Childhood trauma, such as violent, dangerous, or life-threatening events, often elicit fear responses and can violate emotional and bodily integrity. Time-limited or single incidents such as car accidents or natural disasters (e.g., floods or earthquakes) can be detrimental to a child’s mental well-being.

Ongoing stress, such as living in a violent neighborhood, witnessing a war, being a refugee, having abusive or emotionally unavailable parents, or being bullied in school, can take a major psychological toll on children. Childhood trauma does not have to involve experiences that occur directly to the child. Watching a loved one being abused or hurt can be extremely traumatic, as can exposure to violent media.

Research has shown that the long-term effects of childhood trauma can lead to learning disabilities, legal problems, inability to maintain relationships, academic and employment challenges, and ongoing physical and mental health concerns.

Following a traumatic experience, children may exhibit signs of acute stress, including behavioral and emotional symptoms.

Signs and Symptoms to Pay Attention to if Your Child Experienced Trauma

• Acting out
• Acting younger than they are (such as sucking their thumb)
• Anger issues
• Attention problems
• Changes in eating patterns
• Difficulty going to the bathroom or bed wetting
• Difficulty in socializing
• Feeling depressed or anxious
• Irritability
• Hypervigilance
• Loss of interest in activities they once enjoyed
• Mood swings
• Poor school performance
• Preoccupation with fears or phobias
• Shyness
• Somatic, bodily complaints such as muscle tension, headaches, or stomachaches
• They may appear to be detached, numb, or delayed in responding
• Trouble sleeping and nightmares

Source: Fizkes/Canva

Navigating the Path to Family Trauma Recovery

Family systems form the foundation of children’s understanding of what it means to be in a relationship and how to communicate. In the face of a traumatic event, the sense of safety for the child or the entire family system may be disrupted.

While navigating the path to family trauma recovery, we must first create a safe environment where open communication is possible. While empathy may not be natural to some, it can be practiced, taught, and modeled. Interactions with children must be developmentally appropriate—both from a cognitive as well as an emotional standpoint.

The goal is to gain insight into the psychological and physiological effects of the trauma as early as possible so that the therapeutic interventions can have the best chance of reducing symptoms and leading to long-term recovery.

10 Ways to Help Your Child Cope

1. Safety first: After a traumatic incident, help your child understand it was not their fault. Reassure them that you will do everything in your power to keep them safe.
2. Open communication is key: Answer all their questions. Encourage your child to talk about their feelings and validate their emotions.
3. Set predictable, consistent daily routines: Similar bedtimes, regular mealtimes, and clear expectations will enforce a sense of safety. While this sounds basic, the guardrails and comfort they provide are critical.
4. Go at their pace: Be in tune with their needs and allow them to recover at their own pace while sticking to a daily routine as much as possible.
5. Get down to their level: Remember, when talking with children, you are larger in size and may come across as intimidating. Consider getting to your child’s eye level and make sure your tone is calm.
6. Talk in a language they can understand: Monitor your choice of words and use phrases that are not too complicated, are matter-of-fact, and convey your message without blame or shame.
7. Validate and mirror their emotions: Validations such as, “I understand you are feeling scared right now” will allow the child to feel heard and seen. It will also enhance their ability to name their emotions.
8. Read books together that examine experiences like theirs: There are a vast number of resources, picture books, self-help books, and chapter books that address struggles such as grief, bullying, having a sick parent, and more. Reading books that examine similar experiences will allow for self-exploration and organic discussion.
9. Model self-regulation: As a parent or caregiver, we can model self-regulation and mindfulness techniques and normalize having difficult emotions while we show them how we cope.
10. Teach them self-soothing techniques and coping strategies: Help your child discover their own coping strategies by exposing them to simple yet effective tools, such as exercising, going outside for a walk, trying children’s yoga, or doing breathing exercises.

Once a safe environment is established and the stage is set for open communication, you can begin to explore outward manifestations and symptoms of the trauma. When we remove ambiguity and the need for guesswork from our interactions with our children, they will have the opportunity to focus their energy on healing and recovery.

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Making friends at the start of a new school year can be scary for kids such as Trae Bruns, a fifth grader in Troy, Illinois.

Trae has a genetic disorder and physical differences, and he doesn’t always approach other kids, his mother, Jackie Bruns, told me. “He usually waits for them to approach him,” she said. “It can be hard for kids with a disability to approach other kids. They don’t know if they will be rejected or made fun of for their disability.”

Fifteen percent of public school students in the United States have a disability diagnosis, which includes both physical disabilities as well as less obvious learning or social disabilities, according to a Pew Research Center analysis of US Census Bureau data. And 95% of kids with disabilities are taught in mainstream classrooms, which means that most children are going to be engaging with all different types of peers on a regular basis.

Here are a few ways parents can encourage their children to assimilate and befriend someone who seems different.

To make school easier for her son, Bruns sends a letter at the start of each school year to parents in her son’s class explaining that he looks different but wants to be treated like anyone else. “I explain that he loves to read, run, play and, most of all, make new friends.”

Dr. Caroline Mendel, a clinical psychologist at the Child Mind Institute in New York City, agrees with this approach and explains that parents can follow up at home, even before the kids meet. It’s an opportunity to say something such as, “I learned that Trae likes Legos. This sounds like something you might want to do together.”

