Children's Mental Health
A. ISSUE SUMMARY
Vision Statement: "Travis County will be a community which is aware of children's mental health issues and supports the measurable improvement of the mental health of children and their families through a clearly defined continuum of prevention, early intervention, and treatment services that are family-focused and culturally competent."
Strategies for Building a Stronger Community: A Community Guide
The key findings in this chapter pertain to services receiving state funds managed by the Local Mental Health Authority (LMHA). Data from providers receiving City/County revenue are not available at this time.
- Suicides decreased from a high of 4.3 per 100,000 population in 1990 to zero in 1996 for males, females and all children aged 18 and under
- Change scores from the Child Behavior Checklist suggest that services purchased by the LMHA are having a therapeutic impact
- Positive improvements in school behavior have been evidenced locally for the target population
- Re-arrest is down for youth with a history of arrest
- 98% of parents and 97% of children are satisfied with services received from the LMHA provider network
Outcomes for which no appropriate data have been identified are:
- Increased rate of children transferred from Special Education to a less restrictive classroom setting
- Increased rate of individuals with enhanced knowledge/skills about children's mental health issues following educational community presentations
- Increased rate of parents/families reporting receipt of appropriate and comprehensive services
- Increased percentage of parents demonstrating improved parenting skills
- Decreased number of children who are severely impaired by mental illness
This issue summary represents a great step forward in the community's understanding of an overwhelming problem. However, more work must be done. Assessment of community problems, needs, and desired outcomes should be an ongoing process and should include data from all local public and private agencies and organizations.
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B. BACKGROUND AND INFLUENCING FACTORS
Even under the best circumstances, children with mental health needs can disrupt the balance of a family, straining its emotional and economic resources. In addition, many youth are institutionalized at public expense, making the impact on the community difficult to calculate.
Importance to the Community
On any given day, 297 Travis County youth are receiving out-of-home care. Such placement is made possible through funds from the public child welfare, juvenile justice, education, local health and human services, and mental health systems. The annual cost for this service is approximately $12 million.
At the same time, national data indicate that one in five youth in Travis County are in need of community-based mental health services. Unfortunately, it is estimated that two-thirds of these youth do not receive the help they need. What this means is that in Travis County, a majority of public dollars available to serve children are being spent on a relatively small number of youth. In addition, because of limited services or funding regulations, children who could benefit from community-based care are being placed in more expensive and restrictive treatment settings.
Advocates for youth attest to the fact that children and families must be served using an individualized approach that empasizes strengths, is culturally competent, and is community-based. Specifically, child-serving systems must align with one another to enable joint planning, coordination of care, shared responsibilities, and merged funding.
To help lessen the negative impacts on our youth, the Community Action Network has identified some current measures and longitudinal data where available.
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C. OUTCOMES AND KEY INDICATORS
The following six outcomes for Travis County will be analyzed in the next section:
- Decreased rate of youth suicide
- Increased rate of children's school attendance
- Increased percentage of children with improved academic performance
- Decreased rate of school discipline referrals
- Increased percentage of children with improved functioning as a result of receiving services
- Decreased rate of children involved with the juvenile justice system
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OUTCOME: Decreased rate of youth suicide
Suicide is a leading cause of death for people under age 25. Suicide may result from a combination of factors including depression, family problems, a significant loss, social isolation, problems with growing up, pressure to succeed, and poor self-esteem.
When depressed, a person feels helpless to solve his or her problems. Divorce, marital instability, and other relationship/family problems may make a person feel rejected or insecure. Many young people who attempt suicide feel that their families do not understand them. Suicide may be a reaction to the loss of a loved one through death, divorce, or separation; breaking up with a girlfriend or boyfriend; loss of respect; loss of health; or moving away from friends and familiar surroundings. Another element includes the conclusion by the individual that "suicide is an option."
