Public Health Approach to Children’s Mental Health
The Children’s Committee of the OMHSAS Advisory Committee recently formed a Public Health Workgroup to identify a framework for implementing mental health promotion efforts for children and families.
According to a 2007 Report to Congress by the Substance Abuse and Mental Health Services Administration, “promotion and prevention are key elements of a public health approach to mental health….The underlying premise of a public health approach is that it is inherently better to promote health and to prevent illness before an illness begins…. Fundamental to the public health approach is that mental health is everyone’s concern. Responsibility for promotion and prevention programs is shared across multiple systems, including schools, primary health care, mental health care, juvenile justice, child welfare, and substance abuse services.”
The following information is one part of the workgroup’s ongoing effort to focus on promoting the healthy social and emotional development of children and protecting children and families from the risk factors that can lead to mental health problems.
December 2010: "A Public Health Approach to Children's Mental Health," Pennsylvania CASSP Newsletter.
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A Response to the Tragedy in Newtown, Connecticut
From the Office of Mental health and Substance Abuse Services, Bureau of Children's Behavioral Health Services
While the tragedy in Newtown, Connecticut leaves all of us shaken and sad, we need to recommit ourselves to the doing all we can not only to prevent something like this from happening again but also to providing support and assistance to those who are experiencing distress at this time, especially children and families.
First, this incident highlights the need to redouble our efforts to meet the needs of those suffering from mental illness and their families. We have a strong children’s mental health system in Pennsylvania, but we also know that there are times when youth and families who need help fall through the cracks. We need to lessen the stigma that many children and families feel when they are experiencing mental health problems. Current efforts to make mental health treatment available in both primary medical care practices and in public schools need to be supported and expanded.
When children and youth and their families seek treatment from mental health facilities directly, it is essential that they feel welcomed and respected, and that professionals support their decision to seek help and work to engage them. We must also remember that every child has unique interests and strengths, and every child needs positive attention and validation. Parents, mental health professionals, teachers, and other caring adults can encourage children and youth to become involved in community activities or pursue a special interest. Youth who have overcome adversity repeatedly tell us that positive relationships with adults and peers and the discovery of something personally meaningful have helped make the difference.
Second, we need to take care of each other during this time of special stress and confusion, especially the children among us. There are multiple resources available that provide helpful tips on how to talk to children and how to respond to disaster and stress in ways that help to build resilience. Below are several recommended resources.
American Psychological Association: Reacting to the Sandy Hook Elementary School Shooting
American Academy of Child and Adolescent Psychiatry
Center for Safe Schools (links to additional resources)
Child Mind Institute:
The Connecticut School Shooting: How to Help Children Cope With Frightening News
Going Back to School After a Tragedy: Support and Routine are Essential
Substance Abuse and Mental Health Services Administration:
Disaster Distress (click on first circle under rotating photos)
Coping with Violence and Traumatic Events
Finally, we encourage community leaders to promote training in Mental Health First Aid, and Youth Mental Health First Aid. These trainings are available in Pennsylvania, and represent a way that caring citizens can learn how to support others who are struggling with mental health challenges. We need to recognize that, regardless of how children and youth may present themselves, they all need a sense of connection to other people.
It is not just infants who need human connection to grow, remain safe, and thrive. This is true for all of us.
More information about Mental Health First Aid
Information about upcoming training in Pennsylvania on Youth Mental Health First Aid, sponsored by the Pennsylvania Community Providers Association:
Training dates and registration information
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National Children’s Mental Health Report Card, 2011
The Child Mind Institute in New York City, dedicated to “transforming the mental health of children everywhere” through clinical care, research, information and resources, and advocacy, recently released a National Children’s Mental Health Report Card. The report card was based on the results of a national survey of 1,000 adults. Several key findings:
- Nearly one in four parents (22%), reports being concerned about a child's mental health.
- While most parents with concerns sought treatment (87%), almost half (43%) waited more than a year and nearly a quarter (22%) waited more than two years to get help.
- The most common treatments were medication (50%) and psychotherapy (46%). Of those who received medication, 80% found it effective while only 50% found psychotherapy and other treatments effective.
- While 97% of parents said mental health is as important as physical health, only 29% said their pediatricians asked them regularly about their child's mental health.
