ABSTRACT
Evidence suggests that the current mental health system is failing in the provision of quality mental health care for diverse children and families. This paper discusses one critical domain missing to improve care: serious attention given to diversity, culture, and context. It discusses what we mean by understanding culture and context at the individual, family, organizational, and societal level. Focusing on key predictors of children's adjustment in natural contexts would increase attention to building community and family capacities that strengthen children's mental health. To conclude, we suggest changes in organizational culture to build natural supports to enhance children's mental health.
Subject(s)
Adolescent Health Services/organization & administration , Child Health Services/organization & administration , Community Mental Health Services/organization & administration , Cross-Cultural Comparison , Cultural Diversity , Adolescent , Child , Cultural Competency/education , Cultural Competency/organization & administration , Health Services Research/organization & administration , Humans , Social Adjustment , United StatesABSTRACT
There is a widespread recognition that the mental health system is not effective in meeting the needs of the children, adolescents, and families who seek its services. In response to this recognition, researchers and policy makers are developing and implementing strategies to transform mental health systems. This paper suggests that transformational interventions should not proceed faster than our understanding of the complexities of a mental health system. In a complex system, all component parts are interactive and interdependent. Problems with one component cannot be solved in isolation from other components. The inter-relationships between problems create inter-dependencies; and changes in the balance of these inter-dependencies can cause dramatic shifts in policy priorities, such as when managers of mental health systems respond to budget reductions in a recessionary economy. This paper examines the problem domains in mental health systems that are affected by complexity dynamics, and proposes that a well-built infrastructure is a necessary foundation for structural change in a child-adolescent mental health system. The concept of metastructure is proposed to account for the rule-based processes that govern the actions of agents within a system.
Subject(s)
Adolescent Health Services/organization & administration , Child Health Services/organization & administration , Community Mental Health Services/organization & administration , Cooperative Behavior , Health Services Research/organization & administration , Interdisciplinary Communication , Adolescent , Child , Cultural Competency/organization & administration , Cultural Diversity , Health Policy , Health Services Accessibility/organization & administration , Humans , Needs Assessment , Outcome and Process Assessment, Health Care/organization & administration , Policy Making , Treatment Outcome , United States , Suicide PreventionSubject(s)
Adolescent Health Services/organization & administration , Child Health Services/organization & administration , Community Mental Health Services/organization & administration , Health Services Needs and Demand/organization & administration , Health Services Research/organization & administration , Mental Disorders/prevention & control , Mental Disorders/rehabilitation , Public Health , Adolescent , Child , Cooperative Behavior , Delivery of Health Care, Integrated/organization & administration , Health Services Accessibility/organization & administration , Humans , Interdisciplinary Communication , Regional Health Planning/organization & administration , Social Environment , United StatesABSTRACT
The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field.
