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SALT LAKE CITY — Utah leaders and mental health professionals are outlining policy recommendations for early childhood mental health as rates of depression, anxiety, trauma, loneliness and suicide among youth continue to rise statewide.
The group met on Wednesday during the second annual Ready! Resilient! Utah Childhood Mental Health Summit. Last year's summit established a working group of cross-sector leaders and stakeholders in early childhood mental health. A year later, that working group and experts in the topic gathered to understand, prioritize and propose solutions to issues identified previously in a study by the Kem C. Gardner Policy Institute.
"Many themes continue to be important to this work, including adverse childhood experiences, and specifically the acknowledgment and recognition of the significant toll of systemic racism — the impacts of which are far-reaching and devastating," Rebecca J. Dutson, president and CEO of The Children's Center said. "Further, the unprecedented global pandemic, soon to enter its third year, with unimaginable long-term mental health consequences unfolding for children and their caregivers as we speak."
In October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association declared a national emergency regarding the mental health of children and adolescents. The declaration noted that the COVID-19 pandemic intensified the mental health crisis and pointed to the "dramatic increase in emergency department visits for all mental health emergencies including suspected suicide attempts."
Last week, the U.S. surgeon general issued a similar advisory regarding the protection of youth mental health. In the time period from 2007 to 2018, teen suicide increased 57% among youth ages 10 to 24, Dutson said.
The national crisis is amplified in Utah, with the state ranking among a group with the highest prevalence of mental health disorders in children and adolescents. The COVID-19 pandemic intensified a crisis that had already long existed, Gov. Spencer Cox said at the summit.
"While the need to better understand and address Utah's mental needs has long existed, its importance as an issue has really been heightened over the past 18 months as a result of COVID-19," Cox said. "This pandemic has had a negative effect on the emotional well-being of both children and caregivers. Understanding the high costs associated with a failure to address this issue — we really need a clear path forward for our state."
The depth and impact of early childhood mental health intervention was explained by experts in the field. Brenda Jones, director of the Prevention and Early Adversity Research Laboratory at the University of Maryland, explained the devastating effects adverse childhood mental health could have on children and their future outcomes.
"We see socioeconomic status disparities in terms of birth outcomes, developmental outcomes, mental health outcomes; but we also see these disparities in terms of service delivery," Harden said.
"What kinds of child welfare supports do they get? What kind of educational supports do they get? What kinds of health and mental health supports do they get? We've got problems in terms of how they begin life, but we also have problems in terms of how we respond to their experiences," she added.
The questions posed by Harden are cornerstones of the policy recommendations made and discussed by the group.
Samantha Ball and Laura Summers of the University of Utah's Kem C. Gardner Policy Institute presented eight strategies in addressing early childhood mental health. The strategies include what the group called "upstream" and "downstream" approaches: addressing early childhood mental health from pregnancy, postpartum motherhood and throughout the first years of the child's life.
The eight strategies include:
- Create a baseline estimate of the need for early childhood mental health services.
- Collaborate and coordinate with a wide variety of partners to support early childhood mental health through education, resources and early childhood caregiver and provider support.
- Increase early childhood mental health awareness, promotion and prevention-related activities, all of which can really serve to reduce the stigma of mental health.
- Increasing the integration of physical and behavioral health for children by expanding access to mental health screenings, assessments and treatment to Medicaid and all children including in school-based settings.
- Create incentives to help develop and retain a robust early childhood mental health workforce.
- Develop and provide early childhood mental health training for all early childhood caregivers and providers. This is different than the earlier strategy in that it's focused on non-mental health providers.
- Estimate the long-term value of early childhood mental health in Utah.
- Decrease disparities in early childhood mental health access and outcomes for different population groups.
Several policies have been implemented or budgeted for to address the strategies presented by the Kem C. Gardner Policy Institute, Cox said. The Cox administration is working to invest in full-day kindergarten with flexibility for educators to meet student needs with at-risk funding, he said, ensuring all Utah's children have access to health insurance and addressing disparities in access to health care.
Among the policies and approaches is the integration of the Utah Department of Health and Health and Human Services.
"We have a real opportunity to leverage prevention and develop systems of prevention very early on. We don't want families in our defense services. We really want to make sure that we're utilizing our resources upstream as opposed to downstream. And by bringing these programs together in this new department, we're hoping and confident that we're going to be able to develop that prevention system while also meeting the paper health needs of families and young children," Tracy Gruber, executive director of Utah's new Department of Health and Human Services.
Additional attempts to increase access can be seen through the Childen's Center's launch of telecommunication services in January, an initiative funded through the governor. The services will involve cross-sector early childhood providers throughout the state and will include training, case consultation and other services.
"Moving forward, we need to focus more on providing fair and equitable access to mental health services for all young children, including those whose communities experience inequitable health outcomes and those who live in rural communities. I want you to know that I see these issues," Cox said.
A sentiment carried by First Lady Abby Cox, who, like the governor, noted her own struggle with mental health during the summit.
"We are starting now to understand through incredible people like you the holes that we've had in our understanding of how our mental health connects to our overall health and the future health of our entire population," Abby Cox said. "There is nothing more important to me and the governor than the state of the children of this state."
