Thirty-five psychologists were among the 300 experts that Surgeon General David Satcher, MD, PhD, invited to a September conference to craft a national action agenda for preventing, identifying, referring and treating children with mental disorders.
The result was a far-reaching plan that embraced often-neglected aspects of mental health care, such as ensuring cultural sensitivity is part of a child's care and seeking to hear the voices of children themselves.
Meeting participant and APA President-elect Norine G. Johnson, PhD, said the agenda that she and other psychologists helped to create represents a wonderful opportunity for children.
"I know from personal experience as well as from talking to psychologists around the country that children aren't receiving the types of services we know help them the most," she says. "The Surgeon General's Conference on Children's Mental Health was a giant step forward in helping these children."
The action agenda
The Surgeon General's meeting was a collaboration among the U.S. departments of Health and Human Services, Justice and Education.
In addition to the psychologists, the attendees included scientists from other fields, teachers, advocates, family members and young people themselves.
After a series of panel presentations, conference participants broke into groups to develop specific recommendations. By meeting's end, they had come up with a set of points that will form the basis of the Surgeon General's upcoming call to action.
What's needed, they decided, are the following:
- A model of primary mental health, possibly including mental health checkups and integrated social, emotional and physical assessments.
- A public education and awareness campaign to combat stigma and increase understanding of children's mental health.
- Family support and involvement in all phases of treatment.
- A willingness to hear the voices of young people themselves.
- Tangible assessment tools to help practitioners and others improve their recognition of children's mental health problems.
- Access to quality care, including universal screening and referral systems, mental health parity and enhanced school-based programs.
- Coordination of care among primary-care, mental health, education, juvenile justice and other relevant systems.
- Professional training for teachers, physicians and others who work with children.
- Monitoring of the quality of care to ensure cultural sensitivity and the appropriate use of empirically based treatments.
- An expanded research base regarding treatment efficacy and effectiveness, as well as the process of bringing proven treatments to scale.
"The Surgeon General is to be credited with his leadership in the field of mental health," says Ronald F. Levant, EdD, APA Recording Secretary and dean and professor of psychology at Nova Southeastern University in Fort Lauderdale, Fla., who also represented APA at the meeting. "The fact that he sponsored the first-ever Surgeon General's Conference on Children's Mental Health and will follow it up with a report is extremely significant. It indicates that we're moving away from an era where mental health problems were so stigmatized you couldn't even talk about them in the government."
Psychology has contributed to the development of the Surgeon General's action plan at each step of the process, says Ellen Garrison, PhD, director of public interest policy at APA. In fact, the wording in the plan clearly reflects points made in the briefing paper APA provided to its delegates, which was based on input from APA members.
At the conference, APA members gave about 20 percent of the presentations. One given by John R. Weisz, PhD, of the University of California, Los Angeles, summarized what's known about psychosocial treatments for children's mental health problems and emphasized the needs to bridge the gap between research and practice.
The field needs to confirm that programs proven effective in clinical trials also work in real-world service settings, he told participants. "We need to understand the steps required to move from research findings to effective applications," he said.
He added that the federal government should incorporate evaluation components into all the projects it funds and should promote proven psychological treatments as a way of counterbalancing industry's lobbying on behalf of pharmacological treatments. And research findings shouldn't just go to professionals.
"One parent at the conference said that she and her family get much more information about the tuna fish they buy than about the mental health treatment their child is going to receive," said Weisz. "Parents need to be in the loop. Whatever scientific evidence is available about treatments should be made available to parents."
The next steps
APA is now working with relevant governance groups and divisions to come up with next steps. APA has already offered its members' expertise to the Surgeon General as he develops and implements the call to action.
As president-elect, Johnson has recommended that APA develop an action plan of its own for responding to the Surgeon General's call. She would like to see APA form partnerships with pediatricians, advocacy groups, parent groups and others working with children. And she would like to see APA better integrate its various directorates' work on behalf of children.
Johnson and other psychologists at the conference also developed more general recommendations for the field. They want training to extend from universities all the way to community settings such as schools and day-care centers as a way of broadening the pool of potential partners. They want new methods of postgraduate training for psychologists, such as distance-learning initiatives. They also want more research, including longitudinal studies identifying the factors that put children at risk for developing mental health problems.
For APA Past President Robert J. Resnick, PhD, the conference itself inspired confidence that these goals will be met. "I was proud to be part of this group because they stayed very realistic and stayed with the core concerns about children's needs," says Resnick, a practitioner at Dominion Behavioral Healthcare and a psychology professor at Randolph-Macon College in Ashland, Va. "Something's going to happen."Rebecca A. Clay is a writer in Washington, D.C.