An 8-year-old girl with a history of aggressive behavior is having “an episode” at home. She has just returned from a week-long hospital stay after making suicidal threats. Her mother is scared.
Nothing is working to calm her daughter down, and mom is worried about the safety of her two younger kids too. Reaching out, the mother calls the Nebraska Family Helpline. A Helpline counselor, staying on the phone as long as it takes, talks the mom through more strategies to calm her daughter. One of the strategies eventually works. The girl agrees to take her medicine, sits quietly and watches television. For now, the crisis subsides.
Understanding the Need
There is not question that many children and youth in Nebraska face behavioral health problems. Putting exact numbers to this population, however, is difficult due to both underreporting and changing interpretations of what constitutes a behavioral health disorder, particularly among children.
Children’s behavioral health in Nebraska is one of the key issues addressed in the recently released Kids Count 2010 report. Kids Count is a national and state-by-state effort sponsored by the Annie E. Casey Foundation to track the status of children in the United States utilizing the best available data. Key indicators measure the education, social, economic and physical well-being of children.
The focus of the 2010 Report Commentary is on Children's Behavioral Heath. Caring for children with behavioral health problems is challenging even for families who have resources and know where to turn for help. For families who do not, getting help is an even greater struggle.
In 2008, Nebraska found itself at the center of a crisis that highlighted this struggle. Families, recognizing a window left open in a “safe haven” policy that had no age limit, relinquished to the custody of the state 36 children - most of whom suffered from behavioral health problems. Thirty-four of the children had received prior mental health treatment. Almost two-thirds were teenagers.
The debacle prompted the governor to convene a special session of the Legislature, where policymakers closed the loophole and limited the safe abandonment law to infants less that 30 days of age. A few months later, in May 2009, legislators passed LB603. This law called for the creation of services intended to connect families with resources to help them through child behavioral health issues.
January 1, 2010, three key pieces of the law went into effect. The Nebraska Family Helpline, a 24-hour hotline available year-round, began service through a contract with Boys Town. Family Navigator Services, the peer support network, began operating under a contract with Boys Town and its subcontractors. The post-adoption/guardianship program Right Turn also was implemented through a joint contract with Lutheran Family Services and the Nebraska Children’s Home Society.
In Nebraska, it has been estimated that as many as 90,000 children and youth have a behavioral health disorder. More than half of these experience significant impairment from such problems. The most recent National Survey of Children’s Health indicated that about 11 percent of Nebraska children ages 2 to 17 have at least one emotional, behavioral or developmental condition.
With vast areas of sparse population, Nebraska is limited in its offerings of behavioral health services that are diverse enough to satisfy a large variety of needs, close enough to access, and affordable enough for all. About 57 percent (291,585) of Nebraska’s children live in counties determined to be health professional shortage areas for mental health.
Gender and Age Matter
Research indicates that girls are less likely than boys to have a mental health problem; however, prevalence of disorders differs along gender lines. For example, boys are more likely to be diagnosed with disruptive and autism spectrum disorders. Girls, on the other hand, are more likely to be diagnosed with anxiety and depression.
During the first two quarters of 2010, more than half of the calls, 55 percent, to the Nebraska Family Helpline were about problems with boys. In the third quarter, that share rose to 61 percent.
Among families served through Family Navigators, however, the ration of boys to girls was split more evenly: 47.3 percent were male, 44.4 percent were female, and 8.3 percent were unknown.
Though poverty alone does not cause behavioral health disorders, children in poverty experience increased environmental stressors and their parents are less likely to have the resources to address behavioral issues. Economic hardship increases the likelihood that parents themselves will experience behavioral health problems or even become abusive.
The National Survey of Children’s Health reported a 28 percent rate of prevalence among our state’s children living under the poverty line, compared with rates of less than 9 percent for children at higher income ranges. This is particularly troubling in light of increasing rates of child poverty.
In 2009, just over 66,000 children in Nebraska, or 15.2 percent, lived in poverty, an increase over the 2000 rate of 10 percent. Knowing that children in poverty face increasing risks of behavioral health disorders and that child poverty is on the rise, it is even more critical to ensure that all children have access to affordable treatment.
Cause For Concern
The recent economic downturn presents additional challenges for implementing improvements in Nebraska’s child behavioral health system. As the state attempts to strengthen its services, projected budget shortfalls threaten even existing programs.
Already, the Nebraska Family Helpline and Family Navigator Services have been listed as potential programs to cut in an effort to reduce the DHHS budget. It is likely that limited funding will hamper additional efforts to successfully implement behavioral health reform.
Cost of the Nebraska Family Helpline program was projected at $1,015,000 for FY 2010, and $1,700,000 for FY 2011, with costs to be paid from general funds.
Improving children’s access to and utilization of behavioral health services in Nebraska will require the efforts of multiple systems, agencies and stakeholders. When it comes to the mental health of our children, we are all in this together.
NOTE: We will continue our series of Kids Count in Nebraska next week, as we examine the areas of Early Childhood Care and Education, and Health and Nutrition.