Commentary: Addressing the Gap Between Science and Practice in Children's Mental Health

Abstract

In the mid 1700s, a British naval surgeon discovered the cure for scurvy, which would often so decimate the crews of sailing vessels that they would have to terminate their voyages and return to port in order to re-outfit their ships in human resources. In spite of the severe human and economic consequences of scurvy, the simple dietary solution for it was not fully implemented across the British naval fleet and merchant vessels for another hundred years (Valente & Rogers, 1995). These events serve to illustrate the natural barriers that support resistance to the adoption of even the simplest and most powerful of innovations. The gap between science and practice appears to be a chasm that exists in many fields, but nowhere is it greater than in the field of children's mental health. In the past several decades, great progress has been made in the understanding and treatment of children's mental health, but the broad adoption and implementation of evidence-based interventions (i.e., the practice) continues to lag far behind the research (i.e., the science) that accounts for these advances. However, there are emerging signs of hope that this gap may be closing to some degree. In the last several years, many important developments have occurred in the mental health field that may positively affect the welfare of at-risk children who are vulnerable to negative, destructive outcomes. For example, during the decade of the 1990s, there were numerous calls to reprioritize children's mental health needs and to examine critically generic strategies and methods by which this important goal might be achieved. The U.S. Surgeon General's Report on Children's Mental Health (U.S. Department of Health and Human Services, 1999) resulted from a national forum in which critical issues, priorities, and needed actions were addressed by professionals, advocates, and consumers. A series of important legislative and policy directions designed to (a) improve children's mental health services and (b) refocus much stronger governmental action on early identification and intervention for children's mental health problems were incorporated into the report. Secondly, Peter Jensen, M.D., former chief of the NIMH child psychopathology branch, founded the center for Children's Mental Health at columbia and also established The Report on Emotional and Behavioral Disorders of Youth, an influential volume for mental health professionals dedicated to the promulgation and adoption of evidence-based practices in children's mental health. As editor of the report, Jensen has identified and explicated criteria for judging evidence-based intervention approaches (see Jensen, 2001). Finally, a seminal volume by Burns and Hoagwood (2002) has been published that describes the complex landscape of the community-based treatment of children experiencing severe emotional and behavioral problems. These authors provided a thorough and insightful analysis of the conditions, barriers, obstacles, and opportunities that mediate the design, delivery, and evaluation of effective interventions for high-risk children and their families within natural community settings. Burns and Hoagwood call for the development of a public health science that subsumes the related sciences of implementation and dissemination, and that will assist in finding the means to position evidence-based practices and services within community settings, sustain and support them over time, and identify the barriers that impede such positioning. Further, these authors urge examination of features of the practice environment that influence the clinician/client relationship and that have an effect on why some professionals are motiva ted to change and adopt new, proven strategies whereas others are not. They call for a new model of applied, real world research and practice that supports studies of the efficacy of new treatments within the contexts of the practice settings where the service is ultimately placed. …