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

Georgetown University Center for Child and Human Development:
National Technical Assistance Center for Children's Mental Health Training Institute

July 13, 2006
Kissimmee, FL

PowerPoint version

SLIDE 1: TITLE SLIDE

Good morning. Thank you for inviting me to speak to you today. It’s a great pleasure to share the platform with such accomplished and dedicated people. I appreciate the introduction, Gary. Gary heads our Child, Adolescent, & Family Branch at the Center for Mental Health Services (CMHS). He’s a tireless advocate for children and families and we’re fortunate to have him.

We also are extremely fortunate to have Larke Huang as a new member of my agency. Dr. Huang served on the President’s New Freedom Commission for Mental Health and co-chaired the commission’s subcommittee on children and families. In April, she joined our Office of the Administrator as the senior advisor for children and families. We expect to benefit enormously from her passion and expertise in this area.

I’d like to begin my remarks with the traditional greeting used by the Afar tribe in Africa—“How are the children?” Rather than starting a conversation with “How are you?” or “Hello,” the Afar tribe greets one another with an inquiry into what they believe is most important: the welfare of their community’s children. To the Afar, children represent the greatest value in their lives. Children are seen as the energy and the life force of the community.

Each of us holds children and young people in that same sense of high esteem. We all are advocates for our Nation’s youth. And each of us has a critical role to play in transforming our country’s mental health care system to better protect and promote the mental well-being of children. This is our goal: a system that will offer every child and adolescent and their families with or at risk of an emotional disturbance the help they need and deserve. In this system, we will be able to answer the question of “How are the children?” with a resounding response. “Our children are healthy, happy, and safe.”

This training institute offers us an incredible opportunity to move closer to our goal. The people in this room represent the very best minds in the field of children’s mental health. The focus of the institute is on practices that can achieve positive outcomes for children and adolescents who have emotional disturbances and their families. This, in itself, is another noble goal. However, these children and their families will not be the sole beneficiaries of any progress we make. Our communities benefit from healthy families, and we, as professionals, also benefit. As author Ben Sweetland once observed, “We cannot hold a torch to light another’s path without brightening our own.”

I urge you to make the most of this exceptional learning opportunity by developing new collaborations. As in all human endeavors, the more we work together, the more we can achieve and the more rapidly we can achieve it. We must combine our experience, our hope, our strength, and our ideas if we are to provide the quality and breadth of mental health care our Nation’s children deserve.

I am immensely heartened by the transformation in mental health services that is sweeping across our country. Great changes are taking place…changes that hold enormous promise for the future of children’s mental health. I’m going to talk to you today about some of the developments taking place at the Federal level that affect children and their families.

Before I begin, let me stress that the momentum to change mental health care profoundly is growing in countries throughout the world. I was in Scotland last month at a meeting of international mental health care leaders. The same work that we are engaged in here in the United States is underway across continents. Just as we are bringing our best efforts to bear on our Nation’s mental health care challenges, so too are other Nations.

A significant global shift is taking place in the mental health care field. One of the common emerging themes is a focus on “emotional well-being.” Emotional well-being redefines the scope of mental health care. Mental health is not simply the absence or reduction in the symptoms of mental illness. Instead, mental health is defined within a more holistic, all-inclusive approach to health. There is growing worldwide recognition that mental health is crucial to our overall well-being and should be given the same value as our physical health.

Countries around the world are embracing this new concept of mental health care. They are working hard to create equity in terms of mental health care and the prevention and treatment of mental illnesses. What does this mean for us? I believe that we are poised on the cusp of a major sea change in mental health care. You and I are going to experience tremendous shifts in attitudes, values, and practices in our field. We are moving determinedly toward the goals of transformation—not just here in the United States but in countries throughout the world.

Here in the United States, the Substance Abuse and Mental Health Services Administration, or SAMHSA, is leading transformation. Three years ago, President Bush charged SAMHSA, through the U.S. Department of Health and Human Services, to implement the goals and recommendations of a groundbreaking report by the New Freedom Commission on Mental Health. The title of this report is Achieving the Promise: Transforming Mental Health Care in America.

