Highlights of Research on Children with Disabilities in AJO
2016 SPECIAL SECTION ARTICLES
Evans, M. E., Bruns, E. J., Armstrong, M. I., Hodges, S., & Hernandez, M. (2016). New frontiers in building mental, emotional, and behavioral health in children and youth: Introduction to the special section. American Journal of Orthopsychiatry 86, 103-108.
The passage of the Patient Protection and Affordable Care Act (ACA; 2010) has had tremendous influence on behavioral health in the United States (Alker & Chester, 2015). Shortly after its passage, the editors of this special section became interested in examining the provisions of the ACA related to care for mental, emotional, and behavioral disorders in children and youth and synthesizing their implications in the context of other contemporary trends in children’s behavioral health promotion. We first developed a white paper with the goal of increasing our own understanding of these issues and their possible influence on the status quo of designing, implementing, financing, and evaluating behavioral health services for children and their families. From our discussions came the idea of developing a special section in the American Journal of Orthopsychiatry featuring input from researchers who have been exploring these issues and who have tangible and relevant examples of “new frontiers” in building mental, emotional, and behavioral health for children and youth. The result is the current special section, the purpose of which is to highlight the importance of prevention in behavioral health and to explore examples of efforts that have used a broad public health approach to prevention and early intervention in mental, emotional, and substance use disorders in children and youth. Before introducing the seven articles in this special section, we describe in detail our foundational thinking about building mental, emotional, and behavioral health for children and youth, as expressed in our initial white paper on this topic.
http://psycnet.apa.org/journals/ort/86/2/103.pdf&uid=2016-11924-001&db=PA [open access]
Shern, D.L.; Blanch, A.K.; & Steverman, S.M. (2016). Toxic stress, behavioral health, and the next major era in public health. American Journal of Orthopsychiatry 86, 109-123.
Before the development of the germ theory in the late 19th century, infectious illnesses were largely uncontrollable and caused significant mortality. Implementing public hygiene, preventive, and treatment interventions created remarkable improvements in population health. Today’s U.S. public health crises involve threats to health and human capital evidenced by multiple indicators of deteriorating wellbeing. These problems result from the interaction of risk and protective factors. Specifically, we argue that the interaction of genetic vulnerability and toxic stress are antecedents to a developmental cascade that undermines healthy development and human capital. We review relevant literature, summarize effective strategies to prevent or ameliorate this deterioration, and outline a theory of the mechanisms currently undermining our health. A series of strategies that we believe will constitute the next major era in public health are discussed, involving actions at the individual/family, community and societal level to reduce risk and strengthen protective factors.
Oppenheim, J.; Steward, W.; Zoubak, E.; Donato, I.; Huang, L. & Hudock, W. (2016). Launching forward: The integration of behavioral health in primary care as a strategy for promoting young child wellness. American Journal of Orthopsychiatry 86, 124-131.
In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) created a national grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), to improve behavioral health and developmental outcomes for young children through the incorporation of prevention and wellness promotion practices in key early childhood settings. Project LAUNCH supports states, tribal nations, and territories to improve coordination across early childhood systems and implement 5 core strategies of prevention and promotion. This article focuses on the lessons learned from 1 of the 5 core strategies: integration of behavioral health into primary care for young children. This paper analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral problems at a population level.
Kingston, Beverly E., Mihalic, Sharon F., Sigel, Eric J. (2016). Building and evidence-based multitiered system of supports for high-risk youth and communities. American Journal of Orthopsychiatry 86, 132-143.
The mental, emotional and behavioral health problems of high-risk youth and youth living in high-risk communities are not inevitable and can be prevented. A shift from the nation’s focus on treating disease and illness after it occurs to a concentrated effort on preventing the root causes of these problems is needed. Prevention science suggests a comprehensive multitiered approach that provides evidence-based prevention supports for children and youth at each developmental stage and across multiple social contexts is likely to result in the greatest health impact and return on investment. However, actually implementing this approach at a neighborhood level has remained a challenge and an ongoing research gap especially in high-risk communities. This article describes a process and provides a case study example for implementing a comprehensive, multitiered approach in a high-risk community. This includes assessing and prioritizing the specific needs of individuals and communities; selecting evidence-based programs based upon assessed needs; and creating a continuum of programs to improve the health and well-being of youth across developmental age spans, social contexts, and levels of risk. Operational details and challenges for organizing and implementing this comprehensive approach are also described. We estimate that the collective impact of a multitiered evidence-based approach, implemented with fidelity, could conservatively result in a 30 to 40% reduction in problem behaviors.
Salazar, A., Haggerty, K., de Haan, B., Catalano, R., Vann, T., Vinson, J., & Lansing, M. (2016). Using communities that care for community child maltreatment prevention. American Journal of Orthopsychiatry 86, 144-155.
The prevention of mental, emotional, and behavioral (MEB) disorders among children and adolescents is a national priority. One mode of implementing community-wide MEB prevention efforts is through evidence-based community mobilization approaches such as Communities That Care (CTC). This article provides an overview of the CTC framework and discusses the adaptation process of CTC to prevent development of MEBs through preventing child abuse and neglect and bolstering child well-being in children aged 0 to 10. Adaptations include those to the intervention itself as well as those to the evaluation approach. Preliminary findings from the Keeping Families Together pilot study of this evolving approach suggest that the implementation was manageable for sites, and community board functioning and community adoption of a science-based approach to prevention in pilot sites looks promising. Implications and next steps are outlined.
Bruns, Eric J.; Duong, Mylien T.; Lyon, Aaron R.; Pullmann, Michael D.; Cook, Clayton R.; Cheney, Douglas; McCauley, Elizabeth. (2016). Fostering SMART partnerships to develop an effective continuum of behavioral health services and support in schools. American Journal of Orthopsychiatry 86, 156-170.
