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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25347.
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Prepublication Copy Uncorrected Proofs Achieving Behavioral Health Equity for Children, Families, and Communities PROCEEDINGS OF A WORKSHOP Sarah M. Tracey, Erin Kellogg, Clarissa E. Sanchez, and Wendy Keenan, Rapporteurs Forum for Children’s Well-Being: Promoting Cognitive, Affective, and Behavioral Health for Children and Youth Roundtable on the Promotion of Health Equity Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education Health and Medicine Division ADVANCE COPY NOT FOR PUBLIC RELEASE BEFORE Wednesday, February 13, 2019 11:00 am. EDT

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the American Board of Pediatrics (Unnumbered Award); Centers for Disease Control and Prevention (200-2011-38807, TO #69); Conrad N. Hilton Foundation (17605); Doris Duke Charitable Foundation (2018120); Health Resources and Services Administration (HHSH250201500001I); and Robert Wood Johnson Foundation (74234). Additional support came from the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the American Psychological Association, Autism Speaks, the Global Alliance for Behavioral Health and Social Justice, the National Federation of Families for Children's Mental Health, the Nemours Foundation, the Society for Child and Family Policy and Practice, and the Society of Pediatric Psychology. 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. Digital Object Identifier: https://doi.org/10.17226/25347 Additional copies of this publication are available for sale 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. Achieving Behavioral Health Equity for Children, Families, and Communities: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25347. 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. C. D. Mote, Jr., 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. Prepublication Copy, Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s 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 committee’s 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

STEERING COMMITTEE FOR THE WORKSHOP ON ACHIEVING HEALTH EQUITY IN CHILDREN'S COGNITIVE, AFFECTIVE, AND BEHAVIORAL HEALTH WILLIAM R. BEARDSLEE, Baer Prevention Initiatives; Department of Psychiatry (chairman emeritus), Boston Children’s Hospital; Department of Child Psychiatry, Harvard Medical School FELESIA R. BOWEN, Center for Urban Youth School of Nursing, Rutgers, The State University of New Jersey (until May 2018); College of Nursing, Medical University of South Carolina (from June 2018) ANGELA DIAZ, Department of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai; Mount Sinai Adolescent Health Center KIMBERLY EATON HOAGWOOD, Department of Child and Adolescent Psychiatry, School of Medicine, New York University UMA KOTAGAL, Cincinnati Children’s Hospital Medical Center ANDY SHIH, Autism Speaks DEBORAH KLEIN WALKER, Global Alliance for Behavioral Health and Social Justice; Boston University School of Public Health Prepublication Copy, Uncorrected Proofs FM‐v

FORUM FOR CHILDREN’S WELL-BEING: PROMOTING COGNITIVE, AFFECTIVE, AND BEHAVIORAL HEALTH OF CHILDREN AND YOUTH WILLIAM R. BEARDSLEE (Co-Chair), Baer Prevention Initiatives; Department of Psychiatry (chairman emeritus), Boston Children’s Hospital; Department of Child Psychiatry, Harvard Medical School C. HENDRICKS BROWN (Co-Chair), Departments of Psychiatry, Behavioral Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University RUMELI BANIK, Child Well-being Program, Doris Duke Charitable Foundation HAROLYN M.E. BELCHER, Johns Hopkins University School of Medicine; Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute THOMAS F. BOAT, University of Cincinnati College of Medicine (dean emeritus); Cincinnati Children’s Hospital Medical Center FELESIA R. BOWEN, Center for Urban Youth School of Nursing, Rutgers, The State University of New Jersey (until May 2018); College of Nursing, Medical University of South Carolina (from June 2018) RAHIL D. BRIGGS, ZERO TO THREE; Department of Pediatrics, Montefiore Medical Group DEBBIE I. CHANG, Policy and Prevention, Nemours NATHANIEL Z. COUNTS, Mental Health America MARTHA B. DAVIS, Robert Wood Johnson Foundation ALEXA EGGLESTON, Domestic Programs, Conrad N. Hilton Foundation LYNDA GARGAN, National Federation of Families for Children’s Mental Health J. DAVID HAWKINS, School of Social Work, University of Washington CARMEN J. HEAD, American Academy of Child and Adolescent Psychiatry KIMBERLY EATON HOAGWOOD, Department of Child and Adolescent Psychiatry, School of Medicine, New York University JENNIFER W. KAMINSKI, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention KELLY J. KELLEHER, Center for Innovation in Pediatric Practice; Health Services Research and Community Health and Services Research, The Research Institute at Nationwide Children’s Hospital UMA KOTAGAL, Cincinnati Children’s Hospital Medical Center LAUREL K. LESLIE, American Board of Pediatrics; Department of Medicine and Pediatrics, Tufts University School of Medicine DINA LIESER, Maternal and Child Health Bureau, Health Resources and Services Administration (from May 2018) MARY ANN MCCABE, Society for Child and Family Policy and Practice; Society of Pediatric Psychology; Department of Pediatrics, George Washington University School of Medicine; Department of Applied Developmental Psychology, George Mason University MARY JANE ROTHERAM-BORUS, Child Psychiatry and Biobehavioral Sciences, Global Center for Children and Families, Center for HIV Identification, Prevention, and Treatment Services, Department of Psychiatry, University of California, Los Angeles ANDY SHIH, Autism Speaks JOSÉ SZAPOCZNIK, Department of Public Health Sciences, Miami Clinical Translational Science Institute, Center for Family Studies, University of Miami Prepublication Copy, Uncorrected Proofs FM‐vi

