Child and adolescent mental health policy: Promise to provision

International Review of Psychiatry, June 2008; 20(3): 217–224

Child and adolescent mental health policy: Promise to provision

GORDON HARPER1 & FUSUN CUHADAROGLU CETIN2

1Child and Adolescent Services, Massachusetts Department of Mental Health, Harvard Medical School,

Boston, MA and 2Department of Child and Adolescent Psychiatry, Hacettepe University

School of Medicine, Ankara, Turkey

AbstractMental health policy enables the translation of the knowledge base of ‘how’ to help children and families into the actual‘provision’ of help. Amid competing pressures to leave the allocation of services to the market, policy is required to defineneeds, select priorities, match resources with need, and to measure what has been accomplished. Crafting policy requiresbalancing contrasting goals and approaches, here spelled out. Public mental health policy can be compared to other formsof continuous quality improvement (CQI).

Introduction

The past two decades have seen an explosive growth

both in our knowledge of how to help troubled

children1 and in our knowledge of the gulf between

what is needed and what children are actually

receiving. How to bridge this gulf? Mental health

policy translates the possibility of helping troubled

children into actual help (Belfer, 2007; Belfer,

Remschmidt, Nurcombe, Okasha, & Sartorius,

2007). This paper focuses on that relationship and

reviews recent developments in child mental

health policy.

The knowledge base underlying practice

For many years child mental health practice was

guided by clinical experience, theories of child

development and child psychopathology, and

generalization from uncontrolled series of interven-

tions. These sources of clinical experience and

theory, called level I and level II evidence, continue

to guide most interventions in child mental health.

But in the last two decades the knowledge base for

practice has expanded in three ways. First, new modes

of intervention have been developed. Some of these

address children in their world (e.g. community-

based services, particularly the movement known

in the USA as ‘‘wraparound’’) (Kamradt, 2000),

child empowerment (Tanzania) (Kamo, Carlson,

Brennan, & Earls, 2008), or parent support

(Australia) (Sanders, Markie-Dadds, & Turner,

2003). Others address the individual child

(e.g. evidence-based psychotherapies) (e.g. Kazdin

& Weisz, 2003), or pharmacotherapy (e.g. Connor

& Meltzer, 2006). Second, studies of whole

populations have complemented observations of

children brought for help because of family resources.

Third, systematic evaluation of interventions has

produced more robust evidence, level III. Such

evaluations range from controlled clinical trials of

interventions in specific disorders, such as the

Multimodal Treatment Trial in ADHD ( Jensen

et al., 2007) and meta-analyses, which evaluate what

has been learned in all available studies (Cochrane

reviews, no date). See Figure 1 for relevant Cochrane

reviews.

The gaps between need and help offered

In the same years that our knowledge of how we can

help has increased dramatically, the gap between

what children need and what they are receiving has

been compellingly documented. Data are now

available from developed and developing countries

on the prevalence of diagnosable mental disorders

in children and adolescents (Verhulst, 2004).

Prevalence ranges from 15 to 20%. But most

troubled children, whether troubled in development,

mood, conduct, or overall adaptation, get no help.

Many troubled children, even in developed

countries, are seen in non-mental health settings

Correspondence: Gordon Harper, MD, Associate Professor of Psychiatry, Harvard Medical School, and Medical Director, Child and Adolescent Services,

Massachusetts Department of Mental Health, Mailing Address: 128 Crafts Road, Chestnut Hill MA 02467-1826 USA. Tel: 617-626-8083. Fax: 617-626-8225.

E-mail: [email protected]

ISSN 0954–0261 print/ISSN 1369–1627 online � 2008 Informa UK Ltd.

DOI: 10.1080/09540260802030559

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(Harris, Lieberman, & Marans, 2007). In two

publications, the World Health Organization has

reviewed the development, in more than 60 countries,

of policies for child mental health (WHO, 2005a;

2005b.

Policy: The key to translation

Public policy expresses society’s evolving ideas about

what children need (Wise & Richmond, 2007) by

enabling the translation of knowledge into accessible

services. Confronted with the gap between need and

service provided, that is, the gap between what

we know and what we deliver, many think not of

public policy but of other mechanisms of service

implementation. For example, many clinicians and

clinical investigators might say, ‘Science suffices.’

