# data[].attributes.attachment_link.readable_text
Teen Line's latest outreach joins Cedars-Sinai's Share & Care program in providing much-needed bilingual outlets for high-risk teens to relieve anxiety, depression and stress before symptoms become severe.

Share & Care uses art therapy and professional counseling to promote self-esteem and self-expression. Based out of Los Angeles Unified School District schools, some in Latinx communities, the program teaches coping skills for managing emotions, stress and grief.

If you wait too long to intervene when teens are struggling, their risk for serious outcomes such as suicide goes up, experts explain.

"If they're depressed or totally anxious, it doesn't mean they're going to be depressed and anxious their entire life," she says. "It could be a month or a week, but for them, that's forever. That's where the danger comes."

More options for opening up-whether through talk, text, email or art-can ensure teens don't feel alone and get the support and care they need.

"If we can get to kids early on-when they're first struggling-we can turn it around," Suzanne says. "We can give them another, more positive way to think about what they're experiencing, and we can make a difference."

# data[].attributes.attachment_link.title
Expanding Mental Health Resources Among Latinx Youth

# data[].attributes.attachment_link.description
As mental health needs rise among teens, the Latinx community continues to face treatment disparities. A new Teen Line pilot program in East Los Angeles is trying to stand in the gap and build inroads among Latinx youth through peer mental health support.

# data[].attributes.attachment_link.title
7 Must-Know Facts about the Latino Youth Mental Crisis - Salud America

# data[].attributes.attachment_link.description
Youth are facing a mental health crisis that is so widespread that U.S. Surgeon General Dr. Vivek H. Murthy has issued a new advisory calling it an “urgent public health issue.” That is especially true for Latino youth. But why? Let’s explore the mental health challenges impacting Latino youth, and…

# data[].attributes.attachment_link.title
The Kids Are Not Alright: The Mental Health Crisis Affecting Latina Teens

# data[].attributes.attachment_link.readable_text
Editor's Note: This is the third story in a year-long mental health series in a partnership between Seacoast Media Group, the New Hampshire Union Leader and Dartmouth Health.

Before she gets out of bed in the morning, Ani Brooks reaches for her iPhone.

"Heads Up: A Year-Long Mental Health Awareness Journey" is financially supported in part by Dartmouth Health.

# data[].attributes.attachment_link.authors[].name
Howard Altschiller Portsmouth Herald | USA Today Network

# data[].attributes.attachment_link.title
Teens tell their truth about social media and mental health: 'I always have my phone'

# data[].attributes.attachment_link.description
Editor's Note: This is the third story in a year-long mental health series in a partnership between Seacoast Media Group, the New Hampshire Union Leader and Dartmouth Health. Before she gets out of bed in the morning, Ani Brooks reaches for her iPhone.

# data[].attributes.attachment_link.readable_text
Commentary Calls for a Reallocation of Health Care Spending by Hospitals

In a commentary in the Journal of the American Medical Association, Donald Berwick, M.D., M.P.P., former administrator of the Centers for Medicare and Medicaid Services (CMS) and president emeritus of the Institute for Healthcare Improvement, calls on hospitals and health systems to make greater investments in the social determinants of health. He suggests they establish "Ten Teams," each focused on one of 10 social influences on health: health insurance coverage, food insecurity, housing security, immigrant needs, the criminal justice system, climate and decarbonization, voting rights, education supports, early childhood supports, and loneliness among the elderly. As a starting point, he recommends hospitals and health systems allocate at least 2 percent of their budget for this work and tie executive compensation to the success of these efforts. Donald Berwick, " Getting Serious About Producing Health: The Ten Teams Challenge," Journal of the American Medical Association 327, no. 19 (May 2022):1865-6.

Telemedicine Use by Medicare Beneficiaries During the Pandemic Highest Among Those in Disadvantaged Neighborhoods

Researchers found nearly one of 10 Medicare beneficiaries in the fee-for-service program had at least one outpatient telemedicine visit after CMS expanded coverage of telemedicine using a waiver. Before the waiver was issued in March 2020, just 0.42 percent of patients had at least one telemedicine visit. Notably, the study found people residing in the most disadvantaged neighborhoods, as measured by the Area Deprivation Index, were more likely to use telemedicine after the waiver, though the odds of use were persistently lower with increasing age. The authors suggest targeted interventions may be needed to further expand telemedicine access. Sanuja Bost et al., " Medicare Beneficiaries in Disadvantaged Neighborhoods Increased Telemedicine Use During the COVID-19 Pandemic," Health Affairs 41, no. 5 (May 2022):635-42.

New General Internists Locate in States That Expanded Medicaid

Researchers found that new general internists were more likely to locate in states that expanded access to Medicaid after the passage of the Affordable Care Act. They estimate that between 2014 and 2019, nonexpansion states lost 371 new general internists to expansion states. Nearly two-thirds (62.5%) were lost from areas of high social disadvantage, even though these areas account for just 17.9 percent of the population in nonexpansion states. Areas of high social disadvantage were disproportionately small towns and rural areas. Jose Escarce et al., " The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists," Medical Care 60, no. 5 (May 2022):342-50.

In Massachusetts, High-Frequency Hospital Users Accounted for Nearly 70 Percent of Hospital Readmissions

A study of Medicaid beneficiaries in Massachusetts found a small group of high-frequency hospital users had a disproportionate effect on 30-day readmission rates. Among adult MassHealth members with at least one acute hospitalization, 8.7 percent had four or more hospitalizations in a year. These high-frequency hospital users contributed 30.2 percent of hospitalizations and 69.4 percent of readmissions. High-frequency hospital users were more often male and were sicker than others. They also had more social risks: 33.1 percent had housing problems, 44.1 percent were disabled, 83.2 percent had serious mental illness, and 77.1 percent had a substance use disorder. Half (50.7%) of all hospitalizations for high-frequency users led to a readmission within 30 days, affecting the performance of Medicaid accountable care organizations and safety-net hospitals. Hassan Fouayzi and Arlene S. Ash, " High-Frequency Hospital Users: The Tail That Wags the Readmissions Dog," Health Services Research 57, no. 3 (June 2022):579-86.

Nonemergency Medical Transportation Increases Outpatient Visits and Spending

A study of a nonemergency medical transportation benefit offered to Medicare beneficiaries participating in the UNC Health Alliance accountable care organization found the benefit increased outpatient visits (9.2 per person per year) and raised outpatient spending (by $4,420) relative to a comparison group. The researchers found there was no difference in inpatient admissions or emergency department visits and the program was not cost saving. However, qualitative analyses found the participants were highly satisfied with the program, reporting it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health. Seth A. Berkowitz et al., " Evaluating a Nonemergency Medical Transportation Benefit for Accountable Care Organization Members," Health Affairs 41, no. 3 (March 2022):406-13.

American Indian and Alaska Native Veterans at Elevated Risk of Suicide

Researchers found age-adjusted suicide rates among American Indian and Alaska Native veterans more than doubled to 47 per 100,000 person-years over a 15-year observation period ending in 2018. The youngest age group (18-39) exhibited the highest suicide rate (66.0/100,000 person-years). The most frequently used lethal means was firearms (58.8%), followed by suffocation (19.3%) and poisoning (17.2%). Nathaniel Mohatt et al., " Suicide Among American Indian and Alaska Native Veterans Who Use Veterans Health Administration Care: 2004-2018," Medical Care 60, no. 4 (April 2022):275-78.

Medicaid Expansion Has Little Effect on the Closure of Obstetric Services

A study assessing the relationship between Medicaid expansion and obstetric service closures found rural obstetric units were less likely to close immediately after expansion but this effect faded within two years. The researchers also found that although expansion led to a large reduction in hospital closures, the effect was concentrated among hospitals that did not have obstetric units. They say policies supporting access to obstetric care may need to directly address the financial challenges specific to this service line. Caitlin Carroll et al., " Association Between Medicaid Expansion and Closure of Hospital-Based Obstetric Services," Health Affairs 41, no. 4 (April 2022):531-9.

Using Hospitalists to Close Gaps in Treatment for Substance Use Disorder

A 650-bed hospital in Aurora, Colo., trained 11 hospitalists to provide addiction consults to hospitalized patients. After obtaining waivers to prescribe buprenorphine and completing a minimum of 40 hours of online addiction training, as well as shadowing addiction-trained physicians, the hospitalists completed 1,650 consultations on 1,350 unique patients between October 2019 to November 2020. Alcohol use was most common (79%), followed by tobacco (60.4%), methamphetamines/amphetamines (30.5%), and opioids (24.7%). Frequently reported discharge diagnoses were trauma (96.5%), alcohol-related liver disease (33.1%), and cellulitis/abscess (20.6%). Leaving prior to treatment completion was also commonly noted (7.4%). The authors say more research is needed to understand challenges to spreading this model and to evaluate its intended and unintended effects. Susan L. Calcaterra et al., " The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap," Journal of General Internal Medicine 37, no. 5 (April 2022):1065-72.

Promoting Digital Inclusion to Advance Health Equity

A commentary from Jorge A. Rodriguez, M.D., Carmel Shachar, J.D., M.P.H., and David W. Bates, M.D., in the New England Journal of Medicine recommends that health care organizations support the effective and equitable implementation of the recently enacted Infrastructure Investment and Jobs Act. The Act earmarks $42.5 billion for investment in broadband infrastructure and promotes affordability by providing $30 monthly subsidies to help underserved people pay for internet access. Among other strategies, health care organizations can help identify broadband coverage gaps, ensure digital health tools adapt to potential bandwidth limitations, and perform targeted outreach to patients who could benefit from broadband and device subsidy programs. Jorge Rodriguez, " Digital Inclusion as Health Care - Supporting Health Care Equity with Digital-Infrastructure Initiatives," New England Journal of Medicine 386, no. 12:1101-3.

Improving Surveillance of Child and Adolescent Mental Health Disorders

In a commentary in Pediatrics, Ruth Shim, M.D., M.P.H., Moira Szilagyi, M.D., Ph.D., and James M. Perrin, M.D., suggest several ways of improving how the nation assesses the prevalence of child and adolescent mental health conditions. Among their suggestions: better tracking the antecedents of mental health disorders, including adverse childhood experiences and social stressors such as housing and food instability, poverty, community violence, and discrimination. They also advocate for a public health surveillance infrastructure that tracks resilience and mental wellbeing, including cultural practices and traditions that protect Black and Indigenous children from the effects of toxic stress. Ruth Shim, Moira Szilagyi, and James M. Perrin, " Epidemic Rates of Child and Adolescent Mental Health Disorders Require an Urgent Response," Pediatrics 149, no. 5 (May 2022):e2022056611.

Addressing Health Disparities Through State Policies

In a commentary in the Journal of the American Medical Association, Steven H. Woolf, M.D., M.P.H., of Virginia Commonwealth University School of Medicine, points to widening gaps in health disparities by state that cannot be explained by changes in their racial and ethnic composition. Woolf says the growing polarization of public policies may be a cause, as states take different approaches to Medicaid expansion, workplace and product safety, tobacco control, food labelling, gun ownership, and COVID-19 vaccination. He recommends that medical and public health professionals shift their focus to state capitols and be vigilant about policies that threaten health and safety or deepen inequities. Steven H. Woolf, " The Growing Influence of State Governments on Population Health in the United States," Journal of the American Medical Association 327, no. 14 (April 2022):1331-2.

Medicare Advantage Beneficiaries with Chronic Conditions Sensitive to Copay Cost

A study examining whether Medicare Advantage beneficiaries with chronic conditions were sensitive to the price of provider visits found individuals did respond to changes in copayments, but the response was small. The researchers found reductions in copayments for primary care providers led to reduced use of some specialists, particularly for cardiology and endocrinology, suggesting this could be an effective way to reduce unnecessary use of specialists. Christine Buttorff et al., " Do Financial Incentives Affect Utilization for Chronically Ill Medicare Beneficiaries?" Medical Care 60, no. 4 (April 2022):302-10.

# data[].attributes.attachment_link.title
Filling Gaps in Access to Mental Health Treatment for Teens and Young Adults

# data[].attributes.attachment_link.description
In a commentary in the Journal of the American Medical Association, Donald Berwick, M.D., M.P.P., former administrator of the Centers for Medicare and Medicaid Services (CMS) and president emeritus of the Institute for Healthcare Improvement, calls on hospitals and health systems to make greater investments in the social determinants of health.

# data[].attributes.attachment_link.readable_text
About 20 Detroit teens last summer set out to answer some important questions about how their peers are dealing with mental health struggles.

These high school students, part of a city youth organization called Local Circles, wanted to know two things about their peers: How they practice self-love, and how they find peace in a world in which they constantly feel judged.

They are relevant questions. Schools across Michigan are struggling to address the mental health needs of students. Those troubles existed before the pandemic, but the isolation, lingering effects of remote learning, and challenges coping in the midst of a global health crisis have deepened them.

The Detroit teens detailed their findings, and in some cases confronted their own mental health worries, in written pieces. Chalkbeat is publishing excerpts of those pieces today.

Local Circles is an organization that employs young people to research issues that are important to them. Nicole Jurek, the executive director of the organization, wrote in her own piece that adults too often think of young people in terms of what they can do in the future. But they have a voice today, she said.

"Young people have value (intrinsically, as we all do) for what they can do now, in their youth," she wrote.

Read the pieces below from high school students TaMyra Smith, Torrance Johnson, Amaya Nard, Drew Smith Jr., and Stephanie Haney.

When depression takes control

There was a time in my life where the bad days outweighed the good days. Depression took control over my emotions, school became more depressing by the minute, I faced personal problems at home, and, worst of all, COVID had just come out. I could see that I wasn't the only kid dealing with these issues, yet since 2020, our tears have been hidden in the crowd, and there are fake smiles everywhere.

I've heard people say, "Life isn't all that bad," and that might be right. But if that were true, we would have more mentally stable teens in this world. Unfortunately, it is the other way around. It has gotten to the point where we've all become distant from one another, with no one to talk to, so that pain is just sitting within. A friend of mine once said, "The world feels like a ton of bricks have just landed on my chest, and the load won't get any lighter." Why should we have to live like this if we're the future? What are we supposed to do in order to make life a bit easier for us?

About six months ago, a few of my old friends from middle school and I got back in touch via Instagram. Man, oh man, did it feel like we were getting to know one another all over again, and the energy wasn't the same at all. By the way they talked, I could feel and hear the sadness in their voices while trying to hide what was deep down. I'm not the smartest, but I can tell when something is wrong.

The pandemic has done a number on me. I don't and can't go anywhere, can't sleep some nights, always see the negative before the positive, and I doubt almost everything and everyone around me. Just recently, I had five assignments from four different classes that had to be completed the same day. I convinced myself that all of it wouldn't get done, and I was right. And then I received a C in three of those classes since the work was turned in late. See what I mean?

Just the thought of school makes you wish it was already Friday again. More work, more engaging with your classmates, sometimes I don't even want to talk. Many of my peers say that they're being overworked, as if this is college, and I agree.

There is only so much teens can take before we begin to not care and want to give up. You never know what goes on in our heads. It could be built up stress and anger that will soon be released. Us teens need to come together, build our own safe environment and stop going against one another.
TaMyra Smith is a sophomore at the DPSCD Virtual Academy in Detroit.
Music as love and therapy

What makes me feel the most like myself? If you were to look at me, the first thing you would see is the bulky power chair I'm in. For me, my power chair, or rather my disability, is a key part of my being, as the chair and I operate as one. The chair is the first thing most people notice, but that isn't necessarily a bad thing as I feel it's one of my defining characteristics.

Beyond seeing it, whenever I move you can hear the whirring of my chair as my wheels go around. Once someone gets to know me, the chair will become what I use to go from one place to the next. However, this can cause me to struggle to view myself as an individual separate from my chair. I have found a way to remedy this, and I've found it in music.

When I'm creating music there's no wheelchair, no disability, there's just me and a piano keyboard where I'm free to let my heart and soul create. Music is my love, my therapist, my peace, my freedom. To explain why I feel such relief and freedom in making music to express myself, I asked music therapist Matthew Bessette. "When you're creating music, you connect with your emotions and express them on a different level of understanding and connection," he said.

When using music to express yourself, there's no right or wrong way to do it. You don't have to play like Bach or Beethoven to make something beautiful or something that allows you to let feelings out. Since I started playing the piano in February, it has become a passion of mine and something I love to do.

While crafting the survey, my peers and I would meet once a week at a facility in Detroit. I couldn't wait to go there and was typically the first to arrive. In the facility, there was a piano I would play while I anxiously awaited the arrival of my cohort.

I'd begin by playing a single note which can sometimes be the beginning step in describing how you feel. I'd glide my fingers across key by key, letting the anxiety flow from me into the piano, and what came to exist was beauty and freedom. The piano from left to right goes from low to high. As you might guess, a person who is sad would play slow, somber notes compared to a happy person playing upbeat lively notes. I typically experiment with different notes and chords that I don't always know will reflect the emotion of my heart, brain and soul.

For however long I play, I feel safe and unjudged. I simply feel peace! And that is more than okay with me. Playing allowed me to give my burdens away and be able to enjoy being there in the moment with my cohort.
Torrance Johnson is a junior at Clarenceville High School in Livonia.
Families must practice and model self-love

One of the findings that stood out to me from the students we surveyed last summer was that people who said they had a positive view on self-love also had someone older in their life who told them the importance of self-love.

My experience with self-love was different. The importance of self-love was a foreign concept for me growing up. Things like rest and relaxation were not allowed for children in my environment. I often saw adults using unhealthy forms of coping, like substances, instead of practicing self-love. I didn't follow their example. But I can't say the same for other children in my family. That's not to say I wasn't affected. Self image issues are something that I struggle with a lot. According to our survey, the older people got, their view on self-love became more positive. This makes me think that your environment as well as the people around you growing up can affect your view on self-love.

As children we follow the adults in our lives. Learning the importance of self-love in your most formative years will have an effect on how you view yourself then and in the future. Having positive influences in your family can reduce stress and conflict, according to a 2022 study in the journal Wellbeing, Space and Society. Besides family, your environment also plays a role in your well-being. Things like stable housing, food security and overall safety can affect if you practice self-care. That being said, while family and your environment can play a role in how you care for yourself, the main thing is really how you feel about yourself.

Everyone should understand that children needing rest isn't laziness, and parents taking care of themselves is not selfishness. Learning how to love yourself can be challenging, but having supportive people in your life can help a lot. Even if you don't have people in your life like that, you can be that person for yourself.
Amaya Nard is a senior at My Virtual Academy.
'Alarming' data on youth depression

Teens go through a lot, and have been especially impacted by COVID. Sometimes adults might brush off what teens say and feel, and think that we don't know better. We have the same feelings they do, and we wanted teens to know that they are heard and important.

