- the recognition that adverse psychosocial experiences in childhood have lifelong adverse effects on mental and physical health and on psychosocial status;
- the high prevalence of mental health disorders and substance abuse among children and adolescents: an estimated 10% to 11% of children and adolescents have both a mental health disorder and evidence of functional impairment;
- the prevalence of children who do not meet DSM-IV criteria for a disorder but who have a clinically significant impairment (“problems” in DSM-PC terminology8), which is estimated to be equal to twice the prevalence of children with severe emotional disorders;
- the prevalence of mental health concerns in pediatric populations;
- the recognition that fully half of the adults in the United States with a mental health disorder had symptoms by the age of 14 years;
- the low percentage of children receiving care for their mental health or substance abuse problems (20%);
- the shortage and inaccessibility of specialty mental health services, especially for underserved children from low-income families who do not fall within the target population of public/community mental health services;
- the disproportionate effects of unmet mental health needs on minority populations;
What People Are Saying
The Crisis in Numbers
Highlights from the American Academy of Pediatrics: Epidemiology of Pediatric Mental Health Disorders, Problems, and Concerns.
of children and adolescents in the U.S. have impaired MH functioning and do not meet criteria for a disorder
of school-aged children with normal functioning have parents with “concerns”
of adults in U.S. with Mental Health disorders had symptoms by the age of 14 years
of children and adolescents in the U.S. meet diagnostic criteria for MH disorder with impaired functioning
The chronically under-funded public mental health (MH) system focuses on individuals with severe impairment. There is little support for prevention or services to children with emerging or mild/moderate conditions.
National Institute of Health:
Discussion of Assessment
Highlights from this paper are listed below. Click here to view a PDF of the original paper.
This review also provides important insights about where assessment tools are most sorely needed.
Whereas instruments to measure anxiety symptoms in adults and youths were well represented, instruments to assist in diagnosis and treatment monitoring for youth with depressive symptoms were sparse. Only one instrument for disruptive behavior disorders was identified, and this instrument can be used only for screening and/or diagnosis; not treatment monitoring/evaluation, suggesting a need for instrument development and
validation. … Diagnostic tools of overall mental health were missing for youth
While assessment guidelines are available for some disorders, these guidelines often do not take into account the practical constraints facing clinicians working in low resource mental health settings. Guidelines are needed for general practice and for specific disorders, with consideration of the limited time and other resources available to community clinicians.
Another largely ignored issue is the need for clinician training in the use of standardized tools. Without understanding how standardized tools can be useful clinically, they become another administrative burden with little clinical payoff (Garland et al., 2003).
Take advantage of new digital technologies.
Most measures are administered using paper-and-pencil and require time to score and interpret. With current technology we are able to software that scores and interprets data points, reducing clinician burden and increasing standardization. As these technologies become less expensive, clinics could use tablet technology or kiosks to administer measures while clients wait for their appointments. This information then could be transmitted to the clinician in a seamless manner that greatly enhances the accessibility and uniformity of EBA. This may require negotiation with instrument developers as the incorporation of instruments into digital data-collection systems may not be covered under usage terms.
The United States has lagged behind other countries in integrating digital mental health into its health care system.
The U.S. health care system has made a remarkably rapid transition to remote care by relaxing the rules around telemedicine (48); moreover, it has begun considering codes that would support digital health administered by physicians and nurses (50). The need and momentum for the integration of DMHTs into the U.S. health care system are here. Enabling reimbursement would allow health care organizations to make DMHTs broadly available, with evidence standards that would support the selection of DMHT products and services that are effective and can be sustainably implemented.