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Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda (2019)

Chapter: Appendix B: Strengthening Monitoring for MEB Health

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Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Page 283
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Page 284
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Page 285
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Page 286
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
×
Page 287
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Page 288
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
×
Page 289
Suggested Citation:"Appendix B: Strengthening Monitoring for MEB Health." 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. doi: 10.17226/25201.
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Page 290

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Prepublication Copy, Uncorrected Proofs Appendix B Appendix B Strengthening Monitoring for MEB Health The challenges of effectively monitoring influences on mental, emotional, and behavioral (MEB) health and development, outcomes for children and youth, and related information are significant. This appendix supplements the recommendations offered in Chapter 11 with exploration of three areas in which monitoring can be strengthened: effective measurement of key indicators, surveillance and screening, and use of big data. EFFECTIVE MEASUREMENT OF KEY INDICATORS The measurement of indicators useful for effectively monitoring MEB health and development among children and youth poses several challenges. One is that not all the tools used to measure indicators for adults work well with populations of children and adolescents. Development is most fluid during childhood and adolescence, so variables may change swiftly. Children are more sensitive than adults to environmental and social influences because of rapid changes in their physiology and neurodevelopment. Assessments and reporting are often done by a parent or other proxy rather than through self-report, as is done with many adult outcome metrics. Because most children are relatively healthy, many measures have a “ceiling effect” if they do not take into account long-term developmental resilience and vulnerability. And children suffer from different morbidities than adults, which may be reflected in their developmental status. Another challenge is that the purpose of indicators of healthy development varies by the level at which they are used. Individual measures of development are useful for assessing the trajectory of a specific child’s development in ongoing surveillance, such as in primary care practice or school, and should be linked with specific promotion, prevention, or treatment services for children and their families. Community-level measures, such as child development surveys at the school or health system level, are most useful for improvement efforts in neighborhoods or by educational, social, and health services. A related issue is that there are no well-defined indicators that are universally shared for many important factors and outcomes of interest. Even when the indicators and their purposes are well defined, the collection of data on these indicators may not be feasible in some scenarios. For example, a lack of personnel, time, or funding may prevent a school from having the ability to collect and report on indicators of students’ healthy development accurately and adequately. SURVEILLANCE AND SCREENING Surveillance (purposeful observation by a skilled professional) and screening (formal data gathering using a standardized tool) are important methods for identifying problems and opportunities in individuals and populations. Both can be carried out in universal, selective, and indicated modes. Targeting venues that serve all children, such as schools and health care, will create efficiencies for broad application of surveillance and screening.   282

Prepublication Copy, Uncorrected Proofs Appendix B The 2009 National Academies report (National Research Council and Institute of Medicine, 2009) includes a chapter on screening for prevention, which is organized around adaptations of World Health Organization (WHO) guidelines for screening in health care to identify risks to healthy MEB development or for detection of prodromal, concerning behaviors. In the intervening decade, greater attention has been paid to screening and surveillance. Prominent screening programs to date have targeted early identification of MEB health conditions, such as autism spectrum disorder in preschool-age children (Zwaigenbaum et al., 2015) and depression in adolescents (Siu and Force, 2016). Screening for risks of behavioral disorders—for example, screening parents and youth for recollection of adverse childhood experiences—has also received increasing attention in the past decade (Briggs et al., 2014; Finkelhor et al., 2013), as has surveillance for adverse experiences of young children (Bethell, Simpson, and Solloway, 2017). Venues for these surveillance and screening activities include health care settings but also child care settings, preschools, and schools (Dowdy, Ritchey, and Kamphaus, 2010). For example, as discussed in Chapter 11, population-based screening of 5-year-olds in schools in British Columbia has provided feedback to schools and communities about the status of physical, social, and behavioral dimensions of development in their local environment (Guhn et al., 2016). Screening at the community level has been embedded in home visitation. For example, home visitors screen for postpartum depression, providing an opportunity for early treatment of mothers with the rationale that parenting capabilities will be enhanced (Ammerman et al., 2010). See Box B-1 for several examples of existing screening programs. BOX B-1 Examples of Screening Programs That May Be Useful in Efforts to Foster Healthy MEB Development 1. The Early Development Instrument (EDI) includes social and emotional components and is administered every 2 to 3 years in British Columbia kindergartens (see Chapter 11). The program has been administered in seven waves of administration over the past 2 decades that have included approximately 40,000 children per cycle (Human Early Learning Partnership, 2018). 2. Instruments commonly used for social-emotional screening of children and youth in health care practices, schools, and other settings include the Ages and Stages Questionnaire-Social Emotional Component (ASQ-SE) and the Strengths and Difficulties Questionnaire (SDQ). These screening tools are increasingly administered longitudinally and universally in primary child care practices and in educational settings. Results are used to identify children in need of special support and services. 3. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) (Tanner-Smith and Lipsey, 2015) instrument is a brief evidence-based inventory that identifies adolescents with early substance use and uses strategies for preventing substance use disorders. SBIRT has been successfully delivered in primary care (Ridenour et al., 2015; Sterling et al., 2015). 4. Screening tools for children’s strengths and resilience have been described, but their use in institutional settings such as education and health care has been largely in a research context.   283

