Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth A National Agenda (2019) / Chapter Skim
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11 A Comprehensive, National Approach
11 A Comprehensive, National Approach
Pages 309-342
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From page 309... ...
In this closing chapter, we discuss how this body of knowledge can be leveraged effectively to promote MEB health and prevent MEB problems in children and youth -- to help all young people flourish. We begin with our conclusions about what is needed to substantially improve MEB health in children and adolescents.
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From page 310... ...
Such factors in turn both influence her child's developing brain and affect later learning and development through the dynamic interplay of environment and genes. The increasingly sophisticated picture of the interrelated influences on MEB development that emerges from the research reviewed in this report provides a rich context for research on strategies for promoting MEB health and preventing MEB problems in children and youth, described in Part II of this report.
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From page 311... ...
CONCLUSION 11-1: A productive approach to promoting healthy mental, emotional, and behavioral (MEB) development and preventing MEB disorders would take into account a sophisticated understanding of the influences on development, which encompass both proximal factors, including neurobiological processes, the quality of relationships, parental psychopathology, and the physical environment, and more distal factors at the community and societal levels, such as poverty and racism; opportunities for interventions throughout the course of development, from prior to conception to young adulthood and across generations; evidence about the effectiveness of promotion and prevention strategies that operate at the individual, family, community, and societal levels, with particular attention to the value of coordinating strategies rather than targeting single objectives; and evidence that effective implementation of evidence-based strategies requires identification of the needs to be addressed,
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From page 312... ...
The totality of the evidence shows that broad societal factors both contribute significantly to constellations of risk factors and poor developmental outcomes and limit what can be accomplished with a single program or policy, even if it is very effective. Because many of the greatest threats to young people's healthy MEB development are concentrated in neighborhoods and rural areas of high intergenerational poverty, it follows that a great opportunity to advance the MEB health of America's young people will come from transforming these neighborhoods and rural areas into communities where children can flourish.
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From page 313... ...
The kinds of interventions that can support and promote healthy MEB development are intimately linked to multiple sectors, including education, health, social and human services, and business, and to public health objectives. And as noted above, the risks and challenges associated with economic disadvantage in the United States influence not only growing children's MEB health but also their physical health and development, their academic achievement, and their entry into the world of work.
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From page 314... ...
314 TABLE 11-1 Confluence of National Academies Recommendations Relating to Health and Well-Being and Public Health Monitoring Date Report Conclusions or Recommendations Related to Effects of Coordination of Monitoring Poverty/ Efforts Disadvantage 2009 Adolescent Health Services: Missing Opportunities x x 2010 Accounting for Health and Health Care: x Approaches to Measuring the Sources and Costs of Their Improvement 2011 For the Public's Health: The Role of Measurement x in Action and Accountability 2012 Primary Care and Public Health: Exploring x Integration to Improve Population Health 2014 Capturing Social and Behavioral Domains and x Measures in Electronic Health Records: Phase 2 2014 Implementing Juvenile Justice Reform: The Federal x x Role 2015 Vital Signs: Core Metrics for Health and Health x x Care Progress 2015 Mental Disorders and Disabilities Among Low- x Income Children 2015 Investing in the Health and Well-Being of Young x x Adults
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From page 315... ...
TABLE 11-1 Continued Date Report Conclusions or Recommendations Related to Effects of Coordination of Monitoring Poverty/ Efforts Disadvantage 2016 Advancing the Power of Economic Evidence to x Inform Investments in Children, Youth, and Families 2016 Parenting Matters: Supporting Parents of Children x x Ages 0–8 2016 Ending Discrimination Against People with Mental x x and Substance Use Disorders: The Evidence for Stigma Change 2017 Communities in Action: Pathways to Health Equity x x x 2018 Transforming the Financing of Early Care and x Education 2019 A Roadmap for Reducing Child Poverty x x 2019 The Promise of Adolescence: Realizing x x Opportunity for All Youth 2019 Strengthening the Military Family Readiness x x System for a Changing American Society 2019 Monitoring Educational Equity x x x 2019 Vibrant and Healthy Kids: Aligning Science, x x x Practice, and Policy to Advance Health Equity 315
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From page 316... ...
