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Panelists : Joe Gold , MD: Chief Medical Officer and Director of Child and Adolescent Program, Mclean Hospital, chair; Celeste Reid: Director of Community Health Programs, Blue Cross Blue Shield of MA Foundation; Steve Gross : Trauma and Youth Development Specialist, Director, Project JOY; Laura Perille : Executive Director, EdVestors

Steve Gross: The General Surgeon said in a report that 1in 10 children suffers from some kind of mental illness. Less than 20% will ever go to a clinic for treatment. Massive number of children with debilitating issues, aren't accessing services. Need to identify the therapeutic agents within the community. Therapeutic meaning, helping to move towards health. Anyone with a positive connection, can be a driving force in healing--coaches, teachers, after-school providers. How do we give those folks, gatekeepers, the support and the resources, so they can play that critical role in children's healing? They need support to know what they can do, and when to connect with other treatment. Mental health issues are affecting every space, every group of young people that assemble. We have to lean on more than "mental health providers".

Celeste Reid: The BCBS Foundation was aware that providing access to care for children with mental health had huge gaps and barriers, across socio-economic, racial, cultural etc. lines. Saw that fragmentation and absence of collaboration across disciplines was contributing to the problem. The foundation funded 15 programs, only ones that had at active collaborations between mental health, primary care and education partners. Not everyone has to be Mental Health provider to impact mental health. Training and partnering with teachers, staff of different backgrounds etc. helped improve access.

Joe Gold: Need to take more of the load off of schools. Have to bring other disciplines together to help respond to the overwhelming needs of needs. Went over websites developed to support work in schools, (see attached) including one that offered free curriculum to promote adolescent wellness, developed by Children's Hospital and Mclean. Another offered information about mental health disorders and how to make appropriate educational adaptations. He also sited PEAR's website, and another detailing the legislation being proposed in MA to address mental health needs. He focused on MCPAP, a program across the state to help access the consultation and support of child psychiatrists Mass Child Psychiatry Access Project). It came out of the recognition that there are not enough M.H. clinicians, and the need is vast, access difficult. Problems would often present with pediatricians or at school, and doctors and school staff were asking for more help in making diagnoses and treatment. Project worked on helping especially pediatricians with screening, before problems became more severe. Partners came together, including PAL (parent organization), and created six regional hubs, each with child psychiatrists, care coordinators, and social workers, to help people determined if they could with the situation, or would need to access other services. This was all funded by legislation, families paid nothing.

Laura Perille: Schools are coming up with adaptive strategies to respond to M.H. issues.   Can't get all the students who may be in need to professional help. Increasingly see principals saying, I need to dive into M.H issues in order to get to the academics. Can't afford to say it's not connected. Few schools have actual Student Support Team structures, and 25% of students have M.H. issues. Teachers see the issues first, and supporting them will help reach the students more quickly.   There are models emerging where M.H. support is integrated in the school, for example having teachers pair up with M.H. workers to do small groups that promote social skills and other resiliency promoting activities. M.H. workers may model for teachers, but then it's brought into the classroom and has positive impact. Laura asked the group if they had examples where M.H. issues were getting addressed well in school environment.

Questions and discussion touched on many themes, including :

•  Concern that the courts are becoming the "M.H. provider" of last resort. CHIN's etc, puts children in situation where they have to have charges brought against them to be able to they access services. But it's criminalizing young people. Work being done to file bill to insure M.H. support, and change the system to more strengths-based approach. Maybe can change CHINS (child in need of services) to FINS (family in need of services).

•  Why aren't schools looking at out-of school time period as more flexible window to offer counseling services (rather than during regular school hours?

Fragmentation and Need for Integration:

•    People who work with the same children don't talk to each other. For example, sometimes clinicians who work in schools aren't connected to teachers and after-school workers, so opportunity for creating a team of support is lost.

•  Many people expressed that bringing M.H. support to a whole school, creating more supportive school climate etc., would decrease violence, help address M.H. issues, and help with academics. All interconnected. For example, having trouble reading adds to depression, and being depressed makes it hard to learn to treat.

•  Many schools do not have infrastructure. No guidance counselor at school for example. One story of intern who didn't get adequate supervision, and who felt disempowered in the school because she was an intern.

Parents and Families:

•  Models of using parents to help in addressing problems (examples in BCBS programs). One program successfully supported parents who were immigrants, and they in turn brought in other parent.

•  Discussion of how overtaxed parents are, and that it takes 24 hours of care to successfully intervene in the life of a child. We have to help parents get the skills they need, as they have the primary responsibility for their children. Need more resources to support families, and to provide family counseling.

•  Too often, parents are disconnected from the process of care of their own children.

•  Sometimes it seems that parents are not facing the issues their children have, "that never happens at home".