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Monthly Archives: December 2012

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Mental Health Screening in Schools – In the Wake of Newtown

The horror of the mass killings of six faculty and twenty Sandy Hook Elementary School children is still painfully fresh, but it isn’t too soon to begin thinking about what needs to change to try and prevent this from happening again somewhere else.  Much of the discussion following this tragedy will rightly focus on adopting some sensible gun regulations.  But there are other areas that we need to focus on as well because our propensity for social violence is a broad and multifaceted problem.  Our mental health system is another important area to address.  Particularly with respect to children, our ability to identify and treat behavioral problems and mental illness needs to be strengthened.  One aspect of this involves early mental health screenings.  What follows here is a brief and partial list of articles, studies and references on the topic.    It’s not too soon to start educating ourselves.

American academy of pediatrics

MENTAL HEALTH PROBLEMS: CAPACITY TO IDENTIFY, REFER, MANAGE

http://www.nationalguidelines.org/guideline.cfm?guideNum=4-06&gn=d2b44dba-4780-430e-bda1-ef0771de7409

Summary: The purpose of Health, Mental Health and Safety Guidelines for Schools is to help those who influence the health and safety of students and school staff while they are in school, on school grounds, on their way to or from school, and involved in school-sponsored activities. The guidelines recognize that the primary mission of schools is to educate students. Schools also have a responsibility for students’ health and safety while they are at school. By addressing health, mental health, and safety issues (including transportation and motor vehicle safety), schools can improve students’ academic performance today and contribute to their increased longevity and productivity long after they leave school.

Excerpt: Early identification of students with, or at risk for, transient or on-going mental disorders, followed by early intervention can mitigate the severity and duration of these problems and reduce personal, social, educational, and financial costs to the student and family and the educational and health systems. Up to three-quarters of U.S. children receiving professional care for a mental health problem obtained services through a school-based program.

Citations: Suggested citation, prior to written publication:
Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S: Health, Mental Health and Safety Guidelines for Schools. (2004); Available at http://www.schoolhealth.org 

Mental Health Screening in Schools

http://www.nami.org/Template.cfm?Section=schools_and_education&template=/ContentManagement/ContentDisplay.cfm&ContentID=43074

Summary: This article discusses the importance of screening students in

schools for emotional/behavioral problems.  Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented. Careful planning and implementation of mental

health screening in schools offers a number of benefits including enhancing outreach

and help to youth in need, and mobilizing school and community efforts to promote

student mental health while reducing barriers to their learning. When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system.

Excerpt: “Youth with internalizing disorders such as depression, anxiety, or suicide ideation are not as easily identified as those with acting-out or externalizing disorders. Individuals with internalizing conditions comprise a significant population; the 2003 Youth Risk Behavior Survey, a nationally representative sample of more than 15,000 high school students throughout the United States, found that in the 12-month period preceding the survey, 16.9% had seriously considered attempting suicide, 16.5% had

made a plan for attempting suicide, 8.5% had attempted suicide 1 or more times, and 2.9% had made an attempt requiring medical attention.

Citation: Weist MD, Rubin M, Moore E, Adelsheim S, Wrobel G. Mental health

screening in schools. J Sch Health. 2007; 77: 53-58.

Screening Mental Health Problems in Schools

http://smhp.psych.ucla.edu/pdfdocs/policyissues/mhscreeningissues.pdf

Summary:  This brief highlights the following issues:

• How appropriate is large-scale screening for mental health problems?

• Will the costs of large-scale mental health screening programs

outweigh the benefits?

• Are schools an appropriate venue for large-scale screening of mental

health problems?

Excerpt: 

• Advocates for large-scale MH screening in schools see major benefits to individuals and

society of finding many more students with problems in order to treat them before the

problems become severe. In citing benefits for screening children and adolescents, the

assumption is that those identified will receive effective treatments. Based on this

assumption, key benefits claimed are preventing problems from becoming worse and

enhancing student success at school, which generates other benefits for students, their

families, and their teachers and for the society in terms of future productivity and which

reduces costs because there is less need for intensive treatments and special education.

