By Tami Silverman, President & CEO, Indiana Youth Institute

An increasing number of our children and youth have mental health disorders, encountering challenges with school, within their peer groups, and at home. Unfortunately, most of them are not getting the care they need. Signs of mental health disorder may be difficult to recognize, and unfortunately mental health disorders continue to be stigmatized. These, combined with a lack of access to services for many, create substantive barriers to care. More must be done to combat widely-held myths, connect children with treatment, supports, and services, and work to build strong support networks for all our young people.

A February 2019 study in JAMA Pediatrics estimated that 7.7 million American children, one in every 6 children, have at least one mental health disorder. According to the Centers for Disease Control (CDC), ADHD, behavior problems, anxiety and depression are the most commonly diagnosed mental disorders in children, and some of these conditions, such as anxiety and depression, commonly occur together. The JAMA Pediatrics study also showed that roughly half of children do not receive any kind of treatment from a mental health professional.

Last year, 11.6% of Hoosier children received treatment or counseling from a mental health professional, a significant number, and yet still only a portion of Indiana children in need. The National Survey of Children’s Health indicates that 5.2% of Indiana children have ever been diagnosed with depression, and 11.0% have been diagnosed with anxiety. We know that accessibility remains an issue in Indiana. Among our neighboring states, Indiana has the lowest ratio of mental health providers available to serve the population, approximately 1 per every 700 people, and nearly 60% of the state’s population lives in designated mental health professional shortage areas.

Identifying mental health issues may be less obvious than physical ailments, such as broken bones, asthma, or diabetes. Occasional bouts with emotional distress, anxiety, stress, and depression are normal experiences for all children and youth. It can be difficult to distinguish between behaviors and emotions that are related to typical child development, and those that require extra attention and concern.

The national nonprofit Child Mind Institute describes seven myths about childhood mental illness that need to be debunked. These include recognizing that childhood mental illness is not caused by personal weakness or poor parenting. Children and youth cannot overcome mental health problems through willpower, nor will they grow out of their disorder. Instead, understanding that most psychiatric disorders begin before age fourteen provides additional incentive to screen and intervene during childhood. Children who receive early interventions and treatment have a good chance of managing or overcoming their symptoms.

How do you know when a child’s behavior is cause for concern? You should always seek immediate help for a child or teen who harms themselves or others or talks about wanting to do so. While short term stress, anxiety or depression can be developmentally appropriate, the National Institute of Health (NIH) advises that you should also seek help if a child’s behavior or emotional difficulties last more than a few weeks and are causing problems at school, at home or with their friends. Young children may exhibit symptoms such as intense worry or fear, frequent tantrums, complaints about frequent stomach or headaches with no known medical cause, and a lack of interest in playing with other children. Symptoms in teenagers include a loss of interest in previously enjoyable activities, spending increasing amounts of time alone or avoiding social activities, sleeping too little or too much, and engaging in risky, destructive or self-harming behaviors. The NIH recommends talking with your child’s teacher and consulting your pediatrician, asking either for a recommendation to a mental health professional who has specific experience in dealing with children, when and if possible.

Caring adults and a strong support network, including family members, teachers, coaches and mentors, can serve as protective factors for mental health. Indiana’s Family and Social Services Administration Division of Mental Health and Addiction manages our state’s Systems of Care, a model framework used to coordinate services and supports. Schools throughout the state continue to expand their services and expertise, understanding the importance of prevention, intervention, positive development, and communication to families.

While many agree that progress has been made regarding how mental health is viewed, stigma and negative connotations still keep far too many children from getting critical care and support. It is important to understand and work to reduce the barriers of stigma and access to mental health care. It is equally, if not more important, to understand that, for most youth, childhood mental disorders are episodic rather than permanent. Just as with physical illnesses, keys include ensuring children in need can receive appropriate screening and treatment. We would not ignore a child’s physical ailment, and it is time that we consistently take the same approach to their mental health.

(Tami Silverman is the President & CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI. IYI’s mission is to improve the lives of all Indiana children by strengthening and connecting the people, organizations, and communities that are focused on kids and youth.)

Hoosier youth are the hidden victims of the opioid epidemic. The statewide crisis has a negative impact on child well-being, families and communities. Hoosiers are more likely to die from a drug overdose than car crashes and gun homicides combined. In 2017, Indiana’s rate of fatal overdoses was 25.7 per 100,000. This is significantly above the national average of 22.4, ranking Indiana’s overdose death rate as the 15th highest in the nation.