It is enough, in this view, to study children and to

publish what has been learned. Translation of the

knowledge into practice (USA National Institutes of

Health, 2007) will occur spontaneously. Another

view is expressed by some economists and political

leaders, who say, ‘Leave it to the market.’ In this

view, economic forces, without government inter-

ference, will distribute mental health services, like

other services.

Several lines of evidence indicate that these

approaches are not adequate. For one thing, market

forces allocate services according to resources, not

need. Accordingly, the market tends to perpetuate,

not alleviate disparities. Problems in the distribution

of services were summarized long ago by Hart:

‘The availability of good medical care varies inversely

with the need for it in the populations served’

(quoted by Eisenberg in WHO, 2005a). Regarding

innovations in services, entrepreneurial initiative

creates new services, but guarantees of quality and

safety for the public usually lag far behind

(for example, see Friedman et al., 2006). Even the

development of the knowledge base, left to proprie-

tary interests, may be flawed, as was demonstrated

recently in a report of publication bias: clinical

studies of antidepressant medication showing a

positive effect were more likely to be published

than were studies that showed no effect (Turner,

Matthews, Linardatos, Tell, & Rosenthal, 2008).

A more activist role, guiding the research agenda

according to public health priorities, would align

research activities more closely with children’s needs

(McLennan et al., 2006; Head & Stanley, 2007).

A critical gap exists in the knowledge and resources

to adequately assess need, particularly in low income

countries.

Policy: The intersection of culture, science,

advocacy, and politics meet

All societies value children. But what we do on

their behalf depends on our ideas about how

children develop and our idea of their place in society.

The Cochrane reviews survey the world literature and summarize the evidence forspecific interventions. The reviews began with problems in general medicine but now address many problems in child development and child mental health.

Parenting programmes for the treatment of physical abuse and neglect

School feeding of disadvantaged students

Parent-training programmes for improving maternal health

Exercise to improve self-esteem in children and young people

Parent-training programmes for those with children 0–3 years old

Interventions in children with conduct disorder and delinquency

Treatment foster care

Alternatives to in-patient mental health care

Preventing eating disorders

Antipsychotic medication for childhood-onset schizophrenia

Psychological therapies for post-traumatic stress disorders

Folate and/or multivitamins for preventing neural tube defects

Figure 1. The Cochrane reviews – Scope and power (Cochrane reviews, no date).

218 G. Harper & F. C. Cetin

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These ideas are embedded in culture. They vary with

time and across and within nations (Aries, 1962).

They have been rapidly changing in recent times.

Relevant ideas include:

(1) Children as chattel. Children belong to their

parents. Parents have the right to care for them

or to dispose of them as they might dispose of

other assets. Society cannot interfere in parental

prerogatives. Such attitudes offer no challenge

to such practices as the selling of children into

child labour or sexual exploitation.

(2) Developmental nihilism. In this view, there is

little point in trying to establish goals for

children; children’s development is determined

by heredity, fate, or immutable social facts like

race, class, or social group. Such fatalism

justifies inaction on behalf of socially and

economically disadvantaged children.

(3) Child development equated with education; schools

suffice. Child well-being is seen as a legitimate

social goal, and public policy legitimately

concerns itself with promoting child health

and development, but existing institutions,

especially primary health care and schools, are

thought to suffice. Child mental health does not

require separate attention. This minimization of

the mental health needs of children often

coincides with the minimization of mental

health needs in general.

(4) Child mental health a discretionary good. In this

view, child mental health is acknowledged as a

goal, but child mental health services are seen

as a discretionary (or even luxury) good. This

attitude may be seen in both developing and

developed countries. In developing countries,

mental health needs, if acknowledged at all,

may be deemed less important than physical

health needs. In developed countries, trained

professionals, always fewer than needed, pre-

dominantly care for children from privileged

backgrounds.

(5) Medicalization. The introduction of pharma-

cotherapy for children is changing how chil-

dren’s problems are seen. Children’s troubles

are increasingly defined as disorders. Access to

services may require a diagnosis of a disorder.

