Next Steps: Enhancing Behavioral Health in Children and Adolescents

Sponsor/Type: The Duke Endowment
Project Period: 07/01/2022 - 06/30/2025


Radical healthcare inequity gaps exist in behavioral healthcare services for underprivileged, rural and ethnic minority children. It is estimated that one in eight children experience mental healthcare disorders at any time. Post-pandemic data indicate that one in four children demonstrate the symptom constellations that support diagnoses of depression and/or anxiety. Additionally, suicide attempts and success are 2.4 times higher since 2020. Despite state and federal attention to infancy and early childhood care systems and school-based services to bridge inequity gaps, children and families continue to lack provisions for behavioral health (BH) throughout childhood. This contributes to missed opportunities for early intervention for conditions such as: substance use disorder; physical, mental and sexual abuse; depression, mood/psychotic disorders; learning disabilities.

Expanding BH services that build upon existing systems and structures where children and families spend the bulk of their time outside of the home to include medical homes, schools, childcare facilities, and community gathering places is optimal. Most pediatric primary care (PCP) clinics lack BH support staff such as Licensed Clinical Social Workers’s (LCSW), Psychiatric Mental Health Nurse Practitioners (PMHNP), or Psychiatrists who are relied upon to diagnose, intervene and manage BH diagnoses.

Concurrently, there is a lack of available work force ready to serve all children and families that request care. Additionally, BH diagnoses continue to carry stigma in many cultures and geographical regions of our country, including the tri-county region. The culmination of these barriers results in children and adolescents being under-diagnosed, sub-optimally treated and limited in their abilities to achieve academic, social, and family well-being.

This proposal builds on prior successes in BH services within primary care (PC) settings for the 0 to 5 age group in early identification/intervention of BH and other medical conditions. This work has been led by county-wide level of state agencies and programs, provided by South Carolina First Steps to School Readiness. These services, including other BH interventions, encompass programs that rely upon community health workers (CHWs) to provide early screening, intervention, and care planning in collaboration with healthcare providers and LCSW. Our proposed program, titled “Next Steps” has 3 major components (CHWs, co-located BH providers, and engagement with existing PCPs and children’s resources) is designed to have a direct linkage to other community-based wellness initiatives such as MUSC’s Boeing Center for Children’s Wellness and, local school-based BH providers including those providing telehealth.

The currently existing CHW program provides key bidirectional referral paths; for our proposal, we will advance this model among three primary care practices with co-located BH counselors and referral paths to pediatric psychiatric providers in the event medication therapy is needed. We posit that building out these services can assist in ameliorating the need to diagnose, refer and treat BH conditions that occur in childhood. Specifically, our model expands BH services for children through use of established CHWs in known and trusted medical homes to deliver enhanced access to care to culturally congruent comprehensive BH care in the PC setting.

For more information contact
Amy Williams