Most of you probably are familiar with the commission’s report and its call for a drastic, systemwide change in how mental health care is viewed, provided, and financed in this country. The commission identified six goals for a transformed mental health system.

SLIDE 2: SIX GOALS

[PAUSE SLIGHTLY FOR READING]

These goals are intertwined. No single goal can achieve the fundamental restructuring needed to transform our mental health care delivery system.

SLIDE 3: GOAL 4

Goal 4 is sometimes referred to as “the children’s goal” because two of its recommendations specifically focus on the needs of children. This view, however, undervalues the report in terms of its potential to affect children. All of the goals and recommendations of Achieving the Promise have the interests of children embedded in them. Progress in achieving any of them will benefit children and their families.

The combined goals provide a roadmap to a system that offers the comprehensive services and supports necessary to promote recovery and resilience in children and adults. Recovery and resilience are the centerpieces of transformation. Recovery means different things to different people. The New Freedom Commission defined recovery as “the process in which people are able to live, work, learn, and participate fully in their communities.” For some individuals, recovery means the ability to hold a job or to stay in a regular school. For others, recovery simply is the opportunity to help make the decisions that shape their lives.

The adult concept of “recovery” does not necessarily translate well to the needs of children. Children and adolescents are not “small adults.” Their needs are very different from those of adults. In addition, their needs change dramatically at different stages of their development. The services we provide must grow and change with the individual, as he or she grows from a child to an adolescent, and into a young adult…and as the individual’s goals for a life and future change.

Resilience is an important concept in mental health care, especially for children. The term “resilience” has its origins in physics and architecture. To be “resilient” means that a building material, such as tempered steel, has the ability to withstand stress. This same term has been adapted to describe a person’s ability to face the challenges of life. Resilience often is defined as “ the ability of a person to spring back from and successfully adapt to adversity.”

Mental health care for children must focus equally on assisting those who have serious mental health challenges and on helping all children at risk to build resilience and coping skills that can help to protect their mental health. We already know of risk factors that make children more vulnerable to mental health problems and buffering factors that help to promote their mental health. Consequently, mental health transformation implies that we use and expand this knowledge to help prevent disorders from developing in the first place. Prevention figures largely in the future of children’s mental health.

President Kennedy once said, “Children are the world’s most valuable resource and its best hope for the future.” As Gary mentioned, we at the Federal level are making significant headway in some very important areas to promote and protect the mental health of children and adolescents. He mentioned the youth movement; the focus on family-driven, youth-guided services; the establishment of Children’s Mental Health Awareness Day; the primer on cultural competence; and the development of the Ambassador’s Guide.

I’d like to add here that since the last time we talked, we have benefited tremendously from the participation of those involved in the National Youth Movement. We were privileged to have two of these young people present at the last council meeting for the Center for Mental Health Services. Their compelling stories, their experiences, their leadership, and their wisdom added greatly to the meeting. It is absolutely essential that we create opportunities for youth to speak out for better mental health care—and that we pay close attention to their words. Their experiences can guide us in identifying what works, what is not working, and what changes need to be made across mental health service systems.

At the Federal level, we’re moving beyond the vision of the New Freedom Commission’s report into action. I noticed that a workshop named “Beyond the Rhetoric” will be held today. That’s where Federal transformation stands: beyond words, beyond theory, and beyond talking about the challenges before us. We have moved on to concrete, tangible activities that are making a real difference in the lives of thousands of children and adults. Despite budget challenges, we continue to make advances in many areas, some of which are being discussed during the workshops taking place here. We’re making great strides in evidence-based practices, family-driven and youth-guided treatment, the juvenile justice system, cultural competency, trauma and disaster care, and in systems of care. I will continue to channel all available resources to addressing children’s and youth issues.

SLIDE 4: FEDERAL PARTNERS

Since the last time I spoke to you, our Federal Partners Workgroup has grown to include a total of nine Federal agencies as well as the Social Security Administration. The purpose of this workgroup is to coordinate mental health transformation across all the systems that serve adults, families, and children. Last July, the workgroup released its first Federal Action Agenda. I’ve brought copies for you to take home with you.

