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1 in 2 At-Risk Children Are Not Getting the Mental Health Help They Need

Child therapist.

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Key Takeaways

  • According to a new study, more than half of at-risk kids and teens are not receiving the mental health services they could benefit from long-term. 
  • Those most at risk have experienced adverse childhood experiences and/or show high distress symptoms.
  • Improving access to these services through schools and identifying children most at risk could help.

Half of at-risk children and teens in the United States are not getting the mental and behavioral health help they need, according to researchers at the University of New Hampshire.

Children and teens are considered at risk for mental and physical health problems when they experience high levels of adverse childhood experiences (ACEs) and/or high distress symptoms like depression, anxiety, anger, post-traumatic stress, and dissociation. 

For the study, researchers analyzed nearly 12,000 participants. For those between 2 and 9 years of age, 57 percent hadn't received clinical services after experiencing ACEs and 53 percent hadn't after presenting high distress symptoms. For those between 10 and 17, 63 percent hadn't received clinical services after experiencing ACEs and 52 percent hadn't after presenting high distress symptoms. Researchers found that between 41 percent and 63 percent went untreated overall.

"The key thing is that there are a lot of high-risk kids with childhood adversities and mental health symptoms," the study's lead author David Finkelhor, PhD, director of the crimes against children research center and co-director of the family research laboratory at the University of New Hampshire, tells Verywell. "They're not getting behavioral health treatments that we know would improve their life outcomes in terms of their mental and physical health in the future."

It's important to recognize the issue, Finkelhor says, because childhood adversities and mental health problems will likely carry on to adulthood if gone unaddressed. The study was published in mid-March in JAMA Network Open.

What This Means For You

If you or a young person you know has had ACEs or shows high distress symptoms, ask and healthcare providers about how to assist them in getting help.

What Puts Children and Teens "at-Risk"?

For this study, young people were considered "at-risk" when they were dealing with one or both of two things: adverse childhood experiences (ACEs) or high distress symptoms.

ACEs range from verbal and/or physical child abuse to the incarceration of a relative. It is impossible to tell the exact effect of such events on children, and the questionnaire used to screen for ACEs does not take all adverse experiences, or any protective factors, such as strong social supports, into account. However, the events it does cover have previously correlated with mental and physical issues later in life, such as alcoholism and heart disease.

Researchers used a 15-item scale encompassing adverse experiences in and outside the home. An ACE score of five or more was high for children aged 2 to 9, whereas a score of seven was high for those aged 10 to 17.

Some of the symptoms children experienced ranged from depression and anxiety to anger and aggression.

What Services Were They Lacking?

To gauge whether the children and teens were receiving clinical behavioral health services, the surveys asked respondents a variety of questions, including:

  • Does your child currently receive special services at school? These might include an individualized education plan (IEP), 504 plan, or special education services.
  • Does your child currently take any medication associated with an emotional, behavioral, or learning problem?
  • Has your child had an evaluation or received any counseling for emotional, behavioral, or developmental problems in the last year?
  • Has your child ever been diagnosed by a doctor, therapist or another professional with a mental disorder?

Not All Are Equally at Risk

While conducting the interviews, demographic factors such as gender, race, parent education, geographical location, and parental employment were considered.

Compared to their non-Hispanic White peers, kids and teens from every other race were less likely to have received clinical services. Those least likely to receive services were Black children between the ages of 2 and 9.

Young Black children could've been particularly disadvantaged in receiving services due to multiple factors. "It could be places that they're living, lack of ability to pay, transportation issues," Finkelhor says. "It could be feeling like the services are not culturally suited to them, and they may feel stigma or fears that they're going to be further stigmatized." Given all these intersecting factors, he adds understanding and addressing these issues should be a priority in research and practice.

Other groups that were less likely to have had contact with clinical services included:

  • Younger children who had high ACE scores and high symptoms, with high school-educated parents (compared to those with college-educated parents)
  • Older children with high symptoms whose parents had less than a high school education (compared to those with college-educated parents)

In contrast, children and teens whose families had a single parent, stepparents, or other configurations were more likely to receive clinical contact than those with two-parent households, regardless of other demographic factors, ACE scores, and distress symptoms.

How to Improve Access to Clinical Services

Unaddressed mental health and behavioral issues, Finkelhor says, can be a burden for the individual and people around them throughout life. If help isn't received early, he adds, these problems can incur enormous costs for medical and criminal justice systems and lead to other social problems. "It's really one of the key opportunities that we have to make a big difference in outcomes," he says.

If Finkelhor could improve access, he'd focus on a system that:

  • Locates behavioral health services in schools and medical practices
  • Identifies the kids who could most benefit
  • Assures that professionals working in this area were trained and skilled in the best and most evidence-based forms of treatment
  • Reduces the amount of stigma that is associated with receiving these services by changing the way in which they're labeled
  • Publicizes the success of such programs, for example by getting kids to provide testimony about their experience

Treatment and prevention are particularly effective at an earlier stage of life, so access to these programs is crucial. "Children are quite malleable," Finkelhor says. "They can be influenced, and it's one of the easiest stages to provide skills that can be lifelong tools."

That's why societies rely on educational systems, Finkelhor adds: because children are malleable and learn quickly compared to adults. But those systems could make room for behavioral and mental health learning, too. "Educational systems are mostly focused on certain cognitive skills," he says. "We'd benefit from expanding to provide new skills that we now understand are really important, compared to when the educational system was first being designed—such as interpersonal relationships and emotion management."

While more trained staff will be necessary for these changes, the country also has to have a conversation about how to attract more people to the profession. "We need to make sure that more people go into the field," Finkelhor says. "The reimbursement rates for these kinds of services are not all that adequate."

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  1. Finkelhor D, Turner H, LaSelva D. Receipt of behavioral health services among us children and youth with adverse childhood experiences or mental health symptomsJAMA Netw Open. 2021;4(3), e211435. doi:10.1001/jamanetworkopen.2021.1435

  2. Harvard University, Center on the Developing Child. Take the ACE quiz – and learn what it does and doesn't mean. Published March 3, 2015.