Prepublication Copy, Uncorrected Proofs Appendix B Since 2009, there has also been a focus on surveillance to identify the need for interventions to mitigate adverse consequences of social determinants in health care (Garg and Dworkin, 2016). Teachers may conduct surveillance for symptoms of attention deficit- hyperactivity disorder (ADHD) and other behavioral disorders, as well as social determinants of a child’s well-being. The American Academy of Pediatrics sponsors Bright Futures guidelines (Hagan, Shaw, and Duncan, 2017) recommend (in their fourth iteration) surveillance questions during well-child visits for such family risk factors as food insecurity, living situation, child care, excessive screen time, interpersonal violence, and household tobacco/alcohol/substance use, as well as such protective factors as reading to the infant or child, school success, providing opportunity for physical activity, and healthy nutrition. This level of surveillance is recommended as a universal component of practice, as impediments to healthy MEB development occur at all family socioeconomic levels. Evidence suggests that screening for social determinants of health in pediatric practice can result in allocation of greater community resources for families with need, compared with usual care (Garg et al., 2015) and improve child health (Gottlieb et al., 2016); electronic screening may result in higher rates of disclosure of needs (Gottlieb et al., 2014). Guidelines for Selecting and Implementing Screening Programs The setting or context for screening should include capabilities for providing feedback to parents or the child (when old enough). Ideally, feedback would occur in real time, at the point of encounter. The setting should also provide or be linked to resources for following up on screening results that are concerning, with more detailed assessment and intervention as indicated. For many families, referral to another point of service may be overwhelming. For this reason, programs that can identify needs through screening and respond to those needs in a comprehensive fashion within the same setting are in a more advantageous position to gain family acceptance and compliance with intervention plans (Jaycox et al., 2009). Screening should use validated tools and acceptable processes for the population undergoing needs assessment. The tool should be developmentally and educationally appropriate. For example, picture response options can be helpful for younger children. Brief, rather than lengthy surveys are usually preferable, particularly for screens that are administered repetitively over time. Paper surveys have been popular in the past, but online screening at kiosks has proven to be efficient and accepted by most families, and has the advantage of collecting data and providing feedback to the family within the context of a single visit. Online screening also allows for easy reporting of group or population data and can be used for purposes of health services improvement or research (with deidentified data). The environment for entering information should be private and free from distraction to the extent possible. Universal screening has the advantage of avoiding or lessening stigmatization of individuals or families. Well trained screening personnel should support this function. Individuals who can professionally explain the rationale for screening, the process for completion of screening, and follow-up steps can enhance consistent participation by parents and/or children and the quality of screening input. Longitudinal screening has advantages over one-time screens in terms of assessing consistency of responses, as well as being able to track trajectories. Guidelines for determining who is to be screened, how often screening should occur, who interacts with parents and/or children concerning the screening process, and how the results of screening will be managed. should be in place and understood by all personnel involved. Quality   284

