Second in a series of blogs by Policy Analyst Tamara Keeney for Mental Health Month.
Equity in behavioral health will only be achieved by addressing underlying disparities.
This was my top takeaway from three days in Tampa learning about everything from the root cause of behavioral health disparities to early intervention in psychosis for children.
My colleagues were braving the unpredictable weather of March in Colorado, but I had packed up my bathing suit and business cards to attend the conference. The 29th Annual Research and Policy Conference on Child, Adolescent and Young Adult Behavioral Health conference, hosted by the University of South Florida College of Behavioral and Community Sciences, brought together hundreds of researchers, policymakers and advocates.
I attended the conference to build my expertise in behavioral health and specifically, in childhood mental health. The topic has been getting much attention as more research points to early childhood as the critical time for prevention and early intervention. My degree in behavioral neuroscience gave me a solid background in the scientific research and now, in my role as CHI’s behavioral health expert, I get to study how this research is being put into action through policy and programming.
Here are my top learnings.
The opening plenary by Brian Smedley of the National Collaborative for Health Equity addressed the root causes of behavioral health disparities in terms of place, race and disease. Smedley focused much of his talk on the isolating the effects of concentrated poverty and residential segregation for communities of color. Kids growing up in these neighborhoods often struggle with the lasting effects of the isolation and restricted socioeconomic opportunity.
Smedley acknowledged that these root causes of behavioral health disparities can feel overwhelming, especially for legislators who might feel “disempowered” because the issues of poverty and housing may feel beyond their scope. However, Smedley believes that a combination of both place-based investments and people-based strategies — like investing in early childhood education and increasing housing mobility options — can have a sizable impact.
My first breakout session of the conference also fell under the umbrella of equity. “Early Childhood Development and Behavioral Health Systems: Strategies for Enhancing Equity and Justice for Children and Families” featured Joan Lombardi of the Buffet Early Childhood Fund and Michael Wald from Stanford University. Both spoke of the complex factors at play in the behavioral health system.
As someone who is relatively new to the field, I appreciated Lombardi’s look back on the beginning of programs like Head Start and look ahead at the potential of efforts such as mental health consultation. Wald took a more pessimistic view by showing some of the startling data on outcomes for young children in poverty. He stressed the importance of building programs into existing systems. His ideas for working toward equity in childhood behavioral health included a children’s allowance, guaranteed income and skills development for caretakers.
Another takeaway: A trauma-informed system of care is essential for advancing the well-being of children.
During my three-day trip, there were three words I heard more than any others: trauma-informed care.
According to SAMHSA (the Substance Abuse and Mental Health Services Administration), a trauma-informed approach to care is one that: realizes the widespread impact of trauma and understands the potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff and others involved in the system; responds by fully integrating knowledge about trauma into policies, procedures and practices; and seeks to actively resist re-traumatization.
Trauma-informed care found its way into almost every session I attended, including the second day plenary. The speaker was Dr. Donald Warne, chair of the Department of Public Health at North Dakota State University and an incredibly powerful speaker. He discussed the historical trauma experienced by American Indians and the subsequent challenges faced by those who live on reservations. The topic was compelling on its own, but the delivery of his ideas through images of American Indian life on the plains and storytelling was exquisite.
Theresa Barila of the Walla Walla County Community Network delivered another powerful session focused on trauma and the concept of resistance. Barila’s Children’s Resilience Initiative in Washington state aims to bring more public awareness to the impact of the Adverse Childhood Experiences (ACEs). The Walla Walla community, through the work of Barila, has embraced the concepts of resilience building and positive supports to buffer the negative effects of the ACEs.
My final takeaway: We still have work to do, but there has been great progress.
Throughout the conference, I was reminded of both the immense work left to do in childhood and adolescent behavioral health and the progress that has been made.
Stark disparities exist among children of different incomes and ethnicities. Pediatric providers are screening for depression among adolescents at rates much lower than expected. And many parents of children with behavioral health challenges can’t get the help they need.
But mixed in with these challenging statistics, there were stories of hope. This hope felt strong when Tamara Sale from the Early Assessment and Support Alliance (EASA) Center of Excellence in Oregon brought two youth leaders from the EASA Young Adult Leadership Council to share their experiences with psychosis and the opportunities they now have through the Council.
The Leadership Council provides an opportunity for youth with lived experience to advocate for early intervention programs like EASA, which provides information and support to people experiencing symptoms of psychosis for the first time. EASA as a whole has been able to help over 2,000 people maintain a vocational path, reduce hospitalizations and engage with their families.
At the end of the session, the presenters led the entire audience in reading a poem written by an EASA Young Adult leader. I’ll leave you with the last four lines, which best sum up how I felt leaving Tampa after three days immersed in the policies and people working to improve childhood behavioral health:
“Together we have a long journey
Together we have no fear
Together we succeed
Together we create a revolution of hope.”