“Parents can teach kids that the most important thing is that we can’t make assumptions based on how someone looks or acts,” Mendel said. “We need to get to know that individual. The disability may be a part of their identity, but it’s not the only thing that defines them. For example, do we both like Pokémon or enjoy soccer?”

That strategy has helped Trae make friends. “If the other person can just start playing or talking to the person with the disability, it makes that person feel more at ease,” Bruns said. “I have witnessed this happen on multiple occasions.”

Kids may still have questions when they meet a new friend. But they always need to respect others and use kind words. Rather than saying, “What’s wrong with you?” they can ask, “Do you mind if I ask about your (prosthetic) leg or wheelchair?” Mendel said.

“It’s OK to be curious, but do so respectfully and avoid touching equipment or devices without permission,” Mendel said. “Explain to kids that politely asking a question is OK, but not everyone is going to want to talk about it.”

If they do want to share, listen and let them take the lead. Kids may share interesting and fun facts about their disability, said Michelle Hu, who grew up wearing hearing aids and now works as a pediatric audiologist.

“Disabilities can be cool, and having different friends is fun and interesting,” Hu said. “For example, hearing aids and cochlear implants can be connected to a music source like headphones. Remote systems can allow kids to accidentally eavesdrop on teachers’ conversations.”

“Disabilities should be normalized. It’s a part of life,” Hu said. “The deaf and hard of hearing community is closely knit, but deafness has a range. Deaf cultures and communities typically use American Sign Language as their primary language. Take an interest, learn some signs — it can be beautiful.”

Aside from getting comfortable with physical differences, kids with disabilities may move differently or respond differently than their peers. If someone who wears hearing aids doesn’t acknowledge your child right away, it’s OK to get that person’s attention and try again, Hu said.

“A lot of times, I felt left out of a conversation, especially in noisy places like the cafeteria,” Hu said. Go ahead and politely ask, “Can you hear me OK?” There’s no reason to shout, but visual cues and repeating something a different way can help kids who use hearing devices be part of the group, Hu said.

While some disabilities are visible, others are not. And explaining that some people may have different social cues or ways of engaging can help them connect with students.

Ten-year-old Gawain Hootman of the East Bay in California is autistic. He wants to be included but isn’t always up for socializing, his mother, Ramsey Hootman, told me. “If I could tell other kids his age to do one thing, it would be to keep inviting him to join them,” she said. “He doesn’t always like to participate, but he always wants to be invited and welcomed. Please don’t treat a ‘no’ today as a no forever.”

Some kids may need time to process the invitation so giving them another chance to join in creates a more welcoming environment for everyone. It also alleviates social pressure to always be consistent.

“While it may feel more natural to approach someone who seems similar, we can learn something from friends who are different,” Mendel said. “A child with autism may have trouble making eye contact or taking turns in a conversation. It doesn’t mean they don’t want to be your friend.”

The bottom line is that everyone is different, but everyone wants to be included.

“Teach your kids to look around the room or playground for kids who are not engaged and invite them to join,” Hootman said.

Jaclyn Greenberg writes about parenting, accessibility and inclusion. She has written for The New York Times, Wired, Parents, Good Housekeeping and other outlets.

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In a recent study published in JAMA Network Open, researchers investigated whether lifestyle interventions such as Mediterranean diet abidance and mindfulness-based stress reduction (MBSR) during pregnancy could effectively improve pediatric neurodevelopment at two years of age.

Study: Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment. Image Credit: ElizavetaGalitckaia/Shutterstock.com

Background

Maternal lifestyle and maternal stress are known modifiable risk factors for fetal neurodevelopment. Studies have reported that unhealthy dietary habits, including increased consumption of fats, and obesity among mothers, can negatively impact neurodevelopment in their children. At the same time, elevated maternal stress levels alter fetal brain structural growth and worsen postnatal neurodevelopment.

The pathophysiological mechanisms underlying these relationships are unclear; however, the hypothalamus-pituitary-adrenal axis (HPA) is reportedly involved. Interventions promoting healthy dietary patterns and stress reduction may restore HPA functions and improve fetal neurodevelopment.

About the study

In the present study, researchers evaluated the impacts of stress reduction and dietary interventions among pregnant females on neurodevelopment in their children aged two years.

The study included the Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) parallel-group randomized controlled trial (RCT) participants, who were enrolled between February 2017 and October 2019 and followed up until childbirth (until 1 March 2020).

The trial was carried out at an educational facility in Barcelona. In total, 1,221 singleton pregnancies (between gestational weeks 19 and 23) with an increased risk of small-for-gestational-age (SGA) newborn delivery were randomly divided into three groups in a 1:1:1 ratio: the dietary intervention group, the Mindfulness-Based Stress Reduction (MBSR) program group, and the regular care group.

The dietary intervention group participants were provided group- and individual-level educational classes and walnuts and extra virgin-type olive oil complimentary every month.

The MBSR group participants underwent an eight-week stress-lowering program tailored to pregnant individuals, and the regular care group received pregnancy care as per standard protocols.

The MBSR program comprised eight weeks of weekly group classes (20 to 25 females per group) of 2.5 hours, one full-day session, and everyday practice at home. The sessions comprised didactic presentations, 45.0-minute mindfulness meditation practices, body awareness, group discussions, and mindful yoga. 