The benefits of systematic description and

classification must be weighed against the risks

of over-medicalization, the risk of the loss of

a developmental perspective, and the risk of

losing the contributions of non-medical

professionals.

(6) Children as an economic investment. Investment

in children is regarded as an investment like

other investments. This point of view, while

useful in economic analysis, is not satisfactory

as a basis for policy. It fails to recognize

children’s rights and is subject to abuse, for

instance, justifying the denial of care to those

deemed to have little economic potential.

(7) Children’s rights – a new paradigm. Children’s

rights were advocated early in the 20th century

by the pediatrician and child advocate Janusz

Korczak (Lifton & Wiesel, 1997) and later

institutionalized in the United Nations

Convention on the Rights of the Child

(Carlson, 2001; United Nations, 1989). Most

nations have signed the Convention.

Unfortunately, while the Convention, like

other treaties, is legally binding on signatory

nations, there is no correlation between adher-

ence to the Convention and implementation of

policy or programmes for children’s mental

health (Belfer & Saxena, 2006). Despite this

overall pattern, in some countries rights are

being used for advocacy, in an effort to compel

states to provide more services. In non-signa-

tory countries advocates base such claims not

on rights as guaranteed in the Convention but

on statutory entitlements (see Figure 2).

Policy development: Keeping the balance(s)

Making policy that will make a difference in

children’s lives requires balancing the polarities

identified in Figure 3.

. Technocracy versus participatory planning. While

professional expertise in epidemiology, clinical

services, and treatment evaluation is necessary

for policy development, it does not suffice.

Stakeholders who are not mental health profes-

sionals, including parents, social services, religious

leaders, educators and parents, must participate;

policy must respond to their needs and priorities.

The expression of those needs depends on public

mobilization and advocacy. Policy results from the

interplay between an evolving knowledge base,

political will, and political strategy (Richmond

& Kotelchuck, 1983).

. Specialized services versus the natural caretaking

communities. Facilitation of access to specialized

services must be balanced with support for the

natural caretaking communities of the child,

namely home, school, and community. The

introduction of specialized services can erode the

confidence of primary care physicians and teachers

that they can help children. Support for primary

care physicians can take the form of phone access

to specialists (see Figure 4).

. How to describe children’s troubles? The limits of

‘disorders’. The advantage of identifying needs

Child and adolescent mental health policy 219

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in terms of objectively defined disorders must be

balanced with an appreciation of the whole child as

a developing person in the context of family and

community. Health is not only the absence of

disorder (United Nations High Commission on

Human Rights, 1989). The child cannot be

considered apart from the context of family,

culture, and community (Georgiades, Boyle, &

Duku, 2007; Snowden & Yamada, 2005; Munir &

Beardslee, 2001). Intervention may be more

usefully defined, not as treating disorder, but as

facilitating the child’s healthy development. Where

a defined disorder does not adequately reflect the

challenges faced by a child and family, intervention

may be directed to a uniquely defined problem

(Harper, 1989).

Although the USA has not signed the United Nations Convention on the Rights of theChild, advocates have used US federal statute to seek broader mental health services forchildren. The law that established medical services for low-income Americans requiresthat participating states offer children ‘early and periodic screening, diagnosis andtreatment’ (EPSDT). Child advocates have found this requirement, meant to guaranteewell-child services in general, an ‘opening’ to allow them to challenge the way stateshave provided mental health services. Failure to provide EPSDT, they argue, results inchildren’s being placed far from home, in unnecessarily restrictive settings. When judgesin some states have accepted this argument, expansion and reorganization of mentalhealth services has been ordered. In this way the children’s rights concept, by exploitinglocal legal opportunities, spreads beyond the countries that are signatories to theConvention (Massachusetts Office of Health and Human Services, no date).

Figure 2. ‘EPSDT’ and children’s rights in the USA.

