"The biggest thing we need to be doing is figuring out how to prevent children from developing mental health disorders. These children don’t parachute into our communities with mental health disorders and many of these disorders appear in the preschool age group."
- David Tayloe, MD, FAAP, past President, American Academy of Pediatrics
[from a podcast]
Early intervention is key to preventing a child’s mental health state from reaching a crisis point whether that means the child engages in risky behaviors such as substance abuse, delinquency or self-injury. It is estimated that 75-85% of the children who need mental health specialty services fail to receive them. Reasons include lack of access, lack of transportation, financial constraints, child mental health professional shortages, and stigma related to mental health disorders. In addition, there are only 7000 child psychiatrists in the U.S. and very few currently in training programs. This great need combined with lack of access to appropriate care has convinced many pediatricians to broaden their practices to include mental health.
In 2009, the American Academy of Pediatrics issued a policy statement [pdf »] outlining how primary care physicians will need to address the mental health of their patients along with their physical health. In the report, the AAP recognized that “pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems.” In Fall of 2010, the Academy will publish a tool kit with a variety of instruments that pediatricians can use to identify, screen and treat children.
System of Care
For those working on the front lines of children’s mental health, “system of care” is an efficient and, most importantly, effective model for delivering needed services to a family. It is defined as:
- A network of community services and supports for children and youth with serious mental health needs.
- Families, youth, and providers become partners so each child can function better at home, in school and in the community.
The core values of this system are that it is:
- Culturally competent
The US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMSHA) has supported many SOC sites around the country including middle Tennessee.
For more information on System of Care go to:
Charlotte Bryson describes the current system of mental health care in middle Tennessee this way:
"What we find is that families get even more desperate because in a fragmented system if they go to one agency and that agency does not have the service they need, they are kinda shuffled to another agency. In a coordinated system of care, those agencies would come together and- help that family find a good plan. But unfortunately the reality is that families are struggling, being bounced back and forth between agencies to determine what is best for their child. They also find that they’re not listened to, that while they know their child the best… unless they are in a family-driven system of care the likelihood of them getting that kind of respect and listened to as the primary care giver. So families struggle to get heard, to learn what their child needs, and to work carefully through the system to get that coordinated service that their child needs. If they don’t get it…more and more crises develop that they are having to respond to and families are even more desperate to find the right service for their child. And it’s a very difficult navigation to make out there in our system as it exists. Unless they happened to be in a location that has a local system of care developed."
Additional resources on systems of care:
Stroul, B. A. & Friedman, R. M. (1994). A system of care for children and youth with severe emotional disturbances. (Revised edition). Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center
Caring for Every Child’s Mental Health Campaign of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, DHHS
Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services Program for Children and Their Families, SAMHSA.
National Research Council and Institute of Medicine, (2009) Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, The National Academies Press.
In 2008, the Tennessee state legislature passed Public Chapter 1062 which established a council on children's mental health care. The law required the Council to develop a plan for a statewide system of care where children's mental services is family-driven, child guided, and culturally and linguistically competent, and provides a coordinated system of care for children's health needs in the state.
This Council met regularly and developed implementation plans with reports back to the legislature. The legislation and reports are available on the Tennessee Commission on Children and Youth website. The Council plans to complete a plan by July 2010 for statewide implementation of systems of care.