DMH/DD/SAS
Access to the Full Continuum of Services for Children
and Adolescents with Substance Use and Mental Health
Problems
Flo Stein, Chief
DMHDDSAS
Youth Accountability Task Force
April 22, 2010
11

So how should an ideal system of care for
children that addresses prevention, treatment
and recovery from substance use and/or mental
health challenges be designed?
2
The North Carolina Child Plan
To provide for children and families with substance use
disorders or mental health needs services that are :
 Delivered
in the home and community in the least
restrictive, most appropriate and consistent
manner possible.
A
system of effective quality care.
 Accessible,
culturally appropriate treatment,
intervention and prevention and recovery services.
3
NC System of Care



The plan for care for children’s services in our
state is based on the evidence based
program known as the System Of Care
(SOC).
A system of care is a coordinated network of
community –based services and supports
that are organized to meet the challenges of
children, youth and adolescents.
Systems of Care was originally funded by the
Center for Mental Health Services, SAMHSA.
4
Systems of Care



Families and youth work in partnership with public
and private organizations to design services and
supports that are effective and that build on the
strengths of the individual.
Systems of Care is not a program –it is a philosophy
of how care should be delivered.
Each LME has a designated SOC Coordinator that
works with providers and other agencies to conduct
child and family team meetings for each child
needing services.
5
Children with Mental Health Disorders

There are an estimated 4.5 to 6.3 million
children and youth with mental health
challenges in the US. About 2/3 of these
young people do not receive the services
they need
6
Adults and Children with MH Diagnosis Served in SFY
2009



DMH/DD/SAS served a total
of 229,297 individuals with
a diagnosis of mental health
in SFY 2009
27 percent or 62,000 were
17 years or younger
About 1.4 percent of
children were served in
hospitals or residential
centers
Children
27%
Adults
73%
7
Gender of Youth with MH Diagnosis
Served in SFY 2009
61%
39%

Male
Males were
disproportionately
represented
Female
8
Race of Youth with MH Diagnosis Served
in SFY 2009
48.1%
50%
45%
41.4%
40%
35%
American Indian
Black/AA
White
Other
Unknown
30%
25%
20%
15%
10%
5%
7.1%
2.2%
1.6%
0%
9

Children with Substance Use Disorders

Adolescent alcohol and drug use occurs in the
context of rapid developmental change

Teens often use a greater number of or different
types of drugs than adults, resulting in more
complicated withdrawal or dependency patterns.
10

Adolescents with alcohol and drug use problems
are a heterogeneous group. They exhibit marked
individual differences

The vulnerability, risk, resilience and protective
factors associated with adolescent use problems
have been identified
11
Initiation of Substance Abuse Behaviors
Before Age 11 (Middle School) or Age 13 (HS)
20.0%
19.7%
17.3%
15.9%
18.0%
16.0%
14.0%
12.0%
8.8%
8.3%
10.0%
8.0%
6.0%
3.6%
4.0%
2.0%
0.0%
Cigarettes
Alcohol
*Middle School
Marijuana
*High School
* Middle school initiation before age 11yrs; * High school initiation before age 13yrs
Source: NC YRBS, 2007
12
Substance Abuse Behaviors among Youth
in North Carolina (past 30 day use)
37.7%
40.0%
35.0%
30.0%
22.5%
25.0%
19.1%
20.0%
15.0%
11.7%
10.0%
5.7%
5.0%
0.0%
Cigarettes
Alcohol
Middle School
High School
Middle schools students asked the question “ever had a drink other than a few sips” (33.6%) , no comparable
‘past 30 day use’ data available through 2007 YRBS for middle school students.
Source: NC YRBS, 2007
Marijuana
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Illegal Drug Use Patterns Among Middle
School Students (‘ever used’)
20.0%
18.0%
16.0%
13.6%
14.0%
12.0%
10.0%
7.9%
8.0%
6.0%
3.4%
4.0%
3.0%
2.0%
0.0%
Cocaine/crack
Sniffed glue/spray Steroid pills/shots
cans
Prescription pills
Middle School Students
Source: NC YRBS, 2007
14
Illegal Drug Use Patterns Among High
School Students (‘ever used’)
18.0%
17.0%
16.0%
13.8%
14.0%
12.0%
10.0%
8.0%
7.0%
6.4%
6.0%
4.7%
3.9%
4.0%
2.8%
2.0%
ac
k
s
Co
ca
in
e/
Cr
lu
e/
ar
eo
so
l
G
er
oi
n
Sn
iff
H
in
es
M
et
he
m
ph
et
am
cs
ta
sy
E
s
pi
lls
/s
ho
t
St
er
oi
d
Pr
es
cr
ip
ti o
n
D
ru
g
0.0%
High School Students
Source: NC YRBS, 2007
15

A small but significant potion of adolescent who try
alcohol or other drugs will develop substance use
problems. Monitoring the Future indicates a majority
of U. S. teenagers regardless of gender, or
race/ethnicity is exposed to and uses alcohol and other
drugs by the final year of high school
16
SA Prevention Need Among North
Carolina Youth

Almost all of the 731,632 children and adolescents (12-17 yrs
old) of North Carolina need an ‘universal’ prevention program

Through the 2007 NC YRBS, 37.7 % of 12-17 yr old students
reported as having consumed alcohol in the past 30 days

This estimate would place 275,826 of North Carolina’s high school
students in need of selective or indicated prevention programs.

