Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth A National Agenda (2019) / Chapter Skim
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Therefore, investment in the healthy MEB development of the next generation promises not only benefits for individuals, families, and communities, but economic benefits as well. To address the critical gap between achievable goals for both promoting MEB health and reducing the prevalence of MEB disorders, and actual progress 1
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, together with the Centers for Disease Control and Prevention and the National Institutes of Health, asked the National Academies of Sciences, Engineering, and Medicine to convene an ad hoc committee to assess progress and make recommendations for fostering MEB health in the coming decade. The Committee on Fostering Healthy Mental, Emotional, and Behavioral Development Among Children and Youth -- whose members have expertise in behavioral research, child development, child and adolescent psychiatry, education, epidemiology, evaluation research, health care services, implementation science, neuroscience, pediatrics, prevention research, program development, public health, and public policy -- was asked to synthesize scientific advances achieved in this area in the past decade and recommend ways in which public and private agencies and organizations can lead efforts to apply this body of knowledge.
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It describes recent progress in understanding what is necessary to implement effective strategies -- those for which there is evidence of benefit from multiple trials -- at large scales. It also offers our recommendations regarding a national agenda for fostering healthy MEB development among children and youth, and outlines research needed to address remaining gaps in the understanding of MEB development and how it can be strengthened.
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Examples are programs to teach children in preschool and grades K–12 social and emotional skills, including mindful awareness practices; to promote a positive school environment; to promote access to services for low-resourced populations and communities; and to help young people develop resilience to manage multiple health risks, such as bullying, substance use, and suicidal thoughts. Use of primary health care settings to promote healthy MEB development for children and prevent risks for MEB disorders.
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; a well-trained community workforce that is provided with ongoing professional development opportunities; active leadership within organizations responsible for delivering the intervention; the development of strong community coalitions that can muster sustained support for the intervention and provide community-level leadership; a system for monitoring the quality and outcomes of implementation efforts, barriers to successful implementation, trends in risk and protective factors and other influences on MEB development, and other relevant data; learning through evaluation, including which interventions work for whom, and sharing what is learned among networked programs; and multiple methods of communication to publicize and share the intervention objectives with stakeholders and the community at large. A COMPREHENSIVE NATIONAL AGENDA FOR PROMOTING MEB HEALTH From the body of work summarized above, it is clear that achieving meaningful improvements in MEB development and health will require a
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development a national priority, such as by designating a Decade of Children and Youth. 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
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development and mitigate risks to MEB health by, for example, developing and disseminating guidance for use by states and local jurisdictions in delivering effective promotion and prevention interventions -- including preconception, prenatal, and postnatal care services; two-generation (including parent MEB health and parenting) interventions; preschool and school interventions; and universal screening for risk and protective factors -- and in ensuring access to affordable treatment for parents and children to reduce risk; developing both guidance and targeted accountability measures for use by states and local jurisdictions to identify effective ways of reducing the exposure of children and families to risks -- such as lead and air particulate matter; ineffective and inequitable disciplinary practices; unsafe sex and unintended pregnancies; use of tobacco, alcohol, and other drugs; traumatic experiences; and negative living conditions, including exposure to violence, unstable housing, food insufficiency, and underemployment -- that can contribute to unhealthy MEB development; promoting coverage of behavioral health services for children and caregivers, especially those needed during pregnancy and the postpartum period and those offered by parenting programs, in reimbursement for private health insurance and Medicaid, encompassing both behavioral health promotion and risk prevention; setting expectations for the adoption and evaluation of programs known to enhance social and emotional development in schools, in health care settings, and in communities; supporting consistent polices on accreditation, certification, and licensing requirements for a multidisciplinary workforce oriented toward healthy MEB development in children and youth; and supporting and collaborating with local and state initiatives that contribute to healthy MEB development.
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interventions for delivery to large populations by providing funding and other resources to, for example, support research and demonstration projects to determine the effectiveness of promising interventions for MEB health promotion, prevention of MEB disorders, and population screening at large scales, including the implementation of effective in-person and digital interventions; support states and local jurisdictions in developing cross-sector partnerships among schools, employers, the health care system, community-based organizations, and others to advance the scale-up of effective promotion and prevention inter ventions; support states and local jurisdictions in developing innovative funding mechanisms that can be sustained through changes in political leadership or funding shortfalls; use economic evaluation tools and other methods to analyze factors, such as costs and availability of funding, benefit/cost ratio, level of complexity, and need for supportive infra structure; and document needs and develop strategies for sustainability over time. Monitoring to Support Needs Assessment, Scale-Up, Program Improvement, and Outcomes Research The collection of information about quality and outcomes is vital to the continuous improvement that fuels the effective implementation of interventions that can benefit large populations.
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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 depressed parent, or at school, or influences promoting concerning behaviors, such as the consumption of unhealthful food, the use of nicotine-delivery products and such substances as alcohol and marijuana, and exposure to entertainment media that promote social exclusion, violence, or prejudice; access by children, youth, and families to effective health promotion and protective interventions, including pre conception and prenatal health care for parents and care for children and youth from infancy through young adulthood; and effective programs and policies, including how many such efforts are under way, what interventions are being implemented, how many people they are reaching, who
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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. As the committee developed our primary conclusions and recommendations, we were struck by their similarity to those of numerous other committees of the National Academies that had addressed related issues in the past decade.
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Research on health promotion and risk prevention and their impact on the incidence and prevalence of MEB disorders, as well as further advances in the science of program implementation, will provide critical opportunities for ongoing progress in fostering MEB health. The first priority is to continue building on the growing body of work about ways to promote healthy MEB development at the population level.
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12 FOSTERING HEALTHY MEB DEVELOPMENT IN CHILDREN youth in reaching adulthood with the social and emotional skills and assets they need to thrive. This report lays out a set of actions -- both policy drivers and research priorities -- that, if embraced, can help the nation create this future.
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