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

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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)

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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

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Setting the Scene for the New Framework

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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?

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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.

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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.

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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.

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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.

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Key Components of a Public Health Approach

• Population Focus• Promotion and Prevention• Determinants• Process

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Public Health Approach: Process

• Three core functions• Ten essential elements

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The New Framework

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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

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Special Focus on Intervening

EnsuringAssessing

Intervening

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Intervention Framework for Health

Preventing

Problems

P

romotin

g

H

ealth

Treatin

g

Problems

Reclaiming

HealthFocus on Positive Health

Focus on Health Problem

No Focus on an Identified Problem Identified Problem

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Integrating Language in New Intervention Framework

   No identified health problem Focus on an identified health problem

Focus on (and Measurement 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 Measurement 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

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A conversation with Sandra Spencer         Executive Director

Federation of Families for Children's Mental Health

                    Interviewed by Joyce Sebian

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Reference Slides

Visit the Georgetown Website to download an enhanced slide show

July 19th TA Conference Call

http://gucchd.georgetown.edu/programs/ta_center/tacalls2008.html

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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.

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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

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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 2001. http://www.gov.nl.ca/publicat/MentalHealthPolicyPaper.pdf Downloaded April 9, 2007

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IOM Report Fan

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

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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.