Expert-driven

Specialized help

Stand-alone mental healthMental health part ofhealth care

Child as recipient Child as agent

Child per se Child-in-family

Medical Psychosocial

Developmental viewMiniaturization

Defining, analysingproblems

Diagnosing disorders

Natural caretakers

Consumer-driven

PreventionSecondary and tertiarytreatment

Figure 3. Balancing perspectives in Child Mental Health Policy.


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. ‘Miniaturization’ versus developmental focus. In

some countries there may be professional and

administrative pressure to define children’s mental

health problem using criteria ‘down-scaled’ from

adult mental health. Other approaches to assess-

ment of the growing child emphasize dimensional

(Hudziak, Achenbach, Althoff, & Pine, 2007)

diagnosis and developmental assessment, espe-

cially of emotional development (Kagan, 2001).

. Pharmacotherapy: Stand-alone or integrated? It is

necessary to balance judicious use of pharmacolo-

gical agents with a comprehensive approach to all

the factors that may contribute to a child’s trouble.

Otherwise, care becomes centred on or even

limited to pharmacotherapy.

. Child versus family. Principles like ‘child- and

family-centred’ (Stroul & Friedman, 1986) capture

the tension between advocating for the individual

child, even at the risk of alienating parents, and

advocating for the parents who are and will remain

his primary caretakers.

. Child as beneficiary versus child as agent. After

generations in which the child was seen as a passive

recipient of protection and intervention by adults,

the idea is now developing that through a process

of adult-facilitated participation children can

themselves become the agents of change (Carlson

& Earls, 2001). In that spirit, a health promotion

project in Tanzania has aimed to help young

adolescents (aged 10–14) become effective agents

in their communities. These ‘young citizens’ have

opened new channels of public communication

about a highly stigmatized problem, the prevention

of HIV infection and the care and support of

people with AIDS. Through a modular curriculum

they are taught observational and analytical skills,

given information about microbiology and the

social context of infectious disease, and encour-

aged to create community dramas about the risks

of HIV/AIDS and other infectious diseases faced

by young people (Kamo et al., 2008; see Figure 5).

. Child mental health – a part of general health care?

While mental health services for children may

‘stand alone’, they are more usefully integrated

into general health care. Integration is particularly

useful wherever resources are limited (as they are

everywhere) and wherever suspicion of mental

health services, grounded in cultural or religious

beliefs, is an obstacle.

. Intervening early or late: Prevention versus treatment.

Policy must balance universal measures aimed at

promoting health or preventing disorder in the

While all countries report shortages of specialists in child mental health, the state ofMassachusetts in the USA found itself in an unusual situation. Although the state hadmore child psychiatrists per capita than other states, and far more than most othercountries, families faced long waits to get children seen. Primary care physicianscould not refer children when they recognized behavioural and emotional problems.Unable to increase the number of specialists, the state took a different tack: it shiftedto using child psychiatrists as consultants and sought a way to increase access forprimary care physicians. Once contracted child psychiatrists were made available toprimary care physicians by telephone, with back-up face-to-face assessment whenneeded, most pediatricians’ needs were met over the phone. Another positive result:pediatricians had an increased confidence in their own ability to be helpful to childrenwith behavioural or emotional crises (Sarvet et al., 2006).

Figure 4. Primary care physicians and child psychiatrists: Promoting access.

Module 1 (five sessions): fosters group identity, trust, and discussion skills

Module 2 (four sessions): introduces local leadership, teaches skills to be used incommunity surveys

Module 3 (over five weeks): provides information about social transmission of infectious

diseases, especially malaria and HIV/AIDS; youths develop dramas to illustrate risks and

protective strategies

Module 4 (14 sessions): dramas are presented in the community; neighbours watchdramas, discuss risks, strategies, and family matters

- Kamo et al., 2008

Figure 5. Children as young citizens: Structured modules used in CHASE Project in Tanzania.


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entire population, targeted measures aimed at

those at risk, and tertiary (or rehabilitative) services

for those with chronic conditions. The case for

prevention in child mental health has been argued

in Canada (Waddell, McEwan, Peters, Hua, &

Garland, 2007) and the USA (SAMHSA, 2007).

