Workforce Issues and Children's Mental Health
 In the last decade, several reports have recognized critical workforce issues related to children's mental health services. For example, goal seven of the 2000 report of the Surgeon General's Conference on Children's Mental Health identified a need to train frontline providers to recognize and manage mental health issues, and educate mental health providers in scientifically-proven prevention and treatment services. Similarly, a key recommendation of goal five of the President's New Freedom Commission on Mental Health is to improve and expand the workforce.
Current Needs for Children's Mental Health Services in the United States
There are 73 million children (0-17 years) in the United States, according to 2003 estimates. Children represent one quarter of the total population. Recent data from parent reports found that one in twenty children ages 4-17 years has definite or severe difficulties with emotion, concentration, behavior, or being able to get along with other people. There is substantial evidence that many families do not receive the services and support they need to care for their children with emotional and behavioral difficulties. The national shortage of mental health professionals, particularly in the field of children's mental health, is one of the major barriers to addressing this issue. The Child Healthcare Crisis Relief Act (search http://thomas.loc.gov/ to find the article) represents one attempt to introduce legislation that begins to address this shortage.
The problem is even more acute when one considers current disparities in access to treatment, and the demand for services that are competent to meet the needs of an increasingly diverse population. Efforts to increase the racial and ethnic diversity of professionals have had success in limited areas. However, a recent report on the diversity of the healthcare workforce in California described the underrepresentation of minorities as a public health crisis.
The Workforce of the Future
A transformed mental health system, such as that described in the report of the President's New Freedom Commission, has many important implications for workforce development. Changes in current approaches to professional education and training will be required to prepare professionals to work in new ways. A system in which children's mental health is integrated with overall health care calls for the education of a wide range of professionals who come into contact with children and families in a variety of contexts. A more informed workforce is essential if the goals of prevention, detection, and early treatment of children's mental health problems are to be realized. Professional education and training will also need to keep up with the changing and diverse needs of the population being served. This includes preparing professionals to work in ways that promote family-driven approaches to care, and that are based on an understanding of cultural differences and the urgent need to eliminate mental health disparities. New solutions are also required to apply technological advances in ways that improve services and access for children and familes.
If you are a family member, practitioner, educator, student, or have an interest in this important topic, please share your views and perspectives on workforce development now and in the future.
Some questions to consider are:
1. How can education and training prepare current and future professionals to adopt family-driven approaches to care? (Family-driven is defined by the Federation of Families for Children's Mental Health as an approach in which families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation.)
2. How can workforce development contribute to the reduction of mental health disparities?
3. What changes are required to improve prevention, detection, and early treatment of children's mental health problems?
4. What type of training is required to promote family-provider partnerships that advance our understanding of effective practice; for example, through research and evaluation?
5. What skills do professionals need to apply technological developments to improving access and care for children and families with mental health needs?
Please write your comments in the box below. We look forward to hearing your views. As always, we appreciate your thoughts on this important issue.
Your thoughts…
Comments:
 Having worked in the Head Start program for over 30 years ( I too am a dinosaur!), I heartened to see that this topic has finally become an issue for discussion. Mental Health, indeed, begins at birth, and we struggle with helping parents understand, in our Early Head Start programs, that relationships, trust, a sense of security; all begin on day one! We then have to carry this through those critical formative years from Birth to Five, where the foundation for life long mental health is formed. Yet, when we attempt to implement the regulatory requirements of our program, specified by Congress, that every program have a relationship with a mental health professional, providing sufficient time to provide services to children and families appropriate to the children's developmental level, we are faced with a dirth of professionals in the field with knowledge and expertise in working with children under five, and those who do are not always willing to work for the consultant fees that are reasonable, given the funding levels for Head Start and early Head Start!
Even more frustrating is that our programs are working with a population at high risk for mental health issues.
When will our systems finally truly understand that prevention is more cost effective than intervention and implement policies that work. When will we train mental health professionals to be prevention oriented rather than seeing their role as curing a disease? As I work now as a consultant with many programs and see the types of mental health services they are receiving from professionals, the approach (as most special education/intervention approaches still seem to reflect) is a focused fix on a specific behavior problem, rather than a relationship-building, mental health strengthening of the child's ability to have quality relationships, interact with others and understand, express and eventually control his/her own emotions.
While there are a small percentage of children who, because of early trauma or physiological issues, need intensive intervention, the vast majority of young children with behavioral issues first need a foundation for sound mental wellness provided by practioners both in early education programs and from professional mental health practioners.