Through Substance Abuse Block Grant and the SDFSCA grants
approximately 10,000 youth were served (SFY 2006-07)
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Treatment Need

Of the 731,632 children and adolescents in North
Carolina


Based on national prevalence estimates, 54,188 children and
adolescents (12-17 yrs) were in need of SA treatment services
Of this group of children and adolescents approximately
3279 or 6.1 % received substance abuse treatment services
Note: Estimates based on IPRS and Claims data, Estimates do not include prevention
services
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Adverse Consequences of Not Providing
Prevention , Intervention and Treatment







Fatal and non-fatal injuries related to motor vehicle
accidents, suicides, homicides, violence and delinquency
Severe Emotional Disorders
Risky sexual practices
Impulsivity, alienation, and psychological distress
Neurological impairment
Other medical complications
Delayed in normal cognitive and social-emotional
development
19
Family Factors



Family disorganization increases risk of adolescent health
problems including substance use disorders and mental
health disorders.
The family provides crucial background both genetically
and environmentally. Children of parents with substance
use disorders are at increased risk to develop substance use
disorders themselves.
Community disorganization increases risk
20
Resiliency Factors






Self-esteem
Family connectedness or other trusted reliable adults
Religiosity
Other community supports
Coping Skills
Motivation for change
21
Youth with Distinctive Treatment Needs






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Youth in the Juvenile Justice System.
Homeless Youth.
Youth with coexisting mental health disorders.
Youth with chronic physical illness, especially pain
related syndromes.
Youth influenced by traumatic events.
Gang involved youth.
Youth with multiply deployed parents or siblings.
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Essential Elements




Assertive Outreach
Progressive Assessment (GAIN-Global
Appraisal of Individual Needs or LOCUS)
Availability of a comprehensive Continuum of
Care
Conducting Recovery Management Check Ups
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Adolescent Specific Treatment Services





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Targeted sessions (anger, gender, culture)
Focus on skill and competency acquisition
Co-occurring services
Family programming
Education services
Wrap around services and supports
Health care
Recreation and leisure skills and activities
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North Carolina Counties with the MAJORS Program Substance Abuse/Juvenile Justice Initiatives
Alleghany
Ashe
Watauga
Mitchell
Surry
Yadkin
Madison Yancey
Alexander
Catawba
Haywood
Hender
Jackson
son
Macon
Transylvania
Cherokee
McDowell
Rutherford
Polk
Orange
Durham
Randolph
Harnett
Pitt
Wayne
Stanly Montgomery Moore
Lenoir
Mecklenburg
Anson
Washington
Tyrrell
Dare
Hyde
Craven
Pamlico
Cumberland
Hoke
Beaufort
Greene
Lee
Sampson
Jones
Duplin
Onslow
Scotland
Robeson
Alamance-Caswell-Rockingham
Albermarle
CenterPoint
Crossroada
Durham
East Carolina Behavioral Health
Eastpointe
Five County
Guilford
Onslow-Carteret
Orange Person Chatham
Piedmont
Sandhills
Southeastern Center
Southeastern Regional
Wake
Western Highlands
Martin
Johnston
Gaston
Chowan
Bertie
Wilson
Chatham
Cabarrus
Currituck
Nash
Edgecombe
Rowan
Union
LMEs
Franklin
Wake
Davidson
Richmond
Clay
VanceWarren
Granville
Alamance
Lincoln
Cleveland
Gates Camden
Northampton
Hertford
Pasquotank
Halifax
Perquimans
Person
Caswell
Guilford
Forsyth
Davie
Iredell
Burke
Swain
Graham
Rockingha
m
Wilkes
Avery
Caldwell
Buncombe
Stokes
Carteret
Bladen
Pender
Columbus
New
Hanover
Brunswick
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Adolescent Substance Abuse Regional Residential Program Initiative
As of 4/20/10
The Childrens Home
(Opening 2010)
Youth Focus Adolescent
Substance Abuse Program !
Western Region
Central Region
Crossroads
Mitchell
Wilkes
Caldwell
6
Buncombe McDowell
Henderson
Polk
Yadkin
8
Guilford
Forsyth
10
Davie
Alexander
The Beacon Center
Cleveland
Alamance
Randolph
Franklin
5
5
Montgomery
8
Richmond
Union
Anson
Wilson
Johnston
Wayne Lenoir
Cumberland
Sampson
Hoke
Mental Health Partners
Sandhills
McLeod Western Regional
Group Home !
PORT Aberdeen !
Duplin
Bladen
Columbus
9
Pender
New
Hanover
Southeastern Regional
Tyrrell
Dare
Beaufort
Hyde
Craven
Pamlico
Brunswick
Total of 8 ASA Regional Programs with 61 beds.
! Denotes DPI/LEA Specialized Educational Program.
# Local Public High School
10
Jones
Onslow
Robeson
Washington
Pitt
Greene
Scotland
Piedmont
Albemarle
Perquimans
Chowan
Bertie
Martin
Harnett
Moore
Stanly
Mecklenburg
Currituck
Pasquotank
Nash
Wake
Chatham
Lee
Cabarrus
Clay
Western Highlands
Hertford
Halifax
Granville
Durham
Macon
Pathways
Camden
Gates
Warren
Vance
Orange
Davidson
Rowan
Gaston
Person
Edgecombe
Iredell
Lincoln
Rutherford
Transylvania
Cherokee
Stokes
Catawba
Haywood
Rockingham
Caswell
Surry
Avery
Yancey
Burke
Swain
Graham
Jackson
Five County
OPC
Northampton
Ashe
Watauga
Madison
CenterPoint
Eastern Region
Alleghany
Smoky
Mountain
Swain Recovery Center
Adolescent Program !
Stuart House #
Carteret
East Carolina
Behavioral Health
PORT DORM !
Eastpointe
PORT Burgaw
(Opening 2010)
Southeastern Center
Reflects LMEs and Regions as of July 2009
Unless otherwise indicated, the LME name is the county
name(s).
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DMH/DD/SAS
RECOVERY
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