SLIDE 5: ACTION AGENDA

The agenda is our response to the New Freedom Commission’s report. It outlines the first important steps we will take on the road to transformation.It tells the American people where we want to go with transformation and how we intend to get there. This is the document by which the individuals we serve can hold us accountable for seeing that each child and each adult receives the care they both need and deserve.

The agenda targets several significant areas that will benefit children, adolescents, and families. These include, among others:

SLIDE 6: GOALS

• A national strategy for suicide prevention, which includes a focus on adolescents at risk for suicide
• A plan to promote a mental health workforce that is better qualified to practice culturally competent care based on evidence-based practices
• An improved interface between primary and mental health care services
• A national effort focused on the mental health care needs of children and promoting early intervention for children identified to be at risk for mental disorders
• An expanded science-to-service agenda and the development of new evidence-based toolkits.

One of the most important aspects of the Federal Partners Workgroup and our action agenda is the model of transformation it provides. All child-serving Federal agencies now are active partners in transformation. The actions being taken at the Federal level form a model that States can adopt in their own transformation activities.

Our Federal Partners Workgroup has formed a Task Force for Children and Families. This task force has developed a national public education initiative for parents, providers, and policymakers about the importance of the first years of life in developing a healthy foundation. The task force is also proposing a comprehensive approach at the Federal and State levels to assess children identified to be at risk for mental disorders. These assessments will take place only with parental consent. We also are working to educate and train professionals and families in effective treatment approaches and supports.

The issues we confront are complex, without easy solutions. Many parents face the cruel choice of losing custody of their children or not being able to afford or access the mental health services their children need. Imagine having to give up the right to make treatment decisions that affect your child’s life! SAMHSA is involved in efforts to reduce custody loss that extend up to the U.S. Department of Health and Human Services. The Office of the Assistant Secretary for Planning and Evaluation is chairing and spearheading a custody relinquishment workgroup. The workgroup includes representatives from the Administration for Children and Families, the U.S. Department of Justice, and CMHS. A representative from the U.S. Department of Education will be added in the near future.

We cannot place too much emphasis, or devote too much effort, on keeping children and adolescents with emotional disturbances with their families. Families represent one of America’s most under-recognized sources of power to transform mental health care. Families often are the strongest advocates for children 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.

SAMHSA also is working to increase families’ access to home- and community-based services and systems of care for children with serious emotional disturbances. One new development in this area is the Administration for Children and Families’ policy academy, which was a 3-day event cosponsored by the ACF and CMHS. I’d like to acknowledge the ACF grantees who are present here today. We applaud your efforts and look forward to continuing to learn from your experiences.

The policy academy provided the opportunity for States in the mid-Atlantic region to plan and develop policy to build community-based approaches for serving children and their families. Its goals were to create plans that would reduce States’ reliance on out-of-State residential care and to prevent families from having to relinquish custody in order to access needed services.

Another complex—and controversial—issue surrounding the mental health care of children is screening. Schools routinely screen children for physical health problems such as hearing and vision. The idea of screening children for mental health problems, however, has generated an ambivalent response. I believe this ambivalence is rooted in the long-standing stigma associated with a diagnosis of a mental health problem.

According to the results of the recently released National Comorbidity Survey Replication, half of all lifetime cases of mental illnesses begin by age 14. The survey further concluded that untreated mental disorders can lead to more severe, more difficult-to-treat mental health problems and to the development of co-occurring mental illnesses and substance use disorders. This report emphasizes a point I made earlier: Promotion of a child’s mental health also is prevention of mental health problems. The earlier we can identify a child with or at risk for emotional disturbances, the greater our opportunities to ensure a promising future of mental health and well-being for the child.

SAMHSA will not lead efforts that abridge the sanctity of the family and the right to privacy. We will offer effective, targeted screening and assessment when parents determine it is in their child’s best interests. We are working with the U.S. Departments of Health and Human Services, Education, and Justice as well as with consumers, parents, and youth to review screening instruments to determine which are most developmentally and culturally appropriate.

