1. Advancing a Public Health Approach to Children's Mental Health
Georgetown University National TA Center
Advancing a Public Health Approach to Children's Mental Health
Topical Conference Call
February 18, 2010
Neal M. Horen, PhD
Joyce Sebian MS Ed
Georgetown University Center for Child and Human Development
National TA Center for Children’s Mental Health
Rachele
Introductions
1. Diversity of audience
some people have heard this before from previous presentations
Using multiple approaches to share the framework
As we get responses, we are trying to respond in our remarks and presentations
Public Health Approach to Children’s MH

2. Georgetown University National TA Center
Announcing!!!!  
New Publication: A Public Health Approach to Children’s Mental Health: A Conceptual Framework  
Authors:
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.
In partnership with SAMHSA/CMHS, Children Youth and Family Branch and Prevention Program Branch
Rachele
Public Health Approach to Children’s MH

3. Key Components of a Public Health Approach
Georgetown University National TA Center
Key Components of a Public Health Approach
Integration elements:
Population Focus
Includes Promotion and Prevention
Addresses Determinants of Health
Process/Action Steps
Just what is the approach?
Term PH has a lot of confusion. – What does it mean to you? When you think of public health, what comes to mind?
There’s a PH service, system, profession/field, government entity. Other times it is more of an approach - fluoridated water, workplace safety
Shift into thinking about what we mean when we talk about a ph approach
Population Focus
-- for example, immunizations, convincing a person to stop smoking
“intervention”– not using this in the clinical sense to refer to treatment only. In fact, we’re not limiting to intervening with problems. We’re using it to refer to any ways of intervening that create change, either by trying to reduce/eliminate a problem, such as preventing child abuse or treating a child whose been exposed to neighborhood violence, or by trying to improve or strengthen health, such as a Safe & Healthy Schools program that focuses on school climate and social relationships.
Outcomes– number of violent incidents in a school is a population measure
Introduce importance of environment
Promotion and Prevention - “Promotive” interventions aim to optimize health and measure positive outcomes
Preventive interventions aim to reduce problems and measure negative outcomes
Determinants are factors that lead to good or bad health.
When talked about in the context of prevention/problems, they are called risk and protective factors. There are no corresponding terms for promotion. We use determinants to refer to both contexts.
A large focus for public health is driving interventions with data and measuring, The determinants give you measures. Biological as well as environment – determinants are broad
Process and Approach -
Public Health Approach to Children’s MH

4. Using a New Intervention Model: Moving beyond Prevention and Treatment
Georgetown University National TA Center
Using a New Intervention Model: Moving beyond Prevention and Treatment
Rachele
Reflection and ideas for how to improve
2 basic parts
setting the scene
introducing the intervention framework
Public Health Approach to Children’s MH

5. Prevention and Treatment
Prevention Doesn’t consider an identified problem Treatment Does consider an Identified problem

6. Prevention and Treatment (cont’d)
Doesn’t consider an
identified problem
Does consider an identified
problem
Promoting
So how are these two different from each other?
Preventing
Treating

7. An International Model Positive Health and Health Problems
Georgetown University National TA Center
An International Model Positive Health and Health Problems
3) people may have mental illnesses but still have good mental health.
1) people have good mental health and no mental illness.
2) people have poor mental health but do not have a mental illness.
Concept of positive mental health
Feeling good and functioning well.
Dr. Keys has demonstrated that positive mental health and mental illness are different from one another.
It’s not that simple
Scenarios -
Has shown that people that don’t have mental illness but have poor mental health, are not doing well
Important to think about these as different concepts
2) people have mental illnesses and poor mental health.
4) people have mental illnesses and poor mental health.
Valuing Mental Health: A Framework to Support the Development of a Provincial Mental Health Policy for Newfoundland and Labrador, September
Downloaded April 9, 2007
Public Health Approach to Children’s MH

8. Prevention and Treatment (cont’d)
Doesn’t consider an
identified problem
Does consider an identified problem
Optimizing
Positive
Promoting
Mental
???
Health
Reducing
Preventing
Problems
Treating

9. Intervention Model for Children’s Mental Health
Georgetown University National TA Center
Intervention Model for Children’s Mental Health
A Special Emphasis on Intervening – A Model for Children’s Mental Health
Taken together, the first two guiding principles of the conceptual framework (page 1) form the idea that a balanced approach includes promoting positive mental health and addressing mental health for all children regardless of whether they have an identified mental health problem or not. This idea leads to a new model for intervening.
ON the Top – identified problem
ON the Right – Focus positive/problem – need to mention and stress measurement element
The key distinction are whether a problem is identified
Bottom two, reflect the continuum that was in the IOM slide. As long as measuring, can tell
The interventions in this model are divided into four categories. Two of the categories above the mid-line, Promoting and Re/Claiming, optimize and measure positive mental health, while two others, Preventing and Treating, reduce and measure mental health problems. The right two areas focus on Treating and Re/Claiming both focus on intervening with special consideration for an identified mental health problem. On the left side, Promoting and Preventing focus on interventions without consideration of an identified mental health problem.
A new term offered in this model is Re/Claiming. As contrasted with Promoting, Re/Claiming health is intentionally focusing on optimizing health even in the presence of a mental health problem, and taking that mental health problem into consideration as needed. As contrasted with Treating, the emphasis with Re/Claiming is on optimizing positive mental health rather than the disease model’s focus on alleviating suffering associated with mental illness or disorder. Many interventions offer a combination of Treating and Re/Claiming, just as many others offer a full array of interventions that should be provided within a comprehensive approach, and they offer a reminder of the importance of measuring both positive mental health and mental health problem outcomes.
Public Health Approach to Children’s MH

