Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Community Forum on Mental Health at Bradley Hospital
East Providence, RI
May 10, 2005
PowerPoint version
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
[SLIDE 1: Title slide]
Have you ever visited the Web site for the U.S. Census Bureau? The Bureau’s Web site has a population clock that continuously updates the number of people living in the United States.
[SLIDE 2. Baby faces, timed to appear every 8 seconds]
Every 8 seconds a child is born. In the time it took for me to say this sentence, another baby girl or boy was born in this country. What an awesome responsibility, both for the parents of each child and for us as a society! These are our children to raise, to educate, to nurture, and to prepare for adulthood. Their future—their ability to reach their full potential as creative and productive members of our communities—depends on us. . . on how well we support their healthy development, both physically and mentally. Given this tremendous responsibility, we continuously must ask ourselves: Can we do better?
I believe we can. Our Nation has the knowledge, the skills, and the resources to do so much more to promote the healthy mental development of our children. We simply must find new and innovative ways to use our resources to build a better future for children’s mental health care. The children of today will quickly become the adults of tomorrow.
[SLIDE 3. Children, by age group]
More than 80 million children under age 19 now are growing up in the United States. At any given time, 20 percent of them will have a diagnosable emotional or behavioral disorder. Nearly 10 percent will have a serious emotional disturbance. To get a better grasp of those numbers, picture a typical classroom of 30 children.
[SLIDE 4. Classroom statistics]
[CLICK] Six of the students may have identifiable mental health needs; [CLICK] three of them may have a serious condition such as depression or an anxiety disorder. If left undiagnosed and untreated, serious childhood disorders can result in serious and long-term consequences . . . for the child, the family, and our communities. Known consequences include school failure, substance abuse, delinquency, social isolation, and suicide. I imagine that’s why you’re here this evening—to find out what we are doing to prevent such consequences. I also hope you came to learn what you can do to help.
The more we understand childhood development, the more we realize that we have tremendous opportunities to protect and promote the mental health of children. Research conducted or begun during the past “Decade of the Brain” is exploding long-held theories about the brain and its development. The brain is amazingly plastic and adaptive to experience. It can change structurally, and sometimes permanently, in response to our earliest experiences. Our ability to process experiences may begin even before we are born!
Much of our current knowledge about early childhood development is summarized in Neurons to Neighborhoods, a book by the National Research Council and the Institute of Medicine. The title of the book is a reference to the forces that shape our children: neurons, or the basic circuitry of their developing brains and neighborhoods, or the social and cultural influences that come into play.
Neurons to Neighborhoods presents persuasive new evidence about “brain wiring” and our opportunities to raise mentally healthy children. Key findings from Neurons to Neighborhoods have the power to transform our approach to children’s mental health. I’ll discuss just a few of them briefly.
[SLIDE 5. First finding]
The first finding is that “Human development is shaped by a dynamic and continuous interaction between biology and experience.” In other words, children are the joint product of nature working together with nurture. Research indicates that some disorders, such as depression and attention deficit- hyperactivity disorder, have a genetic component. But—and this is extremely important—appropriate interventions can create buffers that help prevent behavioral problems among children with inherited vulnerabilities.
By the same token, we can help children develop their own resilience in dealing with social, emotional, and behavioral challenges. Children have a basic drive to explore and master their own worlds. Our role as adults is to present them with experiences that enable them to satisfy that drive safely and successfully.
[SLIDE 6. Second finding]
A second finding is this: “The timing of early experiences matter, but more often than not, the developing child remains vulnerable to risks and open to protective factors throughout the early years of life and into adulthood.” We’ve heard a great deal about the importance of a child’s first 3 years of life. Yes, these years are critical to healthy development. However, there is no single critical period of brain development in childhood. Different ages and different stages open up whole new worlds of possibility for growth, experiences, and change. We have a continuous opportunity to promote the healthy mental development of children.
[SLIDE 7. Third finding]
This leads to the third finding I’d like to emphasize: “We can alter the course of development in early childhood by effective interventions that change the balance between risk and protection, thereby shifting the odds in favor of more adaptive outcomes.” This finding is a scientific way of saying “an ounce of prevention is worth a pound of cure.” Prevention should be the cornerstone of mental health care for children. In building the future of children’s mental health care, we must shift away from solely a treatment approach to childhood disorders and shift to a positive developmental approach.