Prepublication Copy, Uncorrected Proofs Appendix B improvement of screening programs in health care has augmented outcomes remarkably (Beers et al., 2017). Screening in School Settings Screening to identify students who have MEB health needs has long been carried out in school settings (Dowdy, Ritchey, and Kamphaus, 2010). In the context of a school’s multitiered system of support, universal and indicated screening can be used to detect the mental health needs of individual students or even of the student body for both prevention and treatment (Walker, 2010). Instruments such as the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BESS) (Kamphaus and Reynolds, 2007) can be used in schools to assess for risk of emotional and behavioral problems. School surveys that focus on positive youth development, such as the California Healthy Kids Survey-Social and Emotional Health Survey (CHKS-SEHS) are also available (You et al., 2014). Another emerging area for monitoring in schools is assessment of the organizational school climate, which has been shown to be associated with students’ self-esteem, mental health, bullying, and such outcomes as absenteeism and suspensions (Bear et al., 2011; Thapa, 2013). The rapidly increasing prevalence of anxiety problems treated in college counseling services (Center for Collegiate Mental Health, 2017) has prompted offerings of screening for this disorder which might be considered in middle and high school settings. Screening in Health Care Settings A report from the American Academy of Pediatrics addresses the growing need to screen for behavioral and emotional problems or health in child primary care settings, as well as for changes in health care practice and systems to respond to this need (Weitzman et al., 2015). The benefits of screening programs may extend beyond those originally targeted. For example, screening for maternal depression has been characterized as an opening to address the social determinants of a child’s health (Schor, 2018). The recognition of anxiety and depression in a large proportion of parents of children with disabling and life-threatening chronic health disorders has led to recommendations for parent screening (Quittner et al., 2016). For example, the Cystic Fibrosis Foundation recommends that CF Care Center personnel annually offer the Generalized Anxiety Disorder 7-Item (GAD-7) scale and Patient Health Questionnaire-9 (PHQ- 9) screening tools to parents and encourages the use of the Psychosocial Assessment Tool (PAT) (Kazak et al., 2015) to identify family psychosocial risks. A related effort has been the experimental screening of children with chronic diseases and their families for school attendance and academic barriers, with the goal of improving school success for these children as an important resilience factor (Filigno et al., 2017). Screening of children for behavioral health problems and risks in the emergency room has been successful and may be important when families are disconnected from primary care systems (Williams, Ho, and Grupp-Phelan, 2011). Screening Concerns and Barriers Family concerns about screening programs include labeling and potential stigmatization of children, which has been of particular concern in communities already burdened by racial, social, and economic disadvantage. Universal screening might mitigate some of this concern.   285

Prepublication Copy, Uncorrected Proofs Appendix B Another concern is the inability of programs and systems to respond effectively to needs identified by screening. Perhaps the greatest concern at this time is the ability to support and sustain screening programs financially. In health care, screening is generally not a reimbursable service, by either private or public payers. The Centers for Medicare & Medicaid Services (CMS) has approved payments for maternal depression screening in well-child care, but payment is dependent on state decisions to provide these payments. Most states currently do not reimburse this activity. Some child health care screening may be included in Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service payments, but most activity in this program targets assessment of physical development. The Patient Protection and Affordable Care Act (ACA) included a stipulation that payment for child health care recommendations be included in the Bright Futures guidelines, but implementation of payments never materialized. Recommendations of the U.S. Preventive Services Task Force (USPSTF) are a basis for reimbursement, but recommendations are limited to health care settings, and have not addressed most efforts to foster healthy MEB development or prevent adverse influences on MEB development. The USPSTF has issued statements that the evidence regarding efforts to screen for and/or prevent alcohol misuse, autism, child maltreatment, adolescent depression, illicit drug use, speech and language delays, and suicide risk is inconclusive. Only education to prevent initiation of tobacco use in children and adolescents and screening for adolescent depression are recommended. For these reasons, creating a strong evidence base for MEB health promotion and risk prevention interventions in children is urgent. Although schools have been viewed as ideal venues for screening and MEB risk interventions, public school systems are evaluated based on students’ academic performance and other factors, and not on their students’ MEB outcomes. Screening or surveillance for MEB risks and early behavioral disorders are not widespread in schools, but examples include the Tulane Early Childhood Collaborative (TECC) and the Early Learning Development Instrument (EDI), in which measurement leads to mobilization of resources and engagement with diverse stakeholders in child development. Many states now conduct annual assessments of adolescents’ behaviors, including both problem and, to a lesser extent, prosocial behaviors. The Youth Risk Behavior Surveillance (YRBSS) monitors some MEB-related adolescent behaviors. One example of county-level surveillance of social determinants of health is the Los Angeles Department of Public Health’s Community Health Assessment survey, a population-based random telephone survey of children and adults in the county’s households, including institutionalized and homeless individuals with cell phone access, which is provided in multiple languages. Surveillance at the county level includes characterizations of children (school readiness, television viewing, access to mental health services, teen and parent substance use, physical health, parenting (parent support, child care, breastfeeding), households (employment, food insecurity),and neighborhoods (sense of belonging, crime, access to parks, concerns about climate change, air quality). (See Los Angeles County Department of Public Health [2017] for more information.) Nevertheless, there is not currently consistent measurement of child and adolescent development across the United States. In areas in which youth are routinely assessed, such as the Monitoring the Future survey or Youth Risk Behavior Survey (YRBS), the data provide a valuable tool for policymakers and investigators.   286