A 2022 report from Mental Health America found that in Michigan, nearly 17% of youth ages 12-17 had a major depressive episode in the previous year. That's higher than the national average, which was around 15%, or 3.7 million youths.

The data are alarming.

Here's what we found after surveying our peers:

A lot of teens practice self-care by relaxing, there were a lot more people who had good relationships with self-love than people who didn't, and more younger kids had negative relationships with self-love than the older ones. We concluded that as people grow older, they learn to love themselves more.

When practicing self-love, females will say motivating quotes about their beauty and looks, while males did not really have anything motivating to say other than, "You got this." Female teens had deeper responses to the open-ended questions. Ultimately, we learned self-love impacts what you do in a day, how you react to people, and how much confidence you have.

These findings really made me think about myself and how I practice self-love. What I do to calm down and relax is lay down in my bed and watch a TV show that I enjoy. I never really thought about that being self-love until then. Spending time with my friends and family is also a way I practice self-love.

I started to ask myself, "What can I do to improve love for myself?" Then I remembered one of the questions we asked in the survey: "What are some motivational things you say to yourself?" Respondents said things like, "I am loved," "I am worthy" and "I am beautiful/handsome." Ever since then, I've tried to implement "I am" statements into my everyday life to let myself know what I am.

I'm so grateful for this experience, memories and knowledge learned this summer. And if any teens are reading this in the Detroit area, I want you to know that you are loved and you are heard and that Local Circles cares about you.
Drew Smith Jr. is a junior at Metropolitan Junior Academy in Plymouth.
Seek help when you need it

At times you may not have the best mental health or you won't love yourself as much as you would like to, but that doesn't have to stop you from being you.

Over time you will go on a self discovery to understand yourself better and what makes you happy. Keep negative things out of your life, and if they keep coming back, take a different route to keep them away. There are going to be SO many ups and downs in your life. Try to look at the bright side of things and see how it will make you better. If there is no bright side, make one. Think of a positive situation and stick with it.

If you need help, call or text the mental health hotline at the number 988 ( Michigan's access line to the National Suicide Prevention Lifeline).
Stephanie Haney is a junior at Cass Technical High School in Detroit. Lori Higgins is the bureau chief for Chalkbeat Detroit. You can reach her at lhiggins@chalkbeat.org.

# data[].attributes.attachment_link.title
When depression takes hold, teens say they seek inner peace

# data[].attributes.attachment_link.description
About 20 Detroit teens last summer set out to answer some important questions about how their peers are dealing with mental health struggles. These high school students, part of a city youth organization called Local Circles, wanted to know two things about their peers: How they practice self-love, and how they find peace in a world in which they constantly feel judged.

# data[].attributes.attachment_link.readable_text
NAMI Ending the Silence

A presentation for middle and high school students, school staff and parents or guardians.

NAMI In Our Own Voice

A presentation by people with mental health conditions to promote awareness and recovery.

Contact Your Local NAMI

Across the country, thousands of trained volunteers bring peer-led programs and lived experience to your community.

# data[].attributes.attachment_link.description
One of NAMI's main goals is to ensure that people get help early. Since mental health conditions typically begin during childhood, adolescence or young adulthood, we have compiled essential information and resources intended to help young people get the mental health support they need.

# data[].attributes.attachment_link.readable_text
Research is focused on child and teen mental health, exploring why they are struggling and what can be done to help them

Cite this

Abrams, Z. (2023, January 1). Kids' mental health is in crisis. Here's what psychologists are doing to help. Monitor on Psychology, 54(1). https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health

This content is disabled due to your privacy settings. To re-enable, please adjust your cookie preferences.

The Covid-19 pandemic era ushered in a new set of challenges for youth in the United States, leading to a mental health crisis as declared by the United States surgeon general just over a year ago. But U.S. children and teens have been suffering for far longer.

In the 10 years leading up to the pandemic, feelings of persistent sadness and hopelessness-as well as suicidal thoughts and behaviors-increased by about 40% among young people, according to the Centers for Disease Control and Prevention's (CDC) Youth Risk Behavior Surveillance System.

"We're seeing really high rates of suicide and depression, and this has been going on for a while," said psychologist Kimberly Hoagwood, PhD, a professor of child and adolescent psychiatry at New York University's Grossman School of Medicine. "It certainly got worse during the pandemic."

In addition to the social isolation and academic disruption nearly all children and teens faced, many also lost caregivers to Covid-19, had a parent lose their job, or were victims of physical or emotional abuse at home.

All these difficulties, on top of growing concerns about social media, mass violence, natural disasters, climate change, and political polarization-not to mention the normal ups and downs of childhood and adolescence-can feel insurmountable for those who work with kids.

"The idea of a 'mental health crisis' is really broad. For providers and parents, the term can be anxiety-provoking," said Melissa Brymer, PhD, who directs terrorism and disaster programs at the UCLA-Duke University National Center for Child Traumatic Stress. "Part of our role is to highlight specific areas that are critical in this discussion."

Across the field, psychologists are doing just that. In addition to studying the biological, social, and structural contributors to the current situation, they are developing and disseminating solutions to families, in schools, and at the state level. They're exploring ways to improve clinical training and capacity and working to restructure policies to support the most vulnerable children and teens.

Psychologists were also behind new mental health recommendations from the U.S. Preventive Services Task Force, a group of volunteer health professionals who evaluate evidence on various preventive health services. The task force now recommends regular anxiety screenings for youth ages 8 to 18 and regular depression screenings for adolescents ages 12 to 18.

"I see these trends in children's mental health problems as being critical, but there are solutions," Hoagwood said. "If we refocus our efforts toward those solutions, we could see some of these tides turn."

This content is disabled due to your privacy settings. To re-enable, please adjust your cookie preferences.

Sources of stress

Across the United States, more than 200,000 children lost a parent or primary caregiver to Covid-19 ("Covid-19 Orphanhood," Imperial College London, 2022). In the face of those losses, families had to curtail mourning rituals and goodbye traditions because of social distancing requirements and other public health measures, Brymer said. Many children are still grieving, sometimes while facing added challenges such as moving to a different home or transferring to a new school with unfamiliar peers.

The CDC also reports that during the pandemic, 29% of U.S. high school students had a parent or caregiver who lost their job, 55% were emotionally abused by a parent or caregiver, and 11% were physically abused (Adolescent Behaviors and Experiences Survey-United States, January-June 2021, CDC).

"Schools are crucial for keeping kids safe and connecting them with services, but the pandemic completely disrupted those kinds of supports," Brymer said.

Those extreme disruptions didn't affect all young people equally. Echoing pre-Covid-19 trends, the CDC also found that girls, LGBTQ+ youth, and those who have experienced racism were more likely to have poor mental health during the pandemic, said social psychologist Kathleen Ethier, PhD, director of the CDC's Division of Adolescent and School Health.

Contributing factors likely include stigma, discrimination, and online bullying, Ethier said. Female students also report much higher levels of sexual violence than their male peers, which can further harm mental health.

As much hardship as Covid-19 wrought, it's far from the only factor contributing to the current crisis. Biology also appears to play a role. The age of puberty has been dropping for decades, especially in girls, likely leading to difficulty processing complex feelings and knowing what to do about them ( Eckert-Lind, C., et al., JAMA Pediatrics, Vol. 174, No. 4, 2020). In early puberty, regions of the brain linked to emotions and social behavior are developing more quickly than regions responsible for the cognitive control of behavior, such as the prefrontal cortex, Ethier said.

Those developmental changes drive young people to seek attention and approval from their peers. For some, using social media fulfills that need in a healthy way, providing opportunities for connection and validation to youth who may be isolated from peers, geographically or otherwise.

For others, negative messages-including online bullying and unrealistic standards around physical appearance-appear to have a detrimental effect, but more research is needed to understand who is most at risk.

"There is clearly some aspect of young people's online life that's contributing [to the mental health crisis], we just don't know exactly what that is," said Ethier.

Finally, structural factors that affect millions of U.S. children, including poverty, food insecurity, homelessness, and lack of access to health care and educational opportunities, can lead to stress-response patterns that are known to underlie mental health challenges.

"Even in very young children, prolonged stress can trigger a cycle of emotion-regulation problems, which can in turn lead to anxiety, depression, and behavioral difficulties," Hoagwood said. "These things are well established, but we're not doing enough as a field to address them."

Building capacity in schools

The biggest challenge facing mental health care providers right now, experts say, is a shortage of providers trained to meet the mounting needs of children and adolescents.

"There's a growing recognition that mental health is just as important as physical health in young people's development, but that's happening just as mental health services are under extreme strain," said clinical psychologist Robin Gurwitch, PhD, a professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center.

Schools, for example, are a key way to reach and help children-but a 2022 Pew Research Center survey found that only about half of U.S. public schools offer mental health assessments and even fewer offer treatment services. Psychologists are now ramping up efforts to better equip schools to support student well-being onsite.

Much of that work involves changing policies at the school or district level to provide more support for all students. For example, school connectedness-the degree to which young people feel that adults and peers at school care about them and are invested in their success-is a key contributor to mental health. Youth who felt connected during middle and high school have fewer problems with substance use, mental health, suicidality, and risky sexual behavior as adults ( Steiner, R. J., et al., Pediatrics, Vol. 144, No. 1, 2019).

Through its What Works in Schools program, the CDC funds school districts to make changes that research shows foster school connectedness. Those include improving classroom management, implementing service-learning programs for students in their communities, bringing mentors from the community into schools, and making schools safer and more supportive for LGBTQ+ students.

Psychologists are also building training programs to help teachers and other school staff create supportive classrooms and aid students who are in distress. Classroom Wise (Well-Being Information and Strategies for Educators), developed by the Mental Health Technology Transfer Center Network and the University of Maryland's National Center for School Mental Health (NCSMH), is a free, flexible online course and resource library that draws on psychological research on social-emotional learning, behavioral regulation, mental health literacy, trauma, and more ( Evidence-Based Components of Classroom Wise (PDF, 205KB), NCSMH, 2021).

"We're using evidence-based practices from child and adolescent mental health but making these strategies readily available for teachers to apply in the classroom," said clinical psychologist Nancy Lever, PhD, codirector of NCSMH, who helped develop Classroom Wise.

The course incorporates the voices of students and educators and teaches actionable strategies such as how to create rules and routines that make classrooms feel safe and how to model emotional self-regulation. The strategies can be used by anyone who interacts with students, from teachers and administrators to school nurses, coaches, and bus drivers.

"What we need is to build capacity through all of the systems that are part of children's lives-in families, in schools, in the education of everybody who interacts with children," said psychologist Ann Masten, PhD, a professor of child development at the University of Minnesota.

Other training efforts focus on the students themselves. Given that preteens and teenagers tend to seek support from their peers before turning to adults, the National Child Traumatic Stress Network (NCTSN) created conversation cards to equip kids with basic skills for talking about suicide. The advice, available in English and Spanish, includes how to ask about suicidal thoughts, how to listen without judgment, and when to seek guidance from an adult ( Talking About Suicide With Friends and Peers, NCTSN, 2021).

While training people across the school population to spot and address mental health concerns can help reduce the strain on mental health professionals, there will always be a subset of students who need more specialized support.

Telehealth, nearly ubiquitous these days, is one of the best ways to do that. In South Carolina, psychologist Regan Stewart, PhD, and her colleagues colaunched the Telehealth Outreach Program at the Medical University of South Carolina in 2015. Today, nearly every school in the state has telehealth equipment (Wi-Fi and tablets or laptops that kids can use at school or take home) and access to providers (psychology and social work graduate students and clinicians trained in trauma-focused cognitive behavioral therapy). Students who need services, which are free thanks to grant funding or covered by Medicaid, meet one-on-one with their clinician during the school day or after hours (American Psychologist, Vol. 75, No. 8, 2020).

"We learned a lot about the use of technology during the pandemic," Ethier said. "At this point, it's very much a matter of having sufficient resources so more school districts can access those sources of care."

Expanding the workforce

Limited resources are leaving families low on options, with some young people making multiple trips to the emergency room for mental health-related concerns or spending more than six months on a waiting list for mental health support. That points to a need for more trained emergency responders and psychiatric beds, psychologists say, but also for better upstream screening and prevention to reduce the need for intensive care.

"Just as we need more capacity for psychiatric emergencies in kids, we also need an infusion of knowledge and ordinary strategies to support mental health on the positive side," Masten said.

In New York, Hoagwood helped launch the state-funded Evidence Based Treatment Dissemination Center in 2006, which offers free training on evidence-based practices for trauma, behavioral and attention problems, anxiety, depression, and more to all mental health professionals who work with children in state-licensed programs, which include foster care, juvenile justice, and school settings, among others. The center provides training on a core set of tools known as PracticeWise ( Chorpita, B. F., & Daleiden E. L., Journal of Consulting and Clinical Psychology, Vol. 77, No. 3, 2009). It also offers tailored training based on requests from community agency leaders and clinicians who provide services to children and their families.

Hoagwood, in collaboration with a consortium of family advocates, state officials, and researchers, also helped build and test a state-approved training model and credentialing program for family and youth peer advocates. The peer advocate programs help expand the mental health workforce while giving families access to peers who have similar lived experience ( Psychiatric Services, Vol. 71, No. 5, 2020).

Youth peer advocates are young adults who have personal experience with systems such as foster care, juvenile justice, or state psychiatric care. They work within care teams to provide basic education and emotional support to other youth, such as giving advice on what questions to ask a new mental health practitioner and explaining the differences between psychologists, psychiatrists, and social workers. Youth peer advocates in New York can now receive college credit for their training in peer specialist work.

"Making community health work into a viable career can also increase diversity among mental health workers and help us address structural racism," Hoagwood said.

Pediatricians are another group that can provide a first line of defense, drawing on their relationships with parents to destigmatize mental health care.

"Pediatricians are in many ways uniquely positioned to help address the mental health crisis in youth," said Janine A. Rethy, MD, MPH, division chief of community pediatrics at MedStar Georgetown University Hospital and an associate professor of pediatrics at Georgetown University School of Medicine. "We have the privilege of building long-term relationships with children and their families over many years," with at least 12 well-child checkups in just the first three years of a child's life, followed by annual visits.

During these visits, they can watch for warning signs of social and behavioral problems and screen for maternal depression and other issues in parents, which is now recommended by the American Academy of Pediatrics (PDF, 660KB). Several new resources provide guidance for integrating mental health care into pediatric practices, including the Behavioral Health Integration Compendium (PDF, 4.1MB) and the Healthy Steps program. But most pediatricians need more education on mental health issues in order to effectively respond, Rethy said-yet another area where psychologists may be able to help. Psychologists can provide direct consultations and training to pediatricians through the Pediatric Mental Health Care Access program.

"The more we can weave mental health knowledge, capacity, and checkpoints into places where parents feel comfortable-like the doctor's office and at school-the better," Masten said. "All professionals who work with young people really need the knowledge that's being generated by psychologists."

11 emerging trends for 2023

Further reading

Science shows how to protect kids' mental health, but it's being ignored
Prinstein, M., & Ethier, K. A., Scientific American, 2022

How pediatricians can help mitigate the mental health crisis
Rethy, J. A., & Chawla, E. M., Contemporary Pediatrics, 2022

Review: Structural racism, children's mental health service systems, and recommendations for policy and practice change
Alvarez, K., et al., Journal of the American Academy of Child and Adolescent Psychiatry, 2022

Six Things Psychologists are Talking About

The APA Monitor on Psychology ® sister e-newsletter offers fresh articles on psychology trends, new research, and more.

Speaking of Psychology

Subscribe to APA's audio podcast series highlighting some of the most important and relevant psychological research being conducted today.

Subscribe to Speaking of Psychology and download via:

Apple

Spotify

Contact APA

# data[].attributes.attachment_link.title
Kids' mental health is in crisis. Here's what psychologists are doing to help

# data[].attributes.attachment_link.description
Research is focused on child and teen mental health, exploring why they are struggling and what can be done to help them

# data[].attributes.headline
Youth Mental Health & Dismantling Racial Barriers

# data[].attributes.subject
Youth Mental Health & Dismantling Racial Barriers

# data[].attributes.attachment_link.readable_text
On June 28, WYPR hosted Call to Mind Live: Youth Mental Health & Dismantling Racial Barriers, a Well Beings Virtual Tour Event. The live, virtual discussion was hosted by Sarah Y. Kim, WYPR's Report For America Health and Housing Reporter, Anthony Brandon Fellow, and Farajii Muhammad, Host of WEAA's For The Culture with Farajii. The discussion centered around how evictions affect the mental health of children and youth in Baltimore City, and how trauma from housing instability can span lifetimes and generations. Plus, we talked to parents and mental health specialists about ways that Black parents can have conversations with their children about their humanity and value in the face of policing, misappropriation of Black culture and what it means to be Black in America now. Along with how young leaders are helping their peers to restore their mental health after experiencing the crisis of violence.

Farajii Muhammad: Former host of WEAA's "For The Culture with Farajii"

ABOUT

WELL BEINGS is a major national campaign from WETA addressing health needs in America with a focus on youth mental health.

The WELL BEINGS YOUTH MENTAL HEALTH PROJECT is made possible by Otsuka, Kaiser Permanente, Bank of America, Liberty Mutual Insurance, American Psychiatric Association Foundation, One Mind, Movember, National Alliance on Mental Illness, The Dauten Family Foundation, Dana Foundation, Hersh Foundation, Mental Health Services Oversight & Accountability Commission, Frances Von Schlegell and John E. Von Schlegell, Robina Riccitiello, Sutter Health, and Jackson Family Enterprises. Partners include CALL TO MIND at American Public Media, PBS NewsHour Student Reporting Labs, Forbes, PEOPLE, Mental Health America, National Council for Mental Wellbeing, The Steve Fund, and The Jed Foundation.

# data[].attributes.attachment_link.title
Youth Mental Health & Dismantling Racial Barriers - Call To Mind

# data[].attributes.attachment_link.description
Join Call to Mind, Well Beings and WYPR on June 28 for a live, virtual discussion centered around how evictions affect the mental health of children and youth, and how trauma from housing instability can span lifetimes and generations. As well as a conversation with parents and mental health special

# data[].attributes.attachment_link.readable_text
Skip to main content

We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.

988

¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español!
Haga clic aquí para obtener información sobre cómo acceder a todos los servicios en español.

Conocer más

Stock photo by iStock.

The 988 Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States. We're committed to improving crisis services and advancing suicide prevention by empowering individuals, advancing professional best practices, and building awareness.

About The Lifeline

Anyone could be struggling with suicide. Find more specific resources below.