10. Georgetown University National TA Center
Four intervention categories and distinctions based on action, timing and goal
Action
Timing
Population Goal
Promoting
…is intervening…
to optimize positive mental health by addressing determinants* of positive mental health
before a specific mental health problem has been identified in the individual, group, or population of focus
with the ultimate goal of improving the positive mental health of the population.
Preventing
to reduce mental health problems by addressing determinants* of mental health problems
with the ultimate goal of reducing the number of future mental health problems in the population.
Treating
to diminish or end the effects of an identified mental health problem
after a specific mental health problem has been identified in the individual, group, or population of focus
with the ultimate goal of approaching as close to a problem-free state as possible in the population of focus.
Re/Claiming
… is intervening…
to optimize positive mental health while taking into consideration an identified mental health problem
with the ultimate goal of improving the positive mental health of the population of focus.
So how are those four things really different.
What is the action?
What is the timing?
What is the population goal?
Public Health Approach to Children’s MH

11. Georgetown University National TA Center
A Paradigm Shift
Shifting away from a focus on children’s individual mental health problems and towards strengthening the mental health of all children requires
Working collaboratively across a broad range of systems and sectors
Engaging the child mental health care system, the public health system, and all the other settings and structures that impact children’s well-being
Jon
Public Health Approach to Children’s MH

12. The Public Health Approach Process
Georgetown University National TA Center
The Public Health Approach Process
Three core functions
Ten essential elements/services
In some ways the most important: PH approach is based on a process. Simply put, the process is to gather and interpret data, and use that data to drive decisions (1st core function), intervene, often through policy (second core function), and sustain change by ensuring key steps (third core function).
Starts with assessment (also referred to as surveillance) – important concept is that data drive decision-making
In the public health service and government settings, intervention is focused on policy development. But the three elements that make up the Policy Dev core function describe intervention more broadly as well.
Assurance refers to the ongoing processes– carrying out policies, etc. The four elements can be seen as key parts of ensuring sustainability.
Final element is in center.
Citation: The Future of the Public's Health in the 21st Century, Institute of Medicine, National Academy Press, 2002
Public Health Approach to Children’s MH

13. Georgetown University National TA Center
The Process (cont’d)
Other models emphasize a process that is focused on intervention
Using data to identify a problem and determinant(s) to address
Developing or selecting evidence- based interventions
Evaluating those interventions
The approach for children’s mental health integrates these models
Jon
Public Health Approach to Children’s MH

14. Georgetown University National TA Center
5 Guiding Principles
Population focus
Emphasis on creating supportive environments and building skills
Balanced focus between children’s mental health problems and positive mental health
Cross-system and cross-sector collaboration
Implementation driven by local context
First, it is critical to take a population focus when it comes to children’s mental health in the United States. This means we need to emphasize the mental health of all children, and it means that data need to be gathered and compiled at large population levels to drive decisions about interventions. By incorporating the population, it should be noted that this not mean abandoning the focus on children who need treatment.
Second, it is critical to place greater emphasis on creating environments that promote and support mental health and a greater emphasis on developing skills that enhance resilience. Environments can be social, such as families, gangs, schools, communities, and cultures, or physical, such as buildings, green space, playgrounds. The environment is the focus of intervention in a public health approach
Next, it is critical to focus on children’s “positive” mental health —increasing our measurement of it and striving to optimize it for every child. Helping each child reach his or her optimal level of health rather than simply reducing symptoms among those who have problems will distinguish this new approach from the past.
Fourth, we recognize that this work cannot be done by just one agency or system. The involvement of many, and often new partners is necessary. To work collaboratively across systems and sectors, from the child mental health care system to the public health system to all the other settings and structures that impact children’s well-being. An effective approach requires a comprehensive and coordinated effort among all of the systems and sectors that impact children and their environments.
Finally, we recognize the need to adapt the themes to fit the different settings and contexts within the United States. Communities uniquely tailor to meet the needs of their members – or local adaptation. Data that are crucial in one community may be less relevant in another, interventions that are effective in one place may be as successful in another, and factors that ensure success for one group may lead to failure for another. This cannot be a one-size-fits-all approach. The entire process must be adapted to fit the needs of each particular population/community.
Public Health Approach to Children’s MH

15. Integrated Values of Children’s Mental Health and Public Health
Georgetown University National TA Center
Integrated Values of Children’s Mental Health and Public Health
Be driven by the fundamental value and dignity of every child
Be child centered, youth guided, and family driven
Be community based/locally adapted
Be culturally and linguistically competent
Be equitable, providing the resources for health for all children
Balance the rights of the individuals with the good of the collective, recognizing that each person’s actions affect other people
Be collaborative, with systems and sectors working together to be optimally effective
Use scientific knowledge to drive decision making whenever possible
Operate with accountability, respect, and integrity.
Public Health Approach to Children’s MH

16. Public Health Processes Adapted for Children’s Mental Health

17. Georgetown University National TA Center
A Conceptual Framework for a Public Health Approach to Children’s Mental Health
The Monograph identifies, discusses, and adapts a number of components necessary for building a conceptual framework to guide a public health approach to children’s mental health. The components are organized into four categories in the framework: values that underlie the entire effort, guiding principles that steer the work, a process that includes the three core public health functions, and a model of intervening that incorporates the range of interventions needed to craft a comprehensive approach to improving the mental health of all children.
Public Health Approach to Children’s MH

18. Examples for the Intervening Model for Children’s Mental Health
Georgetown University National TA Center
Examples for the Intervening Model for Children’s Mental Health
Public Health Approach to Children’s MH