Study pushes early identification of kids' mental health problems

Josue, 15, was born to a 12‐year‐old mother. Exposed to domestic violence and abuse, he struggled in school early on and received a special education evaluation in Grade 4 that found weaknesses in reading, math and writing.

By 13, he had been diagnosed with symptoms of bipolar disorder, depression, learning disabilities and attention deficit disorder. Yet, he started high school with limited support services and ended up suspended from school and referred to the juvenile justice system.

His path through public school is not uncommon in Connecticut cities, according to a new report by the Center for Children's Advocacy, a Connecticut nonprofit that provides legal support for abused and neglected children. The report, which examined school records of 102 youths referred to the Center, found that early warning signs of mental and behavioral health problems often went unheeded until the middle school years -- when interventions came too late.

"Red flags for mental and behavioral health problems are often clear before the end of second grade," said Andrea Spencer, educational consultant to the Center and dean of the School of Education at Pace University, whose work was funded with a grant from the Connecticut Health Foundation. "It is imperative that we improve screening and identification, so support for these children can be provided before their academic careers are at risk."

Spencer's study found that more than 70 percent of the students diagnosed with mental illness and behavioral health problems by middle school had exhibited warning signs by second grade. Almost 25 percent exhibited "red flag" developmental issues during pre-kindergarten years.

Despite the vast majority of records including evidence of academic difficulties -- retentions and social promotions, as well as behavioral and emotional problems -- one in four children in the study sample, ages 12 to 16, had not been evaluated or declared eligible for special education services. For those who were found eligible, 95 percent still struggled academically. High rates of absenteeism, truancy and multiple suspensions were common to those students who did not receive special education services, the report says.

The study found a "high frequency" of multiple out-of-school suspensions among students with behavioral and mental health problems. Spencer noted that research indicates that school suspensions correlate with poor academic achievement, delinquency and alienation.

"These data suggest the critical importance of schools playing a central role in recognizing and responding to children's mental health needs," the report says. "Although only a small percentage of children and adolescents receive needed mental health services, schools are the most common settings in which children access this care."

The findings underline disparities in mental health treatment for racial and ethnic minorities, and inadequate detection and treatment of psychiatric conditions, the report says. Among its recommendations are: improved screening for mental health risk factors; improved community and parent education about risk factors and support; and better training and accountability for school staff and other providers.

In addition, the Center for Children's Advocacy is pushing for a statewide policy change to improve the standard of care for children insured through the state's Medicaid (HUSKY A) plan. Federal Medicaid law requires pediatric providers to conduct mental health screenings during well-care visits, to identify children who are at risk for mental health and behavioral abnormalities. However, most pediatric providers do not conduct basic mental health screenings because they do not receive reimbursement, the Center says.

The Connecticut Department of Social Services has agreed to convene a task force that includes representatives from the Center and other state agencies to review regulations and make recommendations about screening, treatment and reimbursement protocols.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).

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