UHF’s recent report, The Ripple Effects of the Adolescent Behavioral Health Crisis, hit close to home in a way I didn’t expect but probably should have. As we partnered with Boston Consulting Group, leveraging their significant analytic and modeling expertise to present a frightening picture of the toll of this crisis, I often ended meetings by recognizing the gravity of human suffering underlying the data and encouraging everyone on the team to give themselves grace when working on such an emotionally heavy issue. It took me six more months and some soul searching to understand that grace was also something I needed to give myself.
As a teenager, I might have answered yes to many of the survey questions yielding the data presented in our report. Fortunately, even growing up in rural Iowa, I had a level of middle-class white privilege that allowed me to see a child psychologist at the first signs of behavior and mental health issues in kindergarten. While I can’t remember the specifics, I know counseling gave me the coping skills and resilience that deterred what could have been a much darker path. Unfortunately, that kind of prevention is still generally only available to the privileged few. To fully address the adolescent behavioral health crisis, that has to change.
PILLARS OF PREVENTION
In early 2024, UHF completed a targeted strategic planning process on how to leverage our significant skills in research and analysis, convening, and on-the-ground innovation to enhance our contribution to the integration of physical, behavioral, and social care. Not surprisingly, given a decade of recent work focused on developing clinical-community partnerships in pediatrics, we quickly coalesced around a few key priorities: addressing critical obstacles to creating a more coordinated system of care that identifies behavioral health needs early and providing support to children and families around early relational health. These pillars of prevention hold the promise for keeping the next generation of younger children from becoming the next set of adolescent crisis statistics.
While UHF has worked with pediatricians on these issues in many ways over the last decade, we do not profess to be experts; nor are we naive enough to believe that expanding our work in this space can alone make the difference. Which is why, with support from UHF’s board of directors, we have engaged David J. Woodlock as a consultant senior behavioral health fellow to help guide this important work. David’s distinguished bio would be more than enough explanation for this decision, but there’s more to the story.
Early on in my now more than a decade at UHF, I first encountered David as a member of the New York State Medicaid Value-Based Payment Children’s Health Subcommittee and Clinical Advisory Group, which UHF facilitated. It took all of about 10 seconds to understand why the current CEO of one of the state’s largest behavioral health providers was in the room and to perceive his passion and vision for a better system of care for children. David quickly became one of a small handful of trusted advisors that helped push the process forward, always with a sharp eye on how value-based payment could disrupt the status quo to make care for kids more integrated and effective. While great progress was achieved by this committee as well as the subsequent First 1,000 Days on Medicaid workgroup on which David continued his leading champion role, there’s still much more work to be done. In my opinion, there’s no one better to take on the role of tireless change agent than David.
OVERCOMING CRITICAL OBSTACLES
The work ahead is complex and multifaceted. While more than enough is known about the barriers to systems of better-integrated care for kids (workforce, regulatory silos, sustainable funding), UHF will harness its research capacity to focus on important quantitative and qualitative questions that can help advance the search for workable solutions. We’ll identify these solutions through a series of stakeholder convenings that will recommend policies and initiatives to support a re-envisioned system of community-based and integrated physical, behavioral, and social care. The ultimate goal is to overcome critical obstacles to childhood behavioral health and prevention. Finally, we’ll put our feet on the ground creating programmatic efforts with providers in the field who are delivering on that re-envisioned system. These efforts may initially be supported by UHF and other funders but will eventually yield transformative results that will be sustained by future policymakers.
Just as the previously described VBP effort had its North Star framework, UHF’s work in children’s behavioral health will be guided by four non-negotiable principles:
- As a catalyst, we intend to be ambitious and to actively challenge the status quo when it isn’t working for kids.
- Recognizing the deep disparities outlined in the “ripple effect” report and myriad other research pieces, UHF will be an equity advancer, specifically addressing the disproportionate impact of behavioral health issues and systemic barriers to health for BIPOC, LGBTQ+, and lower-income communities.
- Building on our historic and ongoing convening roles, UHF will continue to be a collaborator, recognizing stakeholders’ unique strengths and facilitating alignment with other efforts while reducing duplication and miscoordination in the field.
- Finally, UHF will be a conduit that listens to and amplifies the voices of affected community members and centers their experiences in the development of actionable solutions.
As a troubled six-year-old, never could I have imagined that someday I’d have an opportunity to help others get the same care and support I received at a pivotal moment and that led to life-long, preventive benefits. Working with the amazing staff and leadership at UHF, David, and many others to improve the ecosystem of behavioral health prevention and care is the ultimate pay-it-forward opportunity of my lifetime. As the work begins, I know that I’ll be extending grace to all of those joining us in this challenging endeavor at which we cannot afford to fail—and finally extending that grace to myself as well.
Chad Shearer is UHF's Senior Vice President for Policy and Program.
