Foreword
The burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country. Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by those very institutions which were explicitly created to take care of them. It is time that we as a Nation took seriously the task of preventing mental health problems and treating mental illnesses in youth.
The mental health needs of our children have elicited interest from the highest level of government, including the White House and members of both the House of Representatives and the Senate. This Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda represents an extraordinary level of collaboration among three major Federal Departments: the Department of Health and Human Services, the Department of Education, and the Department of Justice.
This report introduces a blueprint for addressing children's mental health in the United States. It reflects the culmination of a number of significant activities over the past year. On March 20, 2000, a White House Meeting launched a new public-private effort to improve the appropriate diagnosis and treatment of children with emotional and behavioral conditions. Serious concerns were raised about the appropriate diagnosis and treatment of emotional and behavioral difficulties in children, and the need to take steps to address this issue. On June 26, 2000, I hosted the Surgeon General's Listening Session on Children's Mental Health. Input on critical issues in children's mental health was solicited from the public through the World Wide Web and by mailing requests to over 500 individuals. Approximately 50 individuals were invited to provide input at a day of thoughtful discussion about the gaps in our knowledge on children's mental health. This input helped shape the agenda for a national conference.
On September 18 and 19, 2000, the Surgeon General's Conference on Children's Mental Health: Developing a National Action Agenda was held in Washington, DC. Three hundred participants were invited, representing a broad cross-section of mental health stakeholders, including youth and family members, professional organizations and associations, advocacy groups, faith-based practitioners, clinicians, educators, healthcare providers, and members of the scientific community and the healthcare industry. This conference enlisted the help of the participants in developing specific recommendations for a National Action Agenda on Children's Mental Health. A related meeting on Psychopharmacology for Young Children: Clinical Needs and Research Opportunities, was held by the National Institute of Mental Health and the Food and Drug Administration on October 2nd and 3rd, 2000. Recommendations from these two meetings formed the basis of this national action agenda. Action steps reflect the consensus recommendations of the participants at the national conference.
One of the chief priorities in the Office of the Surgeon General and Assistant Secretary for Health has been to work to ensure that every child has an optimal chance for a healthy start in life. When we think about a healthy start, we often limit our focus to physical health. But, as clearly articulated in the Surgeon General's Report on Mental Health, mental health is fundamental to overall heath and well-being. And that is why we must ensure that our health system responds as readily to the needs of children's mental health as it does to their physical well-being.
One way to do so is to move the country towards a community health system that balances health promotion, disease prevention, early detection and universal access to care. That system must include a balanced research agenda, including basic, biomedical, clinical, behavioral, health services, school-based and community-based prevention and intervention research, and it must include a new invigorated approach to mental health. There is
no mental health equivalent to the federal government's commitment to childhood immunization. Children and families are suffering because of missed opportunities for prevention and early identification, fragmented services, and low priorities for resources. Overriding all of this is the issue of stigma, which continues to surround mental illness.
Mental healthcare is dispersed across multiple systems: schools, primary care, the juvenile justice system, child welfare and substance abuse treatment. But the first system is the family, and this agenda reflects the voices of youth and family. The vision and goals outlined in this agenda represent an unparalleled opportunity to make a difference in the quality of life for America's children.
David Satcher, M.D., Ph.D.
Assistant Secretary for Health and Surgeon General
Overarching Vision
Mental health is a critical component of children's learning and general health. Fostering social and emotional health in children as a part of healthy child development must therefore be a national priority. Both the promotion of mental health in children and the treatment of mental disorders should be major public health goals. To achieve these goals, the Surgeon General's National Action Agenda for Children's Mental Health takes as its guiding principles a
commitment to:
- Promoting the recognition of mental health as an essential part of child health;
- Integrating family, child and youth-centered mental health services into all systems that serve children and youth;
- Engaging families and incorporating the perspectives of children and youth in the development of all mental healthcare planning; and
- Developing and enhancing a public-private health infrastructure to support these efforts to the fullest extent possible.
Goals
- Promote public awareness of children's mental health issues and reduce stigma associated with mental illness.
- Continue to develop, disseminate, and implement scientifically-proven prevention and treatment services in the field of children's mental health.
- Improve the assessment and recognition of mental health needs in children.
- Eliminate racial/ethnic and socioeconomic disparities in access to mental healthcare.
- Improve the infrastructure for children's mental health services including support for scientifically-proven interventions across professions.
- Increase access to and coordination of quality mental healthcare services.
- Train frontline providers to recognize and manage mental health issues, and educate mental health providers in scientifically-proven prevention and treatment services.