The IMPACT study’s primary endpoint was the proportion of SGA newborns, and the secondary endpoint was adverse perinatal outcomes. The third edition of the Bayley Scales of Infant and Toddler Development Scale (Bayley-III) was used for postnatal evaluation.

All individuals visited the university hospital after completing the intervention (between gestational weeks 34 and 36), to fill out perinatal data-related questionnaires and provide urinary samples for analysis.

The present study outcomes were scores for the motor, language, cognitive, motor, adaptive behavior, and social-emotional Bayley-III domains, evaluated by two trained physiologists. The outcome measure was neurodevelopment at 2.0 years, based on Bayley-III scores.

The relationships between Bayley-III scores, biomarkers, and questionnaire information were also assessed. Linear regression models were used for data analysis between July and November 2022.

Mediterranean dietary evaluations were performed using food frequency questionnaires (FFQs). Stress reduction was assessed using the Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI) questionnaires, the World Health Organization’s Five Well-being Index (WHO-5), and the Five Facet Mindfulness Questionnaire.

Maternal mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ). In addition, maternal 24.0-hour urinary cortisol and cortisone levels were monitored among participants who did not consume corticosteroids.

Results

In total, 626 pediatric individuals [333 (53%) males and 293 (47%) females] participated in the study, among whom the mean age was 25 months. Baseline characteristics were identical among the intervention groups. High adherence was observed among 177 individuals (72%) in the dietary intervention group and 137 (66%) in the MBSR group.

In comparison to regular care group children, those from the dietary intervention group showed higher Bayley-III scores for the socioemotional (mean 109 versus 103) and cognitive (mean 124 versus 119) domains, whereas the MBSR group children showed higher socio-emotional domain scores (mean 108 versus 103), than regular care group children. Similar differences were observed after data adjustments for the mothers’ socioeconomic status and the fetuses’ genders.

Adaptive, motor, and language scores were comparable in the study groups. The IMPACT BCN trial showed a significant decrease in SGA rates (14% with SGA in the dietary intervention group and 16% in the MBSR group compared to 22% in the non-intervention group).

However, non-significant differences were observed in Bayley-III scorings between SGA and non-SGA newborns. The dietary intervention scores showed significantly positive relationships with the language and cognitive domains.

Increased docosahexaenoic acid intake significantly improved language scores, whereas higher trans-fat intake was inversely correlated with language and social-emotional domain scores.

Maternal stress and anxiety levels in the pregnancy period showed significantly negative relationships with domains of Bayley-III. Higher WHO-5 scores were related to higher Bayley-III scores for the language, social-emotional, and adaptive behaviour domains. The 24.0-hour urinary cortisol and cortisone levels were significantly and positively related to the language Bayley-III domain.

Based on the study findings, maternal lifestyle interventions such as MBSR and Mediterranean diets during pregnancy can significantly improve child neurodevelopmental outcomes at two years of age.

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(CBS DETROIT) – As much of the state listens in about the psyche of the Oxford High School shooter, for Cam Romanelli, the descriptions are all too familiar, explained here in a previous interview with CBS Detroit.

“He’s talked about school shootings, he’s talked about shooting up the neighborhood. The school had to implement a safety plan that they pat search him daily. So when I relayed all of this to the school and said I have concerns, he has said, he’s been obsessed with school shootings. It’s documented. The vice principal called me and told me he’s talking to other kids about school shootings,” said Cam Romanelli, the mother of a teen in crisis.

Since the last interview, her son was placed in a mental health facility that she says will send him home within seven to 14 days after arrival. Friday, July 28 marks day number seven. 

“This Friday will be seven days. We have no safety plan created yet. Regarding the release, we are still looking for placement for him. But to date to every placement, I’ve applied at has denied him based on his significant behaviors. There has been no family therapy, nothing in conjunction with him and I, since he’s been in treatment there. And that was part of the plan was doing coordinating family therapy and individual therapy and group therapy for him. So none of that has happened to date,” said Romanelli. 

Michelle Massey Barnes is an administrator with Advocates for Mental Health of Michigan Youth, featured before on CBS Detroit. When asked if Romanelli should be looking for a placement or if it’s something the state should do, she said it depends on who the payer is. 

“It’s seems like there should be a lot more help from the state level at the state or the county to have that kind of help for the family. One of the challenges families have really across the country right now is they’re so few residential beds available that these facilities don’t even call parents back that call and leave messages. There’s a concern that if Cam doesn’t find placement, the option will be then he comes home. And if he comes home and there are not home and community based services to stabilize the needs, then what I mean you have to understand we’re talking about residential placement. But we’re also talking about a youth and a family that can’t access home and community based services at the frequency, duration and scope that is needed for the individual and for the family,” said Barnes.

“My current plan is to refuse to pick him up. We don’t have a safety plan in place and I don’t feel he would be safe to come home for himself for the community and for my family,” said Romanelli. 

So what are the consequences if Romanelli refuses to pick him up?

“The court has made it very clear if I refuse to pick them up a 3200 would be filed against me, which is a CPS case for neglect and abuse, said Romanelli.