Screening for risk or concerning behaviors and early intervention address the needs of individuals or groups of children and families; risk mitigation, treatment, and rehabilitation serving individuals and families provide help for those who do not benefit from promotion and prevention efforts. Meaningful improvements in MEB health are within reach if efforts at these levels are supported and sustained, if available resources across sectors are coordinated around carefully defined shared goals, and if concerted attention is paid to the challenges of scaling up promising health promotion and disorder prevention strategies at the universal, selective, and indicated levels.
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From page 317... ...
Federal agencies are in the best position to articulate the reasons why MEB health deserves national attention and the nature of necessary efforts. Federal leadership will be essential if MEB health is to become a true priority, and the relevant federal agencies can also play a leading role in guiding policy, engaging public and private partners, and directing resources to those efforts.
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From page 318... ...
These agencies should articulate specific national goals and objectives in support of healthy MEB development throughout the life cycle, encompassing health promotion and disorder prevention; develop an integrated plan for longitudinal data collection and coordination and analysis of federal surveys, administrative data, and vital statistics that provides a comprehensive approach to measuring and tracking child and adolescent MEB health; and encourage and support the integration and coordination of new and existing efforts to pursue those goals and objectives at the federal, state, and local levels, using coordinating and convening capacities, pooling of resources, funding of outcomes analyses, regulatory options, and other powers and incentives. RECOMMENDATION 2: Relevant federal agencies should use their program creation, regulatory, and other policy capabilities to promote healthy mental, emotional, and behavioral (MEB)
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From page 319... ...
However, there is much on which to build. For example, the National Prevention, Health Promotion and Public Health Council, acting under the direction of the Surgeon General of the United States, articulated a National Prevention Strategy in 2011 (National Prevention Council, 2011)
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From page 320... ...
. 4 Implementation and Scale-Up Progress in successfully scaling up interventions for which research has produced evidence of effectiveness will be essential for improving MEB development among children and youth at the population level.
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From page 321... ...
The focus of this report is research that has emerged in the past 10 years, but we illustrate in Table 11-2 how efforts at the federal level could cascade to the state and local levels, and how public and private efforts could be integrated to serve the overall objectives of a national agenda. We highlight policies for which evidence indicates potential to ameliorate risks to or promote MEB health at a broad scale, but our primary emphasis is the importance of coordinating efforts and integrating available resources.
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From page 322... ...
Chapters 4, 5, and 6, respectively, describe possibilities for supporting MEB health through the public education system, 5 the health care system, and the use of government policies at multiple levels, while Chapter 10 examines why the business community has a growing interest in supporting families and healthy MEB development. Other community organizations also have a vital role to play.
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From page 323... ...
TABLE 11-2 An Integrated Approach to Promoting MEB Health Mechanism Federal/National Level State Level Local/Community Level Public Health Federal entities, including State agencies, including Local government bodies, Approaches/ HHS, CDC, and the Medicaid, public health, and institutions, and agencies: Coordination Departments of Education and education: • Adapt objectives of a national Justice: • Support and amplify public public health campaign to • Establish national priorities health messages meet local needs • Spearhead a public health • Coordinate with federal • Establish structures for campaign at federal, state, and efforts, adapting them to coordination among social local levels optimally address the needs of service agencies, public • Establish structures for their populations schools, health care systems, coordinating across agencies • Establish structures for businesses, and other and governmental levels coordinating and partnering community partners with local entities • Identify lead entities or agencies to provide the resources and personnel needed to drive the coordination effort (e.g., United Way, children's hospitals, major business enterprises) • Support the development of community coalitions 323
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From page 324... ...
324 TABLE 11-2 Continued Mechanism Federal/National Level State Level Local/Community Level Funding and Provide resources for national • Support community • Provide incentives for Other programs and to states and surveillance community planning and Incentives communities to support • Encourage coverage of program implementation, and • Priority attention to the needs promotion and prevention for cross-sector participation of underresourced urban and efforts as core health in program design and rural areas insurance benefits implementation • Building of capacities • Set expectations for effective • Support collaboration to tailor necessary for successful and school-wide programs interventions to the cultural sustainable scale-up designed to enhance social- and physical needs of the • Demonstration projects to emotional learning community determine the effectiveness • Support effective programs, • Adopt funding mechanisms and scalability of such as home visiting, and that can be sustained through interventions tracking of program outcomes changes in political leadership • Research addressing MEB • Adopt funding mechanisms or funding shortfalls health promotion and that can be sustained through mitigation of risks political changes in leadership • Further development of new, or funding shortfalls more effective and scalable interventions • Population-level monitoring of outcomes to support learning about what works and decisions about program priorities
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From page 325... ...
