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Prepublication Copy, Uncorrected Proofs PrepublicationÂ CopyÂ UncorrectedÂ Proofs Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda Committee on Fostering Healthy Mental, Emotional, and Behavioral Development Among Children and Youth Board on Children Youth and Families Division of Behavioral and Social Sciences and Education A Consensus Study Report of
Prepublication Copy, Uncorrected Proofs Â THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by grants and awards from the Centers for Disease Control and Prevention, Division of Human Development and Disability (200-2011-38807 TO #62); the National Institutes of Health, National Center for Complementary and Integrative Health (HHSN26300131); the National Institutes of Health, National Institute on Drug Abuse (HHSN26300131); and the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (HHSP233201400020B/HHSP23337062). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25201 Library of Congress Control Number: XXXXXXXXXX Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda. Washington, DC: The National Academies Press. https://doi.org/10.17226/25201.
Prepublication Copy, Uncorrected Proofs The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. Â Â
Prepublication Copy, Uncorrected Proofs Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the studyâs statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committeeâs deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
Prepublication Copy, Uncorrected Proofs COMMITTEE ON FOSTERING HEALTHY MENTAL, EMOTIONAL, AND BEHAVIORAL DEVELOPMENT AMONG CHILDREN AND YOUTH THOMAS F. BOAT (Chair), Cincinnati Childrenâs Hospital Medical Center WILLIAM A. ALDRIDGE II, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill ANTHONY BIGLAN, Oregon Research Institute W. THOMAS BOYCE, School of Medicine, University of California, San Francisco (until March 2018) RICHARD F. CATALANO, JR., Social Development Research Group, University of Washington FRANCES CHAMPAGNE, Department of Psychology, Columbia University JENNIFER FRANK, Department of Education, Psychology, Counseling, and Special Education, The Pennsylvania State University PATRICIA JENNINGS, Curry School of Education, University of Virginia SHERYL KATAOKA ENDO, Division of Child and Adolescent Psychiatry, University of California, Los Angeles KELLY KELLEHER, Nationwide Childrenâs Hospital GRACE KOLLIESUAH, Ohio Department of Mental Health and Addiction Services MARGUERITA LIGHTFOOT, Department of Medicine, University of California, San Francisco TAMAR MENDELSON, Johns Hopkins Bloomberg School of Public Health RICARDO F. MUÃOZ, Palo Alto University MYRNA M. WEISSMAN, Mailman School of Public Health, New York State Psychiatric Institute, Columbia University, Vagalos College of Physicians and Surgeons TARA LYNN MAINERO, Study Director (until February 2019) ALEXANDRA BEATTY, Study Director (from February 2019) ERIN KELLOGG, Research Associate (beginning September 2018) MARGARET KELLY, Senior Program Assistant REBEKAH HUTTON, Associate Program Officer (February 2017âFebruary 2018) SARAH TRACEY, Associate Program Officer (AprilâJune 2018) LAIAH FACTOR, Mirzayan Fellow (JanuaryâApril 2018) Fm-v Â
Prepublication Copy, Uncorrected Proofs BOARD ON CHILDREN, YOUTH, AND FAMILIES ANGELA DIAZ (Chair), Departments of Pediatrics and Preventive Medicine, Ichan School of Medicine at Mount Sinai HAROLYN M. E. BELCHER, Center for Diversity in Public Health Leadership, Kennedy Krieger Institute W. THOMAS BOYCE, School of Medicine, University of California, San Francisco DAVID BRITT, Sesame Workshop (retired) RICHARD F. CATALANO, Social Development Research Group, University of Washington DIMITRI A. CHRISTAKIS, School of Medicine, University of Washington JEFFREY W. HUTCHINSON, Uniformed Services University of the Health Sciences JACQUELINE JONES, Foundation for Child Development, New York, New York STEPHANIE MONROE, Wrenwood Group, Washington, DC JAMES M. PERRIN, Harvard Medical School NISHA SACHDEV, Bainum Family Foundation DONALD SCHWARZ, Robert Wood Johnson Foundation MARTÃN SEPÃLVEDA, Research Division, IBM Corporation (retired) MARTIN H. TEICHER, Developmental Biopsychiatry Research Program, McLean Hospital JONATHAN TODRES, Georgia State University College of Law NATACHA BLAIN, Director Fm-vi Â
Prepublication Copy, Uncorrected Proofs Preface This report is the third in a series of reports from the National Academies of Sciences, Engineering, and Medicine (the National Academies) targeting improvement of mental, emotional, and behavioral (MEB) development and health through promotion and prevention activities. The first two reports, Reducing Risks for Mental Disorders (1994) and Preventing Mental, Emotional, and Behavioral Disorders Among Children and Youth (2009), focused on prevention. They were widely read and used to advance childrenâs MEB outcomes. The current report includes greater focus on measures to promote MEB development and health, with increased emphasis on achieving population-level effects. This emphasis reflects the fact that despite the development of programs that are effective in supporting healthy MEB development in individuals and groups of children