Let’s address this issue of cultural competency for a moment. Why is it so important? Within the next half century, more than half of the U.S. population will be people of color. A significant percentage of this population will be children. As emphasized by goal three of the New Freedom Commission report, one characteristic of a transformed system is the elimination of the disparities of care that now affects minorities disproportionately.

Another of SAMHSA’s ongoing efforts is the expansion of the National Registry of Evidence-Based Programs and Practices. This database is a valuable resource for communities seeking programs and practices that have proven most effective in treating or promoting the mental health of individual populations.

As Gary mentioned, we currently are developing a toolkit of evidence-based practices focusing on children who have disruptive behavioral disorders. I am extremely proud to note that several national leaders in evaluation and research are spearheading this effort. The toolkit will serve as an implementation guide for use across all child-serving agencies to improve and benefit their work.

We are also making headway with our Comprehensive Community Mental Health Services Program for Children and their Families. Program grants coordinate systems of care by developing partnerships with mental health; child welfare; education; juvenile justice; and other local, public, and private agencies. Each grant project provides services that are underdeveloped or nonexistent in most communities, such as intensive family-based services, respite care, and therapeutic foster care. We require that each grant reflect our systems of care philosophy, which is based on the premise that service systems should be driven by the needs and preferences of the child and family, and address these needs through a strengths-based approach.

We know how appropriate services can change the lives of children and adolescents and their families. This is just one anecdote about how a systems of care approach empowered a child and family to become advocates for themselves and others.

When Austin was in first grade, he was diagnosed with attention deficit/hyperactivity disorder. When he was 12 years old, he was hospitalized for hallucinations and extreme mood swings. While he in the hospital, he was diagnosed with bipolar disorder. A referral from his school guidance counselor got him accepted into a system of care.

Austin’s mother, Kim, reports that the system of care played a critically important role in helping the family coordinate services. System of care staff helped her learn more about her child’s disorder. They helped her locate services and supports tailored specifically to Austin’s needs, including counseling, health care, specialized schools, after-school programs, transportation, and child care. The system of care also empowered Kim to be a more effective advocate for her son’s needs. She says that before joining the system of care, “I tried to fit the service to the need, rather than fit the need to the service. That was a mistake.” Today, Austin and Kim educate others that he, and other children with emotional disturbances, should be known for who they are rather than the disorders they have.

I’ve covered a lot of ground this morning. I hope I’ve given you some information that will help you in your work. One resource that I hope you will take advantage of is the SAMHSA Web site.

SLIDE 7: GRAPHIC WITH 800 NUMBER

You can receive additional information about SAMHSA’s mental health programs for children, adolescents, and families as well as our publications and other resources by calling 1-800-789-2647 or by visiting the Web site on this slide.

We have a great deal of work still ahead of us, of course, but we are making tremendous strides. And we must continue to move forward, to push the envelope, to challenge ourselves and those around us. Over the last year or so, Hurricanes Katrina, Rita, and Wilma presented us with an unprecedented challenge in dealing with the mental health fallout of natural disasters. Florida, Louisiana, Texas, and Mississippi were engulfed by the tremendous needs of those with and at risk of developing mental and substance abuse problems.

We learned a great deal from our experiences in the wake of those hurricanes. We were very much heartened by the response of family and provider organizations that collaborated to give their time, resources, and assistance to support each other and those who came to them for help. Much credit is due to all of those who gave their time, energy, expertise, and compassion to recovery efforts.

I want to take a moment to recognize the leadership of Conni Wells. Conni was, and is, one of the most important figures in those efforts. With more commitment than money, she accomplished some incredibly impressive things and taught all of us some major lessons in how to deal with trauma and disaster. She is an example of the kind of transformational leaders who are emerging from the Federal to the local level. These are individuals who inspire, support, and assist others every day of their lives.

• So many of you have played absolutely critical roles in the recovery of those affected by these natural disasters. There are some genuine heroes in this room today. I know I speak for everyone in our Nation when I thank you for your courage, strength, and dedication.

SLIDE 8: QUOTE