Research Snapshot: Mental health prevention for young children to improve long-term outcomes

By Cassie Sun
June 18, 2024

Pediatric primary care offers one of the most promising opportunities for early prevention of mental health conditions. New clinical tools are able to detect risks as early as toddlerhood; however, they have yet to be fully incorporated into routine pediatric care. That shortfall has resulted in a pervasive “watch and wait” approach that hinders access to prevention at a crucial stage of development; a problem amplified for families from marginalized populations.

The Mental Health, Earlier approach outlined in new research from scientists at Northwestern University’s Institute for Public Health and Medicine describes multiple strategies for translating developmental evidence into real-world care.

The series of studies was led by Lauren Wakschlag, PhD, professor and vice chair of Medical Social Sciences, and director of the Institute for Innovations in Developmental Sciences (DevSci); and J.D. Smith, PhD, adjunct associate professor of Psychiatry and Behavioral Sciences at Northwestern University’s Feinberg School of Medicine, now associate professor at the University of Utah Spencer Fox Eccles School of Medicine. IPHAM members Rinad S Beidas, Phd;  Allison J Carroll , PhD; Ashley A Knapp , PhD ; Nivedita Mohanty , MD; and Seema K Shah , JD contributed to the research.

This research is foundational to a pending DevSci Center grant for the Mental Health, Earlier partnership that coalesces scientists, clinicians and other community partners towards implementing and testing the innovations developed.

The Big Picture

Up to one quarter of all children are diagnosed with mental health problems by the time they enter kindergarten. The vast majority of youth with chronic mental health problems exhibit early warning signs by the age of five.

By identifying and intervening with those early signs, families and care providers can head off conditions before they escalate. A developmental, community-based approach can equitably reduce the substantial public health burden of chronic mental disorders by targeting their roots.

How the Study was Done

Researchers conducted interviews and focus groups, and established a workgroup, with AllianceChicago community health centers and Lurie Children’s Hospital pediatric clinicians to understand the current state of mental health services.

The study completed feasibility testing of toddler screening procedures in primary care.

Parents across Illinois were also surveyed about their preferences and priorities for integrating research-based solutions into pediatric primary care clinics in the state.

The Results

Researchers found a clear need for new tools to identify children at risk, decision supports for clinicians in how to act based on the child’s risk level, and connect them to preventive services that are non-stigmatizing. The team also found a need to improve trust in clinician-caregiver relationships and reduce potential sources of bias that could lead to inequities in service access and outcomes for families.

Other findings:

• “Benevolent bias,” where clinicians are hesitant to address mental health risks because they are “protective” of families struggling with Social Determinants of Health (SDOH) can unintentionally impede access to critical preventative services.
• There is a major gap between pediatricians’ belief in the high importance of this early screening and their confidence that they could do so effectively because of the difficulty of differentiating normal toddler behavior from clinical red flags.
• Clinicians are hungry for pragmatic decision-making tools that cut through the complexity of this developmental period.

What’s next?

Ongoing efforts of the Mental Health, Earlier Partnership focus on implementing practical, developmentally based screening measures, decision supports for clinicians, and effective interventions in pediatric primary care systems available for integration into routine care. 

Thoughts from the Author

“Through this community-academic partnership,” said Smith. “We can actualize the promise of pediatric primary care for population-level mitigation of the lifelong inequitable burden of mental illness and prevent the early emergence of disparities at their roots.”