Accelerating Solutions to Improve Access and Quality of Empirically-Supported Practices for Youth Mental Health

Presenter

Marcy Burstein, Ph.D. 
Division of Services and Intervention Research

Goal

This concept encourages youth (ages 0-25 years) mental health prevention, treatment, and services research that addresses barriers to empirically-supported and high-quality youth mental health care. It is expected that research supported by this concept will generate knowledge, methods, and approaches that can be readily applied in real-world settings and systems of care. Therefore, this concept emphasizes research that is practice-based, deployment-focused, guided by implementation science frameworks (e.g., hybrid effectiveness-implementation type 1, 2, or 3 designs), designed to prevent threats to implementation fidelity, and relevant across diverse individuals, with the ability to address drivers of mental health disparities.

Rationale

This concept is a call to action in response to the youth mental health crisis in the United States. As many as one in eleven children and adolescents in the United States are diagnosed with a mental health disorder in their lifetime, yet only a fraction of these youth receive treatment. The unmet need for mental health illness prevention, treatment, and services is greatest among youth who experience health disparities, those living in rural and inner-city areas, and those affected by housing and food insecurity. In recent years, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a youth mental health national emergency, and the Office of the U.S. Surgeon General issued an advisory statement on youth mental health. Access to empirically-supported, high quality practices for youth mental health is limited by multiple barriers including: (1) screening, assessment, and intervention approaches that are not scalable or designed for use in the settings where youth are typically identified as being in need of care, (2) interventions that are not sufficiently responsive to the needs of youth and families and not optimally effective, (3) a poorly distributed workforce that is disincentivized to accept insurance, particularly Medicaid, (4) system and service barriers, including fragmented services (e.g., across schools, primary care, and specialty mental health clinics) and poor continuity of care, particularly during the transition from adolescence to adulthood, and (5) a lack of decision support tools and quality measures to guide the delivery of mental health interventions and services.

Examples of relevant research include studies focused on developing, optimizing, testing, and/or comparing:

• Scalable interventions that are of the appropriate intensity or dose based on the severity of the mental health problem.   
• Effective training approaches, including technology-assisted strategies for initial competency and sustained fidelity in the use of evidence-based assessments and interventions.
• Strategies to support integration of empirically-supported practices into child welfare, juvenile justice, foster care, schools, pediatric medicine, or online services, including system redesign.
• Optimal financial and other incentive strategies to encourage mental health providers to participate in insurance. 
• Interventions and implementation strategies to reduce disparities in service access, quality, and outcomes.
• Services interventions to promote detection, engagement, and referral to community-based mental health settings.
• Decision support tools to guide the selection of empirically supported approaches that will be offered in a given practice setting or for matching individual youth to services of appropriate intensity.