Breaking the Disability- Poverty Cycle Early Intervention in Behavioral Health Care.

Breaking the Disability- Breaking the Disability- Poverty CyclePoverty Cycle

Early Intervention in Behavioral Health Care

An Integrated, Family-Centered An Integrated, Family-Centered Approach to Working with High-Risk Approach to Working with High-Risk PopulationsPopulations

Work undertaken at the Center for Mental Health, Inc in Washington, D.C. between 1990-2006

Presented at the Invitation of Karen Burt, M.D., Director of Integrative Health -- to the Family Practice Residents, Tuesday March 24, 2009 – by Johanna Ferman, M.D., Medical Director, Adult System of Care, Mental Health Division, DHS

Prognosis & The Fault Line

The Fault Line:

Untreated Addiction and Mental IllnessCMH

CourtsCriminal Justice

Dysfunctional School System

Institutionalization Of Children &

Adults

Domestic Violence

Broken Child

Welfare System

Crisis and Emergency Room Visits

PovertyNeo-Natology and High Risk Infants Homelessness

Prognosis and The ElephantPrognosis and The Elephant

Learning Disabilities

Out of home

placementSocial

Emotional Developmental

Delays

UntreatedAddiction & mental

Illness

Disruption of familyas “developmental”

environment

“In utero” exposure to alcohol and drugs – multiple sequelae

Soc/Emotional Difficulties

Depression, Aggression

School failure- Drop out

Early Pregnancy

Gang activity

Use of alcohol/drugs to

Medicate underlyingproblems

CMH

CycleCycleofof

Disability Disability Poverty &Poverty &

HopelessnessHopelessness

“…to break the cycle of disability, poverty and

hopelessness due to untreated mental illness and

addiction...”

Mission at CMHMission at CMH

Target Population: AdultsTarget Population: Adults

Dual Dx MI/SA(10 yrs+) and SPMIDissociative DisordersPTSDMultiple Axis III

High-risk

-- Social-emotional skills gap

Is this familiar?

CMH

Target Population: ChildrenTarget Population: Children Birth through 21 Family history of MI and

addiction In utero/later exposure Developmental Delays

Speech, language, motor S-E

Loss, trauma, abuse Also familiar?

CMH

Child & Family

Mental Health

Substance Abuse

Intake

Evaluation

& Treatment

Testing

Planning

Case Mgmt..

Case Management Services

Physical Medicine Psychiatry

BusinessesUnions

GrassrootsCommunity

Agencies Primary healthcare

PublicHousing

JuvenileJustice

Child Welfare

Schools

Social-emotional skillsFood/clothingTransportationPre-Vocational preparation and job placement

CMH

CMH’s Family Health Model: A Developmental

Paradigm

IINTEGRATED NTEGRATED SSERVICESERVICES

• Evaln and Rx Plng• Reduce barriers to care• Drug/alc testing;

sobriety plan• Health training and

linkage; Prenatal • Grp,ind, fam therapies• Medicn mangt• Daily living skills

including s-e skills • Building community

• Milieu/member council

• Case management• Parenting skills• Arts/music/dance/writing• Linkages, legal,

AA/NA/Churches• Graduation Planning• Spiritual component

CMH

CMH

Sample Mean of Family Treatment Goal Attainment

Site 1 Site 2 Site 3 CMH

University of Illinois Outcome Study (1996-2000)

Women MH Consumers & Their Children

What did we learn from this What did we learn from this integrative work?integrative work?

• Family as central to support• S-e skills, groups

• Engagement• Early intervention

• Public health• UC Davis and other centers

Integrate • MH/SA/H• Intensity of each drives setting

CCC -- Strengths to build on:- CCC -- Strengths to build on:-

o Family Practice Addiction Serviceso A Magnet for Change

Integrative Medicine: EDAPT Groups Front end

IMPACT C-L work

CCRMC Ambulatory care

RxM

QuestionsQuestions