The Agency for Healthcare Research and Quality review assesses the effectiveness of quality improvement, implementation, and dissemination strategies that seek to improve the mental health care of children and adolescents.
Approximately one in five children and adolescents living in the United States has one or more mental, emotional, or behavioral health disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in any given year. These disorders contribute to problems with family, peers, and academic functioning; comorbidity (including other mental and substance use disorders and chronic health conditions); and reduced quality of life; they also increase the risk of involvement with the criminal justice system and other risk-taking behaviors and suicide. The evidence base for pediatric mental health interventions that target mood disorders, anxiety disorders, disruptive behavior disorders, psychotic disorders, eating disorders, and substance use disorders continues to grow. Despite advances in the evidence base, outcomes for children with mental health problems remain suboptimal because of issues with access to care, failure of systems and providers to adopt interventions with proven efficacy (e.g., evidence-based practices [EBPs]), and variability in the quality of mental health care received. Studies using nationally representative data on U.S. adolescents show that only approximately one in five children with mental health problems receives services, and only one-third of treatment episodes are considered minimally adequate (at least four visits with psychotropic medication or at least eight visits without psychotropic medication). The current health care system continues to provide fragmented care to children in numerous uncoordinated systems, rendering inefficient delivery of needed services. Other issues include providers not having the time available or knowledge/training to identify mental health problems and treat or refer accordingly.