and youth, successful population-based efforts that can broadly counter adverse environments and experiences that threaten healthy MEB development for so many of the nationâs young people have not materialized. This study was made possible through the sponsorship of the Centers for Disease Control and Prevention, Division of Human Development and Disability; the National Institutes of Health, National Center for Complementary and Integrative Health; the National Institutes of Health, National Institute on Drug Abuse; and the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. These agencies recognized the value of the previous reports but also saw the need to build on them. The statement of task for this committee was broad: it emphasized public health and population-based outcomes, cross-sector mobilization to improve childrenâs MEB development, advancement of program implementation, the intergenerational origins of many adverse outcomes, and the need to further probe the biological as well as environmental antecedents of both healthy and adverse outcomes and their interactions. The statement of task also called for exploration of research conducted in practice (real-world) settings, and signaled that the new committee should consider a broad spectrum of research strategies, greater cross-sector integration for program development and research, and should consider ways of countering neighborhood and community disparities as overarching factors in the rising prevalence of adverse MEB outcomes for children and youth. The committee regarded the charge as an invitation to explore many sources of concern about the MEB health of U.S. children and youth, and to consider policy issues that either impede or support healthy MEB development. In particular, the committee viewed the community settings in which children are raised as an essential target for integrated improvement efforts. The breadth of the committeeâs task was apparent early as we considered the multiplicity of inputs that affect childrenâs MEB development; the changing needs for supports across the developmental sequence from preconception to adulthood; and the array of community, state, and national sectors that must be mobilized to realize improved outcomes. This report addresses ideas for building child support programs using existing infrastructure across sectors, such as education, health care, the workplace, community agencies, and policy makersâeach a promising focus for separate as well as collective action. This charge also required us to consider a voluminous and rapidly expanding body of literature. We continually noted new information as we deliberated and put together this report. We hope that our findings and recommendations will Fm-vii Â
Prepublication Copy, Uncorrected Proofs stimulate continued attention to developing research: updates of this report at shorter intervals may be helpful in this rapidly growing and maturing field. The committee was well equipped by virtue of the expertise of its members in an array of complementary disciplines as scientists, educators, practitioners, and administrators. Members were most generous with their time, collegiality, and attention, and were passionate about realistically assessing the current state of MEB development for children and youth, as well as exploring ways to make better use of what has been learned to enhance healthy child development. We recognized the importance of identifying common active and effective components of evidence-based intervention, understanding their application to the scaling of interventions using a spectrum of adaptions to local contexts, and ensuring the capacity to sustain and continuously improve program implementation if the goal of substantially improving MEB health across diverse populations is to be achieved. We also concluded that the magnitude of the effort required to accomplish this goal would require commitments to partnership from every sector of society. We did not shy away from thinking boldly and creatively about what the future could hold for generations to come if the national prioritizes childrenâs MEB development and health. The committee was also aided in its work by experts in topics beyond the expertise of its members, who generously contributed to the content of this report through presentations in public sessions, commissioned papers, and phone interviews. All have earned our sincere appreciation: Julie Sweetland, Ph.D., Vice President for Strategy and Innovation, The FrameWorks Institute; Byron Powell, Ph.D., Assistant Professor, University of North Carolina Gillings School of Global Public Health, and Fellow at the Cecil G. Sheps Center for Health Services Research and the Frank Porter Graham Child Development Institute; Laura Damschroder, M.S., M.P.H., Research Investigator, Department of Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research; Hendricks Brown, Ph.D., Professor, Departments of Psychiatry and Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Northwestern University (virtual); Elyse Cohen, M.P.H., Senior Director of Food, Health, and Wellness Programs, U.S. Chamber of Commerce Foundation; Christina Bethell, Ph.D., Professor, Johns Hopkins Bloomberg School of