In citing benefits for using schools as a venue for public health programs, as compared to

other community venues, matters of ready access and reduced costs are stressed, as well

as the benefits to schools of having students with problems treated.

• Those who oppose large-scale screening raise a host of concerns (i.e., potential costs). For some, there is a fundamental fear that society will mandate such screening and thereby interfere with what should remain a personal family matter and will violate rights to privacy,  consent, and parental control. Others are concerned that screening will increase referrals for nonexistent treatment resources and that the dollars budgeted for screening will reduce the dollars allocated for treatment. Still others point to the evidence that available screening methods used in schools produce too many errors (e.g., false positive identifications, inappropriate over-identification of subgroups such as some ethnic groups and boys with externalizing problems and girls with internalizing problems). Relatedly, they argue there will be insufficient follow-up assessment resources to correct for false positive identifications.  And, some argue there are significant costs resulting from selffulfilling prophecies and stigmatization.

In arguing against using schools, there is the social philosophical argument that mental

health is one of those matters that should remain a domain for family, not school,

intervention. More pragmatically, it is argued that scarce school time and resources should not be used for matters not directly related to teaching. Others point to the lack of enough competent school personnel to plan, implement, and evaluate large-scale screening.

Examples of documents covering the issues:

Screening Aimed at Preventing Youth Suicide (2005)

by Ellie Ashford for the National School Board Association’s School Board News

http://www.nsba.org/site/print.asp?TRACKID=&VID=55&ACTION=PRINT&CID=682&DID=36189  Provides a quick overview for school boards of some of the controversies and places them in the context of current events.

Screening for Depression: Recommendations and Rationale (2002)

by U.S. Preventive Services Task Force for Agency for Healthcare Research and Quality

http://www.ahrq.gov/clinic/3rduspstf/depressrr.htm  and

Screening for Suicide Risk: Recommendation and Rationale (2004)

by U.S. Preventive Services Task Force for Agency for Healthcare Research and Quality

http://www.ahrq.gov/clinic/3rduspstf/suicide/suiciderr.htm

 

Citation: The Center is co-directed by Howard Adelman and Linda Taylor and operates

under the auspices of the School Mental Health Project, Dept. of Psychology, UCLA,

Write: Center for Mental Health in Schools, Box 951563, Los Angeles, CA90095-1563

Phone: (310) 825-3634     Fax: (310) 206-5895    Toll Free: (866) 846-4843

email: smhp@ucla.edu website: http://smhp.psych.ucla.edu

Mental health screening in schools

http://www.ncbi.nlm.nih.gov/pubmed/17222155

Summary: This article discusses the importance of screening students in schools for emotional/behavioral problems. Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented.

Excerpt: When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system. Screening, as part of a coordinated and comprehensive school mental health program, complements the mission of schools, identifies youth in need, links them to effective services, and contributes to positive educational outcomes valued by families, schools, and communities.

Citations:  Weist MDRubin MMoore EAdelsheim SWrobel G.

Division of Child and Adolescent Psychiatry, Center for School Mental Health Analysis and Action, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mweist@psych.umaryland.edu

 

Study pushes early identification of kids’ mental health problems

http://www.theday.com/article/20120914/NWS12/120919796/1018

Lisa Chedekel, Conn. Health I-Team Writer

Publication: theday.com

Published 09/14/2012 12:00 AM

Updated 09/15/2012 12:13 AM

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.

[SNIP]

“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 PaceUniversity, 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.”

Please go to the above URL address to continue reading.

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Gun Homicide Rate 22 Times Higher Than Other Advanced Nations

The following was just published in October.  Given the events of yesterday it is worth going back to read this again.  Clearly we need to reconsider some sensible changes to our gun laws to keep them out of the hands of people who are emotionally unstable, domestic abusers and criminals.  We should also have a national law against gun trafficking (crazy that we don’t).