Full report card
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Mental Health and Wellness for Youth and Families
A regular column by Dr. Gordon R. Hodas, child psychiatric consultant to the Office of Mental Health and Substance Abuse Services
January 2012: Childhood Inattention as a Key Determinant for Not Graduating from High School
A recent longitudinal study of children over an extended period of time found that, for those children with attention deficit hyperactivity disorder (ADHD), the symptom of childhood inattention, rather than hyperactivity, is associated with poor academic performance. This article highlights inattention as a symptom to be taken seriously, and considers the broader implications of this research, since inattention may also occur with other disorders and under conditions of childhood adversity.
October 2011: Working with Youth: Promoting Medication Adherence and Recovery
Even the most helpful psychotropic medication cannot benefit a child or youth (up to age 21) with a mental health challenge if it is not taken. There is, in fact, evidence that non-adherence by youth to prescribed medication is quite common. Helping youth accept mental health services, including psychotropic medication as well as therapy, involves recognition of the salience of stigma in society and of the youth’s developmental need to achieve mastery and independence. While the need to appear tough may at times serve as a barrier to help-seeking by youth, this same concept can be embraced as a convincing rationale for youth to accept help and take charge of their life.
April 2011: Expanding Our Understanding of “Positive Mental Health”
A recent article, “A Dual-Factor Model of Mental Health: Toward a More Comprehensive Understanding of Youth Functioning,” reports the results of a study measuring the mental health status of adolescents. The study outlines a conception of mental health that takes into account both the symptoms (psychopathology) and the subjective well-being of the individual. In contrast to the traditional view that equates mental health with the absence of psychopathology, the authors indicate that “positive mental health” and positive youth functioning are best seen as involving circumstances in which one’s psychopathology is low and what they refer to as subjective well-being is high. Thus, positive mental health involves more than the mere absence of mental illness or psychopathology. The authors refer to the combined assessment of psychopathology in conjunction with subjective well-being as a “dual-factor model of mental health,” and discuss the reasons why this model is more useful than the more limited, traditional approach to understanding mental health.
July 2010: Food for Thought (and Health)
Our choice of diet affects our mental health, not just our physical health. While there has been awareness of the importance of “good nutrition” on emotional functioning for many years, research on adult Australian women goes beyond this generalization, by comparing the effect of commonly followed dietary patterns on emotional stability in adult women. The results have implications for individual lifestyles and for public health prevention for all ages, including children and adolescents and their families.
March 2010: Emotional Intelligence as a Protective Factor in Public Health
Childhood sexual abuse is one of the most stressful life events for youth and suicidality (suicidal ideation and suicide attempts) represents one of the most serious responses to stressful life events. A recent study examined whether the presence of emotional intelligence is a protective factor against suicidal behaviors in youth with a history of childhood sexual abuse. The findings provide preliminary evidence that emotional intelligence is in fact a protective factor. This article also explores additional implications relevant to mental health and public health.
December 2009: Public Endorsement by AACAP of the Need for Family and Youth Involvement in Clinical Decision-Making
In October 2009, the American Academy of Child and Adolescent Psychiatry (AACAP) endorsed a policy statement in support of family and youth participation in clinical decision-making. This paper reviews the rationale for family and youth participation in clinical treatment, and the significance of AACAP’s policy statement for the field of mental health and human services.
September 2009: Advancing a Public Health Approach to Children’s Mental Health in Pennsylvania
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Public Health Approach to Children’s Mental Health: A Conceptual Framework
The National Technical Assistance Center for Children’s Mental Health at Georgetown University recently published a monograph that “applies public health concepts to effort that support children’s mental health and development. “ Intervention activities described in the monograph include promoting positive mental, preventing and treating mental health problems, and “re/claiming” health while addressing a mental health problem. The complete monograph can be downloaded here.
Resiliency in the Public Health Framework: Information from a webinar sponsored by the National Association of State Mental Health Program Directors in collaboration with the National Technical Assistance Center for Children’s Mental Health
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Additional Resources (listed alphabetically):
About Our Kids (New York University Child Study Center)
Act Early Campaign, Centers for Disease Control: FREE materials for parents, healthcare providers, and childcare providers; printed with English on one side and Spanish on the other.
