On May 8, 2014, national policymakers and over 1,000 communities and organizations, including Youth Advocate Programs, Inc. (YAP), will observe National Children’s Mental Health Awareness Day. Awareness Day was developed in 2005 by a partnership of mental health and substance abuse treatment agencies to promote awareness of the importance of recognizing children’s mental health issues.

YAP is among those who believe that this is also a time to focus on in-home and community-based mental health services for children and adolescents in need. Statistics define existing problems and a growing body of research supports the benefits of in-home, community-based care.

It is estimated that at least one in five children and adolescents is affected by a mental health disorder. Sadly, reports also show that as many as four out of five children do not receive the mental health services they need.

Despite growing recognition of the prevalence of mental health difficulties in children and the consequences of leaving these disorders untreated, there persists a shortage of effective mental health services for children in the United States. Oftentimes due to the lack of treatment options, children with mental health needs are removed from their homes and placed into various congregate care facilities – foster and group homes, juvenile detention facilities and residential treatment centers. All too often, parents and communities send their children to residential treatment facilities because there is no alternative available to meet their mental health needs. Children in need of residential care at one time may be forced to stay for longer than necessary due to the lack of services available in their communities upon discharge (National Alliance on Mental Illness: Reinvesting in Community, 2009).

According to the Bazelon Center for Mental Health Law, the number of children placed in residential treatment centers is “growing exponentially.” While exact numbers are unavailable, research indicates that anywhere from 50,000 to upwards of 200,000 children and adolescents are sent to live in these centers each year, often far from their homes and families.

Research has shown that many children do not experience improvement in their conditions while placed out-of-home, and of those who do experience progress, these gains are not sustained upon their return to the home. In a 2002 study, the National Council on Crime and Delinquency found that almost half of children admitted to a residential treatment facility were later readmitted, and up to 75 percent were either reinstitutionalized or arrested.

Likely contributing to this high rate of failure is a lack of family and community involvement in the treatment process. When children are placed outside of their homes, family therapy and involvement in treatment becomes more difficult, and oftentimes impossible, especially for lower-income families who lack the resources to travel to the residential facility for visitation and therapy. As a result, there is little to no change in the family system and children and families are unable to gain new skills and insights to assist them in navigating their environments together upon the child’s discharge from residential care.

Communities also suffer when they rely on residential care for the mental health treatment of their youngest citizens. As noted by the Bazelon Center, children in residential treatment “are unable to draw upon the strengths of their communities and their communities are unable to contribute to the children’s treatment” when placed far from home. The costs of sending children to residential treatment are substantial. For one child, the cost of out-of-home placement can be more than $250,000 per year – much higher than the cost of an array of home and community based services that could be provided to the child and family. Each year, nearly a quarter of the nation’s expenditures for mental health services are allocated to residential treatment. Communities would be better served by reallocating these dollars to increase the range of home and community based therapeutic and support services available to assist children and families in need, thus reducing the need for residential services.

Numerous studies demonstrate the positive outcomes achieved through the provision of home and community based services. Youth involved in these services show significant improvements in their behavior, mental and emotional health, and overall functioning. School attendance and academic performance improves and children are less likely to be suspended or expelled. Recipients of home and community based services experience greater stability and permanency in their housing placements, as well as reduced levels of depression, anxiety, and suicidal ideation and attempts. Rates of delinquency, arrests, and involvement in the juvenile justice system are reduced.

For close to 40 years, YAP has provided communities with effective home and community based alternatives to residential and out-of-home placements. In 1996, YAP’s Behavioral Health Services specifically began to address the mental health needs of the children and adolescents we serve. In keeping with YAP’s Core Principles, our behavioral health programming provides individualized, family-driven, strengths-based interventions, delivered in clients’ homes and communities. Our “no eject, no reject” policy means no youth or family will be refused services because of their needs or history, and no family will be ejected from services because of challenges or difficulties. In fact, YAP provides specialized programming for populations that historically face the greatest lack of services alternatives – children with developmental, intellectual, and autism spectrum disorders, child welfare and juvenile justice involved youth, and youth who have experienced trauma.

In 2013, YAP launched the Safely Home Campaign, a nationwide movement to safely care for all youth and young adults in their home communities and with their families by reducing and preventing unnecessary out-of-home placements and creating safer, more supportive communities for at-risk young people. Increasing the range of prevention, early intervention, and treatment options and availability for children and adolescents with mental health needs is a crucial part of this mission.

Mental health treatment and community based services work for children and adolescents, even those with the most serious needs, and their families and communities. Join YAP and the Safely Home Campaign in raising awareness of the importance of improving children’s mental health and access to home and community based services, not just on National Children’s Mental Health Day, but every day. Our children deserve no less.