A Public Health Approach to Intervention: A New Framework for Strengthening Children's Mental Health and Well-Being Georgetown University Center for Child and Human Development National TA Center for Children’s Mental Health Webinar July 30, 2008

2 Key Themes & Concepts Shift to a population focus (all children) Emphasize the importance of environments Include a focus on children’s positive mental health Involve and engage new partners Adapt themes to meet the needs of community (local adaptation)

3 Structure of the Monograph Chapter 1 – An Overview Chapter 2 – Language Chapter 3 – Public Health and its Application to Children’s Mental Health Chapter 4 – An Intervention Framework Chapter 5 – Applying the Framework

4 Setting the Scene for the New Framework

5 The Current Approach: Children’s Mental Health Care System Children’s mental health care system has made great strides, particularly in the last 20 years. This system focuses almost exclusively on treating problems. What happens if nothing is done to check the growing numbers of children who develop problems?

6 Public Health System The public health system also impacts children’s health. Public health focuses on promoting health and preventing problems in addition to treating problems. Mental heath is not yet a significant focus for the public health system.

7 Integrating Mental Health and Public Health Children’s mental health care system will add a focus on promoting positive mental health and preventing problems. Public health system will increase their focus on mental health. Other systems will recognize the part they play in supporting the positive mental health of all children.

8 Language It is difficult for people to communicate across systems. There are no common definitions for key terms including health, mental health, and positive mental health. The monograph offers definitions to use as starting points for discussion.

9 Money Mental health treatment services are already limited in the US. Promotion/prevention services are likely to be seen as in competition for the same dollars as treatment. Insurance reimbursement process is not designed for preventing problems before they occur. Other funding sources are scarce and require time and energy to pursue. The monograph offers examples of places that are innovating in this area.

10 Key Components of a Public Health Approach Population Focus Promotion and Prevention Determinants Process

11 Public Health Approach: Process Three core functions Ten essential elements

12 The New Framework

13 Approach to Children's Mental Health Grounded in Public Health Core Functions EnsuringAssessing Intervening Quality, access, and sustainability Public policies, community programs, family/individual services, and more Gathering and analyzing data to drive decisions

14 Special Focus on Intervening EnsuringAssessing Intervening

15 Intervention Framework for Health Preventing Problems Promoting Health Treating Problems Reclaiming Health Focus on Positive Health Focus on Health Problem NoFocus on an Identified Problem

16 Integrating Language in New Intervention Framework No identified health problemFocus on an identified health problem Focus on (and Measuremen t of) Positive Health Universal Promoting Targeted Promoting Early Reclaiming (includes early identification and screening) Reclaiming Ongoing Reclaiming (includes Recovery, job programs, etc.) Focus on (and Measuremen t of) Health Problems Universal Preventing (or Primary Preventing) Targeted Preventing (includes Selective and Indicated Preventing) Early Treating (includes Secondary Preventing, Early Identification and screening) Treating (includes Standard Treating, Tertiary Prevention, Preventing worsening of symptoms & co-occurring problems) Ongoing Treating (Continuing Care or Maintenance) Includes Tertiary Preventing, Preventing Relapse, Long-term Care, After-Care, Rehabilitation

17 A conversation with Sandra Spencer Executive Director Federation of Families for Children's Mental Health Interviewed by Joyce Sebian

18 Reference Slides Visit the Georgetown Website to download an enhanced slide showGeorgetown Website July 19 th TA Conference Call ta_center/tacalls2008.html

19 The Vision Communities, as well as society at large… will work to positively shape and strengthen children's physical, social, cultural, political, and economic environments in ways that promote optimal well-being and help prevent mental health problems. will provide a full continuum of services and supports, from promoting health and preventing problems to treating problems and reclaiming health, that help all children manage environmental, social, and emotional challenges, thrive, and be contributing members of society.

20 Selected Sectors that Impact Children’s Mental Health Education Early Education/Head Start Maternal & Child Health Bureau Child Care Primary Medical Care Juvenile Justice Child Welfare Early Education Families Media

21 Positive Health and Health Problems as Independent Dimensions Valuing Mental Health: A Framework to Support the Development of a Provincial Mental Health Policy for Newfoundland and Labrador, September Downloaded April 9, 2007

22 IOM Report Fan Citation: 1994 Institute of Medicine (IOM) report entitled Reducing the Risks for Mental Disorders: Frontiers for Preventive Intervention Research

23 PH/MH Core Monograph Team Searchlight Consulting LLC –Jon Miles, Ph.D. Georgetown University Center for Child and Human Development, National TA Center for Children’s Mental Health –Rachele C Espiritu, Ph.D. –Neal M Horen, Ph.D. –Joyce Sebian, M.S. Ed. –Elizabeth Waetzig, J.D.