“A Public Health Approach to Children’s Mental Health: A Conceptual Framework”
Authors: Jon Miles, Ph.D., Rachele C. Espiritu, Ph.D., Neal M. Horen, Ph.D., Joyce Sebian, MS. Ed., Elizabeth Waetzig, J.D. (March 2009)
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Vision: Communities, as well as society at large will:
• Work to positively shape and strengthen children's physical, social, cultural, political, and economic environments in ways that promote optimal well-being and help prevent mental health problems.
• Provide a full continuum of services and supports, from promoting health and preventing problems to treating problems and reclaiming health, that help all children manage environmental, social, and emotional challenges, thrive, and be contributing members of society.
This handout is available full-text online.
Preventing Mental, Emotional, and Behavioral Disorders Among Young People (2009)
In February of 2009, the Institutes of Medicine released its latest work, Preventing Mental, Emotional, and Behavioral Disorders Among Young People, which presents compelling arguments on the role of promotion, prevention and intervention in children’s mental health. This report updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing special attention on the research base and program experience with younger populations that have emerged since that time. This new report provides information on the critical role of prevention, including updated research since the 1994 report, as well as expands on the notion of the critical role of promotion activities in a public health approach to mental health.
Unclaimed Children Revisited: The Status of Children’s Mental Health Policy in the United States (2008)
Over 25 years ago Jane Knitzer, in the report Unclaimed Children: The Failure of Public Responsibility to Children in Need of Mental Health Services, documented policy and program disconnects that meant children and youth with mental health needs and their families did not get the services they needed. More than a quarter of a century later, NCCP posed the central question for today’s children’s mental health system: to what extent is this new knowledge incorporated into the policy and practice frameworks governing children’s mental health? This report is based on a study that documents how current child mental health policies across the United States respond to the needs of children and youth with mental health problems, those at risk, and their families. Our aim was to identify best policy practices that support family- and youth-focused, research informed, developmentally appropriate, culturally and linguistically competent services and supports.
Chapter 2 of the report highlights more specifically how states are moving toward a children’s mental health system that is guided by a Public Health Approach that integrates prevention, early intervention and treatment. States were asked about their progress toward implementing a public health framework. Twenty-five states responded to queries on whether they funded prevention and early intervention services and supports for children and youth, birth to age 18. In addition, 39 states indicated that they had taken specific steps to balance prevention, early intervention, and treatment services. Thirty-eight states described some of the strategies that made up this shift.
Mental health, resilience and inequalities by Dr Lynne Friedli
This report explores the wealth of evidence that mental health influences a very wide range of outcomes for individuals and communities. These include healthier lifestyles; better physical health; improved recovery from illness; fewer limitations in daily living; higher educational attainment; greater productivity, employment and earnings; better relationships with adults and with children; more social cohesion and engagement and improved quality of life.
For more information on the Public Health Approach to Children’s Mental Health, please visit our Data Matters archives to access previously featured resources:
January 17, 2008 call – New Directions: Implementing a Public Health Approach to Mental Health
June 19, 2008 call: A Public Health Approach to Intervention: A New Framework for Strengthening Children’s Mental Health and Well-Being
The mission of this monograph is to:
• Present a conceptual framework for a public health approach to children’s mental health grounded in values and principles.
• Present a new intervention model for children’s mental health.
• Demonstrate the integration of a public health approach with the intervention model for children’s mental health.
• Show how the array of systems, agencies, and organization, as well as a variety of interventions that serve children are key to the implementation of a public health approach to children’s mental health.
• Offer terms and definitions for use in the monograph and language for the public health approach to children’s mental health and encourages their use.
• Provide examples of interventions and policies that have shown promise as components of the new framework.
• Suggest how partners, stakeholders and consumers might use this framework in their
Five Guiding Principles of the Conceptual Framework
A public health approach to children’s mental health requires a:
• Population focus.
• Balanced focus between children’s mental health problems and optimizing children’s positive mental health.
• Collaborative effort across a broad range of formal and informal systems and sectors that impact children’s mental health.
• Greater emphasis on creating environments that promote and support optimal mental health and the development of skills that enhance resilience.
• Adapting the approach to fit different settings and contexts.
A Public Health Process: Assessing, Intervening and Ensuring
The three core functions of a public health approach, adapted for children’s mental health in this conceptual framework, outline a process that provides the information, interventions and evaluation necessary to create a comprehensive and coordinated approach to optimizing mental health for all children.
Assessing: Assessing involves gathering data about positive aspects of mental health as well as mental health problems at the population level. Data are also gathered about factors that influence children’s mental health. These data are collectively analyzed and used to drive decisions about intervening.
Intervening: Intervening can include policy, programs, services, environmental change, education, and social marketing. These activities can take place at an individual, community, tribal, and state level. While they can occur across the entire population or for populations of focus, the benefits are felt across the population.
Ensuring: Ensuring describes a process of making sure that intervening is done with a high level of quality, effectiveness and sustainability. Ensuring also addresses the need to be sure that those providing interventions are adequately trained. This function also provides that all children as well as their families have access to interventions that may benefit them.
A Special Emphasis on Intervening – A Model for Children’s Mental Health
Taken together, the first two guiding principles of the conceptual framework form the idea that a balanced approach includes promoting positive mental health and addressing mental health for all children regardless of whether they have an identified mental health problem or not. This idea leads to a new model for intervening.
The interventions in this model are divided into four categories. Two of the categories above the mid‐line, Promoting and Re/Claiming, optimize and measure positive mental health, while two others, Preventing and Treating, reduce and measure mental health problems. The right two areas focus on Treating and Re/Claiming both focus on intervening with special consideration for an identified mental health problem. On the left side, Promoting and Preventing focus on interventions without consideration of an identified mental health problem.
A new term offered in this model is Re/Claiming. As contrasted with Promoting, Re/Claiming health is intentionally focusing on optimizing health even in the presence of a mental health problem, and taking that mental health problem into consideration as needed. As contrasted with Treating, the emphasis with Re/Claiming is on optimizing positive mental health rather than the disease model’s focus on alleviating suffering associated with mental illness or disorder. Many interventions offer a combination of Treating and Re/Claiming, just as many others offer a full array of interventions that should be provided within a comprehensive approach, and they offer a reminder of the importance of measuring both positive mental health and mental health problem outcomes.
A Conceptual Framework for a Public Health Approach to Children’s Mental Health.
The Monograph identifies, discusses, and adapts a number of components necessary for building a conceptual framework to guide a public health approach to children’s mental health. The components are organized into four categories in the framework: values that underlie the entire effort, guiding principles that steer the work, a process that includes the three core public health functions, and a model of intervening that incorporates the range of interventions needed to craft a comprehensive approach to improving the mental health of all children.
Structure of the Monograph
• Acknowledgements, Foreword and Executive Summary
• Chapter 1: Introduction
• Chapter 2: Laying the Foundation: Key Terms and Concepts
• Chapter 3: Key Concepts of a Public Health Approach
• Chapter 4: Applying a Public Health Approach to Children’s Mental Health
• Chapter 5: A Comprehensive Framework
• Chapter 6: Moving Forward: What Can Leaders Do?
• Appendix A – Evolution of “Intervening” in Mental Health
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