BOSTON— An estimated 15 million American children are diagnosed with a mental disorder, but only about a quarter of them are getting appropriate treatment based on scientific evidence. Many more children are at risk of developing behavioral disorders. And the problem is only going to get worse unless the health care system changes how it delivers services, according to a task force of the American Psychological Association.
A report released Wednesday by APA's Presidential Task Force on Evidence-Based Practice with Children and Adolescents recommends dissemination of evidence-based practice approaches – treatments that are based on scientific evidence along with clinical expertise while taking into account patient characteristics, culture and preferences – as a way to ensure that children and adolescents with mental health problems receive the best available care.
"The care should include prevention, early intervention, targeted treatments for particular disorders, an understanding of developmental processes and continuity of care," said task force chair Anne E. Kazak, PhD, ABPP. "Furthermore, treatments should be accessible regardless of age, gender, sexual orientation, disability, race, ethnicity and culture. Lastly, evidence-based practice should be cross-disciplinary and include collaborations with families, schools, practitioners and researchers from various health fields."
These treatments and services need to reach youth from all different cultures, geographic regions and socioeconomic groups to prevent further escalation of the problem, said Kazak. "This is especially true for low-income youth, for youth in the juvenile justice and child welfare systems, ethnic minority youth, and those with drug/alcohol problems."
The report of the seven-member task force builds on and extends the work of a 2005 Presidential Task Force on Evidence-Based Practice. The current task force conceptualized evidence-based care for children and adolescents, including those at risk for as well as those diagnosed with a mental disorder, across a number of settings. Settings included families, schools, health care systems, and the juvenile justice system.
The task force members cite several examples of evidence-based practice's effectiveness in treating ethnic minority youth with anxiety-related problems, ADHD, depression, conduct problems, substance use problems and other trauma-related syndromes. These treatments were effective, according to the report, because practitioners were culturally responsive to their clients and were able to treat them long enough for them to experience the benefits. There is a high dropout rate for clinicians who are not culturally sensitive to their ethnic minority clients, the report found.
Several reviews and meta-analyses examined in the report also showed the benefits of using empirically tested treatment programs for both children and their parents in dealing with autism, eating problems and disorders, depression, phobias and anxiety disorders, obsessive-compulsive disorder, trauma and substance abuse.
The task force concluded that evidence-based practice is essential for addressing the needs of children and adolescents with myriad mental health problems. The report recommends ways for psychologists to build relationships with health and educational institutions to generate more research in this area and transfer it into clinical practice. Further, the report offers ways to educate and train practitioners delivering this type of care and suggestions for changing policies so evidence-based care will be financially feasible and available to those who need it.
The following are some of the specific recommendations by the task force.
Research
- Increase research funding to develop and deliver evidence-based practice to children in different settings
- Establish multidisciplinary coalitions to provide guidance on funding mechanisms for development and dissemination of evidence-based practice for children and adolescents
Education and Training
- Develop interdisciplinary Web-based training on core areas of evidence-based practice that include social work, education, pediatrics and psychiatry
- Develop accessible Web-based interactive system to allow stakeholders – state psychological associations, state directors of children's mental health services, universities, mental health agencies, practitioners and families with youth needing treatment – to share information about using evidence-based practice in different settings
- Increase evidence-based practice for children and adolescents in graduate and post-graduate training programs and develop means for evaluating EBP training
- Include evidence-based practice in continuing education to increase likelihood that frontline professionals have training opportunities
- Encourage cross-disciplinary, culturally diverse training in an international framework to encourage attention to evidence-based practice
Practice and Policy
- Identify appropriate funding levels so adequate coverage for evidence-based practice is secured for children and adolescents
- Develop policies that promote access to evidence-based practice for children and families, especially for underserved populations, such as ethnic minority children, pre-adolescents, children with multiple health and substance abuse problems and those with disabilities. Additionally, children who are in the child welfare and juvenile justice system and those in homeless shelters also need access to evidence-based interventions.
- Eliminate barriers to evidence-based practice for children and adolescents in the private sector and at the state and federal level as well as in regulatory and policy initiatives.
- Establish a cross-disciplinary, multi-agency task force to examine the barriers to evidence-based practice for children and adolescents