Overview

Child mental health is an essential part of healthy development with long-term implications for a child’s and family’s quality of life. It should be addressed where children live, play, work and grow. Investing early in young children’s mental health can lead to savings downstream in areas such as special education, child welfare, juvenile justice, work productivity and physical health.

However, public policy currently addresses these issues when there are problems, which is not a good fit for children or for fostering healthy development. Instead, policies should look upstream toward mental health promotion and prevention, and retain an emphasis on the accessibility of evidence-based practices for all families. Healthy Development Summit II: Changing frames and expanding partnerships to promote children’s mental health and social/emotional wellbeing assembled a diverse group of stakeholders who might not otherwise be drawn together to generate ideas for new ways to move forward to promote young children’s mental health.

Introduction to the executive summary

As indicated in the title, this is the second of two summits. This summit focused on the application of the research to practice and policy across sectors of society; that is using what we know to inform what we do. The summit was designed to convene unlikely partners across society representing “opportunity structures” for promoting child mental health. It built on the success and interdisciplinary consensus developed at the 2009 summit that focused on what we know about young children’s mental health. (The full report is available online).

With these factors in mind, the summit was designed with the following goals: encourage effective and shared framing about the importance of child mental health for healthy development, increase effective collaboration across sectors of society and arrive at consensus regarding feasible and actionable recommendations that could be implemented across disciplines to assure continued progress in promoting young children’s mental health. The summit included presentations that were designed to catalyze discussion or change frames among the summit participants in subsequent small working groups. Morning speakers each provided a different but critical perspective on young children’s mental health that provided a foundation for the afternoon’s work. These perspectives included public health, communication science and implementation science.

The first working group session consisted of four working groups (groups 1-4) each focused on a domain of child mental health as described by Tolan and Dodge (2005). The domains included the importance of mental health for normal child development, everyday challenges for parents, prevention opportunities in child mental health and effective treatment for childhood mental health problems. Each of the four working groups reported their key priorities to all summit participants for discussion. These reports were followed by a presentation that emphasized the challenges that still face the early childhood field and the importance collaboration among the sectors involved in young children’s development. This helped to focus the second working group session on enhancing partnerships.

The second working group session also consisted of four working groups (groups 5-8) that represented sectors of society with the opportunity to promote child mental health and social/emotional wellbeing, practitioners and scholars, the public and families, policymakers, organizations and agencies. They were tasked with identifying key outcomes and next steps. Key opportunities identified by groups 1-4 are provided below followed by priority outcomes and next steps developed by groups 5-8.

Key opportunities identified for the domains of child mental health are provided in the next section.

The importance of mental health for normal child development
Key Opportunities
  • Identify and leverage over time the opportunities to promote children’s social/emotional wellbeing provided by overlapping policies and priorities in domains such as, health care, education and economics (i.e., Patient Protection and Affordable Care Act1 (U.S. Department of Health and Human Services, 2010), Common Core State Standards (National Governors Association and Council of Chief State School Officers, 2012), Early Learning: America’s Middle Class Promise Begins Early, (U.S. Department of Education, 2013)).
  • Leverage social media and other technologies. Review children’s and parent’s media diets and technology used with the goal of creating and disseminating positive and supportive messages using those media and technologies.
  • Improve existing and establish new relationships and coalitions among those who come into contact with children where they live, grow, work and play (i.e., early childhood settings, schools, after-school summer programs, medical care facilities, faith-based and community–based settings) to create a healthy overall environment for children.
  • Educate those who work with young children and families in various settings (i.e., education, medical and mental health care, clergy) about the importance of early childhood mental health and its importance in healthy child development and social/emotional development.

1More commonly referred to as the Affordable Care Act (ACA).

Everyday challenges for parents
Key Opportunities
  • Develop positive messages for diverse parents2 about the importance of day-to-day relationships and parenting, early child development, child mental health and social and emotional development that will give them a sense of hopefulness and improve child outcomes.
  • Identify and utilize existing community platforms and networks to disseminate effective, supportive and positive messages that promote children’s mental health and are appropriate for that community’s population.
  • Engage community opinion leaders in developing and delivering culturally and locally relevant messages, including cultural and organizational leaders as well as parents with different needs, such as those facing poverty or whose children have disabilities.
  • Convey to those who work with families the importance of supporting parents and caregivers, particularly those facing more parenting challenges, to ensure healthy developmental outcomes over the long-term.

2Parents are defined in this report as inclusive of other biological and non-biological parental figures/caregivers.

