Maile Bay, Psy.D, is a 2009 graduate of the PsyD Program in Clinical Psychology at Antioch University, Seattle.

Dissertation Committee

Lang Tien, Psy.D., Committee Chair

Margaret Heldring, Ph.D., Committee Member

Molly Reid, Ph.D., Committee Member


Mental health, policy, children, families, adolescents, Washington State, United States, child welfare, cultural competency, evidence-based practice, foster care, juvenile justice

Document Type


Publication Date



Due to continued fragmentation and gaps in mental health services and the increase in the prevalence of mental health problems for children, youth, and their families, these populations remain underserved. In 2003, the federal New Freedom Commission (Commission) responded by publishing policies to address these concerns. As directed in 2005, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded planning incentive grants to states to transform their delivery of care.

The study reviewed the federal policy, specifically the recommendations of the Commission’s Subcommittee on Children and Families, and Washington State’s policy and implementation actions of its five-year SAMHSA incentive grant. The method included searching, reviewing, and analyzing the literature on the topic published since
approximately 2002. The analysis distilled the recommended determinants in children’s mental health care transformation: prevention, early intervention, and screening in child welfare (juvenile justice and foster care) strategies; evidence-based practices; geographic disparities; workforce barriers; cultural competence aspirations; and consumer, schoolbased mental health, and primary care providers’ role expectations.

Despite innumerable studies, policies and services remain fragmented with gaps. The following topics from the outcome data require continuing attention: increasing the 2 cultural competency of professional services that are efficacious, and designing and promulgating measures for evidence-based practice specific to children.

Three themes emerged regarding how to serve children’s mental health needs in Washington State in a more efficacious manner. Within the penumbras of cultural competency and outcome-based measures, constructs for evidence-based practice for children need to be age-developmentally appropriate. Simultaneously, both the family

role and venues of service delivery need to be considered, e.g., schools, out-of-home placement, and clinics. Access to mental health care through schools and primary care providers needs to be collaborative with behavioral health professionals. School policy needs to link students’ attendance and achievement with their physical and behavioral health. Training for the mental health workforce requires increased cultural competency. Rural mental health care requires incentives to train and retain a workforce reflective of the demographics, particularly in the areas populated by persons of color. Also, the number of prescribers needs to increase through certification of nurse practitioners and psychologists.


Maile Bay, Psy.D., 2009