Last year (2022), the US Surgeon General and American Academy of Pediatrics highlighted dramatic increases in youth mental health episodes because of a lack of social interaction, grief, and loss due to the COVID-19 pandemic, and fragmented healthcare services (find the report here). With few preventative mental health support services in place, many children and young adults end up in emergency situations that are detrimental, burdensome, traumatic, and stigmatizing for themselves, their families, and their local communities. As a nation, we have reached a crucial moment where youth mental health continuums of care must be broadened to include early detection and prevention, as well as bolster treatment options across systems. In Miami, this is ever more important as state-level politics/policies intersect with a large array of diversity, including nuances that stem from extremely low access to mental health care (49th out of 50 nation-wide by state), being a minority-majority city, an expansive metropolitan identity, and other state-level circumstances like Medicaid non-expansion.
These circumstances created a call to action and thankfully, community organizations and other key stakeholders across Miami have responded through an array of approaches to ameliorate the local youth mental health crisis. Here at Behavioral Science Research Institute, we have seen some of these approaches firsthand – having served as evaluators for some of them – and want to take a moment to spotlight them. The purpose of this blog post is to describe four of those efforts, moving from more targeted, individual, and reactive approaches to more open and preventative approaches. In each section, we use some of our evaluation findings to showcase the important work those organizations/individuals are doing. Towards the end of the post, we briefly outline the necessity to simultaneously draw from reactive and proactive approaches to mitigate current youth mental health crises.
Approach 1: Targeting ReaDmissions
The first approach we would like to present is a targeted, individualized care coordination program from a local mental health center in Hialeah. The program was developed to address high rates of recidivism within crisis/inpatient units, of which led to increased trauma and decreased mental health wellness, created family and community instability, and ultimately created difficult challenges for this local mental health clinic. Specifically, the program identified, screened, and assessed potential clients with complex health needs (e.g., serious mental illness, co-occurring substance use disorders, chronic primary care conditions, etc.). Then, the program team provided individualized care coordination to persons deemed at risk for crisis readmission. While the program was designed to work with both youth and adults, it proved effective over time and reduced readmission rates for both groups while the patients were enrolled in the nine-month program. This was largely due to the possibility for the Care Coordinators to link their patients with other services at this local mental health center. Ultimately, this also led to improvements in the community and within the patients’ everyday life (see below), thought youth patients in particular were less likely to attend school regularly after the program.
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Approach 2: Helping Youth Transition to Adulthood
The next approach we would like to highlight is a program that links youth and adult mental health services to maintain recovery into adulthood. The approach takes a system of care framework – i.e., a spectrum of effective, community-based services and support organized into a coordinated network – and provides mental health services for young people aged 14-21 years old. The idea is that differences in children’s services and adult services, as well as expectations of children versus adults in general, warrant a transitional period that helps children/youth become adults (see Figure 2).
Specifically, the program used TIP (Transition to Independence) and Wraparound – two Evidence Based Practices – that help young people gain the skills necessary to succeed as adults, even if the majority had behavioral health challenges like major depressive or other mood disorders. The largest improvements were found in young peoples’ abilities to secure employment and housing and complete their education.
Approach 3: Training Middle- & High-School Staff to Identify Mental Health Warning Signs in Youth
The third approach we want to showcase is a preventative approach to the youth mental health crisis in schools. A significant aspect of this approach is Youth Mental Health First Aid Training that at once informs adults about common mental health concerns amongst youth; reduces stigma around mental health; teaches adults how to recognize signs and symptoms of mental health and substance use problems in youth; and provides adults with skills to use a 5-step action plan to help a young person who may be facing a mental health problem or crisis (e.g., suicide) until a mental health professional can get involved.
Over three years, roughly 1,000 school personnel (teachers, administrators, coaches, janitors, etc.) have been trained in Youth Mental Health First Aid. This is a great achievement and, as you will see in Figure 3, this approach has reached many parts of Miami-Dade County. This is critical as we well know that the youth mental health crisis knows no boundaries.
Approach 4: Screening Kindergarten Students for Social Emotional Learning (SEL) Challenges
The fourth and final approach we present today is a universal social emotional learning (SEL) screening tool to identify and address gaps at the systems level. While the approach is still being developed, the goal is to map school readiness factors and other factors that contribute to resilience across Miami. Specifically, the screening tool will be used in schools and community programs to collect SEL data for children across Miami-Dade County to inform us about current SEL statuses. The project is taking a strengths-based approach, so we (the evaluators and project implementers) are looking to find out where the pockets of resilience are, what is helping with that resilience, and then replicate those conditions in other places to help increase kindergarten readiness for all children in Miami-Dade County.
Figure Source: University of Miami (2022). Miami-Dade IDEAS Consortium for Children. University of Miami Department of Psychology. https://ideas.psy.miami.edu/partners/index.html
The overall goal of the project is to implement a data-to-action feedback loop to utilize data for decision-making. This feedback loop will influence program development, advocacy efforts, and funding allocations. Critical to this process is engaging with community partners and local institutions (like schools) to first pilot the SEL screening tool and then expand their efforts. If successful, the SEL screening tool will be useful in identifying opportunities for improvement in the name of preventing future youth mental health crises locally.
Conclusion: Coordination and Collaboration… NOT Competition
Many of our teammates here at BSRI have been very fortunate to witness all the hard work that our community counterparts are engaged in to lessen the youth mental health crisis in Miami. As you can see, there are many moving pieces here. Some people/organizations are focused on treating the young people (and adults) who currently have mental health needs. Other people/organizations are dedicated to finding prevention models that help now and into the future. Together, community counterparts in our own backyard are collaborating and coordinating responses, whether they realize it or not.
To create a sustainable and community-supported system of change and ultimately to alleviate the rapidly growing youth mental health crisis, we need more collaboration and coordination… not competition. Sometimes, prevention and treatment are spoken about in a hierarchy where prevention is proactive – a gold standard of sorts – and treatment is reactive — a knee-jerk reaction. But we need them both right now. We must continue to find ways to prevent as well as treat those who are currently in crisis, and we do not have the luxury of preferring one approach over the other.
As we move forward, we think it is critical to search for ways to coordinate both ends of the prevention-treatment spectrum and identify opportunities for collaboration between systems level programs/projects and more individually focused systems of care. This of course is challenging, especially as funding is often siloed and programs/projects across the U.S. leverage their niche to gain access to vital financial support. Nevertheless, we must realize that there are levels of collaboration and coordination that happen despite individual project/program foci. It is ever more important to search for ways to leverage them together until we ameliorate the current youth mental health crisis. In the future, prevention will be key but for now, prevention and treatment collaborations and coordination are the necessary approach.
This work is funded through multiple SAMHSA grants as well as The Children’s Trust located in Miami-Dade, Florida. The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Substance Abuse Treatment (CSAT), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS). Perhaps most importantly, THANK YOU to our project teams, community partners, their individuals served, changemakers, and systems thinkers.