Even before COVID-19, children and youth across the country were experiencing emotional distress at unprecedented levels. The past decade has witnessed sharp increases in rates of suicide, suicidal ideation, and self-injury; increases in the number of mental health hospitalizations; and increases in the rate of youth self-reported mental health needs. Yet, due to a fragmented system that fails to acknowledge root and pervasive causes of harm, only one-third of youth who report needing behavioral health support receive it, and far fewer get what they need to heal.

In 2018, ZFF seeded funding for the California Children’s Trust (CCT) to re-imagine California’s approach to children’s behavioral health through a Framework for Solutions centered on equity and justice. CCT envisions an integrated and equitable approach to promote child well-being rather than the current diagnostic-driven response to pathology.  Toward this end, CCT leads and participates in critical conversations to raise awareness and advance policy solutions that address the persistent and pernicious effects of racism and toxic stress on the mental health of California’s children, and that have the potential to generate significant new federal revenue.  This envisioned future requires the following:

• Acknowledging the shortcomings of the medical model and the impact of structural racism and poverty on the social and emotional health of children
• Systems that honor the wisdom, strength, and resilience of low-income families
• Changes in public and private insurance that remove diagnosis as a prerequisite for care
• A dramatic expansion of investment in social models, peer to peer supports, and recovery supports
• Reforms to ensure that schools are centers of healing for children and youth
• An overhaul of California’s troubled behavioral health financing and administrative practices
• Advocacy efforts to keep the promise of the EPSDT entitlement and the Mental Health Parity and Addiction Equity Act

In just two short years, CCT has become a leading voice and resource for policymakers, advocates and funders across every child-serving system.  Examples of their work and impact include:

• Partnered with a leading children’s health care provider and one of the state’s largest managed care plans to demonstrate the clinical benefit of covering the cost of dyadic mental health care for mothers and babies, resulting in state policy change to remove medical diagnosis as a prerequisite to receive family therapy, and to integrate social determinants of health as qualifying criteria
• Joined others to successfully advocate for legislation that provides for the certification and training of peer support specialists that can bill Medi-Cal
• Working with state and county education leaders to advocate for healing-centered schools by claiming Medi-Cal dollars through local partnerships to support students’ social and emotional well-being as described in this “Practical Guide for Financing Social, Emotional and Mental Health in Schools,” developed in partnership with Breaking Barriers

In sum, CCT recognizes that to truly address the children’s mental health crisis, we need a reimagined system. While more clinicians are essential, they are woefully insufficient to address the root causes of toxic stress, trauma and emotional suffering, which are inextricably linked to historic and persistent economic and racial inequities.  CCT and its coalition partners are pushing hard to access the funds promised to children through EPSDT (Medicaid) to support a transformed system that promotes healthy development instead of simply responding to pathology. In the meantime, as CCT’s principal Alex Briscoe notes, “We must gratefully accept and acknowledge critical incremental change… while we impatiently and persistently await the revolution.”

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