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The House Select Committee on Youth Health & Safety met on October 4th to discuss the impact of COVID-19 on the mental health needs of Texas youth and identify of effective treatment strategies.

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Opening Comments

  • Chair Lozano – Committee works to protect state’s most valuable asset, the youth
  • Committee was created to examine issues with youth health, juvenile justice; continuing work to reform juvenile justice and minimize negative effects of COVID-19
  • Focusing on mental health needs and effective treatment strategies, youth have suffered from loss of routine due to COVID-19, will not know full impact for some time
  • Highlights “COVID slide,” backslide from previous academic gains

 

Dr. Andy Keller, Meadows Mental Health Policy Institute

  • Providing overview of COVID-19 impact on mental health, was an epidemic of mental health needs before COVID-19 and now there are much more
  • 15% of mental health issues develop by 14, but typically do not meet these needs until 8-10 years after they develop; no screening or protection at scale, not addressing until things reach a crisis
  • Suicides peaked in 2018 and stayed there in 2019, rose again last year; rising because of additional rates of depression
  • 4x percent as many people reported negative impacts of depression at start of pandemic, peaked at 4x, seeing ER visits in youth at double what they were; primarily driven by young women and girls
  • Seeing more boys acting out in the community
  • Early treatment is key
  • SB 672 put collaborative care in place, payments for doctors that have mental health needs present in their practice; PCPs often have little experience with mental health issues, collaborative care helps address this
  • Children’s Mental Health Care Consortium was created 2 sessions ago, funding will not meet all needs, but will ramp up to start addressing them; could also meet needs like care for perinatal moms
  • Could also spend more in the research lane, need better understanding of what works for TX children
  • Youth in juvenile justice system have experienced significant trauma and pain, typically end up in this system due to things that happen to them, not because they are bad; can’t ramp up new facilities quick enough
  • Can develop pediatric mental health crisis response teams
  • Multi-systemic therapy (MST) will also help youth in juvenile justice system, works 60% of the time, only doesn’t work when we can’t find an adult to be in that youth’s life
  • Neave – Do we have MSTin Dallas, why or why not?
    • We had them in the late 90s and early 2000s, it does exist in Harris County, one of the best teams around
    • Started one with DSRIP funds in El Paso about 5 years ago, Nueces has one
    • Legislature funded two pilot teams to reach youth before they see the justice system in Harris and El Paso
    • Also now have ability to do this through “in lieu of” funding
    • Love the pilots, ample need for expansion
  • Neave – Would love to talk later about this
  • Leach – Highlights issue of children whose parents are involved in the justice system, parents who should be home; do we have data on this?
    • Definitive links between absence of parent and mental health
    • Also new research showing long-term lingering effects, also generational trauma
    • Also good evidence that it isn’t the severity of the mental illness that gets you into the juvenile justice system
  • Frank – Mentioned in-home intervention is lieu of residential treatment, can you talk about this?
    • There are a lot of in-home programs, Medicaid provides in-home supports through certain programs
    • Problem is these supports are not intensive for youth in the justice system, systematic supports are often non-existent
  • Frank – Asks for more information
    • There are those in Harris, El Paso who have done this, can speak with them
  • Frank – Residential treatment often doesn’t help
  • Dutton – Who is a juvenile in Texas?
    • Someone under the age of 18
  • Dutton – But we passed a bill that you can’t buy cigarettes if you aren’t 21, does this create a new class
    • When you’re 18 you go to adult court
  • Dutton – TX has a law classifying 17 year olds as adults that is over 100 years old, TX doesn’t seem to know who is a juvenile; only 3 states that treat 17 year olds as adults for criminal responsibility, thoughts on whether this is a creating a problem?
