The Podium

The changing landscape of children’s mental health

Recent incidents of violence perpetrated by teenagers and young adults have once again focused attention on the nation’s mental health system. The alarming frequency of events like the fatal Oregon high school shooting is making our nation take pause. And many concerned parents and government leaders are calling for changes in policy and practice to address these concerns.

Mental health is often at the center of these debates. While we know that children or youth with mental health problems are not inherently violent and that mental health problems do not cause someone to become violent, we also know that untreated mental health issues put our children and youth at higher risk for a variety of lifelong problems and can exacerbate social and behavioral problems — especially in youth prone to violence.

Increased incidents of trauma, school failure, and behavioral health concerns are debated when youths who apparently “fall through the cracks” turn to violence or drug use as means to express their anger and frustration with the world, or escape from it. Well-intentioned government agencies and policy makers often try to address such problems by proposing increases in spending to expand existing services. Massachusetts recently confronted the dramatic rise in opiate addiction by investing $20 million in treatment and recovery services. But more money invested in treatment as usual is not always the best solution; nor is casting blame about who failed our children. We need to invest in solutions that have the optimal chance of helping our children in need.


In recent years, the Commonwealth of Massachusetts, faced with an unprecedented federal lawsuit, has invested hundreds of millions of dollars each year to better meet the needs of vulnerable children and families through the creation of the Children’s Behavioral Health Initiative . As a result of this litigation, Massachusetts must provide behavioral health screening, diagnostic evaluation and an array of behavioral health services to children up to age 21 who have MassHealth. The Initiative’s broader goal is to identify and treat all children at risk earlier, and to support a more robust system of community-based services for children and families. This initiative is both noble and ambitious. It is a good example of how state government, as a result of legal action, has made sweeping reforms to try to better meet the mental health needs of children. However, when trying to improve the current mental health system for children, we shouldn’t only look at the lack of needed services and supports. We must also examine the quality of available services and supports.

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Interventions for children that have been demonstrated by research to be effective, referred to as “evidence-based treatments,” have been developed for a wide range of common childhood mental health disorders such as PTSD, anxiety, depression, substance abuse and behavioral problems. These interventions use effective strategies to reduce problematic symptoms and help restore the child’s ability to function normally. Interventions that can be provided in community-based outpatient settings, such as Trauma-focused Cognitive Behavior Therapy and the Modular Approach to Therapy for Children, or treatments that can be provided in the family’s home, such as Multisystemic Therapy, have proven track records to address targeted mental health problems and help children and families recover.

Although states like Massachusetts and Connecticut have begun to implement some evidence-based treatments, in most cases they are not widely available. When working to reform our mental health systems, one of our primary tasks should be making sure effective services and supports such as these are available to all children in need. It’s not always easy to translate research to practice in the real world, but we have learned a great deal about how to bridge that gap and raise the standard of mental health care for children and families. Investments in training, dissemination, and sustainability of treatments proven to work would be dollars well spent to ensure a healthy future for our children.

Residents of Massachusetts — and the nation — deserve the best mental health interventions available. We must recognize that quality care means paying attention to what services are delivered, how they are delivered, and how we train professionals who work with families. We need to identify what works, routinely collect data that measure outcomes and include families in our decision-making. By implementing quality, evidence-based treatments we can provide our children with the best chance for recovery and healthy development. Families deserve no less, and the futures of our most vulnerable children depend on it.

Robert P. Franks is president and CEO of Judge Baker Children’s Center in Boston.

Robert P. Franks is president and CEO of Judge Baker Children’s Center in Boston.