How child mental health policy arises:

A developmental view

Those interested in child mental health policy,

borrowing on clinical experience, take a develop-

mental, multi-sectoral view of how policy arises. This

approach contrasts with the technocrat’s dream that

all it takes to create policy is assessment by experts of

needs and design by experts of a rational system.

Child mental health policy, like other political

initiatives, arises from the interaction of knowledge

base, public awareness and mobilization, advocacy,

and a social strategy (Wise & Richmond, 2007).

For example, the development of a strongly child-

orientated tradition in healthcare and law in Sweden

occurred not just as the result of scientific–academic

progress, but as the product of a child-focused

cultural–educational–social–political movement over

a century (Figure 6). Similarly, the first child mental

health services in Australia and the USA arose during

periods of progressive social and political movements

that created the first juvenile courts (Richmond

& Harper, 1996).

Historical accidents may provide impetus to

developing mental health services. In Turkey,

severe earthquakes in 1997 led to increased recogni-

tion, both in and outside the country, of needs to

increase services and to coordinate them better

(Munir, Ergene, Tunaligil, & Erol, 2004). In India,

natural and human-made disasters have been fol-

lowed by enhancement of emergency relief and

mental health services; progress in rehabilitation

and rebuilding has been slower (Rao, 2006).

The role of out-of-country help deserves special

consideration. Pilot projects, like those supported by

agencies like UNICEF or WHO, may be useful in

initiating services. But after the pilot, the challenge

is to find sustainable funding over the longer term.

Services stimulated from abroad must also be

culturally compatible and respond to local priorities,

not the priorities chosen by international consultants.

As indicated earlier the process of policy formulation

is complex. The involvement of outside consultants

is best seen as supporting the local professionals and

other stakeholders rather than leading the effort.

The former is more likely to ensure sustainability and

lessen conflict (Cuhadaroglu, 2000).

In many countries today, the debate about services

for children is enriched not only by an expanded

knowledge base, but also by the participation in the

debate of clients (patients) themselves (Matarese,

McGinnis, & Mora, 2005). Echoing movements in

disability rights (see ‘Nothing about us without us’;

Charlton, 1998) and ‘Person-first’ language

(Snow, 2008), these initiatives bring children and

adolescents who have struggled with serious mental

illness to the table, to share their experience, offer

hope to those at an earlier stage of recovery, and give

feedback to providers about what works and what

does not.

In a developmental spirit, it is worth remembering

that policy is not static, produced in a one-time

event. Policy is continually evolving, an interaction

of assessment, political priorities, and a changing

In Sweden, giving children legal status independent of parents’ rights goes back tothe 1800s. Ellen Key, an educator and writer, called the 20th century the ‘centuryof the child’ and sought to support the child’s natural ‘systems’, the family and the

school. Her books had a great impact. In addition, Sweden created the firstacademic chair in pediatrics in 1845. Dr Berg, the first professor, developed

pediatrics, health statistics, child and adolescent psychiatry, epidemiology andsocial medicine. These academic initiatives occurred along with social reforms.

The first day-care system for children of poor mothers was started in 1866. Childmental health in the Stockholm public schools began during the First World War.

Two other traditions began then: an annual ‘children’s day’ including fund raising,and the selling of ‘mayflowers’ (‘children help children’) to support school

activities and children’s research. In 1924 each Swedish community had to set upa children’s welfare board to plan for their children, especially children at risk ofneglect or abuse or at risk becoming delinquents. All these activities led to the

Swedish ‘transition’ into a country with a strong ‘child advocacy perspective’ inthe health system and the legal system.

– Key, 1912

Rydelius, P-A, Karolinska Institute, Stockholm

Figure 6. Children’s right in Sweden – a long inter-sectoral tradition.


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knowledge base. The use of data to define problems,

set goals, and measure the effects of actions taken, in

order to revise goals, constitute continuous quality

improvement (CQI). While the application of CQI to

health planning has been advocated in the developed

world (Wang, Hyun, Harrison, Shortell, & Fraser,

2006; New York City Department of Health and

Mental Hygiene, 2008), the need for a data-based

CQI approach may be even greater in low-resource

countries (Siddiqi & Newell, 2005). In this spirit,

Bailie, Si, O’Donoghue and Dowden (2007) have

illustrated the application of CQI to health planning

for the aboriginal and Torres Straits peoples in

Australia. The application of the Plan-Do-Study-Act

CQI cycle to planning in child mental health is

illustrated in Figure 7.

