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The Kids Are Not All Right: Researchers Find Little to Celebrate 25 Years After Groundbreaking Child Mental Health Study Urged Federal Leadership

Atlanta...A quarter of a century has passed since a groundbreaking, 50-state study shone a piercing light on America's alarming disarray of mental health services for children and urged strong federal leadership on policies to support states' efforts. A follow-up study released today finds that states are still struggling to deliver effective care while a lack of federal leadership remains.

"It's upsetting that 25 years after the first report there still are so many children and families who need help and are not getting it," says Janice L. Cooper, PhD, co-author of the report along with Jane Knitzer, EdD, who authored the first study in 1982. Dr. Cooper directs the child health and mental health focus at the National Center for Children in Poverty (NCCP), part of the Mailman School of Public Health at Columbia University, and Dr. Knitzer is NCCP's director.

"The lack of federal leadership has led to inequity between the states, often leading to disappointing results for children, youth and families. Children in one state might have fared considerably better across the border in a neighboring state," says Cooper. "Sadly, children bear the burden of those inequities. We need a nationwide mental health system that focuses on prevention, early intervention and treatment."

The NCCP report, Unclaimed Children Revisited: The Status of Children's Mental Health Policy in the United States, is being presented at the 24th Annual Rosalynn Carter Symposium on Mental Health Policy at The Carter Center on Nov. 20-21, 2008 in Atlanta. Drawing noted advocates, professionals and family leaders, The Carter Center symposium is an opportunity for mental health leaders to formulate an action agenda to respond to the NCCP research findings.

"The findings from this nationwide study reveal that despite the considerable advances in knowledge about the prevention, diagnoses, and treatment of mental health conditions in children, we still have much work to do," said former First Lady Rosalynn Carter, founder of the Carter Center's Mental Health Program. "I hope that the Unclaimed Children Revisited report will drive constructive discussion both at our symposium and around the country that will result in improvement in the quality of mental health care for children in America."

Researchers collected and analyzed data from all 50 states plus the District of Columbia, Guam and Puerto Rico. Their report shows that in the quarter century since the first study, there has been an explosion of new knowledge, new understandings of how children and their problems develop, and new ways of providing preventive and treatment services. But this body of knowledge is haphazardly factored into policy decisions regarding children's mental health issues.

"At the time of the first study, we only had a fraction of the information we now have about effective services for children and youth. Today that is totally different – we know what's effective, but aren't necessarily doing what's effective," says Cooper. "Mental health care providers don't always implement evidence-based practices, such as following a tested therapy protocol, then measuring the results to see if actual progress has been made with the child."

The study also reveals poor accountability for both successful outcomes with children as well as how the dollars are spent, says Dr. Knitzer. "A big problem is that the money we're spending as a nation is often not supporting effective services."

NCCP found that only half of the states and territories were able or willing to report their annual children's mental health budgets. Twelve states could not identify any group of children they served well.

Other findings include:

  • Nationally, across the age span, mental health services are spotty at best.
  • Only 23 states report investing in early childhood mental health and of those, there are limited statewide strategies.
  • Only 24 states invest in school-based mental health services despite evidence that this is a core opportunity to both improve children's mental health and learning.
  • Too often money is spent on practices that are not evidence-based, and family supportive, despite emerging knowledge.
  • Reimbursement policies impede states' ability to deliver age-appropriate, effective care.
  • Emphasis in care delivery has been on children with severe emotional issues; but little emphasis has been placed on those children who are at-risk for mental health problems, and who could benefit from early intervention.
  • Only two states reported having an advanced information technology infrastructure to support children's mental health service delivery.

"We need to join our collective knowledge about what works, our understanding about what children need at different stages of growth and development, and our fiscal policies so they support this framework." says Dr. Knitzer. "Despite pockets of excellence, today we have a financing and delivery system that remains largely unaccountable and lacking in transparency, coupled with a failure to implement effective practices. We cannot wait another 25 years – we need to move forward now."

Editor's Note:

  • The full report can be found online at
  • Media unable to attend the Carter Center symposium are invited to tune in to live-streaming video coverage available on the Web at
  • Visit to learn more about the Carter Center's Mental Health Program and access resource material such as reports, the Center's mental health journalism archive, and expert Q&As.

The National Center for Children in Poverty (NCCP) is the nation's leading public policy center dedicated to promoting the economic security, health and well-being of America's low-income families and children. Part of Columbia University's Mailman School of Public Health, NCCP uses research to inform policy and practice with the goal of ensuring positive outcomes for the next generation.

The Carter Center is a not-for-profit, nongovernmental organization that has helped to improve life for people in more than 70 countries by resolving conflicts; advancing democracy, human rights, and economic opportunity; preventing diseases; improving mental health care; and teaching farmers in developing nations to increase crop production. The Carter Center's Mental Health Program works to decrease stigma and discrimination against people with mental illnesses as well as promote positive policy change on mental health issues. The Carter Center was founded in 1982 by former U.S. President Jimmy Carter and his wife, Rosalynn, in partnership with Emory University, to advance peace and health worldwide.

New Findings on Nation's Delivery of Children's Mental Health Care to be Released at Rosalynn Carter Symposium on Mental Health Policy >

Read the full report >

Watch archived webcasts from the Twenty-Fourth Annual Rosalynn Carter Symposium on Mental Health Policy >

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