I'm Struggling With Individuals with Neurodivergence

We understand that every struggle is different. Experience the stories of people like you, and how they overcame crisis to find hope and recovery.
read stories of hope & recovery

First, you'll hear an automated message featuring additional options while your call is routed to your local 988 Lifeline network crisis center.

We'll play you a little music while we connect you to a skilled, trained crisis worker.

A trained crisis worker at your local center will answer the phone.

This person will listen to you, understand how your problem is affecting you, provide support, and get you the help you need.

988 Lifeline Center calls are free and confidential, and we're available 24/7.

Show What Happens When You Call The Lifeline

Everyone Plays A Role In Suicide Prevention

Get in touch

Call the Lifeline

# data[].attributes.attachment_link.description
Skip to main content We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States. 988 ¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español!

# data[].attributes.attachment_link.title
Resources - The Youth Mental Health Project

# data[].attributes.attachment_link.description
Additional ResourcesThe information here is provided as a courtesy and is not intended as a substitute for professional mental health treatment or emergency/crisis services. Below you will find informational resources, websites, and articles on the following topics related to mental health: Families…

# data[].attributes.attachment_link.readable_text
The Future is . is an ongoing series of news reports by young feminists. This series is made possible by a grant from SayItForward.org in support of teen journalists and the series editor, Katina Paron.
It all started when Induja Kumar realized one of her best friends was struggling with self-harm and depression. Without parents to take her seriously or a professional to talk to at her school in Arizona, the friend began to sink.

While Kumar and others were able to support the friend enough for her to recover, it put everyone in a risky position.

"The fact that we, as students, as teenage girls, had to deal with a person who is suicidal, it just shouldn't happen," Kumar, 17, said. "That should never be a situation that we have to deal with."

(Sinn Féin / Creative Commons)

Arizona's student-to-counselor ratio is the worst in the nation, averaging at about 905 students per counselor. In response to this and her friend's predicament, Kumar and another teen, Catherine Broski, helped lobby the state legislator for $20 million to increase mental health resources in Arizona schools to advocate for a "safe mind, safe campus."

Access to counselors and social workers-rather than the addition of school resource officers-is critical to supporting students' mental health, Broski said.

"If you can't feel safe where you are, you can't focus in class," Broski, 18, said. "All of those things don't contribute to a safe campus because they're not contributing to a safe mind."

Schools are an intersection of different parts of students' identity so they need mental health resources to support students, Tahira Khalid, social worker at a middle school in Brooklyn, N.Y., said.

"Some of the issues the activists are talking about in terms of gun violence and toxic masculinity and representation are issues that are of particular importance to young people now," Khalid said. "Social workers and counselors make space for that."

Kumar feels the need every day at school."We see that teenage girls are very susceptible to self-harm because they don't have the right mental health resources to provide them with a stable background in which to find themselves and accept their femininity," Kumar said.

The original goal was a state-wide bill allocating better mental health resources in public schools. After failing in the House rules committee, Kumar and Broski got the attention of Kathy Hoffman, Arizona's superintendent of public instruction.

Hoffman saw how important the issue was and was able to get a $20 million grant from the state to hire 148 school counselors, 118 social workers, and 117 school resource officers.

It's a start. But Kumar and Broski don't think it is enough, so they're pursuing House Bill 2256 again to focus solely on mental health resources and remove school resource officers-police officers who are responsible for safety and crime prevention in schools-who they believe militarize schools.

The recent hire of school counselors is a start to decreasing Arizona's student to counselor ratio to the recommended average of 250 to 1, said Katherine Pastor-Lorents, a school counselor at Flagstaff High School in Arizona.

Broski and Kumar's push for mental health resources also aligns with the March For Our Lives Peace Plan, which states that mental health work and the fight against gun violence should be "preventative" and "proactive."
The Future is Ms. is committed to amplifying the voices of young women everywhere. Share one of your own stories about your path to empowerment at SayItForward.org
"This is just the first step in a series of steps that need to be taken in order to make sure that no kid has to deal with something as big as depression, and nor do the other people in that community have to take on the brunt of what a professional should be doing," Kumar said.

# data[].attributes.attachment_link.title
Providing Better Mental Health Services for Students is Non-Negotiable - Ms. Magazine

# data[].attributes.attachment_link.description
Arizona's student-to-counselor ratio is the worst in the nation, averaging at about 905 students per counselor. In response to this fact and personal experience, two teens helped lobby the state legislator for $20 million to increase mental health resources in Arizona schools to advocate for a "safe mind, safe campus."

# data[].attributes.attachment_link.readable_text
By Cassie Shortsleeve
There are lots of ways to find low- or no-cost mental health care. Not sure where to begin? Here are seven easy-to-access mental health care options, many of which are free.

1. Text or call for help right away.

Keep these numbers in a safe place and use them when you're struggling or if you need immediate help.

Text HOME to 741-741 for a free, confidential conversation with a trained counselor any time of day.

If you are experiencing a mental health crisis, text or call 988.

If this is a medical emergency or there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.

2. Make use of other hotlines with people trained to talk with you.

Call 800-852-8336: From 6 p.m. to 10 p.m. PST each night, you can connect to the Teen Line , an anonymous, nonjudgmental space for youth.

Text TEEN to 839-863: Teen Line's peer-to-peer support service enables you to talk with other teenagers who are trained in mental health support.

Text START to 678-678 or call 866-488-7386: Reach trained mental health support from the Trevor Project , which specializes in supporting LGBTQ youth.

"People would be surprised if they knew how much intensive training folks who work on those lines get," says Sarah M. Skoterro, a licensed mental health counselor with THIRA Health in Bellevue, Washington.

You can also find resources in your state. Washington , Oregon , Maine , California , and others offer crisis connection lines specifically for teens. Google your state and "teen hotline" or "teen crisis line" to find resources close to home.

3. See what your school offers.

High schools and colleges often have on-site counseling staff you can talk to if you're struggling. They may also have relationships with community-based organizations that offer low- or no-cost care.

4. Look for low-cost therapy.

Some therapists offer "sliding scale" or "pay what you can" payment structures. Others provide free counseling as a service to the community. This type of counseling isn't always easy to find, but some states ( New York and Massachusetts , for example) offer free call lines that can connect you with free counseling or referrals to therapists.

Federally qualified health centers across the country provide mental health services, and many offer tele-counseling. They will help you even if you have no health insurance; you pay what you can afford based on your income. Use the health center locator tool to search for a health center by address, state, or county.

Some health startups, such as Charlie Health , offer digital therapy for teens across the country with virtually no wait lists. Skoterro says Charlie Health offers high-quality therapy, "while making it accessible to people with low or no insurance coverage."

Another option is the Open Path Collective , a nonprofit network of mental health providers in all 50 states and Canada that provides inclusive and deeply reduced-cost therapy.

5. Find a community mental health center.

Community health, behavioral health, or mental health centers exist all over the country. Some take insurance, while others are funded by donors, foundations, or hospitals. Most offer flexible fees and provide financial assistance. These centers also typically have bilingual providers and specialized programs such as substance misuse programs or services for refugees.

Check out your state, town, and local government websites to find a list of community health centers near you.

6. Make use of other community organizations.

True connection-having people in your corner who can help you and hear you-is one of the best ways to take care of your mental health. Places to look for community support:

Any religious organizations you are a member of (and where you feel supported).

Coaches or leaders of organized activities you participate in.

Your parents or your friends' parents.

7. Learn online.

More and more websites offer free resources for mental health. Academic institutions-think hospitals and universities-with behavioral health departments or psychiatry departments often offer free content on their websites that can help you get started. Some even help you learn coping skills and find support.

Vibrant Emotional Health's Safe Space offers stories of real people and how they worked through mental health challenges, peer support from other people in your position, and calming exercises.

On the Trevor Project 's website, you'll find educational articles about mental health, sexual orientation, and gender identity, as well as volunteer opportunities and an online community to meet friends .

NowMattersNow.org is a collection of free videos from experts and teens that explain distress skills and relay messages of support for managing mental health and suicidal thoughts.

The National Alliance on Mental Illness's Peer-to-Peer groups offer eight free educational sessions for adults with mental health conditions.

Search Resource Center

Type your search term below

# data[].attributes.attachment_link.title
7 Ways to Get Affordable Mental Health Care | JED

# data[].attributes.attachment_link.description
By Cassie Shortsleeve There are lots of ways to find low- or no-cost mental health care. Not sure where to begin? Here are seven easy-to-access mental health care options, many of which are free. Keep these numbers in a safe place and use them when you're struggling or if you need immediate help.

# data[].attributes.attachment_link.readable_text
The Future is . is an ongoing series of news reports by young feminists. This series is made possible by a grant from SayItForward.org in support of teen journalists and the series editor, Katina Paron.
Instead of wasting away hours scrolling on Instagram and TikTok during quarantine in 2021, Alyssa Simone spent her time researching mental health techniques and sharing her knowledge with her peers. Simone was diagnosed with OCD in early 2021 and felt her own mental health declining when her socialization at school was replaced with texts and Zoom calls and her general routine disrupted.

She knew if she was struggling her peers must be, too. In May of that year, Simone and friends founded Child Resilient. The nonprofit started as a way to share Instagram infographics keeping their peers informed on mental health topics, like parenting styles and the effects of microaggressions on children. Eventually, Simone and her team saw the need for teens to have their own self-development community.

Mentalligence is an immersive program making mental health education accessible to teens weekly via Zoom, (Courtesy of Child Resilient)

Capitalizing on the free time students had last summer when jobs and summer programs were limited due to the Omicron variant, Simone's group launched Mentalligence, an immersive program making mental health education accessible to teens weekly via Zoom. So far, over 150 NYC students have connected in small groups to learn about and experiment with different therapy techniques.

"Therapy isn't a one size fits all model," said the Staten Island Technical High School senior. Simone emphasizes the importance of experimenting with a variety of therapy approaches to see what works best for teens in differing circumstances. Under supervision of three psychologists on the board, Simone and the other leaders introduce teens to cognitive behavioral therapy, acceptance and commitment therapy and interpersonal psychotherapy, among other styles.

Each workshop includes learning about the history, accepted usage and intended benefits of practicing a certain therapy. Students then break into small cohorts to do an activity led by student mentors, before returning as a group to reflect on experiential takeaways.

(Courtesy of Child Resilient)

For 14-year-old Ovoke Akpude, Mentalligence came at just the right time. When her school, Brooklyn Technical High School, went virtual, she said she was "bored and kind of closed off." Ovoke socialized on Discord and other social media platforms but the Mentalligence program was where she really felt a sense of connection again. "Mentalligence encourages a new kind of community," she said. "Everyone gets to relate on their own level."

Social isolation, like what many teens experience during the pandemic, can be detrimental to young people, said Dr. June Rousso, a psychologist on the board of Child Resilient. She views this switch to a remote environment as a cause for delay in the development of many teenagers' identity socially and emotionally.

"When you're a teenager, you learn from each other, you compare, 'oh they're doing that. I like that.' It's just sort of a way to help develop your own personal identity," said Rousso.

Students that are a part of historically underrepresented groups are most negatively impacted by the lack of mental health support from school professionals and a lack of resources. Federal data shows the crisis has been exacerbated in Black and Latino communities especially.

This is the group Mentalligence is aimed for, Simone said. Nearly 85 percent of their participants identify as female or teens of color, most of whom receive no professional support.

The leaders reflect this about those they serve, and that is part of the success, says Nana Opare-Addo, a sophomore at Brooklyn Latin and group leader.

"Mentalligence works so well because we the leaders have endured similar issues and can relate to our participants," she said.
The Future is Ms. is committed to amplifying the voices of young women everywhere. Share one of your own stories about your path to empowerment at SayItForward.org

# data[].attributes.attachment_link.title
NYC Teen Activist Bridges Gap for Mental Health Support: "When You're a Teenager, You Learn From Each Other" - Ms. Magazine

# data[].attributes.attachment_link.description
The Future is . is an ongoing series of news reports by young feminists. This series is made possible by a grant from SayItForward.org in support of teen journalists and the series editor, Katina Paron. Instead of wasting away hours scrolling on Instagram and TikTok during quarantine in 2021, Alyssa Simone spent her time researching mental health techniques and sharing her knowledge with her peers.

# data[].attributes.attachment_link.title
Teen Mental Health Advocacy | Work2BeWell

# data[].attributes.attachment_link.description
Our teen mental health advocacy opportunities empower, inspire and educate young people to raise awareness and increase well being.

# data[].attributes.attachment_link.authors[].name
Jackie Menjivar - TBTContent & Creative Strategist

# data[].attributes.attachment_link.title
9 Young Mental Health Activists You Should Know

# data[].attributes.attachment_link.description
“One thing that gives me hope is seeing young people step up and speak out about their challenges and their needs for change.”

# data[].attributes.attachment_link.readable_text
By Leslie Goldman
As a longtime Girl Scout, Hikmah Jamal has had plenty of opportunities to engage in community service. In sixth grade, she helped raise funds for a local Islamic school to purchase books for its struggling library. She made and donated no-sew blankets to a hospital for patients with cancer during her first year of high school. But to earn the highest Girl Scout award, Jamal, now 20 and going to college in Austin, Texas, was challenged to create and implement a long-lasting solution to a problem or cause she felt deserved attention.

At the time, Jamal was a high school senior and had seen "several friends and classmates within my Muslim community self-medicating with drinking, drugs, and food." Having struggled with her own mental health, Jamal says, "I chose to step up and speak."

Jamal consulted with mental health professionals and developed multiple workshops and seminars to educate community members about the dangers of self-medication, how to develop healthier coping skills, and how to help a loved one who is self-medicating. Nearly 50 people attended one of her virtual seminars, which "felt really empowering," she says. "We were all in a really rough spot in the middle of quarantine, but when I saw all the people I was able to reach, I remember thinking, 'Wow, I did this.' And I think it made everyone feel less alone."

Jamal didn't realize it at the time, but her activism allowed her to tap into what's known as a "helper's high." When we give our time, energy, or help to others, our brains release feel-good chemicals such as dopamine, serotonin, and oxytocin that increase feelings of pleasure, happiness, and social bonding.

And if there ever was a time we need feel-good emotions, it's now.

Many of us are still grappling with the mental health impacts of the pandemic, and with each passing day comes word of a new tragedy, a new type of suffering, a different group of people being oppressed in some way. The need for self-care- the act of taking care of your physical, mental, and emotional health -is greater than ever. And so is the call to do something.

Enter activism. When you volunteer or champion a cause you believe in-whether it's racial equity, climate change, animal rights, or another issue you care deeply about-you open the door to a number of mind-body benefits, all of which count as self-care. Here are a few of them:

Activism is a way to find your people. When you show up to your first meeting for your high school's recycling club, join your college campus's Pride Society, take part in an online boycott, or wear clothing that supports a cause you care about, you're almost guaranteed to connect with like-minded peers. It's a direct path to making friends, and spending time with friends is one of the simplest, most powerful forms of self-care.

Activism helps you channel and process anger. It's natural and healthy to feel angry when you see people being treated unfairly because of their gender, race, or socioeconomic status; watch animals suffer in shelters; or hear about the devastating effects of climate change. But stewing in anger can make your mental health worse. Letting it fuel you to make change helps you process and alleviate your anger. Instead of feeling helpless and powerless in the face of bad news, you can feel like you're a part of changing it.

Activism connects-instead of isolates-us. Whether you're marching for gun safety, posting #MeToo on Insta, or attending a screening of "Save the Bees!," everyone is united in working for something greater than themselves. The cause becomes the thing that brings you together and eliminates the ways we label, isolate, or even bully each other.

Activism lowers stress hormones. Studies have shown that volunteering and performing acts of kindness can lower levels of cortisol and reduce inflammation in the body. That can have a range of health benefits, including strengthening your immune system, improving your cardiovascular health, and lowering your risk of chronic diseases.

Activism helps you feel less alone. Everyone struggles with something. If it's not depression, addiction, or poor body image, it's food insecurity, religious oppression, or one of thousands of other challenges. Volunteering lets you step outside yourself for a moment and do something for others. It can be a good distraction from tough times or drama, and it sends your mind and body a powerful message: I can make a difference, and I matter.

Activism helps you share your values with the world. By talking about-and taking action for-a cause you care about, you are telling the world what matters to you, which helps you be seen for something you care about.

Activism can reduce feelings of loneliness and depression by increasing our social connection and sense of purpose. Overall, experiencing a helper's high can contribute to a greater sense of well-being and a more positive outlook on life.

We talked with teens and young adults across the country to find out what activism does for them and their mental health.

Jenna Landau, 18, Lincolnshire, Illinois

"I struggle with severe anxiety, but I have found outlets in the clubs at my high school. For Feminism Club, we took the train into Chicago to march to defend abortion rights in fall 2022. Roe v. Wade had recently been overturned by the Supreme Court, and I was angry. My family and I are very split politically, so being able to stand up for a cause I'm so passionate about made me feel like I had a voice.

"In choir, we volunteer every semester with Feed My Starving Children, packaging food to send to children in need. The vibe is so good. We play music and jam along as we pack, always trying to beat the number of boxes we packed last semester. When I'm there, all I'm thinking about is, 'How many boxes can I get done?' I know that the more boxes I pack, the more kids I'll help feed. It serves as a very positive distraction from whatever I'm struggling with, and we know we're doing a good thing.

"I've also volunteered as a personal shopper at an annual free pop-up prom shop. Just seeing the confidence and smiles on these girls' faces when they found the perfect dress was amazing. The anxiety of not being able to afford a prom dress completely washed away. I helped make that happen.

"I'm not super out there socially. I have one best friend. That's it. But with every group I join, I meet new people. It's really uplifting. I've felt like an outsider a lot of my life, and being a part of these clubs and volunteer activities has helped me embrace myself."

Bennie Williams, 22, Atlanta

"In 2020, when I was an undergrad student at Morehouse College in Atlanta, my friends and I got tired of seeing the same images of people who looked like us encountering police violence-and injustice in general. George Floyd, of course, but also the violence we'd hear about in our city that doesn't make the news. We wanted our voices to be heard. In the beginning, it was just a few of us talking to each other, a lot of FaceTime group chats with us asking, 'What can we do?' We made flyers advertising a protest at the state capitol and reached out to some organizers on Instagram for advice. It wasn't the biggest protest ever, but there was a lot of representation, including other ally groups and our parents.

"It was empowering to connect with people over the same mission, including those in other cities. But it also became really tiring, especially with school and COVID. After a couple of months, I found it hard to keep coming up with fresh ideas, and I was struggling to keep up with my organizing meetings along with all my school assignments. I wish someone had told me to prioritize rest and decompress, and to keep doing things I enjoy, like reading and writing. I definitely got burned out.

