Advancing a Public Health Approach to Children's Mental Health

A Public Health Approach to Children's Mental Health: A Conceptual Framework. (2010)
Miles, J., Espiritu, R.C., Horen, N., Sebian, J., & Waetzig, E. (2010). A Public Health Approach to Children's Mental Health: A Conceptual Framework. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health."

Excerpts from Chapter 6: Moving Forward: What Can Leaders Do?

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The first five chapters of this monograph have provided the background and justification for a public health approach to children’s mental health, a foundation upon which collaborators can build a common language, a brief overview of public health, a sense of how public health is applicable to children’s mental health, and finally a conceptual framework for a public health approach to children’s mental health. This last chapter provides leaders with concrete strategies to put the public mental health intervention framework into action. The chapter illustrates how pieces of the framework have been implemented in communities or states, and offers effective change strategies and tools to support the work of creating, refining and using the proposed framework. Within this chapter, tools and resources are provided that collaborating groups can adapt in any phase of the process.

Widespread, major transformation around a system’s beliefs, values, and practices is required for communities or interest groups to strengthen the mental health of all children. The hope is to energize a movement at all levels—national, state, tribal, territorial and community—by galvanizing leaders from diverse groups to participate in and facilitate the application of a public health approach. However, societal change is a continuous and complex process that requires new behaviors, new partners, and profound changes in structure, culture, policy and programs; it will not happen overnight. Whether leaders take small steps (adding positive health measures to data gathering efforts) or take a series of jumps (strategically adding promotion efforts into existing paradigms), or take a big leap (legislating new rule sets that leverage a public health approach to mental health), each strategy moves closer to a new way of thinking and doing. With every person, every organization, and every system that becomes part of this change, progress is made toward realizing the vision.

First, before exploring the details of what can change, it is important to note where change takes place. Agents of change who improve the quality of children’s mental health exist at all levels of the many systems and sectors that impact children. Planning and implementing interventions occurs at the national level, state level, tribal, territorial and local level and in formal and informal systems. Important change often happens at the local level and is often spearheaded by a small group of individuals with a common interest and passion. In this chapter, the term “group” will be used to refer to the collection of individuals, collaborators, or partner organizations, united by some common interest, who are working to implement a framework for optimizing all children’s positive mental health. The group might reside in a town, a community, or in a larger geographic area, such as a county, territory, state, region or a sovereign tribal nation.

Implementing a public health approach to children’s mental health involves these three processes: Assessing, Intervening and Ensuring. The first part of this chapter (Part A) offers strategies, resources and tools for each of the three core functions of the process. Although presented in a linear fashion in the text, it is important to keep in mind that the processes are interrelated. One must drive the others as they come together to form a continuous feedback loop.

While Part A of this chapter provides a sense of what the work of implementing the framework should look like, Part B provides initial guidance for leaders on how to engage and sustain a process that leads to fundamental change for children’s mental health. The latter section also offers tools and templates to create a vision and a strategic plan for moving forward.

While “what” the work of implementing the public health approach is (i.e., the three adapted public health processes) and “how” to support the work getting done (engaging partners with a shared vision and sufficient resources) have been separated for purposes of clarity in this chapter, in practice both are needed simultaneously. In other words, the process of convening, visioning and planning must support a process of assessing, intervening, and ensuring.

The implementation process must also be considered within the context of the guiding principles stressed throughout this document. The implementation of the framework should be driven by the needs of the children and families within a population or subpopulation and a major first step is to identify shared outcomes. These shared outcomes can, in turn, guide decisions about assessing, intervening, and ensuring. This is not intended to be a one size fits all approach to the framework. Rather, multiple systems within and across communities, regions, tribes, territories, and states must come together to develop and implement plans that are unique and responsive to their unique population.

The Center for Disease Control (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) provide leadership to the nation on public health approaches to children’s mental health and have initiated a number of activities to improve children’s mental health outcomes. As examples;

• Legacy for Children™ The Centers for Disease Control and Prevention (CDC): CDC has initiated a number of public health programs to improve the health of children. One example is Legacy for Children™. This program endeavors to promote optimal child outcomes by improving child development through promoting self-efficacy in parents and community support. Parental self-efficacy helps parents understand that their behavior can positively influence the development of their children and give them the chance they truly deserve. Additionally, parents do a better job of adopting and maintaining behaviors that enhance their child's development if they receive support for these behaviors from a peer group and have a sense of belonging to a community larger than themselves.
         Investing in our children is investing in our future. Early childhood investment can reduce social costs, both tangible costs such as special education, foster care, welfare, medical care, law enforcement, social security and social services, and intangible costs such as physical and emotional pain experienced by children with developmental delays and their families. Legacy's desired long-term outcome is that children will have the capacity to be self-supporting and emotionally healthy in order to lead productive lives, and to become productive citizens. Research and Evaluation efforts are underway to inform this work.

• Project LAUNCH: SAMHSA: The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has created a new grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health). The program is designed to promote the wellness of young children ages birth to 8 years of age by addressing the physical, emotional, social, and behavioral aspects of their development.
         Project LAUNCH grantees will implement a range of evidence-based public health strategies to support young child wellness. Participating states and tribes will work to improve coordination among child-serving systems, build infrastructure, and improve methods for providing services. The majority of the funds will be passed from the state and tribal level to an identified locality where the grant will support the enhancement and integration of services in addition to system coordination and development.
         Local service enhancement efforts may include mental health consultation for childcare and early education providers, developmental assessments in a range of settings, family strengthening programs, parenting skills training and home visitation.
         “These Project LAUNCH grants will enhance and coordinate key child-serving systems in communities across the country,” said SAMHSA Acting Administrator Eric Broderick, DDS, MPH. “By providing young children with supportive and nurturing environments, we can promote healthy development and prevent problems before they occur.”
  

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