Re the issue of staff development/training- while distance learning, conferences, workshops, etc. provide the information that practitioners need to address children's mental wellness and mental health needs, implementation requires that supervisors are also knowledgable and provide ongoing expectations, observations and feedback as to the effectiveness of the practitioner. Research tells us this is necessary for behavior change. Otherwise, they do the same ole', same ole'!
My hope is that this dialogue can inform both those who prepare professionals in the field to specifically address the needs of preschoolers and those who supervise in programs for young children. If we don't get a handle on it, we will continue to see teenagers, and even younger children, who may be beyond help!
The final travesty is that in the face of all of this, our national educational policy is to focus on literacy, almost to the exclusion of any other developmental progress. Yet we know that both physical and mental health are essential to learning!
Posted Tuesday, January 24, 2006 by Linda Scheer, Early Education at 08:19 AM
As an advanced practice nurse in community health, I have always looked at the earliest time to provide assessment and intervention. Therefore, I advocate that those prepared to recognize,assess, and intervene in the earliest infant-parent relationship (infant mental health) have the greatest promise. In some states there is preparation for practice in infant/early childhood mental health but other states need the impetus of a national resource for training funds.
Posted Friday, January 20, 2006 by Carol in WV at 03:00 PM
I am pleased that these questions are on the table
as I am terrified that there is very little clear
thinking about such things anywhere I look. As a
psychiatrist trained in the 70's I am a bit of a
dinasaur I am afraid, but I retain some old clinical
values that don't get mentioned much: relationship
formation, continuity of care, human concern for
one's clients and their families. In all mental health
work these values are bedrock. And when not
practiced with youth, we systematically turn off our
clientele. In fact at that point we are irrelevant. We
are experience as insulting, rude and hurtful, and
having way too much power thus we are perceived
as dangerous. It is my impression that "going for
counseling" tops the list after even probation
appointments as a youth's least favorite activity.
This is the condition of an inordinate number of
youth who get dragged to my office expecting very
little from me. Pracitcing the values I learned 100
years ago enables me to turn that around within the
first hour.
The values articulated in System of Care writing
come the closest to these old values and force us to
make some really critical adaptations; ie aloofness
does not beget relationship, and really caring for
your patients and their families is not bad
boundaries. Collaborative partnership with parents
and caregivers is an absolutely critical element in
any work with youth and there is no other way to
train our up and coming work force other then for
families to do the training. Thank God we have
family organizations up for the task. Each should be
embraced by all relevant faculty of any and all
training institutions.
But more difficult is how to relate to the youth. I
mean teenagers. Younger kids play and many child
MH professionals learn to work well through play.
but youth are universally approached as "the
enemy" where we are scanning for manipulation,
hidden drug abuse, and have an attitute of
pervasive mistrust. How can we train MH
professionals to actually care for, adore, believe in
and respect adolescents? I train away any where any
time but feel terribly frustrated and overwhelmed at
the vacuum of value based approaches to teens. It
is my opinion that youth need to be mobilized to do
this teaching and given cover by clued in faculty/
profesionals so that they will be listened to. That
was my mission during our grant and we made a
start with in the SOC community locally and
nationally with our HnA group and successfully
lobbying for youth inclusion in CMHS grant
activities. But does this effort even touch training
institutions? NOT!
It ismy opinion that Evidence Based Practices are as
good as worthless unless these basics preceed their
implementation. The arrogance of imposing a
bright idea on a kid and a family that have been
insulted by the structure and attitudes they
encouter in the hot shot clinic delivering and EBP
dooms the outcome. And the corrolary is also true.
Where a respectful and inclusive spirit exists and
warm and sincere relationships are formed those
professionals who have mastered the behavioral
skills of CBT, Skills Training, Exposure Therapy,
varioius manualized family therapies, etc, etc, have
a leg up on those who don't have such tools. But it
is still true that a good relationship facilititates and
biases towards a positive outcome for even a non-
specific but practical sort of counseling.
We spend so much time laboring over EBP's and
how to implement them that we forget old values
and the innovations of SOC as old values were
upgraded. We must integrate and teach a Value
Based Treatment in with Evidence Based Therapy if
we are to have any chance of creating a relevant
work force.
Charley Huffine, Seattle Posted Thursday, January 19, 2006 at 11:25 PM
I am pleased that these questions are on the table
as I am terrified that there is very little clear
thinking about such things anywhere I look. As a
psychiatrist trained in the 70's I am a bit of a
dinasaur I am afraid, but I retain some old clinical
values that don't get mentioned much: relationship
formation, continuity of care, human concern for
one's clients and their families. In all mental health
work these values are bedrock. And when not
practiced with youth, we systematically turn off our
clientele. In fact at that point we are irrelevant. We
are experience as insulting, rude and hurtful, and
having way too much power thus we are perceived
as dangerous. It is my impression that "going for
counseling" tops the list after even probation
appointments as a youth's least favorite activity.