Public Health, and Director, Child and Adolescent Health Measurement Initiative; Linda Collins, Ph.D., Director, The Methodology Center, and Distinguished Professor, Department of Human Development and Family Studies, Department of Statistics, Pennsylvania State University; Katie McLaughlin, Ph.D., Lab Director, Stress and Development Laboratory, University of Washington; Ken Warner, Ph.D., Avedis Donabedian Distinguished University Professor Emeritus of Public Health, Professor Emeritus of Health Management & Policy, and Dean Emeritus of Public Health, University of Michigan School of Public Health; Kimberly Schonert-Reichl, Ph.D., Director, Human Early Learning Partnership; David M. Murray, M.D., Ph.D., Associate Director for Prevention and Director, Office of Disease Prevention, National Institutes of Health. The committee notes in this report that a number of recent studies and workshops of the National Academiesâ Board on Children, Youth, and Families, as well as other National Academies boards, have addressed specific areas related to this committeeâs task. These contributions are cataloged in this report. We encourage readers to further explore the perspectives offered in these reports. It is our hope that this report will be helpful to the many and diverse individuals, programs, agencies, and policy makers dedicated to improving the productivity and quality of life of all who will constitute the next generations of adults in the United States. Fm-viii Â
Prepublication Copy, Uncorrected Proofs The committee wishes to thank the staff of the Board on Children, Youth, and Families who diligently and effectively guided our deliberations and contributions to this report. Great appreciation goes to the study director for the initial phases of the project, Tara Lynn Mainero, as well as Erin Kellogg, Sarah Tracey, Rebekah Hutton, Margaret Kelly, and Laiah Factor, who supported and guided our efforts. Special appreciation goes to Alexandra Beatty, study director for the final phases of the project, who took our input and masterfully shaped this report to reflect our intent while ensuring that it would speak to a wide range of audiences. Working with all of these individuals has been a pleasure. The committee also wishes to acknowledge the guidance provided by leaders of the Board on Children, Youth, and Families and the Division of Behavioral and Social Sciences and Education. Finally, we note with appreciation the contributions of Thomas Boyce who was unable to continue as a member of the committee. This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Christina Bethell, Child and Adolescent Health Measurement Initiative, Bloomberg School of Public Health, Johns Hopkins University; Felesia R. Bowen, Undergraduate Programs, College of Nursing, Medical University of South Carolina; C. Hendricks Brown, Preventive Medicine, Feinberg School of Medicine, Northwestern University; Janet Currie, Center for Health and Wellbeing, Princeton University; Iheoma U. Iruka, Center for Early Education Research and Evaluation, HighScope Educational Research Foundation; Benjamin F. Miller, Chief Strategy Officer, Well Being Trust; Bernice A. Pescosolido, Department of Sociology, Indiana University; Heather J. Risser, Mental Health Services and Policy Program, Northwestern University. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Richard G. Frank, Department of Health Care Policy, Harvard Medical School and Alan F. Schatzberg, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. Thomas F. Boat, Chair Committee on Fostering Healthy Mental, Emotional, and Behavioral Development Among Children and Youth Fm-ix Â
Prepublication Copy, Uncorrected Proofs Contents Summary 1 Introduction Charge to the Committee Context for the Study Committeeâs Approach to Its Charge New Research Perspectives Integrated Understanding of Influences on MEB Health Expanded Understanding of Implementation Implications A Life-Course Approach to Understanding Development A Public Health Framework for MEB Health Promotion A Community Approach to Fostering Healthy MEB Development A Word about Evidence Study Process Guide to This Report PART I: MENTAL, EMOTIONAL, AND BEHAVIORAL DEVELOPMENT 2 Influences on Mental, Emotional, and Behavioral Development An Integrative Perspective on MEB Development Biological Integration Environmental Integration The Neurobiological Basis of MEB Outcomes Developmental Acceleration Differential Susceptibility and Sex Differences Genetic and Epigenetic Variation Sensitive Periods Individual Influences Preconception and Prenatal Factors and Premature Birth Preconception The Prenatal Period Preterm Birth Infancy and Childhood Adverse Childhood Experiences Peer Influence Adolescence Protective Factors in Adolescence Sexual Orientation and Gender Identity Lifestyle Factors Physical Activity and Nutrition Sleep Technology Use and Screen Time Family Influences Fm-x Â