Table 11-2 Continued Mechanism Federal/National Level State Level Local/Community Level Regulation and Provide research-based guidance • Mirror federal MEB health- • Mirror federal and state MEB Policy for local jurisdictions to use in related policies regarding health-related policies setting MEB-related policies health promotion and • Monitor adverse experiences related to prevention of risk, and adapt and childhood trauma at the • Interventions, e.g., prenatal to state needs, preferences, local level care services, two-generation and resources • Make data on needs and (including parenting) • Create model state-wide outcomes of interventions interventions, preschool programs and track outcomes fully transparent to the public interventions, and universal that can be shared with other • Place high priority on screening for MEB states policies that serve under development, including risk resource populations and protective factors • Exposure to risks, e.g., lead and air particulate matter; school suspensions and expulsions; unsafe sex and unintended pregnancies; use of tobacco, alcohol, and other drugs; and traumatic experiences • Coverage of behavioral health by private health insurance and Medicaid 325 • Accreditation, certification, and licensing requirements
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From page 326... ...
TABLE 11-2 Continued 326 for a multidisciplinary, child oriented workforce that promotes healthy MEB development Mechanism Federal/National Level State Level Local/Community Level Private Entity • Collaborate in developing a • Establish funding priorities Local leaders: Contributions common agenda for the that align with national • Identify and engage local advancement of healthy priorities for promoting foundations and other MEB development that MEB health potential funders, such as integrates efforts and • Collaborate with and support business enterprises and resources other state and local-level health systems, to participate • Establish giving priorities public and private funders in in program planning, that align with national pursuing MEB priorities implementation, and priorities for promoting • Identify corporations, health evaluation MEB health care systems, and other Local-level foundations: • Collaborate across national, community partners to • Partner with local authorities state-, and local-level collaborate in promoting to target neighborhoods that constituencies in pursuing MEB-related initiatives at lack resources to address approaches to foster healthy the regional and state levels adverse environments for MEB development healthy MEB development
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From page 327... ...
As discussed in Part III of this report, effective implementation of strategies focused on MEB health requires significantly greater capacity and commitment than generally has been recognized. We have emphasized throughout this report that ad hoc approaches targeting specific problems in isolation have less population impact than integrated approaches that can yield far greater benefits, as well as savings in some areas.
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From page 328... ...
That discussion is oriented to what is needed in a particular implementation effort, but in the context of the national agenda we recommend here, more is possible, and more is needed. Both coordination of existing data sources and the collection of new data will be needed to support meaningful improvements in MEB health.
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From page 329... ...
, yet these efforts do not provide the comprehensive, timely data needed by government entities at all levels if they are to understand the challenges to healthy child and adolescent MEB development and the possibilities for fostering MEB health for all children and youth more effectively. In considering the data collection and monitoring needed to support the national agenda we recommend, we considered the work of other National Academies committees on this topic; Box 11-1 lists objectives for data collection related to developmental health and well-being identified by National Academies committees in the past decade.
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From page 330... ...
Policy makers and the public need information about the status of the nation's young people if they are to fully understand risks to MEB development and possibilities for improving MEB health. To support efforts to promote MEB health, prevent MEB disorders, and address related problems, therefore, regular collection and coordination of data on indicators of mental, social-emotional, and behavioral development and health at the national, state, and local levels is needed.
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From page 331... ...
health and development of children and youth, the factors that influence it, and current efforts to promote MEB health and address MEB problems. Based on the results of this assessment, the agency should develop a plan for coordinating existing data and initiating additional data collection efforts to build the capacity to track the status of young people's MEB development at intervals over the developmental course, including both indicators of disorder and evidence of cognitive development, social emotional growth, and flourishing in life activities; children's exposure to risks for unhealthy MEB development at the family, community, and societal levels, including adverse experiences at home, such as the presence of a seriously
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From page 332... ...
standardized indicators of positive MEB development and health, and efforts to improve MEB outcomes; collect indicator data universally at the local level and aggregate these data to the community, state, regional, and national levels; share data across all levels, encompassing both locale-specific data documenting community efforts, including those of the public education system, and national and state data, for use in formulating policy; coordinate existing data collection efforts, including community monitoring systems and public health systems for surveillance and screening, at all levels; and support regular reporting and analysis of results to identify progress toward improvement goals. A nonpartisan, nonprofit organization akin to the National Bureau of Economic Research, which played a key role in the development of economic indicators for the nation during the Great Depression in the 1930s, or an entity within the federal government could take the lead in coordinating the collection of relevant data, which could also serve other policy objectives related to children, youth, and families.