Such an approach, however, will not begin or end with children or even their families. Effective prevention involves a community. It involves your childcare providers, your neighbors and your pediatricians, as well as the schools and other agencies and organizations that touch the lives of families.
One expanding field of research and initial practice related to the healthy mental development of children is social and emotional learning. This field is opening up promising new pathways to help children develop to their full potential. In addition, advances being made by this field reinforce the concept that children are a community responsibility.
[SLIDE 8. Social/emotional learning definition]
So what is this kind of learning? Social and emotional learning is a process through which a child acquires
“the skills to recognize and manage emotions, develop caring and concern for others, make responsible decisions, establish positive relationships, and handle challenging situations effectively .”
These are the skills that ensure a child’s fullest possible life in his or her community. That community can be a family, a school, a workplace—all the gradually expanding environments that mark a child’s successful passage into adulthood as a mature, independent individual.
One of the most important aspects of social and emotional learning is that it involves teachable skills that build a child’s resilience to face life’s challenges. All children gradually can learn competencies that enable them to regulate their behavioral responses. We never lose our opportunity to help children develop positively.
The Illinois State Board of Education believes that social and emotional learning is so essential to a child’s academic achievement that the Board has taken a groundbreaking step. This past December, the Board established social and emotional learning standards for all students in kindergarten through grade 12.
The most important aspect of the Board’s action is its extent: promoting the healthy mental development of children now involves everyone within the Illinois education system! This is not one program being introduced into one school, with training limited to a small group of teachers. Illinois has incorporated behavioral standards and teacher training statewide! Promotion of social and emotional development is the prevention of childhood disorders. Think of the phenomenal difference we could make in the lives and futures of our children if every State school system adopted a positive developmental approach for students.
We at the Federal level have begun our own process to transform our national approach to mental health care. Our roadmap for a new direction is a report called Achieving the Promise: Transforming Mental Health Care in America. [Copies of this report are available from Christine Brown.]
[SLIDE 9. Achieving the Promise]
About 2 years ago, the President’s New Freedom Commission on Mental Health released this report about our mental health system. The report begins with a vision of a future in which individuals at any stage of life will have access to effective mental health treatment and supports—all the essentials for living, working, learning, and participating fully in the community. To achieve this vision, the report calls for profound changes in how we currently provide mental health care. The ultimate goal of this change—this transformation—is a system that will be consumer and family driven, with a focus on recovery and on building resilience across the lifespan.
[SLIDE 10. Federal Partners Workgroup]
Our first step toward transformation was to bring together eight Federal departments and the Social Security Administration, all of which have a stake in mental health care. This slide shows how broad our national mental health system really is. Together, members of the Federal Partners Workgroup are developing or expanding programs that respond to each of the goals and recommendations of Achieving the Promise. As transformation moves from the Federal level to State and community levels, the same broad-based collaboration will be required and should be expected and demanded.
Our Federal workgroup developed an action agenda to guide our response to each of the goals and recommendations of Achieving the Promise. Several action items specifically relate to children. One item is to support State efforts to provide appropriate and relevant early screening and intervention services for children. For decades, federally funded programs such as Head Start have been screening children to identify developmental, learning, or behavioral concerns. Based on this experience, we know that early identification and intervention—with full parental consent and involvement—can eliminate or reduce the impact of childhood disorders. Screening, assessments, or both are simply other best practices we can apply to help children reach their full potential.
We are looking at expanding our Youth Transition Program. Achieving the Promise envisions a future when individuals have access to a continuum of services across the lifespan. Our efforts to transform children’s mental health care include better programs to ease an adolescent’s passage into adulthood and adult systems of care. Grantees in five different States currently are developing effective transition models. We’d like to see more of these programs at the State level because of their potential to transform services for all age groups. The cross-agency linkages needed to support transition programs for adolescents can improve the quality of care for everyone. We currently are collaborating with the U.S. Departments of Education and Labor and other Federal agencies on plans to expand the number of transition sites.
We also are using our grant programs to kick-start broader community involvement in children’s mental health. A few minutes ago, I emphasized that children’s mental health care is a community concern. Achieving the Promise underscores this concept by framing mental health as a public health issue. The basic premise of public health is that a community protects its overall health by promoting and protecting the health of its individual members.
