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
Psychiatric Grand Rounds
Brown Medical School at Bradley Hospital
East Providence, RI
May 11, 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 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. We have 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, innovative ways to use the resources we have because we can and must 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 for fly-ins]
[CLICK] Six of the students may have identifiable mental health needs; [CLICK] three of the six 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.
As children’s mental health professionals, you are well aware of the prevalence and impact of childhood disorders. You confront these challenges every day. Thank you for believing—for knowing—that you can make a difference in the lives of children who have mental disorders and their families. More importantly, thank you for sharing your hope in recovery and resilience with them. Hope is an evidence-based practice. It helps children overcome hurdles that they otherwise could not scale, and it moves them forward to a place where they can believe in themselves and their future. Never let children lose hope in their incredible capacity for change.
The more we understand childhood development, the more we realize that we have tremendous and continuous opportunities to 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.
[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 this 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." A child’s first 3 years of life are crucial to his or her healthy mental development. However, there is no single critical period of brain development in early childhood. Different ages and different stages continue to present children with whole new worlds of possibility for growth, adaptation, resilience-building, and recovery.
[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.
Bradley Hospital and others similar to it are essential components of systems of care for children but, over time, we’d like to see much smaller demands for hospital-based treatment services. Your therapeutic schools and residential treatment centers are a giant step in the right direction. Ideally, however, children will have access to early intervention services in a variety of settings, including mainstream schools and their homes.
One expanding field of research and initial practice related to the continuous mental development by 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. Effective promotion of children’s mental health involves a community. It involves childcare providers; teachers, sports coaches, pediatricians, and all the agencies and organizations that touch the lives of families.
[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 very 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.
The Illinois State Board of Education believes that social and emotional learning is so essential to a child’s academic achievement that its members have taken a groundbreaking step. This past December, the Board established social and emotional learning standards for all students in kindergarten through grade 12.
This step is transformation in action! Promoting the healthy mental development of children is 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 standards and teacher training statewide! Promotion of social and emotional development is 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 evaluation of 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 called 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. Every one of these agencies has a stake in the mental health and well-being of Americans. This slide illustrates how broad the national mental health system is. State mental health and substance abuse agencies are just parts within this system. 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 to the State and community levels, the same level of broad-based collaboration will be required and should be expected and demanded.
At the Center for Mental Health Services, we 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. A basic premise of the public health model 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 to 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 first sets of Safe Schools/Healthy Students 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. These grants are 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.
Our new “transformation” grants are unique because their purpose is 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 these agencies together—to create common data systems, to identify service gaps, and to collaborate on eliminating 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 and Justice, as well as 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 that. 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 very important reason: The depth and breadth of change required to get all 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 opportunity for innovation.
I’m now going to talk about transformation as it relates to you personally. Transformation is ultimately about newness—about new values, new attitudes, and new beliefs that are expressed in the changed behavior of people. As children’s mental health professionals, you, too, will have to change.
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 we serve. We square improvement because we must repeatedly ask ourselves how we can do better.
At this point, I challenge you to envision a better future for children’s mental health care. What does your vision for the future look like and what is your role in achieving it? Can you be a leader? Charles Kettering, an American inventor, made this observation: no vision has ever been achieved unless some individual dreamed that it should, some individual believed that it could, and some individual willed that it must! Transformation, above all, requires leaders who believe we should, could, and must improve mental health care for all Americans.
I’m going to share with you my vision about service providers of the future. I expect, however, that many of you already may embrace my vision. Bradley Hospital always has been a leader in children’s mental health care. Help to develop service providers of the future by becoming mentors, role models, and coaches for others in your field, including consumer professionals.
For the past 2 years, my agency has been working with the Annapolis Coalition on Behavioral Workforce Education to identify ways to improve the quality and relevance of training. Our current efforts focus on core standards of competency. You have a similar and highly commendable initiative here to identify mission-critical competencies for teaching and training.
Among the core standards the Annapolis Coalition is examining 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 vision is that providers of the future will offer treatments and supports that respect the unique traits of their race and culture. You, as medical professionals, will bear a huge responsibility for ending current disparities of care.
A second core standard is a service 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 because it takes too long to move science to service. This simply is not acceptable.
I’m extremely pleased that the Bradley Hasbro Children’s Research Center is aggressive in its efforts to move research forward faster. I understand that the Center publishes a research journal about its work almost monthly. This is how research findings should be handled—available to other professionals as soon as possible.
Evidence-based practices give hope to children and their families. Providers of the future will know how to access and deliver the best treatment options available. They will aggressively seek out alternatives to practices known to cause harm, such as seclusion and restraints. For children with histories of trauma, the use of coercive practices can mimic the original abuse and deepen the wounds they already carry.
A provider of the future will develop strategies to treat families and children as partners in determining treatment plans. 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 a child’s incredible personal growth—socially, emotionally, and educationally.
Families, however, are too seldom educated, empowered, or enabled to assume their essential role as decisionmakers. This situation lacks logic. There are serious choices to be made, such as choices in programs and medications. These are choices that should be made in partnership with those whose lives and futures are affected most directly.
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.”
[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 to identify meaningful ways to involve families in mental health planning. Rhode Island is one of our developmental sites. We have awarded the Parent Support Network of Rhode Island a statewide grant to make mental health care for your children more family driven.
Providers of the future also will take steps to involve children in decisionmaking, which we define as “youth-guided” care.
[SLIDE 14. Definition of youth-guided]
For older youth, their participation may involve directing 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. After all, these systems affect their lives and their future significantly . We recently established the first-ever national youth development board. The goal for this board?—to create a forum that gives youth a voice in calling for needed changes to mental health care for America’s children.
[SLIDE 15. Web site]
We also have developed a p ublication called, “Youth Involvement in Systems of Care: A Guide to Empowerment.” Our guide is a starting point for building a youth-directed movement within a local system of care. You can find additional information at the Web address on the slide. If youth are not involved in any decisionmaking capacity at Bradley Hospital, then the time to give them a voice is now.
The ideas that I have described involve a tremendous restructuring of the medical professional’s traditional approach to children’s mental health care. For you, my vision may imply letting loose of preconceived ideas about your role. First and foremost, children’s mental health professionals are conveyors of hope. Recovery and resilience in response to childhood disorders should be the expectation, and not the exception, to treatment.
You also might have to rethink how decisions about care are made and who makes them. Consumers who have been given the opportunity to regain control over their own lives believe that greater self-determination was vital to their recovery. Families and children deserve real and meaningful choices as an essential component of care.
I am deeply grateful that intelligent, caring, and compassionate people such as you are willing to be part of the future of children’s mental health care. It takes special people to dedicate their life’s work to changing the lives of children. To paraphrase former Surgeon General Antonio Novello, your job demands that you be able to “ see with a child's eyes, to hear with a child's ears, and to feel with a child's heart."
So, before I close, I have one more challenge to offer you. Consider a career in the public sector. Our government needs the best among you to help develop national mental health care policies and programs. Your reward will be the opportunity to affect the lives of millions of children.
As mental health professionals, we 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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