This is the condition of an inordinate number of
youth who get dragged to my office expecting very
little from me. Pracitcing the values I learned 100
years ago enables me to turn that around within the
first hour.
The values articulated in System of Care writing
come the closest to these old values and force us to
make some really critical adaptations; ie aloofness
does not beget relationship, and really caring for
your patients and their families is not bad
boundaries. Collaborative partnership with parents
and caregivers is an absolutely critical element in
any work with youth and there is no other way to
train our up and coming work force other then for
families to do the training. Thank God we have
family organizations up for the task. Each should be
embraced by all relevant faculty of any and all
training institutions.
But more difficult is how to relate to the youth. I
mean teenagers. Younger kids play and many child
MH professionals learn to work well through play.
but youth are universally approached as "the
enemy" where we are scanning for manipulation,
hidden drug abuse, and have an attitute of
pervasive mistrust. How can we train MH
professionals to actually care for, adore, believe in
and respect adolescents? I train away any where any
time but feel terribly frustrated and overwhelmed at
the vacuum of value based approaches to teens. It
is my opinion that youth need to be mobilized to do
this teaching and given cover by clued in faculty/
profesionals so that they will be listened to. That
was my mission during our grant and we made a
start with in the SOC community locally and
nationally with our HnA group and successfully
lobbying for youth inclusion in CMHS grant
activities. But does this effort even touch training
institutions? NOT!
It ismy opinion that Evidence Based Practices are as
good as worthless unless these basics preceed their
implementation. The arrogance of imposing a
bright idea on a kid and a family that have been
insulted by the structure and attitudes they
encouter in the hot shot clinic delivering and EBP
dooms the outcome. And the corrolary is also true.
Where a respectful and inclusive spirit exists and
warm and sincere relationships are formed those
professionals who have mastered the behavioral
skills of CBT, Skills Training, Exposure Therapy,
varioius manualized family therapies, etc, etc, have
a leg up on those who don't have such tools. But it
is still true that a good relationship facilititates and
biases towards a positive outcome for even a non-
specific but practical sort of counseling.
We spend so much time laboring over EBP's and
how to implement them that we forget old values
and the innovations of SOC as old values were
upgraded. We must integrate and teach a Value
Based Treatment in with Evidence Based Therapy if
we are to have any chance of creating a relevant
work force.
Charley Huffine, Seattle Posted Thursday, January 19, 2006 at 11:25 PM
Well, those are 5 good questions, but I have a question that begs an answer before we get to the questions listed above (at least I think so). Question: Given the pressure on time, great distances to travel to a central location or conference, the ongoing pressure for increased productivity rates, and other budgetary constraints, how do we make workforce development a priority; how are we supposed to get this important task done?
I'm Steve Trout, Southern Consortium for Children located in 10 Appalachian counties of southern Ohio. This is the question that I have been about answering for the last 7 years (and, yes, I like answering my own questions!). A simple one word answer is: technology. We have been using interactive videoconferencing technology since 1998 to provide trainings twice monthly to our regional child and family workforce. Over this span of time we have trained over 5,000 participants and issued over 6,000 CEUs and addressed the fiscal constraints listed above. Secondly, we have created the Children's Behavioral Health Network, a website (www.cbhed.com) devoted to bringing online one hour streaming video presentations by nationally known presenters for general information and for CEUs (at a modest price). Lastly, I have considered but not tried "Webinars," which I hope would be an answer to the rather tedious and antiquated "national conference calls." Clearly, technology has it's issues in access, connectivity type, firewalls etc. Notwithstanding is the behavioral health system's need to embrace technology and use it as a tool, not only for distance learning and workforce development, but for direct service too. I have a lot more to say on this topic but will stop here as I have taken up far too much space! ST
Posted Thursday, January 19, 2006 by strout@frognet.net at 01:36 PM
Since children with mental health needs are often involved with special education, child welfare, and juvenile justice, what type of cross training can be provided to foster greater understanding across these disciplines? How will mental health professionals be prepared to interact effectively with these allied disciplines? How will practitioners in each of those disciplines be prepared to interact effectively with the mental health system? What training will mental health professionals receive to provide effective service coordination for families with needy children? Posted Thursday, January 19, 2006 by Howard in Wisconsin at 01:03 PM
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