“All Babies Cry” is a project to prevent child abuse during the first year of life. The project is funded by the National Institute of Health and produced by Vida Health Communications. “All Babies Cry is a multiple-dose intervention intended for new parents. It includes a video program for hospital closed-circuit TV systems, a DVD for families to take home, a 28-page booklet with checklists, ability to stream the videos online, an online training course for staff implementation, and a Facebook community. All materials are in English and Spanish. The materials are intended to be introduced to parents as part of bedside education during maternity stays. The program incorporates the protective factors of the Strengthening Families initiative and empowers new mothers and fathers with practical demonstrations of infant soothing and clear strategies for managing normal stress in parenting.
America’s Report Card 2012: Children in the U.S., from First Focus and Save the Children. Commissioned by former Connecticut Senator Chris Dodd, and current Pennsylvania Senator, Bob Casey, this report provides a holistic picture of unmet needs in five areas of a child’s life: economic security, early childhood education, K-12 education, permanence and stability, and health and safety.
Better Kid Care, a program of Penn State Extension; provides professional development opportunities and educational information on caring for children.
Bright Futures: A Public Health Approach to Mental Health (Georgetown University Child Development Center)
Centers for Disease Control Parent Portal: “a wealth of information from across all of CDC, covering everything from safety at home and the community to immunization schedules and developmental milestones.”
Child Trends Fact Sheet, “What Works for Promoting and Enhancing Positive Social Skills: Lessons from Experimental Evaluations of Programs and Interventions,” March 2011
Children's Mental Health: What Every Policy Maker Should Know, published by the National Center for Children in Poverty, April 2010.
Defending Childhood, U.S. Department of Justice: Launched in 2010 to address the national crisis of the exposure of America’s children to violence as victims and as witnesses. Children’s exposure to violence, whether as victims or witnesses, is often associated with long-term physical, psychological, and emotional harm. Children exposed to violence are also at a higher risk of engaging in criminal behavior later in life and becoming part of a cycle of violence.
Family Education (Family Education Network)
The First Eight Years: Giving Kids a Foundation for Lifetime Success; Policy Report from Kids Count, Annie E. Casey Foundation
Healthy Children, parenting web site from the American Academy of Pediatrics. Divided into user-friendly sections, such as “ages and stages” (developmental milestones and other health issues from infancy through adolescence), healthy living (including emotional wellness with information about resilience in children), safety and prevention, and health issues. You can also submit a question to a pediatrician or find a pediatrician in your area and there is a bookstore.
Healthy Mothers, Healthy Babies Coalition: Each year in the US, more than 500,000 babies are born prematurely and an estimated 28,000 children die before their first birthday. In response to this national public health crisis, the National Healthy Mothers, Healthy Babies Coalition (HMHB) has launched Text4baby, a free mobile information service that provides pregnant women and new moms with information to help them care for their health and give their babies the best possible start in life.
Infant Early Learning GPS (Guiding Parents Smoothly), a program of Pennsylvania’s Promise for Children. Helps families set the right course for their children’s success in kindergarten and beyond. Great for anyone who has a baby in their life—grandparents, aunts, uncles, friends and neighbors.
KidsHealth (“most-visited site on the Web for information about health, behavior, and development from before birth through the teen years”)
Mental Health America (factsheet on What Every Child Needs for Good Mental Health)
Mentalhealth.gov: From the federal Department of Health and Human Services, MentalHealth.gov provides one-stop access to US government mental health and mental health problems information. The President’s plan to protect our children and our communities by reducing gun violence directed the Departments of Health and Human Services (HHS) and Education to launch a national dialogue on mental health with young people who have experienced mental health problems, members of the faith community, foundations, and school and business leaders.
Mental Health—A Public Approach: Developing a Prevention-Oriented Mental Health Sustem in Washington State (Washington State Board of Health, 2007)
National Association of Health Education Center (local educational resources dedicated to the current and future health of our nation's children)
National Mental Health Information Center (Substance Abuse and Mental Health Service Administration)
NEW! Pediatric Medical Homes: Laying the Foundation of a Promising Model of Care, published by the National Center for Children in Poverty, October 2011
Promoting Mental Health: Concepts, Emerging Evidence (World Health Organization, 2004)
The American Academy of Pediatrics offers “Sound Advice on Mental Health,” a series of audio recordings of interviews with pediatricians who talk about child behavior, emotions, and other mental health topics. Topics include:
- Parenting Advice About Child Behavior
- How to Recognize Anxiety and Depression
- Nurturing Your Young Children’s Emotional Development
- Mental Health After Trauma and Loss
Strategies for System Change in Children’s Mental Health: A Chapter Action Kit (American Academy of Pediatrics, 2007)
Stop Underage Drinking: Portal of Federal Resources: www.stopalcoholabuse.gov. Public awareness campaign: "Talk Early, Talk Often. Get Involved:" www.underagedrinking.samhsa.gov
This Emotional Life (Three-part PBS series explores ways to improve our social relationships, cope with emotional issues, and become more positive, resilient individuals.)
