Promoting Children’s Mental, Emotional, and Behavioral (MEB) Health in All Public Systems, Post‑COVID‑19

The prevalence of children’s psychological disorders is 17.4%, and rates for anxiety, depression and suicide are steadily increasing (Cree et al. 2018; Mojtabai et al. 2016). Glaring racial and ethnic disparities exist in access to and quality of mental health services (Merikangas et al. 2011). Contributing to both prevalence and service disparities, 18% of children lived in poverty, and 33% had parents who lacked stable employment before COVID. These situations are worsening with the pandemic. The combination of rising rates of children’s disorders, a high poverty rate, high unemployment, limited schooling and services, and the escalating financial crisis posed by COVID-19 threaten healthy development for this generation of children. To counter these threats, we need a plan that prioritizes social responsibility for children’s well-being and encompasses all public systems serving children. Hoagwood and Kelleher (2020) outlined core principles for such a response. They called for a fundamental societal shift to redress generations of public service system neglect of children. Modeled on the Marshall Plan, they outlined an economic and social reconstruction effort whose cornerstone is a childrenfirst ethic: a societal pivot to prioritize children’s healthy development. The plan calls for the equitable coordination of public systems serving children and youth: mental health, early learning and education, maternal and child health, child welfare, and corrections. Given that the vast * Kimberly Eaton Hoagwood 1 Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA 2 2543 Painter Court, Annapolis, MD 21401, USA 3 Senior Research Chair in Child and Adolescent Psychiatry, Children’s Hospital of Eastern Ontario Research Institute and Professor of Epidemiology, University of Ottawa, Ottawa, ON, Canada 4 Abigail Wexner Research Institute At Nationwide Children’s Hospital, Columbus, OH, USA 5 The Ohio State University College of Medicine, Columbus, OH, USA 380 Administration and Policy in Mental Health and Mental Health Services Research (2021) 48:379–387 1 3 majority of MEB challenges begin before age 14, the plan would move services upstream to promote children’s early development and support families, thereby mitigating the well-documented risks that lead to later mental, emotional and behavioral (MEB) disorders. The children’s mental health system in this country was not managing the pre-pandemic demand for services. By itself, it will not be able to address the predicted surge in demand post-COVID-19. But scientific evidence points to a multitude of community-facing programs, policies, and strategies that prevent mental health problems from developing in the first place and promote children’s MEB health by addressing child and family developmental needs early in life. The National Academies of Science, Engineering and Medicine (NASEM) has called for all sectors of society to engage in the healthy development of resilient children by strengthening families and communities (National Academies of Sciences Engineering & Medicine, 2017a, 2017b, 2019a). Effective strategies to promote healthy development and to address the negative consequences of racism on families and communities can be implemented using a multi-sector, coordinated plan; in fact, numerous state and local pediatric population health experiments were doing that before COVID-19. Hoagwood and Kelleher (2020) outlined actionable steps that state and local mental health systems could undertake to move services upstream. These included coalition building with other systems. These coalitions were strengthened by contracts that improved accountability for outcomes, including required metrics to measure those outcomes. Coalition building includes establishing the structural conditions for implementing a prevention/promotion initiative, workforce issues (i.e., who will carry the program out), and engaging communities and families in the effort. Contractual considerations include establishing agreed-upon measures and metrics to monitor outcomes, assigning accountability for those outcomes and delineating realistic time frames for these investments before expecting improved outcomes. In this paper, the authors extend the plan to non-mental health systems, with suggestions about scientifically based services programs or policies that can be immediately mobilized, including under-represented racial minority children who may be particularly vulnerable because of ongoing systemic racism and pandemic effects. The abrupt shutdown of many state public services and the economic recession has further weakened the public safety net infrastructure. Nevertheless, the disruption also provides an opportunity to commit to social priorities that focus on upstream services targeted at children’s healthy mental, emotional, and behavioral development. While space precludes our discussion of financing issues—those will be addressed in future papers–there is strong evidence supporting the positive return of early investments in children (National Academies of Sciences Engineering & Medicine, 2016, 2017a, 2017b, 2019a), and benefit–cost ratios have also been calculated for many early education programs (Institute & for Public Policy.Benefit–Cost Results: Children’s Mental Health.In:, 2020:https: www. wsipp. wa. gov, BenefitCosttopicId=5. 2020) (see https:// www. wsipp. wa. gov/ Benefi tCost). Creative financing strategies have also been developed to support early education initiatives, which have longer-range return-on-investments (Foundation et al. 2018) and are now being used by several states (Hoagwood et al. 2020). New federal investments are also testing these models of care nationally (i.e., Integrated Care for Kids (IncK.) (Care and for Kids (InCK) Model. 2020; https: I, Inn