Children, Families & Mental Health

A majority of children who face mental health problems often fail to get treatment, a panel on Children, Families and Mental Health reported. This, panelists said, could drive them into crime, leave them homeless or fail to give them the skills to work productively.

The panel members agreed that these disorders could be less severe if diagnosed and treated early, but the current screening programs are inadequate in the face of the need.

The presentations by the panelists also noted that children in minority groups had a higher percentage of mental disorders in California's child population because of the poverty of their families.

The panel was chaired by Abram Rosenblatt, Ph.D., Director, the Child Research Group, UCSF. Other panelists were Lonnie R. Snowden Jr., Ph.D., Professor, School of Social Welfare, UC Berkeley; Joan Asarnow, Ph.D., Professor of Psychiatry and Biobehavioral Sciences, UCLA, School of Medicine; and Toby Ewing, Project Manager, the Little Hoover Commission Report on Children's Mental Health.

Dr. Snowden said that whatever happens to mental health services disproportionately affects minority children, especially the inability to get treatment.

Dr. Asarnow said studies in which she participated showed the need to significantly improve screening processes to detect mental disorders and open the door to treatment for children.

Mr. Ewing reported the Surgeon General's Report said that of every four children with emotional disabilities, just one will graduate from high school. With an impending adolescent population bubble, he called for action now to prevent these children from turning to crime, becoming homeless and growing up without the skills to join the work force.

Dr. Rosenblatt, also Associate Adjunct Professor at UCSF, reported that early treatment benefits the children tremendously.

He said that access to services is a significant problem, but added that most research was focused in a university setting and that there is limited research on services available in community settings.

Dr. Rosenblatt cited studies that showed 500,000 to 1 million children in California have functional impairments. He said the scientific community was shocked because the numbers are so high.

Dr. Rosenblatt said that prevalence of mental disorders was lower in the younger children but this may be explained because it is easier to diagnose illness in older children. He listed causes of mental illness among children as poverty, a family history of illness, low birth weight, abuse and neglect among others.

He said as treatment interventions with positive outcomes include the following:

Home Based Services (especially Multi-Systemic Therapy)

Therapeutic Foster Care

Some Case Management

He also cited specific outpatient programs with positive outcomes to include:

Psychosocial treatments focusing on problem solving

Parent management training

Child-Parent interpersonal skill strengthening

Encouraging: Wraparound Process (comprehensive and coordinated treatment)

Dr. Snowden focused on mental health problems among minorities, noting that he had served as scientific editor of a supplement report on Mental Health Culture, Race & Ethnicity put out by the U.S. Surgeon General. He said the report attempts to synthesize what we know about mental health problems and access to care among minority communities.

Dr. Snowden said that minorities make up a major share of California's population and that the percentage of minority children among the child population is even higher.

He noted that many minority children are on welfare and in the juvenile justice system. He said that the extent of government funding of programs significantly impacts the quality of services for minority children. Treating these children now, he said, could help avoid problems later in life that would be more costly to society.

Poverty affects these communities because it lessens their level of resources and heightens levels of stress. Minorities, he said, lack savings, assets and home ownership which means that when health problems arise problems compound without the means to deal with them.

Dr. Asarnow addressed the questions: How to give children the best possible treatment; how to increase access to state-of-art treatments; and how to enhance the role of primary care.

Dr. Asarnow, and her colleagues, found in their studies that primary care appointments were the most effective place to screen children since most children have some contact with primary care medical services.

At present, she said, primary care could be a great access point for mental health treatment because some 70 percent of children have some contact with primary care, yet at present it does not meet the test.

Primary care programs, she said, fail to detect mental health disorders in children screened and the emphasis is on physical health. Yet, she cited studies showing a high incidence of adolescent depression among children, reinforcing the need for effective screening.

Even when care givers detect mental health problems, she said, they face major barriers that prevent them from following through with the patient.

These barriers, she said, may be due such individual concerns as a person's fear of being stigmatized, a stated belief that it is "against my religion," or the individuals do not agree that they need help.

The need, she said, is to develop intervention strategies to reduce these barriers and improve access to high quality care.

She said most kids have some contact with primary care, but often come with a pregnancy or other problem, which they do not share with their parents.

Additional training for those in the primary care system, she said, would be required to achieve needed changes, but the detection of mental illness would allow for earlier treatment with substantial benefits for the children.

Mr. Ewing said Little Hoover commission studies show that the programs for children and families lack vision and leadership, that funding is not aligned with the policy goals, and that accountability is lacking. He said the studies show that agencies often fail to meet the needs of the children.

Mr. Ewing, calling for a better system of accountability, said the public needs to know it is getting the right value for the dollar.

Accountability, while urgently needed, he said, is hard to come by in the current fragmented service and delivery system plagued by finger pointing from one level of government or agency to another.

Agencies, he said, are driven by distinct missions, and it is hard to get them out of those circles, even when their clients do not live in such circles.

He said agencies and individuals meet the highest stardards of services and yet children remain poorly served. It is the way we organize our services, he added, that allows too many children to get inadequate care.

To counter these weaknesses, he called for consistent care regardless of how the system is accessed, for comprehensive services to meet a full range of needs, consistent care as children age or needs evolve, a single point of responsibility and accountability for outcomes and services designed around long-term individual family and community goals.

Mr. Ewing said the Governor and the Legislature should ensure that no child or family suffers needlessly because state and local programs fail to work toward common objectives.

He called for Legislation that would:

Establish Policy Goals.

Establish an innovation project.

Create a Secretary of Children's Services

Form a multi-agency coordinating committee.

Create mechanisms for local accountability.

He said the adoption of better solutions would go a long way to helping families seeking to cope within the bounds of current programs, where, he said, they face great uncertainty. He cited one case of a family with twins where one youngster ended up in foster care while the other ended up in jail to illustrate the problem.

California, he said, does not fund, organize or administer services to comprehensively meet the needs of children and families.