    • Vast majority of 17 year olds have remediable behavioral situations, vast majority would be far better served outside the justice system with
    • One exception, there are some people we’re scared of, not my expertise on how to handle these public safety concerns
  • Dutton – Overwhelming majority of 17 year olds commit nonviolent felonies, yet we treat them as adults; highlights one individual who was charged and led to probation and jail, could have been avoided
    • Example highlights how we negatively impacted that child’s life
    • With systemic therapy, most nonviolent offenders never offend again
    • Would prefer youths don’t go to TDCJ, but also not get arrested, getting arrested shouldn’t be precursor to care
  • A Johnson – Very common scenario, can you explain process for fin ding appropriate adult in MST?
    • Yes, appropriate adult is someone who will be around when necessary, want an adult to monitor to see if child is getting into trouble situations
    • Point is building the support network of relations that existed more in the past
  • A Johnson – Works between 3-7 months?
    • Yes, either works or it doesn’t in 3-7 months, go to juvenile justice system if it doesn’t
    • MST also ensures youths get appropriate medical care and medication
  • A Johnson – Can you explain how collaborative care will reduce overmedication in children?
    • Yes, has been studied; well child visit will not typically address mental health issues & doctors cannot typically act beyond references
    • Some references may be dead, etc., because insurance companies don’t clean network records; doing better on parity now, but still needs work
    • Can put the child on Lexapro or similar, but not fit for the problem
    • Poor prescribing and overall prescriptions go down under collaborative care, supports other options like groups and therapy
  • A Johnson – Legislature had wisdom to put this in effect, but should be doing more?
    • Yes, Consortium will help greatly with coordination, start up grants, etc.
  • A Johnson – Any positive impact on potential problems later?
    • Yes, can provide data, very good evidence that early treatment leads to better outcomes
    • Also helps avoid developmental issues
  • A Johnson – What do we need to address this moment in time and stressors on children?
    • Need to look at other major disruptions like hurricanes, folks coming back from extended conflicts, etc.
    • Haven’t seen extent of mental health impacts yet, will happen 2-4 years after the event; will move through this after 4 years
  • Hull – Is there a difference in increased symptoms?
    • Seeing tremendous increase in suicide rates overall
    • Examinations of data of deaths in young black adolescent women showed big increase amongst those going into high pressure environments with little support
    • There are additional stresses and toxicities
  • Hull – Do they screen at the beginning of the care visit for collaborative care?
    • Links in through screenings, about 80% accurate
    • Below age of 13, they should look for other indicators like reports from parents
  • Allison – What role do you see for organizations like Communities in Schools? Other groups filling in the after school hours?
    • Some ISDs work with LMHAs, some can work with Communities in Schools
    • TEA has set up a framework that allows each ISD to decide what supports they need, necessary for such a large & diverse state
    • Texas Child Health Access Through Telemedicine (THCATT) Program from 2019 helped provide access to those without
    • More funding would be helpfully absolutely
  • Dutton – What relationship do you have to counselors in schools?
    • We don’t work for any of these organizations
    • Counselors in schools are a fantastic resource, but can’t expect them to provide for all mental health needs like psychosis treatment, medical visits, etc.; best for them to be in charge of multi-tiered supports (MTSS)
  • Dutton – Shouldn’t they be at the forefront of identifying children with needs?
    • Should be at forefront of designing the system, but no way the counselors can address all needs themselves
    • Shouldn’t be sole provider or frontline provider, best in management & coordination
  • Dutton – Highlights importance of teacher training
    • Partially agree with this, every teacher should have mental health first aid training
    • But don’t want teachers being frontline or caregiver for mental health care
  • Neave – Wants to thank Rep. Dutton for lead on raise the age legislation, House has taken lead on criminal justice reform

