Children and Adolescents

Childhood and adolescence are developmental periods of immense change and great promise. Accordingly, a meaningful exploration of child and adolescent mental health must first examine the various trajectories of normal development to understand the divergences from this course. The multiple determinants of mental health problems (i.e., psychological, social, environmental, and genetic/biological factors) and their possible interactions could then be effectively isolated and evaluated, along with key protective factors (e.g., parental involvement and positive peer relations). Empirically based approaches would be developed that offer effective treatment for and prevention of mental health problems in childhood and adolescence.

Access to Mental Health Care

Increased access to mental health care is critically needed by our nation's children and adolescents, millions being uninsured and/or at risk.

In the absence of national epidemiological studies, the Center for Mental Health Services estimates that 20% or 13.7 million of our nation's children have a diagnosable mental disorder. About two-thirds of these children do not receive any mental health care.

Major barriers to the effective utilization of mental health services include: lack of health insurance; limited access to mental health services in some insurance plans; absence of appropriately trained providers on some insurance panels; lack of care appropriate for children and adolescents; geographic inaccessibility; fear of stigma; and differences in language and cultural attitudes and beliefs between service providers and recipients.

Children and families can receive services in a variety of community- based settings, including schools, mental health centers, hospitals, and professional practice venues.

Mental Health Services

Child and adolescent mental health services need to be comprehensive, coordinated, developmentally appropriate, and of high quality to address the unique ethnic, cultural, and linguistic needs of our nation's increasingly diverse population. The particular needs of gay, lesbian, bisexual, and questioning youth, as well as children with disabilities and/or chronic health problems, must also be addressed.

Systems of care for children and their families should include a continuum of services ranging from prevention to crisis intervention to psychiatric hospitalization and a high degree of coordination/collaboration with health, education, child welfare, and juvenile justice agencies. Confidential care for mental health, substance abuse, and reproductive health should be assured for adolescents, consistent with state and federal law.

Services should be consumer-driven, outcome-oriented, and focused on competence and self-sufficiency rather than exclusively on dysfunction and pathology. They must be provided by qualified mental health professionals with training and experience in working with children and adolescents.

Flexible funding mechanisms need to be in place to support such generally unfunded services as: home-based intervention; family therapy; "wrap-around" programs (which provide comprehensive, individually-tailored services); prevention; consultation to parents, teachers, and other health care providers; f amily preservation; and comprehensive care in multi-disciplinary settings.

Multi-modal therapy combining psychosocial interventions and pharmacotherapy should be implemented where efficacious (e.g., attention deficit/hyperactivity disorder). Caution should be exercised with medication to ensure that the type and quantity are appropriate for children and that the long-term effects are known and understood, which could be further elucidated through additional research.

Prevention and Early Intervention

Prevention and early intervention services (e.g., violence prevention programs and the early diagnosis of learning disabilities) are essential to improve the overall mental health status of our nation's children and youth.

Professional training on healthy child development and adjustment should be widely available for child care workers, pediatricians, school personnel (including preschool and Head Start teachers), and others who routinely interact with young children and adolescents to identify possible mental health problems early on and refer to mental health professionals, as appropriate. The public at large, including prospective parents, could also benefit greatly from empirically-based information on child development.

Early identification and intervention programs are beneficial and cost-effective at all ages, not just during the first three years of life. They need to offer support to parents and help them overcome any resistance to seeking appropriate mental health care for their children.

Concerted attention should also be focused on the needs of children with serious mental health problems, including those who have been victims of natural disasters or violence.

References

Albee, G.W., & Gullotta, T.P. (1997). Primary Prevention Works. Thousand Oaks, CA: Sage.

American Psychological Association. (1994). Children's mental health needs: Reform of the current system (Policy resolution endorsed by the Council of Representatives.) Washington, DC: Author.

American Psychological Association Task Force Report on Innovative Models of Mental Health Services for Children, Adolescents, and Their Families. (1994). Journal of Clinical Child Psychology, 23, Supplement.

Paavola, J.C., et al. (1994). Comprehensive and Coordinated Psychological Services for Children: A Call for Service Integration. Washington, DC: American Psychological Association Task Force on Comprehensive and Coordinated Psychological Services for Children: Ages 0-10.

Seligman, M., Reivich, K., Jaycox, G., & Gillham, J. (1995). The Optimistic Child. Boston: Houghton Mifflin.

U.S. Department of Health and Human Services. (1998). Trends in the Well-Being of America's Children and Youth: 1998. Washington, DC: Author.