- Monitor the access to and coordination of quality mental healthcare services.
Goal 1: Promote public awareness of children's mental health issues and reduce stigma associated with mental illness.
ACTION STEPS
- Promote social, emotional, and behavioral well-being as an integral part of a child's health development.
- Develop and/or disseminate existing guidelines on how to enhance child development, including mental health. Different sets of guidelines will need to be created for the general public, families, parents and caregivers, and professional groups.
- Identify early indicators for mental health problems.
- Integrate mental health consultations as part of children's overall general healthcare and advise healthcare providers regarding the importance of assessing for mental health needs.
- Develop national capacity to provide adequate preventive mental health services.
- Conduct a public education campaign to address the stigma associated with mental health disorders. This could be accomplished through partnerships with the media, youth, public health systems, communities, health professionals, and advocacy groups.
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Goal 2: Continue to develop, disseminate, and implement scientifically-proven prevention and treatment services in the field of children's mental health.
ACTION STEPS
- Support basic research on child development, and the use of knowledge about neurological, cognitive, social, and psychological development to design better screening, assessment, and treatment tools and to develop prevention efforts.
- Support research on familial, cultural, and ecological contexts to identify opportunities for promoting mental health in children and providing effective prevention, treatment, and services.
- Support research in developmental psychopathology to help clarify diagnoses and provide methodology that is sensitive, specific, and that can be used in designing and interpreting pharmacological and other clinical trials.
- Support research in basic and clinical neuroscience to provide better information and understanding of pharmacogenetics and ontogeny of drug effects on the developing brain in the short term, as well as the long-term consequences of pharmacological intervention, associated with both acute and chronic exposure.
- Support research on legal/ethical and confidentiality issues associated with the treatment of children and families.
- Support research to develop and test innovative behavioral, pharmacological, and multimodal interventions.
- Increase research on proven treatments, practices, and services developed in the laboratory to assess their effectiveness in real-world settings.
- Study the nature and effectiveness of clinical practices in real-world settings.
- Assess the short- and long-term outcomes of prevention and treatment efforts, including the effect of early intervention on prognosis and course of mental illness.
- Promote research on factors that facilitate or impede the implementation and dissemination of scientifically-proven interventions.
- Support research evaluating the process and impact of promising policies and programs, including cost-effectiveness research (e.g., EPSDT, IDEA, Head Start, SCHIP [see Appendix B]).
- Evaluate the impact of organization and financing of services on access, the use of scientifically-proven prevention and treatment services, and outcomes for children and families.
- Develop and evaluate model programs that can be disseminated and sustained in the community.
- Build private and public partnerships to facilitate the dissemination and cross-fertilization of knowledge.
- Create a forum for promoting direct communication among researchers, providers, youth and families to bridge the gap between research and practice.
- Create a standing workgroup for the purpose of identifying research opportunities, discussing potential approaches, monitoring progress in the area of psychopharmacology for young children, and addressing ethical issues regarding research with children. This group should include representatives of all interested parties, such as researchers, practitioners, youth and families, industry, and federal regulatory, research, and services agencies.
- Create an oversight system to identify and approve scientifically-based prevention and treatment interventions, promote their use, and monitor their implementation.
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Goal 3: Improve the assessment and recognition of mental health needs in children.
ACTION STEPS
- Encourage early identification of mental health needs in existing preschool, childcare, education, health, welfare, juvenile justice, and substance abuse treatment systems.
- Create tangible tools for practitioners in these systems to help them assess children's social and emotional needs, discuss mental health issues with parents/caregivers and children, and make appropriate referrals for further assessments or interventions.
- Train all primary healthcare providers and educational personnel in ways to enhance child mental health and recognize early indicators of mental health problems, including among children with special health care needs, children of fragmented families, and children of parents with mental health and/or substance abuse disorders.
- Promote cost-effective, proactive systems of behavior support at the school level. These systems of behavior support should emphasize universal, primary prevention methods that recognize the unique differences of all children and youth, but include selective individual student supports for those who have more intense and long-term needs.
- Increase provider understanding and training to address the various mental health issues among children with special health care needs and their families.
- Increase the understanding of practitioners, policymakers, and the public of the role that untreated mental health problems play in placing children and youth at risk for entering the juvenile justice system.
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Goal 4: Eliminate racial/ethnic and socioeconomic disparities in access to mental healthcare.
ACTION STEPS
- Increase accessible, culturally competent, scientifically-proven services that are sensitive to youth and family strengths and needs.
