Children exposed to violence aren’t getting the mental health treatment they need, a medical study published today shows.
The research appears in Journal of the American Medical Association. “These findings suggest that large portions of the high-risk youth population are not receiving behavioral health services that could improve their developmental outcomes,” concluded the authors.
Social scientists from the University of New Hampshire Crimes Against Children Research Center conducted the study. They looked at data from 12,000 youths who participated in the National Surveys of Children’s Exposure to Violence. The data came from telephone interviews with the youths and their caregivers.
“In this cross-sectional study combining findings from three U.S. national surveys, large portions of children at high risk because of adversity or mental health symptoms were not receiving clinical services,” the researchers concluded. “Better ways are needed to find these at-risk populations and help them obtain relevant intervention resources.”
Adverse childhood experiences, distress measured
The researchers assessed adverse childhood experiences for each child and then analyzed whether they received mental health treatment. They also looked at whether the children were exhibiting signs of distress.
The scientists defined adverse childhood experiences as “life exposures that have been found to be strongly associated with both early and later emotional and behavioral problems,” adding “literatures have argued for the need to make a greater effort to identify such problems in children, possibly by developing protocols for universal screening.
“However, debates exist about how to go about such screening, who to screen, and what to screen for.”
Distress signals were measured by anger or aggression, depression, anxiety, dissociation, and post-traumatic stress scales of the Trauma Symptoms Checklist for Children (TSCC) and the Trauma Symptoms Checklist for Young Children.
More than half of at-risk children don’t see clinician
Among participants ages two to nine, no contact with a health care professional was reported for 57 percent of children reporting high adverse childhood experiences. For children exhibiting symptoms of high distress, the percentage receiving mental health care was even lower, at 53 percent.
Among participants ages 10 to 17, almost two-thirds of children reporting high adverse childhood experiences had no contact with a health care professional.
Black children were the least likely to see a doctor after reporting adverse childhood experiences. Non-Hispanic whites were most likely.
Some health care providers endorse mental health screening in schools. But it’s a touchy subject with school boards and some parents.
Should schools require mental health screens?
“The literature concerned with mental health screening highlights epidemiologic studies showing that as much as one-quarter of the child and youth population experiences mental health disorders, but only one-third to one-half of those with disorders get treatment,” the authors explained in the study. “Advocates point out that effective treatments exist for many of these conditions and have urged universal screening, especially for widespread, specific, and treatable problems, such as anxiety and depression.
“Universal screening experiments to identify mental health symptoms have been fielded in some locales.”
The most widespread problems children experience include physical and sexual abuse, parental drug and alcohol abuse and interpersonal violence.
“An accumulation of these adversities has been also found to be strongly associated with mental health problems in childhood and adolescence,” the authors reported. “Advocates have argued that children with these multiple adversities need to be screened and flagged for intervention, much if not all of it through referral to behavioral health practitioners.”
California has universal mental health screening
California already has universal mental health screening in pediatric care. Other large community health systems have followed suit.
“Interestingly, high-risk children and youth in nontraditional family structures were substantially more likely to have clinical contact than their counterparts living with two biological parents,” the authors observed. “It may be that parental divorce and the transition to blended families represent highly disruptive changes or worrisome conditions for caregivers that are likely to trigger clinical contact.”
The authors posed arguments for universal screening. “It provides a more valid indicator that a harmful process is under way, considering that adversities can occur with minimal impact,” they explained. “Another argument is that symptoms are easier to match to treatment options because clinical treatment is typically more organized around symptoms (e.g., depression or ADHD) than it is around adversities (having an incarcerated parent or being exposed to a crime scene).
“The fact that adversities and symptoms do not fully overlap might mean that referral based only on adversities would swamp behavioral health resources with children for whom the treatment target was uncertain. “