Efforts Across HHS to Promote Behavioral Health for Children and Youth
Updated: Oct 20, 2021
Press Release: U.S. Department of Health & Human Services
Behavioral health is fundamental to the well-being of our country’s children and youth. That’s why agencies and offices across the U.S. Department of Health and Human Services (HHS) are working together to advance behavioral health for children, youth, and their families, with an emphasis on improving access, promoting equity, and fostering innovation. These efforts have resulted in over 300 distinct initiatives, some of which are highlighted below:
Partnering with Schools
HHS and the Department of Education have established an Interagency Workgroup for Executive Order (#14000) on Supporting the Reopening and Continued Operation of Schools and Early Childhood Education.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting Project AWARE (Advancing Wellness and Resiliency in Education). HHS has invested $107 million in FY 2021 annual appropriations to help build or expand state and local governments' coordination to increase awareness of mental health issues among school-aged youth, provide training for school personnel and other adults who interact with school-aged youth to detect and respond to mental health issues, and connect school-aged youth who may have behavioral health issues (including serious emotional disturbance or serious mental illness), and their families, to needed services. Project AWARE sites have been established in Indiana, Montana, North Carolina, and Washington as well as the Saginaw Chippewa Indian Tribe of Michigan, among others.
The Health Resources and Services Administration (HRSA) is supporting the Collaborative Improvement and Innovation Network for School Based Health Services, which provides technical assistance to promote best practices among school-based health centers, comprehensive school mental health systems, schools, and school districts. This network also assists school-based health services to address emerging behavioral health conditions among children and adolescents.
The Centers for Disease Control and Prevention (CDC) has funded a project to synthesize the best available research and practices into a toolkit that describes how to develop, implement, evaluate, and sustain a comprehensive mental health promotion program in K-12 schools that is developmentally and culturally appropriate. This guide will help school districts, administrators, and other key stakeholders identify and prioritize strategies to promote equitable mental health and reduce symptoms associated with poor mental health, such as depression and anxiety.
The CDC has also established demonstration projects to investigate strategies that could help schools and students recover from the adverse impacts of the COVID-19 pandemic. Projects build on existing school district infrastructure and existing evidence-based mental health models and frameworks such as the Multi-Tiered System of Support (MTSS) and social emotional learning (SEL) to support student and staff connectedness to school and promote mental health through linkages to mental health services, professional development, and health education, in local education agencies.
CDC supports local school districts in establishing effective health and wellness infrastructure and employing primary prevention strategies demonstrated to improve the mental health of adolescents, with a specific focus on advancing health equity.
Improving Access, Capacity, and Equity
SAMHSA is advancing the following initiatives to expand access to youth behavioral health services. HHS has invested approximately $190 million to support these programs:
Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) Grant Program seeks to promote the wellness of young children, from birth to age 8, by addressing social, emotional, cognitive, physical, and behavioral aspects of their development. The goal of Project LAUNCH is for children to be thriving in safe, supportive environments, and entering school ready to learn and able to succeed.
The Children’s Mental Health Initiative, which seeks to improve the mental health outcomes for children and youth, from birth through age 21, with serious emotional disturbance, and their families. This program supports the implementation, expansion, and integration of the Systems of Care approach by creating sustainable infrastructure and services that are required as part of the Comprehensive Community Mental Health Services for Children and their Families Program.
The Infant and Early Childhood Mental Health Grant Program seeks to improve outcomes for young children (from birth to age 12) through increasing access to high quality infant and early childhood mental health promotion, prevention, early intervention, and treatment services.
The Native Connections Grant Program, which seeks to help American Indian and Alaska Native communities identify and address the behavioral health needs of Native youth.
The Statewide Family Network seeks to support statewide, nonprofit, family-run organizations supporting families with children with serious emotional disturbance.
The Youth and Family TREE (Enhancement and Expansion of Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families) Grant Program seeks to enhance and expand comprehensive treatment, early intervention, and recovery support services for adolescents (ages 12–18), transitional aged youth (ages 16–25), and their families/primary caregivers with SUDs and/or co-occurring substance use and mental disorders.