 

Dr. David Lakey, University of Texas System

  • Provides overview of Texas Child Mental Health Care Consortium, primary purpose is to advance mental health care quality & access through collaboration
  • Child Psychiatric Access Network (CPAN) also supports PCP to assist in getting appropriate care to children
  • Mental Health Care Consortium was stood up very quickly, pandemic made this more difficult, authorized to start Sept. 1, 2019 and came to that meeting ready and stood up programs within the next year
  • Part of CPAN work is registering providers, conduct surveys to ensure providers have what they need
  • Highlights good outcomes through TCHATT, addressed a variety of behaviors
  • Have had chances to collaborate with LMHAs through CPAN and TCHATT
  • Expansion of fellowship slots, UT previously trained 28, 14 additional were opened in the last biennium, programs across the state were expanded as well
  • COVID-19 has had a significant impact on mental health needs
  • There are opportunities to improve CPAN, education for PCPs, also can move from entirely telephonic to other methods to get kids seen
  • Many PCPs want to be able to use these services through EMR
  • Also a possibility to use CPAN to address mental health needs for pregnant women
  • TCHATT is primarily high acuity, could expand services to less acute children; can also expand into more ISDs
  • Have also heard concerns that 4 visits under TCHATT isn’t enough, need to be able to expand
  • Opportunity as well for more members of the workforce
  • Lozano – Do any programs give students ability to directly contact someone?
    • One statewide number to support CPAN, also have a data system to monitor changes
    • But CPAN is based on supporting PCP always through intermediary
  • Lozano – Could be useful to have a text-in program
    • Not sure of a text in program, HHSC may have something similar, have seen this done on a research basis
    • Have looked at similar programs for tobacco and vaping cessation
  • Frank – Regarding the Consortium, is there anyone looking at root causes of mental health problems; many seem to result from decisions in society
    • Great question, this is why 10% of Consortium allocation is for research
    • Work primarily on identifying trauma and depression and how to improve system of care
  • Frank – This is research on the treatment side, talking about research on root causes and policy decisions needed, e.g. addressing isolation
    • Not part of the Consortium right now, not because we aren’t interested
  • Frank – Will be a lot of money going to treatment, need to look at this
    • Research we’re looking at is more focused on gaps in care, will be important
  • Allison – Regarding fellowship program, how is it going?
    • Doing better, many residents are wanting to go into psychiatry
    • Need to look at adding more fellowship slots. Those trained in the state are more likely to stay; highlights that 75% of fellows in Houston stayed in the state
  • Allison – Anything we can do to enhance that, why wouldn’t they stay here?
    • Too early for this program; having experience of working in mental health system will have a tremendous impact
  • Allison – So increasing fellowship options would be a good investment?
    • Yes, many mental health needs around the state
  • Dutton – Are there programs to help parents of children with mental illness?
    • There are programs that HHSC has to support, not the design of Consortium right now
  • Dutton – Concerned about corporal punishment and potential impacts on mental health
  • A Johnson – What do you need to look at supports for pregnant mothers? Statutory authority?
    • Consortium by statute must be focused on children
    • Also a funding concern, ARPA funds were put towards Consortium
    • Could consider doing a pilot program
  • A Johnson – You’ve already made a request for ARPA funds to build out support infrastructure, but then you could also do a pilot program for pregnant mothers?
    • Yes, can leverage telephone and data system already set up under the Consortium
    • Could put in the dollars and give us direction, or set up the pilot program in a rider
  • Morales – What can we do to bring these resources to rural Texas towns?
    • This is part of our ask, Texas Tech would like to expand into more of these regions
  • Morales – Are you working with Soros in Alpine?
    • Health related institutions are part of the Consortium, would partner with local entities
  • Morales – So at present waiting for ARPA funds?
    • Yes
    • Highlights telehealth work, UTRGV has been very aggressive in pursuing this for rural areas of the state
  • Morales – Had a problem brought from Maverick County where they had to pay in for licensed counselors, but no one was in the service area; telehealth option would be beneficial to these areas, have been losing doctors

 