“The neglect and abuse is what’s called medical abandonment. So, it would be refusing to pick him up from a facility. Refusing to pick him up from a facility does not seem to be directly tied to the availability of services in the home and in the community. For the safety of the home and in the community,” said Massey-Barnes/Mental Health Advocate 

Once again, CBS News Detroit reached out to HealthWest and the Michigan Department of Health and Human Services to ask about the safety plan. The state’s public information office responded with some general information about community mental health. 

The following is the full email response: 

Hi Amyre,

Here is the information I promised you. I saw your latest questions. I believe Health West will need to respond to those, but I will check with my team if we can provide general input.

Every child deserves access to behavioral health care where and when they need it. When a youth needs treatment services in a residential facility, it is very important that they have services and support for a healthy and successful transition back to the community, including planning for community-based services and supports. Medicaid-funded behavioral health specialty services and supports are managed by a public system through 10 locally operated Prepaid Inpatient Health Plans (PIHP). The residential care facility and the family work with their local Community Mental Health (CMH) to determine a personalized treatment plan tailored to the specific needs of the youth and family. In that plan a longer-term community placement may be needed, or the youth may be able to be treated at home with services coordinated through their local CMH. 

If a family believes that services are not being delivered appropriately, they can take the following actions:

• Request a Person-Centered Planning (PCP) meeting with the CMH.
• Request mediation through the CMH – A recipient or his or her individual representative must be offered an opportunity to request mediation to resolve a dispute between the recipient or his or her individual representative and the community mental health services program or other service provider under contract with the community mental health services program related to planning and providing services or supports to the recipient.
• Contact CMH Customer Service for local dispute resolution 
• Request dispute resolution at the PIHP level or file for a Medicaid fair hearing.
• Medicaid consumer requests a State Fair Hearing with the Michigan Office of Administrative Hearings and Rules (MOAHR)  after receiving notice that an adverse benefit determination (ABD) was upheld by the Local Dispute Resolution Committee.
• A Medicaid consumer initiates a State Fair Hearing with the MOAHR, because the PIHP/CMHSP failed to adhere to the notice and timing requirements. (When this occurs, a consumer is deemed to have exhausted the internal appeals processes).
• A non-Medicaid consumer completes the Local Dispute Resolution Process and requests a Michigan Department of Health and Human Services Alternative Dispute Resolution Hearing.
• File a recipient rights complaint. Contact Information for Local Rights Officers by County. (michigan.gov)

  Background: Public behavioral health services in Michigan are delivered through county-based Community Mental Health Services Programs (CMHSPs), which are public entities that are created by county governments to provide a comprehensive array of mental health services to meet local needs regardless of an individual’s ability to pay. CMHSPs provide Medicaid, state, block grant, and locally funded services to children with serious emotional disturbances, adults with serious mental illness, and children and adults with intellectual/developmental disabilities. These services are either provided directly by the CMHSP or through contracts with providers in the community. Some CMHSPs also contract for direct provision of outpatient and other substance use disorder treatment services (residential, detoxification, and inpatient rehabilitation).

• Prepaid Inpatient Health Plans (PIHPs) contract with CMHSPs, which on behalf of MDHHS, serve as the state’s publicly operated managed behavioral health system for Medicaid-funded behavioral health specialty services and supports. PIHPs are also the responsible entities for directly managing Substance Use Block Grant funding and local substance abuse funding. Ten regionalized PIHPs operate throughout the state and contract directly with MDHHS.

Services for individuals with mild to moderate mental illness are covered by Michigan’s Medicaid Health Plans (MHPs) separate from the PIHPs. MHPs have developed a network of private providers to serve the needs of those with mild to moderate behavioral health problems. Mild to moderate behavioral health services are a benefit that is provided as part of the contracting process for Medicaid health services, including physical health services, by MDHHS.”

As a follow-up to the join e-mail, a meeting was requested with both MDHHS and HealthWest, Romanelli, Massey-Barnes, and myself. Romanelli was sent a waiver by the state granting permission for us all to speak, which she signed. We’re now waiting for that meeting to be scheduled. 

“It’s setting him up to fail. It’s a very unsettling, terrible feeling, not to know from day to day, like what’s happening, what our future looks like, what’s going to happen to my other children? What’s going to happen to me, when all of this comes to an end? So I, my job, I’m tasked with finding a placement by myself, while caring for all of the other children, and dealing with all of these meetings, and everything else. And then if I don’t, they’re going to force me to take him home, which creates an unsafe environment, for my family and for him and for the community. And if I don’t, I’ve been threatened with the removal of my children. I don’t think that’s fair,” said Romanelli. 

Lynn Suftin from MDHHS issued the following statement:     

MDHHS is committed to ensuring every child has access to behavioral health care where and when they need it. (Redacted) Romanelli is currently receiving services provided by (redacted). His mother has located a potential program that will best serve his needs and is working on the admissions process. MDHHS staff, the facility and his mother are reviewing program requirements to assist in coordinating the services as the family sees fit for (redacted). MDHHS has been able to confirm that a safety plan is in place and MDHHS is working to ensure the safety of this family and youth.

MDHHS has a number of resources to help families in crisis. While the authorization provided allows MDHHS to share information about (redacted) behavioral health services, it does not allow the department to discuss other services that may be subject to a different set of confidentiality laws.  

