Early Identification of Mental and Behavioral Health Issues Critical, CT Study Finds

A recent report by the Connecticut-based Center for Children’s Advocacy revealed that early warning signs of mental and behavioral health problems are often not identified until middle school years, but could be uncovered much earlier. In any given year, the report noted that “about one out of every five Connecticut children (87,500 to 125,000) struggles with a mental health condition or substance abuse problem. More than half receive no treatment.”

With a grant from the Connecticut Health Foundation, Dr. Andrea Spencer, dean of the School of Education at Pace University and educational consultant to the Center for Children’s Advocacy, examined children’s educational records to identify how early these warning signs appear.  The report, issued in September 2012, documents the direct link between undiagnosed and unaddressed mental health issues with increases in school suspensions, expulsions and entry into the state’s juvenile justice system.  It also noted that:

  • Over 70% of students diagnosed with mental illness and behavioral health problems by middle school exhibited warning signs by second grade.
  • Almost 25% exhibited red flags during pre-Kindergarten years.

Early indicators, according to the report, included developmental and health issues, adverse social factors and exposure to trauma. The report, entitled “Blind Spot,” found that 25 percent of the children studied had documented traumatic experiences in their records  It recommends implementation of a series of initiatives:

  • Improve screening for mental health risk factors
  • Improve referral to early intervention services (mental health and special education)
  • Improve collaboration between service providers
  • Improve community and parent education about risk factors and support available
  • Improve training and accountability for school staff and other providers

“Red flags for mental and behavioral health problems are often clear before the end of second grade,” said Dr. Spencer. “It is imperative that we improve screening and identification so support for these children can be provided before their academic careers are at risk.”

As a result of this report, the Center for Children’s Advocacy - a Connecticut nonprofit that provides legal support for abused and neglected children - introduced a statewide policy initiative to improve the quality and standard of care for children insured through the Connecticut’s Medicaid (HUSKY A) plan.

In addition, the Center noted that the Connecticut Department of Social Services (DSS) has agreed to convene a task force that includes representatives from the Center for Children’s Advocacy, Department of Children and Families, Department of Mental Health & Addiction Services, Office of Policy and Management, Value Options (contracted provider of mental health services under HUSKY/ Medicaid), American Academy of Pediatrics (CT Chapter), Academy of Child & Adolescent Psychiatrists (CT Chapter), Head Start, developmental pediatricians, Birth to Three Program, Department of Education, and the Connecticut Health Development Institute.

The task force is to review current regulations, make recommendations regarding screening and treatment protocols, and provide recommendations on reimbursement rates for pediatric providers, according to a news release issued by the Center.



CT's Mental Health Services Ranking is Good, But "Citizens Deserve Better"

The National Alliance on Mental Illness (NAMI), in its ranking of states in 2009, placed Connecticut as among the top six states in the nation, along with Maine, Maryland, Massachusetts, New York and Oklahoma.  However, it described Connecticut as “a state of paradoxes” in mental health care and treatment, stressing that “Connecticut’s citizens deserve far better.” The state ranked 31st in the prevalence of mental illness, with 108,730 individuals, according to the organization, which pointed out that even in states with solid grades, “there is no doubt that many of their residents living with serious mental illnesses are not receiving the services and supports they need.”

Connecticut’s overall grade was “B,” according to the report, “Grading the States 2009.”  The Alliance graded states in four categories:  

  • Health Promotion and Measurement,
  • Financing & Core Treatment/Recovery Services,
  • Consumer & Family Empowerment, and
  • Community Integration and Social Inclusion.

Connecticut received a “C” in Community Integration and Social Inclusion, an “A” in Consumer and Family Empowerment – the only state in the nation to receive the top grade – and a “B” in the other two categories.

Three “urgent needs” were noted for Connecticut:  Increase community-based services, housing as an alternative to more restrictive placements, and ending nursing home warehousing.

In the days after the mass killings of 20 first-graders and six adults at the Sandy Hook Elementary School in Newtown, Connecticut, questions have been raised about the role of mental health services as part of a state and national response to the tragedy.

Overall, NAMI gave the United States a grade of “D.”  In the 2009 report, NAMI reviewed progress made since the organization’s previous state-by-state report in 2006, and found state mental health agencies “making valiant efforts to improve systems and promote recovery despite rising demand for services, serious workforce shortages, and inadequate resources.  Many states are adopting better policies and plans, promoting evidence-based practices, and encouraging more peer-run and peer-delivered services.”

However, NAMI reported that “these improvements are neither deep nor widespread enough to improve the national average. The grades for almost half the states (23) remain unchanged since 2006, and 12 states have fallen behind.”

Nearly 60 million Americans experience a mental health condition every year, according to data cited by NAMI, which  is the nation’s largest grassroots mental health organization dedicated to building better lives for Americans affected by mental illness.

The 2009 report concluded that “Without a significant commitment from our nation’s leaders—in Washington, among governors, and in state legislatures—state mental health agencies will continue to struggle to provide even minimally adequate services to people living with serious mental illnesses.”

Specifically, the report noted that as a nation, “We have too few psychiatric beds, treatment services, and community-based supports for those who need them; people with mental illnesses are neglected until they reach the point of crisis, and are then dumped onto other systems. Across the nation, people with mental illnesses are unnecessarily incarcerated, homeless, out of work, and unable to access needed medicines. On top of it all, we have an extremely limited capacity to monitor and measure our own efforts—the very foundation of effective reform.”

See NAMI video