Karen Price, Texas Children’s Hospital

  • Seeing this crisis at every entry at Texas Children’s, most of the time when parents are bringing children to urgent care don’t have anywhere else to turn; numbers increased significantly over the last year
  • Seeing increases in children with aggressive issues, developmental issues, etc.; most come from homes where parents were good advocates, but pandemic has made school programs and other supports difficult
  • Staff not always equipped to properly care for these children, needing to take significant action to protect themselves and patients
  • Volume for referrals for behavioral health compete with other see more than 22k referrals for behavioral health, only behind orthopedic or otolaryngological
  • Working on creating behavioral health care team and dedicated beds, expanding outpatient programs, improving training, and increasing safe care locations
  • Long term looking at behavioral health urgent care, inpatient program, school supports and expanded research
  • Need to strengthen community partnerships, need community health workers or navigators, and mental health training for crisis response
  • Have discussed increasing funding to support next generation of pediatric mental health providers, improving reimbursement models,
  • Seeing increase in psychiatry practices that don’t take insurance which affects access & quality
  • Need to look at partnerships with local providers, expand access for mothers in the perinatal period, and improving high speed and telephonic access
  • Morales – How many do we have in the workforce for psychology and counseling?
    • Currently 60 providers throughout Texas Children’s Hospital
  • Morales – Statewide? Concerned about how many more we need
    • Don’t have the statewide number, but also need to empower community personnel to recognize problems early on and direct children to services
  • Morales – Seems like we’re barely touching the surface of discussing this openly, issue is possibly more prevalent than other significant health problems
    • Early identification and intervention will be key, at the tip of the iceberg now
  • Frank – Do you treat the high number of behavioral health patients internally or are those referred out?
    • Combination, e.g. those in crisis or needing specialty services
    • Try to get them out to a community providing if they are waiting more than a few months
  • Frank – How do you measure success? Easier for orthopedic surgery, etc.
    • In the last several years behavioral health has taken off in terms of measurement based care; gauging how symptoms improve and functioning goes up
  • A Johnson – Asks after pandemic effect
    • Data was already coming in before the pandemic on negative impact of things like social media
  • A Johnson – COVID-19 was not infecting children at the beginning, but now seeing a significant health crisis with RSV and COVID; how is this impacting mental health of children, families, and hospital system?
    • We are seeing more hospitalizations with Delta, but low mortality for children, but uncertainty is driving mental health concerns among parents
    • As families are coming out of pandemic, related effects like job loss or loss of supports are adding to this uncertainty
    • Some of the recent research suggests we are not past the worst of it, depression and anxiety are worse now than in the beginning of the pandemic
    • Other piece that isn’t getting attention is grief and bereavement, will need support for this moving forward
  • Hull – Are you seeing the same numbers of children presenting to the ER?
    • Had a peak around April & May of this year, hopefully we have passed peak but uncertain
  • Hull – Hopefully this keeps going down with doctors’ offices and supports open
    • Hoping for more eyes on children and more community supports in place
  • Leach – Do we have stats on percentage of children with regular practitioner they visit throughout their childhood? Have seen stats that this is less common
    • Don’t know what data would say, would agree with this impression
    • Also losing multigenerational piece & continuity of care between parent and child
  • A Johnson – Can you describe circumstances and impact of child suicide?
    • Have 1 child die by suicide every 2 weeks in Harris County
    • Launched a suicide prevention ask force in Harris County to combat impact

 

Trina Ita, Texas Health and Human Services Commission

  • Providing overview of COVID impact and HHSC programs, so immediate concerns about access to care and needed to pivot quickly to address this via telehealth
  • Also seeing related effects like higher caseloads, workforce investments have not kept up with other portions of response
  • Waiting times have increased, number of children on waitlist for more than 30 days has surpassed 2019-20 already
  • Provides overview of Statewide Behavioral Health Coordinating Council, collaborative council between numerous state agencies
  • Implemented COVID mental health support line across the state, provides basic intervention and possible referral
  • Highlights integrated behavioral health clinics, working to certify all LMHAs and BHAs within the next year
  • Provides overview of mental health services programs that affect youth around the state
  • Legislature invested in community mental health grants a couple session ago, 9 focused on services for children
  • Mental Health First Aid has been very effective in early intervention, trained 125k teachers K-12 and in higher education
  • COVID-19 federal rescue funds, received ARPA funds through block grant pathway, focused on expanding capacity of programs already in place, e.g. outpatient capacity, housing support
  • Frank – Regarding Youth Empowerment Services Waiver, how big is this? Concerned about possible relation to children relinquished by their parents
    • Primary purpose is to prevent relinquishment
  • Frank – Funding goes to third parties?
    • LMHA and BHA run the services, possibly not using waiver services when connected through this
  • A Johnson – What can happen now to fill in gaps in rural areas?
    • 39 LMHAs and BHAs covering all counties
    • Rural communities often have challenges in access and resources
    • COVID-19 flexibilities for telehealth have helped cast a wider net
    • Bills like SB 454 helped to continue these efforts
  • A Johnson – To what extent are we or should we ensure children have access to helplines?
    • HHSC runs the crisis hotline, helps triage individuals who meet eligibility requirements or not
  • A Johnson – How important are connection to schools & programs like Communities in Schools in supplementing care
    • Some LMHAs do partner with ISDs, has also been work to embed personnel to provide mental health training

 

Cheryl Loving, Texas Counseling Association

  • Agree with testimony on impact so far, seeing increasing issues with grief
  • Highlights Texas school counseling model, need to ensure counselors are able to address issues and have resources needed to do this
  • A Johnson – What tools?
    • Many admin processes get in the way of services for children, could have support personnel to take care of tasks that do not need specialized degrees

 