Prepublication Copy, Uncorrected Proofs Appendix B BIG DATA Most research in social and behavioral sciences has involved the generation of data to answer particular questions, but data that have been generated for other purposes may contain elements that are applicable and can be repurposed to answer questions in the social and behavioral realms. Increasingly, large volumes of data collected by electronic systems, often referred to as “big data,” are available for research purposes and such data may play a crucial role in the development of a national monitoring system for children’s MEB health. Data sources that may be useful in efforts to address social and behavioral issues include those that are local (e.g., social services, school system, healthcare system), state wide, or national. Data sources might include administrative data, aggregated individual child or family data, census data, tax records, juvenile justice records, and national surveys. Data from social media and other Internet activity, if collected with sufficient privacy protections, may also be informative. Another example is electronic medical record data related to social determinants of health, for example, in narrative social worker notes, which could be mined using natural language processing to identify risks and other patterns (Pestian et al., 2016, 2017). Analyzing large data sources may be particularly useful for generating hypotheses. Scientists from disciplines including social and behavioral science fields, can collaborate to define project objectives, and consider varied perspectives on ways to harvest useful information from new data sources (Mathematica, 2018). Communities concerned with healthy development lack readily available tools for measuring salient attributes, and also lack resources or systems for collecting, analyzing, and reporting data on child development. Investments in shared infrastructure for data management will be essential. Hospitals, schools, and social service organizations such as United Way may be most skilled in data collection and management. Continued investment in measurement science for children is critical. Assessment tools developed in laboratories play an important role but support will be needed as well for emerging frontiers and challenges, including digital monitoring of children and their development; the development of algorithms for processing large amounts of monitoring data and other tools for detecting patterns, connections, and other pertinent information; the integration of records across service sectors that care for children; and the continued development of safeguards to ensure confidentiality and privacy in coordinated records. As system processing improves, some measures and monitoring devices may be useful for both individual tracking of the developmental status of children over time and, when aggregated, community- and societal-level tracking. Recognition of the importance of developmental indicators for children and youth is growing; examples include the Vital Signs project of the National Academy of Medicine and the 500 Cities project of the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation illustrate the valuable role they can play.   287

