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Several creative new programs are bringing mental health care to children where they live, go to school and receive primary health care, which could make them more effective than traditional services, says pediatric psychologist Barry Anton, PhD, who chaired the 2003 APA Task Force on Psychology's Agenda for Child and Adolescent Mental Health.

Highlighted by Anton and other task force members for their evidence-based promise, these up-and-coming interventions assist the families of juvenile offenders, support parents when they first seek medical help for child behavioral problems and take services to teachers in schools.

The three programs could offer a glimpse into the future of children's mental health care, they say.

Whole-family help for juvenile offenders

The Dawn Project in the Indianapolis area takes a holistic approach to court-ordered help for children whose problem behaviors could land them in a juvenile detention facility or get them expelled from school. Instead of paying only for traditional mental health providers, courts and social services agencies send problem children to the Dawn Project, which addresses the economic, social and emotional problems facing children and their families for a court-paid fee of about $4,500 a month.

Through recommendations by a Dawn care-management team that can include parents, social workers, psychologists, school counselors, probation officers and other relatives, the program provides traditional psychotherapy but also Dawn-subsidized mentoring, job assistance for parents, child care and even, in the event of a crisis, money for rent and groceries. The goal is to stabilize children's home environments and build bonds between them and their parents--in addition to helping children work on emotional and behavioral problems like depression and anger.

"Typically when a child goes into a justice system, the judge says 'You're ordered into therapy,' and the court just pays for the therapy," explains Knute Rotto, CEO for Choices Inc., the quasi-public entity that manages Dawn. "But when they're ordered into Dawn, only the Dawn fee is paid by the court, and from there we're able to provide a coordinated set of interdisciplinary services that carefully meet the needs of both the child and the family."

Assessments of the seven-year-old program show that two-thirds of Dawn-treated children stay out of the juvenile justice system in the next year, Rotto adds, an improvement on the effectiveness of psychotherapy alone.

Early pediatric help

Often, clues to a behavioral problem show up before age 5 in small ways like sleep difficulties and temper tantrums. But pediatricians often struggle to find time to offer parents comprehensive solutions to such problems, child experts note. If not treated at the outset, however, such behavioral problems as failure to potty train can stress parent-child bonds and create future problems, says psychologist Jennifer Shroff Pendley, PhD.

So she and other psychologists at the Alfred duPont Hospital for Children in Wilmington, Del., have developed the Behavioral Consultation Clinic to help parents intervene early to quickly improve child habits.

Psychologists evaluate problems and offer empirically based behavioral solutions, like advising parents to provide positive feedback for good behaviors and ignore some negative behaviors, in 30-minute consultations. More specifically, counselors instruct the parents to develop more frequent positive interactions with children through directed play, like partnering to put a puzzle together, and frequent positive feedback, such as commending children when they go to bed without fussing. If that doesn't work, counselors educate parents to ignore the tantrums and give direct commands to correct children's behavior, explains Pendley, also the program's director.

The staff intentionally calls the Friday-morning sessions "consultations" to prevent stigma associated with "counseling," she notes.

"We've found that this small amount of direction solves the problem for about half of the families and in many of the other children, it's an important way to screen for more serious problems and get those families referred to more comprehensive services," Pendley says. Since its inception eight years ago, the program has served more than 600 children.

Involving the school

Providing more comprehensive, in-depth training is The Incredible Years program, which shows children ages 3 to 8 and their parents and teachers how to stop aggression and behavior problems and increase social competence at home and at school. The program is unique because it brings help into nonclinical settings and involves teachers.

The Incredible Years trains child mental health-care professionals nationwide to provide its three-prong services:

  • Group parent training on how to manage child behaviors, handle difficult temperaments, build a positive relationship with a child and partner with teachers to coordinate discipline and learning.

  • Group child training on how to build social skills, manage anger and be friendly and inviting to potential friends. Children learn by practicing positive behaviors in a controlled setting.

  • Group teacher training on how to teach positive behavioral skills in the classroom and partner with parents for the best outcome.

Beyond those initial trainings, the program offers considerable flexibility, says its creator and director, psychologist Carolyn Webster-Stratton, PhD, professor of family and child nursing at the University of Washington.

"Additional services, such as help for parents with their own emotional problems and more frequent and individualized treatments for children with higher risk factors like diagnosed oppositional disorder or attention-deficit hyperactivity disorder, can be added," she explains.

Compared with other more conventional one-on-one interventions, the treatments are inexpensive and remarkably effective, she adds. Randomized control group evaluations of the trainings have consistently demonstrated improved child behavior, parent relationships and academic success, Webster-Stratton says. In fact, the U.S. Office of Juvenile Justice and Delinquency Prevention selected The Incredible Years as an "exemplary" best practice program in 2003 and recommends it to schools.

"Because the intervention is early, before the development of negative peer groups and before parents begin to despair, this is an easy way to turn behavioral problems around and change these families' lives," says Webster-Stratton.