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From page 333... ...
Research Priorities Federal support for research relevant to MEB health has tended to focus on treatment and prevention of specific disorders at the expense of investigations of the social and environmental determinants of health and well-being and efforts to promote MEB health population wide (Murray et al., 2015)
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From page 334... ...
Promising research targets include mechanisms to support social-emotional learning, including mindful awareness approaches; rigorous trials of school-based interventions for children and youth at all levels, from preschool to higher education, to better shape these interventions and document the size and duration of their effects, as well as how they affect social, cognitive, and emotional learning; identification of the core elements of and amount of exposure to social emotional learning programs needed to promote sustainable growth in
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From page 335... ...
Promising research targets include population wide trends and variation in MEB health outcomes by subgroups, particularly for underresourced communities and those at highest risk, and community partnerships intended to implement
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From page 336... ...
Promising research targets include identification of core intervention elements and mechanisms of effects to promote intervention fidelity and adaptation in scale-up; evaluation of digital tools that counteract "drift" and can be implemented widely as tested in outcome studies; infrastructure required to ensure the success and sustainability of interventions, with emphasis on strategies for workforce development; design of quality implementation and improvement plans for intervention scale-up; decision making about potential trade-offs, such as intervention effectiveness versus reach to achieve population-level management; strategies for scaling programs across diverse settings and delivering them effectively, including use of digital technology and tiered intervention structures; benefit/cost relationships when interventions are brought to scale; identification of incentives that drive favorable implementation outcomes among organizations and systems; strategies for blending funding from diverse federal agencies to support implementation at the population level; projects that feature cross-sectional expertise and resources to reach all children in need; and projects that address the development and use of population-level data systems to identify needs and track outcomes of interventions/projects.
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From page 337... ...
A number of well-established methods beyond randomized controlled trials are promising for the study of influences on MEB health and development and the implementation of interventions, including pragmatic (real-world) clinical trials, comparative effectiveness trials, hybrid designs that blend components of efficacy and effectiveness trials, trials targeting health policy outcomes, carefully structured pre–post observations, interrupted time series designs, quality improvement research, and
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From page 338... ...
Such administrative data are collected at the local, state, and national levels, such as by social service agencies, school districts, health care systems, and the like (e.g., the census, tax records, juvenile justice records) , and can be linked to answer questions about how interventions for promoting MEB health may influence such outcomes as school attendance, arrest rates, and emergency room visits.
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From page 339... ...
ASPIRATIONS FOR A DECADE OF CHILDREN AND YOUTH We close with an overview of what would be different from today at the end of a Decade of Children and Youth in which supporting healthy MEB development and working to ensure that every child and adolescent had the opportunity to meet her potential was a national priority: Scientists, educators, business leaders, health care systems, human services agencies, and policy makers together would have recognized the critical importance of measuring and tracking the MEB health and development of young people, and of responding to identified needs at the federal, state, and local levels through the allocation of necessary resources. Local, state, and national public health campaigns would have raised broad awareness of the need for improved MEB outcomes for children and youth and the social and economic gains that result.
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From page 340... ...
Information about genetic and environmental susceptibility to adverse MEB outcomes would have been used in the development of effective interventions and the monitoring of outcomes for individual children, as well as populations of children. The Decade of Children and Youth campaign would have resulted in identifiable and continuous improvement of the MEB development and health of young people; recognition of the family, community, and societal advantages of these efforts; and a national resolve to continue investments in a better future as the United States became a world leader in child wellness advocacy.
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From page 341... ...
doi:10.17226/25246. National Prevention Council.
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From page 342... ...
. Getting off the "gold standard": Randomized controlled trials and education research.
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