"I'm currently news editor for our campus newspapers, so I stay involved by covering student movements on campus. I'll cover protests even if they challenge our institution, like when students recently spoke out against the construction of the Atlanta Public Safety Training Center , also known as Cop City, and demanded the funds be reallocated to investing in the Atlanta community. Students come up to me and say, 'Thank you for putting this out there.'"

Search Resource Center

Type your search term below

# data[].attributes.attachment_link.title
How to Use Activism as Self-Care | The Jed Foundation

# data[].attributes.attachment_link.description
By Leslie Goldman As a longtime Girl Scout, Hikmah Jamal has had plenty of opportunities to engage in community service. In sixth grade, she helped raise funds for a local Islamic school to purchase books for its struggling library. She made and donated no-sew blankets to a hospital for patients with cancer during her first year of high school.

# data[].attributes.attachment_link.title
Tales from a Teenage Mental Health Advocate

# data[].attributes.attachment_link.description
Fifteen-year-old Amanda Southworth, discusses how her struggle with mental illness and suicidal thoughts inspired her start coding. She used this outlet as a tool to develop apps designed to help others stop suffering in silence and find the courage to reach out and change their life.

# data[].attributes.attachment_link.title
Why We Need to Re-Brand Adolescent Mental Health

# data[].attributes.attachment_link.description
It is crucial that we re-brand mental health awareness & services for young people. Amber Cowburn is a Cambridge graduate, unwavering mental health advocate and Founding Trustee of The Invictus Trust: a charity which aims to raise awareness and support teenagers in Cornwall who are suffering from poor mental health.

# data[].attributes.attachment_link.title
How to Listen and Be Heard – Ant Clemons

# data[].attributes.attachment_link.description
Learn about the risk factors and mental health issues affecting today's LGBTQ young people.

# data[].attributes.attachment_link.readable_text
Mental Health America works nationally and locally to raise awareness about mental health and ensures that those at-risk for mental illnesses and related disorders receive proper, timely and effective treatment. MHA incorporates culturally competent strategies to ensure that it is effectively addressing the treatment and psychosocial needs of consumers and families with diverse values, beliefs, sexual orientations, and backgrounds that vary by race, ethnicity and/or language.

Demographics/Societal Issues

Cultural Factors

Many Native/Indigenous tribes embrace a worldview that encompasses the notions of connectedness (with the past and with others), strong family bonds, adaptability, oneness with nature, wisdom of elders, meaningful traditions and strong spirit that may serve as protective factors when it comes to mental health.

Prevalence

Treatment Issues

The concept of mental illness and beliefs about why and how it develops have many different meanings and interpretations among Native/Indigenous people. Physical complaints and psychological concerns are not distinguished, and Native/Indigenous people may express emotional distress in ways that are not consistent with standard diagnostic categories.

Native/Indigenous people who meet the criteria for depression, anxiety, or substance abuse disorders are much more likely to seek help from a spiritual and/or traditional healer than from specialty or other medical sources.

Due to high levels of poverty, many Native/Indigenous people in America face economic barriers that prevent them from receiving treatment.

Lack of awareness about mental health issues and services that are available and a lack of programs and providers that are sensitive to native and indigenous culture can prevent Native/Indigenous people from receiving treatment.

Access/Insurance

Access to mental health services is severely limited by the rural, isolated location of many Native/Indigenous communities. Additionally, access is limited because most clinics and hospitals of the Indian Health Service are located on reservations, yet the majority of Native/Indigenous people in America live outside of tribal areas.

Compared to non-Hispanic whites, nearly 3 times as many Native/Indigenous people had no health insurance - 5.9 percent compared to 14.9 percent. Approximately 43 percent of Native/Indigenous people in America rely on the Medicaid or public coverage.

Mental Health Resources for Native and Indigenous Communities

Indigenous Story Studio: creates illustrations, posters, videos, and comic books on health and social issues for youth (Canada-based)

One Sky Center: The American Indian/Alaska Native National Resource Center for Health, Education, and Research; mission is to improve prevention and treatment of mental health and substance use problems and services among Native people

WeRNative: a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities and nation at large

StrongHearts Native Helpline: The StrongHearts Native Helpline (1-844-762-8483) is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT.

Partnerships and Resources
GLSEN's Website on Native and Indigenous LGBTQ Youth in U.S. Schools Two Spirit and LGBTQ Health "Celebrating Our Magic" Toolkit from NPAIHB Indian Health Services, U.S. Department of Health and Human Services National Center for American Indian and Alaska Native Mental Health Research

# data[].attributes.attachment_link.title
Native and Indigenous Communities and Mental Health

# data[].attributes.attachment_link.description
Mental Health America works nationally and locally to raise awareness about mental health and ensures that those at-risk for mental illnesses and related disorders receive proper, timely and effective treatment. MHA incorporates culturally competent strategies to ensure that it is effectively addressing the treatment and psychosocial needs of consumers and families with diverse values, beliefs, sexual orientations, and backgrounds that vary by race, ethnicity and/or language.

# data[].attributes.attachment_link.readable_text
Poor Mental Health Impacts Adolescent Well-being

The number of adolescents reporting poor mental health is increasing.

Building strong bonds and connecting to youth can protect their mental health.

Schools and parents can create protective relationships with students and help them grow into healthy adulthood.

Adolescent Mental Health Continues to Worsen

CDC's Youth Risk Behavior Surveillance Data Summary & Trends Report: 2011-2021 [PDF - 10 MB] highlights concerning trends about the mental health of U.S. high school students.

In 2021, more than 4 in 10 (42%) students felt persistently sad or hopeless and nearly one-third (29%) experienced poor mental health.

In 2021, more than 1 in 5 (22%) students seriously considered attempting suicide and 1 in 10 (10%) attempted suicide.

These data bring into focus the level of distress many students are experiencing.

Some groups are more affected than others.

Why Is This a Big Deal?

Poor mental health in adolescence is more than feeling blue. It can impact many areas of a teen's life. Youth with poor mental health may struggle with school and grades, decision making, and their health.

Mental health problems in youth often go hand-in-hand with other health and behavioral risks like increased risk of drug use, experiencing violence, and higher risk sexual behaviors that can lead to HIV, STDs, and unintended pregnancy.

Because many health behaviors and habits are established in adolescence that will carry over into adult years, it is very important to help youth develop good mental health.

The good news is that teens are resilient, and we know what works to support their mental health: feeling connected to school and family.

Fortunately, the same prevention strategies that promote mental health-like helping students feel connected to school/family-help prevent a range of negative experiences, like drug use and violence.

Building strong bonds and relationships with adults and friends at school, at home and in the community provides youth with a sense of connectedness.

This feeling of connectedness is important and can protect adolescents from poor mental health, and other risks like drug use and violence.

Youth need to know someone cares about them. Connections can be made virtually or in person.

There is a Role for Everyone in Supporting Teen Mental Health

As we've learned nationally during the COVID-19 pandemic, schools are critical in our communities to supporting children and families. While the expectation is that schools provide education, they also provide opportunities for youth to engage in physical activity and academic, social, mental health, and physical health services, all of which can relieve stress and help protect against negative outcomes.

However, the pandemic disrupted many school-based services, increasing the burden on parents, increasing stress on families, and potentially affecting long-term health outcomes for parents and children alike, especially among families already at risk for negative health outcomes from social and environmental factors.

Critical supports and services need to be comprehensive and community wide and should include:

Help students cope with emergencies and their aftermath.

Provide safe and supportive environments-whether in person or virtually.

Linking students to mental health services.

Integrating social emotional learning.

Training staff.

Supporting staff mental health.

Reviewing discipline policies to ensure equity.

Building safe and supportive environments.

Communicate openly and honestly, including about their values.

Supervise their adolescent to facilitate healthy decision-making.

Spend time with their adolescent enjoying shared activities.

Become engaged in school activities and help with homework.

Volunteer at their adolescent's school.

Communicate regularly with teachers and administrators.

Ask adolescents about family relationships and school experiences as a part of routine health screenings.

Encourage positive parenting practices.

Engage parents in discussions about how to connect with their adolescents, communicate effectively, and monitor activities and health behaviors.

Educate parents and youth about adolescent development and health risks.

Parents and families may find the following resources helpful to support the mental and emotional well-being of their adolescents:

# data[].attributes.attachment_link.description
Learn about the teen mental health crisis, who is at most risk, and how schools and families can protect teen mental health.

# data[].attributes.attachment_link.readable_text
Even before the pandemic, demand for mental health and substance use services was increasing, especially for our nation's young people. The COVID-19 pandemic has only made the situation more challenging, subjecting many young Americans to social isolation, loss of routines, and traumatic grief. Epidemiological data now show alarming rates of behavioral health needs among school-age youth, with significant increases in the number experiencing moderate to severe anxiety and depression. Even more concerning, suicide remains the second leading cause of death among young people between the ages of 10 and 24. Mental health emergencies among young people have increased across the board. In 2020, there was a 24 percent increase in emergency room visits for mental health reasons for children ages 5 through 11, and a more than a 30 percent increase in visits for those between 12 and 17 years old.

Unfortunately, a significant proportion of our nation's youth still lack access to affordable health care coverage. Even for those with coverage, gaps in access to behavioral health care services remain. Significant disparities also exist for young people of color, Indigenous youth, and LGBTQ+ youth, denying many young people the behavioral health services and supports they need to thrive.

Eliminating these barriers and expanding the full continuum of prevention, treatment, and recovery services, as well as prioritizing integration of these services into settings where young people and their families can access them, are key priorities for the Biden-Harris Administration. This is why, today, on the heels of World Mental Health Day, the Department of Education is announcing a new resource, "Supporting Child and Student Social, Emotional, Behavioral and Mental Health," that outlines key challenges in providing and accessing mental health supports in schools and provides evidence-based recommendations for educators, staff, and providers to create a system of supports for students with behavioral health needs and their families.

The release of this new resource builds on the Administration's emphasis on youth mental health and substance use since taking office, including:

Ensuring Access to Quality, Affordable Health Care

Connecting Children to Coverage. Access to coverage is the first step to improving care for mental health and substance use conditions. Medicaid and the Children's Health Insurance Program (CHIP) serve as critical sources of coverage for children and youth, covering nearly 39 million children nationwide and providing robust coverage for mental health and substance use conditions, including services provided at school. The Biden-Harris Administration is committed to continuing the progress made in children's coverage rates since the enactment of the Affordable Care Act (ACA) by making sure children are connected to coverage. In May, Connecting Kids to Coverage, a national outreach and enrollment initiative that reaches out to families with children and teens eligible for Medicaid and CHIP, launched a campaign with a particular emphasis on mental health. This Administration is also committed to ensuring children, youth, and their families have access to quality and affordable coverage through HealthCare.gov and state-based Marketplaces, quadrupling the number of Navigator organizations available to help young people and their families enroll in coverage through HealthCare.gov, Medicaid and CHIP.

Strengthening Quality of Care. The Biden-Harris Administration is also committed to strengthening the quality of care provided to - and health outcomes of - children enrolled in Medicaid and CHIP. This commitment includes supporting state reporting on a range of quality of care measures that encompass both physical and behavioral health. All measures on the Medicaid and CHIP Child Core Set will become mandatory for states to report starting in 2024.

Investing in Community-based Youth Mental Health and Substance Use Care

Dedicating American Rescue Plan Funds to Youth Mental Health. The American Rescue Plan provided $80 million for the Pediatric Mental Health Care Access program, which promotes integrating care for behavioral health needs into pediatric primary care settings, and directed $20 million to support youth suicide prevention programs to help reduce risks and deliver crisis services. In addition, the American Rescue Plan provides $10 million to support the National Child Traumatic Stress Network, which raises the standard of care and improves access to services for traumatized children, their families, and their communities; $50 million for community-based funding for local behavioral health needs worsened by the pandemic; and $30 million for community-based funding for local substance use services. The American Rescue Plan also invested $420 million in the Certified Community Behavioral Health Clinics (CCBHC) expansion grant program, which increases access to and improves the quality of community mental health and substance use disorder treatment services. CCBHCs provide person- and family-centered integrated services, including 24/7 crisis intervention services for individuals with serious mental illness or substance use disorders, including opioid use disorders; children and adolescents with serious emotional disturbance; and individuals with co-occurring mental and substance disorders.

Enhancing Access to Youth Behavioral Health Services Across the Continuum. The Department of Health and Human Services (HHS) has invested approximately $190 million in supporting initiatives to advance access to behavioral health services for youth. This includes:

Project LAUNCH (Linking Actions for Unmet Needs in Children's Health): Makes grants to promote the wellness of young children, from birth to 8 years of age, by addressing social, emotional, cognitive, physical, and behavioral aspects of their development.

The Children's Mental Health Initiative: Improves the mental health outcomes for children and youth, birth through age 21, with serious emotional disturbance, and their families. This program supports the implementation, expansion, and integration of the Systems of Care approach by creating sustainable infrastructure and services that are required as part of the Comprehensive Community Mental Health Services for Children and their Families Program.

The Infant and Early Childhood Mental Health Grant Program: Improves outcomes for young children by increasing access to high quality infant and early childhood mental health promotion, prevention, early intervention, and treatment services.

The Native Connections Grant Program: Helps American Indian and Alaska Native communities identify and address the behavioral health needs of Native youth.

The Statewide Family Network: Supports statewide, nonprofit, family-run organizations supporting families with children with serious emotional disturbance.

The Youth and Family TREE Grant Program: Enhances and expands comprehensive treatment, early intervention, and recovery support services for adolescents), transitional aged youth, and their families/primary caregivers with SUDs and/or co-occurring substance use and mental disorders.

Preventing Youth Substance Use. In September, the Office of National Drug Control Policy (ONDCP) announced $13.2 million in grants for 106 Drug-Free Communities Support Programs across the country. The grants provide funding to community coalitions working to prevent youth substance use through evidence-based prevention strategies. In June, ONDCP announced $3.2 million for 65 communities nationwide for its Community-Based Coalition Enhancement Grants to Address Local Drug Crises Program to reduce youth use of opioids or methamphetamines and misuse of prescription drugs. All these programs support the Biden-Harris Administration's Drug Policy Priorities for Year One, which include evidence-based efforts to prevent and reduce youth substance use.

Increasing School-Based Behavioral Health Supports

As students have returned to school this fall, supporting their mental health is a top priority for the Biden-Harris Administration. Research shows that students are more likely to receive behavioral health supports if they are offered at school. This summer, the Department of Education launched its Return to School Roadmap, which highlights as one of three landmark priorities supporting students' social, emotional, and mental health needs.

Supporting Student Mental Health with American Rescue Plan Resources. To support our students hit hard by the pandemic, the American Rescue Plan provided $122 billion in relief funds for schools to help them reopen safely and address the mental health, social, emotional, and academic needs of students. The Department has strongly encouraged school districts to use these funds to hire school psychologists, counselors, social workers, nurses and other health professionals to address the behavioral health needs of students and fund other strategies to support students' mental health. States and school districts are using these and previous rounds of relief funding to expand access to services for students and their families. For example:

The Oklahoma State Department of Education is creating the Oklahoma School Counselor Corps grant program, which will provide funds for school districts to hire school counselors and other school-based mental health professionals.

The Iowa Department of Education is providing grants to school districts to help them meet mental health needs and provide wraparound services for students and families. In addition, the Iowa Department of Education is partnering with the University of Iowa's Baker Teacher Leader Center to establish a new Center for School Mental Health that will provide training and professional development to both student teachers and practicing teachers.

The New Hampshire Department of Education has teamed with the Community Behavioral Health Association to use relief funding for mental health training for summer camp counselors and enable mental health staff to be on-site at camps.

The Arizona Department of Education is investing federal recovery dollars to hire school counselors and social workers.

The Cleveland Teachers Union and Cleveland Metropolitan School District are working together to increase student access to highly qualified school health professionals. The District has announced plans to hire 50 school nurses and 45 licensed practical nurses for 94 campuses in the 2021-2022 school year.

The New York City Department of Education plans to hire 500 social workers this year and has already hired more than 90 percent of them. City officials say the infusion of new mental health support staff - which includes school psychologists - will ensure every school has at least one full-time social worker or mental health clinic.

The American Rescue Plan also included $30 million for Project AWARE, an HHS grant program for state and tribal education agencies to advance wellness and resiliency for children and youth in school-based settings. This program funds school-based activities designed to increase awareness of mental health issues among school-aged youth, provide training for school professionals to help them identify and respond to mental health issues, and to connect school-aged youth to services. Project AWARE sites have been established in Indiana, Montana, North Carolina, and Washington, as well as the Saginaw Chippewa Indian Tribe of Michigan, among others.

Creating mental health resources for schools. The Department of Education has provided multiple resources that highlight evidence-based practices to support students' social, emotional, and mental health needs that the American Rescue Plan can fund, including the COVID-19 Handbook, Volume 2: Roadmap to Reopening Safely and Meeting All Students' Needs, the Safer Schools and Campuses Best Practices Clearinghouse, COVID-19 Handbook, Volume 3: Strategies for Safe Operation and Addressing the Impact of COVID-19 on Higher Education Students, Faculty, and Staff; and other guidance. The Department also featured approaches to supporting student mental health in the Lessons from the Field webinar series and the Summer Learning and Enrichment Collaborative, which brought together and supported state, district, and community leaders in using American Rescue Plan funds to implement meaningful summer learning and enrichment opportunities, particularly for students most impacted by the pandemic. In addition, the Department's technical assistance centers-the Comprehensive Centers, the Center to Improve Social and Emotional Learning and Improve School Safety, the Center on Positive Behavioral Interventions and Supports, and the National Center on Safe and Supportive Learning Environments-provide resources and support on addressing trauma and supporting students' mental health. Last week, the Department released a Dear Educator Letter, and, along with the Department of Justice, released a fact sheet and Dear Colleague Letter that provide information on Federal civil rights laws that protect students with mental health disabilities and grant an equal opportunity to learn.

Developing K-12 mental health promotion toolkit. The Centers for Disease Control and Prevention has also funded a project to synthesize the best available research and practice into a toolkit that describes how to develop, implement, evaluate, and sustain a comprehensive, developmentally and culturally appropriate, mental health promotion program in K-12 schools. This guide for K-12 schools will help them identify and prioritize a comprehensive and integrated set of strategies to promote equitable mental health and resilience, and reduce symptoms associated with poor mental health, such as depression and anxiety. The primary end users of this technical package are school district and school-level administrators.

Establishing interagency working group. In addition, the Departments of Health and Human Services and Education have established an interagency working group to improve the delivery of health care services in schools, including mental health and substance use services. The interagency working group will primarily focus on school-based health services reimbursed by Medicaid, and will work to strengthen the interagency coordination for these vital services, and identify more actions the federal government can take to support this work.