- Increase efforts to recruit and train minority providers who represent the racial, ethnic, and cultural diversity of the country.
- Co-locate mental health services with other key systems (e.g., education, primary care, welfare, juvenile justice, substance abuse treatment) to improve access, especially in remote or rural communities.
- Strengthen the resource capacity of schools to serve as a key link to a comprehensive, seamless system of school- and community-based identification, assessment and treatment services, to meet the needs of youth and their families where they are.
- Encourage the development and integration of alternative, testable approaches to engage families in prevention and intervention strategies (e.g., pastoral counseling).
- Develop policies for uninsured children across diverse populations and geographic areas to address the problem of disparities in mental health access.
- Develop and support mental health programs designed to divert youth with mental health problems from the juvenile justice system.
- Increase research on diagnosis, prevention, treatment, and service delivery to address disparities, especially among different racial, ethnic, gender, sexual orientation, and socioeconomic groups.
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Goal 5: Improve the infrastructure for children's mental health services including support for scientifically-proven interventions across professions.
ACTION STEPS
- Encourage the health system to respond to mental health prevention and treatment service needs through universal, comprehensive, and continuous health coverage.
- Review both incentives and disincentives for healthcare providers to assess the mental health needs of children, including preventive interventions, screening, and referral.
- Provide the infrastructure for cost-effective, cross-system collaboration and integrated care, including support to healthcare providers for identification, treatment coordination, and/or referral to specialty services; and the development of integrated community networks to increase appropriate referral opportunities.
- Provide incentives for scientifically-proven and cost-effective prevention and treatment interventions that are organized to support families, and that consider children and their caregivers as a basic unit (e.g., family therapy, home-based treatment, intensive case management).
- Create incentives and support for agencies, programs and individual practitioners to develop and utilize science-based strategies and interventions in community settings.
- Determine which policies and programs for children are most cost-effective and improve access to quality care, especially among the uninsured.
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Goal 6: Increase access to and coordination of quality mental healthcare services.
ACTION STEPS
- Develop a common language to describe children's mental health, emphasizing adaptive functioning and taking into account ecological, cultural, and familial context. A common language is important to facilitate service delivery across systems.
- Develop a universal measurement system across all major service sectors that is age-appropriate, culturally-competent, and gender sensitive to (i) identify children, including those with special health care needs, who may need mental health services; (ii) track child progress during treatment; and (iii) measure treatment outcomes for individual patients.
- Modify definitions and evaluation procedures used by education systems to identify and serve children and youth who have mental health needs. These definitions and procedures should facilitate access to, not exclusion from, essential services.
- Provide access to services in places where youth and families congregate (e.g., schools, recreation centers, churches, and others).
- Support the development of coordinated responses by emergency medical providers (e.g., paramedics, emergency room personnel) and community mental health service providers to expedite appropriate treatment and/or referral for children presenting with emergency and traumatic episodes in hospital emergency rooms.
- Address issues of confidentiality in ways that respect a family's right to privacy, but encourage coordination and collaboration among providers in different systems.
- Encourage family organizations to help family members access information on how to enhance children's mental health and effective treatments for mental illness so that they can make fully-informed decisions about interventions offered.
- Include youth in treatment planning by offering them direct information in developmentally appropriate ways about service options. As much as possible, allow youth to make decisions and choices about preferred intervention strategies.
- Use family advocates, such as family members with prior experience, to assist families in interacting effectively with complicated service systems such as healthcare, education, juvenile justice, child welfare, and substance abuse treatment.
- Provide a mechanism for input from youth and families in setting a national mental health agenda and in assessing policies and programs to promote mental health services delivery.
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Goal 7: Train frontline providers to recognize and manage mental health issues, and educate mental health providers in scientifically-proven prevention and treatment services.
ACTION STEPS
- Engage professional organizations in educating new frontline providers in various systems (e.g., teachers, physicians, nurses, hospital emergency personnel, daycare providers, probation officers, and other child healthcare providers) in child development; equip them with skills to address and enhance children's mental health; and train them to recognize early symptoms of emotional or behavioral problems for proactive intervention. Such training must focus on developmental and cultural differences in cognitive, social, emotional, and behavioral functioning, and understanding these issues in familial and ecological context.
- Facilitate training of new providers by building knowledge of child development into the existing curricula of professional programs and encouraging on-going training opportunities across disciplines to facilitate the development of effective partnerships.
- Develop and evaluate multidisiplinary programs for healthcare professionals that focus on child and family mental health.