Our Safe Schools/Healthy Students program is cofunded by the U.S. Departments of Education and Justice and addresses the healthy development of students in safe, secure school environments. We need only remember the tragedies of the Columbine and Red Lake school shootings to understand why children’s mental health is a public health issue. In a Safe Schools/Healthy Students grant program, community involvement by the education system, local law enforcement, and mental health agencies is mandatory.
I’m very proud that the Newport, Rhode Island, public school system received one of our very first set of grants, back in 1999. Rhode Island is a State known for setting new standards in children’s mental health. This tradition dates back to 1931, when Bradley Hospital opened as the Nation’s first psychiatric hospital devoted exclusively to children and adolescents. I can’t think of a tradition more fitting for a State with “Hope” as its motto.
We recently launched a new grant program called State Incentive Grants for Mental Health Transformation. Our new program offers a truly exciting opportunity for the States. Most of our other grants provide funding to develop one specific service, such as our Project HOPE grant here in Rhode Island. This grant is helping your State develop a better system to move youth from a juvenile detention facility to services in the community.
But new “transformation” grants have a much broader focus. These grants will provide funding to help a State transform its entire network of care! Think back to all of the systems that have a stake in mental health, such as education, justice, and housing. Transformation grants will help States to build the infrastructure needed to link agencies together—to create common data systems, to identify service gaps, and to work together to eliminate these gaps.
The impact on children’s mental health care could be incredible. I’ve been asked how a State can accomplish more for children without additional funds. States can do more by using available funds more effectively. Every State receives a mental health block grant. States also may receive Federal grants related to mental health from the U.S. Departments of Education, Justice, Housing and Urban Development, and others. Think of what a State could accomplish in terms of prevention, early intervention, and treatment if it pooled grant funds. Our transformation grants ask that States explore opportunities to do just this. Combine the different trickles of funding coming into a State and you have a river of resources.
Eligibility to apply for a transformation grant is limited to the Office of the Governor for each State. We imposed this limit for one important reason: The depth and breadth of change required to get all of these systems working together can be accomplished only by the person ultimately responsible for them.
[SLIDE 11. Governor’s Office contact information]
Applications for a transformation grant are due June 1. Tomorrow, call Governor Carcieri’s office. Ask him if Rhode Island is applying for a mental health transformation grant. Lend your support to this oportunity for innovation.
I’m now going to talk about actions we are taking that may require change from you, as mental health professionals, parents, and community members. Transformation is ultimately about newness—about new values, new attitudes, and new beliefs that are expressed in the changed behavior of people.
Our “transformation equation” illustrates the personal nature of change:
[SLIDE 12.Transformation equation]
Transformation equals our vision, plus belief, plus action, times continuous quality improvement, squared.
- Vision provides direction for our efforts,
- Belief guides the work we do,
- Action is what we do to make our vision and beliefs a reality; and
- Continuous quality improvement helps to ensure that our actions reflect the wishes and needs of the people being served. We square it because we repeatedly must ask ourselves how we can do better.
Changes to policies and practices do not drive transformation. People drive transformation: people who help shape the policies and implement the practices that embody the vision.
For the past 2 years, my agency has been working with the Annapolis Coalition on Behavioral Workforce Education to identify necessary changes in provider education. The coalition represents a national effort to improve the quality and relevance of training. Its current efforts focus on core standards of competency.
Among the core standards being examined is cultural competency. This standard is of increasing importance. Within the next half century, more than half of our population will be people of color. A significant percentage will be children of color. Even now, children of color are disproportionately diagnosed as having developmental disorders. The U.S. Department of Education, for example, indicates that African American children are twice as likely as White children to be labeled as emotionally disturbed. They also are more than three times as likely to live in poverty. The effects of poverty on children are manifestly important. My concern is that providers must be trained in services that respect the unique traits of families of different races and cultures. They bear a huge responsibility for ending current disparities of care.
A second core standard is the provider’s use of evidence-based practices; that is, the treatments and supports that lead to recovery and resilience. As it stands now, it may take up to 20 years before an effective treatment becomes routine practice. Twenty years—roughly the same time it takes to raise a child from birth through college graduation. We cannot afford to lose a generation of children simply because it takes too long to move science to service. This simply is not acceptable.