Health Resources and Services Administration supports the Pediatric Mental Health Care Access program. The program seeks to promote behavioral health integration into pediatric primary care using telehealth. State or regional networks of pediatric mental health team provide teleconsultation, training, technical assistance, and care coordination for pediatric primary care providers to diagnose, treat, and refer child with behavioral health conditions. HHS invested $10 million in this program in FY 2021 and announced a $10.7 million expansion from the American Rescue Plan in August 2021.
The Indian Health Services provides several programs that serve youth behavioral health. In FY 2021, IHS invested approximately $31 million in the following programs:
The Indian Health Service (IHS) is supporting the Indian Children’s Program. The mission of the program is to equip healthcare providers working in the IHS, Tribal, and Urban Indian Health system with training and education needed to provide excellent care for American Indian/Alaska Native youth with Autism Spectrum Disorder, Fetal Alcohol Spectrum Disorder, and other Neurodevelopmental disorders. The Indian Children’s Program also provides free provider to provider consultation to clinical and school staff working with AI/AN youth.
IHS also provides recurring funding for 12 Youth Regional Treatment Centers (YRTC) to address substance abuse and co-occurring disorders among American Indian/Alaska Native youth. These YRTCs provide education and culture-based prevention initiatives, evidence-based and practice-based models of treatment, family strengthening, and recreational activities.
IHS also supports the Youth Regional Treatment Center (YRTC) Aftercare Pilot Project ($1.8 million annually). Two YRTC facilities, Desert Sage and the Healing Lodge of the 7 Nations are in the last year of an IHS supported aftercare pilot project. YRTCs have an important role in maintaining the health of patients after discharge. This aftercare pilot emphasized developing culture-based treatment that prevents alcohol and substance abuse relapse among youth discharged. While evaluations are in place, current data indicates that these programs have resulted in improved coordination around aftercare and case management, increased training of community supports for the adolescents, improved identification of transitional living, increased awareness of the use of social media, and improved follow-up with data collection after discharge. This pilot program will continue to support the YRTC’s ability to support the IHS Strategic Plan Goal 1 to ensure comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people. Particularly, in the recovery from alcohol and substance use disorders.
The IHS receives $16.5 million in congressional appropriations for the Generation Indigenous Initiative Support. These awards focus on early intervention strategies and implement positive youth development programming to reduce risk factors for suicidal behavioral and substance abuse. The projects work with Native youth ages 8 to 24 to: implement evidence-based and practice-based approaches to build resiliency, promote positive development, and increase self-sufficiency behaviors among Native youth; promote family engagement; and, increase access to prevention activities for youth to prevent substance use that contribute to suicidal behaviors, in culturally appropriate ways.
The Administration for Children and Families (ACF) is coordinating mental health consultations across early childhood with a focus on Head Start with the goal of populating an existing national map developed by the SAMHSA-funded Center of Excellence for infant and early childhood mental health consultation with the names of mental health consultants working in Head Start programs.
ACF also delivers the Regional Partnership Grant Program supports regional partnerships in establishing or enhancing a collaborative infrastructure to build a region’s capacity to meet a broad range of needs for families affected by substance use disorder and involved with or at risk for involvement with the child welfare system.
The Office of the Assistant Secretary of Health (OASH) is convening a National Academies of Science, Engineering, and Mathematics Workshop on Suicide Prevention in American Indian/Alaska Native Communities. The main goal of this workshop is to identify gaps, challenges and culturally appropriate opportunities to prevent suicide among American Indian/Alaska Native (AI/AN) individuals. Issues that are unique to AI/AN children and youth, young, middle-aged, and older adults will also be explored.
The CDC is supporting the following initiatives:
The State Level Children’s Mental Health Champions Program in 9 states (Colorado, New Mexico, California, Maine, Virginia, Kentucky, South Dakota, Connecticut, North Carolina, Georgia) and one territory (American Samoa) to address the mental health needs of children and families by supporting the implementation of effective strategies for mental health promotion, prevention supports, and early identification and referral networks based on state needs assessments.
