Meeting the mental health needs of children and youth through integrated care: A systems and policy perspective.

The health home program established under the Affordable Care Act (2010) is derived from the medical home concept originated by the American Academy of Pediatrics in 1968 to provide a care delivery model for children with special health care needs. As applied to behavioral health, health homes or medical homes have become increasingly adult-focused models, with a primary goal of coordinating physical and behavioral health care. For children and youth with serious emotional disorders, health homes must go beyond physical and behavioral health care to connect with other child-focused sectors, such as education, child welfare, and juvenile justice.

Use of Mental Health Services by Children Ages Six to 11 With Emotional or Behavioral Difficulties.

Objective: The authors reported use of mental health services among children in the United States between ages six and 11 who were described by their parents as having emotional or behavioral difficulties (EBDs).

Methods: Using data from the 2010-2012 National Health Interview Survey, the authors estimated the national percentage of children ages six to 11 with serious or minor EBDs (N=2,500) who received treatment for their difficulties, including only mental health services other than medication (psychosocial services), only medication, both psychosocial services and medication, and neither type of service. They calculated the percentage of children who received school-based and non-school-based psychosocial services in 2011-2012 and who had unmet need for psychosocial services in 2010-2012.

The need and opportunity to expand substance use disorder treatment in school-based settings.

In this paper, we explore the unmet need for substance use disorder (SUD) treatment among youth, its consequences, and the opportunity to address this gap due to the expansion of behavioral health services to school-based settings under the Parity and Affordable Care Acts. We discuss the importance of using evidence-based approaches to assessment and treatment to ensure effectiveness and cost-effectiveness and show how the severity of SUD is related to a wide range of school, substance, mental, health, and health care utilization problems. Next, we introduce the other three articles in the special issue that further demonstrate the feasibility and impact of using these evidence-based practices in school-based settings, the challenges of identifying and interviewing with youth, and the need for a full continuum of interventions.

Mental health surveillance among children--United States, 2005-2011.

Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999).

Mental health disparities.

Mental health disparities have received increased attention in the literature in recent years. After considering 165 different health disparity conditions, the Federal Collaborative for Health Disparities Research chose mental health disparity as one of four topics warranting its immediate national research attention. In this essay, we describe the challenges and opportunities encountered in developing a research agenda to address mental health disparities in the United States.

The influence of race and ethnicity on psychiatric diagnoses and clinical characteristics of children and adolescents in children's services.

This study examined the influence of race and ethnicity on psychiatric diagnoses and clinical characteristics of 1,189 children and adolescents participating in the federally funded Comprehensive Community Mental Health Services for Children and Their Families Program. Results showed that after controlling for age, gender, functional impairment, and socioeconomic status, there were significant race and ethnicity effects on diagnosis and clinical characteristics. Black and Native Hawaiian youth were more likely than White youth to be diagnosed with disruptive behavioral disorders.

Co-occurring disorders of adolescents in primary care: closing the gaps.

The increasing prevalence of co-occurring mental health and substance use disorders in adolescents is a serious challenge for the primary care system. The needs of these youth continue to be underrecognized, poorly diagnosed, and inappropriately treated in primary care settings, which are often the first point of contact with the health provider system. This article highlights the need for changes at the clinical, organizational, and policy levels to create a system of care that can effectively identify, refer, treat, and coordinate the care for these adolescents and their families.

Adolescents with co-occurring mental health and substance use disorders in primary care.

Co-occurring mental and substance use disorders (COD) among children and adolescents present special challenges for family members and primary care clinicians. A broad understanding of prevalence rates, etiology, risk and protective factors, and intervention strategies is important in promoting evidence-based practices. The authors present a synopsis of important issues in this area and provide support for integrating behavioral health into primary care practice.