The Office of the Surgeon General has identified eight goals to improve the mental health care infrastructure for children in United States (Office of the Surgeon General, 2000) (Figure 2). This comprehensive infrastructure is necessary if we are to effectively address the languishing nature of mental health care services for children. The success of this project will depend on an unprecedented collaboration and commitment by three core federal and state departments that strongly shape the context in which children live: the U.S. Department of Health and Human Services (HHS), the U.S. Department of Education (DOE), and the U.S. Department of Justice (DOJ). Although children and adolescents with serious emotional disturbances are more likely to receive treatment from a program supported by the HHS, most children who receive mental health care in the United States are within the jurisdiction of the DOE (Burns et al., 1995). However, the greatest need for a mental health care services overhaul may be within the DOJ. For example, incarcerated children who have been traumatized as a victim and a perpetrator of violent offenses need extensive mental health care attention but are unlikely to receive adequate care (Simpatico et al., 2002). The multisystemic partnership proposed by the Surgeon General is the first step in addressing the crises in mental health care services for America's youth.
Goal 1: Promote public awareness of children's mental health care issues and reduce the stigma associated with mental illness. Campaigns should help identify early indicators for mental health while promoting social, emotional and behavioral well-being.
Goal 2: Continue to develop, disseminate and implement scientifically proven prevention and treatment services. Advancements in neurological, cognitive, social and psychological development will aid the design of better screening assessment and treatment tools.
Goal 3: Improve the assessment and recognition of mental health care needs in children. Increasing the understanding of policy-makers and practitioners may accomplish this goal by identifying early mental health care needs in preschool, child care, education, health care, welfare, juvenile justice and substance abuse treatment settings. Since most of the children with mental health care needs are under the purview of the DOE, promoting cost-effective and proactive systems of behavioral support within schools will be necessary.
Goal 4: Significant disparities exist between non-white and white use of mental health care services. Increasing culturally competent white and non-white health care professionals and research on service delivery disparities will be extremely useful in attaining this difficult goal of reducing such disparities. Other avenues toward the elimination of the broad disparities include developing policies for uninsured children; encouraging alternative prevention/intervention strategies; and co-locating mental health care services with other key systems such as education, primary care, welfare, juvenile justice and substance abuse treatment.
Goal 5: Improve the infrastructure of children's mental health care services, including support for scientifically proven interventions across professions. The primary objective for this goal is twofold: review incentives and disincentives for health care providers to assess the mental health needs of children; and provide incentives to agencies, programs and individual practitioners to use scientifically proven and cost-effective prevention and intervention strategies.
Goal 6: Increase access to and coordination of quality mental health care services. Health care professionals must develop a common language to describe children's mental health that considers cultural, ecological and familial context. There is an additional need for a universal measurement system across all major service sectors that is age-appropriate and culturally and gender sensitive. Improving access to services and involving key community stakeholders in the design and delivery of services to their communities are also critical.
Goal 7: Train frontline providers to recognize and manage mental health care issues and educate mental health care providers in scientifically proven prevention and treatment services.
Goal 8: Monitor the access to and coordination of quality mental health care services. This goal may be maintained by establishing formal partnerships among federal research regulatory and service agencies, professional associations, and families/caregivers to transfer evidence-based knowledge.
We have empirical evidence that exposure to adverse childhood experiences is cumulatively associated with negative health outcomes in adults. Following the U.S. Surgeon General's report on children's mental health, we propose developing public mental health care and wellness systems that will support prevention and intervention of children's exposure to adverse childhood experiences by using evidence-based strategies that can be widely disseminated (Bell, 2002).