Conclusion

Policy is moving from being an under-discussed

topic in child mental health to being recognized as a

key ingredient in moving the possibility of helping

children into the actuality of services provided. The

opportunities, given a growing body of knowledge

underlying practice and also given extensive unmet

need, are enormous. Policymakers must appreciate

the several dimensions which must be balanced in

developing policy.

Declaration of interest: The authors report

no conflicts of interest. The authors alone are

responsible for the content and writing of the paper.

Note

1. ‘Children’ refers to children and adolescents.

References

Adams, J., Nolte, M., & Schalansky, J. (2000). Who will

hear our voices? In H. B. Clark & M. Davis (Eds.),

Transition to adulthood: A resource for assisting young people

with emotional or behavioral disturbance. Baltimore, MD:

Paul H. Brookes.

Aries, P. (1962). Centuries of childhood: A social history of family life.

New York: Random House.

Bailie, R. S., Si, D., O’Donoghue, L., & Dowden, M. (2007).

Indigenous health: Effective and sustainable health services

through continuous quality improvement. Medical Journal of

Australia, 186, 525–527.

Belfer, M. L. (2007). Critical review of world policies for mental

healthcare for children and adolescents. Current Opinion in

Psychiatry, 20, 349–352.

Belfer, M. L., & Saxena, S. (2006). WHO Child Atlas Project.

The Lancet, 367, 551–552.

Belfer, M., Remschmidt, H., Nurcombe, B., Okasha, A., &

Sartorius, N. (2007). A global programme for child and

adolescent mental health: A challenge in the new millennium.

In H. Remschmidt, B. Nurcombe, M. L. Belfer, & N. Sartorius

(Eds.), The mental health of children and adolescents: An area of

global neglect. Hoboken, NJ: John Wiley & Sons.

Carlson, M. (2001). Child rights and mental health.

Child and Adolescent Psychiatric Clinics of North America, 10,

825–839.

Carlson, M., & Earls, F. (2001). The child as citizen:

Implications for the science and practice of child develop-

ment. International Society for the Study of Behavioral

Development Newsletter, 38, 12–16.

Charlton, J. I. (1998). Nothing about us without us: Disability

oppression and empowerment. Berkeley, CA: UC Press.

Accessed 1 February 2008. http://ftp.disabilityisnatural.com/

documents/PFL8.pdf

Cochrane reviews. Accessed 1 February 2008. http://www.mrw.

interscience.wiley.com.ezp1.harvard.edu/cochrane/cochrane_

clsysrev_articles_fs.html

Connor, D. F., & Meltzer, B. M. (2006). Pediatric psychopharma-

cology: Fast facts. New York: Norton.

Cuhadaroglu, F. (2000). A Turkish self psychologist reflects on

her country’s earthquake. International Association of Self

Psychology: Self Psychology News, June, 13–14.

Friedman, R. M., Pinto, A., Behar, L., Bush, N.,

Chirolla, A., Epstein, M., Green, A., Hawkins, P.,

Huff, B., & Huffine, C. (2006). Alliance for the safe,

therapeutic and appropriate use of residential treatment.

Unlicensed residential programs: The next challenge in

protecting youth. American Journal of Orthopsychiatry, 76,

295–303.

Georgiades, K., Boyle, M. H., & Duku, E. (2007). Contextual

influences on children’s mental health and school performance:

The moderating effects of family immigrant status. Child

Development, 78, 1572–1591.

Harper, G. (1989). Focal inpatient treatment planning.

Journal of the American Academy of Child and Adolescent


Harris, W. W., Lieberman, A. F., & Marans, S. (2007). In the best

interests of society. Journal of Child Psychology and Psychiatry,

48, 392–411.

Head, B. W., & Stanley, F. J. (2007). Evidence-based advocacy:

The Australian Research Alliance for Children and Youth

(ARACY). International Journal of Adolescent Medical Health,

19, 255–262.

