CMHS Report to Congress on Child Mental Health Emphasizes a Public Health Approach

A new report to Congress by the Center for Mental Health Services (CMHS) places children's mental health programs squarely in a public health context. The report notes that a public health approach includes traditional areas of medicine—diagnosis and treatment—but also focuses on surveillance, health promotion, prevention, and access to services. Because half of all diagnosable cases of mental illness begin by age 14 and three-fourths by age 24, prevention is key to ensuring that children's mental health problems will be addressed before they can evolve into full-blown disorders. Fundamental to the public health approach is shared responsibility across multiple systems.

The 67-page report, Promotion and Prevention in Mental Health: Strengthening Parenting and Enhancing Child Resilience, was prepared by CMHS at the request of a Senate subcommittee, which charged the agency with reviewing the effectiveness of programs that use a strengths-based family approach to prevention and mental health promotion among at-risk children. Section 1 of the report, which provides the rationale for a public health approach, summarizes research on risk factors and on protective factors that may lead to a child's resilience. The report notes that resilience is not a static trait and that "individuals do not develop resilience by 'pulling themselves up by the bootstraps' when faced with life's challenges. Resilient adaptation to adversity comes about as a result of characteristics of an individual interacting with resources in the environment, such as caring adults, good schools, safe neighbors, good friends, and other 'protective factors.'"

Section 2 of the report describes 12 programs that have been shown to strengthen families and support child resilience. The brief program descriptions and outcome summaries are drawn from the database of the National Registry of Effective Programs and Practices, a system developed by the Substance Abuse and Mental Health Services Administration for the scientific evaluation of prevention programs (modelprograms.samhsa.gov). The programs described for infants and young children include the High/Scope Perry Preschool Program, the Incredible Years, and the Nurse-Family Partnership (NFP). Programs for children and early adolescents include Promoting Alternative Thinking Strategies (PATHS), Olweus Bullying Prevention, Family Effectiveness Training (FET), Families and Schools Together (FAST), and Second Step. Programs for adolescents include the Strengthening Families Program for Parents and Caregivers and Youth, Brief Strategic Family Therapy, Parenting Wisely, and Reconnecting Youth.

Section 3 of the report describes some of the challenges of conducting cost-benefit analyses of prevention programs and summarizes the estimated benefits and costs per youth for a sample of prevention interventions. Section 4, "Best Opportunities for Implementing Evidence-Based Practices to Reach Families in Need," emphasizes the importance of recognizing and supporting parents and other caregivers as decision makers at the service level with respect to the care their children receive and at the system level in policy making and planning, implementing, and evaluating programs and service systems.

The report concludes with eight broad-based recommendations for federal, state, and local collaboration to advance promotion and prevention programs.

• Communicate the good news of prevention, including the economic and social benefits of investing in prevention.

• Provide families, other caregivers, community leaders, and local educators with the latest knowledge for strengthening parenting and building child resilience.

• Build on existing programs to maximize available knowledge and resources.

• Encourage development of the state and local infrastructure necessary to implement and sustain evidence-based practices.

• Encourage a coordinated assessment and accountability system for promotion, prevention, and treatment in children's mental health.

• Examine more systematic strategies to increase and coordinate funding for prevention efforts across federal and state agencies.

• Build a workforce capable of implementing age- and culturally appropriate evidence-based practices effectively.

• Include families in a decision-making role from the outset.

The report is available on the CMHS Web site at mentalhealth.samhsa.gov.