MCHB/EPI Miami Conference — December 7 - 9, 2005

The National Survey for Children's Health: From Data to Action in Two States — Transcript

SAMARA VINER-BROWN: I was wondering what Michael was going to say about me, so now I know. I shouldn't have told him I was really nervous. This is definitely an honor. I'm both honored and terrified, as Michael was alluding to moments ago, to be here. And so hopefully, I'll calm down for you.

What I'm going to be talking about is children's mental health in Rhode Island . And I like the acronyms so I said Children's Mental Health in Rhode Island Now, needs, opportunities and will, meaning will, political will. But before I begin, I wanted to acknowledge my colleague, Hannah Kim, who is sitting over there. Wave, Hannah. And Hannah is the one who--she's a senior public health epidemiologist at the Rhode Island Department of Health. And she's the one who really generated all the data and did all the analyses. And I'm just really the mouthpiece here so I just wanted to give credit to Hannah for all the hard work that she did.

So what I'm going to be talking about is just to give you a brief description of Rhode Island of those of you who are not familiar with our little state, and then go onto give you a definition or index of how we describe mental health. Talk about the prevalence, service needs, educational issues, parental concerns, behaviors, family stress, and other family and neighborhood characteristics. The national survey of children's health is full of so much data that it was really hard to sort of limit what went into this presentation so I kind of probably went a little overboard and so I'm going to be throwing a lot of slides at you at this wonderful time of day when I know the ocean is sitting out there, but I sort of put ocean up background here. So, you know, it helps a little bit. So in terms of Rhode Island, and by the way, Rhode Island is the ocean state, so there are multiple reasons why I decided, you know, the ocean should be the background of this presentation.

Rhode Island has a population of just over a million folks. There are about 240,000 children aged less than 18. We have six core cities which were designated based on the percentage of children living in poverty. Those cities have more than 15 percent of children living in poverty. We have five counties. We have no local health departments, two psychiatric hospitals. We have a Medicare managed care program called Right Care. We have a lot of "rights" in Rhode Island , using our lovely RI. And we have 18 mental health centers. And then in terms of the survey, 2,019 children are represented.

So we decided to focus in on mental health because we have done a lot of different needs assessments in the state. And talked to the AAP and other folks would have determined that mental health is definitely an issue that needs to be examined and programs and policies need to address those issues. So we decided to take a set of questions within the survey and I've listed them here. And so children were classified as having a mental health problem if their parents answered yes to one of the following: Whether the child has any kind of emotional, developmental or behavioral problem for which he or she needs treatment or counseling. Whether a doctor or health professional ever told them that their child has ADD or ADHD; whether a doctor or health professional ever told them that the child has depression or anxiety problems, and then finally, whether a doctor or health professional ever told them that their child has behavioral or conduct problems. So that's a limitation right there because we sort of decided to use those questions and broad classification of mental health. And people can sort of argue whether or not that really covers mental health or not, but we wanted to at least pull in those areas to use.

And now I'm just going to talk about the prevalence data. So based on those four issues, we compared Rhode Island to the U.S., and in three of the four categories, Rhode Island was actually slightly higher than the country as a whole. So in terms of whether or not their problem needs treatment, you can see 8.3 percent. For ADD/ADHD, 8.7, compared to 6.9 for the country as a whole. Seven percent for depression or anxiety, and then behavioral or conduct was fairly close to the nation as a whole so it was about five percent.

So using those four pieces, we came up an index, basically, that 15.2 percent of Rhode Island children have mental health problems as we're calling them. And that represents children age two through 17. And then looking at it by age groups, you can see among early childhood population, 3.1 percent of children fell into that category, compared to 4.4 percent for the country as a whole. And then when you look at the older children, Rhode Island has a higher prevalence rate, 16.5 percent and then 22.8 percent for the teens. And so you can see there's a larger difference between Rhode Island and the country as a whole for the adolescents.