As soon as MDHHS was made aware of the issues the family was having in getting services for (redacted), MDHHS reached out to Lakeshore Regional Entity (LRE) which is the managed care entity responsible to ensure its contracted providers are complying with its expectations, standards and requirements outlined in the MDHHS/PIHP contract. Through its contract with the LRE, MDHHS requires all medically necessary services be provided to children in the amount, scope and duration necessary to allow children to remain safely and successfully in the community. MDHHS requested documentation from the PIHP and CMH outlining the services and supports they were providing. MDHHS has requested further information and is awaiting documentation to assure compliance with contracts and policies. MDHHS is committed to holding its system partners accountable to the high standards outlined in their contracts.

Amyre Makupson

Amyre Makupson is a proud native of Detroit, Michigan. She is a graduate of Mercy High School in Farmington Hills.

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In March 2022, John called the police to his home in Mecklenburg County because his 16-year-old son Paul was experiencing a violent behavioral health episode.

John and his wife began fostering Paul and his two younger siblings when Paul was 12 and later adopted all three children. John said child welfare services had been involved in Paul’s life from a young age, and the boy had several behavioral health diagnoses, including ADHD, a disruptive behavior disorder and an attachment disorder. A child with an attachment disorder struggles to form healthy relationships, and they can have trouble regulating their emotions.

“His behavioral issues became apparent really quick, but we were trying to commit to taking care of him and loving him and keeping the kids together,” John said.

EDITOR’S NOTE: Due to stigma attached to mental illness, this article assigns the pseudonym Paul to an adolescent who has experienced psychiatric hospitalization. His father is identified by his first name only. NC Health News verified their identities and reviewed relevant medical records with the father’s permission.

These violent episodes were not new for Paul. When they happened, John said Paul would scream and throw things, sometimes for more than an hour. No one could calm him down. That March day also wasn’t the first time John had called the police to help with his son. Two years earlier, John said he had to physically restrain his then 14-year-old son when he tried to attack other family members. 

After that, John remembers thinking, “If this happens again, we’ve got to find somewhere else for him to live — because we have two other kids… And if this keeps happening, it’s obvious that whatever we’re doing with [Paul] isn’t what he needs, like he needs more help than we can provide.”

At 16 years old, Paul is now over 6 feet tall and 200 pounds, and John said he can no longer intervene. John also says that Paul started using opioid pills and smoking marijuana, which John believes has negatively affected his son’s behavior. So this time when the police came, the parents asked that their son be taken to Atrium Behavioral Health in downtown Charlotte. 

“We don’t feel safe. We don’t know what to do. We really need treatment for him. Please help us,” John remembers telling hospital staff as he explained the violent episodes at home.

But Paul told the hospital staff that he was fine and said he didn’t know why he was there, John said, adding that Paul has learned what to say to get out of situations. The next day, John said hospital staff called and said that Paul was ready to be discharged and he needed to come pick up his son. 

John told the staff no. He insisted they find a psychiatric treatment facility for Paul. He reiterated that he didn’t feel his family would be safe if Paul came home without some kind of treatment. 

“A different person from the hospital was calling me every day, like, very angry, saying ‘I can’t believe that you would leave your kid here. You need to come get him,’” John recalled. 

When John refused to pick Paul up from the hospital, he said that hospital staff threatened to call the county department of social services and file a child abandonment case. A few days later, someone from the county department showed up at John’s door.

There have been stories like John and Paul’s playing out across the state for some time, child welfare advocates say. A lack of outpatient mental health treatment options and services for children with complex behavioral health issues puts families and hospital emergency departments in a hard spot when it comes to finding care for these kids.

Lack of treatment options

In recent years, more people have sought mental health care, particularly in the wake of the pandemic. For many in crisis, the first stop is in their local emergency room. 

“Because of a lack of resources outside of the walls of our hospitals, behavioral health hospitals and emergency rooms are out of space — to the point of it being a crisis,” an Atrium Health spokesperson told NC Health News in an emailed statement. “Too often, behavioral health patients are ready to be discharged — only to have nowhere to go, and hospitals are forced to house them until a bed opens in a residential type facility or a parent or guardian picks them up.

“There are rare instances when, as a last resort, we need to engage the … social services to intervene to help connect families with social and community resources. We recognize this may create challenges for some families, but it is a necessary step in some cases to ensure those patients in immediate need have support in accessing resources and services,” Atrium’s spokesperson wrote. 

Hospital staff being left with no other option but to call their county social services when a child needs help is “an indictment” of North Carolina’s mental health system, said Corye Dunn, an attorney and the director of public policy with Disability Rights NC.

“It’s not because their needs are intractable but because our system is not set up to meet those needs,” she said. “Then it creates this adversarial relationship, where the parents don’t trust the care providers and the care providers don’t trust the parents. Parents are painted as uncooperative or undermining the care planning because they insist that the child’s care meets a reasonable standard.”

Though it’s difficult to quantify just how often this scenario occurs, Dunn said it’s a problem across the state in rural and urban areas. She added that people often hear about the issue of children in mental health crises and think the solution is to create more inpatient psychiatric beds. 

“But the problem is we don’t have any supports — even when there is inpatient treatment offered,” Dunn explained. “The lack of community-based support is . . . allowing kids to go into crisis because they’re not getting what they need at a lower level of intensity. And then on top of that, the lack of community-based services means that it’s very difficult to discharge from an emergency department or a [psychiatric residential treatment facility] or a psychiatric hospital because there’s not an adequate community-based safety net for kids or adults.”

