC said District agencies provided mental health services to over 12,500 children and youth in 2014, a 30 percent increase from the year before. The D.C. Department of Behavioral Health develops, manages, and oversees the city’s public mental health system, while the Department of Health Care Finance oversees the managed care organizations that enroll the majority of children in Medicaid.

Pediatricians in the District are now required to screen children for mental health needs during regular well-child visits. The report states that hundreds of clinicians were trained in the past year in standardized screening tools.

In addition, the District has launched an effort to help pediatricians by providing a network of on-call psychiatric professionals to provide advice and give referrals.

Still, families of children with mental health issues face long wait times to get the help they need, according to the CLC, which also questioned the quality of treatment available for low-income children in the District.

“The good news is that for the first time since [CLC] has been rating the District’s mental health system, more children than ever are now getting help for their mental health needs,” says Sandalow. “The bad news is that children are still waiting much too long to get help, it’s still very hard for parents to locate the right services for their children, and the quality of the help they do get is frequently poor.”

The report also found that few children appeared to have case managers to help their families effectively navigate the complex network of providers, programs, and services within the mental health system. Officials from the Department of Behavioral Health did not respond to requests for comment.

Toxic Stress and Trauma

One area in which the District should continue to improve is its handling of cases involving children who have been exposed to multiple traumatic events, Sandalow says.

In recent years, mental health experts and advocates have increasingly focused on services for children who have experienced complex trauma, or multiple adverse experiences.

A traumatic event is an experience that causes emotional or psychological trauma, and individuals who endure traumatic events generally feel that their personal safety or the stability of their world has been threatened. There are a number of events that experts describe as potentially traumatic: the death of a loved one, intense humiliation, having witnessed or experienced domestic abuse, to name a few.

According to mental health experts, a child who lives in poverty has an increased likelihood of being exposed to a traumatic event. In the poorest pockets of Washington, D.C., and elsewhere throughout the country, children experience violence, homelessness, neglect, gang pressure, crime, abuse, and hunger, sometimes on a regular basis.

“The evidence is clear: ongoing exposure to trauma can impact every area of a child’s life long into adulthood,” says Sandalow. “This includes difficulty building and maintaining close relationships, serious health problems and illness, and the ability to earn and maintain employment. The negative effects of trauma on children’s ability to function and learn in schools have been extensively documented.”

Sandalow says children “with trauma histories are more likely to be referred for special education, have higher rates of school discipline referrals and suspensions, [have] lower test scores and grades, and are less likely to graduate.”

Children exposed to complex trauma or toxic stress can develop a variety of symptoms. Some studies link trauma-induced stress, sometimes known as posttraumatic stress disorder, to other mental health conditions, including anxiety disorders, conduct disorder, and depression. These children can have learning difficulties, develop low self-esteem, and, in the end, drop out of school.

A study by the Johns Hopkins Bloomberg School of Public Health showed that children exposed to two or more traumas were more than 2.5 times more likely to become disengaged in school and repeat a grade than non-traumatized children.

Through targeted mental health services, children can learn coping strategies to overcome the long-term effects of trauma. Ideally, by getting the help they need, children who might otherwise slide into lives of crime or other difficulties can instead have the opportunity for more stable, more productive futures, advocates say.

Read the full article by clicking on the link below.