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Introduction

A problem that runs throughout the areas of training and services is the divide between the rich and the poor. It is evident that the attraction of private practice is drawing child psychiatrists into private practice, where the financial rewards are greater. This leaves the public sector with a shortage of needed personnel.

Further, there is a definite movement of trained child psychiatrists out of the LAC countries because of economic concerns or quality of life issues. Efforts need to be made to reverse these trends. On the services side, as long as better-off families can obtain the care they need outside the public sector, there will be a diminished incentive to establish meaningful public systems of care that can be accessed by all persons. Given the challenges of providing care and mobilizing both financial and professional resources, efforts must be made to increase the awareness of and potential for preventive interventions.

However, traditionally in the LAC countries the family has played a major role in society, so no prevention program has a chance of success without fully involving families in the process.

Improving child mental health services and training depends on profound and large-scale socioeconomic and political changes in the LAC nations. However, waiting for these changes may not be the most realistic strategy Four suggested general guidelines for the future of training and services are given in the following paragraphs. First, programs addressing infant mental health that promote community mobilization and that improve social networks are needed.

Simple, integrative, inexpensive interventions should be emphasized. Regular home visits by a trained nurse from the prenatal period until a child is 2 to 3 years old could concomitantly address both general and mental health issues with the family Second, child mental health providers who are not specialists should be trained in less complex interventions such as using medication for uncomplicated ADHD cases, brief cognitive-behavioral interventions for mild cases of anxiety or depressive disorders, and parental management of problems of parent-infant interaction and developmental problems of adolescents.

Third, child mental health services should be supported for special populations such as indigenous groups, children of refugees, street children, pregnant adolescents, and abandoned or victimized children. Fourth, there is an urgent need to encourage child mental health professionals to work collaboratively with schools, with primary care providers, and with persons in sectors other than health care in delivering integrated systems of care. Programs in these settings should aim to: 1 educate teachers and pediatricians to recognize and manage the most prevalent child psychiatric problems; 2 implement basic crisis management techniques to deal with simple family problems; 3 develop school and community programs where children and their parents can discuss issues related to self-esteem and quality of life; 4 provide care for the care-givers, with support groups for professionals; and 5 teach professionals when and how to refer the most severe cases.

Finally, for more developed countries, such intervention programs should be frequently assessed for cost-effectiveness 21, While more traditional child psychiatry research is in evidence in academic settings in the LAC nations, the Pan American Health Organization PAHO has taken a special interest in identifying and supporting research that is relevant to policy concerns. Representative projects from Brazil, Chile, Colombia, Costa Rica, and Jamaica have been identified, and the projects are now being refined to incorporate common process and outcome measures.

The common research components are dependent on securing funding, which may come from various sources. The ultimate research goals are to: 1 identify principles that should guide the development of child mental health policy in the LAC nations and 2 initiate a discussion about country-specific principles, goals, and strategies related to the formulation and implementation of child mental health policy.

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Module 6: Barriers to Mental Health Care

The five projects are described in the following subsections. Child health rights in Brazil. Enacted in , the Brazilian Child and Adolescent Rights Act goes beyond a declaration of child rights and actually mandates the means to facilitate the implementation of these rights. The Act states that every Brazilian municipality should have a child rights council and a child guardianship council GC. Targeting a population at high risk for multiple negative outcomes with a community-based strategy could be an effective way of helping children who usually do not have access to health care, education, proper nutrition, or a safe place to live.

The research will evaluate the impact on child health in general and on mental health in particular that has come from implementing the GCs. The research will describe how much the health-related actions of the GCs vary by child age, gender, socioeconomic status, and location; examine changes in objective health indicators associated with the GCs; and study the interface that GCs have with different segments of the health care sector, as well as with children involved with other sectors that also provide care. Community empowerment for child health and development in Jamaica.

Impairment of optimal development in the early childhood years, and its impact on school failure in the primary and secondary years, occurs in many countries, but it is particularly prevalent in developing countries.

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There is relatively little information available about the factors contributing to impaired development in children from developing countries. The Jamaican research and intervention programs are expected to include community child development education and parenting seminars; child health and development screening and education programs at health centers; development of a parent-held, culturally relevant child development record; in-service training for day-care and primary-school teachers; and provision of appropriate educational materials on child development at day-care and primary schools.

A depression treatment model to protect children and strengthen the family in Costa Rica. When parents suffer from depression, the illness affects not only them but all areas of family functioning. Any treatment approach for depressed parents should take into consideration the known risk factors for depression, and it should have a preventive component. A family-based strategy seems particularly suitable to accomplishing such tasks. This project in Costa Rica will test the validity of a depression treatment model that has been proven elsewhere.

The model is intended to prevent parents' depression from having consequences for their children. The project will train local health workers in the use of this model. In turn, these clinicians will train more local health professionals in order to propagate and extend the coverage of the intervention for depressed parents and their families. Another goal of the project will be to start a preventive mental health intervention program among the mental health systems in Costa Rica.

An evidence-based developmental health service in Chile. Research has shown that an integrated health intervention that transforms a child's life experience improves the child development outcomes, thus pointing to the need for health care systems that are designed to improve developmental health.

The purpose of this research in a middle-income area of Chile is to add to the knowledge about child development, and to contribute to policy-making on child development through scientific evidence on health care. Mental health promotion to build better citizens in Colombia. While the current initiative has not met with the expected success, community leaders and academicians are convinced that an intervention could prevent violence.

A decision has been made to develop two things: 1 a program beginning to work on child growth and development when children are younger and 2 a healthy schools initiative. The intervention will apply the social ecology concept developed by Earls and colleagues 23 , coupled with the life course health development concept utilized for many years by WHO. With adequate political will the vision for child mental health services, training, and research in the LAC countries can be expanded, drawing on the experiences in other regions of the world that have faced or are now facing similar challenges.

The next three paragraphs describe three specific actions that we believe are both feasible and in the best interests of developing a long-term strategy for child and adolescent mental health in the LAC nations.

One step would be to initiate a yearly research training seminar that would help to develop a cadre of young LAC researchers and establish key mentoring relationships. Another possible action would be to establish an LAC child and adolescent mental health training committee. This could be done under the auspices of one of the LAC child and adolescent mental health professional organizations, or it could be established ad hoc by PAHO.

Such a group could carry out a systematic study of existing training programs, coordinate them, and identify extrabudgetary resources for additional training programs. One model for establishing more uniform standards is the European Union of Medical Specialists, which provides training guidelines and accreditation for specialists.

Child and adolescent mental health policy worldwide: an update - Europe PMC Article - Europe PMC

Another measure that we recommend would be to establish an LAC mechanism for the dissemination of model programs. The LAC countries have no lack of interesting, innovative, and meaningful programs, but there is no consistent mechanism for program dissemination. With the downturn in the LAC economies, using professional meetings is no longer an effective mechanism for broad dissemination. These meetings also often fail to involve important stakeholders from the education, health, and political spheres.

One possibility would be to establish an LAC journal on child and adolescent mental health.

This might be done in collaboration with the Journal of the American Academy of Child and Adolescent Psychiatry or as a collaborative effort by LAC academic institutions. The LAC countries have long been concerned about child and adolescent health, including mental health. LAC professionals are active in professional organizations and scientific inquiry around the world. Coupled with vigorous political will based on the framework of the UNCRC, this concern and professional expertise could usher in a new era of progressive development in child and adolescent mental health in the LAC nations.

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