Dunn said that the state’s six LME-MCOs are the groups responsible for managing behavioral health care for those with the most complex needs and for ensuring that there is an adequate network of services available. 

“I think we have to ask ourselves why those services don’t exist,” Dunn said. 

Why hospitals refer to social services

When a hospital calls a department of social services, they are making a dependency referral as defined under North Carolina statute 7B-101, explained Sen. Sydney Batch (D-Raleigh), who is a family law attorney and child welfare advocate in her work outside in the state legislature. The hospital is telling social services that a parent or guardian is unable to take care of their child and does not have an alternative child care setting. 

Other scenarios where this statute could be applied is if a parent was in a coma, entering substance use treatment or a psychiatric hospital and no relative was available to take the child, Batch said. 

“So the key with dependency is the parent is unable to care for the child,” Batch said. “And in this situation, as you can imagine, the parent is unable. They can’t control the behaviors. There are a lot of issues with regards to mental health, and a child needs a higher level of care than the parent can provide.”

Batch says she gets similar calls from clients in these situations. She had a client tell her that their child tried to stab them, and now they sleep with a lock on their door and they don’t feel their other children are safe. Meanwhile, the hospital emergency department said that the child was “medically ready” to be discharged.

“I do have empathy for the hospitals because they are now the dumping ground of the mental health system,” Batch said.

It can be particularly challenging if a parent has private insurance. Private payers don’t cover in-home intensive services or therapeutic placements at the same level as Medicaid, Batch explained. Medicaid often provides more services and better coverage for children with behavioral health needs. Every child that enters the foster care system automatically receives Medicaid coverage, which could open up more placement and treatment options.

“And so the only choice that the hospital frankly has at that point is to call social services to say, parents can’t pick the kid up and you’re going to have to intervene,” Batch said. “And at that point, DSS should call the parents and try to come up with some alternatives to help the parents navigate a very complicated and broken siloed mental health system that we have in North Carolina.”

Foster families need more support

But even with Medicaid, Paul lacked the appropriate support until he went into crisis and his father fought for help. 

John said Paul had intensive in-home mental health services during the pandemic, but because of social distancing protocols, he claimed the workers never came to their home and only met with Paul over Zoom. John said he always felt like they were just going through the motions and checking off boxes in their care of Paul.

Later, when John discovered Paul was using substances, he tried to get his son help. But unless Paul was actively intoxicated, failed a drug test or was in crisis, the local substance use programs said they couldn’t help, John recalled. He said everywhere he called suggested the same handful of programs that were always full, and no one had any new ideas.

Then, as John argued with Atrium’s staff about finding long-term treatment for his son, he said he started calling private and public facilities looking for a treatment placement for Paul. Some of the private facilities were “eye wateringly” expensive, John said, with price tags of $15,000 a month out of pocket.

John held off on picking up Paul from Atrium for two weeks until a placement was found at an in-state psychiatric residential treatment facility. Now, more than a year later, Paul is living in an intensive group home, and John said his son is doing really well. There’s a possibility that he’ll even be able to live at home again soon.

The county department of social services did open a case. In the family’s paperwork, it says the reason was because the parents refused to pick up their son from Atrium Behavioral Health. The social worker’s written plan for the family was simply to keep in touch with the hospital and the department of social services and follow medical recommendations for Paul’s treatment. 

“It’s very toothless. The hospital and DSS makes these threats towards you. The hospital says, ‘We’re calling DSS.’ And if you’ve never dealt with that before, that sounds really bad. And then you find out later that’s the only play they’ve got,” John said. “Then when DSS gets involved and finds out that you’re a responsible parent trying to get help for your kid, they back off.”

Disability Rights’ Dunn argues that the community has a legal obligation to provide support for children with prior social services involvement — even long after they are adopted. 

“I think there is this optimistic notion that if we just recruit more foster parents or adoptive parents, more families to support children, that that is enough. That is important, but it is absolutely not enough,” she said. “We should expect that kids in general — and particularly kids with DSS involvement — may need treatment on an episodic or ongoing basis. So waiting for them to go into crisis as a way to decide how you’re going to hand out services is cruel.”

Attention from state lawmakers

Problems in  the foster care system  have garnered gut wrenching news stories, including reports about large numbers of children in custody with mental health issues, children boarding for weeks in emergency departments, sleeping in social service offices and being sent out of state for treatment. 

North Carolina is one of only nine states in the country that has a child welfare system that’s directed at the state level, but administered by county governments. Of those nine states, North Carolina had the lowest per child investment across all public funding sources in that system, according to a report generated by DHHS in 2018. 

Annual per child investment in child welfare across peers (states with state-led county-administered child welfare systems). Graphic courtesy: NC DHHS,

“There is an urgent crisis of children with complex behavioral needs who come into the care of child welfare services. Each week, at least 75 of these children are sleeping in child welfare offices or emergency rooms because there is nowhere else for them to go,” said a DHHS  spokesperson in an email to NC Health News. 

“North Carolina has long underfunded its child welfare system, ranking last in per-child funding among peer states with decentralized child welfare systems,” the statement continued. “NCDHHS continues to work with lawmakers to make significant, critical investments in the child welfare system that are as urgently needed as policy improvements. NCDHHS is grateful for NCGA’s $5.7M annual investment in kinship subsidies to ensure more children move into a safe and stable home, and we know that greater investment is needed to address our full system.