From: John Hopkins Bloomberg School of Public Health

October 25, 2012

Restricting High-Risk Individuals from Owning Guns Saves Lives

On July 20, a gunman in Aurora, Colorado, used an assault rifle to murder 12 people and wound 58 others. Although this was one of the worst mass shootings in U.S. history, all mass shootings account for a small percentage of gun violence that occurs in the U.S. every day. In the past 100 days since the Aurora shooting, an estimated 3,035 Americans have died as a result of gun violence.

new report by researchers at the Johns Hopkins Bloomberg School of Public Health examines policies and initiatives for reducing gun violence in the U.S. by reforming current gun policies. The report, a synthesis of prior research and analysis conducted by researchers with the Johns Hopkins Center for Gun Policy and Research, includes the following key findings:

  • Easy access to firearms with large-capacity magazines facilitates higher casualties in mass shootings.
  • “Right-to-carry” gun laws do not reduce violent crime.
  • Prohibiting high-risk groups from having guns–criminals, perpetrators of domestic violence, youths under age 21, substance abusers, and those with severe mental illnesses–and closing loopholes that enable them to have guns are integral and politically feasible steps to reduce gun violence. 

Please go to the new report (above) or the full News Release.

Another Dark Day Passing

I am sick, and angry and so sad all at once.   The news of the shootings at Sandy Hook school in Newtown, Connecticut, is deeply disturbing.  Twenty little children murdered.  My heart breaks for the parents whose children won’t be there for Christmas, for the families of the faculty who died in service to their community and to every person who must bear the burden of what they witnessed in Newtown today.  This moment is reserved for those most devastated by the tragedy.   The rest of us can only imagine joining with them in their grief and profound loss. 

But when these days of mourning are over, and a time for sober reflection emerges, don’t let our insane national gun control dialogue crowd out all the other important areas to which our attention must turn:  Our failing  mental health systems;  cyber violence and violence in our entertainment media;  child abuse and neglect;  bullying;  aggressive models for  problem solving and the unrestrained hostility in our very public  discourse.  There is, unfortunately, always a smoking gun in mass shootings but there is never a single direction to look for answers.  If we can muster the patience, the  persistence and the discipline to look both broadly and deeply into our propensity for violence we may come away with a better understanding of how to change.  Let this be the legacy of the children we lost today in Newtown.

 

 

Government Jobs Not Rebounding As In Past Recessions

The graph below depicts the rebound in government jobs over the past four recessions.  This time it is different.  Government jobs aren’t returning.  The present financial crisis and austerity budgets at the state level have given governors the green light to radically reduce public sector employment levels in unprecedented ways.  This not only hurts our economy, it damages the ability of state and local governments to serve the needs of its citizens.
 In a prior post I presented original data on state employment data showing the national trend in state austerity budgets.  The private sector job growth has already rebounded to pre-recession levels, but has not caught up to where it should be by now. In contrast, government austerity budgets are keeping public sector employment depressed and below pre-recession levels.  The graph above and the following article add to this information. State governors should be helping to lead us out of this recession and at the least preserving jobs.]

Public-sector austerity in one graph

Posted by  at 03:35 PM ET, 06/11/2012

On Friday, I ran some numbers on public-sector employment:  Since Obama was elected, the public sector has lost about 600,000 jobs. If you put those jobs back, the unemployment rate would be 7.8 percent. [SNIP]

Today, Ben Polak, chairman of the economics department at Yale University, and Peter K. Schott, professor of economics at the Yale School of Management, widen the lens, with similar results: There is something historically different about this recession and its aftermath: in the past, local government employment has been almost recession-proof. This time it’s not.  [SNIP] Go to like to read the rest of Ezra Klein’s article.  Thank you.

Clearing the Air – We’ve Made Progress in Fighting Pollution

Government regulation is so demonized today in part because it is a victim of its own success.  Who needs air pollution standards when skies are blue and the air smells sweet?  Aren’t federal government regulations just a drag on the economy?  As progress is made in cleaning up the air we breath, push back to dismantle the regulations that have been working becomes greater sometimes.  The same powers of industry that created unbearable air quality in the past are pressuring Congress today to ease up on clean air emissions standards.  We must hold the line and, in fact, move forward with improved standards.