Although they account for only 10% of the population, youth who are homosexual or bisexual account for approximately 30% of all suicides. Adolescence is a confusing time filled with changes. Some young people are not ready to handle greater responsibilities, new relationships, physical changes, etc. Others feel hapless because they are ready to handle greater responsibilities but society will not let them. Young people may feel pressured to get good grades, be accepted at a good college and get a good job. For many young people, winning is everything. There is no room for failure. Feelings of worthlessness may be caused by physical awkwardness, failure in academics or athletics, lack of attention, praise or love.
Table 4.9.1
Travis County Youth (Below Age 18) Suicide Death Rates (per 100,000); 1986-1996
|
Below 18 Years of Age
|
1986
|
1987
|
1988
|
1989
|
1990
|
1991
|
1992
|
1993
|
1994
|
1995
|
1996
|
| Male Death Rate |
1.4
|
1.4
|
2.9
|
5.7
|
4.2
|
1.3
|
5.2
|
2.5
|
3.5
|
0.0
|
0.0
|
| Female Death Rate |
3.0
|
0.0
|
3.0
|
1.5
|
4.4
|
0.0
|
0.0
|
0.0
|
1.2
|
0.0
|
0.0
|
| Total Death Rate |
2.2
|
0.7
|
2.9
|
3.7
|
4.3
|
0.7
|
2.7
|
1.3
|
2.4
|
0.0
|
0.0
|
Source: Epigram: Total death rates for all races in Travis County, 1986-1996.
Figure 4.9.1
Travis County Youth (Below Age 18) Suicide Death Rates, per 100,000
Source: Texas Department of Health, Epigram.
Figure 4.9.1 suggests that the suicide death rates for children in Travis County are zero for the past two years recorded. However, more data must be collected to determine exact numbers of suicides in juveniles, as some deaths recorded as "accidental" may actually be suicides.
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OUTCOME: Increased rate of children's school attendance
Figure 4.9.2
Attendance Rates for School Years 1995 and 1996
Source: Texas Education Agency.
All school districts show higher than 92% attendance rates. There has not been much change between the 1994-95 school year and the 1995-96 school year.
Although average daily attendance has gone up, so has the population and the number of school-aged children in Travis County. What is needed here is a measure of the "target" population (i.e., children with mental illness) and their average daily attendance. Perhaps TEA, TXMHMR, or AISD will have these numbers in the near future.
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OUTCOME: Increased percentage of children with improved academic performance
Table 4.9.2
Percent of Children with Improvement in School Behavior, 1996, 1997 and 1998, 2nd Quarter
|
Local Mental Health Authority
|
1996
|
1997
|
1998
|
| Austin-Travis Co. Provider Network |
59%
|
66%
|
Not Available
|
| Statewide |
57%
|
89%
|
73%
|
Source: The Evaluation Review, Research and Evaluation, Texas MHMR (4th Quarter, FY96 and FY97).
A good proxy for increased mental health in children is the demonstration of continued improvement in school behavior. The state target is greater than or equal to 60%. The LMHA provider network has essentially met its targets for the past two fiscal years.
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OUTCOME: Decreased rate of school discipline referrals
Table 4.9.3
Annual Evaluation Reports: School Year 1995-96 and School Year 1996-97
|
School District
|
Drug Use
|
School Violence
|
| Del Valle |
Decreased
|
Same
|
| Eanes |
Same
|
Decreased
|
| Manor |
Same
|
Increased
|
| Pflugerville |
Same
|
Increased
|
| Austin |
Increased
|
Increased
|
| Lake Travis |
Increased
|
Increased
|
| Lago Vista |
Same
|
Same
|
Source: Texas Education Agency, Special Reports.
Table 4.9.4
Incidences reported by School District, School Year 1996-1997
|
Percent of Incidences
|
|
|
|
District
|
Elementary
|
Middle School
|
High School
|
Total incidences 1
|
% Change 2
|
| Pflugerville |
14.9%
|
55.8%
|
29.2%
|
817
|
42.5%
|
| Del Valle |
10.6%
|
67.0%
|
22.0%
|
1464
|
26.9%
|
| Austin |
20.5%
|
39.1%
|
40.4%
|
8320
|
20.7%
|
| Manor |
4.2%
|
40.3%
|
55.5%
|
355
|
17.9%
|
| Eanes |
5.2%
|
42.2%
|
52.7%
|
562
|
-3.3%
|
| Lake Travis |
4.9%
|
49.2%
|
45.9%
|
242
|
NA
|
| Lago Vista |
30.0%
|
34.8%
|
36.2%
|
69
|
NA
|
Source: Texas Education Agency, Special Reports.