  • In 2017, 1,138 Hoosiers died from an opioid overdose, a rate of 17.1 deaths per 100,000 Indiana residents.
  • In 2016, opioid overdose deaths were most common among white (89.8%), followed by black (8.9%) and all other Hoosiers (1.3%).
  • 83 out of the 92 Indiana counties had at least one non-fatal emergency department visit involving any opioid in 2017.

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As parents, caring adults and community leaders, we must create the conditions for healthy kids to thrive. This means recognizing and addressing the dangers children face when they live in unhealthy environments, reducing health-harming behaviors like smoking and substance use by children and around children, and building communities that make it easier for kids and families to make healthy choices about food and physical activity.

Unfortunately, Indiana comes in 35th for overall children’s health in the U.S. Recognizing this, a new statewide collaboration, the Alliance for a Healthier Indiana, is bringing together business and community leaders to address the health of our citizens. The Indiana Youth Institute is joining this important effort to support building a healthier state from the child up.

Growing up in an environment with trauma and abuse creates lasting negative effects on children’s health, including slowing a child’s social and cognitive growth, raising their likelihood for obesity, tobacco and drug use, and inflicting long term consequences to their health and life opportunities. By understanding the co-occurrence and impact of these Adverse Childhood Experiences (ACEs)*, we are better able to create positive interventions and conditions for change.

If we can reduce child and adult smoking rates, we can have a significant effect on Hoosier health. Indiana ranks 41st in the nation for the percentage of smokers, and an estimated 95 percent of adult smokers start smoking before age 21. More than 4,100 Hoosiers under age 18 become new daily smokers each year. In 2017, nine percent of Indiana high school students smoked cigarettes in the past month, and 14.9 percent of Indiana high school students used electronic vapor products. This is especially concerning, as teens who use e-cigarettes are more likely to subsequently take up cigarette smoking.

Governor Holcomb has challenged Indiana to lower its infant mortality rate, as Hoosier kids infants are 24 percent more likely to die before their first birthday than the national average. Smoking is a significant contributor to problems arising during pregnancy and in the child’s development and health. Almost 1 out of every 7 pregnant women in Indiana smokes during pregnancy, a rate that is 68 percent higher than the national average. Smoking while pregnant is associated with a higher risk of miscarriage, low birthweight, premature birth, some birth defects and Sudden Infant Death Syndrome (SIDS).

Our state’s struggle with opioid use disorder is also taking a tremendous toll on our babies and children. Newborns exposed to opioids in utero have a 60-80 percent likelihood of suffering from Neonatal Abstinence Syndrome, a condition which impacts the child’s long-term growth, behaviors, language abilities, cognitive development, and academic achievement. Last year, Indiana had one of the nation’s greatest percentage increases in the number of children being placed in foster care. The Indiana Department of Child Services reported a sizable increase in the number of substantiated cases of abuse or neglect, with over half of the removals due to parental substance abuse.

Parental overdoses have both an immediate as well as a cumulative impact on children in the home. Children double their likelihood of developing addictive disorders when they come from homes where one or more adults abuse alcohol or drugs. While we do not yet know precisely how many Indiana children are living with adults struggling with opioid use disorder, we do know that these children are suffering and that immediate interventions are needed.

The prevalence of substance use disorder has captured recent headlines, but Indiana’s struggle with obesity is a longstanding problem that we have yet to effectively address. Indiana is the 10th worst state for adult obesity rates, and 1 in 3 Indiana youth ages 10-17 are overweight or obese. According to Julie Burns, CEO of Jump IN for Healthy Kids, in central Indiana the obesity/overweight rate is 25 percent higher than the national average, and three times higher than the goal of 15 percent. Burns stresses the importance of focusing on young children, as habits around food and physical activity are developed by age 5.

Healthy kids grow up with greater chances to be healthy adults, and are more likely to become productive and successful citizens. Far too many Hoosier children face the issues caused by ACEs, smoking, opioid use, obesity and are lost due to infant mortality. We support and applaud the efforts of the Alliance for a Healthier Indiana. Local events to improve Hoosier health are taking place across the state, and we encourage everyone to find a way to contribute by going to www.healthierindiana.org. By collectively dedicating ourselves to these efforts, and by taking a multi-generational approach, we hope to increase the health and success of all Indiana residents.

