Mental health for kids: The need and the challenge, at times, to fill it

A student and her mother walk up to Sunset Elementary for the first day of school.
Cuyler Meade / Craig Press

Trauma and mental health struggles can affect anyone for a long period of time in his or her life, but when those traumatic events happen to a child, access to mental health care becomes all the more important. In Craig and across the state of Colorado, behavioral health professionals are working to help stop the cycle of developmental decline before it happens.

What does mental health care for a child look like?

In most cases, there are a lot of moving parts. Liz Kraeger, an early childhood mental health consultant at Mind Springs in Craig, said that when she works with a case, she involves various adults and family members in a child’s life in order to approach the issue from all sides. This way, she said, they can not only find solutions and coping skills that work with the child, but then everyone is on the same page.

“A child learns and grows in a relationship, so you would need to focus on the relationship and tweak the relationship,” Kraeger said. “Children don’t have control over their entire world. Part of that control is in their parents, and their teachers and their caregivers, so we need to involve all of them — and change all of it — to make it better for a child.”

Kraeger said these meetings can happen all together or individually. She starts with the parents to get a developmental history of the child (their normal behaviors, family history and parental/sibling changes) in order to have an understanding of what may have disrupted or affected a child’s normal routine or life.

“Depending on their age and depending on what’s going on in their lives, it can be really hard to change,” Kraeger said. “Changes that (adults) feel are little can be huge for a child.”

Kraeger, who works with children from birth to six years old, also observes children in classroom settings to see how they react to their teachers. When working with teachers, she said she works collaboratively to support early childhood development and create a more “pro-social learning environment.” This means teachers have the skills to teach students about social and emotional skills as well as appropriate behaviors in social settings.

Why is early intervention important?

To Kraeger, providing mental health care for a child is harder and usually more complicated than it is for adults. In addition to the moving parts of involving most of the people in a child’s life, sometimes the children she works with are nonverbal — whether that’s due to the age of the child or their developmental ability.

When a child is nonverbal, it can be even harder to understand when there may be a need for someone to step in. To help nonverbal children, Kraeger said they introduce co-regulation, or coaching to help them understand and express emotions, and babies as young as five months old can learn to do that with their caregivers.

“A little baby can’t say, ‘Oh, I’m hungry, Mom,’ or ‘I’m tired. I’m bored,'” she said. “They can only use their voice, and they don’t have any words. So we have to look at that as communication. A little kid that’s hitting — they’re communicating something with us.”

Children whose issues go without intervention or treatment can be affected for years after a traumatic incident, or even the rest of their lives. Kraeger said often children can act out or become hypersensitive to their environment — so much so that it can be mistaken for ADHD. Others begin kicking or biting in order to get attention from the adults around them. Negative attention is still attention, she said.

“Their development can kind of stall, and they go into this survival mode,” she said. “They’re so hyper-sensitive to their environment, (and) they’re just trying to be safe. They have to keep themselves safe instead of relying on an adult, sometimes. Sometimes, that trauma might involve not being safe, so they’re at this high sense of alertness that they can’t calm down enough to be able to learn or enjoy life.”

Financially, early intervention is a good investment for a child and his or her future. Kraeger said the Early Childhood Mental Health Consultation grant offers services to promote social and emotional development to children ages 0 to 6, families, child care centers, preschools and teachers free of charge. As that child grows, the care they require can be more complicated and specialized.

“I like to say that $1 that goes towards prevention is $12 saved in treatment,” she said. “It’s easier to help them when they’re younger than when they become teenagers. We can teach them language and what to say when they mean something, or how to address their emotions and their feelings, and how to regulate themselves. A toddler that can’t regulate themselves is going to turn into a teenager that’s exposed.”

And this isn’t just a problem for younger kids. Paul Barnett, Colorado Office of Behavioral Health director of child, youth, and family behavioral health, said that in 2019, a survey showed nearly one in three Colorado high school students reported feeling sad or hopeless — so much so that it disrupted their daily lives. In recent years, suicide has been the leading cause of death among Coloradans between 10 and 24 years old.

“Data show that youth of color are also more likely to attempt suicide than their white peers,” Barnett said. “And with the disruption of the pandemic, isolation and grief over the last year and a half has increased. The pandemic has just amplified the behavioral health problems. We’ve heard of kids as young as eight years old being brought to emergency rooms for mental health crises.”

Barnett said that finding services for youth has been increasingly difficult, as well. This, he said, is because children have problems that are almost exclusive to their age group. They may have depression or anxiety just like anyone else, but the way that can manifest itself is unique to a child’s age group. If not addressed appropriately, those problems can have a developmental impact, Barnett said.

“I think (mental health care specifically for children) is actually more difficult to come by. We provide more services to adults by quite a big amount than kids, but I think a part of that is that more providers are comfortable with adults, and not as many providers are comfortable with kids,” Barnett said.

How the state is trying to help

House Bill 1258, which was passed earlier this summer, provides resources for youth in the state — allocating $9 million for those resources. This bill enables all Colorado youth under the age of 18 — and young adults 18 to 21 years old with special needs — to qualify for three free mental health or therapy sessions. By establishing a pattern early, some proponents of the bill say this could destigmatize mental health care for future generations. Barnett called this “continuity of care in the behavioral health system.”

“Providing mental health sessions free of charge to youth across the state can help break down barriers to access and create a sustainable community of care and long-lasting relationships between youth and mental health professionals,” the bill states.

Services covered by the bill include substance abuse support, as well. The temporary mental health program will help youth and parents navigate access to care in their area — both in-person and telehealth options.

A child does not need to be on a certain “level” of distress; there is no threshold as to how severe a case is to determine whether or not they get the sessions. Any preliminary screening is done to see what issues the child may have coming into the program, and that screening helps decide how to move forward. A young person who is simply interested in how therapy works or what it means can access those sessions.

“Really, the earlier, the better — in terms of making contact with a mental health professional,” Barnett said. “And any sort of screening can then lead to the decision that maybe (a child) needs a more in-depth assessment. Maybe they have a mental health diagnosis where they need more intensive treatment.”

Barnett added that early intervention can affect someone’s physical health later in life, including heart disease, chronic fatigue and chronic pain. If signs show up in a child, it’s best to attack those problems now, instead of 10-15 years down the line.

“If those aren’t corrected, the research over many, many years shows that those problems just get worse and worse,” he said. Then because kids grow up, they tend to have much greater problems as adults. They may continue to have trouble in school, eventually, with work. Maybe they try to go to college or some other kind of learning environment; they may struggle there. Actually, it can lead to other functional problems for adults, such as employment and housing.”

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