Breaking the Disability- Poverty Cycle

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Breaking the Disability- Poverty Cycle

• Early Intervention in Behavioral Health Care

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

• 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

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Prognosis and The Elephant
Prognosis The Fault Line
Criminal Justice
Dysfunctional School System
Courts
Institutionalization Of Children Adults
Crisis and Emergency Room Visits
Domestic Violence
Broken Child Welfare System
Poverty
Neo-Natology and High Risk Infants
Homelessness
The Fault Line Untreated Addiction and
Mental Illness
CMH
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CycleofDisability Poverty Hopelessness
Out of home placement
Soc/Emotional Difficulties Depression, Aggression

Social Emotional Developmental Delays
School failure- Drop out
Early Pregnancy
Learning Disabilities

• Disruption of family
• as developmental
• environment

Gang activity
Use of alcohol/drugs to Medicate
underlying problems
In utero exposure to alcohol and drugs
multiple sequelae
Untreated Addiction mental Illness
CMH
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Mission at CMH
to break the cycle of disability, poverty and
hopelessness due to untreated mental illness and
addiction...
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Target Population Adults

• Dual Dx MI/SA(10 yrs) and SPMI
• Dissociative Disorders
• PTSD
• Multiple Axis III
• High-risk
• -- Social-emotional skills gap
• Is this familiar?

CMH
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Target 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
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Family Health Model
Physical Medicine Psychiatry
Businesses Unions
Grassroots Community Agencies
Primary healthcare
Child Family
Intake Evaluation Treatment Testing Planning Cas
e Mgmt..
Child Welfare
Public Housing
Mental Health
Substance Abuse
Juvenile Justice
Schools
Case
Management Services
Social-emotional skills Food/clothing Transporta
tion Pre-Vocational preparation and job placement
CMHs Family Health Model
A Developmental Paradigm
CMH
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INTEGRATED SERVICES

• 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
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Outcome data Changing Prognosis
University of Illinois Outcome Study (1996-2000)
Women MH Consumers Their Children
Site 1
Site 2
Site 3
CMH
Sample Mean of Family Treatment Goal Attainment
CMH
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What did we learn from this 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

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CCC -- Strengths to build on-

• Family Practice Addiction Services
• A Magnet for Change
• Integrative Medicine EDAPT
• Groups Front end
• IMPACT
• C-L work
• CCRMC
• Ambulatory care
• RxM

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Questions