Laying the Groundwork for Future Improvements in Youth Mental Health and Substance Use Prevention and Treatment

Engaging Youth in Solution Setting. The Department of Health and Human Services recently announced a collaboration with MTV Entertainment Group to host a Youth Mental Health Forum in early 2022. The forum will focus on inspiring and encouraging young people to take steps to improve their own mental health and to check in on each other.

Enhancing coordination across HHS. In May, HHS formed a new Behavioral Health Coordinating Council (BHCC) to serve as a coordinating body across the Department. One of the five BHCC focus areas includes child and youth behavioral health. Led by the Administration for Children and Families and the Center for Medicare & Medicaid Services, this work will help to drive improvements and integration of child, youth and family-centered behavioral health programs and activities across HHS. Over the coming months, the youth work of the BHCC will include a focus on improving the coordination and access to behavioral health services for children, youth, and parents involved or at risk of entering the child welfare system; ensuring that children and youth are accessing behavioral health services and supports in the most integrated setting possible; and identifying opportunities to support resilience in children and youth affected by trauma and disasters.

Highlighting the Pandemic's Impact on Youth Mental Health. The Office of the U.S. Surgeon General is launching an effort to highlight the pandemic's impact on youth mental health and promote recommendations to support the mental health of young people. In the coming months, this will include convening stakeholders, engaging in school visits, and developing resources to better understand the unique challenges that young people face and ways the federal government can further address these challenges.

FY 2022 Budget. President Biden's FY22 discretionary budget calls for more than doubling the funding to address mental health and substance use. These additional resources would be used to support youth with behavioral health needs and their families, partner mental health providers with law enforcement, expand suicide prevention, and support the hiring of school-based health professionals. This includes:

$1 billion for a new School-Based Health Professionals program that will help build the pipeline and support the hiring of school counselors, nurses, social workers, and school psychologists, working towards the President's goal to double the number of these staff.

$443 million for community schools, an increase of more than $400 million, to establish schools that offer wraparound services for students and their families, including supporting mental health, through partnerships with community-based organizations.

$1.6 billion for the Community Mental Health Service Block Grant, which doubles the funding over the prior fiscal years. This funding serves as a critical safety net for mental health services for the nation's most vulnerable populations, including children with serious emotional disturbances.

$191.5 million for Project AWARE, an increase of more than $60 million.

$375 million for Certified Community Based Behavioral Health Centers (CCBHCs) an increase of $125 million over prior years. This funding will support a new cohort of 158 grants and 22 continuation grants, and serve to increase access to and improve the quality of community mental and substance use disorder treatment services, including for children and adolescents with serious emotional disturbance.

$36.9 million for Youth Suicide Early Intervention and Prevention Strategies, which includes funding to support the Garrett Lee Smith Youth Suicide Prevention Grant programs. These programs deliver critical early intervention and suicide prevention services through State/Tribal grants as well as Campus grants.

$10 million for the Pediatric Mental Health Care Access Program, which will continue to support the development or improvement of statewide or regional pediatric mental health care telehealth access programs. These programs provide tele-consultations, training, technical assistance and care coordination for pediatric primary care providers to assist their work in managing children with behavioral health conditions.

This is only the beginning. The Biden-Harris Administration will continue its work to improve youth mental health, expanding access to affordable, quality services across the continuum of prevention, treatment, and recovery, and eliminating the stigmatization of those who need help.

For more information, see Fact Sheet: Efforts Across HHS to Promote Behavioral Health for Children and Youth | HHS.gov

###

# data[].attributes.attachment_link.title
FACT SHEET: Improving Access and Care for Youth Mental Health and Substance Use Conditions | The White House

# data[].attributes.attachment_link.description
Even before the pandemic, demand for mental health and substance use services was increasing, especially for our nation's young people. The COVID-19 pandemic has only made the situation more challenging, subjecting many young Americans to social isolation, loss of routines, and traumatic grief.

# data[].attributes.headline
U of M Article: Racial & Ethnic Inequity

# data[].attributes.subject
U of M Article: Racial & Ethnic Inequity

# data[].attributes.attachment_link.provider_name
Institute for Healthcare Policy & Innovation

# data[].attributes.attachment_link.readable_text
ANN ARBOR, Mich. - Teens in the U.S. have more availability of mental health care than they did two years ago, according to a new survey from the University of Michigan National Voices Project, but access is not equal in all communities.

In a 2014 National Voices Project survey, 40 percent of adults said teens in their communities had lots of availability for mental health care. In a 2012 survey, only 30 percent of adults reported lots of availability. In comparison, 59 percent of adults in 2014 said that teens had lots of availability for primary care.

Adults' perceptions of healthcare availability were much different in communities where respondents perceived some or many racial/ethnic inequities. In these communities, just 35 percent of adults saw lots of availability for teens to get mental health care in 2014, up from 24 percent in 2012.

For the communities with few or no racial/ethnic inequities, 54 percent of adults perceived lots of availability for mental health care for teens, an improvement from 39 percent in 2012.

"Access to mental health care for teens remains a problem," says Matthew M. Davis, M.D., M.A.P.P., director of the National Voices Project and professor of pediatrics, internal medicine, public policy, and health management and policy at the University of Michigan.

"The good news is that adults are seeing improvements in access for teens in their communities in comparison with 2012. However, the bad news is that they are still seeing significant disparities in healthcare access for teens in communities where they perceive racial and ethnic inequities.

"Furthermore, mental health services are perceived as much less available than primary health care services for teens," says Davis, who is deputy director of the U-M Institute for Healthcare Policy and Innovation. "Given how common mental health concerns are among adolescents, improving access to behavioral services is as important as enhancing access to primary care."

Mental health services for children are also the subject of this month's C.S. Mott Children's Hospital National Poll on Children's Health. The poll, also directed by Davis, surveyed parents across the U.S. and found that many were reluctant to discuss their children's behavioral and emotional concerns with their doctors. Both surveys, released during Mental Health Awareness Month in May, highlight the continued need to improve mental health care for young people in the U.S.

These data are part of the sixth survey from the National Voices Project, conducted in September to October 2014.

Full Report: http://nationalvoicesproject.org/healthcare-availability-2014
Full Size Infographic: http://nationalvoicesproject.org/sites/default/files/resources/infographic_healthcareavailability2014.png
Data Source: Data are based on responses from National Voices Project 2014 Survey, fielded September-October 2014. The National Voices Project is conducted in partnership with GfK, an international survey research organization that maintains KnowledgePanel®, a nationally representative web-enabled panel of adult members of households across the United States. Survey respondents included 2,147 adults from 50 states and D.C. that work or volunteer with children. 1,082 respondents have jobs that affect education, healthcare, economic opportunities, or community and civic engagement for children. Another 1,065 respondents volunteer in ways that affect education, healthcare, economic opportunities, or community and civic engagement for children.

About the National Voices Project: The University of Michigan National Voices Project is an effort to bring the perspectives of thousands of people to the national dialogue about children. Children thrive on opportunity. But when opportunities differ because of children's race or ethnicity, where they live, or because of who they are, children face barriers in their health, education, and economic security and success. Measuring disparities for children is a key step toward addressing disadvantage. Careful measurement of sensitive issues can bring greater understanding. In turn, understanding informs new initiatives that can lead to meaningful changes for children. The National Voices Project is funded through the W.K. Kellogg Foundation as part of the America Healing initiative.

Connect with the National Voices Project: Web: NationalVoicesProject.org Facebook: http://www.facebook.com/nationalvoicesproject Twitter: @NatlVoices

Findings from the National Voices Project do not represent the opinions of the investigators or the opinions of the University of Michigan.

# data[].attributes.attachment_link.title
Access to mental health care for teens improving, but less for communities with disparities

# data[].attributes.attachment_link.description
ANN ARBOR, Mich. - Teens in the U.S. have more availability of mental health care than they did two years ago, according to a new survey from the University of Michigan National Voices Project, but access is not equal in all communities.

# data[].attributes.attachment_link.readable_text
Promoting children's mental and behavioral health ¹ underlies healthy development and health equity across the lifespan. Advances across broad areas of behavioral, social and neuroscience inform practice, programs, and policy in child and adolescent mental and behavioral health. ²

The Importance of Development

Most common mental disorders, including those with the greatest morbidity, have an onset in childhood or adolescence (Kessler & Wang, 2008), with the peak incidence for common disorders occurring during adolescence (Paus, Keshavan, & Giedd, 2008). While some disorders (e.g., depression) typically develop during adolescence, others (e.g., attention deficit disorder) may have an earlier onset, but remain undiagnosed due to developmental context or limitations in screening and assessment. Childhood and adolescence provide critical periods for prevention, early detection, and intervention to promote child mental and behavioral health . Advances in brain imaging (Giedd J., Raznahan A., Alexander-Bloch A., Schmitt E., Gogtay N., & Rapoport J.L. ,2015), neuroscience (Casey, Getz, & Galvan, 2008; Luciana & Collins, 2012; Strang, Chein, & Steinberg, 2013) and behavioral science (Albert, Chein, & Steinberg, 2013; Smith, Chein, & Steinberg, 2013) have shown that there are critical environmental and genetic developmental influences on child and adolescent mental health, across biological, socioemotional, and behavioral domains ³. For example, early childhood is a period in which essential skills for self-regulation begin to develop (Berger, 2011; Diamond, 2013; Skinner & Zimmer-Gembeck, 2009), while adolescence is a period in which numerous risks become salient (National Research Council and Institute of Medicine , 2011), such as increased vulnerability to sensation-seeking, risk-taking behaviors, and susceptibility to peer influence. This can result in, among other things, enhanced vulnerability to substance use and addiction (Chambers, Taylor, & Potenza, 2003), including opioids (Wall et al., 2018). Moreover, research has identified multiple pathways and several risk factors leading to the development of mental and behavioral disorders in children and adolescents (Cross-Disorder Group of the Psychiatric Genomics Consortium, 2013; Frick, 2012; Latimer et al., 2012; Reiss, 2013). Disorder presentations are affected by biological determinants, environmental influences and genetics, including prenatal development and exposures and subsequent nutrition, in an interplay that is multi-determined and complex (Dunn et al., 2011; Tercyak, 2010). For example, research in epigenetics has shown that environmental and social factors (such as prenatal substance abuse, lead, pesticides, and other common, everyday exposures) alter gene expression, and experience interacts with genetic predisposition (Szyf, 2009). Clinicians and psychological scientists recognize that the etiological factors and behavioral expression of childhood disorders often overlap and interact, and co-morbidities are common. Some conditions, particularly developmental and intellectual disabilities, render children and adolescents vulnerable to under-diagnosis of co-morbid mental health and health problems ("diagnostic overshadowing") (Matson & Williams, 2013).

Different pathways can progress to either mental and behavioral health symptoms or a diagnosable mental and behavioral disorder. These pathways involve multiple and interacting risk factors (described below) ³ that influence periods of vulnerable development (Frick, 2012, 2016). Psychological and psychiatric research has found these factors to be interrelated in the development of a range of psychological problems, including disruptive behavior disorders (attention deficit hyperactive disorder, oppositional defiant disorder, and conduct disorder), depression and mood disorders, anxiety, posttraumatic stress disorders, obsessive compulsive disorders, eating and feeding disorders, schizophrenia, autism spectrum disorder, and intellectual disabilities (World Health Organization, 2018). Importantly, some mental health conditions with an onset during childhood are associated with heightened mortality (e.g., developmental disabilities, Hirvikoski, et al., 2016; mood disorders, Goldstein, 2009).

Structural Determinants of Mental and Behavioral Health

Environmental risk factors that function as structural determinants of health include socioeconomic status, adverse and risky environmental conditions, and educational opportunities and outcomes. Low socioeconomic status (SES), indicated by lower household income, educational status, and poverty, is associated with greater risk of developing a mental and behavioral disorder than children and adolescents of middle or high SES (APA, 2018b; Reiss, 2013). Although SES is viewed as a family characteristic (human capital), low SES is often associated with structural and community level characteristics, such as systemic racism and oppression that drive policies that force families into under-resourced and unstable conditions. For example, children in lower SES families often receive inadequate physical and mental health care, leading to higher risk for mental and behavioral health problems and psychological disorders (e.g., Reiss, 2013; Russell, Ford, Williams, & Russell, 2016; Yoshikawa, Aber, & Beardslee, 2012).

Inadequate and inequitable educational opportunities and poor educational attainment are both risk factors for the development of psychological disorders and an outcome of serious mental and behavioral health problems in childhood and adolescence. For example, lower parental education is associated with development of mental and behavioral disorders in their children, likely related to low SES. Poor parental educational attainment often limits educational opportunities for the child and is related to the child's mental and behavioral health status. In contrast, positive academic performance is a strong indicator of subsequent positive life course outcomes (e.g., employment) as well as underrepresentation in psychiatric populations, drug use, school dropout and subsequent legal trouble (Farn & Adams, 2016).

Additionally, when children have a mental and behavioral health disorder, they often develop academic impairments or difficulties leading to educational underachievement due to frequent absences, higher rates of suspension or expulsion, or failure and drop out from high school (Breslau, Lane, Sampson, & Kessler, 2008; Russell, Ford, Williams, & Russell, 2016; Veldman, Bültmann, Almansa, & Reijneveld, 2015; Veldman, et al., 2015).

Risk factors in the environment, such as prenatal exposure to toxins including maternal cigarette smoking and alcohol use, chemical contaminants in the environment, and maternal stress, can influence development of mental and behavioral health disorders in infancy, childhood, and adolescence (Latimer et al., 2012; Frick, 2016). Later in development, psychosocial environment conditions (such as inadequate child care, ineffective family discipline, family disruption, deviant peer influences, childhood trauma from maltreatment, discrimination, family separation, or disasters, and neighborhoods with exposure to violence) influence the development of psychological disorders (Benner et al., 2018; Frick, 2012, 2016; Kearney, Wechsler, Kaur, & Lemos-Miller, 2010; Latimer et al., 2012).

Additionally, research shows that toxic stress (prolonged exposure to trauma and the biological stress response) impacts early brain development and later brain function, including executive functions such as control over emotions and impulses (APA, 2018b; Center on the Developing Child, 2014; Shonkoff & Gardner, 2012). A landmark study documented the profound impact of adverse childhood experiences on later adult health outcomes (Felitti et al., 1998), and subsequent research has clarified that this lifelong effect is due to significant changes in the nervous, endocrine and immune systems from prolonged exposure to the stress response (Danese & McEwan, 2012). In short, health across the lifespan is impacted by early childhood experiences (Conti & Heckman, 2013; Halfon & Hochstein, 2002; Halfon, Wise, & Forrest, 2014). However, research shows that the impact of environmental risk factors can be lessened or even prevented through building resilience (Masten, 2014), which, in turn, can be promoted through prevention and early intervention (Center on the Developing Child, 2015; Leslie et al., 2016). Moreover, reducing environmental risk factors has the potential to promote emotional health early in the life cycle (Center on the Developing Child, 2015).

Mental and Behavioral Health Disparities

Although all children and families may have difficulty accessing and utilizing adequate and effective mental and behavioral health services, low SES and minority children and adolescents have an even greater difficulty in receiving quality mental and behavioral health care. Minority stress and adverse experiences influence mental and behavioral health within oppressed populations, such as defined by gender, race and ethnicity, gender identity and sexual orientation, immigration status, physical, developmental, and intellectual disabilities, or chronic medical conditions.

Mental and behavioral health challenges in children and adolescents vary significantly by race and ethnicity, with higher rates of moderate and severe challenges among Hispanics and African Americans than among non-Hispanic Whites (Alegría, Green, McLaughlin, & Loder, 2015; Kataoka, Zhang, & Wells, 2002). Studies show that in comparison to their non- Hispanic White counterparts, racial/ethnic minority adolescents have similar or lower rates of mental and behavioral health challenges (Chatterji, Alegría, & Takeuchi, 2009; Kessler et al., 2005). However, while racial/ethnic minority adolescents do have similar rates, the course of mental and behavioral health challenges appears to be more persistent for them than for their non-minority counterparts (Chatterji, Alegría, & Takeuchi, 2009; Kessler et al., 2005). A recent report on mental health disparities identified four determinants of racial/ethnic minority mental health burden in children and adolescents (Alegría, Green, McLaughlin, & Loder, 2015). First, socioeconomic status, which can impact all children (as noted above) but disproportionately disadvantages racial/ethnic minority children, has been linked with material deprivation, perceived minority status, and higher levels of family stress, which contribute to mental health disparities (Dennis et al., 2003; Melchior et al., 2009). Second, family structure, such as single parent homes and step- families, contributes to mental health disparities through increased exposure to adverse childhood experiences (Wang, 2004), early transition to adult roles (Molina, Alegría, & Chen, 2012), and burdened parental capacities (Dennis et al., 2003; Shonkoff et al., 2012). Third, as noted above, adverse childhood experiences, particularly early and chronic exposure, have a negative impact on lifelong health (Shonkoff et al., 2012). Finally, neighborhood and social stress contribute to mental and behavioral health disparities via residential segregation, economic disadvantage, mobility, and violence and environmental toxicity (Sampson, Morenoff, & Gannon-Rowley, 2002).

In addition to the mental and behavioral health burden experienced by racial/ethnic minority children and adolescents, significant barriers exist in their access to and utilization of mental and behavioral health services (Austin & Wagner, 2010). For example, attitudes and beliefs about mental and behavioral health, due to concerns about stigma, can impact racial and ethnic minority families' decisions to seek treatment for their children (APA, 2017a; Turner, Jensen-Doss, & Heffer, 2015). Overall, racial/ethnic minority youth are less likely to receive services for internalizing challenges than non-Hispanic White youth (Gudiño, Lau, McCabe, & Hough, 2009). In addition, there are fewer mental and behavioral health services in low-income, racially segregated neighborhoods (Alegría, Vallas, & Pumariega, 2010 ). Even when services do exist, racial/ethnic minority children are less likely to receive quality care than their White, non-Hispanic counterparts (Alegría, Green, McLaughlin, & Loder, 2015), which is why the development of culturally appropriate, evidence-based mental and behavioral health promotion, prevention, and early intervention programs are so imperative.