Dr. Cissy Reynolds-Perez, Kingsville ISD Superintendent

  • Important to personally listen to teachers and children
  • Highlights children experiencing abuse or home issues have not had a break for 2 years, children are now returning to schools; many school officials are afraid of being labeled due to the upcoming expected negative metrics
  • Have 3rd graders who were last in school in Kindergarten, etc., will have difficulties in the upcoming STAAR tests
  • Helping students must start with helping teachers and counselors, do not have enough
  • Provides statements from students on biggest fear, incl. being alone, not passing STAAR, etc.
  • Teachers have noted that students are dealing with death much more, students are having difficulties socializing, younger students have not learned phonics, can’t write, etc.
  • Schools are concerned about accountability ratings, many are concerned about what we’re doing wrong, many students are concerned about not passing exams and not graduating
  • Frank – How long were you closed to in person learning?
    • Went into remote instruction shortly after spring break, many Cleburne County students stayed home even after campuses were open
    • Everyone is in person this year
  • Hull – In the written material, if someone hits, slaps, or stabs them, they can file assault charges, but only if they don’t fight back?
    • Yes, trying to encourage kids to block; children are not afraid of getting in trouble
  • Hull – Just wanted to make sure they weren’t being told they couldn’t defend themselves

 

Julie Wayman, Texas Education Agency

  • Highlights COVID-19 impact, no data for post-pandemic, but hopelessness, depression, etc. are a significant concern
  • TEA works with the Statewide Health Coordinating Council
  • Mental health will continue to be a challenge for Texas children for some time to come, students have suffered from a lack of connection to others
  • Lozano – There’s no formal data sharing?
    • TEA does not have authority to collect PEMS data
  • Lozano – ISDs are capturing data on outcries?
    • ISDs collect this and make connections, TEA provides support in making connections, but they don’t provide this data to TEA
  • Lozano – So if the legislature felt it would be good to have a statewide student mental health data collection agency, wouldn’t TEA be the best repository?
    • Yes, 86th legislature did provide funding for collaborative mental health supports group, one of the tasks is to study mental health services in schools
    • Submitted an initial report and now collecting data on building out best practices in schools
  • Lozano – Texas House members would want TEA to collect data from schools regarding suicidal ideation, etc.; every student report needs to be catalogued by TEA, Commissioner can do it by rule
  • Lozano – Not the time to be rating school districts for STAAR, would ask you relay this to Commissioner Morath
    • Appreciate this, highlights TEA applying for funding with SAMHSA, working to address mental health issues in schools, Project Restore, etc.
    • SAMHSA funding will help ESC be able to train personnel better
    • Highlights 4-point plan to promote wellness, Consortium and Statewide Council just finished a care summit
  • Morales – Asks for links to material
  • Frank – Agree with Chair Lozano regarding data with TEA, have concerns with asking ISDs to do so much and moving mission away from educating children
  • Morales – I like the idea of TEA being the repository for this data, you referenced the legislative task force?
    • Yes, stood this up the September before the pandemic, subcommittee meetings are ongoing
  • Morales – Timeline for us to get this data?
    • November 2022
  • Morales – Publicly available?
    • Not sure, would need to meet with staff
  • Morales – Was the 2020 data available?
    • Schools were not surveyed in 2020, landscape study was done in year 1
  • Morales – Is this data available to us?
    • Can get with you all, not sure what data is collected, not collecting student data because there isn’t PEMS data

 

Tim Regal, Texas Education Agency

  • Providing overview of new Safe & Supportive Schools division, working to ensure the right resources are provided to educators at the right time
  • Effective Schools Framework is used as basis for campuses to self-assess, used to identify areas for improvement
  • Hoping Effective District Framework can serve the same role of identifying needed improvements at a district level
  • Working on premise that basic training alone is not sufficient to change behavior, often only see about 10% absorption from coursework, combined with other methods this can climb to 90%
  • Also working to ensure supports are appropriately designed
  • Lozano – What would be the easiest way for TEA to collect data on outcries?
    • Would start with the authority to collect this data, once established could work with ISDs to collect in a way that isn’t burdensome
  • Lozano – What is currently collected other than academic scores?
    • Hundreds of lines of PEMS data, discipline is one of those
  • Lozano – Would you say we’re in a mental health crisis?
    • Situation has certainly been exacerbated by COVID-19, had an issue with this before the pandemic as well

 