The COVID-19: Prevention of Suicide, Intimate Partner Violence, and Adverse Childhood Events in Indian Country Program, which seeks to build public health capacity in the COVID-19 response and aftermath and prevent injuries and violence, focusing on Suicide, Adverse Childhood Experiences (ACEs) and intimate partner violence (IPV). The project provides a concrete data to action approach with initial goals to improve tribal data and information systems and to use those data to drive and support public health responses in prevention efforts (programs, activities, policies, or other relevant practices). Recipients include 12 tribal health-serving regional boards.
The Developing Local Infrastructure to Address the Significant Needs of Caregivers with Opioid Addiction and Their Children Program, which seeks to use a 3-pronged strategy to redirect trajectories of adolescents away from delinquency and substance misuse, and reduce caregiver relapse and opioid overdose.
Innovating Care Models and Following the Data: The Office of the Assistant Secretary for Health supports Healthy People 2030, which provides science-based, 10-year measurable objectives and targets to improve the health and well-being of the nation. Healthy People is grounded in the notion that establishing national health goals and monitoring progress can motivate action. Several of the Healthy People 2030 objectives are relevant to behavioral health in children and youth.
The Office of the Surgeon General (OSG) is launching an effort to make sense of the pandemic’s impact on youth mental health, identify recommendations for key stakeholders (e.g. parents, school leaders, health professionals), and convene stakeholders to advance these recommendations in the coming months. One product being considered is a Surgeon General's advisory on youth mental health.
The Centers for Medicare and Medicaid Services (CMS) is supporting the Integrated Care for Kids (InCK) Model, which is a child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid through prevention, early identification, and treatment of behavioral and physical health needs. In FY 2021, CMS invested $25 million in the InCK program.
The Centers for Medicare and Medicaid is also collaborating with the Assistant Secretary for Planning and Evaluation to reduce barriers to using telehealth for pediatric populations by authoring a report on use of behavioral health services via telehealth for Medicaid beneficiaries aged 21 and younger.
HRSA is supporting the Screening and Interventions for Adverse Childhood Experiences (ACEs) in Primary Care Settings Demonstration Project, which seeks to study how best to implement, in primary care settings, screening protocols and evidence-based interventions for children and adolescents who have experienced ACEs. The goal of this program is to yield a model for integrating ACEs screening and strength-based, trauma-informed services into primary care settings.
The National Institutes of Health (NIH) will support research in the following areas in FY 2022:
Systems-Level Risk Detection and Interventions to Reduce Suicide, Ideation, and Behaviors in Black Children and Adolescents, which supports research to test the effectiveness of combined interventions to both detect and intervene to reduce risk of suicide and suicide ideation and behavior and/or non-suicidal self-harm among Black children and adolescents. NIH intends to commit an estimated $2.5 million in FY 2022 to fund up to 4 awards.
Initiation of a Mental Health Family Navigator Model to Promote Early Access, Engagement, and Coordination of Needed Mental Health Services for Children and Adolescents to develop and test the effectiveness and implementation of family navigator models designed to promote early access, engagement, coordination and optimization of mental health treatment and services for children and adolescents who are experiencing early symptoms of mental health problems.
The CDC is also supporting the Promoting Positive Childhoods During the COVID-19 Pandemic and Beyond initiative, which seeks to build public health capacity in the COVID-19 response and aftermath and prevent injuries and violence focusing on Suicide, Adverse Childhood Experiences, and intimate partner violence.
CDC supports five National Center of Excellence for Youth Violence Prevention to advance the science and practice of youth violence prevention research. Youth who experience violence as victims, perpetrators, or witnesses have experienced an ACE, and so are more likely to have short-term and chronic physical and mental health conditions and behavioral difficulties. By preventing youth violence, these Centers are also improving youth mental health.