CHECK: arechildren better

off?

DO: implementthe plan

PLAN:prioritize problems,

analyse them, choosewhat to do

ACT:study results,

revise plan, carryit out

Figure 7. Application of continuous quality improvement

(CQI) Plan-Do-Study-Act (PDSA) cycle to mental health

planning.


Int R

ev P

sych

iatr

y D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y C

DL

-UC

San

Die

go o

n 10

/08/

14Fo

r pe

rson

al u

se o

nly.

Hudziak, J. J., Achenbach, T. M., Althoff, R. R., & Pine, D. S.

(2007). A dimensional approach to developmental psycho-

pathology. International Journal of Methods in Psychiatric

Research, 16(Suppl.1), 16–23.

Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello, B., Abikoff,

H. B., Greenhill, L. L., Hechtman, L., Hinshaw, S. P., Pelham,

W. E., Wells, K. C., et al. (2007). Three-year follow-up of the

NIMH MTA study. Journal of the American Academy of

Child and Adolescent Psychiatry, 46, 989–1002. Also available

at: http://www.nimh.nih.gov/health/trials/nimh-research-on-

treatment-for-attention-deficit-hyperactivity-disorder-adhd-

questions-and-answers-about-the-multimodal-treatmen.shtml

Kagan, J. (2001). Emotional development and psychiatry.

Biological Psychiatry, 49, 973–979.

Kamo, N., Carlson, M., Brennan, R. T. & Earls, F. (2008).

Young citizens as health agents: Use of drama in promoting

community efficacy for HIV/AIDS. American Journal of Public

Health, 98, 201–204. Also available at CHASE website: http://

www.hms.harvard.edu/chase/projects/tanzania/tzindex.html

Kamradt, B. J. (2000). Wraparound Milwaukee: Aiding youth

with mental health needs. Juvenile Justice Journal, 7, 19–26.

Kazdin, A. E., & Weisz, J. R. (2003). Evidence-based psychothera-

pies for children and adolescents. New York: Guilford Press.

Key, E. (1912). The century of the child. New York: Putnam’s.

Lifton, B. J., Wiesel, E. (1997). The king of children: The life and

death of Janusz Korczak. New York: St Martin’s Press.

Notes on Korczak also available at: http://en.wikipedia.org/

wiki/Janusz_Korczak

Massachusetts Office of Health and Human Services, Children’s

Behavioral Health Initiative. Accessed 1 March 2008 at

mass.gov/masshealth/childbehavioralhealth

Matarese, M., McGinnis, L. & Mora, M. (2005). Youth involve-

ment in systems of care: A guide to empowerment. Washington,

DC: Technical Assistance Partnership. Also available at: http://

www.systemsofcare.samhsa.gov/headermenus/docsHM/

youthguidedlink.pdf

McLennan, J. D., Wathen, C. N., MacMillan, H. L., & Lavis, J.

N. (2006). Research-practice gaps in child mental health.

Journal of the American Academy of Child and Adolescent


Munir, K., Ergene, T., Tunaligil, V., & Erol, N. (2004).

A window of opportunity for the transformation of national

mental health policy in Turkey following two major

earthquakes. Harvard Review of Psychiatry, 12, 238–251.

Munir, K. M., & Beardslee, W. R. (2001). A developmental and

psychobiologic framework for understanding the role of culture

in child and adolescent psychiatry. Child and Adolescent

Psychiatric Clinics of North America, 10, 667–677.

New York City Department of Health and Mental Hygiene

(2008). Quality impact. Available at: http://www.ci.nyc.ny.us/

html/doh/html/qi/qi-cqi.shtml

Rao, K. (2006). Lessons learnt in mental health and psychosocial

care in India after disasters. International Review of Psychiatry,

18, 547–552.

Richmond, J. B., & Harper, G. (1996). Child and adolescent

psychiatry: Toward the twenty-first century. Harvard Review of


Richmond, J. B., & Kotelchuck, M. (1983). Political influences:

Rethinking national health policy. In C. H. McGuire,

R. P. Foley, A. Gorr, & R. W. Richards (Eds.), The handbook

of health professions education. San Francisco: Jossey-Bass.

