One of San Diego County’s behavioral health centers. (photo courtesy of the county)
Eighteen months ago, the San Diego County Board of Supervisors took a big step forward for children and youth in the region.
In an effort to confront mental health challenges in the early years, the board directed county Behavioral Health Services to put together a plan with a wonky, but important title. It was dubbed the Children, Youth, and Transition Age Youth Behavioral Health Continuum Framework for San Diego County.
As an advocate for San Diego’s children, I was thrilled that help was on its way for kids of all ages.
Except, when I called in to comment on the framework at last week’s Board of Supervisors’ meeting, “children” had disappeared from the plan. It was now simply the Youth Optimal Care Pathways model.
Words matter here. Because they reflect choices. Choices about who gets served, as well as about how we strategize to build a truly “optimal” pathway for care.
Because a truly optimal pathway would include a plan for tending to our youngest San Diegans. It would acknowledge that the roots of adolescent mental health crises can begin in early childhood. And it would account for the fact that the most cost-effective and humane intervention point is during the 0-5 period, not after symptoms have escalated.
In the work I do as director of San Diego for Every Child, a nonprofit focused on alleviating child poverty, and co-lead of Children First Collective, a local child care advocacy coalition, we hear from parents and child care providers how difficult it is to get help for a young child facing a mental or behavioral health issue, let alone a crisis.
Because of the workforce shortage and specialized training needed, the wait list can be months long.
That’s a huge percentage of a young child’s life, and waiting can disrupt everything from their healthy development and a teacher’s capacity to manage a whole classroom, to a parent’s ability to go to work.
In 2024, we were part of the group that pushed for the county to create this plan. We did so knowing that services for young children would be on the chopping block in multiple ways in the coming years because of declining state revenue in the tobacco tax that supports First 5 San Diego, the singular county entity expressly focused on children under 5, and a reduction of family supports and mental health prevention dollars because of Proposition 1.
I fully support the county’s investment in San Diego’s youth mental health. In the wake of COVID and with substantial concerns around social media, substance use and more, we know youth are struggling.
But the ask from here is pretty clear-cut: let’s not forget about San Diego’s youngest population when we’re talking about mental and behavioral health.
Their diagnosis, needs, and treatment look vastly different than an adult or even a young person’s in many cases.
Children aged 0-5 require what is called dyadic care. It means integrating the many caring adults in a child’s life and focusing on relational health and well-being that stems from safe, stable and nurturing relationships.
Parent and caregiver understanding and ability to respond effectively is foundational for both the diagnosis and treatment of a young child. It’s not just something nice to have, it is critical to that child’s success.
In fact, focusing on prevention and early intervention can help address any diagnoses or issues before they worsen. And the first step to doing that is to build them into plans like this — capturing which services are being offered for them and where the gaps are.
There are great efforts underway, such as the Strategic Behavioral Health Initiative, in which practitioners and advocates for young children’s mental and behavioral health are already convening.
Let’s see the county’s Behavioral Health Services continue to collaborate with partners in existing spaces like that in a meaningful way, so we don’t reinvent the wheel; that way, we’ll all be able to better understand the field’s specificities, deficits and strengths.
We know that families are navigating a lot right now; the cost of housing, child care, groceries and more is debilitating. Let’s do what we can to ensure that those who also have a little one struggling with a mental or behavioral health issue get the support they need and deserve.
Erin Hogeboom is director of San Diego for Every Child, a nonprofit focused on alleviating child poverty, and co-leader of Children First Collective, a local child care advocacy coalition.
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