As most psychologists are aware, mental health is one of Surgeon General David M. Satcher's top priorities, and in that arena, children and adolescents command a key spot. Satcher has delivered four major reports that focus on or include young people's mental health (see box, next page), and all of them bring a public health perspective to the way researchers study and practitioners provide services to these youngsters.
In a keynote address at APA's Eighth Annual Institute for Psychology in the Schools held during APA's 2001 Annual Convention, National Institute of Mental Health psychologist Kimberly Hoagwood, PhD, discussed how Satcher's orientation is influencing the field, and what the sea change means for psychologists who work with children.
"The Surgeon General's efforts represent a fundamental change in how research findings will be used," said Hoagwood, who directs child and adolescent mental health research at NIMH and has worked closely with Satcher on a number of initiatives.
"We've been doing things in a backward kind of a way." Traditionally, she explained, scientists who study children's mental health have developed research questions in relative isolation from public practice, then tested them in the field. Satcher's strategy is the opposite: He believes that researchers, practitioners and key community stake holders must collaborate in the trenches to determine problems, then launch research interventions based on kids' real needs. The model encourages further testing and refining of programs in a real-world context, said Hoagwood, and by its nature, requires practitioner involvement.
Satcher also advocates a preventive and developmental approach to children's mental health problems as well as equal access to quality care for all youth, Hoagwood continued. While many programs try to provide coordinated care for children with mental health needs, the children's mental health system remains fragmented, she said. Underlying all of Satcher's initiatives, therefore, is the unifying public health notion that "mental health is an essential part of children's health," she said.
One of Satcher's initiatives--the September 2000 Surgeon General's Conference on Children's Mental Health--demonstrates his passion for the topic. Satcher launched the meeting when he determined that the requirements for improving mental health services for young people described in his landmark 1999 mental health report were highly complex, and that additional action steps were needed to address them. The conference, planned by representatives from 13 federal agencies, ballooned to include 300 participants, including practitioners, scientists, families and youth themselves. More than a year after the event, Hoagwood noted, the federal planning group continues to meet on a regular basis to put conference recommendations into action.
Satcher's approach is riddled with challenges, Hoagwood admitted. For instance, while he calls for new mental health programs to be supported by good science, the science base is uneven. Likewise, getting scientists to work with psychologists in schools, teachers and policy-makers is likely to represent culture shock for some. The results, though, are likely to be worth it, she said.
"The aim is for mental health to become a standard part of general health care, to eliminate the dualism in the current system," said Hoagwood. "This means retraining practitioners to use the science base and strengthening the science base to make it more usable for practitioners."
For more information about the implications of the Surgeon General's report for psychology and schools, contact the APA Practice Directorate's Office of Policy and Advocacy in the Schools by sending an e-mail or by calling (202) 336-5858.
Tori DeAngelis is a writer in Syracuse, N.Y.
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