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Children and Families
Overview
Transforming the Workforce in Children’s Behavioral Health
The work of children’s behavioral health depends on people--from parents to professionals, volunteers to friends, teachers to probation officers. Success in children’s behavioral health depends on the ability of systems to support the development of their competencies.
A report from the President’s New Freedom Commission on Mental Health in 2003 described the need for "significant changes in practice models and in the organization of services to improve access, quality and outcomes in mental health.” The Commission recognized that substantial changes are needed in both who does the work in mental health and how that work is done.
Workforce issues, including training for the delivery of behavioral health services for children and adolescents, are particularly critical because:
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Children and adolescents change constantly as they grow through largely predictable developmental stages.
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Children and adolescents live in families and a "whole family" approach is needed for services and supports to be effective.
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Behavioral health needs of children and adolescents are complex and linked to developmental stages.
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Children and adolescents with behavioral health needs often interact with multiple service systems (e.g., health; mental health, education; child welfare; juvenile justice, substance abuse).
Preparation and training are complex for the people working with children and adolescents in behavioral health because:
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Community-based care for children with severe mental health and substance use disorders requires different competencies than were addressed in the preparation of many professionals currently working in the field.
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There are critical shortages of providers trained with the skills necessary to work effectively in a family-centered, community-based, culturally and linguistically competent, and collaborative service delivery model.
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There is a long "lag time" between the development of the evidence-based, effective interventions and their implementation in frontline service delivery.
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Very few professionals receive training in the attitudes, knowledge and skills consistent with the new models of service provision.
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Direct care staff in health, childcare, education, child welfare, and juvenile justice must be recognized as part of the child behavioral health workforce and be trained to effectively carry out this role.
What do we need to do differently to have an effective workforce
President Bush's Freedom Commission on Mental Health identified the following key principles as critical for its proposed "transformation" of the mental health system:
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Care is consumer and family-driven.
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Care is oriented toward recovery and resilience - toward hope.
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Disparities in the care of racial and ethnic minorities are reduced and care is culturally competent.
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A broad array of community-based alternatives to traditional care is accessible in the community, based on evidence-based tests and practices.
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Care is individualized and flexible, utilizes child and family strengths.
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Care is coordinated across all child and family serving systems.
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Children's developmental differences are recognized, especially for groups of children with specialized needs, such as those with co-occurring disorders.
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Technological advances are used effectively.
We must train professionals to have attitudes, behaviors and skills that are congruent with the changes in the fields of children's mental health and substance use. these include:
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Collaborating respectfully with caregivers, so that families are viewed as the experts on their children.
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Honoring caregivers and their cultural traditions.
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Recognizing and harnessing family strengths and abilities.
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Listening, reflecting, and synthesizing from a "system's thinking" as well as family-focused perspective.
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Working effectively in cross agency service planning teams.
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Striving toward cultural and linguistic competence when serving diverse ethnic and racial groups.
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Valuing cross agency collaborations to organize and deliver services in more creative, flexible and effective ways.
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Taking a broader view of who are service providers for children and families, including non-traditional and culturally specific providers.
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Increasing respect for the ideas and decision-making skills of frontline, direct care staff.
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Promoting and using evidence-based mental health and substance use practices
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Increasing application of advances in information technology to improve services.
What can we do?
State human service agencies can:
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Adopt cross-agency workforce development plans with consistent competencies.
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Create strong bridges between mental health and substance use agencies and practitioners.
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Develop stakeholder consensus around core competencies for direct care.
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Standardize curricula across agency systems and in multiple practice areas.
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Engage diverse parents, caregivers and youth as competency instructors.
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Utilize tele-health and web-based learning strategies, especially in rural areas.
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Promote scholarship and internship opportunities to address professional shortages in the public sector.
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Offer university and community college loan and loan repayment programs for public sector service.
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Work with historically Black colleges and universities to recruit, prepare and support students for public sector service.
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Promote paraprofessional training in needed service technologies and effective interventions.
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Implement marketing strategies to interest high school students in public service.
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Build strong links to federally funded Comprehensive Community System of Care grant sites to expand knowledge about effective approaches.
Community provider agencies can:
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Develop curricula to train personnel in key Systems of Care services and supports.
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Develop ongoing paraprofessional training programs.
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Offer staff a range of incentives for personal growth and training in competencies needed for cross-agency collaboration and new ways of working with families.
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Offer incentives for practice in areas with under-served populations.
Universities and community colleges can:
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Design and promote pre-service education that is aligned with competencies needed in the public sector to provide new service delivery models and approaches.
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Promote and expand cross-disciplinary training in the treatment of co-occurring disorders.
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Recruit and support students from diverse racial, ethnic and cultural backgrounds.
Professional associations and organizations can:
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Promote cutting-edge service delivery models.
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Refine accreditation and credentialing standards to support cross-disciplinary competencies.
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Advocate for public-sector workforce improvements in recruiting, retaining, training and remunerating at the Federal and State levels.
Family advocacy organizations can:
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Promote the involvement of diverse caregivers in all agency systems planning and implementation activities.
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Develop partnerships with universities and colleges to develop and co-teach courses.
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Educate legislators in human service workforce issues and advocate solutions.
Individual citizens can:
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Explore training and educational opportunities to work in child serving agencies.
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Request ongoing training from child serving agencies and organizations.
References
This overview is excerpted with permission from the authors from the National Technical Assistance Center for Children’s Mental Health, Issue Brief, Georgetown University Center for Child and Human Development, February 2005. The complete article is available below in pdf format.
Transforming Children's Health
Senior Advisor Information:
Joan M. Dodge, PhD
Georgetown University
National Technical Assistance Center for Children's Mental Health
3300 Whitehaven Street, NW
Washington, DC 20007
OFFICE: 202-687-5054
FAX: 202-687-1954
MOBILE: 202-276-1197
dodgej@georgetown.edu
Larke N. Huang, PhD
Managing Research Scientist
American Institutes for Research
1000 Thomas Jefferson St. NW
Washington, DC 20007
OFFICE: 202-403-5180
FAX: 202-403-5007
Lhuang@air.org
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