Departmental leaders have asked for a total of $47.5M to strengthen specialized behavioral health treatment options in community, residential and inpatient settings for kids. The department asked for $20 million to support child welfare and behavioral health workers across the state and another $12.5 million for services to foster care families. 

State lawmakers included several provisions in their latest state budget proposals to help address some of these problems, but not at the level that’s been requested by DHHS.

The Senate budget proposal includes $15 million in additional funds to support new and enhanced Medicaid services for children receiving foster care services. The Senate budget includes the creation of a work group to identify “innovative Medicaid service options” to address gaps in care for foster youth. Work group tasks include: 

• identifying models of community evidence-based practices that support a foster child returning to the child’s family. 
• diverting higher-level foster care placements.
• identifying short-term residential treatment options to serve children with high needs, which could divert a child away from a psychiatric facility placement. 

The Senate budget proposal also orders the state health department to issue a request for proposals for a single statewide specialty insurance plan for children in the foster care system and their families. A bill that would create this single statewide health plan for children and families involved in the foster care system has been discussed for years. This year’s bill has already passed the North Carolina Senate, but it has been at a halt in the state House of Representatives since early March.

The Senate proposal includes a provision of $750,000 in fiscal year 2023-24 to fund the development and implementation of a trauma-informed, standardized assessment for every child entering the foster care system. This screening is intended to assess the trauma experienced by children in the child welfare system. The Senate proposal would require the assessment to be completed within 10 working days of the referral for children ages 4-17. Currently, there is no standard assessment for kids entering foster care. 

Meanwhile, both chambers propose that foster care funds be used to provide financial support to kids who are in a permanent family placement, who are eligible for legal guardianship or who are otherwise unlikely to achieve permanency. 

The House budget proposal would appropriate $2 million in recurring money for the foster care permanency initiative and add $5.1 million in recurring dollars in fiscal year 2023-24 and $10.2 million in recurring funding in fiscal year 2024-25 to support increased payments to relatives caring for a child in foster care and to support child welfare staffing and administrative costs.  

State lawmakers are hashing out the differences between their budget proposals now, and in the coming weeks they will share their consensus budget plan with the public.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

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Sunshine by LISSUN is dedicated to helping children overcome a range of psychological challenges, including issues related to adolescence, relationship dynamics, behaviour, parental management, career choices, anxiety, depression, OCD, PTSD, and more

LISSUN, India’s one of the largest mental health platforms, has announced the launch of its first offline centre for children facing developmental and behavioural disorders- Sunshine by LISSUN. This initiative reflects the company’s ongoing commitment to addressing the challenges faced by parents and children in finding quality care for issues like Autism, ADHD, Cerebral Palsy, etc. The first Sunshine Centre has been inaugurated in the vibrant neighbourhood of East Patel Nagar, New Delhi. The announcement follows the recent addition of renowned psychologist Dr. Roma Kumar to its team, further enhancing LISSUN’s expertise in child mental health.

 The centre boasts state-of-the-art facilities, including counselling rooms, occupational therapy areas, assessment zones, and more, ensuring a seamless experience for both parents and children. Each Sunshine Centre will feature a dedicated team of Developmental paediatricians, Clinical Psychologists, Speech Therapists, Occupation Therapists, Special Educators, and ABA therapists to help provide multi-disciplinary expertise to parents and their children.

“Amidst the distressing reality that over 50 million children in India grapple with mental health and developmental or behavioural issues, an alarming 80-90% struggle without seeking support. Regrettably, the system remains inadequately funded to tackle this pressing crisis. At LISSUN, we stand firmly dedicated to fostering the well-being of the next generation through the introduction of Sunshine, a profound initiative prioritizing the development of children. We believe that every child deserves access to comprehensive support, and it is our mission to bridge the gap between the need and the available resources. Through Sunshine, we aim to create a safe and nurturing environment where children can explore their emotions, develop resilience, and receive expert guidance tailored to their unique needs.” said Mr. Tarun Gupta, Co-founder & Director, LISSUN.

“In recognizing the limitations of relying solely on a 100 percent digital model for assessing a child’s behaviour, it becomes evident that ensuring accurate findings requires a physical presence. LISSUN has long embraced a phygital approach, understanding the indispensable role of a physical structure in this field backed by a strong tech backbone. Hence, launching the inaugural physical centre for Sunshine by LISSUN signifies yet another stride towards our mission,” stated Dr. Krishna Veer Singh, Co-founder & Director, LISSUN.

Going forward, LISSUN has ambitious plans to establish a chain of Sunshine centres nationwide. In the initial phase, multiple centres are set to be launched in Pune, Lucknow, Jaipur, and Delhi NCR region. This expansion aims to extend the reach and amplify the positive impact of this pioneering initiative, ensuring that children across different locations have access to comprehensive mental health support.

About LISSUN

Launched on 15th August 2021, Headquartered in Gurugram, LISSUN is an organization that has been established to address the rising challenge of mental illness in society. LISSUN was founded by two industry veterans, Krishna Veer Singh and Tarun Gupta, to provide individuals with the right guidance, therapies, and solutions for their emotional and mental well-being in a world full of conflicts. The platform provides end-to-end care for mental health by offering self-diagnosis through tech tools and then provides the necessary treatment to the patient.