Like race and ethnicity, gender also serves as a determinant of mental and behavioral health. Risk factors for experiencing mental and behavioral health difficulties may affect girls and boys differently. One such risk factor is exposure to violence. Girls have an increased risk of experiencing sexual abuse and assault at any age; whereas boys have an increased risk of experiencing physical violence and exposure to gang violence ( Brown & Bzostek, 2003; Kelly et al., 2012; Turner, Finkelhor & Ormrod, 2006) . During childhood, boys are more likely to be associated with and be treated for externalizing symptoms, whereas, girls are more likely to be associated with internalizing symptoms, which can go unrecognized and untreated, often due to gender bias in diagnosing (Green, Clopton & Pope, 1996; Merikangas et al., 2011; Seedat et al., 2009; World Health Organization, International, 2018). Prepubescent girls and boys have similar rates of depression, until adolescents, when girls are twice as likely to experience depression than are boys (Nolen-Hoeksema & Girgus, 1994 ). Moreover, girls are at greater risk of poor mental health due to gender-based violence, low income and income inequality, low social rank, and socioeconomic disadvantage ( Mendelson et al., 2008; World Health Organization, International, 2018). However, boys are less likely than girls to access care or to seek help due to stigma, which is even greater at the intersection of race and gender for Black adolescent males (Lindsey, Joe & Nebbitt, 2010).

Likewise, lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth face similar mental and behavioral health disparities (Cohn & Leake, 2012; Eisenberg & Resnick, 2006; Mustanski, Garafalo & Emerson, 2011). According to the Minority Stress Model (Hendricks & Testa, 2012; Meyer, 2003), due to stressors associated with status, discrimination, prejudice, social stigma, internalized stigma, rejection, and/or victimization, LGBTQ individuals are at an increased risk for mental and behavioral health problems and poorer physical health as compared to their cisgender heterosexual counterparts (Fredriksen-Goldsen et al., 2014), such as higher reported rates of anxiety and depression, low self-esteem, engaging in self-injurious behaviors, suicide, substance use, homelessness, and eating disorders (APA & National Association of School Psychologists, 2015). According to the Safe and Supportive School's Project on Youth at Disproportionate Risk, LGBTQ adolescents are more likely to engage in sexual risk- taking behaviors (e.g., earlier age at first sexual contact, engaging in unprotected sex, more lifetime and recent sex partners, and drinking alcohol or using other drugs prior to last sexual contact) that may impact mental health (APA, 2018a). Furthermore, LGBTQ students are more likely to face harassment, bullying, and a higher prevalence of dating violence compared to their heterosexual and/or cisgender peers, which can lead to suicidal thoughts or attempts and lower academic achievement (APA, 2018a; Russell et. al., 2011). They are also less likely to access and utilize health care services, especially if the provider lacks the necessary tools and sensitivity to provide comprehensive care and are uncomfortable having discussions about sexuality and diversity in sexual orientation and gender identity with adolescents (Coker, Austin, & Schuster, 2010).

Similarly, children and adolescents with developmental and physical disabilities and chronic medical conditions can face mental and behavioral health challenges. Mental and behavioral health disparities can occur within these populations due to discrimination, attitudinal and physical barriers, abuse and neglect, and lack of accessible and disability-sensitive services (APA, 2011). Although more attention is being paid to disability issues within graduate education and training related to children's mental and behavioral health (e.g., pediatric psychology), more needs to be done to prevent mental and behavioral health disparities within these specific populations.

Finally, it is important to appreciate the magnified effects of intersectionality (i.e., intersecting identities and multiple minority status, such as being a person of color as well as female, a gender identity and sexual orientation minority, an immigrant or a person with a disability) on mental and behavioral health and disparities.

Evidence-Based Practices

The field of psychology has pursued a primary role in the promotion of mental and behavioral health and the development of evidence-based prevention and intervention programs for children (National Research Council and Institute of Medicine, 2009a). However, access to, and utilization of, high-quality mental and behavioral health care, programs, and services lags significantly behind the needs of children and families, particularly in low-income communities and among children of minority backgrounds (Alegría, Green, McLaughlin, & Loder, 2015; Alegría Vallas & Pumariega, 2010 ; Atkins, Graczyk, Frazier, Abdul-Adil, 2003; Austin & Wagner, 2010; Kataoka, Zang& Wells, 2002 ). The effects of lack of access and utilization can be seen in the annual cost of mental, emotional, and behavioral disorders in children, and is estimated at $247 billion. Childhood mental and behavioral health disorders account for the largest category of spending of health dollars for children (AHRQ, 2012 ), with additional costs in special education, child welfare and juvenile justice. This expense can be mitigated through the implementation of evidence-based prevention and intervention programs, particularly early in childhood - beginning with infant mental health promotion and parenting support. At least sixteen family-focused prevention programs have been widely tested and shown to be effective (Blueprints, 2018), and several have been shown to be cost-effective as well (Washington State Institute for Public Policy, 2015) ⁴. Evidence-based prevention and intervention can also have significant investment returns in the long-term labor market, with increased individual earnings and reduced welfare dependence (Independent Evaluation Group, 2015).

Prevention and early intervention programs that are multiyear are fundamental in early childhood. Interventions that target school readiness, social-emotional skills, behavioral concerns, and attachment positively impact children's IQ, academic achievement, language development, self-regulation, and attachment to caregivers in the short-term, while increasing safety behaviors and decreasing the likelihood of the development of specific mental and behavioral health problems and substance use into adulthood (Anderson, et al., 2003; Independent Evaluation Group, 2015; Mountain, Cahill & Thorpe, 2017; Neil & Christensen, 2009). These interventions should take place early in child development; target risk and protective factors, rather than disorders; and promote change across multiple environments (home and school) (National Research Council and Institute of Medicine, 2009a).

Many interventions have shown efficacy in research settings and effectiveness in community-based settings, but the frequency with which evidence-based practices are employed is low, despite evidence of their effectiveness among youth (APA Presidential Task Force, 2006; APA Task Force on Evidence-Based Practice for Children and Adolescents, 2008; Kazak et al., 2010; Weisz et al., 2006). Evidence-based practice in psychology (EBPP) ⁵, which is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (APA Presidential Task Force, 2006; Levant, 2005), has garnered increased attention in the context of mental and behavioral health interventions among youth (e.g., APA Task Force on Evidence-Based Practice for Children and Adolescents, 2008; Kazak et al., 2010) ⁶.

At the systems level, important factors to consider for improving dissemination and implementation, as well as promoting mental and behavioral health, include the settings in which prevention and early interventions take place (APA Task Force on Evidence-Based Practice for Children and Adolescents, 2008; Kazak et al., 2010; Southam-Gerow et al., 2012). Despite lower usage of evidence-based practices among youth and community-based settings, literature reviews have indicated that there are numerous evidence-based practices for children and adolescents for a variety of presenting conditions, including anxiety, attention difficulties, depression, conduct disorders, traumatic stress, substance use, eating problems, and mental and behavioral health diagnoses and problems related to developmental disabilities (Breland- Noble, Al-Mateen & Singh, 2016; Breland-Noble, Burriss & Poole, 2010; Eyberg, Nelson & Boggs, 2008; Flay et al., 2005; Weisz, Doss & Hawley, 2005; Weisz, Jensen-Doss & Hawley, 2006) ⁶. Adaptations of these evidence-based practices should be considered, especially in terms of client characteristics, developmental modifications, culture and other contextual processes, and family preferences (cf., Chorpita & Daleiden, 2009; Roberts & James, 2008; Roberts, Blossom, Evans, Amaro & Kanine, 2017). Cultural attunement, the practice of developing new interventions specifically for minority groups, is a more nascent area that promises to improve a tailored approach to serving minorities (Falicov, 2009).

Barriers to successful implementation of evidence-based practice in community clinical settings involve multiple domains, including the child level (e.g., youth in community settings have higher levels of comorbidity and contextual risk, as well as greater levels of ethnic and socioeconomic diversity than those treated in research settings); the clinician level (e.g., reservations about applicability or utility of evidence-based practices); and the system level (e.g., availability of resources, training, or supervision) (Roberts et al., 2017; Southam-Gerow, Rodriguez, Chorpita & Daleiden, 2012; Whaley & Davis, 2007). Moreover, research on evidence-based practice often includes samples that might not generalize to clients seen in community-based settings (Kazak et al., 2010; Southam-Gerow et al., 2012; Weisz et al., 2006; Whaley & Davis, 2007).

Currently it takes many years for any original research to inform practice, creating an additional barrier in bridging the research to practice gap (e.g., Grant, Green, & Mason, 2003). Although significant issues remain with extensively implementing evidence-based interventions in community-based settings (Flay et al., 2005; Lochman et al., 2009; Southam-Gerow et al., 2012), numerous implementation frameworks have been developed (Albers et al., 2017). Implementation frameworks involve multiple factors, including stages, collaboration, key stakeholders across settings and domains, training, and supervision. Yet more work needs to be done to move from the current, comprehensive implementation frameworks towards a more flexible, modular approach (Albers et al., 2017; Breland- Noble, Burriss, & Poole, 2010). It would be helpful to research and understand barriers to implementation and sustainability (e.g., staff turnover, resources) by evaluating the most effective means of gaining support from key stakeholders and how to address concerns with adopting evidence-based practice at the clinician and contextual levels (e.g., APA Task Force on Evidence-Based Practice for Children and Adolescents, 2008; Kazak et al., 2010; McHugh & Barlow, 2010; Southam-Gerow et al., 2012). Dissemination and implementation of these evidence-based practices in alternative and real-world settings, such as community- based settings, needs to increase (APA Task Force on Evidence-Based Practice for Children and Adolescents, 2008; Beidas & Kendall, 2010; Beidas et al., 2012; Kazak et al., 2010; Whaley & Davis, 2007).

To increase society's capacity to serve periodic and subclinical-level child mental and behavioral health needs, mental and behavioral health should be addressed where children live, play, work, pray, and grow (Society for Research in Child Development, 2009; Tolan & Dodge 2005). The mental and behavioral health treatment enterprise needs to be interdisciplinary in order to fully understand and address the complex issues families face. Partnering and bringing together different sources of knowledge and expertise (both traditional and nontraditional providers), with the goal of promoting child mental and behavioral health and addressing mental and behavioral health problems, is key to influencing change in public understanding of, and attitude towards, child mental and behavioral health. Beginning in infancy, collaborations across systems, integrated mental health services, and parenting consultations, where all children and families access services (i.e., primary/specialty care, schools, early childhood education, child care, and home visiting programs) are essential (e.g., Adams, Hinojosa, Armstrong, Takagishi & Dabrow, 2016; Biel, Anthony, Mlynarski, Godoy & Beers, 2017; Kaliebe, 2017; Splett & Maras, 2011; Woltmann et al., 2012; Yu, Kolko, & Torres, 2017)). Providing services to children in school is especially important due to the link between good student health, mental and behavioral health, and academic success (Hass & Fosse, 2008). The data shows that most children receive mental health services at school (Farmer et al., 2003; Rones & Hoagwood, 2000). It is also critical to ensure smooth transitions from pediatric to adult health and mental and behavioral health care and social services, particularly for adolescents with chronic conditions and/or developmental disabilities (National Research Council and Institute of Medicine, 2009b; Institute of Medicine and National Research Council, 2015). Additionally, in order to reduce health disparities, more research is needed to examine implementation of mental and behavioral health promotion, prevention, and intervention programs across diverse settings that utilizes screening to identify risk, and that tests the outcomes of culturally appropriate adaptations to evidence-based programs.

Child and Adolescent Mental and Behavioral Health Workforce

Education and training are needed for those who work with young children and families in various settings (i.e. education, medical and mental health care, rural communities, faith-based services) about the importance of childhood mental and behavioral health, its importance in healthy development and social/emotional development (Society for Child and Family Policy and Practice, 2013), and the availability of evidence-based prevention and intervention practices. The lack of availability and limited access to mental and behavioral health care and services is especially evident within rural areas due to distance, transportation, and a shortage of mental and behavioral health providers working within these areas (National Academy of Sciences, 2017). To meet the needs of rural populations, there needs to be an increase in mental and behavioral health workers who are specifically trained and willing to work in rural populations (National Academy of Sciences, 2017). Additionally, in order to have culturally appropriate adaptations, the diversity of the mental and behavioral health (including psychology) workforce needs to be addressed. While the ethnic and racial diversity of the U.S. population continues to grow, the psychology workforce has largely remained majority White, with less than 12 percent being from diverse racial and ethnic groups (APA, 2017b), leading to a substantial shortage of racial/ethnic minority providers of mental and behavioral health services (SAMHSA, 2016). It is important to have ethnically diverse and competent providers, educators, and researchers within the field, in order to both meet the needs of the public and uphold psychology's commitment to social justice (Maton et al., 2006; Vasquez & Jones, 2006). It is equally important to ensure that providers engage in culturally sensitive assessment and intervention (APA, 2017c; Turner et al., in press). The lack of providers from diverse racial and ethnic groups influences disparities in prevention, assessment and treatment among racial and ethnic minority populations (e.g., APA, 2017c; Turner et al., in press).

Not only is it important to have diversity in terms of race and ethnicity, it also necessary to encourage diversity in terms of gender, disability status, sexual orientation, and gender identity, in order to truly meet the needs of a diverse population. Additionally, professional education and training is needed to address gender-specific concerns, including provision of clinical services, efforts to counter biased policy, efforts to highlight and remove barriers to psychological well-being and to reduce bias based on perceived gender. The literature notes that client-therapist matching may be important to rapport and intervention success, therefore increasing the diversity of the profession is important (e.g., Turner, Malone, & Douglas, in press; Vasquez & Jones, 2006). Policy efforts at the university, state, and national level are needed to increase the number of psychologists from diverse groups to address equity, fairness, and services to the public (e.g., Turner & Turner, 2015; Vasquez & Jones, 2006).

To increase diversity within the field, there needs to be more diversity within the pool of students pursuing higher degrees in the field of psychology (Turner & Turner, 2015; Vasquez & Jones, 2006). To improve the pipeline, academic support, and recruitment and retention of these students, diverse faculty are important at the undergraduate and graduate level (Maton, Kohout, Wicherski, Leary & Vinokurov, 2006; Vasquez & Jones, 2006). However, research shows that recruitment and retention are influenced by lack of financial resources, limited peer-faculty support, and mis-match between the student and doctoral programs (e.g., Callahan et al., 2018; Evans & Cokley, 2008; Turner & Turner, 2015; Vasquez & Jones, 2006; Yeo, Erickson Cornish & Meyer, 2017).

Summary

Childhood mental and behavioral health is essential to health and wellbeing across the lifespan. While psychology has made substantial contributions to promoting children's mental and behavioral health, much remains to be done. Structural determinants of mental and behavioral health, limitations in access to, and implementation of, evidence-based prevention and treatment practices, and workforce and training needs persist. Without renewed attention from psychology, mental and behavioral health problems, disparities, and societal costs will continue.

Footnotes

¹ The term child mental and behavioral health, as used in this resolution, includes mental, social, and emotional health of all infants, children and adolescents, including those with developmental disorders, physical disabilities, and chronic medical conditions. This definition contrasts with the notion of child mental illness, in that mental illness denotes a condition or disorder that meets DSM/ICD criteria. This definition is consistent with the Report of the Surgeon General's Conference on Children's Mental Health (2000) which states, "mental health is a critical component of children's learning and general health." It is also consistent with the World Health Organization (WHO) (2014) definition: "Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community."

² The Child and Adolescent Mental and Behavioral Health Resolution is a document relevant specifically to the United States, due to the science referenced in this document being largely based on US populations, which may or may not reflect on other countries.

³ See next section on Structural Determinants of Mental Health for examples of risk factors.

⁴ For more information on evidence-based prevention and treatment programs specific to children and families, please visit http://effectivechildtherapy.org , https://infoaboutkids.org and https://pedpsych.org/ebp_resources

⁵ This definition of EBPP closely parallels the definition of evidence-based practice adopted by the Institute of Medicine (2001, p. 147) as adapted from Sackett and colleagues (2000): "Evidence-based practice is the integration of best research evidence with clinical expertise and patient values." The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention (APA, 2006).

Best available research refers to, "to scientific results related to intervention strategies, assessment, clinical problems, and patient populations in laboratory and field settings as well as to clinically relevant results of basic research in psychology and related fields. A sizeable body of evidence drawn from a variety of research designs and methodologies attests to the effectiveness of psychological practices. Generally, evidence derived from clinically relevant research on psychological practices should be based on systematic reviews, reasonable effect sizes, statistical and clinical significance, and a body of supporting evidence (APA, 2006)."

⁶ Also see articles in (1) Real-World Applications of Evidence-Based Interventions in Pediatric Psychology Special Issue of the APA Journal Clinical Practice in Pediatric Psychology , Vol. 2, No. 3, September 2014; (2) JCAAP Evidence-Based Series Article Collection, Journal of Clinical Child & Adolescent Psychology ; (3) Weisz, J.R., Doss, A.J., & Hawley, K.M. (2005). Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Review of Psychology , 56, 337-363.

References

Adams, C. D., Hinojosa, S., Armstrong, K., Takagishi, J., & Dabrow, S. (2016). An innovative model of integrated behavioral health: school psychologists in pediatric primary care settings. Advances in School Mental Health Promotion, 9(3-4), 188-200.

Albers, B., Mildon, R., Lyon, A.R., & Shlonsky, A. (2017). Implementation frameworks in child, youth and family services - Results from a scoping review. Children and Youth Services Review, 81, 101-116.

Albert, D., Chein, J., & Steinberg, L. (2013). Peer influences on adolescent decision-making. Current Directions in Psychological Science, 22, 80-86.

Alegría, M., Green, J. G., McLaughlin, K. A., & Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the US. William T. Grant Foundation. https://philanthropynewyork.org/sites/default/files/resources/Disparitiesinchildandadolescenthealth.pdf.

Alegría, M., Vallas, M., & Pumariega, A. J. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19, 759-774.

Agency for Healthcare Research and Quality. (2012). Household Component of the Medical Expenditures Panel Survey . https://meps.ahrq.gov/data_files/publications/st472/stat472.shtml.

American Academy of Pediatrics. (2014). Adverse Childhood Experiences and the Lifelong Consequences of Trauma. https://www.aap.org/enus/Documents/ttb_aces_consequences.pdf.

American Psychological Association. (2008). Task Force on Evidence-Based Practice for Children and Adolescents. Disseminating Evidence-Based Practice for Children and Adolescents: A Systems Approach to Enhancing Care. Washington, DC: American Psychological Association.

American Psychological Association. (2011). Task Force on Guidelines for Assessment and Treatment of Persons with Disabilities. Guidelines for Assessment of and Interventions with Persons with Disabilities. https://www.apa.org/pi/disability/resources/assessment-disabilities.

American Psychological Association. (2017a). Working Group for Addressing Racial and Ethnic Disparities in Youth Mental Health. Addressing the mental health needs of racial and ethnic minority youth: A guide for practitioners. https://www.apa.org/pi/families/resources/mental-health-needs.pdf.