Jamie Frenny, Mental Health America of Greater Houston

  • Need to look beyond behavior and ask about conditions in student’s lives, provides example of one student who experienced difficulties returning to school
  • Mental health has implications for children’s brain development, can ingrain fight, flight, or freeze response
  • Co-locating mental health services on campuses increases access and decreases behavioral issues
  • MTSS needs to be implemented fully to see positive outcomes
  • Need to prevent students from entering criminal justice system
  • Suggests increase access to campus mental health services
  • Should implement strategies to improve school disciplinary policies, students do not have the option to take time for self-care and can often act out
  • A Johnson – Can you highlight the role of types of counselors
    • Often counselors are there for academic support, but can mean those who are trained for mental health supports and services
    • Recommending each campus has a mental health professional, someone who can triage and refer
  • Morales – Why can’t the counselors there perform that function?
    • They can, but often times academic supports and teacher supports takes up their time
  • Morales – Seems like we’re overpaying for people to monitor lunchrooms, etc.
    • Unfortunate reality of lack of staff at campuses
  • Morales – Has your organization made the request to have a mental health professional on campuses, what would that do to the budget?
    • Have made the recommendation of one counselor to every 250 students
    • There are lower cost options for different staff, often times children need to be heard and can serve this function
  • Frank – Asks after role of mental health personnel
    • When we talk about mental health personnel, they are there to receive students, not necessarily to find the students; can then advise teachers and others
    • Mental health personnel would help support operations
  • Frank – Would be in place of teachers
    • Definitely is needed
  • Frank – Not saying it isn’t needed, would be less money for teachers
    • Elected officials have the power to change that
  • Frank – If we put $50m we can say more teachers or more personnel
  • Lozano – So currently 1 counselor for every 900 in HISD
    • One academic counselor to 900 students
    • State target is one to 250

 

Colleen Horton, Hogg Foundation for Mental Health

  • Building healthy communities addresses root cause of problem; mental health impacts in youth have been exacerbated by COVID-19
  • Children in elementary school are missing significant chunks of instructional years & development is impacted
  • Children are impacted not only by the virus itself, but also by anxious adults, bad behavior; charging children with assault when they are doing the same things
  • Classroom removals, suspensions, and expulsions – 1 in 10 children were removed from classrooms, but not collecting data on why; could be mental health or trauma impact
  • COVID-19 has showcased longstanding inequities in mental health, youth of color are often at heightened risk and do not receive needed services, deaths from COVID-19 are higher
  • Mental health can only improve when political and social determinants are addressed
  • Funding should not always require evidence-based practice, limits innovation
  • ARPA funds should be directed to communities to address these determinants
  • Recommend establishing Office of Health Equity, congratulates House & Speaker Phelan support
  • Neave – Do you have data to show impact on youth of color?
    • Not on me, Biden-Harris task force has collected some data and can get you in contact
  • Youth with disabilities often see mental health issues at 2-3x higher than other populations, important to invest in these needs
  • Lozano – Agrees with comments that there needs to be more done
    • TCHATT and CPAN are great and are expanding access, but not everyone has a PCP or pediatrician
  • As of last month, TX only met 34.5% of state’s mental health professional need; need to investigate other cost-effective ways to expand beyond mental health workforce, e.g. promotoras, peer support specialists, school counselors, etc.
  • HB 1486 from 86(R) allowed peer support services to be Medicaid reimbursed per the state plan, but youth were determined to be ineligible through HHSC rule

 

Josette Saxton, Texans Care for Children

  • Need a continuum of care & look at prevention and identification of stressors of more intensive services
  • Continuum focuses on providing children with resiliency when they do face adversity
  • Need to look at how we reacclimate children treated in hospitals or residential facilities
  • Shares report on preventative strategies
  • Now have a state plan for student mental health & resources exist for schools to reach out, Rep. Allen passed these bills in the 86th Session
  • SB 11 and HB 18 from 86(R) can build upon data collection efforts, creates behavioral health threat assessment teams; ISDs should be collecting some fata on suicide, etc.
  • Not about treating kids in schools, schools are doing this because they know it is important for a child’s education; schools should be ensuring children have a safe & secure environment
  • For children with serous emotional disturbances, research shows they do best when served in the community, e.g. can stay with parents, stay in school, etc.
  • Need to ensure proper services as well, e.g. not using medication on children that don’t need it
  • Recommendations: invest in things like CPAN, expanding services to perinatal mothers
  • Should recognize that all programs across different agencies are important in the continuum of care to ensure children do not need medication or psychiatrist visits
  • Baseline is identifying gaps and finding preventative strategies to prioritize