Evidence-based practices give hope to children and their families. A child’s future is not defined by a social, emotional, or behavioral disorder, but by what we can do to help a child overcome or learn how to manage the disorder. Consider depression in adolescents. Parents and professionals can help teenagers deal with depression through therapy and medication. We also can help teens learn self-care, such as stress management and maintaining physical health, to build their resilience.
My agency, together with the National Institute of Mental Health, is devoting substantial resources to identifying and distributing treatments proven to be effective. I’m extremely pleased that the Bradley Hasbro Children’s Research Center is aggressive in its efforts to move research forward faster. The center publishes a journal about its work almost monthly. This is how research findings should be handled—available to professionals as soon as possible.
We at the Center for Mental Health Services are turning to families to help transform mental health care for children. As you may recall, the mental health care described in Achieving the Promise places consumers and their families at the very center of care. Families represent one of America’s most under-recognized sources of power that can transform mental health care. Families often are the strongest advocates for youth and their staunchest supporters. More than anyone else, families understand that each child possesses unique strengths and abilities. It is these traits that can be the foundation of their incredible personal growth—socially, emotionally, and educationally.
Last year, we held a family-led workshop to address issues related to the concept of “family-driven” care. Organizations such as the Federation of Families for Children’s Mental Health and the United Advocates for Children worked with us to define what it means for a system to be “family-driven.”
You may wonder why a definition is important. The reason is this: words have the power to shape public attitude and change policies and practices. Think about the changes that flowed from a simple clause in the Individuals with Disabilities Education Act—that children with disabilities are entitled to an appropriate public education in the least restrictive environment. Congress left it to the courts to define the meaning of “least restrictive environment.” Our schools changed dramatically as a result. Court after court defined this term to mean a child’s right to full inclusion and mainstreaming with nondisabled peers whenever appropriate.
[SLIDE 13. Family-driven definition]
Our definition of “family driven” recognizes the right of families to be involved in mental health care for children. “ Family driven” means that families have a decisionmaking role in the care of their own children as well as the policies and procedures governing care for all children in the community, State, and Nation. This includes choosing supports, services, and providers. It includes setting goals; designing and implementing programs; and monitoring outcomes. It also includes their involvement in determining the effectiveness of efforts to promote the mental health of children.
We now are working with children’s advocacy groups to refine this definition and to identify meaningful ways to involve families in mental health planning. You, as parents, can take part by becoming more active in planning mental health care systems in your State. We have awarded the Parent Support Network of Rhode Island a statewide grant to make children’s mental health care more family driven. Let the network know about your ideas for building a family- and consumer-driven system of care for your children. Work through the network to ensure that your mental health agencies and providers come to embrace the concept of family-driven care.
[SLIDE 14. Definition of youth-guided]
We also are taking steps to make mental health care more youth guided, which means that youth have an expanding role in decisionmaking. For older youth, their role may be to direct their own care. Children grow toward adulthood by practicing independence. Every opportunity of choice is an opportunity for them to grow toward a healthy, self-directed adult life. This is what we want for their future—this is the future our children want for themselves.
We at the Center for Mental Health Services attach great importance to having youth participate in transforming systems of care for children. The adequacy and effectiveness of these systems can affect their lives and their future significantly . We recently established the first-ever national youth development board. Our goal?—to create a forum that gives youth a voice in changing mental health care for America’s children.
[SLIDE 15. Web address]
We also have developed a p ublication called, “Youth Involvement in Systems of Care: A Guide to Empowerment.” Our guide is a starting point to help communities create a youth-directed movement within their local systems of care.
All of what I have described this evening involves a tremendous restructuring of our traditional approach to children’s mental health care. Moving forward will require change by Federal and State governments, by providers, by families, and even by children as they grow older. It’s possible that the only human that inherently looks forward to change is a wet baby. But, just like for that baby, change can bring tremendous benefits.
We as parents, community members, and mental health professionals share an enormous responsibility for building better mental health care for children. There is no better time to begin building a better future than now, during May, our national month for promoting sound mental health. Let’s do what we can to ensure that all children can grow toward a future that will hold as much joy, as much potential, and as much promise as their birth. It’s time. Thank you.
[SLIDE 16. “The beginning”]
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