It is well-known that early experiences in life often influence our behavior in adolescence and adulthood. Equally notable is that providing prevention strategies when children are young can significantly impact whether or not they develop behavioral problems when they are older (Daly, Nicholls, Aggarwal, & Sander, 2014). So, if we know that “prevention works” and that the best way to address behavioral health issues is to provide quality services and supports so that those “problems” never materialize, then why do prevention services often receive the least amount of funding when compared to treatment approaches that are implemented after a behavioral health issue has surfaced?

From a mental health perspective, in the long run, treating behavioral health problems at an early age can reduce the risk of the occurrence of increased problems throughout adulthood. Even more compelling, prevention services provided before behavioral problems develop can improve future outcomes for children and adolescents. Adults with serious mental, emotional, and behavioral disorders have reported that the onset of those disorders began in childhood or adolescence (Institute of Medicine, 2009). Not providing youth with mental health prevention services early on can result in the onset and increase of social, emotional, and behavioral problems (Daly, Nicholls, Aggarwal, & Sander, 2014). These problems worsen the longer they are left untreated and ignored (Daly, Nicholls, Aggarwal, & Sander, 2014). Youth with serious behavioral problems and who do not receive prevention services are at risk for socioemotional developmental problems and conduct problems, antisocial behaviors, delinquency, and serious mental health problems (Daly, Nicholls, Aggarwal, & Sander, 2014). At-risk youth from low-income communities, lower socioeconomic status, and children of color are at greater risk for developing these problems into adulthood (Daly, Nicholls, Aggarwal, & Sander, 2014).

The application of prevention services not only prevents and addresses problems in youth but also helps uncover problems that, without the proper training, may not have been easily noticeable or determined within the classroom. Prevention services in schools have shown proven results in reducing the onset and continuation of behavioral problems and promoting youths’ social and emotional development (Daly, Nicholls, Aggarwal, & Sander, 2014). Providing these services in schools address social determinants and health disparities, allowing easy accessibility to services for those who are disadvantaged, allowing for better engagement and the fostering of positive mental health from parents and teachers, people who are with these youth the majority of their lives (Daly, Nicholls, Aggarwal, & Sander, 2014).

From a policy perspective, prevention services improve the cost-effectiveness of services and can decrease the funding needed for behavioral health services in adolescence and adulthood. Not providing mental health prevention services early on becomes costly when needing to treat more severe problems later (Institute of Medicine, 2009). While mental health legislation includes prevention services as a focus, unfortunately, the percentage of funding allocation towards prevention is often minimal (Institute of Medicine, 2009; 21st Century Cures Act, 2016). Increased allocation of funds for prevention services could save the behavioral health sector millions of dollars in the long run. More importantly, the increased implementation of prevention services benefits children, adolescents, their families, and society.

With all this research showing the effectiveness of prevention services for children and adolescents, why does it seem like more needs to be done?

There are many reasons for this disconnect, and all are interrelated.

Historical definition of prevention
Prior definitions of prevention related to people without diagnosed disorders focus on reducing new disorder cases (Institute of Medicine, 2009). These past definitions have created narrow ideas of prevention, which resulted in reduced interest in funding for research and practice, partly due to a perception that prevention is less of a priority and that money would be better spent on treating youth with existing disorders.

Historical focus on treatment
Treating behavioral health problems to show immediate reductions in severity, hopefully reducing long-term consequences. Seeing that the problem is “no longer present” gives the effect of “fixing the problem.”

Focus on acute care
With many at-risk populations, acute care has been the typical response. Most provider treatment organizations provide acute care and are not necessarily set up for prevention services.

Stigma and lack of awareness
Mental health care is still surrounded by stigma, though this is improving. More research is needed to show the interconnectedness between prevention services and behavioral health outcomes.

Funding Priorities
There is no specific and targeted funding for prevention specifically for mental health (Institute of Medicine, 2009). Although funding for prevention and treatment research increased over time, funding for prevention was significantly less than for treatment (Institute of Medicine, 2009).

