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Rethinking Our Approach to Youth Mental Health Care

Dr. J. Stuart Ablon

We are in the midst of a youth mental health crisis, the likes of which we have not seen in the last half-century or more, and the ripple effects may be felt for generations. The lasting impact of the chronic stress and trauma of the pandemic has exacerbated what were already dangerously high levels of mental health challenges in kids.

As we know, necessity often breeds innovation. During the pandemic, our reliance on videoconference technology to connect with each other facilitated easier access to remote treatment. This helped lower the barriers to accessing mental health care for many youth and families. However, sadly, no matter how many more psychologists, psychiatrists, and social workers we train and how easy we make it to see them, it is clear that there is no way that we can possibly meet the overwhelming needs of our youth using traditional models of mental health care delivery. We have to think outside the box.
It is clear there is no way that we can possibly meet the overwhelming needs of our youth using traditional models of #MentalHealth care delivery. We have to think outside the box.… Click To Tweet

Is there good news? Yes. As neuroscientists help the mental health community continue learning more about the brain, we realize that the traditional way mental health care was delivered left a lot to be desired anyway. Primarily because it often violated some basic principles of how we change the brain, a.k.a. “neuroplasticity.” First, we know that new connections in the brain are made by repeating many small doses of what neuro-biologists call “good stress.” To change someone’s brain successfully, those small doses of stress would ideally occur many times throughout the day rather than, for example, once a week from 4:00 – 4:50 pm in the therapist’s office! For example, whether you are trying to learn to play tennis or the violin, your skills would advance more by practicing for 20 minutes a day rather than one hour once a week.

Secondly, skills learned in one situation, like a therapist’s office, often don’t transfer or generalize to other situations. These skills often don’t transfer because of the “specificity principle” of neuroplasticity. The specificity principle suggests that to create a new connection in the brain, you need to activate that specific connection or pathway. Artificially created situations do not trigger the same connections or pathways. This is the reason so many of us look great practicing things when no one is watching but then struggle to have that same success when the pressure is on. If you want to get better at hitting a golf ball under pressure, you can’t just practice hitting golf balls. You have to practice hitting golf balls under pressure!

Now that the mental health community has recognized the extensive demands on and limitations of traditional mental health care delivery, many attempts are being made to think outside the box with innovative uses of digital tools to reach youth struggling with their mental health. While digital tools can be helpful for milder symptoms and in short-term ways, many of these digital tools still fly in the face of perhaps the most important principle of neuroplasticity: our brains develop best in rich relationship-based situations, which is hard to recreate in the digital world.

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So, what does this all mean? Youth mental health care needs to be delivered by people who already spend lots of time with them in their everyday lives. We need caring people who can provide enough small doses of “good stress” through existing relationships in the real-life situations facing our youth. Who are these people who can help address this youth mental health crisis? Parents and teachers!

Our work at Think:Kids is focused on helping youth with social, emotional, and behavioral challenges by teaching the adults in their lives an evidence-based approach called Collaborative Problem Solving. Behavior challenges rarely occur in isolation. Instead, problematic behaviors like defiance and aggression often happen alongside other issues. They are often the first sign that something is wrong. Behavioral challenges reflect underlying skills deficits across various diagnoses, including mood, anxiety, and autism spectrum disorders, not just disruptive behavior disorders like ADHD.

Through our work, we have shown that parents, teachers, and other adult caretakers can learn and practice an evidence-based approach to mental health care that can be used in everyday life. Our research has proven that when adults practice Collaborative Problem Solving with kids across a wide range of diagnoses, their specific symptoms lessen. In fact, how they are doing overall improves—not just behavioral difficulties. How does it work? The Collaborative Problem Solving approach builds and strengthens relationships, decreases conflict and stress, and builds neurocognitive skills, which improves mental health functioning broadly.

There is no one or simple solution to the current youth mental health crisis. But the answer cannot be simply training more clinicians or solely relying on digital tools. We must rethink the very methods by which we deliver mental health care. Teaching evidence-based approaches to parents and teachers is a powerful way to help address our kids’ mental health needs.


Pollastri, AR, Wang L Eddy, CJ, Ablon, JS. An Open trial of Collaborative Problem Solving in a naturalistic outpatient settingClinical Child Psychology & Psychiatry, 00, 2022, 1-13.

A version of this article originally appeared on Psychology Today.

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