Challenges and Opportunities in Childrens Mental Health
A View from Families and Youth
Publication Date: July 2006
Children and youth with mental health problems and their families need the appropriate skills, tools, services, and supports to reach their full potential as productive, contributing citizens. Quality mental health services and supports can significantly improve their ability to attain school success, mental health, and social and emotional well-being, to maintain healthy relationships, to remain in stable living situations, and to stay out of jail and the juvenile justice system. This report, based on a meeting of youth and family members of children and youth who experience mental health problems, highlights how family-driven and youth-guided values and frameworks can improve research, policy, and practice and ultimately result in better care and healthier children and youth. Below we identify the challenges that the family members and youth reported as well as the policy, service, and research solutions that they proposed. The full report also includes examples of research, policy, and practice that involve families and youth as active partners.
The major take-home message is that a strong family-driven and youth-guided perspective in research, policy, and practice propels more effective, responsive service delivery systems. At the center of families’ and youth’s support for effective strategies rests their desire to see children and youth with mental health problems get better and lead productive lives. They called for an outcomes-focused delivery system that holds all stakeholders accountable, regardless of which service system the children and families are in.
Youth leaders, family, and community advocates also linked research with quality services. Today, too many children and youth with mental health problems and their families continue to encounter service delivery systems that struggle to meet their needs. Oftentimes, there are too few services, and many of those that exist rely on a deficit-based care model. Across the country, small numbers of children, youth, and their families do benefit from programs that focus on the individual strengths and needs. Thus, creating a policy framework that provides this kind of access to high-quality services for all children, youth, and families who need them is essential. Family members and youth recognize that they have a significant role to play in strengthening and expanding the array of quality mental health services and supports. For instance, increasingly family and youth:
- Serve as participatory researchers, system navigators for parents and youth, peer supporters, trainers, and service providers.
- Act as advocates for other parents.
- Help to address the workforce shortage, especially by increasing providers with linguistic and cultural competence.
Family members and youth also acknowledged the need for more widespread adoption of evidence-based practices and called for strategies that: (1) invest in research to determine the effectiveness of family/youth centered, and culturally and linguistically competent interventions that show promise in communities; (2) include family and youth engagement components; (3) embed strength-based and resilience principles and strategies; and (4) emphasize functional outcomes for children and youth in the home, school, and the community.
Finally, and importantly, family members and youth also considered themselves accountable as advocates. They called for the elimination of harmful policy practices such as custody relinquishment in exchange for services. This, they noted, conflicts with societal, family, and youth values and with the basic principles of health care. Family members and youth also indicated the need to amend rules in the Supplemental Security Income (SSI) program that serve as disincentives to work. They wanted a relaxation of SSI requirements that jeopardize youth health insurance or social supports. These and other urgent policy matters often first surface from children, youth, and families affected by mental health issues. Therefore, family members and youth strongly urged states to strengthen family and youth advocacy organizations in order to better serve mental health services users.
To strengthen family-driven and youth-guided research, policymakers should:
- Promote collaborative partnerships with families and youth in research.
- Increase the use of positive outcomes measures.
- Ensure the dissemination of outcomes data and research through user-friendly techniques and language.
To strengthen family and youth support in the context of all services, policymakers, researchers, and providers should:
- Make family and youth support a funded and essential component of service delivery.
- Provide family-driven, youth-guided, and responsive services and supports in settings that are readily accessible to children, youth, and their families.
- Take family-driven and youth-guided services to scale.
- Promote mental wellness and positive social and behavioral competencies by engaging children and youth in interesting and appropriate activities.
To take family-driven and youth-guided services to scale for high-need youth, policymakers and practitioners should:
- Provide family-driven, youth-guided, and responsive services and supports in settings that are readily accessible to children, youth and their families.
- Require cross-system accountability for improved outcomes as a condition of funding based upon developmentally appropriate, family-driven, and youth-guided practice.
- Require greater accountability for improved outcomes for children and youth as a condition for funding residential treatment providers.
- Foster adoption of family-driven and youth-guided evidence-based practice that works in community based setting and with diverse populations.
- Infuse family-focused, culturally and linguistically competent, and developmentally appropriate principles across all mental health services, not just those delivered within the context of systems of care.
To address harmful practices and policies, state and federal-level policymakers should:
- Eliminate the practice of custody relinquishment in exchange for mental health services for children and youth.
- Amend rules governing Supplement Security Income to remove work disincentives for youth with mental health problems.
- Implement administrative practices that strengthen the family and youth voice.
- Support organizational and leadership development for family and youth advocacy organizations.
To strengthen the policy infrastructure to better support family and youth perspectives, policymakers and advocates should:
- Increase funding and other resources to support family meetings, including transportation, meals, and on-site specialized child care.
- Expand or create opportunities for policymakers and administrators to hear directly from families and youth.
- Build in policy requirements that give families and youth roles in policymaking bodies.
- Enhance networking capacity of parents, youth, and other family members.
- Invest in family and youth advocacy organizations and services directed by youth and families.
- Expand technical assistance offered by the federal government to states and communities that do not have formal systems of care grants.
- Promote and fund the development of a public health model that embraces a universal focus on children’s mental health and addresses the needs of the most troubled children and youth.