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Sandy's Perspective on Improving Children's Mental Health through the Science and Practice o

We have a children’s mental health crisis in this country, and we need all of psychology to help address it. The fact that we have watched daily as families have routinely been separated at our southern border reflects a major gap between psychology’s scientifically-based understanding of child adjustment and the development of effective, culturally-responsive public policy.

Question 1. What do you see as the most pressing issues affecting children’s mental health?

From my perspective, access and advocacy are two very pressing issues affecting children’s mental health. First, there is a pressing need for access to quality, culturally-responsive mental health services for all children. In general, finding child-trained psychologists is often challenging. For those children in need of hospitalization, there is often a shortage of beds. As a result, many children do not receive the level and quality care they need. Our current financial models for healthcare have discouraged prevention for child populations. We know this is a confounded problem for marginalized populations. The current immigration crisis on our southern US border is a daily painful reminder of mental health needs for children in our ethnic minority communities and the limited understanding of the intensity of these needs by policymakers.

In terms of stimulus access, children today are living in a world where they are exposed to many exciting events and modalities. They are growing up in a technology-accelerated age, where stresses and pressures are coming at them all the time. They clearly have more virtual communication but likely less face-to-face connection. This can have an impact on how they form and define relationships and how they feel about themselves in comparison to others. The virtual (e.g., social media) spaces seem to allow for more ongoing comparisons to others, bullying that seems inescapable, and less direct positive relational engagement. It is thus a concern that many children and adolescents are feeling increasingly more pressured and stressed and are, endorsing increased signs of depression, anxiety, and self-harm.

Parents of children with mental health problems are totally isolated. There are too few systems and too few providers that can accommodate working parents. We need to develop ways for people to access all that psychology has to offer so that parents and the institutions that support families are invested in accurate diagnosis and effective treatment. Too often, we are failing to provide families, schools, and communities access to treatments that work to improve child adjustment.

In terms of advocacy, there is great need for children’s mental health to remain a major focus for providing and accessing mental health care. If psychological science was informing policy effectively, we would have policies in place that were more financially responsible and avoided harm to children, whether at the border or in our cities and communities. This is especially true in light of the rapidly changing health care system and policies, where children’s mental health can easily be obscured as a priority. We have sound science in psychology on how to address anxiety and how to build up positive relationships between parents and children. Division 53, child clinical psychology, brings an important voice and science to policy issue development and advocacy within APA. The voice of child clinical psychology needs to be enhanced. Child clinical and adolescent psychology has the tools for coping with behavioral, physical, social, and cognitive developmental delay, but our expertise is under- recognized.

Finally, the current and ongoing immigration crisis involving children being separated from their parents presents both an extraordinary obligation and opportunity to inform the public about child and adolescent psychological needs and issues. There is no better time for psychology, especially child clinical psychology, to use its scientific foundation and treatment voice to contribute to the welfare of all children and adolescents.

Question 2. How can APA increase children’s access to evidence-based practice in mental health care practice?

First, APA can advocate for an increase in the number of child-trained and family-trained psychologists in mental health settings. Not enough psychologists are receiving the necessary training to deal with the level of children’s mental health needs across many communities. Further, children’s mental health represents a great example of an area that could benefit tremendously from stronger collaboration at the APA level across divisions and directorates. A collaborative advocacy approach at the APA level could leverage impact on issues such as access to services for underserved children’s populations. We could push out resources and information much more effectively and widely, providing more resources for both practitioners and parents/kids/families. We could also provide more depth, breadth and visibility to policy concerns related to immigration and children’s mental health. We need to be able to bring our expertise to systems and to advance expert treatment in innovative models that broaden the reach of psychology via other professionals such as master’s prepared clinicians.

Second, APA can advocate for culturally-responsive adaptations of EBP’s. We must take a significant role in using our science to establish psychology as a meaningful part of interprofessional, evidence-based healthcare. We must also be diverse and inclusive scientifically if we want EBP’s to be valid and maximally helpful and effective for the public.

Question 3. How can APA advance the science and training of clinical child and adolescent psychologists?

APA can encourage the inclusion of a greater amount of child and adolescent coursework across professional training programs. This should include an emphasis on culturally-responsive treatment for a range of underserved populations. Diversity training should include working with multiracial families and children. We also need to be able to both collaborate with and distinguish our expertise and services offerings from other providers of children’s services in school and community settings, both at the doctoral and masters levels. Clinical child psychologists are experts in applied development science, and the training matters.

Further, APA could support an increase in the number of accredited internships and postdoc opportunities for child and adolescent specialties. Such internships and postdocs could provide great resources to meet the increasing needs of child and adolescent populations, especially for those who are currently underserved.

Perhaps APA could put more emphasis on provision of CE opportunities for practitioners to learn about EBPs and culturally-responsive approaches to working with children. This could be encouraged through a variety of formats ranging from in-person workshops at Conventions to remotely accessible webinar series.

Question 4. How can APA promote the science of clinical child and adolescent psychology?

APA can support, encourage and advocate for research with policy makers and funders about all aspects of child and adolescent mental health. The development of clinical guidelines tends to emphasize adult patient/client populations and needs to put more emphasis on children and adolescents. For example, the recent PTSD Guidelines did not contain much about children. While the Obesity Guidelines did address children, there was limited research to address the relevant issues. Encouraging research and emphasizing coverage of children and adolescents in clinical guideline development can mutually support an increase in child and adolescent mental health research.

APA needs to continue to make children, youth and families a priority in its advocacy portfolio. With the new integrated approach to advocacy, applying more resources across the directorates, teamed in collaboration with several APA divisions, could leverage our advocacy impact. The recent focus on children’s separation from parents in the US immigration process presents a platform to promote research on the mental health of children and adolescents from a variety of underserved populations.

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