Sanders, M. R., Markie-Dadds, C. & Turner, K. M. T. (2003).

Theoretical, scientific and clinical foundations of the Triple-P

Positive Parenting Program: A population approach to the promotion

of parenting competence. Parenting Research and Practice

Monograph No. 1. Parenting and Family Support Centre,

University of Queensland. Further resources available from the

Triple P website at: http://www.triplep.net/files/pdf/

Parenting_Research_and_Practice_Monograph_No.1.pdf

Snow, K. (2008). People First Language. Woodland Park, CO:

Disability is Natural – BraveHeart Press. Available at:

www.disabilityisnatural.com

Snowden, L. R., & Yamada, A. M. (2005). Cultural differences in

access to care. Annual Review of Clinical Psychology, 1, 143–166.

Sarvet, B., Fassler, D., Sulik, L. R., Preuss, L., & Straus, J. H.

(2006). Child psychiatry partnerships with primary care:

Population-based practice models. Meeting of the American

Academy of Child and Adolescent Psychiatry. San Diego, CA,

USA.

Siddiqi, K., & Newell, J. N. (2005). Putting evidence into practice

in low-resource settings. Bulletin of World Health Organization,

83, 882–883.

Stroul, B. A. & Friedman, R. M. (1986). A system of care for youth

& youth with severe emotional disturbances. Washington DC:

Georgetown University Child Development Center, CASSP

Technical Assistance Center.

Substance Abuse and Mental Health Services Administration

(SAMHSA) (Center for Mental Health Services) (2007).

Promotion and prevention in mental health: Strengthening parenting

and enhancing child resilience. Rockville, MD: US Department of

Health and Human Services. Also available at: http://mental-

health.samhsa.gov/publications/allpubs/svp-0186/

Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., &

Rosenthal, R. (2008). Selective publication of antidepressant

trials and its influence on apparent efficacy. New England

Journal of Medicine, 358, 252–260.

United Nations High Commission on Human Rights (1989).

Convention on the rights of the child. New York: United

Nations. Available at: http://www.unhchr.ch/html/menu3/b/

k2crc.htm

USA National Institutes of Health (2007). Conference on

dissemination and implementation in the service of public

health. Available at: http://search2.google.cit.nih.gov/search?q¼

cache:tj3n17-xVH0J:obssr.od.nih.gov/di2007/images/agenda

%2520final.pdfþscienceþtoþservice&access¼p&output¼xml

_no_dtd&ie¼UTF-8&client¼NIHNEW_frontend&site¼NIH

_Master&proxystylesheet¼NIHNEW_frontend&oe¼UTF-8

Verhulst, F. C. (2004). Epidemiology as a basis for the conception

and planning of services. In H. Remschmidt, M. L. Belfer, &

I. Goodyer (Eds.), Facilitating pathways: Care, treatment, and

prevention in child and adolescent mental health (pp. 3–15). Berlin:

Springer Verlag.

Waddell, C., McEwan, K., Peters, R. D., Hua, J. M., &

Garland, O. (2007). Preventing mental disorders in children:

A public health priority. Canadian Journal of Public Health, 98,

174–178.

Wang, M. C., Hyun, J. K., Harrison, M., Shortell, S. M., &

Fraser, I. (2006). Redesigning health systems for quality:

Lessons from emerging practices. Joint Commission Journal of

Quality and Patient Safety, 32, 599–611.

Wise, P. H., & Richmond, J. B. (2007). In M. L. Wolraid,

P. H. Dworkin, D. D. Drotar, & E. C. Perrin (Eds.),

The history of child developmental-behavioral health policy in

the United States. St Louis, MO: Elsevier.

WHO (2005a). Atlas: Child and adolescent mental health resources:

Global concerns, implications for the future. Geneva: World Health

Organization.

WHO (2005b). Mental health policy and service guidance package:

Child and adolescent mental health policies and plans. Geneva:

World Health Organization.


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Child and adolescent mental health policy: Promise to provision