Lack of resources
Compared to treatment services, prevention resources are often limited.

Difficulty Measuring Outcomes
Measuring outcomes for prevention services can be complex, and difficult to prove effectiveness to investors and policymakers.

Measuring results from prevention efforts can take years
Prevention services do not show as immediate results in reducing behavioral challenges as do treatment services. Prevention needs to be seen as a long-term investment, making it difficult for many lawmakers to prioritize it.

Need for a community-level systems approach
To provide prevention services to children, services must be implemented in multiple systems, including public health, healthcare, education, and community provider organizations (Institute of Medicine, 2009). To effectively promote and provide for the services, they must be supported and funded through multiple outlets.

Missing shared information
There is no shared definition of prevention across agencies (Institute of Medicine, 2009). There is a need for a clearer and more consistent description of prevention for people and organizations serving children and adolescents with behavioral health problems.

21st Century Cures Act—The Law of the Land for Children’s Prevention
The 21st Century Cures Act changed the landscape of children’s mental health prevention services. This act worked to increase and accelerate research and funding through the National Institute of Health (NIH) to improve the health of people within the U.S. (21st Century Cures Act, 2016). The act authorized $500 million spread out over nine years towards innovative projects, medicine enhancement, and advanced research toward the behavioral and physical health of people within the U.S. (21st Century Cures Act, 2016). The 21st Century Cures Act has provided funding for increased access to prevention services and has created many new prevention programs to aid in preventing behavioral health problems in youth.

For prevention services for children and adolescents specifically, the 21st Century Cures Act supported:

• The promotion of prevention-based programs for substance abuse and mental health;
• Funding for prevention and early intervention, addressing children and adolescents, addressing social determinants of mental health;
• Integration of prevention and treatment for behavioral health and establishing programs for prevention and treatment;
• Technology-based prevention for mental and substance abuse; digital platforms and access to treatment for those who don’t utilize services;
• Emphasis on early intervention before problems become severe.

Recommendations
Although more is being done to implement prevention services for children and adolescents, the process could be faster. These services should be prioritized when states and local communities make funding decisions. Treatment services are necessary and should not be ignored. However, a thorough cost analysis of how and what services are provided shows the benefit of increased support for prevention services.

To provide for children and adolescents’ mental health and well-being, all while reducing the cost to the country for these services, there needs to be increased awareness about the effectiveness of prevention services. A logical place to focus is in the schools, involving all stakeholders who share in developing mentally healthy children.

Efforts to improve prevention services in the schools should include:

• Providing evidence-based prevention support to schools, ensuring that children and families have sufficient socioemotional support and care.
• Involve youth and families in assisting with research and program decision-making, exhibiting a more inclusive approach to program decision-making.
• Increase the allocation of funding for prevention services.
• Provide better and more consistent behavioral health screening for all children in school.
• Reduce stigma and increase awareness of positive mental health.
• Educate caretakers and children about the need for culturally inclusive approaches to providing prevention services.

Next Morning Zen
Many improvements can be made to prevention services for children. In the next Morning Zen, I will dive deep into a promising prevention program that has shown proven results for children and adolescents. I’ll investigate how communities are finding ways to fund implementation, the cost benefits of this program, and what providers, educators, and family members say about this prevention program and its focus on building healthy coping strategies, reducing the likelihood of behavioral health challenges occurring later in life.

Stay tuned!

References
Daly, B., P., Nicholls, E., Aggarwal, R., & Sander, M. (2014). Promoting social competence and reducing behavior problems in at-risk students: Implementation and efficacy of universal and selective prevention programs in schools. In Weist et al. (Eds.), Handbook of school mental health: Research, training, practice, and policy (2nd ed., pp. 131–144). Springer.

Institute of Medicine. 2009. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press. doi: 10.17226/12480.

Murthy, V. H. 2022. The mental health of minority and marginalized young people: An opportunity for action. Public Health Report, 137(4), 613-616.

21st Century Cures Act. Public Law 114-255. H.R. 34, 114th Congress. 2016.