American Psychological Association. (2017b). Demographics of U.S. Psychology Workforce [interactive data tool]. https://www.apa.org/workforce/data-tools/demographics.

American Psychological Association. (2017c). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. https://www.apa.org/about/policy/multicultural-guidelines.pdf.

American Psychological Association. (2018a). Safe and Supportive Schools Project: Youth at Disproportionate Risk. https://www.apa.org/pi/lgbt/programs/safe-supportive/disproportionate-risk.

American Psychological Association. (2018b). Working Group on Health Disparities in Boys and Men. Health disparities in racial/ethnic and sexual minority boys and men. https://www.apa.org/pi/health-disparities/resources/race-sexuality-men.

American Psychological Association & National Association of School Psychologists. (2015). Resolution on gender and sexual orientation diversity in children and adolescents in schools. https://www.apa.org/about/policy/orientation-diversity.

American Psychological Association Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.

Anderson, L.M., Shinn, C., Fullilove, M.T., Scrimshaw, S.C., Fielding, J.E., Normand, J., Carande-Kulis, V.G., & the Task Force on Community Preventive Services. (2003). The effectiveness of early childhood development programs: A systematic review. American Journal of Preventive Medicine, 24(3S), 32-46.

Atkins, M. S., Graczyk, P. A., Frazier, S. L., & Abdul-Adil, J. (2003). Toward a New Model for Promoting Urban Children's Mental Health: Accessible, Effective, and Sustainable School-Based Mental Health Services. School Psychology Review, 32(4), 503-514.

Austin, A., & Wagner, E. F. (2010). Treatment attrition among racial and ethnic minority youth. Journal of Social Work Practice in the Addictions, 10 , 63-80.

Beidas, R.S. & Kendall, P.C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17(1),1-30.

Beidas, R.S., Mychailyszyn, M.P., Edmunds, J.M., Khanna, M.S., Downey, M.M., Kendall, P.C. (2012). Training school mental health providers to deliver cognitive-behavioral therapy. School Mental Health , 4(4),197-206.

Benner, A., Wang, Y., Shen, Y., Boyle, A., Polk, R., & Cheng, Y. (2018). Racial/ethnic discrimination and well-being during adolescence: A meta-analytic review. American Psychologist, 73(7), 855-883 .

Berger, A. (2011). Self-Regulation: Brain, Cognition and Development. Washington DC: APA Press.

Biel, M. G., Anthony, B. J., Mlynarski, L., Godoy, L., & Beers, L. S. (2017). Collaborative training efforts with pediatric providers in addressing mental health problems in primary care. Academic Psychiatry , 41(5), 610-616.

Blueprints for Healthy Youth Development. (2018). Blueprints programs. www.blueprintsprograms.com/programs

Breland-Noble, A. M., Al-Mateen, C. S., & Singh, N. N. (Eds.). (2016). Handbook of mental health in African American youth. New York: Springer.

Breland-Noble, A. M., Burriss, A., & Poole, H. K. (2010). Engaging depressed African American adolescents in treatment: Lessons from the AAKOMA PROJECT. Journal of Clinical Psychology , 66(8), 868-879.

Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research , 42(9), 708-716.

Brown, B., & Bzostek, S. (2003). Violence in the Lives of Children. https://www.childtrends.org/wp-content/uploads/2003/01/2003-15ViolenceChildren.pdf .

Callahan, J. L., Smotherman, J. M., Dziurzynski, K. E., Love, P. K., Kilmer, E. D., Niemann, Y. F., & Ruggero, C. J. (2018). Diversity in the professional psychology training-to-workforce pipeline: Results from doctoral psychology student population data. Training and Education in Professional Psychology .

Casey, B.J., Getz, S., Galvan, A. (2008). The Adolescent Brain. Developmental Review, 28, p. 62-77.

Center on the Developing Child. (2014). Key Concepts: Toxic Stress. Harvard University. http://developingchild.harvard.edu/key_concepts/toxic_stress_response.

Center on the Developing Child at Harvard University. (2015). Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper No. 13. www.developingchild.harvard.edu.

Center on the Developing Child at Harvard University. (2016). From Best Practices to Breakthrough Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and Families. https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2016/05/From_Best_Practices_to_Breakthrough_Impacts-4.pdf.

Chambers, R.A., Taylor, J.R., & Potenza, M.N. (2003). Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability . The American Journal of Psychiatry , 160(6), 1041-1052.

Chatterji, P., Alegría, M., & Takeuchi, D. (2009). Racial/ethnic differences in the effects of psychiatric disorders on employment. Atlantic Economic Journal, 37 , 243-257.

Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566-579.

Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., Phillips, L., Ward, A., Lynch, R., Trent, L., Smith, R. L., Okamura, K., & Starace, N. (2011). Evidence-based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18, 154-172.

Cohn, T. J., & Leake, V. S. (2012). Affective distress among adolescents who endorse same-sex sexual attraction: Urban versus rural differences and the role of protective factors. Journal of Gay & Lesbian Mental Health, 16(4). 291-305.

Coker, T., Austin, S., & Schuster, M. (2010). The Health and Health Care of Lesbian, Gay, and Bisexual Adolescents. Annual Review of Public Health, 31(1), 457-477.

Conti, G. & Heckman, J.J. (2013). The developmental approach to child and adult health. Pediatrics, 131, S133-S141.

Cross-Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. The Lancet , 381 , 1371-1379.

Danese, A. & McEwen, B.S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology and Behavior, 106, 29-29.

Dennis, J. M., Parke, R. D., Coltrane, S., Blacher, J., & Borthwick-Duffy, S. A. (2003). Economic pressure, maternal depression, and child adjustment in Latino families: An exploratory study. Journal of Family and Economic Issues, 24, 183-202.

Diamond, A. (2013). Executive Functions. Annual Review of Psychology . 64 , 135-168.

Dunn, E. C., Uddin, M., Subramanian, S. V., Smoller, J. W., Galea, S., & Koenen, K. C. (2011). Research review: Gene-environment interaction research in youth depression - a systematic review with recommendations for future research. Journal of Child Psychology and Psychiatry , 52(12), 1223-1238.

Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among Gay, Lesbian and Bisexual Youth: The Role of Protective Factors. Journal of Adolescent Health, 39(5), 662-668.

Evans, G. L., & Cokley, K. O. (2008). African American women and the academy: Using career mentoring to increase research productivity. Training and Education in Professional Psychology, 2 (1), 50-57.

Eyberg, S.M., Nelson, M.M., & Boggs, S.R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37, 215-237.

Falicov, C. J. (2009). Commentary: On the wisdom and challenges of culturally attuned treatments for Latinos. Family Process , 48(2), 292-309.

Farmer, E. M., Burns, B. J., Philip, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services , 54, 60-67.

Farn, A. & Adams, J. (2016). Education and interagency collaboration: A lifeline for justice involved youth. Washington, DC: Center for Juvenile Justice Reform, Georgetown University McCourt School of Public Policy. http://cjjr.georgetown.edu/wpcontent/uploads/2016/08/Lifeline-for-Justice-Involved-Youth_August-2016.pdf.

Felitti, V., Anda, R., Nordenberg, D., Williamson, D. F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S., (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences Study. American Journal of Preventive Medicine, 14, 245-258.

Flay, B.R., Biglan, A., Boruch, R.F., Gonzalez Castro, F., Gottfredson, D., Kellam, S., Moscicki, E.K., Schinke, S., Valentine, J.C., & Ji, P. (2005). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science, 6, 151-175.

Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H.-J., Lehavot, K., Walters, K. L., Yang, J., ..., Muraco, A. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry , 84(6), 653-663.

Frick, P. J. (2012). Developmental pathways to conduct disorder: Implications for future directions in research, assessment, and treatment. Journal of Clinical Child and Adolescent Psychology , 41(3), 378-389.

Frick, P. J. (2016). Current research on conduct disorder in children and adolescents. South African Journal of Psychology , 46(2), 160-174.

Giedd J. , Raznahan A., Alexander-Bloch A., Schmitt E., Gogtay N., & Rapoport J.L. (2015). Child psychiatry branch of the National Institute of Mental Health longitudinal structural magnetic resonance imaging study of human brain development. Neuropsychopharmacology , 40 , 43-9.

Grant J., Green L., & Mason B. (2003). Basic research and health: a reassessment of the scientific basis for the support of biomedical science. Research Evaluation, 12, 217-224.

Green, M., Clopton, J., & Pope, A. (1996). Understanding Gender Differences in Referral of Children to Mental Health Services. Journal of Emotional and Behavioral Disorders, 4 (3), 182-190.

Gudiño, O. G., Lau, A. S., Yeh, M., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by problem type?. Journal of Emotional and Behavioral Disorders , 17(1), 3-16.

Halfon, N. & Hochstein, M. (2002). Life course health development: an integrated framework for developing health, policy, and research. Milbank Quarterly, 80 , 433-79.

Halfon, N., Wise, P.H., & Forrest, C.B. (2014). The changing nature of children's health development: New challenges require major policy solutions. Health Affairs, 33, 2116-2124.

Haas, S. A., & Fosse, N. E. (2008). Health and the educational attainment of adolescents: Evidence from the NLSY97. Journal of Health & Social Behavior, 49(2), 178-192.

Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender non-conforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460-467.

Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016). Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 208(03), 232-238.

Institute of Medicine and National Research Council. (2015) Investing in the Health and Well-being of Young Adults. Washington, DC: National Academies Press.

Kaliebe, K. E. (2017). Expanding our Reach: Integrating Child and Adolescent Psychiatry into Primary Care at Federally Qualified Health Centers. Journal of the American Academy of Child & Adolescent Psychiatry, 56(11), 907-909.

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548-1555.

Kazak, A.E., Hoagwood, L., Weisz, J.R., Hood, K., Kratochwill, T.R., Vargas, L.A., & Banez, G.A. (2010). A meta-systems approach to evidence-based practice for children and adolescents. American Psychologist , 65, 85-97.

Kearney, C. A., Wechsler, A., Kaur, H., & Lemos-Miller, A. (2010). Posttraumatic stress disorder in maltreated youth: A review of contemporary research and thought. Clinical Child and Family Psychology Review , 13(1), 46-76.

Kelly, S., Anderson, D., Hall, L., Peden, A., & Cerel, J. (2012). The Effects of Exposure to Gang Violence on Adolescent Boys' Mental Health. Issues in Mental Health Nursing , 33 (2), 80-88.

Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry , 62, 593-602.

Kessler, R.C. & Wang, P.S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115-129.

Latimer, K., Wilson, P., Kemp, J., Thompson, L., Sim, F., Gillberg, C., . . . Minnis, H. (2012). Disruptive behavior disorders: A systematic review of environmental antenatal and early years risk factors. Child Care, Health and Development , 38(5), 611-628.

Leslie, L.K., Mehus, C.J., Hawkins, J.D., Boat, T., McCabe, M.A., Barkin, S., Perrin, E., Metzler, C., Prado, G., Tait, V.F., Brown, R., & Beardslee, W. (2016). Primary health care: potential home for family-focused preventive interventions. American Journal of Preventive Medicine , 51 , 106-118.

Levant, R.F. (2005). Report of the 2005 Presidential Task Force on Evidence-Based Practice. http://www.apa.org/practice/resources/evidence/evidence-based-report.pdf.

Lindsey, M., Joe, S., & Nebbitt, V. (2010). Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking Among African American Boys. Journal of Black Psychology , 36(4), 458-482.

Lochman, J.E., Boxmeyer, C., Powell, N., Wi, L., Wells, K., & Windle, M. (2009). Dissemination of the Coping Power Program: Importance of intensity of counselor training. Journal of Consulting and Clinical Psychology, 77, 397-409.

Luciana, M. & Collins, P.F. (2012). Incentive motivation, cognitive control and the adolescent brain: Is it time for a paradigm shift? Child Development Perspectives, 6, 392-399.

Masten, A. (2014). Ordinary Magic: Resilience in Development. NY: Guilford.

Maton, K. I., Kohout, J. L., Wicherski, M., Leary, G. E., & Vinokurov, A. (2006). Minority students of color and the psychology graduate pipeline: Disquieting and encouraging trends, 1989-2003. American Psychologist , 61 (2), 117-131.

Matson, J.L. & Williams, L.W. (2013). Differential diagnosis and comorbidity: distinguishing autism from other mental health issues. Neuropsychiatry , 3, 233-243.

Melchior, M., Caspi, A., Howard, L.M., Ambler, A. P., Bolton, H., Mountain, N., Moffitt, T. E. (2009). Mental health context of food insecurity: A representative cohort of families with young children. Pediatrics, 124 , e564-e572.

Mendelson, T., Kubzansky, L., Datta, G., & Buka, S. (2008). Relation of female gender and low socioeconomic status to internalizing symptoms among adolescents: A case of double jeopardy?. Social Science & Medicine , 66(6), 1284-1296.

Merikangas, K., He, J., Burstein, M., Swendsen, J., Avenevoli, S., & Case, B. et al. (2011). Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32-45.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin , 129, 674-697.

Molina, K.M., Alegría, M., Chen, C. (2012). Neighborhood context and substance use disorders: a comparative analysis of racial and ethnic groups in the United States. Drug and Alcohol Dependence, 125, S35-S43.

Mountain, G., Cahill, J., & Thorpe, H. (2017). Sensitivity and attachment interventions in early childhood: A systematic review and meta-analysis. Infant Behavior and Development, 46, 14-32.

Mustanski, B., Garofalo, R., & Emerson, E. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health , 100(12), 2426-2432.

National Academies of Sciences, Engineering, and Medicine. (2017). Training the Future Child Health Care Workforce to Improve Behavioral Health Outcomes for Children, Youth, and Families Proceedings of a Workshop-in Brief. Washington, DC: National Academies Press.

National Association of School Psychologists. (2015). Early Childhood services: Promoting positive outcomes for young children. [Position statement]. Bethesda, MD: Author.

National Research Council and Institute of Medicine. (2009a). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: National Academies Press.

National Research Council and Institute of Medicine (2009b). Adolescent Health Services: Missing Opportunities. Washington DC: National Academies Press.

National Research Council and Institute of Medicine. (2011). The Science of Adolescent Risk-Taking: Workshop Report. Washington DC: National Academies Press.

Neil, A. L. & Christensen, H. (2009). Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clinical Psychology Review , 29, 208-215.

Nolen-Hoeksema, S., & Girgus, J. (1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin , 115(3), 424-443.

Paus, T., Keshavan , M. & Giedd , J.N. (2008). Why do many psychiatric disorders emerge during adolescence ? Nature Reviews Neuroscience, 9 , 947-957.

Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine , 90, 24-31.

Roberts, M.C., Blossom, J.B., Evans, S.C., Amaro, C.M., & Kanine, R.M. (2017). Advancing the scientific foundation for evidence-based practice in clinical child and adolescent psychology. Journal of Clinical Child and Adolescent Psychology, 46, 915-928.

Roberts, M. C., & James, R. L. (2008). Empirically supported treatments and evidence-based practice for children and adolescents. In R. G. Steele, T. D. Elkin & M. C. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents: Bridging science and practice, 9-24, Springer Science + Business Media, New York, NY.

Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3(4), 223-241.

Russell, A. E., Ford, T., Williams, R., & Russell, G. (2016). The association between socioeconomic disadvantage and attention deficit/hyperactivity disorder (ADHD): A systematic review. Child Psychiatry and Human Development , 47(3), 440-458.

Russell, S. T., Ryan, C., Toomey, R. B., Diaz, R. M., & Sanchez, J. (2011). Lesbian, gay, bisexual, and transgender adolescent school victimization: Implications for young adult health and adjustment. Journal of School Health , 81(5), 223-230.

Sampson, R.J., Morenoff, J.D., & Gannon-Rowley, T. 2002. Assessing "neighborhood effects": Social processes and new directions in research. Annual Review of Sociology , 443-478.

Seedat, S., Scott, K., Angermeyer, M., Berglund, P., Bromet, E., & Brugha, T. et al. (2009). Cross-National Associations Between Gender and Mental Disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry , 66(7), 785.

Shonkoff, J.P. & Gardner, A. (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 1542, 2011-2663.

Shonkoff, J.P., Boyce, W.T., & McEwen, B.S. (2009). Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities Building a New Framework for Health Promotion and Disease Prevention. JAMA , 301, 2252-2259.

Skinner, E.A. & Zimmer-Gembeck, M.J (Eds.). (2009). Coping and the development of self-regulation. New Directions for Child and Adolescent Development, No. 124. San Francisco: Wiley.

Smith, A.R., Chein, J., & Steinberg, L. (2013). Impact of socio-emotional context, brain development, and pubertal maturation on adolescent risk-taking. Hormones and Behavior, 64 , 323-332.

Society for Child and Family Policy and Practice. (2013). Report of Healthy Development Summit II: Changing Frames and Expanding Partnerships to Promote Children's Mental Health and Social/Emotional Wellbeing. Washington, DC.

Society for Research in Child Development. (2009). Report of Healthy Development: A Summit on Young Children's Mental Health. Partnering with Communication Scientists, collaborating across Disciplines and Leveraging Impact to Promote Children's Mental Health. Washington, DC.

Splett, J. W., & Maras, M. A. (2011). Closing the gap in school mental health: A community-centered model for school psychology. Psychology in the Schools, 48(4), 385-399.

Southam-Gerow, M. A., Rodríguez, A., Chorpita, B. F., & Daleiden, E. L. (2012). Dissemination and implementation of evidence-based treatments for youth: Challenges and recommendations. Professional Psychology: Research and Practice , 43, 527-534.

Strang, N.M., Chein, J.M., & Steinberg, L. (2013). The value of the dual systems model of adolescent risk taking. Frontiers in Human Neuroscience, 7, 1-4.

Substance Abuse and Mental Health Services Administration [SAMHSA], National Registry of Evidence-based Programs and Practices (NREPP). (2016). Learning Center Literature Review: Mental health disparities. Prepared in 2016 by Development Services Group, Inc. under contract no. HHSS 2832 0120 0037i/HHSS 2834 2002T, ref, no. 283-12-3702.

Szyf, M. (2009). The early life environment and the epigenome. Biochimica et Biophysica Acta , 1790, 878-885 .

Tanner, J. C., Candland, T., & Odden, W. (2015). Later Impacts of Early Childhood Interventions: A systematic review. Independent Evaluation Group.

Tercyak, K. P. (Ed.). (2010). Handbook of genomics and the family: Psychosocial context for children and adolescents. New York: Springer.

Tolan, P. H., & Dodge, K. A. (2005). Children's mental health as a primary care and concern: a system for comprehensive support and service. American Psychologist , 60(6), 601.