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Singapore, Singapore–(Newsfile Corp. – May 31, 2023) – Research has shown that most mental disorders develop in childhood and adolescence before the age of 25, with one-quarter of years lived by young people with disability due to mental and substance use disorders.

To address this pressing concern and mobilise global efforts, the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), International Society for Adolescent Psychiatry and Psychology (ISAPP), World Association for Infant Mental Health (WAIMH), and World Psychiatric Association Child and Adolescent Psychiatry (WPA-CAP) have jointly declared April 23 as the World Infant, Child and Adolescent Mental Health Day (WICAMHD).

This year witnessed the second annual WICAMHD event under the theme of Stand Against Infant, Child and Adolescent Trauma.

Children and adolescents form one third of the world’s population. Childhood and adolescence are foundational years characterised by growth, learning, and carefree exploration. However, many around the world are inflicted by trauma and crisis – adverse experiences which research has shown to have long-lasting effects on their mental and physical well-being.

Studies also show that about 15 percent to 43 percent of girls and 14 percent to 43 percent of boys experience at least one traumatic experience.

Adverse Childhood Experiences (ACEs) are also contributing factors in the development of mental disorders in adult years. The indirect and compounding effects of this is a ballooning economic burden on society, especially in the areas of healthcare and productivity loss.

Children in war zones and natural disasters are particularly vulnerable. During the second annual WICAMHD event under, three renowned speakers shared their expertise on childhood trauma.

Dr Dennis Ougrin, Consultant Child and Adolescent Psychiatrist, Visiting Professor of Child and Adolescent Psychiatry and Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London discussed the impacts of the war in Ukraine.

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Dr Fusun Cetin Cuhadaroglu, Professor of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey presented on the traumatising effects of the recent earthquake in Turkey.

Finally, Dr Michelle Miller, Director of Mental Health Programs, National Children’s Alliance, United States highlighted evidence-based response for children subjected to trauma. This was followed by a panel discussion.

In addition to the main event, several national organisations held events and advocacy efforts commemorating WICAMHD.

These include the Indian Association for Child and Adolescent Mental Health (IACAM), the Lithuanian Society of Child and Adolescent Psychiatry (LVPPD), the American Academy of Child and Adolescent Psychiatry (AACAP), the Austrian Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ASCAP) and the Section of Child and Adolescent Psychiatry, College of Psychiatrists, Academy of Medicine, Singapore (SCAP).

A recording of the event can be viewed at https://www.youtube.com/watch?v=ZoOu7tm9oQU.

Hashtag: #IACAPAP

The issuer is solely responsible for the content of this announcement.

ABOUT THE ORGANISATIONS

INTERNATIONAL ASSOCIATION FOR CHILD AND ADOLESCENT PSYCHIATRY AND ALLIED PROFESSIONS (IACAPAP)

The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) mission is to advocate for the promotion of the mental health and development of children and adolescents through policy, practice and research.

For more information, visit: https://iacapap.org/.

INTERNATIONAL SOCIETY OF ADOLESCENT PSYCHIATRY AND PSYCHOLOGY (ISAPP)

International Society for Adolescent Psychiatry and Psychology (ISAPP) is an organization established to work for the mental health of adolescents, and it is comprised of individual members devoted to working with adolescents, either in the field of child psychiatry and psychology or adult psychiatry and psychology.

The International Society for Adolescent Psychiatry and Psychology’s (ISAPP) mission is to increase public and professional awareness about the mental health and development of adolescents all around the world.

For more information, visit: http://www.isapp.org/.

WORLD ASSOCIATION FOR INFANT MENTAL HEALTH (WAIMH)

The World Association for Infant Mental Health (WAIMH) is a not-for-profit organization for scientific and educational professionals. WAIMH’s central aim is to promote the mental wellbeing and healthy development of infants throughout the world, taking into account cultural, regional, and environmental variations and generating and disseminating scientific knowledge.

WAIMH’s mission promotes education, research, and study of the effects of mental, emotional and social development during infancy on later normal and psychopathological development through international and interdisciplinary cooperation, publications, affiliate associations, and through regional and biennial congresses devoted to scientific, educational, and clinical work with infants and their caregivers.

For more information, visit: https://waimh.org/.

WORLD PSYCHIATRIC ASSOCIATION CHILD AND ADOLESCENT PSYCHIATRY SECTION (WPA-CAP)

The World Psychiatric Association Child and Adolescent Psychiatry (WPA-CAP) section supports the overall mission and goals of the WPA in:

• Working with its members and partners around the world to promote child and adolescent mental health and to encourage the highest possible standards of clinical practice and ethical behaviour in child and adolescent psychiatry.

• Contributing to education programs and research, meetings, and publications to increase knowledge about child and adolescent mental disorders and skills in addressing them.

• Disseminating knowledge about evidence-based therapy and values-based practice in child and adolescent psychiatry.

• Being a voice for the dignity and human rights of young patients and their families

• Upholding the rights of the child and adolescent psychiatrists where they may be challenged.

For more information, visit: https://www.wpanet.org/child-adolescent-psychiatry.

Ms Sue Wong
International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP)
Email: info@iacapap.org

To view the source version of this press release, please visit https://www.newsfilecorp.com/release/167984

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