Prepublication Copy, Uncorrected Proofs Parenting and Family Stability Substance Use Effects of Chronic Illness and Severe Health Problems Community- and Society-Level Influences Community Influences Neighborhood Attributes School Organization and Characteristics Foster Care Societal Influences Poverty and Inequality Discrimination and Racism Marketing of Unhealthy Products Cigarettes Alcohol Unhealthful Food The Criminal Justice System Summary PART II: STRATEGIES FOR FOSTERING HEALTHY MENTAL, EMOTIONAL, AND BEHAVIORAL DEVELOPMENT IN CHILDREN AND YOUTH 3 Generational Strategies Parenting Interventions Addressing Parental Mental Health and Substance Use Disorders Depression in Pregnant and Postpartum Women Treatment and Prevention Benefits for Infants and Older Children Treatment for Substance Use Disorders and Parenting Training Child Neglect and Abuse Neglect and Physical Abuse Sexual Abuse Summary 4 Strategies for Educational Settings Early Education and Preschool Settings Evidence That Early Education Matters The Abecedarian Project Head Start The Child-Parent Center The HighScope Perry Preschool Project Challenges Social-Emotional Learning in Early Childhood Education Kâ12 Settings Promotion of MEB Health Promoting a Positive School Climate Promoting Social-Emotional Learning Fm-xi Â
Prepublication Copy, Uncorrected Proofs Promoting Contemplative Practices Health Promotion for the Education Workforce Prevention Strategies Disruptive Behavior Anxiety Disorders Posttraumatic Stress Disorder and Trauma Depressive Disorders Substance Use Disorders Bullying Violence Suicide School Dropout Postsecondary Settings Summary 5 Strategies for Health Care Settings Preconception Health Care Prenatal Health Care Preterm Birth Adverse Exposures and Conditions Prenatal Parenting Education Postnatal Health Care Integrating Behavioral Care and Primary Health Care Adolescent and Young Adult Medicine Chronic Disease Care for Children and Youth Summary 6 Policy Strategies Health Care and Nutrition Health Care Access to and Affordability of Health Care Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program Mental Health Parity Act (MHPA) Nutrition Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Supplemental Nutrition Assistance Program (SNAP) National School Lunch Program (NSLP) Economic Well-Being Minimum Wage Laws Paid Family Leave Earned Income Tax Credit (EITC) Child Care Subsidies Temporary Assistance for Needy Families (TANF) Risk Behavior and Injury Fm-xii Â
Prepublication Copy, Uncorrected Proofs Limiting Harmful Behaviors and Exposures Alcohol Tobacco Marijuana Opioids Lead Injury Prevention Motor Vehicles Bicycle Helmets and Concussion Protocols Firearms Education Zero Tolerance Policies Every Student Succeeds Act (ESSA) Individuals with Disabilities Education Act (IDEA) State Policies on Social-Emotional Learning Summary 7 Assessing the Evidence on Interventions PART III: IMPLEMENTATION AND SCALE-UP OF EFFECTIVE INTERVENTIONS 8 Effective Implementation: Core Components, Adaptation, and Strategies Identifying and Monitoring the Fidelity of Core Components Studying Mediating Factors Example: Preventing Adolescent Depression Example: Preventing Substance Use in Adolescents Example: A Blended Strategy to Address Substance Use and Antisocial Behavior Pinning Down Essential Factors Monitoring Fidelity Choosing and Adapting Programs for Local Communities Frameworks for Cultural Adaptation A Focus on Community Engagement Implementation Strategies Discrete Implementation Strategies Blended Implementation Strategies: Three Examples Communities That Care (CTC) Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER) Getting to Outcomes (GTO) Evidence about Implementation Support Summary 9 Effective Implementation: Partners and Capacities A Model of System Functioning Co-Creation Partners Fm-xiii Â
Prepublication Copy, Uncorrected Proofs Community Members Service Providers Funders and Policy Makers Purveyors and Intermediary Organizations Intervention Developers and Researchers Key Elements of Capacity for Scale-Up Collaboration Leadership and Implementation Teams Community Coalitions Learning Collaboratives Workforce Development Systems Quality and Outcome Monitoring Systems Communications and Media Systems Summary PART IV: NEXT STEPS 10 Exploring Recent Progress A Sampling of Promising Efforts Federal Initiatives State and Local Initiatives California Colorado Massachusetts Ohio Oregon Pennsylvania Other State Initiatives Efforts of Private Foundations Evidence2Success Moving the Needle The Pew-MacArthur Results First Initiative Role of the Business Community Technology-Based Developments Ongoing Challenges Trade-offs Financing 11 A Comprehensive, National Approach An Integrated Approach to Promoting MEB Health Recommendations: A National Agenda for Improving the MEB Health of Children and Youth Federal Leadership and Partnership Implementation and Scale-Up of Effective Interventions Raise Public Awareness Build Stable Coalitions Across Sectors and Entities Fm-xiv Â
Prepublication Copy, Uncorrected Proofs Address Funding and Capacity Challenges Monitoring to Support Needs Assessment, Scale-Up, Improvement, and Research A Research Agenda Research Priorities Research Opportunities Alternative Research Designs and Methods Leveraging of New Kinds of Data Aspirations for a Decade of Children and Youth APPENDIXES A Related Reports of the National Academies of Sciences, Engineering, and Medicine B Strengthening Monitoring for MEB Health C Biographical Sketches of Committee Members Fm-xv Â