California youth: Trouble in mind

Collaboration: Agencies must work together to alter a life path

Gang membership, school dropout, juvenile delinquency and substance abuse are highly correlated with the chronic mental health disorders that affect 1 in every 5 children under the age of 17.

Because few community resources exist for early diagnosis and treatment, however, only 1 in 10 will ever receive the mental health treatment they need.

Certainly, public agencies face formidable barriers to change this life trajectory. But if communities can find a way to coordinate services to meet the mental health needs of children, then there is hope that early intervention will make a difference.

Fortunately for Mary, the mother of one of these children, models of agency collaboration already exist in some counties.

“Alan has a behavior,” Mary began. “He hits himself and he hits other children. Instead of him trying to use his words, he would attack you.”

For the past three years, Mary has retold the story. Like many young mothers, Mary had not noticed anything unusual about her baby’s development. Somewhere around age 2, however, language development stopped and he became increasingly aggressive, especially toward his mother. Anxious for help, Mary started with her pediatrician and followed the path of referrals from one agency to another.

The journey was frustrating. At each encounter, the agencies offered a diagnosis and suggested interventions. But they did not talk to one another, and no one suggested that they should.

While everyone wanted to help, interventions were piecemeal and disjointed. Hope soon turned to frustration. After nearly two years, progress stayed minimal and the professional flow of new ideas ran dry. As the severity of the tantrums, screaming and aggression escalated, the likelihood that Alan would improve and not deteriorate further became increasingly remote, and Mary pessimistically awaited the outcome of one final referral.

Mary’s experience is not uncommon. Left to navigate a system of multiple service agencies, each with differing eligibility, funding, licensing and accountability standards, families must oftentimes accept services that lack the coordination necessary to address the complex needs of their children.

While collaboration within professions is common, collaboration across professions is rare. As a result, each agency interprets the needs of the child from their own perspective.

But this time, Mary’s experience was different. Alan was referred to an interagency collaborative clinic where everyone was focused on his unique strengths and needs. As professionals with medical, psychological, educational and mental health expertise talked together, a new pattern of coordinated and intensive services was proposed.

The results were dramatic. At 4½, Alan went from functioning at a 14month level to age-appropriate levels in expressive and receptive language, behavior and school readiness.

“Like I said before,” Mary said and smiled, “he’s wonderful! He’s amazing! Family and friends are noticing a change and asking, ‘Did you put him on drugs?’ ”

While Alan’s progress is exceptional, it is not an outlier in a program with a decade of coordinated care. There have been many stories of child outcomes that are equally impressive. Each changed trajectory has been made possible because public agencies chose to work together for the good of the children and their families.

Alan’s story holds out hope that other counties will choose the same.