Bringing Evidence-Based Mental-Health Care to Children Worldwide

This is a photo of a therapist comforting a depressed adolescent.According to the World Health Organization (2011), South Africa has 0.27 psychiatrists and 0.31 psychologists per 100,000 people, while Lebanon has 1.41 psychiatrists and 2.12 psychologists for 100,000 people. The lack of mental health providers in these countries presents a barrier for those trying to access mental-health care. How then, can access to mental-health care be broadened, not just in these two countries, but in countries across the world?

In a 2016 article published in the South African Journal of Psychology, APS Fellow Michael C. Roberts, Rebecca M. Kanine, Christina M. Amaro, Spencer C. Evans, Jennifer B. Blossom, and Andrea M. Garcia from the University of Kansas describe the current state of clinical science for some of our most vulnerable populations — children and adolescents. They describe efforts in the United States and internationally (with a special focus on South Africa) to improve training, interventions, and youth’s access to mental health care.

According to the authors, clinical child psychologists work in a variety of settings including hospitals, schools, universities, and community mental-health centers. Their work spans from assessment and treatment of cognitive, emotional, developmental, behavioral, and family problems to teaching, research, and policy work. Although the field of child and adolescent psychology is well recognized today, the authors note that this recognition has only become widespread in the last 50 years.

One of the contributors to the dearth of child psychological health professionals is limitations of education and training in this field, write the authors. The level and requirements of training vary from country to country, and unlike other medical areas — such as nursing —few internationally agreed upon training standards exist.

In the United States, the authors say, training programs generally follow a scientist-practitioner model, where research is combined with clinical practice and clinicians gravitate toward the use of evidence-based practices in treatment. The adoption of this training model is growing internationally. These training programs, the authors write, must be focused on inclusion of evidence-based practitioner principles while meeting the unique needs of populations from different cultural and economic backgrounds. In order to accomplish this, some training programs take special steps to integrate multicultural experiences into their training modules. In Mexico, for example, some training programs include an immersion module to give students exposure to other cultures and experiences. In South Africa, students are required to spend a year serving the community as part of their training.

The application of science-based principles is important, not just for clinical training, but also for clinical practice. The authors note an emerging focus on providing evidence-based treatments in both high- and low-income countries. The adoption of these types of treatments, the authors say, are especially important in countries with limited resources. According to the authors, the implementation of these programs will be challenging and will require a focus on training programs that stress the scientist-practitioner approach, and buy-in from key stakeholders such as parents, teachers, and national and local leaders.

Although steps are being taken to improve the quality and quantity of child and adolescent mental-health care, much remains to be done. The authors suggest that in order to spread access to care, there needs to be continued focus on the training and utilization of evidence-based practices and more research into how different interventions and assessments perform with diverse populations. The creation of internationally accepted training standards for clinicians is one way to help boost the quality of care worldwide. At the legislative level, policymakers must focus on creating mental-health policy that focuses on the specific psychological and environmental challenges children and adolescents face.

Reference

Roberts, M. C., Kanine, R. M., Amaro, C. M., Evans, S. C., Blossom, J. B., & Garcia, A. M. (2015). International education and training for clinical child and adolescent psychology. South African Journal of Psychology, 46, 9-24. doi: 10.1177/0081246315619510.

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