Report: Utah needs more early childhood mental health services

SALT LAKE CITY — While Utah has increasingly focused its attention on the teen mental health crisis, younger children also face a shortage of resources that could prevent long-term emotional and physical health problems, according to a new study.

National estimates show between 10% and 20% of Utah children through age 8 could experience mental, emotional, developmental or behavioral challenges, Samantha Ball, senior research associate with the Kem C. Gardner Policy Institute, said as she presented key findings from the institute’s soon-to-be released study during the inaugural Summit on Children’s Mental Health.

“The goal of the report is to provide a foundation or a starting point for discussing how to increase early childhood mental health services access, and to do so at the earliest point possible to make the greatest difference in current lives of children in their mental health” and to avoid future mental health issues, Ball said.

Utah also has among the highest prevalence of youth mental health disorders and those who are not receiving care in the nation, she noted.

The new study, which will be released in full within the next two weeks, builds on findings from the institute’s 2019 study on mental health resources in the state. That study found that the demand for mental health providers in Utah was growing at a pace that the current shortage couldn’t keep up with.

The 2019 study found that 14.9% of boys ages 15-17 and 28.5% of girls “seriously considered attempting suicide” between 2015 and 2017. But almost 40% of youth ages 12-17 with depression did not receive treatment or counseling, researchers say.

But the new study is the first to delve into resources for younger children, Ball said.

“There is a need for early childhood mental health services in the state of Utah,” said Laura Summers, senior health care analyst with the institute.

Factors considered in the report included poverty, chronic school absence, child abuse and neglect, foster care placement, maternal education levels, maternal mental health and uninsured rates of children.

Another measure of the study was adverse childhood experiences, as research shows a relationship between the number of adverse childhood experiences someone has and diminished health and well-being outcomes “immediately and later in life,” Summers said.

Data from the National Survey of Children’s Health shows that more than 1 in 6 children in Utah have experienced two or more adverse childhood experiences before they turn 18, Summers said. Meanwhile, about 15% of adults in Utah report having experienced four or more adverse childhood experiences in their lives, according to data from the Utah Department of Health.

Utah’s minority populations, however, are disproportionately impacted by adverse childhood experiences, especially American Indians — 30.9% — and Black or African American adults — 22.2%.

The more adverse childhood experiences someone has including abuse, neglect and household dysfunction, the higher their risk of mental health and behavioral problems, said Dr. Nadine Burke Harris, California’s surgeon general whose work has focused on the topic. Adverse childhood experiences are also linked to serious health problems including heart disease, cancer, diabetes and stroke.

“What we found is that an ounce of prevention is worth a pound of cure, especially when we’re looking at the multiple and myriad impacts of adverse childhood experiences,” Harris Burke said during the summit.

She likened adverse childhood experiences to an encounter with a bear in the forest, which would cause the body to activate both a stress and immune response. When that process is repeated “over and over and over,” the stress response becomes maladapted, Burke Harris said.

“And children are especially sensitive to the repeated activation of the stress response because their brains and bodies are just developing. And so high doses of adversity are associated with changes in brain structure and function, changes in the immune system, changes in the hormonal system. And these are long-term changes,” she said.

She said early detection and evidence-based intervention, however, can change health outcomes.

The Kem C. Gardner Police Institute also looked at the number of children living in poverty throughout the state.

“As we all know … economic stability is a key factor in health and well-being as well as a person’s mental health,” Summers said.

The percentage of children living in poverty in Utah is 10% compared to the 18% national average, but some areas have much higher rates, she noted. San Juan County and some areas of Salt Lake County claim percentages close to double the national rate of childhood poverty, Summers said, and close to half of all children in San Juan County are living in poverty.

“As such, we really feel like strategies to improve Utah’s early childhood mental health system and mitigate risk should consider effective means to reach these high-risk areas and populations,” she said.

The researchers found that it’s difficult to identify resources directed at early childhood mental health services in Utah compared to other programs like parental support and early education, Ball said. The report calls for collection of data on early childhood mental health services, the number of children receiving services, and school-based mental health services.

There is, however, “variety” in the early childhood mental health programs in the state including Baby Watch Early Intervention, Head Start, family support centers and crises nurseries, Ball said.

Interestingly, some of Utah’s rural areas have the most early childhood mental health programs per 1,000 children, while more populated areas like Davis, Utah and Washington counties have the fewest.

The researchers found through in-depth interviews that one of the biggest challenges stakeholders face is “helping parents, physicians, school leaders and the general population understand the importance of early childhood mental health,” Ball said.

“Stakeholders reported hesitation by some parents or caregivers to accept mental health care suggestions and diagnoses, and sometimes this was for the children who needed help the most,” she said.

There’s also a limited access to mental health providers, who are “unevenly distributed” in Utah, Ball noted. Other barriers are cost, transportation, waiting lists and a limited number of bilingual and multicultural mental health professionals. Some therapists also don’t feel comfortable treating children 4 and younger.

Researchers did, however, find “silver linings” in the report, she said.

“There are examples of successful program collaborations in different areas of the state, there are reports of increasing resources and training available for trauma informed approaches to care, and there’s a general increased awareness of the importance of early childhood mental health,” Ball said.

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