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  • Writer's pictureJorge Petit

Addressing the Adolescent Behavioral Health Crisis: Key Insights and Recommendations


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Over the last year I have been writing about the growing public health crisis of behavioral health challenges among adolescents and young adults, especially BIPOC and LGBTQ+ youth. The United Hospital Fund (UHF), in collaboration with the Boston Consulting Group (BCG), recently released The Ripple Effects of the Adolescent Behavioral Health Crisis, which provides a comprehensive analysis of the behavioral health issues among adolescents in the United States, with a focused lens on New York State and New York City. This is a much-needed summary of the critical issues facing adolescents with actionable recommendations for healthcare professionals and policymakers.


The report calls out the rising prevalence of behavioral health conditions, with approximately 1 in 4 adolescents in New York State experiencing behavioral health conditions such as depression, anxiety, and ADHD, often co-occurring with substance use and risky behaviors.  Alarmingly, 42% of the roughly 340,000 adolescents in NY who had one or more behavioral health conditions in 2022 did not receive the behavioral health care they needed and sadly this disparity in access was more pronounced among Black and Hispanic adolescents.


For healthcare professionals and organizations, understanding the breadth and depth of these issue is crucial for developing strategies that address the specific needs of adolescents while integrating efforts across different sectors and disciplines to create a more inclusive healthcare system.


The report lays out a series of recommendations:

  • Enhancing Access to Care: Increased access to behavioral health services is critically needed. This requires increasing the availability of healthcare providers, including non-clinical workers, like The Ballmer Institute for Children’s Behavioral Health at the University of Oregon, which is a specialized training program with undergraduate degree in child behavioral health.

  • Raising Public Awareness and Stigma Reduction: Campaigns like "Find Your Words" by Kaiser Permanente encourage open discussions about mental health, aiming to reduce stigma and promote early intervention.

  • Community and School Engagement: Schools and community centers should adopt integrated health programs that combine medical, behavioral health, and social services to address the multifaceted needs of adolescents. Programs like the Montefiore School Health Program offer a model for effective community-based health services that could be replicated nationwide to provide comprehensive support for adolescents.


While health disparities were called out in this report, I am proposing here that we need to delve deeper into the unique behavioral health challenges faced by BIPOC and LGBTQ+ youth. Our healthcare system needs a more tailored approach, along with robust family/caregiver engagement and integrated treatment options, that can form the cornerstone of a more inclusive and effective system of care.

 

Here’s a look at 3 specific strategies, and some model programs, that are specifically aimed at improving behavioral health outcomes among BIPOC and LGBTQ+ youth:

  1. Culturally Competent Care: Healthcare providers must receive specialized training to understand the cultural, social, and economic barriers that disproportionately affect BIPOC and LGBTQ+ adolescents. Centers and programs, many sponsored by HHS/SAMHSA, such as the LGBTQ+ Behavioral Health Equity Center of Excellence,  Think Cultural Health, or the Hispanic/Latino Behavioral Health Center of Excellence provide healthcare professionals with trainings to better serve diverse populations and their healthcare needs.

  2. Supportive School Programs: For LGBTQ+ youth, school-based support groups or alliances such as Gay-Straight Alliances (GSAs) provide critical peer support and can significantly mitigate feelings of isolation and depression. These programs also educate the broader school community, reducing stigma and bullying, which are major stressors for LGBTQ+ adolescents. The Steve Fund is dedicated to the mental health and emotional well-being of students of color and works with a broad coalition of stakeholders and young people to promote programs and strategies that build understanding and assistance for the mental health of the BIPOC population.

  3. Community-Based Initiatives: These programs represent a range of models, from grassroots initiatives to more formalized programs, all aimed at improving behavioral health outcomes among BIPOC and LGBTQ+ youth populations through culturally relevant services, community empowerment, and direct support.

  • The Trevor Project offers crisis intervention and suicide prevention services to LGBTQ+ young people, with 24/7 crisis support via text, chat, or phone.

  • Brother, You're on My Mind (BYOMM) is an initiative by the National Institute on Minority Health and Health Disparities and the Omega Psi Phi fraternity. BYOMM focuses on changing the stigma associated with mental health issues among African American men, including young adults. The initiative provides toolkits for community dialogues, engages in community outreach, and creates platforms for discussions about mental health, resilience, and seeking help.

  • We R Native is a comprehensive health resource for Native youth, by Native youth, providing content and stories about the topics that matter most to them. It includes mental health resources and encourages young people to take action within their communities through ambassador programs, which help amplify the focus on behavioral health and wellness.

  • API Wellness Center, based in San Francisco, the API Wellness Center is an LGBTQ and people of color health organization that delivers holistic and culturally competent services with a focus on Asian and Pacific Islanders (API). Their services include mental health counseling, substance use treatment, and support groups specifically designed for LGBTQ+ youth.

  • SAMHSA’s national “Talk. They Hear You."® youth substance use prevention campaign helps parents and caregivers, educators, and community members get informed, be prepared, and take action to prevent underage drinking and other substance use.


Additionally, we must enhance family/caregiver outreach, engagement and supports and continue to promote more integrated treatment models across the continuum of care, such as:

Family/Caregiver Outreach, Engagement and Supports:

  • Integrating family therapy into treatment can be pivotal; models like Multisystemic Therapy (MST)—which address the various systems that impact a youth’s network (family, school, and community)—are effective in treating behavioral issues while improving family dynamics. This approach not only treats the adolescent but also educates and empowers families to support their child’s mental health and wellbeing.

  • Educating parents about the signs of mental health issues and the importance of early intervention can greatly improve outcomes. NAMI Basics, a free, 6-session education program offered by the National Alliance on Mental Illness, is designed for parents and other family caregivers of children and adolescents with emotional or behavioral issues. It provides critical information on how to effectively support their child and navigate the mental health system.


Integrated Treatment Models

There are several national models and programs have been designed to provide integrated treatment models across the continuum of care, particularly focusing on LGBTQ and BIPOC youth. These programs aim to address mental health, substance use, and other wellness aspects through a holistic approach that considers the specific cultural and identity-related needs of these populations. Models and programs, like school-based health centers and wraparound services, assist with delivering comprehensive, holistic care that considers the entire well-being of an individual, not just their medical or emotional conditions.   

  • Project ECHO (Extension for Community Healthcare Outcomes), originally developed to meet the challenge of treating chronic, complex diseases in rural and underserved areas, Project ECHO has been adapted to many other areas, including integrated behavioral health and primary care. The model uses tele-mentoring to build primary care provider competencies and has been used to address pediatric mental health, among other conditions, creating multidisciplinary professional teams that work collaboratively across different sectors.


The escalating crisis of adolescent behavioral health requires a concerted effort from all stakeholders—healthcare providers, payers, educators, policymakers, and communities. Addressing the behavioral health needs of adolescents, especially those from BIPOC and LGBTQ+ communities, necessitates a comprehensive and culturally sensitive approach that will ensure that all adolescents, regardless of background or identity, receive the support and care they need to thrive. By implementing more holistic, integrated programs and engaging families/caregivers in the treatment and recovery process, we can ultimately achieve a more supportive and effective healthcare environment.

 

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