The news offers daily reminders of the complex challenges our communities, state and country face in the opioid crisis. Governor Eric Holcomb made attacking the drug epidemic a pillar of his inaugural policy agenda. Indiana University has announced its Grand Challenge to respond to the addictions crisis, committing $50 million to finding solutions. Indiana’s social service, emergency service, criminal justice, health care, and public health providers are working to respond to the relentless array of ongoing, interconnected needs arising from the crisis. Collaborations among local, state and federal agencies are developing new cross-cutting partnerships and interventions. At the Indiana Youth Institute, we are concentrating on identifying and addressing the short- and long-term consequences of the opioid crisis on Hoosier children.

For the past three years the number of children in Indiana’s foster care system has increased steadily. Experts, including Mary Beth Bonaventura, director of the Indiana Department of Child services, agree these increases are directly linked to the opioid problem.

“We have more children in care than we’ve ever had in history, nationwide and in Indiana, Bonventura said. “With all cases counted, (we have) close to 29,000 kids in care in some way shape or form.”

In 2016, 52 percent of children DCS removed from a home were removed due to parental substance abuse. When substance abuse is included as a secondary cause, that rate rises to nearly 80 percent.

Who cares for the kids caught in this crisis? In Whitley County, 2 percent of children live with foster parents, and 6.2 percent of children live with their grandparents. Bonaventura states in Indiana nearly 51 percent of all DCS foster care placements are with relatives. A September 2017 Pew Charitable Trusts study shows parents of adult children who either struggle with substance use disorder, or have died from an overdose, are raising an increasing number of their grandchildren.

Child placements with relatives, also called kinship care, can be a formal placement from the state or an informal arrangement between the parents and the relative caregivers. In fact, the Pew research estimates that for every foster child formally placed with a relative as a primary caregiver, there are 20 more in informal kinship arrangements. Tina Cloer, president and CEO of Children’s Bureau, Inc., says “I get calls all the time from people all over the city and state who have now inherited their nieces and nephews, their grandchildren, their friends’ kids, because they’re struggling with addiction.”

About 39 percent of grandparents caring for grandchildren are older than 60, 21 percent live below the poverty line and 26 percent have a disability. Like all children in care, children in kinship care have been found to lack adequate access to primary care, immunization, vision, hearing and dental care services. Despite these challenges, the American Academy of Pediatrics stresses the benefits of kinship care, including increased stability and well-being, reduced trauma, and an increased likelihood that siblings will stay together.

We can help grandparents and family members caring for these young victims of our state’s addiction crisis. Kinship care is often unexpected and unplanned. Many families are unaware of available help. For instance, grandparents and families who become licensed foster families can access services and financial supports. Organizations such as Grandfamilies.org provide valuable information on applicable laws and resources. Cloer works with many faith-based and community groups that are reaching out to grandparents caring for their grandchildren with basic needs items such as diapers, formula and clothing. As employers, we can offer flexible schedules for those suddenly faced with caring for these children. Schools and youth organizations also need to be sensitive to kinship care arrangements.

Any comprehensive solution to Indiana’s opioid crisis must include the impacted children and family members. Most child welfare experts agree that an increased focus on the impacts on the youngest victims is warranted. While we look for policy and systems change at the state level, at the local level we can immediately step in to help families providing kinship care. Actions taken now can help prevent this crisis from lasting into the next generation.

For more information on the impact of opioids on children, see IYI’s Issue Brief on the opioid epidemic’s impact on Hoosierchildren.

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Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI. IYI’s mission is to promote the healthy development of Indiana children and youth by serving the people, institutions and communities that impact their well-being.
Download data on children in foster families and children living with grandparents.

syringe, pills, and spoon

Youth are the hidden victims of the opioid epidemic.

Nationally, the issue has grown so severe that in 2017, the Commission on Combatting Drug Abuse and the Opioid Crisis submitted a letter to the president requesting that the opioid crisis be declared a national emergency. In Indiana, there were 1,271 deaths from drug overdoses in 2016, a 33% increase from 2011. Drug overdoses have risen so sharply in Indiana that they now kill more Hoosiers than car crashes and gun homicides combined.

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