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Report on 19th Annual Rosalyn Carter Georgia Mental Health Forum-May 16, 2014

Tuesday, June 03, 2014  
Posted by: GPA Staff
*GPA Member Betsy Gard, PhD attended the event as a GPA representative.

The Forum consisted of three panels. The first panel provided an update on Georgia’s progress in Year 3 following the Department of Justice Settlement. The second panel presented the state of ADHD care in Georgia. The third panel examined the current status of the mental health workforce in Georgia.

In the first panel, the Georgia Department of Behavioral Health and Developmental Disabilities reported that there has been significant progress and they have met goals in their Mobile crisis teams, Intensive case Management Teams, in Supportive Employment Programs, in Intensive Case Management Programs, in Peer Support Programs, in Crisis Respite Apartments, and in Crisis Service Units. They are continuing to work on Supported Housing. There are continuing needs to work with those who have Developmental Disabilities to meet their needs as laid out by the Department and DOJ.

In the 2nd Panel, a report was made on the state of children and ADHD. ADHD is the most prevalent mental disorder in children and was found to be diagnosed nationwide in 11% of children aged 4-17 in 2011. 8.8 % were found to have a current diagnosis in 2011. In Georgia, we were found to have a slightly higher prevalence of 9.2 %. The greatest concern was raised over the diagnosis and treatment of ADHD in very young children, under the age of six.

This was then reported on in the New York Times on May 16, 2004.

The New Inequality for Toddlers: Less Income; More Ritalin

By KJ DELL'ANTONIA MAY 16, 2014, 9:47 PM

“More  than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.


Motherlode Blog: The New Inequality for Toddlers: Less Income; More Ritalin MAY 16, 2014

“The American Academy of Pediatrics standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger — let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. “It’s absolutely shocking, and it shouldn’t be happening,” said Anita Zervigon-Hakes, a children’s mental health consultant to the Carter Center. “People are just feeling around in the dark. We obviously don’t have our act together for little children.”

“Particularly given that there is still a debate among practitioners and researchers regarding whether ADHD has a biological basis, or is a label given to a collection of symptoms, diagnosis among very young children of a disorder based on symptoms that can be considered typical of many young children (short attention spans, talking a lot, unusually active and noisy, prone to disregarding instructions to remain still) is difficult at best. A diagnosis solid enough to use as a basis for prescribing stimulant medications, which have not been proved safe or effective for that age group, should be nearly impossible to come by. Judging by the numbers, under certain circumstances, that isn’t the case.

Medication for some toddlers can seem like a cheap and fast fix, and one that parents who are probably already struggling may welcome. Many toddlers on Medicaid live in single-parent homes, where the time to put into alternative programs may be as scarce as the programs themselves.

It was recommended that behavioral therapy be the 1st therapy approach for young children that only if behavioral therapy is ineffective, that medication be considered for moderate to severe disturbances that do not significantly improve.

In the 3rd panel, the discussion focused on the problems with the inadequate number of mental health work force that is available in Georgia. The following ranking were found for Georgia across the different disciplines:

Rankings of Behavioral Health Professionals per 100,000 in Georgia
Marriage and Family Counselors—31st
Psychiatric Advance Practice RNS -28th
Psychiatrists-30th Psychologists-42nd
Registered Nurses-40th Physicians-40th
Social Workers-41st.

The discussion then focused on what can help in the future with Work Force Challenges. These included; using multidisciplinary teams to provide services. We will also need to use data to improve practice, make sure we employ a recovery based approach, try to increase the diversity of the health care providers to more match the population of those needing care, use telehealth and technology to extend our reach to meet those in rural populations, and use stepped care models for better systems of care.

We also need to provide more systematic career ladders and have better leadership development. We need to provide better supervision models and assure that an incompetent service system does not thwart competent workers.