EBD Blog

The US Congress is considering legislation to prevent abusive restraint and seclusion of students in schools. This is a welcome consequence of the highly visible reports about terrible abuses of students’ right to be free from harm. However, as much as I support this initiative, it is important to make clear that the laws (and regulations resulting from them) must be crafted carefully.

Here’s some text from the press efforts by the US House of Representatives about this important legislation. I follow it with a cautious support of the law.
Continue reading ‘US legislators consider law for preventing abusive restraint and seclusion’

Buie et al.’s “Take-Away Messages”

In Pediatrics Dr. Timothy Buie and colleagues published a paper providing evidence-based recommendations for pediatricians who evaluate and treat gastrointestinal problems in patients with Autism. The authors, who represent many important scientific groups concerned with allergies, gastrointestinal disorders, nutrition, and similar problems, concluded that children with Autism and related disorders should be assessed and, as approriate, given medical care just as would individuals without Autism. The team encouraged pediatricians to develop and employ “evidence-based algorithms for the assessment of abdominal pain, constipation, chronic diarrhea, and gastroesophageal reflux disease (GERD).”
Continue reading ‘Science, gastro-intestinal problems, diets, and Autism’

Right here in my home commonwealth of Virginia last week, Mira Signe, Vicki Hardy-Murrell, John Morgan, and Margaret Nimmo Crowe explained why it is important that government and private organizations attend to and address issues in children’s mental health. By explaining that Virginia has inadequate services and that one in every five children or youths experience mental health problems at some time during their lives, they made the point that that there is a tremendous need for public focus on these issues. This was the kick-off event for the Campaign for Children’s Mental Health.

The Campaign for Children’s Mental Health is a 3-year sustained effort to make mental health services more available and accessible to Virginia children in need. It will strongly endorse Governor-elect McDonnell’s call for system improvements; urge the General Assembly and state and local government to work collaboratively with the administration to address system deficiencies; and conduct a high-profile three-year advocacy and education drive to build public and political support for improved mental health services for children.

Only about one in 20 of Virginia’s children have access to the key services listed in the accompanying box. So, four out of five children who need these services do not have access to them.

No, Virginia, this is not an acceptable way to treat our children. Let’s do better.

• Down load the press release (source of the excerpt quoted here).
• Read coverage in these newspapers:
  • Lynchburg News and Advance—Coalition pushes mental-health care for children
  • Washington Examiner&mdash:Advocates start bid to expand children’s mental health services under bleak budget;
  • Richmond Times Dispatch— Coalition advocate mental-health care for children
  • Washington Post (blog)—New coalition has AG’s support for mental health reforms
• Visit (and support) the Web site of the Campaign for Children’s Mental Health.
• Download pdfs of “Survey of Community Services Board Child and Adolescent Services” and “Review of Community Services Board Child and Adolescent Services“; these are report by James W. Stewart, Inspector General for Virginia’s Mental Health, Mental Retardation & Substance Abuse Services (now called Behavioral Health and Development Services). The list of key services comes from these reports;
• Visit the < href="http://www.facebook.com/pages/The-Campaign-for-Childrens-Mental-Health/183467424796?v=wall" target="_blank">Facebook page;
• Listen to a brief (3+ min) interview with Ms. Crowe from WMRA: Pushing for Children’s Mental Health Reform.

Hill Walker and colleagues reported that the First Step to Success program benefitted young children at risk for developing emotional or behavioral disorders. In a longitudinal study of the three-year program conducted in Albuquerque (NM, US), the researchers found substantial reductions in disruptive behavior and improvements in social functioning.

In a press release, Professor Walker said, “Albuquerque was the first opportunity we had to mount a large-scale study of the program using a randomized control group, the gold standard for research. First Step has been implemented widely, but not [studied] in this way.”
Continue reading ‘First Step takes off’

Michael Aman and co-authors (and there are at least 25 of them) reported that a combination of medication and parent training in behavior management was more effective than medication alone in reducing behavior problems. They assigned families randomly assigned to receive either risperidone as well as parent management training or risperidone alone. After 24 weeks, they assessed the children’s behavior with parent-report measures. The parents who learned to use behavior management strategies reported lower levels of non-compliant behavior and irritability.
Continue reading ‘Meds plus behavior management for Autism’

Arne Duncan, US Secretary of Education, wrote to the chief officers of education for each of the states in the US on 31 July 2009 regarding the use of seclusion and restraint in schools. He expressed concern about the testimony heard recently by the Education and Labor Committee of the US House of Representatives, and recommended that states adopt Positive Behavioral Interventions and Support.

My home State of Illinois has what I believe to be one good approach, including both a strong focus upon Positive Behavior Intervention and Supports (PBIS) as well as State regulations that limit the use of seclusion and restraint under most circumstances….

Several other States have also adopted effective seclusion and/or restraint policies, but there are many jurisdictions that have not, leaving students and teachers vulnerable.
Continue reading ‘A. Duncan promotes PBIS’

The Substance Abuse and Mental Health Services Administration, which is a part of the US Department of Health and Human Services, maintains a Web site where users can search for and learn more about methods for preventing or treating some Emotional and Behavioral Disorders. It’s called the “National Registry of Evidence-based Programs and Practices” (NREPP) and, for those who are concerned about employing or recommending evidence-based practices, it’s worth reviewing.