And then looking at socio-demographic characteristics, you can see that more males were likely to have mental health problems, 18.1 percent, compared to 12 percent of females. Those living in less than 200 percent of poverty, 21.1 percent, or one out of five kids living in poverty had a mental health problem compared to 12.9 percent of those at or above 200 percent. And then family structure, there were also significant differences. Those who were living in a single head of household were more likely to have mental health problems, twice as likely to have mental health problems, compared to those living in a household being raised by two biological parents. And then those born in the U.S. were more likely--four times more likely to have mental health problems compared to those who were born in other countries. And then English as a primarily language, again, much higher, 16.4 percent had mental health problems, compared to 6.5 percent who spoke other languages.

And then I'm just going to talk a little bit about care and service needs. So in terms of those who had difficulties with emotions, concentration, behavior and getting along with others, 73.6 percent of those who had mental health problems fell into that category, compared to 9.4 percent of those who were without mental health problems. And then you can see that less than half of those children who had mental health problems actually received counseling, 48.4 percent.

And then getting into specialists. Specialty care and special services. 57.9 percent of children with mental health problems need a specialist, meaning--and this pulls in all kinds of doctors, surgeons, allergists, includes psychiatrists. And this was more than double that of children without mental health problems. And then looking at whether or not they had problems getting a specialist, 20.3 percent of children with mental health problems had problems getting to specialists, compared to 8.4 percent of those without mental health problems. And then looking at special services and that includes physical therapy, medical equipment, special education and counseling. 42.9 percent of children with mental health problems needed those services, only 7.2 percent of those without mental health problems did. And then in looking at actually getting those special services, 26.4 percent of children with mental health problems had problems getting those services, compared to 11.4 percent of children without.

And then having difficulties getting specialty care and services, this is just focusing on the population of children with mental health problems. And so this is just comparing the specialists, that's the yellow bars, and the special services which are the blue bars. So again, you saw the 20.3 percent in terms of problems getting care, and then 26.4 percent had problems getting special services. And you can see that where it comes to special services, they had more of a problem in terms of getting help, and also having their primary provider or health provider who didn't really discuss the services. And so that sort of gets it a little bit at care coordination component of medical home that we heard about earlier.

And then talking about educational issues, I just wanted to talk first about residential mobility. And the reason why I sort of put mobility here is that in Rhode Island, we actually have conducted studies looking at the effect of residential mobility on both health outcomes and educational outcomes. And what we found was that residential mobility actually impacted educational outcomes more than health outcomes that kids were actually able to get the care they needed, but when it came to their education, they actually had poor outcomes if they were more mobile. So in this case, children with mental health problems, 51.4 percent moved three or more times since kindergarten, compared to 24.5 percent of those without mental health problems.

And then looking at missing days of school due to illness, and this is missing more than three days of school due to illness, among those with mental health problems, 49.9 percent missed school compared to 34.3 percent. And wanted to note that in terms of the education questions, this actually includes just children aged six through 17.

And then coming to the children who repeated a grade, and that's exactly the outcome that we found with the mobility issue by the way, was that they were more likely to repeat a grade. In terms of children with mental health problems, 21.4 percent repeated a grade, compared to 8.9 percent of those without mental health problems.

And then there's a question in the survey that has to do with the frequency the school contacted the families regarding problems with the child. And so on the left, I decided to sort of get away from some of the bar charts and throw in some pies, just, you know, a little variety. So it's a little busy, sorry. But so with mental health problems, in terms of more than the school contacts them more than once, more than half were in that category, 56.2 percent, compared to those without mental health problems, 12 percent were contacted. So it's 12 percent versus 56.2 percent. Or if you look at the never, 75.8 percent of those without mental health problems were never contacted regarding their problems with the child in school.

And now I'm going to talk about present parental concerns about their children. And I sort of threw a lot of concerns on one chart, so sorry. But these were all significantly different. In terms of achievement, parents having concern about their children's achievement, 59.9 percent of parents of children with mental health problems were very concerned about their child's achievement, which is almost double that of parents of children without mental health problems. And then you can sort of see the other bars in terms of parents having, uh, being concerned a lot about not having enough time with their child, about their relationship with their child, about their child's self-esteem, 46.1 percent of parents with children with mental health problems were very concerned about their child's self-esteem, were twice as likely to be concerned compared to those parents of children without mental health problems. And you can see comparable differences in terms of stress that they felt if their child had a lot of stress. And then the same with being concerned about their child's depression.