- Create training support for professionals, paraprofessionals, and family advocates to keep abreast of new developments in the field of children's mental health.
- Address the shortage of well-trained child mental health specialists, particularly minority individuals, through active recruitment and incentive efforts by professional organizations, federal programs, and federal legislation, and consider the development of training programs for mid-level providers in mental health to address inadequate capacity.
- Engage professional boards for mental health specialists (e.g., psychiatry, psychology, social work, and nursing) to require training in: evidence-based prevention and treatment interventions; outcome-based quality assurance; competency-based assessment and diagnostic skills; principles of culturally-competent care; and engaging youth and families as partners in assessment, intervention, and outcome monitoring.
- Ensure mechanisms to monitor and evaluate efforts to train new professionals, retrain existing professionals, and examine the effectiveness of these training efforts.
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Goal 8: Monitor the access to and coordination of quality mental healthcare services.
ACTION STEPS
- Establish formal partnerships among federal research, regulatory, and service agencies, professional associations and families/caregivers to facilitate the transfer of knowledge among research, practice, and policy related to children's mental health.
- Encourage behavioral healthcare industry and service agencies to develop and use broad-based outcome and process measures to ensure accountability. These measures should be relevant and meaningful, such as symptom severity, adaptive functioning, family satisfaction, and societal/economic costs and benefits in terms of involvement in systems such as special education, welfare, and juvenile justice.
- Develop national quality improvement protocols that emphasize the use of scientifically-proven practices and evaluate the effectiveness of service systems.
- Encourage providers to inform consumers about evidence for and against the effectiveness of proposed treatments and services.
- Make available information on effective prevention and treatment interventions through federal partners, professional organizations, family organizations, and private foundations. In addition, provide information that will allow practitioners to evaluate the worth of promising interventions.
- Encourage industry and service agencies to develop a variety of mechanisms for consumers to communicate their experiences and concerns to funding agencies and purchasers of healthcare plans (i.e., federal, state and local governments, and private employers).
- Monitor efforts to coordinate services and reduce mental health access disparities through public health surveillance and evaluation research.
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Proceedings based on the Surgeon General's Conference on Children's Mental Health: Developing a National Action Agenda
Conference Summary
Background
The nation is facing a public crisis in mental health for infants, children and adolescents. Many children have mental health problems that interfere with normal development and functioning. In the United States, one in ten children and adolescents suffer from mental illness severe enough to cause some level of impairment. Yet, in any given year, it is estimated that about one in five children receive mental health services. Unmet need for services remains as high now as it was 20 years ago. Recent evidence compiled by the World Health Organization indicates that by the year 2020, childhood neuropsychiatric disorders will rise proportionately by over 50 percent, internationally, to become one of the five most common causes of morbidity, mortality, and disability among children.
Concerns about inappropriate diagnosis—that is, either over- or under-diagnosis—of children's mental health problems and about the availability of evidence-based (i.e., scientifically-proven) treatments and services for children and their families have sparked a national dialogue around these issues. There is broad evidence that the nation lacks a unified infrastructure to help these children and many are falling through the cracks. Too often, children who are not identified as having mental health problems and who do not receive services end up in jail. Children and families are suffering because of missed opportunities for prevention and early identification, fragmented treatment services, and low priorities for resources.
To address these critical issues, the Office of the Surgeon General held a conference on Children's Mental Health: Developing a National Action Agenda on September 18 – 19, 2000 in Washington, DC. This conference represented an extraordinary level of collaboration among three major Federal Departments: the Department of Health and Human Services, the Department of Justice, and the Department of Education. The purpose of the conference was to engage a group of thoughtful citizens in a meaningful dialogue about issues involved in prevention, identification, recognition, and referral of children with mental health needs for appropriate, evidence-based treatments or services. The 300 invited presenters and participants represented a broad cross-section of mental health stakeholders, including primary care, education, juvenile justice, child welfare, and substance abuse. Disciplines represented include education, pediatrics, social work, psychiatry, psychology, nursing, public health, and faith-based practitioners. Individuals representing associations, advocacy groups, the scientific community, members of the healthcare industry, clinicians, healthcare providers, families and youth attended this conference.
This conference is one piece of a national conversation addressing the mental health of our Nation's children. The White House Conference on Mental Health, in June 1999, was the first major public orientation to the realities of mental illness in the United States. This was followed by the Surgeon General's Call to Action to Prevent Suicide in July 1999, and the release of a first-ever Surgeon General's Report on Mental Health in December 1999. This report addressed complex issues in mental health and included a chapter on the mental health of children. Most recently, in March of this year, the White House held another meeting specifically addressing the need to improve the diagnosis and treatment of children with emotional and behavioral conditions. Following this conference, the National Institute of Mental Health and the Food and Drug Administration held a meeting in early October, focusing on research needed to develop psychopharmaceuticals for young children.
