June 24, 2024

Serene Nest

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Specialists are being educated to address youth mental health

3 min read

Last year saw a stream of dismal headlines about kids’ mental health. Children and teens in the US are struggling with higher levels of depression and anxiety. Rates of suicides and eating disorders are on the rise. Now there’s reason to be hopeful: An experiment in Oregon could point the way to a novel solution.

Much of the last two years was spent trying to analyse the root cause of alarming statistics rather than discussing what to do about them, though there has been some positive change. New guidelines recommending widespread screening for childhood anxiety and depression were a good start, and so was the Biden administration’s investment in helping connect families to behavioural and health services. Several states have expanded training for educators and improved access to telehealth.

These cannot completely address the fundamental problem: The number of kids who need help exceeds the number of available mental health providers. The paediatric mental health workforce hasn’t expanded despite ever-growing demand. A 2019 study that used US National Survey of Children’s Health data found that about half of the kids with a mental health disorder did not receive treatment. The shortfall is likely even worse now.

“We need to try something new—something that’s radically different than what we’ve been doing, which is clearly not working,” child clinical psychologist Katie McLaughlin told me.

McLaughlin recently left Harvard to be the executive director of the Ballmer Institute for Children’s Behavioral Health, launched at the University of Oregon in 2022 aiming to expand the workforce by creating a new type of mental health provider, an endeavour made possible by a $425 million gift from Connie and Steve Ballmer. The bachelor’s-level position will work in community settings to identify struggling kids and offer brief and early interventions to help them.

During their last two years of college, students enrolled at Ballmer will receive intensive hands-on training on evidence-backed interventions. They will gain experience at Portland-area elementary and high schools and could later choose to embed at paediatricians’ offices, community centres or preschools. On graduating, they will be ready to go out into the field.

These students won’t replace school counsellors or psychiatrists who have graduate-level degrees, but in an ideal world, brief interventions could prevent some kids from needing more intensive resources, freeing up people with advanced degrees to focus on those who need them most.

There’s good reason to believe the Oregon experiment will work. The UK pioneered a highly successful ‘low intensity’ mental health workforce as part of a 2008 plan to expand access to services, which involved establishing a new type of provider called a “Psychological Well-being Practitioner,” who offers brief interventions to struggling adults. Anyone who doesn’t benefit is referred to more intensive therapy. An analysis found that the program had a major impact on lowering depression and anxiety levels in the UK.

The model is sound, but the experiment in Oregon has much to prove. McLaughlin will need to produce robust data that her students are having a positive impact on children—but that evidence shouldn’t take long to collect. The first cohort heads into classrooms next fall. McLaughlin says anyone who interacts with a Ballmer student will be given an opportunity to offer feedback on the experience, allowing a quick assessment on whether a child or family was satisfied with their experience and in time, whether the services provided actually improve kids’ mental health.

The Ballmer Institute is essentially creating a new profession, which entails some practical challenges. The first hurdle was cleared in late 2022, when the state higher education commission approved the program. The next is working with US policymakers to establish standards for becoming certified as a child behavioural health specialist and defining the kind of services such a professional will be allowed to deliver. And then there’s convincing insurers that the care provided by these new professionals is worth paying for.

If this experiment works, other institutions might consider adopting the new degree, in theory helping to establish a new layer of support for children around the country.

The price tag on the Ballmer’s experiment can’t be ignored. Not every institution will be handed more than $400 million to try fix the mental health crisis. But if Ballmer can show the concept works, it shouldn’t be too hard for others to follow. The price of the status quo is just too high to ignore. ©bloomberg


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