Prepublication Copy, Uncorrected Proofs Appendix B REFERENCES Ammerman, R.T., Putnam, F.W., Bosse, N.R., Teeters, A.R., and Van Ginkel, J.B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15(3), 191–200. Bear, G.G., Gaskins, C., Blank, J., and Chen, F.F. (2011). Delaware school climate surveystudent: SCS— StIts factor structure, concurrent validity, and reliability. Journal of School Psychology, 49(2), 157–174. Beers, L.S., Godoy, L., John, T., Long, M., Biel, M.G., Anthony, B., Mlynarski, L., Moon, R., and Weissman, M. (2017). Mental health screening quality improvement learning collaborative in pediatric primary care. Pediatrics, 140(6). Bethell, C.D., Simpson, L.A., and Solloway, M.R. (2017). Child well-being and adverse childhood experiences in the United States. Academic Pediatrics, 17(7S), S1-S3. Briggs, R.D., Silver, E.J., Krug, L.M., Mason, Z.S., Schrag, R.D.A., Chinitz, S., and Racine, A.D. (2014). Healthy steps as a moderator: The impact of maternal trauma on child social-emotional development. Clinical Practice in Pediatric Psychology, 2(2), 166–175. Center for Collegiate Mental Health. (2017). 2017 annual report. University Park, PA: Penn State University. Available: https://sites.psu.edu/ccmh/files/2018/01/2017_CCMH_Report-1r3iri4.pdf. Chapin Hall, n.d. Studies explore use of administrative data. Available: https://www.chapinhall.org/project/studies-explore-use-of-administrative-data. Dowdy, E., Ritchey, K., and Kamphaus, R.W. (2010). School-based screening: A population-based approach to inform and monitor childrens’ mental health needs. School Mental Health: A Multidisciplinary Research and Practice Journal, 2(4), 166–176. Filigno, S.S., Strong, S., Hente, E., Elam, M., Mara, C., and Boat, T. (2017). Poster session abstracts. Pediatric Pulmonology, 52(S47), S214–S516. Finkelhor, D., Shattuck, A., Turner, H., and Hamby, S. (2013). Improving the adverse childhood experiences study scale. JAMA Pediatrics, 167(1), 70–75. Garg, A., and Dworkin, P.H. (2016). Surveillance and screening for social determinants of health: The medical home and beyond. JAMA Pediatrics, 170(3), 189–190. Garg, A., Toy, S., Tripodis, Y., Silverstein, M., and Freeman, E. (2015). Addressing social determinants of health at well child care visits: A cluster RCT. Pediatrics, 135(2), e296–e304. Gottlieb, L., Hessler, D., Long, D., Amaya, A., and Adler, N. (2014). A randomized trial on screening for social determinants of health: The iScreen study. Pediatrics, 134(6), e1611–1618. Gottlieb, L.M., Hessler, D., Long, D., Laves, E., Burns, A.R., Amaya, A., Sweeney, P., Schudel, C., and Adler, N.E. (2016). Effects of social needs screening and in-person service navigation on child health: A randomized clinical trial. JAMA Pediatrics, 170(11), e162521. Guhn, M., Janus, M., Enns, J., Brownell, M., Forer, B., Duku, E., Muhajarine, N., and Raos, R. (2016). Examining the social determinants of children's developmental health: Protocol for building a pan-Canadian population-based monitoring system for early childhood development. BMJ Open, 6(4), e012020. Hagan, J., Shaw, J., and Duncan, P. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents [pocket guide]. American Academy of Pediatrics (Ed.). Elk Grove Village, IL. Human Early Learning Partnership. (2018). The early development instrument: Fact sheet. Vancouver, BC: University of British Columbia. Jaycox, L.H., Stein, B.D., Paddock, S., Miles, J.N., Chandra, A., Meredith, L.S., Tanielian, T., Hickey, S., and Burnam, M.A. (2009). Impact of teen depression on academic, social, and physical functioning. Pediatrics, 124(4), e596-605. Kamphaus, R.W., and Reynolds, C.R. (2007). Behavior Assessment System for children, second edition (BASC-2). London, UK: Pearson Assessments   288