1 Total incidences for school year 1996-97. 2 Percent change for school year 1995-96 and 1996-97.
Some of the incidents reported include assaults against students; acts of vandalism/criminal mischief against school and student property; confiscated weapons; referrals for disciplinary action; and arrests for offenses related to possession, sale, or use of tobacco, alcohol, and other drugs.
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OUTCOME: Increased percentage of children with improved functioning as a result of receiving services
Table 4.9.5
Improvement in Behavioral-Emotional Functioning CBCL Change Scores 1996-1998, Quarters 1 and 2
|
Local Mental Health Authority
|
1996
|
1997
|
1998
|
| Austin-Travis Co. Provider Network |
-5.86
|
-4.50
|
-4.3
|
| Statewide |
-10.10
|
-9.10
|
-3.70
|
Source: The Evaluation Review, Research and Evaluation, Texas MHMR (4th Quarter, FY96 and FY97).
The Child Behavior Checklist (CBCL) is a form completed by the child, parent, and collateral contact person before and after services have been rendered. A decrease of 10 points is clinically significant. The state's target is a decrease of five points.
As measured by the CBCL, in 1997 the functioning of children who were consumers of the LMHA provider network deteriorated from the 1996 level at all measured sites. The LMHA is taking corrective action to ensure that return rates from providers and families increase, enabling a larger and more representative sample of data.
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OUTCOME: Decreased rate of children involved with juvenile justice system
Numbers for the LMHA provider network improved 5%. They are now comparable to the state (i.e., the overall) average. The trend appears to be a decrease in re-arrest.
Table 4.9.6
Percent of Children with a History of Arrest Avoiding Re-arrest 1996-1998, 2nd Quarter
|
Local Mental Health Authority
|
1996
|
1997
|
1998
|
| Austin-Travis (A/TCMHMR) |
81%
|
86%
|
Not Available
|
| Statewide |
80%
|
88%
|
89%
|
Source: The Evaluation Review, Research and Evaluation, Texas MHMR (4th Quarter, FY96 and FY97).
One way to improve other measures is with the First Time Offender program. If more First Time Offenders are helped, then there will be fewer re-arrests. The LMHA provider network has met its 75% contract target.
Table 4.9.7
Percent of Contract Target Met for Services to First Time Offenders 1996 and 1997
|
Local Mental Health Authority
|
1996
|
1997
|
1998
|
| Austin-Travis Co. Provider Network |
93%
|
103%
|
110%
|
| Statewide |
117%
|
120%
|
115%
|
Source: The Evaluation Review, Research and Evaluation, Texas MHMR (4th Quarter, FY96 and FY97).
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D. Outcomes and Indicators
The Community Guide identified other outcomes, and subsequent consultations with key groups added several additional outcomes. They are listed below with annotations that include clarification, availability of data, and recommendations for further treatment.
The following outcome is being addressed in other chapters:
- Increased percentage of parents demonstrating improved parenting skills
The following outcomes are ambiguous and require more consideration in future activities of the CAN to identify concrete measures of these outcomes:
- Increased rate of children transferred from Special Education to a less restrictive classroom setting
- Increased rate of individuals with enhanced knowledge/skills about children's mental health issues following educational community presentations
- Increased rate of parents/families reporting receipt of appropriate and comprehensive services
- Decreased number of children who are severely impaired by mental illness
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E. PRIMARY CONCERNS: CRITICAL STRATEGIES
The CAN Administrative Team summarized the issues by extracting the following set of critical strategies from the 1997 Community Guide.
- Increase wrap-around and home-based services to improve parenting skills and improve family functioning
- Create a purchasing alliance to provide comprehensive, cost efficient, integrated services to youth
- Design, implement, and evaluate school-based mental health services
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