Below are some picture that tell a story all by themselves, followed by a reminder that the relatively clean air and water we enjoy today was a hard fought bipartisan victory thanks, in part, to Richard Nixon.
This post began with the following note  from a friend:  My Urban Policy studies lead me to these websites.  My favorite is Planetizen.  If you are at all interested in how the commonwealth works, give these a look.
Anyway, here’s a look at Pittsburgh before government regulation of industrial pollution.  This is what unfettered capitalism will do.  The Republicans of today would have us believe that regulation is the devil.  Shall we go back to theEden that was America?

What Pittsburgh Looked Like When It Decided It Had a Pollution Problem

by Mark Barnes – June 5, 2012
 

In 1941, influenced by a similar policy introduced in St. Louis four years earlier, the city of Pittsburgh passed a law designed to reduce coal production in pursuit of cleaner air. Not willing to cripple such an important part of the local economy, it promised to clean the air by using treated local coal. The new policy ended up not being fully enacted until after World War II.

While the idea was a small step in the right direction, other factors ultimately helped improvePittsburgh’s notorious air quality. Natural gas was piped into the city. Regional railroad companies switched from coal to diesel locomotives. And, ultimately, the collapse of the iron and steel production industries in the 1980s led to rapidly improved air quality leading into the 21st century.  Control of coal smoke made it possible to clean soot-covered buildings and to re-plant hillsides, helping provide the city a look it could hardly envision in the depths of its industrial heyday.

Below, a look at downtown Pittsburgh between 1940 and 1945, courtesy of the University of Pittsburgh’s Smoke Control Lantern Slide Collection: [note: Only a small selection from website appear here.  Go to the website to see all the photographs.]
 

 

Remarks on Signing the Clean Air Amendments of 1970.
December 31, 1970

[excerpt]

The year 1970 has been a year of great progress in this field. In February, you will recall that I submitted the most comprehensive message on the environment ever proposed by a President of the United States. During the year, there have been some administrative actions, some legislative actions.

Time, however, has been required for the Congress to consider the proposals of the administration and, finally, to agree on the legislation that will be sent to the President for signature.

This is the most important piece of legislation, in my opinion, dealing with the problem of clean air that we have this year and the most important in our history.
It provides, as you know, for provisions dealing with fuel emissions and also for air quality standards, and it provides for ‘the additional enforcement procedures which are absolutely important in this particular area.

How did this come about? It came about by the President proposing. It came about by a bipartisan effort represented by the Senators and Congressmen, who are here today, in acting. Senator Randolph, Senator Cooper, and Congressman Springer represent both parties and both Houses of the Congress. [snip]

And if, as we sign this bill in this room, we can look back and say, in the Roosevelt Room on the last day of 1970, we signed a historic piece of legislation that put us far down the road toward a goal that Theodore Roosevelt, 70 years ago, spoke eloquently about: a goal of clean air, clean water, and open spaces for the future generations of America.

Read more at the American Presidency Project:Richard Nixon: Remarks on Signing the Clean Air Amendments of 1970.

A Flat Tax Payroll Deduction Might Save Social Security

DATA DRIVEN POINT OF VIEW: Don’t be fooled.  Discussions about raising or lowering Federal Income Taxes has little to do with Social Security and Medicare, which are separately funded by payroll deductions.  Is there a funding crisis for Social Security and Medicare?  A long term problem, yes.  A crisis, no.  Can America continue to afford these programs given the number of baby boomer retirements?  The answer is yes, of course we can.  We are the wealthiest county on Earth.  Nations with far less wealthier already provide their citizens with much more generous benefits.  The reason we feel the funding punch is that the structure we’ve enacted to pay for federal insurance benefits is so regressive.