Prepublication Copy, Uncorrected Proofs Appendix B Kazak, A.E., Schneider, S., Didonato, S., and Pai, A.L. (2015). Family psychosocial risk screening guided by the pediatric psychosocial preventative health model (PPPHM) using the psychosocial assessment tool (PAT). Acta Oncologica, 54(5), 574–580. Los Angeles County Department of Public Health. (2017). Key indicators of health by service planning area. . Available: http://publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH- KIH_2017-sec%20UPDATED.pdf Mathematica. (2018). At the intersection of data science and social science. Available: https://www.mathematica-mpr.com/events/at-the-intersection-of-data-science-and-social-science National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press. Pestian, J.P., Grupp-Phelan, J., Bretonnel Cohen, K., Meyers, G., Richey, L.A., Matykiewicz, P., and Sorter, M.T. (2016). A controlled trial using natural language processing to examine the language of suicidal adolescents in the emergency department. Suicide andLife Threat Behav-eningior, 46(2), 154–159. Pestian, J.P., Sorter, M., Connolly, B., Bretonnel Cohen, K., McCullumsmith, C., Gee, J.T., Morency, L.P., Scherer, S., and Rohlfs, L. (2017). A machine learning approach to identifying the thought markers of suicidal subjects: A prospective multicenter trial. Suicide and Life Threat Behav- eningior, 47(1), 112–121. Quittner, A.L., Abbott, J., Georgiopoulos, A.M., Goldbeck, L., Smith, B., Hempstead, S.E., Marshall, B., Sabadosa, K.A., Elborn, S., International Committee on Mental Health,and EPOS Trial Study Group (2016). International committee on mental health in cystic fibrosis: Cystic fibrosis foundation and European cystic fibrosis society consensus statements for screening and treating depression and anxiety. Thorax, 71(1), 26–34. Ridenour, T.A., Willis, D., Bogen, D.L., Novak, S., Scherer, J., Reynolds, M.D., Zhai, Z.W., and Tarter, R.E. (2015). Detecting initiation or risk for initiation of substance use before high school during pediatric well-child check-ups. Drug and Alcohol Dependence, 150, 54–62. Schor, E.L. (2018). Maternal depression screening as an opening to address social determinants of children's health. JAMA Pediatrics, 172(8), 717–719. Siu, A.L., and U.S.Preventive Services Task Force (2016). Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Pediatrics, 137(3), e20154467. Sterling, S., Kline-Simon, A.H., Satre, D.D., Jones, A., Mertens, J., Wong, A., and Weisner, C. (2015). Implementation of screening, brief intervention, and referral to treatment for adolescents in pediatric primary care: A cluster randomized trial. JAMA Pediatrics, 169(11), e153145. Tanner-Smith, E.E., and Lipsey, M.W. (2015). Brief alcohol interventions for adolescents and young adults: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18. Thapa, A. (2013). School climate research.New York: National School Climate Center. Walker, B.A. (2010). Effective schoolwide screening to identify students at risk for social and behavioral problems. Intervention in School and Clinic, 46(2), 104–110. Weitzman, C., Wegner, L., Section on., Developmental and Behavioral Pediatrics Committee on Psychosocial Aspects of Child and Family Health,Council on Early., Childhood, Society for Developmental and Behavioral Pediatrics, and American Academy of Pediatrics. (2015). Promoting optimal development: Screening for behavioral and emotional problems. Pediatrics, 135(2), 384–395. Williams, J.R., Ho, M.L., and Grupp-Phelan, J. (2011). The acceptability of mental health screening in a pediatric emergency department. 27(7), 611–615. You, S., Furlong, M.J., Dowdy, E., Renshaw, T.L., Smith, D.C., and Omalley, M.D. (2014). Further validation of the social and emotional health survey for high school students. Applied Research in Quality of Life : The Official Journal of the International Society for Quality-of-Life Studies, 9(4), 997–1015.   289

Prepublication Copy, Uncorrected Proofs Appendix B Zwaigenbaum, L., Bauman, M.L., Fein, D., Pierce, K., Buie, T., Davis, P.A., Newschaffer, C., Robins, D.L., Wetherby, A., Choueiri, R., Kasari, C., Stone, W.L., Yirmiya, N., Estes, A., Hansen, R.L., McPartland, J.C., Natowicz, M.R., Carter, A., Granpeesheh, D., Mailloux, Z., Smith Roley, S., and Wagner, S. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136 (Suppl. 1,) S41–S59.   290

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Healthy mental, emotional, and behavioral (MEB) development is a critical foundation for a productive adulthood. Much is known about strategies to support families and communities in strengthening the MEB development of children and youth, by promoting healthy development and also by preventing and mitigating disorder, so that young people reach adulthood ready to thrive and contribute to society. Over the last decade, a growing body of research has significantly strengthened understanding of healthy MEB development and the factors that influence it, as well as how it can be fostered. Yet, the United States has not taken full advantage of this growing knowledge base. Ten years later, the nation still is not effectively mitigating risks for poor MEB health outcomes; these risks remain prevalent, and available data show no significant reductions in their prevalence.

Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda examines the gap between current research and achievable national goals for the next ten years. This report identifies the complexities of childhood influences and highlights the need for a tailored approach when implementing new policies and practices. This report provides a framework for a cohesive, multidisciplinary national approach to improving MEB health.

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