W. DOUGLAS TYNAN, Integrated Health Care, American Psychological Association VERA FRANCES “FAN” TAIT, American Academy of Pediatrics DEBORAH KLEIN WALKER, Global Alliance for Behavioral Health and Social Justice; Boston University School of Public Health DAVID WILLIS, Maternal and Child Health Bureau, Health Resources and Services Administration (until April 2018) Forum Staff WENDY KEENAN, Forum Director SARAH M. TRACEY, Associate Program Officer (until September 2018) ERIN KELLOGG, Research Associate (from September 2018) MARY GHITELMAN, Senior Program Assistant (September 2017–January 2018) MARGARET KELLY, Senior Program Assistant (from July 2018) CLARISSA E. SANCHEZ, Fellow, Archer Center Graduate Program in Public Policy, University of Texas Health Science Center (May–August 2018) Board on Children, Youth, and Families Staff NATACHA BLAIN, Board Director PAMELLA ATAYI, Program Coordinator ANTHONY BRYANT, Financial Associate Prepublication Copy, Uncorrected Proofs FM‐vii

Acknowledgments This Proceedings of a Workshop 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 proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: Harolyn M.E. Belcher, Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute, Johns Hopkins School of Medicine; EUGENE E. GARCIA, emeritus, Mary Lou Fulton Teachers’ College, Arizona State University; and Tatiana Perrino, Department of Public Health Sciences, University of Miami Miller School of Medicine. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Patrick H. Deleon, F. Edward Herbert School of Medicine and the Graduate School of Nursing, Uniformed Services University of the Health Sciences. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur(s) and the National Academies. Prepublication Copy, Uncorrected Proofs FM‐viii

Contents 1 Introduction to the Workshop and Proceedings 2 Introduction to Health Equity and Social Determinants of Health 3 Opportunities for Advancing Behavioral Health Equity Through State and Local Policy 4 Addressing Quality and Access: Promoting Behavioral Health in Rural Communities 5 Addressing Historical, Intergenerational, and Chronic Trauma: Impacts on Children, Families, and Communities 6 Accelerating the Rate of Learning Through Population-Based Research Strategies 7 Creating Partnerships and Engaging Communities 8 Implementing Family-Focused Preventive Interventions 9 Adopting Restorative Policies and Practices to Achieve Health Equity 10 A Pathway Forward References Appendix A Workshop Statement of Task Appendix B Workshop Agenda Appendix C Speaker and Committee Biosketches Appendix D Continuing the Conversation Prepublication Copy, Uncorrected Proofs FM‐ix

Prepublication Copy, Uncorrected Proofs FM‐x

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In November 2017, the The Forum on Promoting Children's Cognitive, Affective, and Behavioral Health, in collaboration with the Roundtable on the Promotion of Health Equity, convened a workshop on promoting children's behavioral health equity. The workshop used a socio-ecological developmental model to explore health equity of children and families, including those with complex needs and chronic conditions. Particular attention was paid to challenges experienced by children and families in both rural and urban contexts, to include but not limited to poverty, individual and institutional racism, low-resourced communities, and hindered access to educational and health care services. Workshop participants also engaged in solution-oriented discussions of initiatives, policies, and programs that aim to improve social determinants of health, opportunities for behavioral health promotion, and access to quality services that address the behavioral health of all children and families. This publication summarizes the presentations and discussion of the event.

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