Trauma Faced by Children of Military Families: What Every Policymaker Should Know, National Center for Children in Poverty, May 2010
Your Typically Developing Child (Minnesota's Our Children Succeed Initiative
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Resources for Military Families
Children of Military Service Members Resource Guide, from the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The document is a quick reference tool that addresses the mental and emotional well-being of military children. Whether concerns are associated with deployment, rehabilitation or reintegration - aspects that are common with military service - they can be challenging for the entire family unit, especially children. The resource guide is one way to help recognize and respond to the psychological and emotional health needs of children of military families.
Helping Military Families, part of PBS television series, This Emotional Life. Includes a Handbook for Family and Friends of Service Members.
Military Children and Families, from the National Child Traumatic Stress Network. Includes a series for educating families, medical professionals and school personnel on how to serve military children experiencing greif, and a Military Families Knowledge Bank.
Military Families, a priority of the Substance Abuse and Mental Health Services Administration to support service men and women, their families and communities by leading efforts to ensure that needed behavioral health services are accessible and outcomes are positive.
MilitaryKidsConnect, online community of military children (ages 6-17 yr old) that provides access to age-appropriate resources to support children from pre-deployment, through a parent's or caregiver's return. Includes information in four categories: kids, ages 6-8; tweens, ages 9-12; teens, ages 13-17; and teachers, parents and caregivers.
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Strengthening Families Through Early Care and Education
Pennsylvania is one of 17 state affiliates of the Strengthening Families National Network and is working to implement the Strengthening Families approach in early childhood programs.
Strengthening Families is a project of the Center for the Study of Social Policy and emphasizes five protective factors that not only reduce the incidence of child abuse and neglect but also encourage healthy social and emotional development. These protective factors are:
- Parental resilience: the ability of parents to cope with challenges
- Social connections: friends, family members, neighbors and other community members who provide emotional support and assistance to parents
- Knowledge of parenting and child development: accurate information about child development and how to appropriately discipline young children
- Concrete support in times of need: financial, formal and informal supports
- Children’s emotional and social competence: child’s ability to interact positively with others and communicate emotions effectively.
Early childhood programs can use an online self-assessment tool to help them begin to build the protective with families.
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Preventing Behavioral Health Problems in Children and Youth
Benefits and Costs of Prevention and Early Intervention Programs for Youth, 2004: Findings from a 2003 study by the Washington State Institute for Public Policy.
NEW! Mobilizing Communities to Implement Tested and Effective Programs to Help Youth Avoid Risky Behaviors: The Communities That Care Approach, a ChildTrends Research Brief, October 2011
National Prevention Strategy: America’s Plan for Better Health and Wellness. A comprehensive plan from the National Prevention, Health Promotion, and Public Health Council, U.S. Department of Health and Human Services, June 2011. One of seven priorities is “Mental and Emotional Well-being.” To promote mental and emotional well-being, the document listed four recommendations: 1) promote positive early childhood development, including positive parenting and violence-free homes; 2) facilitate social connectedness and community engagement across the lifespan; 3) provide individuals and families with the support necessary to maintain positive mental well-being; 4) promote early identification of mental health needs and access to quality services.
Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, 2009. Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of children and adolescents. The costs of treatment have stimulated increasing interest in prevention practices, including programs for selected at-risk populations (such as children and youth in the child welfare system), school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations. The book is available to read free online; there are also report briefs for policymakers and researchers, and a resource for parents.
NEW! Preventing Multiple Risky Behaviors Among Adolescents: Seven Strategies, a ChildTrends Research-to-Results Brief, September 2011
Promotion and Prevention in Mental Health: Strengthening Parenting and Enhancing Child Resilience (SAMHSA, 2007)
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