The Behavioral Health Needs of Children
Emotional and behavioral health is essential to a child's overall well-being. Boys and girls suffering from stress, trauma, and other mental health issues must have access to quality treatment.
Emotional and behavioral health is essential to a child's overall well-being. Yet compared to physical illnesses, mental health issues are go untreated, leading to a range of poor outcomes for a child. Stress, anxiety, depression, adverse and trauma-related experiences and other mental health issues interfere with normal development and often prevent children from forming healthy relationships and living healthy lives. Before this happens, greater efforts are needed to support positive development and access to treatment.
Barriers to Health Care
While approximately 120,000 children statewide face diagnosable and treatable mental health problems, only an estimated 20,000 of them access necessary clinical services1.
Part of the problem is a lack of information. Even the most determined families may be unsure about where to turn for appropriate and affordable care.
Cost is another frequent barrier. Families who not qualify for the free or low-cost insurance program may be deterred by the expensive costs of private behavioral health services.
At Clifford W. Beers Guidance Clinic, the community-based mental health clinic for children and families, 99% of the patients qualify for the Medicaid-funded HUSKY health insurance2.
Lack of access to affordable transportation is another barrier that prevents parents and caregivers from bringing their children to the necessary appointments or sessions.
Stigma: An Additional Barrier
Because of the confusion and stereotypes they face, children and adolescents with mental disorders often have difficulty coping with their feelings. And they may not tell anyone about troubling thoughts or traumatic events they have experienced.
Parents of a child with mental health issues also face challenge. They may think their children are devalued, bullied, or misunderstood. Parents may also feel responsible or blame themselves for their child's disorder. Unfortunately, these feelings can prevent children and families from seeking out mental health services.
Many mental health challenges in children can be traced back to adverse or traumatic experiences. Examples include sexual abuse, emotional abuse, emotional neglect, physical abuse, substance abuse in the home, mental illness in the home, incarceration of a family member, parental discord, witnessing violence against a parent, and discrimination. These events contribute to toxic stress, which is biological response that has potentially long-term consequences3.
The link between maltreatment during childhood and poor health and wellbeing in adulthood was revealed in the Adverse Childhood Experiences (ACE) study, the large-scale investigation by the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego4. The study showed that individuals with four or more adverse childhood experiences are at a high risk of engaging in unhealthy behaviors such as smoking, drug and alcohol abuse, face an increased risk of attempting suicide, and have an increased chance of dying prematurely.
Abuse, Neglect and Children's Mental Health
Mistreatment of children is a significant public health issue. In 2011, the Department of Children and Families (DCF) received reports of 5,826 allegations of abuse or neglect against children in New Haven alone (See Figure 1). Allegations included physical abuse, educational neglect, emotional neglect, medical neglect, physical neglect, at risk for sexual abuse, and sexual abuse.
Figure 1: Allegations reported to The CT Department of Children and Families (DCF) (New Haven, 2011)
Figure 2: Total allegations substantiated by DCF (New Haven, 2011)
Services in the Community
In response to growing concerns about childhood trauma, services in Greater New Haven are identifying children at high risk for toxic stress and supporting their families and caregivers. The Clifford Beers Clinic and the Yale Child Study Center are both members of the National Child Traumatic Stress Network. Both sites deliver the evidence-based Child and Family Traumatic Stress Intervention (CFTSI).
Children who experience trauma after witnessing an even that involved a death, injury, or the threat of injury or death are referred to an intervention by a hospitals and the New Haven Child Development Community Policing Program. The intervention attempts to prevent the development of post-traumatic stress disorder (PTSD).
It is not known why traumatic events cause PTSD in some people but not others. Having a history of trauma may increase the risk for PTSD after a recent traumatic event.
CFTSI emphasizes the importance of social and family support which has resulted in statistically and clinically significant reductions in PTSD diagnosis.
School-Based Health Centers
Because of the barriers to accessing community mental health services, many children with mental health issues receive services at their schools. Many are able to provide the services efficiently, according to Eric Arzubi, M.D., an adolescent Psychiatry Fellow at the Yale Child Study Center5. In addition, African American and Latino adolescent boys are much more likely to use mental health services at school than at traditional community treatment centers, according to Patricia Baker, President of the Connecticut Health Foundation.
What Can We Do?
Whether you are a parent, a friend, a teacher, a mentor, a community member or a clinician, we all play an important role in raising awareness for and supporting children's mental, behavioral and emotional health. Please refer to the list of local resources for families, providers and advocates for more information.