And then we're going to look at behaviors. And this has to do with negative behaviors among children. And you can really see the differences in terms of children with mental health problems compared to children without mental health problems. So and again, all of these data are reported by the parents, so this is the parents' perspective. But 41.6 percent of parents of children with mental health problems say that their child usually or always argues. And then in terms of compared to 15.3 percent of parents with children without mental health problems. And then looking at whether or not their child was usually or always disobedient, 11.9 percent for mental health problems compared to 3.9 percent of parents of children without. And then flipping sort of the scale here, there's a couple of questions about whether or not children respect their teachers or neighbors, and in this case, it's never or sometimes. And you can see 16.2 percent of parents of children with mental health problems said that they felt that their child fell into this category, compared to five percent. And then looking at whether or not their child gets along with other children, never or sometimes, and it's 27.8 percent of parents of children with mental health problems reported that, compared to just 5.5 percent of children without mental health problems.

And then looking at additional issues around for children, 6.9 percent of parents said that their child feels worthless, compared to 1.3 percent of parents of children without mental health problems. And then looking at whether or not their child is unhappy, 8.8 percent reported that for children with mental health problems, compared to less than one percent. And then whether or not their child was withdrawn, 5.3 percent of children with mental health problems, compared to 1.7 percent. As so although these numbers are small, there are very significant differences.

Now we're going to talk about family stress. Like me, stress. Okay. In terms of whether or not--the question that was asked is whether or not the parent that their child is hard tore cake for than most children. So 21.4, one out of five parents felt that their child was harder to care for, if their child had a mental health problem, compared to 3.4 percent of parents of children without mental health problems. And then the next piece is--let me see. The child does things that bother the parent a lot. My son kind of falls into that category a little bit. Okay. Yeah, right. That's right. Michael just asked, "Why isn't that a hundred percent?" But anyway, okay. But in this case, 14.2 percent of parents of children with mental health problems reported that their child does bother them a lot, compared to 3.6 percent of--there is a difference between mental health problems and without. And then looking at whether or not the parents felt that they have given up more of their life to meet their child's needs than they expected, 26.8 percent of parents of children with mental health problems said that they did, compared to 14.2 percent of parents of children without mental health problems.

And just looking at a couple more slides. Around family or neighborhood characteristics, we wanted to look at the mother's health, both mental health and general health. And this actually asks about whether or not--the data that I present here, the mother's health fell into the category of fair or poor. So in terms of mental health, mothers of children with mental health problems, more than one out of five had fair or poor mental health, compare the to 5.3 percent of mothers of children without mental health problems. And then for general health, one out of five moms ever children with mental health problems said that their general health was fair or poor, compared to 7.8 percent of mothers of children without mental health problems.

And then there are some questions about neighborhood characteristics. And 28.3 percent of parent of children with mental health problems said that they disagreed with the statement that neighbors helped each other out, compared to 16.3 percent. And then whether or not they can count on their neighbors, they disagreed with that and 22 percent of families with children with mental health problems fell into that category, compared to 13.2 percent of parents of children without mental health problems.

So in summary, Rhode Island has a higher prevalence rate of children with mental health problems than the nation. The prevalence is higher among males, among those living less than 200 percent of the poverty level, those raised in single-parent families, and born in the U.S. , nearly two-thirds of the children where mental health problems had difficulties with emotions, concentration, behavior or getting along with others. Less than have of the children with mental health problems received counseling. Children with mental health problems are more likely to need specialty care and services and have difficulties getting those services. To repeat a grade, to miss school, to exhibit negative behaviors, to feel unhappy, worthless, and more than one in four parents of children with mental health problems feel they are giving up more of their lives to meet their child's needs than expected.

And I think that's it. So the whole thing is, is that what question want to do is to be able to, now that we have gleaned this data, we want to then work with our program managers, our policy makers, our sister agencies, community organizations, to move this kind of information to action, and so Jorge is going to speak to that. So thank you.