Turner, E. A., Jensen-Doss, A., & Heffer, R. W. (2015). Ethnicity as a moderator of how parents' attitudes and perceived stigma influence intentions to seek child mental health services. Cultural Diversity and Ethnic Minority Psychology , 21(4), 613.

Turner, E.A . , Malone, C., & Douglas, C. (in press). Barriers to mental health care for African Americans: Applying a model of treatment initiation to reduce disparities. In M. Williams, D. Rosen, & J. Kanter (Eds.), Eliminating Race-Based Mental Health Disparities. New Harbinger Press.

Turner, E.A. & Turner, T. (2015). Diversity in the Psychology Workforce: Challenges and Opportunities to Increase the Presence of African American Males in Psychology Graduate Programs. The Register Report, 41, 26-30.

Turner, H., Finkelhor, D., & Ormrod, R. (2006). The effect of lifetime victimization on the mental health of children and adolescents. Social Science & Medicine, 62(1), 13-27.

Vasquez, M. J., & Jones, J. M. (2006). Increasing the number of psychologists of color: Public policy issues for affirmative diversity. American Psychologist, 61, 132-142.

Veldman, K., Bültmann, U., Almansa, J., & Reijneveld, S. A. (2015). Childhood adversities and educational attainment in young adulthood: The role of mental health problems in adolescence. Journal of Adolescent Health , 57(5), 462-467.

Veldman, K., Reijneveld, S. A., Ortiz, J. A., Verhulst, F. C., & Bültmann, U. (2015). Mental health trajectories from childhood to young adulthood affect the educational and employment status of young adults: Results from the TRAILS study. Journal of Epidemiology and Community Health, 69(6), 588-593.

Wall, M., Cheslack-Postava, K, Hu, M., Feng, T., Griesler, P., & Kandel, D.B. (2018). Nonmedical prescription opioids and pathways of drug involvement in the US: Generational differences. Drug and Alcohol Dependence , 182 , 103-111.

Wang, J.L. (2004). The difference between single and married mothers in the 12-month prevalence of major depressive syndrome, associated factors and mental health service utilization. Social Psychiatry and Psychiatric Epidemiology, 39(1), 26-32.

Washington State Institute for Public Policy (2012). Benefit-Cost Results: Children's Mental Health. http://wsipp.wa.gov/BenefitCost?topicId=5.

Weisz, J.R., Doss, A.J., & Hawley, K. M. (2005). Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Review of Psychology, 56, 337-363.

Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist , 61, 671-689.

Whaley, A. L., & Davis, K. E. (2007). Cultural competence and evidence-based practice in mental health services: A complementary perspective. American Psychologist , 62, 563-574.

Woltmann, E., Grogan-Kaylor, A., Perron, B., Georges, H., Kilbourne, A. M., & Bauer, M. S. (2012). Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta- analysis. American Journal of Psychiatry, 169 (8), 790-804.

World Health Organization. (2014). Mental health: A state of well-being. http://www.who.int/features/factfiles/mental_health/en.

World Health Organization. (2018). International classification of diseases-11 (ICD-11) for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version Chapter 06: Mental, behavioral or neurodevelopmental disorders. http://www.who.int/classifications/icd/en.

World Health Organization, International. (2018). Gender Disparities in Mental Health.

Yeo, V., Erickson Cornish, J. A., & Meyer, L. (2017). An analysis of diversity content in doctoral health service psychology program websites. Training and Education in Professional Psychology, 11(2), 86-93.

Yoshikawa, H., Aber, J. L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional, and behavioral health of children and youth: Implications for prevention. American Psychologist, 67(4), 272-284.

Yu, H., Kolko, D. J., & Torres, E. (2017). Collaborative mental health care for pediatric behavior disorders in primary care: Does it reduce mental health care costs?. Families, Systems, & Health, 35 (1), 46.

# data[].attributes.attachment_link.title
Child and Adolescent Mental and Behavioral Health Resolution

# data[].attributes.attachment_link.description
Promoting children's mental and behavioral health underlies healthy development and health equity across the lifespan.

# data[].attributes.headline
Statistics about Mental Health & Poverty

# data[].attributes.subject
Statistics about Mental Health & Poverty

# data[].attributes.attachment_link.readable_text
Mental Health Disparities and Equity

The HHS Office of Minority Health developed Minority Population Profiles that include detailed demographic and health status information, including mental and behavioral health indicators, for youth and adults in several racial and ethnic groups. For more information about disparities in mental health, see the following:

As symptoms of mental health disorders emerge and develop, they have strong influences on an adolescent's behavior and can become more difficult to treat. Although effective therapies exist for many mental health disorders, not all adolescents who need treatment receive it. The following disparities may partially explain why use of mental health services differs by gender, age, race/ethnicity, income, and other characteristics:

Twenty-one percent of youth ages 6 to 17 who live in poverty have mental health disorders.

Half of all youth in the child welfare system, and nearly 70 percent of youth in the juvenile justice system, have a diagnosable mental health disorder.

Children who are living in foster care have a substantially greater risk of experiencing mental health disorders, especially those connected with traumatic stress, such as abuse and neglect.

Lesbian, gay, bisexual, and transgender (LGBT) youth have higher rates of mental health disorder challenges than other youth.

High school students who identify as lesbian, gay, or bisexual are much more likely to think about suicide than those who identify as heterosexual.

Female adolescents are more likely than male adolescents to receive mental health services.

Asian adolescents are less likely than adolescents of most other races/ethnicities to receive mental health services.

White youth are more likely to receive mental health services compared to youth of color.

A higher proportion of Hispanic youth have unmet mental health needs, compared to black and white youth.

Advances in Mental Health and Healthcare-Related Legislation

The Mental Health Parity and Addiction Equity Act of 2008, the Affordable Care Act of 2010, and the recent Medicaid expansion in many states have helped improve access to mental health services for Americans of all ages:

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that insurers cover and reimburse services for mental health and substance use disorders as they would other physical health services. However, MHPAEA does not require health insurance plans to include mental health/substance use disorders benefits; its requirements apply only to insurers that include mental health/substance use disorders in their existing benefit packages.

The Affordable Care Act (ACA) requires that most individual and small-employer health insurance plans-including all plans offered through the Health Insurance Marketplace-cover mental health and substance use disorders services. Additionally, under the ACA, most health plans must now cover preventive services (e.g., depression screening for adults and behavioral assessments for children) at no additional cost.

Medicaid expansion includes benefits for people with mental health and substance use disorders, and states that coverage must meet the same parity requirements required under MHPAEA for other health plans.

The Children's Health Insurance Program also is required to comply with mental health and substance use disorder parity requirements.

Footnotes

# data[].attributes.attachment_link.description
As symptoms of mental health disorders emerge and develop, they have strong influences on an adolescent's behavior and can become more difficult to treat. Although effective therapies exist for many mental health disorders, not all adolescents who need treatment receive it.

# data[].attributes.attachment_link.readable_text
Back in 2017, psychologist Jean Twenge set off a firestorm in the field of psychology.

Twenge studies generational trends at San Diego State University. When she looked at mental health metrics for teenagers around 2012, what she saw shocked her. "In all my analyses of generational data - some reaching back to the 1930s - I had never seen anything like it," Twenge wrote in the Atlantic in 2017.

Twenge warned of a mental health crisis on the horizon. Rates of depression, anxiety and loneliness were rising. And she had a hypothesis for the cause: smartphones and all the social media that comes along with them. "Smartphones were used by the majority of Americans around 2012, and that's the same time loneliness increases. That's very suspicious," Twenge told NPR in 2017.

But many of her colleagues were skeptical. Some even accused her of inciting a panic with too little - and too weak - data to back her claims.

Now, six years later, Twenge is back. She has a new book out this week, called Generations, with much more data backing her hypothesis. At the same time, several high-quality studies have begun to answer critical questions, such as does social media cause teens to become depressed and is it a key contributor to a rise in depression?

In particular, studies from three different types of experiments, altogether, point in the same direction. "Indeed, I think the picture is getting more and more consistent," says economist Alexey Makarin, at the Massachusetts Institute of Technology.

A seismic change in how teens spend their time

In Generations, Twenge analyzes mental health trends for five age groups, from the Silent Generation, who were born between 1925 and 1945, to Gen Z, who were born between 1995 and 2012. She shows definitively that "the way teens spend their time outside of school fundamentally changed in 2012," as Twenge writes in the book.

Take for instance, hanging out with friends, in person. Since 1976, the number of times per week teens go out with friends - and without their parents - held basically steady for nearly 30 years. In 2004, it slid a bit. Then in 2010, it nosedived.

"It was just like a Black Diamond ski slope straight down," Twenge tells NPR. "So these really big changes occur."

At the same time, around 2012, time on social media began to soar. In 2009, only about half of teens used social media every day, Twenge reports. In 2017, 85% used it daily. By 2022, 95% of teens said they use some social media, and about a third say they use it constantly, a poll from Pew Research Center found.

"Now, in the most recent data, 22% of 10th grade girls spend seven or more hours a day on social media," Twenge says, which means many teenage girls are doing little else than sleeping, going to school and engaging with social media.

Not surprisingly, all this screen time has cut into many kids' sleep time. Between 2010 and 2021, the percentage of 10th and 12th graders who slept seven or fewer hours each night rose from a third to nearly one-half. "That's a big jump," Twenge says. "Kids in that age group are supposed to sleep nine hours a night. So less than seven hours is a really serious problem."

On its own, sleep deprivation can cause mental health issues. "Sleep is absolutely crucial for physical health and for mental health. Not getting enough sleep is a major risk factor for anxiety and depression and self-harm," she explains. Unfortunately, all of those mental health problems have continued to rise since Twenge first sounded the alarm six years ago.

"Nuclear bomb" on teen social life

"Every indicator of mental health and psychological well-being has become more negative among teens and young adults since 2012," Twenge writes in Generations. "The trends are stunning in their consistency, breadth and size."

Across the board, since 2010, anxiety, depression and loneliness have all increased. "And it's not just symptoms that rose, but also behaviors," she says, "including emergency room visits for self-harm, for suicide attempts and completed suicides." The data goes up through 2019, so it doesn't include changes due to COVID-19.

All these rapid changes coincide with what, Twenge says, may be the most rapid uptake in a new technology in human history: the incorporation of smartphones into our lives, which has allowed nearly nonstop engagement with social media apps. Apple introduced the first iPhones in 2007, and by 2012, about 50% of American adults owned a smartphone, the Pew Research Center found.

The timing is hard to ignore, says data scientist Chris Said, who has a Ph.D. in psychology from Princeton University and has worked at Facebook and Twitter. "Social media was like a nuclear bomb on teen social life," he says. "I don't think there's anything in recent memory, or even distant history, that has changed the way teens socialize as much as social media."

Murky picture becomes clearer on causes of teen depression

But the timing doesn't tell you whether social media actually causes depression in teens.

In the past decade, scientists have published a whole slew of studies trying to answer this question, and those studies sparked intense debate among scientists and in the media. But, Said says, what many people don't realize is scientists weren't using - or didn't even have - the proper tools to answer the question. "This is a very hard problem to study," he says. "The data they were analyzing couldn't really solve the problem."

So the findings have been all over the place. They've been murky, noisy, inconclusive and confusing. "When you use tools that can't fully answer the question, you're going to get weak answers," he says. "So I think that's one reason why really strong evidence didn't show up in the data, at least early on."

On top of it, psychology has a bad track record in this field, Said points out. For nearly a century, psychologists have repeatedly blamed new technologies for mental and physical health problems of children, even when they've had little - or shady - data to back up their claims.

For example, in the 1940s, psychologists worried that children were becoming addicted to radio crime dramas, psychologist Amy Orben at the University of Cambridge explains in her doctoral thesis. After that, they raised concerns about comic books, television and - eventually - video games. Thus, many researchers worried that social media may simply be the newest scapegoat for children's mental health issues.

A handful of scientists, including MIT's Alexey Makarin, noticed this problem with the data, the tools and the field's past failures, and so they took the matter into their own hands. They went out and found better tools.

Hundreds of thousands of more college students depressed

Over the past few years, several high-quality studies have come that can directly test whether social media causes depression. Instead of being murky and mixed, they support each other and show clear effects of social media. "The body of literature seems to suggest that indeed, social media has negative effects on mental health, especially on young adults' mental health," says Makarin, who led what many scientists say is the best study on the topic to date.

In that study, Makarin and his team took advantage of a once-in-a-lifetime opportunity: the staggered introduction of Facebook across U.S. colleges from 2004 to 2006. Facebook rolled out into society first on college campuses, but not all campuses introduced Facebook at the same time.

For Makarin and his colleagues, this staggered rollout is experimental gold.

"It allowed us to compare students' mental health between colleges where Facebook just arrived to colleges where Facebook had not yet arrived," he says. They could also measure how students' mental health shifted on a particular campus when people started to spend a bunch of their time on social media.

Luckily, his team could track mental health at the time because college administrators were also conducting a national survey that asked students an array of questions about their mental health, including diagnoses, therapies and medications for depression, anxiety and eating disorders. "These are not just people's feelings," Makarin says. "These are actual conditions that people have to report."

They had data on a large number of students. "The data comes from more than 350,000 student responses across more than 300 colleges," Makarin says.

This type of study is called a quasi-experiment, and it allows scientists to estimate how much social media actually changes teens' mental health, or as Makarin says, "We can get causal estimates of the impact of Facebook on mental health."

So what happened? "Almost immediately after Facebook arrives on campus, we see an uptick in mental health issues that students report," Makarin says. "We especially find an impact on depression rates, anxiety disorders and other questions associated with depression in general."

And the effect isn't small, he says. Across the population, the rollout of Facebook caused about 2% of college students to become clinically depressed. That may sound modest, but with more than 17 million college students in the U.S. at the time, that means Facebook caused more than 300,000 young adults to suffer from depression.

For an individual, on average, engaging with Facebook decreases their mental health by roughly 22% of the effect of losing one's job, as reported by a previous meta-analysis, Makarin and his team found.

Facebook's rollout had a larger effect on women's mental health than on men's mental health, the study showed. But the difference was small, Makarin says.

He and his colleagues published their findings last November in the American Economic Review. "I love that paper," says economist Matthew Gentzkow at Stanford University, who was not involved in the research. "It's probably the most convincing study I've seen. I think it shows a clear effect, and it's really credible. They did a good job of isolating the effect of Facebook, which isn't easy."

Of course, the study has limitations, Gentzkow says. First off, it's Facebook, which teens are using less and less. And the version of Facebook is barebones. In 2006, the platform didn't have a "like" button" or a "newsfeed." This older version probably wasn't as "potent" as social media now, says data scientist Chris Said. Furthermore, students used the platform only on a computer because smartphones weren't available yet. And the study only examined mental health impacts over a six-month period.

Nevertheless, the findings in this study bolster other recent studies, including one that Gentzkow led.

Social media is "like the ocean" for kids

Back in 2018, Gentzkow and his team recruited about 2,700 Facebook users ages 18 or over. They paid about half of them to deactivate their Facebook accounts for four weeks. Then Gentzkow and his team looked to see how a Facebook break shifted their mental health. They reported their findings in March 2020 in the American Economic Review.

This type of study is called a randomized experiment, and it's thought of as the best way to estimate whether a variable in life causes a particular problem. But with social media, these randomized experiments have big limitations. For one, the experiments are short-term - here only four weeks. Also, people use social media in clusters, not as individuals. So having individuals quit Facebook won't capture the effect of having an entire social group quit together. Both of these limitations could underestimate the impact of social media on an individual and community.

Nevertheless, Gentzkow could see how deactivating Facebook made people, on average, feel better. "Being off Facebook was positive across well-being outcomes," he says. "You see higher happiness, life satisfaction, and also lower depression, lower anxiety, and maybe a little bit lower loneliness."

Gentzkow and his team measured participants' well-being by giving them a survey at the end of the experiment but also asking questions, via text message, through the experiment. "For example, we sent people text messages that say, 'Right now, would you say you're feeling happy or not happy,'" he explains.

Again, as with Makarin's experiment, the effect was moderate. Gentzkow and his colleagues estimate that temporarily quitting Facebook improves a person's mental health by about 30% of the positive effect seen by going to therapy. "You could view that meaning these effects are pretty big," he explains, "or you could also see that as meaning that the effects of therapy are somewhat small. And I think both of those things are true to an extent."

Scientists still don't know to what extent social media is behind the rising mental health issues among teenagers and whether it is the primary cause. "It seems to be the case - like it's a big factor," says MIT's Alexey Makarin, "but that's still up for debate."

Still, though, other specifics are beginning to crystallize. Scientists are narrowing in on what aspects of social media are most problematic. And they can see that social media won't hurt every teen - or hurt them by the same amount. The data suggests that the more hours a child devotes to social media, the higher their risk for mental health problems.

Finally, some adolescents are likely more vulnerable to social media, and children may be more vulnerable at particular ages. A study published in February 2022 looked to see how time spent on social media varies with life satisfaction during different times in a child's life (see the graphic).

The researchers also looked to see if a child's present use of social media predicted a decrease of life satisfaction one year later. That data suggeststwo windows of time when children are most sensitive to detrimental effects of social media, especially heavy use of it. For girls, one window occurs at ages 11 through 13. And for boys, one window occurs at ages 14 and 15. For both genders, there's a window of sensitivity around age 19 - or near the time teenagers enter college. Amy Orben and her team at the University of Cambridge reported the findings in Nature Communications.

This type of evidence is known as a correlative. "It's hard to draw conclusions from these studies," Gentzkow says, because many factors contribute to life satisfaction, such as environmental factors and family backgrounds. Plus, people may use social media because they're depressed (and so depression could be the cause, not the outcome of social media use).

"Nevertheless, these correlative studies, together with the evidence from the causal experiments, paint a picture that suggests we should take social media seriously and be concerned," Gentzkow adds.

Psychologist Orben once heard a metaphor that may help parents understand how to approach this new technology. Social media for children is a bit like the ocean, she says, noting that it can be an extremely dangerous place for children. Before parents let children swim in any open water, they make sure the child is well-prepared and equipped to handle problems that arise. They provide safety vests, swimming lessons, often in less dangerous waters, and even then parents provide a huge amount of supervision.
Alyson Hurt created the graphic. Jane Greenhalgh and Diane Webber edited the story.

# data[].attributes.attachment_link.title
The truth about teens, social media and the mental health crisis

# data[].attributes.attachment_link.description
A striking decline in teen mental health has coincided with the rise of smartphones and social media. Is social media causing the mental health challenges? Finally, research can answer that question.

# data[].attributes.attachment_link.title
Surviving Depression With Indigenous Teens | Grace L Chao | TEDxFargo