The education sector offers compelling opportunities to address the shortcomings of traditional mental health delivery systems and to prevent and treat youth mental, emotional, and behavioral (MEB) problems. Recognizing that social and emotional wellness is intrinsically related to academic success, schools are moving to adopt multi-tier frameworks based on the public health model that provide a continuum of services to all children, including services to address both academic and MEB problems. In this article, we review the potential value of multi-tier frameworks in facilitating access to, and increasing the effectiveness of, mental health services in schools, and review the empirical support for school-based mental health interventions by tier. We go on to describe a community–academic partnership between the Seattle Public Schools and the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center that exemplifies how multi-tier educational frameworks, research and evidence, and purposeful collaboration can combine to improve development and implementation of a range of school-based strategies focused on MEB needs of students. Finally, we present a set of 10 recommendations that may help guide other research and practice improvement efforts to address MEB problems in youth through effective school mental health programming.
Nagle, Geoffrey A.; Usry, Lindsay R. (2016). Using public health strategies to shape early childhood policy. American Journal of Orthopsychiatry 86, 171-178.
There is clear evidence that ensuring safe, stimulating, and nurturing caregiving environments for young children may be one of the most impactful health promotion strategies available, with lifelong and intergenerational benefits. Supports and interventions in the early years of life may in fact be the most effective way to improve school performance, increase high school graduation rates, job performance, and adult productivity. A public health approach to early childhood well-being, as opposed to the needs of children being addressed in multiple siloes, may be a more effective strategy that will lead to smarter investments and increasing financial commitments. Louisiana is used as a case study, with examples of strategies organized by the 3 core functions of public health.
Morris, John A. (2016). Can behavioral health drive its own reformation? The challenges of shifting direction. American Journal of Orthopsychiatry 86, 179-185.
This paper is designed to provide a broad-view perspective on at least some of the implications of the Affordable Care Act for children’s behavioral health. Historical trends in behavioral health have tended to isolate both consumers of services (including children, youth and families) and practitioners from the larger world of healthcare, with decidedly mixed results. This paper uses the concept of path dependence to highlight the multiple challenges facing child behavioral health as it moves forward. The paper builds its recommendations on the 4 pillars of sustainable change: politics, practice, economics, and science. In a changing health care environment, behavioral health has to transform. The paper concludes with some observations on the kinds of transformative change required to move in new directions.
Levine, Murray. (2015). Children come first? A brief history of children's mental health services. American Journal of Orthopsychiatry 85(5):S22-S28.
This article provides a brief history on the evolution of child mental health services. From 1961 when modern day mental health programming began with the Joint Commission on Mental Health and Illness to key developments in children 's mental health services and prevention in modern day.
Butler, Amy C. (2014). Poverty and adolescent depressive symptoms. American Journal of Orthopsychiatry 84(1):82-94.
Longitudinal data on non-Hispanic White children from the Panel Study of Income Dynamics (N = 1,056) were used to examine whether the relationship between poverty (early childhood poverty, poverty persistence, and current poverty) and adolescent depressive symptoms (measured by the Children’s Depression Inventory and the Internalizing Index) can be explained by the mother’s own childhood depression and family characteristics measured during the child’s first year of life. Associations between poverty and depressive symptoms among adolescents were explained by mother’s childhood depression and whether the adolescent had lived with both parents during the first year of life. The findings highlight the need for appropriate treatment of childhood depression so as to reduce the adverse consequences in adulthood and for the next generation.
Turner, H., Finkelhor, D., Ormrod, R., Hammy, S., Leeb, R., Mercy, J., & Holt, M. (2012). Family context, victimization, and child trauma symptoms: Variations in safe, stable, and nurturing relationships during early and middle childhood. American Journal of Orthopsychiatry 82(2):209-219.
Based on a nationally representative sample of 2,017 children age 2–9 years, this study examines variations in “safe, stable, and nurturing” relationships (SSNRs), including several forms of family perpetrated victimization, and documents associations between these factors and child trauma symptoms. Findings show that many children were exposed to multiple forms of victimization within the family (such as physical or sexual abuse, emotional maltreatment, child neglect, sibling victimization, and witnessing family violence), as evidenced by substantial intercorrelations among the different forms of victimization. Moreover, victimization exposure was significantly associated with several indices of parental dysfunction, family adversity, residential instability, and problematic parenting practices. Of all SSNR variables considered, emotional abuse and inconsistent or hostile parenting emerged as having the most powerful independent effects on child trauma symptoms. Also, findings supported a cumulative risk model, whereby trauma symptom levels increased with each additional SSNR risk factor to which children were exposed. Implications for research and practice are discussed.
D'Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry 82(2):187-200.
Childhood exposure to victimization is prevalent and has been shown to contribute to significant immediate and long‐term psychological distress and functional impairment. Children exposed to interpersonal victimization often meet criteria for psychiatric disorders other than posttraumatic stress disorder (PTSD). Therefore, this article summarizes research that suggests directions for broadening current diagnostic conceptualizations for victimized children, focusing on findings regarding victimization, the prevalence of a variety of psychiatric symptoms related to affect and behavior dysregulation, disturbances of consciousness and cognition, alterations in attribution and schema, and interpersonal impairment. A wide range of symptoms is common in victimized children. As a result, in the current psychiatric nosology, multiple comorbid diagnoses are necessary—but not necessarily accurate—to describe many victimized children, potentially leading to both undertreatment and overtreatment. Related findings regarding biological correlates of childhood victimization and the treatment outcome literature are also reviewed. Recommendations for future research aimed at enhancing diagnosis and treatment of victimized children are provided.