The agenda for this meeting was developed with extensive input from a broad range of interested individuals. In May, public input was solicited through the World Wide Web and mailings to over 500 individuals. Nearly 400 responses were received within a month. On June 26, 50 individuals were invited to a formal Listening Session with the Surgeon General to help craft the agenda for this conference. Key issues of concern to families, service providers, and researchers were identified, and included:
- Educating the public about mental health and illness in children;
- Ensuring screening and early identification of children within key service systems;
- Implementing evidence-based treatments and services;
- Providing adequate and appropriate education and training to frontline providers;
- Engaging families in all aspects of service delivery; and
- Continuing to build the research base on children's mental health.
The conference agenda was thus developed to address these major concerns, with the aim of addressing the need to improve the state of children's mental health and their families'. To initiate national dialogue about children's mental health concerns, conference participants listened to plenary sessions in which leaders in the field, including youth and family members themselves, briefly outlined key issues involved in:
- Identifying, recognizing, and referring children with mental health needs in key services systems;
- Health services disparities: increasing access to services through family engagement and reducing disparities in access; and
- State of the evidence in treatments, services, systems of care and financing: the gap between what we know and what we do.
These presentations, summarized below, provided conference participants with information to engage in meaningful discussions on children's mental health issues. Conference participants were divided into 10 working groups over the two days. To help develop consensus recommendations, participants aided by selected facilitators and recorders, were asked to:
- Identify the barriers to appropriate identification and recognition of children with mental health needs and the factors that impede access to appropriate treatments or services;
- Identify major opportunities for promoting child and adolescent mental health and for preventing risks and antecedents associated with mental illness;
- Identify the major policies that offer opportunity for strengthening recognition and improving access to care;
- Identify professional training needs in child and adolescent mental health;
- Identify the major barriers to implementing evidence-based treatments and services; and
- Develop recommendations for bridging the gaps among research, practice, and policy.
Facilitators and recorders of each group helped group members prioritize their recommendations, and came together each day of the conference to synthesize the input from their respective groups.
Consensus among the top recommendations was developed, and these were presented to the Surgeon General and the conference participants. Youths present at the conference formed their own group, and presented their input directly to the Surgeon General and the participants as well.
Conference participants also had the opportunity to directly address Dr. Satcher, and to provide their comments. These recommendations, together with those developed from the NIMH/FDA meeting on Psychopharmacology for Young Children: Clinical Needs and Research Opportunities, were used as a basis for the development of the Surgeon General's National Action Agenda for Children's Mental Health.
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Conference Proceedings
These summary statements reflect the views expressed in the presentations by invited speakers and discussants at the conference.
Welcome
DAVID SATCHER, M.D., Ph.D.,
Assistant Secretary for Health and Surgeon General
Dr. Satcher applauded the nation's unprecedented focus on children's mental health, and in particular, the interest from the White House and members of both the House of Representatives and the Senate. He shared his struggle with issues of policy and science in his role as both Assistant Secretary for Health and Surgeon General. Dr. Satcher commended the exemplary collaboration among the three Federal Departments: the Department of Health and Human Services, the Department of Education, and the Department of Justice, in this monumental effort. He briefly highlighted the historical context for the development of this conference, including the White House Meeting in March that launched a new public-private effort to improve the appropriate diagnosis and treatment of children with emotional and behavioral conditions; solicitation of public input on children's mental health issues; and the Surgeon General's Listening Session on Children's Mental Health on June 26, 2000. These events helped shaped the agenda for today's conference.
Dr. Satcher said that one of the chief priorities in the Office of the Surgeon General and Assistant Secretary for Health has been to work to ensure that every child has an optimal chance for a healthy start in life. When we think about a healthy start, we often limit our focus to physical health. But, as clearly articulated in the Surgeon General's Report on Mental Health, mental health is fundamental to overall health and well-being. Just as things go wrong with the heart, the lungs, the liver and the kidneys, things go wrong with the brain. And that is why we must ensure that our health system responds as readily to the needs of children's mental health as it does to the needs of their physical well-being.
