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The Boston Globe

Health & wellness

Q&A

A vision of better mental health care for children

Suzanne Kreiter/Globe staff

In a few weeks, clinical psychologist Robert Franks will take over leadership of the Judge Baker Children’s Center, a century-old Harvard affiliated center that addresses children’s mental health. There’s a lot more that can be done to support children’s mental health, said Franks, currently an assistant clinical professor at the schools of medicine at both Yale University and the University of Connecticut.

Q. What do you think are the most important issues facing children’s mental health today?

A. Ensuring that children and families have access to quality care. There tends to be a gap between what we know works and what’s actually done. I’ve tried to narrow that gap. The other issue that is really important to me is engaging parents and families in care.

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Q. Are the mental health needs of children different than the needs of adults?

A. As adults, if we struggle with mental health, it might interfere with work, relationships, leisure. For children, it really disrupts their ability to play, to engage in appropriate social relationships, to live harmoniously in a family environment. It has a huge impact on school performance. It affects their lives, but it also affects their future.

Q. You’ve said that childhood trauma is far more common than most of us realize.

A. About 70 percent of kids, by the time they reach adulthood, have experienced some kind of significant, scary event — abuse, neglect, loss of a loved one. There just hasn’t been quality care for these kids.

Q. Is there effective help?

A. There are proven treatments that really help kids. We have 30 centers in Connecticut that deliver quality care. What we’re seeing is 80 percent of kids who go through [our centers] are having full remission of their PTSD diagnosis, which is just tremendous.

Q. And addressing these problems early helps keep the problems from getting worse later?

A. When bad things happen to kids when they’re very young children, if they go untreated, they can turn into lifelong mental health and health problems: things like cancer, heart, disease and other chronic illnesses as adults. Children who are victimized or struggle with untreated mental health [can] end up later in the juvenile justice system.

Q. How many children need mental health services?

A. In the general population, 20 to 40 percent of kids will need some mental health treatment at some time, particularly if they have a loss or an accident or something terrible happens to them.

Q. Do social norms exacerbate childhood violence?

A. Our children are faced with a lot of violent content; if you look at the video games kids play, the movies and TV shows they watch, we’re feeding them a constant diet of violence. You are what you eat. That’s going to have an effect on young people’s development, particularly people who may have problems to begin with.

Q. Is the stigma around childhood mental illness changing?

A. Stigma is still a big issue. We see stigma issues differ depending on people’s ethnic and cultural backgrounds. [But] we’ve come a long way.

Q. There has been a lot of discussion lately about whether we’re overmedicating kids for mental health issues: 4-year-olds treated with multiple heavy-duty medications, etc.

A. We tend to remember those extreme cases. It’s important to remind people that there are many, many children treated successfully every year — more than not. In any medical field we have to make sure there are checks and balances in place to make sure quality care is being delivered.

Q. What do you see as the biggest issues for parents of children in the mental health system?

A. I’ve talked to a lot of parents who struggle because they can’t take time off work to get to the appointment with their child. They can’t afford to get across town to get to the appointment. These are very practical barriers. And as a result, we are not adequately meeting the needs of our kids.

Q. How does Massachusetts, which is known for its conservative medical care, compare with other states in terms of mental health care for children and young adults?

A. I see Massachusetts as a great seeding ground for innovative and best practices. Compared with other states there’s a much higher density of providers here. There are many providers who were trained originally in very traditional models. It takes time to steer that ship.

Q. Presumably, funding issues are affecting mental health care?

A. It is challenging to make sure many of our community-based providers and practitioners make ends meet. Working in the mental health field is not a lucrative profession, so it’s sometimes difficult to have a stable workforce that is well trained.

Q. What is your vision for Judge Baker? What do you hope to accomplish there?

A. I’ve spent a lot of time in my career focused on implementation. That’s the knowledge I want to bring to the Baker. I’d like to establish the Baker as a resource for the state so we can work to improve the quality of care.

Q. What motivates you to do what you do?

A. As long as I can remember, I’ve loved children.

Q. Is it depressing to care for children who are suffering, who’ve experienced trauma?

A. It’s actually the most hopeful profession there is. When people come to seek help, they want to have change in their lives. And change is possible. They can recover. It’s very gratifying.

Interview was edited and condensed. Karen Weintraub can be reached at weintraubkaren@gmail.com.
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