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Position Statement 43: The Federal Role in Services that Address the Health and Wellness of Children, Youth, and Families
With the recent understanding that prevention and promotion programs can be effective in reducing the prevalence of mental health and substance use conditions in American society,[i] it is important for the federal government to support comprehensive prevention, promotion, and early intervention[ii] activities to address the behavioral health needs of young people and their families. In addition to increasing the behavioral health interventions needed to improve child welfare and education,[iii] reflecting the growing intergovernmental partnership to improve young people’s opportunities throughout the United States, behavioral health promotion and services and prevention of mental health and substance use conditions should be fully integrated with federal health care reform under the Affordable Care Act. Prevention and timely treatment can be effective in alleviating the distress experienced by young people and their families in coping with mental health and substance use conditions.[iv]
The federal role must be shared among many federal agencies, including the Departments of Health and Human Services, Education, Labor, and Justice. Among other things, federal programs have stimulated great improvements in nutrition, literacy, school-based programs, youth development, immunization, substance abuse treatment and prevention, education, delinquency prevention, primary and behavioral healthcare, early childhood development, housing, employment and training. Mental Health America (MHA) urges Congress to spare these programs from cuts to the extent possible.
A nurturing, supportive family unit, whether traditional or non-traditional, offers young people an environment conducive to healthy development and emotional well-being. However, many families face unprecedented challenges to their health, wellness, economic stability, housing, safety, and transportation. These issues, combined with limited access to social services, put many young people at risk for the development of general or behavioral health problems. Without support, young people with mental health and substance use conditions are particularly vulnerable to developing problems at home, in school, with their peers, and within the broader community.
Broad availability of preventive family-focused interventions like home visits and help with parenting skills is the proven answer.
The Board on Children, Youth, and Families at the National Academies of Sciences, Engineering, and Medicine has contributed enormously to the science of child development through the consensus reports From Neurons to Neighborhoods: The Science of Early Childhood Development (2000)[v] and Preventing Mental, Emotional, and Behavioral Disorders in Children: Progress and Possibilities (2009),[vi] along with the ongoing work of the Forum on Children’s Cognitive, Affective, and Behavioral Health. This work has consistently identified home visitation, parent education programs, and family support and strengthening interventions (commonly referred to as family-focused interventions) as powerful tools to prevent many mental health conditions and to promote strong families. Research on family-focused interventions provided in primary care, educational, and community settings has demonstrated the potential to strengthen the social-emotional resources of children and adolescents, and to provide them with skills to succeed in school and in life. In that way these preventive interventions can improve the mental health of children, adolescents, and families, and reduce the incidence of suicide, violence, sexual risk taking, and substance abuse.[vii]
Benefits from these family-focused interventions are present for almost all children, whether or not a family was at heightened risk for negative outcomes. The interventions give families access to evidence-based information about raising healthy children, and offer families an opportunity to support one another and forge positive relationships. Family-focused preventive interventions have also proven effective for children at risk of diagnosis for behavioral health problems detected through screening for identification of early warning signs in the child or in the environment in which the child is developing. Family-focused interventions have also proven effective in reducing developmental risks and behavioral health problems encountered at specific developmental periods, such as with interventions offered universally to all parents of children entering adolescence. Thus, some family-focused interventions can be recommended as universal prevention, or as selective or indicated preventive intervention in follow-up to a screen.
For LGBTQ teens and young people and families of color, the challenges are even more difficult. Stresses and confusion are pronounced in stigmatized racial environments and for young people who are coming to terms with a stigmatized sexual orientation and considering coming out. Studies show a strong correlation between gay, lesbian or bisexual sexual identity and the risk of suicide.[viii]
According to the Institutes of Medicine, families of color often have unequal access to health care treatment.[ix] Disparities in health care have become more significant as the ethnic demographics of the United States have continued to evolve. Issues of sexual orientation, color, race and ethnicity pose a challenge for the federal government to lead, in partnership with the states, efforts to develop and implement culturally and linguistically competent programs that promote the health, safety and wellness of young people and their families and deal directly with the stresses of homophobia and racism that continue to plague American society.
Federal agencies increasingly support initiatives to improve cross-agency collaboration, and the implementation of the Affordable Care Act has required new levels of cooperation.[x] Most recently in January 2016, the Department of Education and the Department of Health and Human Services released Healthy Students, Promising Futures, a toolkit on five high-impact opportunities for schools and health care systems to collaborate to improve outcomes in each.[xi] MHA applauds these efforts as well as the increased recognition of health promotion and wellness as a priority area of focus as the need to manage medical interventions becomes more and more pressing. MHA believes that interagency collaboration and service integration are essential elements to address the health and well-being of young people and their families, particularly individuals with multiple needs requiring the attention of several agencies.