The National Registry of Evidence-based Programs and Practices (NREPP) is a searchable online registry of mental health and substance abuse interventions that have been reviewed and rated by independent reviewers.

The purpose of this registry is to assist the public in identifying approaches to preventing and treating mental and/or substance use disorders that have been scientifically tested and that can be readily disseminated to the field. NREPP is one way that SAMHSA is working to improve access to information on tested interventions and thereby reduce the lag time between the creation of scientific knowledge and its practical application in the field.

NREPP is a voluntary, self-nominating system in which intervention developers elect to participate. There will always be some interventions that are not submitted to NREPP, and not all that are submitted are reviewed. In addition, new intervention summaries are continually being added. The registry is expected to grow to a large number of interventions over the coming months and years. Please check back regularly to access the latest updates.

Although NREPP originally focused on substance abuse, its coverage is broader now. Look for resources about, for examples, Across Ages; Aggressors, Victims, and Bystanders: Thinking and Acting To Prevent Violence; Al’s Pals: Kids Making Healthy Choices; All Stars; Caring School Community; CASASTART; Children’s Summer Treatment Program (STP); Coping Cat; Creating Lasting Family Connections (CLFC)/Creating Lasting Connections (CLC); Early Risers “Skills for Success”; Families and Schools Together (FAST); Guiding Good Choices; Incredible Years; Keep A Clear Mind (KACM); Keepin’ it REAL; Lions Quest Skills for Adolescence; Multisystemic Therapy (MST) for Juvenile Offenders; Multisystemic Therapy With Psychiatric Supports (MST-Psychiatric); Positive Action; Primary Project; Project Northland; Project Towards No Tobacco Use; Project Venture; Promoting Alternative THinking Strategies (PATHS), PATHS Preschool; Protecting You/Protecting Me; Right Decisions, Right Now: Be Tobacco Free; SAFEChildren; Second Step; SMARTteam; Storytelling for Empowerment; Strengthening Families Program; Strengthening Families Program: For Parents and Youth 10-14; Success in Stages: Build Respect, Stop Bullying; Too Good for Drugs; and Too Good for Violence;

Children and youths with ADHD and their families ought to know about systems of care. Systems of care are networks of services that are coordinated across different agencies and groups within the community. A system of care focuses on the needs of individuals and should be designed so that it takes advantage of that person’s strengths (i.e., is “strengths based”) and unique characteristics (e.g., ethnic background and native language).

Systems of care have been studied extensively in the disciplines focused on Emotional and Behavioral Disorders. They are not just for kids “lost to the streets.” The coordination of services can be beneficial for individuals with ADHD, too.

Learn more about ADHD and systems of care from the SAMHSA, the US Substance Abuse and Mental Health Services Administration. Download a PDF.

Summer in the US finds children and youths out of school and, perhaps, less vulnerable to some of the problems that are associated with the social and academic demands that are part of schooling. As a result, perhaps fewer of the familiar problems illustrated in this poster are apparent during summer.

If summer seems like a relief from such problems, though, that could be an important indicator that those very problems need to be addressed. A few weeks away from school probably will not cure them. Those same difficulties may still be occurring, just less obviously, and they are likely to recur soon.

Individuals or the families of children who experience the kinds of problems noted in the poster should consult the resources available from the US government’s Substance Abuse and Mental Health Services Administration. One will not find easy cures there, but by carefully perusing the resources available one can learn what signs to monitor and where to go to get help.

The image is hot. Click it to get to a good starting place.

Even though many schools in the US have closed for the summer or are about to do so, I want to remind folks that this is not a good time to take a break from considering the mental health needs of children and youth. Although they are likely to wax and wane over time, mental health problems don’t take many vacations.

Learn more about US resources for individual children and youths who have emotional and behavioral disorders by surfing the rich resources assembled by the Substance Abuse and Mental Health Services Administration (SAMSHA) of the US Department of Health and Human Services. Although some of the materials may be a tad out of date (e.g., prevalence figures have been updated for some disorders such as Autism), there are still plenty of valuable materials available from SAMHSA.

Go there! Compare what you see learn there with what’s available at other trustworthy sites. Learn what to do and from whom help is available.

The Council for Children with Behavior Disorders (CCBD), an international group concerned about children and youths with EBD, published statements about the use of seclusion and restraint with students. Although the documents appear to be in preliminary form, they began circulating on the Internet today, so I’m posting copies of the PDFs here. Watch for an update of them.

• CCBD’s Position Summary on Physical Restraint & Seclusion Procedures in School Settings
• CCBD’S Position Summary on the Use of Physical Restraint Procedures in School Settings
• CCBD’S Position Summary on the The Use of Seclusion in School Settings

Link to the CCBD Web site.

Reporting on US National Public Radio’s Morning Edition, Joanne Silberner presented a story about police officers handling incidents in which they encounter people with emotional and behavior disorders who are behaving in ways that appear threatening to the officers. Although her story uses adult cases for illustrations, this topic should also be of interest for youths who have EBD and for the families of children with EBD.

Here’s an excerpt from Ms. Silberner’s report.

It’s a situation no one wants to see: An armed police officer is called because someone is in the throes of a psychotic episode. “How the officer handles that situation can have a significant impact,” says Russell Laine, head of the International Association of Chiefs of Police.
Continue reading ‘Officer training for handling incidents’