The Child Trauma resource provides information and resources for parents and caregivers to help their child who has been the victim of a traumatic event.
The Child Health and Development Institute of Connecticut (CHDI), works to improve the quality of care for all children in Connecticut by ensuring they have access to and benefit from a comprehensive, effective, community-based health and mental health care system.
CHDI is focused on long-term systemic change by identifying and evaluating effective practices, and then building the capacity to implement them statewide.
The mission of Clifford Beers Clinic is to “provide accessible community-based mental health services and advocacy that promote healthy and resilient lives for children and families.”
An important resource for parents and caregivers, providers and advocates in CT.
The School-Based Mental Health section of Kids Mental Health Info provides information and resources about how mental health affects the way a child learns and develops and directly impacts a child's experience at school. This site was designed as a resource to help parents and caregivers understand what type of problemsthat mightbe impacting their child'sschool performance and adjustment, as well as identify the supports that are available in both the community and at school. A FAQ helps parents navigate the school system if their child has a mental health issue or disability.
The Educational Care Collaborative (ECC) is continuum of care that spans the home, school, and community. Their mission is to improve access to mental health services and social supports for family and children in Hamden, CT.
Child Development Infoline (CDI) is a specialized unit of United Way of Connecticut. Care Coordinators are available to answer the phone Monday through Friday from 8am-6pm, except on holidays. Messages can be left 24 hours a day, seven days a week, and are returned promptly. This service is free and confidential, with multi-lingual and TTY capacity.
This manual is a reference for advocates, providers, outreach workers and community-based organizations who work with families and help them enroll in HUSKY. Rules governing the HUSKY program change each year, as do income guidelines. The manual will be updated periodically to reflect rule changes.
What the Community Foundation is Doing
Operating, program, and sponsorship grants to organizations working to improve the mental health of children with in Greater New Haven include:
- The National Center for Children Exposed to Violence - To support the Child Development – Community Policing (CD-CP) program, which provides immediate and coordinated clinical and police interventions for children traumatized by violence. Developed at the Yale Child Study Center in collaboration with the City of New Haven and its police department, CD-CP is now a model program that has been replicated nationwide.
- Clifford Beers Guidance Clinic for its delivery of community-based mental health services to children. In 2011, The Foundation funded the Clinical Collaborative Consultation Project, a training program for people who work with children in local youth-serving organizations. The program educates non-clinical counselors to identify and help children who have been exposed to trauma or violence.
- Ansonia Family Services to provide community mental health services to low-income Valley children and youth with emotional and behavioral disorders.
- The Children's Center of Hamden,for the overall program, which serves an average of 170 children daily who struggle with serious emotional, behavioral psychological and social problems, such as physical and/or sexual abuse; psychiatric illness; learning disabilities; substance abuse; and family trauma.
- The New Haven Early Childhood Council, to implement Child First, a home-based model of care that works to prevent serious emotional and learning problems before they start. Child First identifies at-risk children under 5 and provides treatment programs to them and their families.
- The Consultation Center, to support Grandparents Raising Grandchildren, which provides custodial grandparents with respite opportunities, support groups, and skills training.
- The Children's Community Programs of CT for programs that provide support services to children and their families including parenting skills to foster, adoptive, and biological parents. In 2008, a multi-year grant from The Foundation helped fund the Youth Development Program, which provides life skills to juveniles in the criminal justice system.
- Lower Naugatuck Valley Parent Child Resource Center for aiding the positive behavioral health of children and families. In 2006, a multi-year grant helped LNVPC expand Prevention through Early Intervention (PEIP), which helps parents and early educators develop the social and emotional skills of preschoolers with challenging behaviors.
1. Eric R. Arzubi. “School-Based Mental Health and the Achievement Gap.” The CT Mirror. April 17, 2012.
2. Forrester, Alice. Personal interview. The Clifford Beers Guidance Clinic, March 28, 2012.
3. Jack P. Shonkoff, Benjamin S. Siegel, Mary I. Dobbins, Marian F. Earls, Andrew S. Garder, Laura McGuinn. “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health Pediatrics.” Journal of the American Academy of Pediatrics 129. e224-e231, 2011, accessed April 7,2012.
5. Eric R. Arzubi. “School-Based Mental Health and the Achievement Gap.” The CT Mirror. April 17, 2012.
Special thanks to Yale School of Public Health students Emily Dally, Christine Dang-Vu, Hannah-Rose Mitchell, Rushabh Shah and Jennifer So for their work on this Issue Brief.
© The Community Foundation for Greater New Haven