The table below makes obvious that wealthy Americans currently share almost none of the burden for Social Security and Medicare benefits.  The problem is that wealth is concentrated at the top of the income scale while payroll deductions are disproportionately collected from the bottom of the scale.  We can continue to raise the contribution rates but this only hurts those who earn the least.  We can keep raising the income cap but this only marginally increases the number of people pay into the system.

—  OR  —

We could institute a flat tax for Social Security and Medicare.  The table below shows what this might generate in premiums at the current 7.65% rate of payroll deductions.  This plan would clearly generate more revenue than needed for current benefits.  A flat payroll tax of significantly less than the current 7.65% would be all that is needed to fully fund Social Security and Medicare. It would reduce payroll taxes for the majority of Americans.

Payroll Taxes for Social Security and Medicare
Total Income from Wages
Amount Currently Deducted
Contribution As a % of Income
Contribution if deductions were based on a flat tax
$1,000
$77
7.65%
$77
This Segment Represents 57 million households
$10,000
$765
7.65%
$765
$50,000
$3,825
7.65%
$3,825
$100,000
$7,650
7.65%
$7,650
$500,000
$8,423
1.68%
$38,250
$1,000,000
$8,423
0.84%
$76,500
There are at least 100,000 household in this segment
$10,000,000
$8,423
0.084%
$765,000
$50,000,000
$8,423
0.017%
$3,825,000
$100,000,000
$8,423
0.0084%
$7,650,000
$500,000,000
$8,423
0.0017%
$38,250,000
$1,000,000,000
$8,423
0.00084%
$76,500,000
$10,000,000,000
$8,423
0.000084%
$765,000,000

This table assumes that income from wages for the wealthy are at least $110,100, which is the income cap for 2012, and assumes they are not self-employed. Income from investments are not subject to payroll deductions.  Employers pay an additional 7.65% in payroll taxes for their employees. The self employed also pay corresponding more in payroll taxes for their Social Security and Medicare benefits. Additional payroll deductions for unemployment and disability insurance may also apply in certain states and with certain individual.

These programs exist for everyone, and everyone should contribute according to their means. Those who are fortunate enough not to need the benefits still have a moral obligation to assure a minimal level of care to those less fortunate, and a social obligation to contributed to those who gave a lifetime of labor creating the fabulous wealth that the wealthy have accumulated.

Originally posted 14th June by 

Map Pinpoints Where Children Are Being Sexually Abused. Why Aren’t We INVESTIGATING?

The trial and conviction of former Penn State football coach, Jerry Sandusky,  for child sexual abuse allowed many people to hear  for the first time the graph details that makes these crimes so repulsive.   Civil hearings on child sexual abuse cases usually take place in closed courtrooms for the protection of these young victims.  In this case, however, the victims are now adults, the trial was public and very high profile.  People paid attention and learned just how violent these child rapes are.   This made it  easy to see just how destructive these betrayals of a child’s trust are and why it scars children for life.

This may be a good point to consider the scope of the child sexual abuse problem.   Perhaps the information presented below will have greater resonance than when first posted a number of months ago.  Each red dot on the map below is a Sandusky type horror story for some innocent child in America.   So what are we going to do about it???

The map below shows the locations of hundreds of thousands of criminals trafficking in child abuse images… and the locations of many of their U.S. child victims. Produced by the Wyoming Attorney General’s Office, and based on investigations by Internet Crimes Against Children (ICAC) law enforcement task forces, it was introduced as evidence in U.S. House and Senate hearings in 2007-2008. The red dots represent unique computers seen by the ICACs trafficking in video and photos of very young children being raped. These images are often called “child pornography,” but they are actually crime scene recordings.

Map

Most of these children wait for a rescue that will never come. They are in extreme danger and law enforcement knows where they are. Investigators go home every night knowing there are thousands of children out there beyond their reach, because they have not been given the resources they need to rescue them.

See The Ed Show Segment on this issue
Watch a Video Plea From Children
Go to Protect for More Detailed Information
Take Action
View my post on Child Fatality Risk Factors (Because child sexual abuse is not the only problem our children face every day)