The MHTTC Network is working to align our messaging and coordinate our response to the Nation's youth mental health crisis. With the declaration of a National State of Emergency in Children's Mental Health from the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) and the U.S. Surgeon General’s Advisory on Protecting Youth Mental Health at the forefront of our discussions, we took some time to interview our collaborators who are thought leaders in the field of child and adolescent mental health.
Steven Adelsheim, MD, DFAACAP, DFAPA
Clinical Professor Director, Stanford Center for Youth Mental Health and Wellbeing
Associate Chair for Community Engagement
Department of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Sharon Hoover, Ph.D.
Co-Director, National Center for School Mental Health
Professor, Division of Child and Adolescent Psychiatry
Director, NCTSN Center for Safe Supportive Schools
University of Maryland School of Medicine
Nancy Lever, Ph.D.
Co-Director National Center for School Mental Health
Associate Professor, Division of Child and Adolescent Psychiatry
University of Maryland School of Medicine
Q: What does the Declaration mean for the mental health field?
A: The declaration represents the affirmation of the crisis we already had in terms of lack of support for student/youth mental health around the country and the disparities in access to care for children given that half of all mental illnesses start by the age of 14. The situation has only gone from bad to worse during the pandemic, and the declaration was needed because of the lack of focus on addressing the mental health needs of our children across the country.
Q: Given the effect of COVID-19 on children and adolescents, what is being done/can be done to address their mental health needs?
A: Creating structured models for early identification including screening and early intervention from those models. The ALLCOVE model is an integrated youth mental health model we are developing that is a critical way to reach young people in settings that are comfortable to them. It provides integrated care from early intervention, for mental health, for primary care, supportive education/employment, peer support, and early addiction treatment. Linking these models to schools is critical to give young people multiple access points that they are comfortable with for early mental health care. In addition we need to be linking federal funding for early psychosis programs to secondary schools. Also, increasing training for secondary schools and recognition of young people with early psychosis risks and needs, as well as training the early psychosis programs on how to work more effectively with secondary schools to have earlier identification of young people at risk.
Q: The Declaration calls for advocates and policymakers to “Increase implementation and sustainable funding of effective models of school-based mental health care, including clinical strategies and models for payment.” What specific changes do you think are most important, or should occur first?
A: In terms of the declaration comments, I think what is important is the outreach to rura, and disparities populations. We need to ensure we have connectivity to our rural schools and have an expanded focus on supporting rural providers and those from disparities populations, particularly our Black and Native American students. One example of the work that we are doing is creating a Project ECHO model to target schools working with Native American children and youth that are willing to provide additional support in school mental health models of care; we will be starting that in January and running through September in partnership with the California Indian Health Service. I believe that we need more of these types of training and supportive models for rural and isolated providers and those working with unique disparities populations to increase their access to early services and support. In terms of funding models, we really need to ensure that we can provide access to school mental health services for all young people regardless of whether they are uninsured, on Medicaid, or have commercial coverage. Too often the coverage has not been available to programs for young people that are commercially insured. For example, in the San Mateo County and Santa Clara County areas, there have been suicides of young people on commercial coverage, this has led to the question of: What do public systems feel in terms of responsibility for commercially covered youth? Even going back to 2015, the San Mateo County Grand Jury Report recommended the need to expand school mental health services for those with commercial insurance, and that has still not happened. So, figuring out those structures seems very important. In addition, we need to expand incentives for community mental health programs to provide services in school-based settings and expand the collaboration between school mental health professionals and community providers in schools and build that infrastructure in a more consistent way across the country.
Q: What is being done/can be done to support the mental health workforce in addressing this crisis?
A: In terms of addressing the workforce, we have ongoing issues related to low repayment and the additional costs for people to get additional training to do child and adolescent mental health; given this difficulty and the fact that half of all mental illnesses start by the age 14, its critically that we make the investment in early childhood mental health provider training more effectively and create first step models for young people to get training in child and adolescent mental health with a school-based focus. We also need to expand child psychiatry training to be more onsite and clinically connected to school related programs as well.
Q: How do you think the MHTTC Network can respond to this declaration?
A: I think the Mental Health Technology Transfer Center Network can really respond through advocacy or at least education in terms of making people aware of these needs for supports. The Network can provide active training in school mental health and model dissemination of effective models both for financing and service delivery, and through the Regional Centers, expand the voice of programs across the country. In addition, it will be important to highlight particularly effective culturally-based programs with a focus on rural communities. We are doing a lot of this work through the MHTTCs that work with early psychosis programs, and it would be great to see the School Mental Health Initiative expand on that in addition to all the wonderful curriculum work that is being done.
Q: From your perspective, what does the Declaration mean for the mental health field?
A: It recognizes the urgency and significance of mental health issues among children and adolescents from nationally recognized sources and may further galvanize the field to act.
Q: Given the effect of COVID-19 on children and adolescents, what is being done/can be done to address their mental health needs?
A: Schools across the nation are working to support the mental health needs of students in the context of COVID-19. Establishing comprehensive school mental health systems to promote mental health and prevent and address mental illness is a critical strategy to address the rising mental health needs resulting from the pandemic..
Q: The Declaration calls for advocates and policymakers to “Increase implementation and sustainable funding of effective models of school-based mental health care, including clinical strategies and models for payment.” What specific changes do you think are most important, or should occur first?
A: States and local communities should leverage this opportunity to create sustainable funding strategies that promote evidence-based practices and programs across the continuum of mental health supports in schools. The National Center for School Mental Health (NCSMH), in partnership with the Council of Chief State School Officers and the Healthy Schools Campaign, released a guidance document detailing several key strategies for leveraging Medicaid and ESSER funding to support student and staff well-being and connection: Restart & Recovery: Leveraging Federal COVID Relief Funding & Medicaid to Support Student & Staff Wellbeing & Connection.
Q: What is being done/can be done to support the mental health workforce in addressing this crisis?
A: We must attend to both the organizational and individual factors that promote workforce well-being. In addition to supporting self-care strategies among our behavioral health workforce, it is crucial to address other domains that impact staff well-being including the domains reflected in the new Organizational Well-being Inventory (OWBI) at ProviderWellBeing.org
Q: How do you think the MHTTC Network can respond to this declaration?
A: Put out a Response Statement declaring the Network’s recognition of the crisis and efforts to respond, including a statement of the scope and purpose of the Network and how communities can access its resources.