One way to do so is to move the country towards a community health system that balances health promotion, disease prevention, early detection and offers universal access to care. Such a system must include a balanced research agenda, including basic, biomedical, clinical, behavioral, health services and community-based prevention research, and it must include a new invigorated approach to mental health. Dr. Satcher noted that there is no mental health equivalent to the federal government's commitment to childhood immunization. Children and families are suffering because of missed opportunities for prevention and early identification, fragmented services, and low priorities for resources. Overriding all of this is the issue of stigma, which continues to surround mental illness.
Mental healthcare is dispersed across multiple settings: schools, primary care, the juvenile justice system, and child welfare. But the first system is the family, and the family is represented here today, and probably better represented at this conference than any conference in the history of a Surgeon General's report. To improve services for children with mental health problems and their families, Dr. Satcher stated that we need to take three steps: 1) To improve early recognition and appropriate identification of mental disorders in children within all systems serving children; 2) To improve access to services by removing barriers faced by families with mental health needs, with a specific aim to reduce disparities in access to care; and 3) To close the gap between research and practice, ensuring evidence-based treatments for children.
The goal of this conference is to enlist the help of all 300 invited participants in developing specific recommendations for a National Action Agenda for children's mental health. This conference represents an unparalleled opportunity to make a difference in the quality of life for America's children and adolescents. While the task ahead will not be easy, he emphasized the need to take advantage of "golden opportunities" which can often be "disguised as irresolvable problems."
STEVEN E. HYMAN, M.D.,
Director, National Institute of Mental Health
Dr. Hyman stressed how important Dr. Satcher's focus on mental health issues has been. Dr. Satcher has devoted much of his time to mental health, he said, and it has made an enormous difference. When the Surgeon General of the United States recognizes the centrality of mental health to all of health, there is an enormous change throughout the country. It is difficult to imagine anything more important than the mental health of our children.
There is a need to recognize that children are engaged in a process of development. What does it mean if a child is unable to attend in school, spends years sad, anxious and unable to learn? Can children regain lost ground if untreated for two, five, or eight years? We have spent so much time, appropriately so, on the physical health of children. In education, cognitive development has been emphasized. In contrast, social and
emotional school readiness has been pushed under the rug, or perhaps lost in debate over what we really know, who is responsible for what, and what impact is from parents, peers, and the community. In the meantime, our understanding of the social and emotional factors that provide for school readiness and for healthy development has lagged. More research is needed, but at the same time, much is known. There is a terrifying gap between what we do know and how we act, between the services we could offer and those we offer, and between what families can afford and what families can access.
Stigma is an important factor. Parents are fearful about bringing the social and emotional difficulties of their children to the attention of medical professionals, perhaps afraid they may be blamed. Children are sometimes directly stigmatized by the cruelty of classmates. This is stigma squared. Dr. Hyman reminded conference participants that we are working against a politicized environment rather than in a purely medical environment. There are many people who would like very much to have a referendum on the use of psychotropic drugs in children, he said. Yet, the real issue is appropriate diagnosis and treatment of our children. Do we have access to those treatments and to that care? What are the qualifications of the people to whom we bring our children? Have they been educated in these areas? How thorough is the investigation into what might be going wrong in a child? Does the practitioner have the training, the time, the financial resources to interact with the child, to talk to the family, to engage the family, to talk to the school, the daycare centers, and really understand what is going on? Do we have, too often, because of problems of access and problems of finance, an emergency room or a crisis mentality? In this conference, we have the opportunity to focus on the core issues that are going to affect the health of children.
BERNARD S. ARONS, M.D.,
Director, Center for Mental Health Services
Dr. Arons described the Center for Mental Health Services, which was formed eight years ago and whose mission is to improve the delivery of mental health services. The center, through block grants and Knowledge, Development and Application
(KDA) grants, has funded projects on a wide variety of issues, including homelessness and job performance. KDA grants were used to pioneer systems of care for children with serious emotional disorders—a concept that changed the paradigm for delivering services to American children and their families.
The essential role of families in the care of those with mental illness is critical. The Center hammers away at barriers to care, Dr. Arons said. But progress is slow. Access and cultural competence are important issues. The center is trying to construct a bridge between science and treatment and back again. Prevention is critical. There is a critical need to intervene sooner. Dr. Arons provided an analogy of a surfer, treading water out in the ocean waiting for the right wave to come along. That wave is here, particularly for children's mental health, he said.
Each of the participants in this conference has been carefully chosen because of contributions he or she has made to the mental health of children. Many American children and families are not getting the help they need. What should be done to improve the way children with mental illnesses are served? The conference organizers look forward to the participants helping to move children's mental health to the next steps.
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