Download Briefing Report

The purpose of this brief is to summarize key points from the presentation by Professor Leslie Leve, Lorry Lokey Chair in Education and Department Head, Counseling Psychology and Human Services, at the University of Oregon. Dr. Leve’s presentation was the second of three at the 2023 Oregon Family Impact Seminars. Information about the approach taken in Family Impact Seminars model can be found online HERE. We focus on nonpartisan, solution-oriented dialogue, with a focus on the impact of policies on families.

The topic of the 2023 Oregon Family Impact Seminar was Youth and Family Mental Health. The state of youth and family mental health in the US is concerning, especially for those living in Oregon. The state ranks 50 in the US for the highest prevalence of mental illness and has the lowest rates of access to care (Reinert et al., 2021). Oregon has 800,000 youth under the age of 18 and 21% of youth between the ages of 12 and 17 report having a mental illness (Hayden, 2023). Policy and practices that support positive youth development are essential for building mental health (Kendall-Taylor & Fuligni, 2022). Dr. Leve’s presentation addresses three areas of research including (1) National Mental Health Models that Work, (2) Substance Use in Youth, (3) Workforce Development and policies relevant to addressing the mental health crisis in Oregon.

NATIONAL MENTAL HEALTH MODELS THAT WORK

Effective mental health models recognize the complex interplay of ecological contexts, such as school, work, and family, that influence youth and family mental health. The operating assumption is that risk factors, such as economic and social stress and parental substance abuse, negatively impact the family as a whole and, in turn, adolescents, and conversely, protective factors, such as positive parenting and social support, can promote adolescent mental health. Adolescence is a time when effective, research-based interventions can have a particular impact. Below are two examples of national mental health models that work.

The Family Check-up Model

The Family Check-up Model (FCU) is a primary prevention model developed at the University of Oregon with the goals of detecting problems early and providing family-based supports to prevent mental health problems. The FCU is a strengths-based model that rests on four key principles (1) Accessibility, (2) Motivational Processes to Support Change & Empower Parents, (3) Trauma-Informed, and (4) Collaborative & Culturally Responsive (Family Check-up, n.d.). The effectiveness of this program is far reaching and includes benefits across multiple levels and over time such as direct youth outcomes, long-term improvements, and lifetime advances. Examples of direct youth outcomes include improvements in school readiness (Lunkenheimer et al., 2008), attendance (Stormshak et al., 2009), academic achievement (Brennan et al., 2013), and emotional adjustment (Hentges et al., 2020), as well as decreases in ADHD symptoms (Chang et al., 2014). Long-term improvements are evident in decreases in depression and suicide risk as well as increases in peer relationships (Chang et al., 2017; Connell et al., 2019; Fosco et al., 2016). Lastly, lifetime benefits of the FCU are healthy adult outcomes such as decreases in arrest rates, high-risk behaviors, and adult alcohol abuse (Family Check-up, n.d.).

Policy Implications

Evidence-based Models

• Invest in programs and practices shown to prevent youth mental illness, especially those that center the family and use strength-based approaches to address youth mental health.
• Promote and expand programs which center the family unit as a primary source of supporting and fostering positive youth development and mental health outcomes.
• Invest in programs and facilities for youth and families with complex mental health problems.

Youth Substance Use

• Increase qualified treatment providers (for parents and youth).
• Expand parent education resources to teach about potential risk factors, having difficult conversations with your teen, and strategies for nurturing positive parent-child relationships.
• Reduce the routine prescription of opioids for medical procedures.

Workforce Development

• Promote professional pathways that reduce barriers to joining the behavioral health field.
• Ensure trainings, professional development, and career pathways are equitable by ensuring individuals who are underrepresented in mental health professions have access and opportunities.
• Provide compensation for mental health professionals that is commensurate with their skills and training.

KEEP: Prevention Programs for Youth and Families with Known Risk Factors

KEEP is a trauma-informed model that promotes positive attachments for foster and kinship parents in the Child Welfare System (Oregon Social Learning Center, 2024). The pilot site started in 2017 in the Portland metro area, and after receiving legislative funding in 2019, KEEP scaled-up and was offered statewide (Oregon Social Learning Center, 2024b). Through both online and in-person settings, KEEP is a support group which focuses on skills parents can use to provide safety and predictability along with support and encouragement for the kids and teens in their homes. There are a multitude of positive outcomes associated with KEEP. For children and adolescents, examples include lower rates of emotional and behavioral challenges such as health-risking sexual behavior, more frequent reunification with family, and less substance use (Oregon Social Learning Center, 2024b). The outcomes for foster and kinship parents include higher rates of positive parenting and lower rates of harsh discipline and turnover. Lastly, KEEP outcomes for the Child Welfare System/Workforce include longer tenure for foster and kinship parents providing care and fewer days in care (Oregon Social Learning Center, 2024b).

YOUTH SUBSTANCE USE

Mental health and substance use are connected problems for youth and families. Oregon’s substance use statistics are rather concerning but provide insights into areas for improvement. Oregon ranks in the top 5 states for percentage of the population with an illicit drug use disorder in the last year, needing but not receiving treatment for substance use disorder, deaths due to drug use, substance use disorder in the past year, and alcohol use disorder in the past year (Lenahan et al., 2023). Results suggest youth are generally doing well across the three substance use areas, but then fall off between the ages of 18 and 25 (see table 1; Lenahan et al., 2023 pp. 14-15). Therefore, prevention efforts should consider the continuation of services and/or teaching youth about how to access services for young adults’ substance use.

Three Pillars of Prevention for Youth Substance Use

There are three pillars of prevention for youth substance use which include identify the risks, prevent through knowledge, and discuss.

1. Identify

The first step to preventing youth substance use is being aware of potential risks. Risk factors may include substance use, thrill-seeking behaviors, medications in the home, and friend groups. It is important to note the presence of risk factors does not mean youth will engage in heavy substance use and/or be at risk for overdose.

2. Prevent through Knowledge

Knowledge of youth’s behaviors and activities can provide important information to prevent substance use. Information can be gathered by the five “W’s”: Who is your child with? What activity are they doing? Where are they? When is curfew? Communicate why their well-being is important.

3. Discuss

Talk with youth about drugs and alcohol. Studies from the Substance Abuse and Mental Health Services Administration show that communication decreases experimentation by 400%, yet only 30% of parents discuss drugs and alcohol with their kids.

WORKFORCE DEVELOPMENT

The final area related to youth and family mental health is workforce development. Bolstering the mental health workforce ensures youth and families receive the support and services they need to thrive. There are at least two major efforts being implemented in Oregon to promote workforce development.

1. One is a new professional pathway created by The Ballmer Institute called a Child Behavioral Health Specialist (The Ballmer Institute for Children’s Behavioral Health, n.d.). Providing this training at the undergraduate level seeks to reduce barriers of entering the behavioral health field and creates a pathway for students who are traditionally under-represented in mental health professions.
2. A second effort is a Child Behavioral Health Undergraduate Program which was formally approved by Higher Education Coordinating Commission (HECC) in December 2022, and transfer pathways for Fall 2024 have been established for Lane, Mount Hood, and Portland Community Colleges (Bushnell University, 2023).