Call to Action
MHA supports federal leadership in the following areas:
- Bringing greater visibility to the behavioral health and wellness needs of America's young people and their families;
- Including families as partners in the design, development, planning, and evaluation of services developed or promoted by federal agencies;
- Educating the general public about the mental health conditions that affect young people, suicide prevention, maternal depression, strategies for recovery, and effective mental health and substance abuse services;
- Supporting wellness, prevention, promotion and early identification programs;
- Integrating behavioral health promotion and services
- Promoting inter- and intra-agency coordination, collaboration, service integration, and the development of comprehensive national cross-agency initiatives to improve the behavioral health and wellness of America's young people and their families;
- Financing initiatives that allow states and communities to develop and implement community-based, culturally and linguistically competent primary and behavioral health, substance abuse, prevention, promotion and treatment services for all young people and families;
- Building the capacity of states and communities to achieve health and wellness for young people and their families through knowledge dissemination, technical assistance, web-based technology, and targeted discretionary grant programs, including an expanded mental health block grant program;
- Expanding research on prevention and promotion, the efficacy of treatment and service delivery methods, and evaluation of promising practices;
- Giving attention to practices that show promise in meeting the needs of specific populations (rural/urban, race/culture, age/developmental stage) of young people and families;
- Encouraging and supporting state efforts to collect data on the mental health needs of young people in federally-assisted child-serving systems (child welfare, juvenile justice, education, primary health, behavioral health, substance abuse, child care, and Head Start);
- Disseminating best practices to all communities, not just those receiving federal grants, including rural and under-served areas as well as communities of color;
- Prioritizing prevention, early identification, and early intervention for families with children at risk of developing emotional or behavioral disorders; and
- Addressing policy barriers, regulatory conflicts, and funding mechanisms that inhibit creative and flexible service delivery to young people and families; more must be done to address the evolving sexual diversity and changing ethnic demographics of the United States.
MHA urges that the following additional strategies be implemented:
- Mandating coverage of certain family-focused interventions[xii] for at-risk families, as the U.S. Preventive Services Task Force does under the Affordable Care Act for clinical prevention, so that at-risk families can get the support they need at no cost. Assess cost-benefits of these interventions and begin to build the case for universal coverage of these interventions so all families may benefit;
- Offering incentives and technical assistance for health care systems to invest in effective early care and education that have returns on investment to health care, as well as to invest in mental health promotion and prevention interventions in schools;
- Soliciting input on challenges and barriers to full implementation of the Healthy Students, Promising Futures toolkit and provide more guidance and assistance to enable schools and communities to implement the five high-impact opportunities as quickly as possible;
- Supporting the integration of behavioral health treatment and prevention in schools;
- Establishing policies to provide increased consistency and equity of care for LGBTQ youth and young people and families of color;
- Establishing policies that eliminate cultural and linguistic barriers to accessing services; and
- Designing and implementing behavioral health workforce training programs that address the diverse developmental, cultural, and linguistic needs of young people and families;
The Mental Health America Board of Directors Approved this Policy on September 9, 2016. It is reviewed as required by the Mental Health America Public Policy Committee.
[i] See MHA Position Statement 48, Prevention of Mental Health and Substance Use Disorders in Young People, http://www.nmha.org/go/about-us/what-we-believe/position-statements/p-48-prevention-in-young-people/position-statement-48-prevention-of-mental-health-and-substance-use-disorders-in-young-people .
[iv] See MHA Position Statement 42, Services for Children with Mental Health Conditions and Their Families,
http://www.nmha.org/go/position-statements/42 . “Mental health conditions” includes, without limitation, the federal term “severe emotional disorders.”
[v] From Neurons to Neighborhoods: The Science of Early Childhood Development, The National Research Council and The Institute of Medicine (2000), available at http://www.nap.edu/catalog/9824/from-neurons-to-neighborhoods-the-science-of-early-childhood-development.
[vi] Preventing Mental, Emotional, and Behavioral Disorders in Children: Progress and Possibilities, The National Research Council and The Institute of Medicine (2009), available at http://www.nap.edu/catalog/12480/preventing-mental-emotional-and-behavioral-disorders-among-young-people-progress.
[vii] See, e.g., Family Foundations, Nurse-Family Partnership, Family Check-up, Triple P System, Incredible Years – Parent, Parent Management Training – Oregon Model, Parent-Child Interaction Therapy, New Beginnings (For children of divorce), Strong African American Families Program, Strengthening Families 10-14, EFFEKT, Familias Unidas Preventive Intervention, Guiding Good Choices, Positive Family Support – Family Check-up, Functional Family Therapy, Multisystemic Therapy – Problem Sexual Behavior, Blueprints for Healthy Youth Development, http://www.blueprintsprograms.com .
[viii] See, e.g., Fergusson, D.M., Horwood, L.J., & Beautrais, A.L., “Is Sexual Orientation Related to Mental Health Problems and Suicidality in Young People?” Arch Gen Psychiatry 56(10):876-80 (1999), http://archpsyc.ama-assn.org/cgi/content/full/56/10/876 . Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95% CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3).
[ix] Institute of Medicine, Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare (2002), http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=Unequal+Treatment%3A+What+Healthcare+Providers+need+to+Know+About+Racial+and+Ethnic+Disparities+in+Healthcare (pdf).
[x] See MHA Position Statement 71, Health Care Reform, http://www.nmha.org/go/about-us/what-we-believe/position-statements/position-statement-71-health-care-reform/position-statement-71-health-care-reform .