Prevention opportunities in child mental health
Key Opportunities
  • Develop a science-based operational definition of prevention that enhances communication between providers and parents, that promotes positive early childhood mental health outcomes and social/emotional development, and that aims to reduce or eliminate mental health disorders.
  • Identify existing and establish new broad-based community networks to determine what prevention and health promotion programs exist and, if necessary, how to modify them so the community will obtain the best outcome for children.
  • Utilize a 21st century public health approach to bring stakeholders from multiple disciplines and systems together to enhance linkages and to maximize the utilization of existing information, opportunities and resources that optimize child health and mental health outcomes.
  • Restructure the fee-for-service system to compensate providers for time spent with children and families in prevention and promotion efforts and for similar efforts that require collaboration or collateral contacts across multiple systems and networks.
  • Utilize a variety of social media technologies as essential elements for successful and appropriate prevention and promotion messages tailored to specific community audiences.
Effective treatment for childhood mental health problems
Key Opportunities
  • Develop new or redesign the existing child mental health service delivery infrastructure so that it is dominated by evidence-based practices that are provided by a workforce with the capacity and training to provide culturally, linguistically and ethnically appropriate services to diverse children and families.
  • Advocate for new or enhance existing funding for training to encourage people to advance their education as mental health service providers and to train community members to serve and support families (e.g., peer counselors, health coaches).
  • Reduce or eliminate barriers to data collection, monitoring and sharing across providers and infrastructures, such as those posed by the Health Insurance Portability and Accountability Act (U. S. Department of Health and Human Services, 1996) and Family Education and Rights Privacy Act (U.S. Department of Education, 1974).
  • Gather and analyze a broad range of functional (i.e., school success, clinical outcomes), process (i.e., provider availability, wait times) and program outcome data; utilize these data in determining whether or not a program should be recommended for new or continuing implementation.
  • Utilize a multi-dimensional service model that includes family members, peers and professionals from multiple child serving agencies to collaborate in fully addressing the often complex array of family and child mental health needs and concerns.

Priority outcomes and next steps for the sectors of society are provided in the next section.

Practitioners and scholars
Priority Outcomes and Next Steps
  • Capitalize on existing energy at the local level to build new or strengthen existing contacts and collaborations across systems where children and families access services (i.e., mental health, primary care, early childhood education, child care and home visiting programs) so that next steps to improve developmental outcomes can be taken.
  • Develop and implement advocacy strategies by identifying personal contacts or points of influence at the community, state and federal levels and in the business community to advocate for early childhood programs that incorporate social/emotional development and mental health supports.
  • Identify and advocate for opportunities and convergences within Surgeon General Satcher’s action agenda (U.S. Department of Health and Human Services, 2000), the Affordable Care Act, various other federal initiatives and electronic health records implementation that can be utilized to address child and family mental health needs and improve mental health outcomes.
  • Develop a training strategy that includes traditional and non-traditional providers (i.e., business leaders, economists, early childhood educators, child care providers, community care providers and community members) who interact with children and families and can disseminate science-based messages about the importance of children’s mental health for positive developmental outcomes.
The public and families
Priority Outcomes and Next Steps:
  • Develop strategies that prioritize and provide appropriate programs and services to those most in need in the community.
  • Disseminate science-based, culturally, ethnically and linguistically relevant information about normal child development, social/emotional development and ways to support children’s mental health to broad audiences (i.e., parents/families, child care providers, and educators) using existing community platforms and multiple delivery systems (i.e., social media, families and grass roots venues).
  • Define, or redefine, families to reflect communities’ diverse cultural values and beliefs, and recognize their power to communicate effectively within and across communities.
  • Provide educators and child care workers with information about healthy social/emotional development and behavior that will give them the necessary tools to determine if a child’s behavior is appropriate at a given age and to manage classrooms and child care centers.
Policymakers
Priority Outcomes and Next Steps
  • Seize opportunities in the Affordable Care Act (2010) to promote children’s mental health and social and emotional development by integrating behavioral health into health care, expanding Medicaid coverage, expanding home visiting programs and addressing workforce training issues.
  • Make healthy child development a national priority by utilizing and building upon currently available resources (e.g., president’s early learning initiative) to develop and disseminate compelling messages and narratives about the importance of healthy development for the success of business and society as well as the wellbeing of the child, family and community.
  • Advocate for early childhood programs that are sustainable over time and that move seamlessly to school age programs, thereby continuing to improve child mental health outcomes throughout the developmental sequence.
Organizations and agencies
Priority Outcomes and Next Steps
  • Utilize a broad range of service providers and consumers to develop navigation systems, staffed by those who are knowledgeable about services and programs, to assure coordinated access to resources and programs in one location for mental health care consumers.
  • Work in collaboration with consumers, providers and communities to promote provider and system transparency (e.g., which services and programs are provided) and accountability (e.g., outcomes of services and programs) in order to enhance both service delivery and child mental health outcomes.
  • Educate consumers about available programs, services and expected outcomes and help them develop the necessary advocacy skills to access appropriate services.
  • Continue integration of mental health care providers as equal partners in health care systems, emphasizing their credibility and their unique perspectives, skills, service delivery models and data, in order to improve child mental health and health outcomes.

In addition to key opportunities, outcomes and next steps, several overarching themes emerged across the day in small and large group discussions. They highlight key considerations that cross the domains of child mental health and sectors of society and underlie the foregoing specific recommendations. For example, summit discussions emphasized the importance of diverse families, existing community platforms, and social media and innovative technology for sharing hopeful messages that promote child mental health. Several key suggestions were made for children and families in the implementation of health care reform; they are included in the full report text. Summit participants expressed a commitment to collaboration as the route to progress in promoting child mental health as a critical part of healthy development. This report summarizes this summit as a step in that collaboration.