Children's Mental Health Matters (CMHM)

Dr. Gordon Hodas and Dr. John Biever, consulting child psychiatrists for the Children’s Bureau, each write a monthly column on Children’s Mental Health Matters (CMHM), addressing contemporary issues in children’s mental health and wellness. Dr. Hodas most recent column addressed how human service professionals can validate their work with youth using the principles of trauma-informed care. Dr. Biever is in the middle of a series on the importance of empathy in developing meaningful relationships between parents and young children. These articles along with the complete series of articles are available at (Resources/Children’s Mental Health Matters). In addition, each month the children’s bureau publishes a brief reader-friendly discussion of a topic related to the healthy social and emotional development of young children. The most recent factsheet is on how to take advantage of the natural ability of young children (Early Childhood Mental Health-ECMH) to imitate their parents and caregivers:  FOCUS on ECMH factsheets (currently 66 different ones).

November 10, 2014
Recent editions of the Children’s Mental Health Matters columns—written by Dr. Gordon Hodas and Dr. John Biever, consulting child psychiatrists for the Children’s Bureau—feature the progress Pennsylvania has made in children behavioral health services and the importance of developing empathy in young children. In his October column (see below), Dr. Hodas lists seven reasons why children’s behavioral health services are succeeding. In his column, Dr. Biever completes his series on “Empathy: The Magical Pathway to Joyful Relationships,” and suggests three principles for interacting with children in an “empathy-building way.” These articles along with the complete series of articles are available at (Resources/Children’s Mental Health Matters).

Children’s Mental Health Matters is a monthly column to support children, adolescents and their families from the Office of Mental Health Services, Bureau of Children’s Behavioral Health Services. It is available online at and can be printed and distributed as desired.


Number 28, October 2014 

Children’s Mental Health and Human Services in Pennsylvania Are Succeeding: Here’s Why  

By Gordon R. Hodas, M.D.


Sometimes a look back can help us appreciate how far we’ve come and guide our movement forward. While the service systems for youth in Pennsylvania are not perfect, our collective efforts have made and will continue to make a positive difference. A look at the landscape from 30 years ago can help us understand why we are succeeding, and how we can continue to succeed. In the discussion below, we consider some of the key changes that have taken place over that time, and how we can sustain this progress.

What Has Changed?

Today We Accept the Challenge

In 1982, there was no system of care for children and adolescents and their families. Each child-serving system functioned on its own, even though these systems often served the same youth. In addition, the needs of youth with the greatest challenges – e.g., those presenting with many behaviors of concern, involved in multiple systems, and at risk of institutional placements – were overlooked or ignored. This led Jane Knitzer to write her now historic book, Unclaimed Children (1982), challenging states and communities to “step up” and meet their responsibilities. This book, along with subsequent seed money to states by the National Institute of Mental Health in the mid-1980s, helped give rise to what is now the children’s system of care movement, which includes mental health and other child-serving systems.

Today We Work With Youth and Families

The prevailing human services ideology thirty years ago tended to blame families for the challenges their children faced, rather than recognize families as essential partners in treatment and care. Mothers were often blamed for their child’s mental illness and challenging behaviors. Therapists and other human service professionals viewed themselves as experts with “the answers,” rather than as partners with families, whose strengths and lived experience can help guide treatment and promote healing.

Today We Try to Engage Youth and Families

Thirty years ago, it was assumed that truly motivated youth and families would pursue mental health treatment and attend regularly with little assistance. Those who failed to do so were regarded as being “resistant.” Today we recognize how mental health stigma inhibits help-seeking, as do services that are not culturally appropriate. As a result, we now recognize the courage of those who seek mental health services. We understand the need to be welcoming, strengths-based, and hopeful. Since “one-size-does-not fit all,” we try to individualize services consistent with the strengths, needs, and culture of the youth and family.

Today We Try to Collaborate With Our System Partners

Thirty years ago, we had “silos,” and each service system did its own thing. Although “silos” have not disappeared entirely, most human service professionals today recognize that multi-system collaboration promotes teamwork, engagement, and positive outcomes. Consensus-building addresses challenges far better than mutual blaming.

Today We Recognize the Significance of Natural Supports and Peer Support

Unlike in the past, we now understand that formal services, important as they are, are best complemented by the use of natural supports–involving extended family, friends, faith-based organizations, and other community resources. We also understand how peer support, when available adds a new dimension to mental health treatment, supporting families while also promoting greater trust of involved professionals.

Today We Understand the Need to be Trauma Informed 

Today we better understand that the quality of youth and family relationships with professionals is as important as the specific services offered. Without positive relationships, even the most evidence-based interventions lose their effectiveness. Both service systems and the professionals within them need to be trauma informed, promoting safety, trustworthiness, choice, collaboration, and empowerment (Fallot and Harris, 2009).

Today the Pennsylvania System of Care Partnership Exists

The Pennsylvania System of Care Partnership, supported by two federal grants, provides the opportunity at both the state and county levels to empower “youth leaders, family leaders, and system leaders together in equal partnership to integrate child-serving systems,” so that “every youth and family in Pennsylvania will be able to access and navigate a unified network of effective services and supports that are structured in adherence to System of Care Values and Principles” (2014). Counties that join the Partnership are assisted in building the necessary infrastructure, and can address the needs of identified youth ages 8-18 years old with complex behavioral health challenges who are involved with child welfare or juvenile justice and also in or at risk of out-of-home placement.

Where Do We Go from Here?

The key to moving forward involves continuing to build effective systems of care within Pennsylvania. My involvement in the Systems of Care Committee of the American Academy of Child and Adolescent Psychiatry has enabled me to see how states and communities benefit from systems of care. Thirty years in the making, the systems of care approach is neither trivial nor transient. The Pennsylvania System of Care Partnership needs to continue to grow. The work is difficult, but the rewards are greater.


Fallot, R. & Harris, M. (2009). Creating cultures of trauma-informed care (CCTIC): A self-assessment and planning protocol. University of Iowa: Community Connections.

Knitzer, J. (1982). Unclaimed Children: The Failure of Public Responsibility toChildren and Adolescents in Need of Mental Health Services. Washington, DC: Children’s Defense Fund.

PA System of Care Partnership.(2014). Children’s Mental Health Matters is a monthly column to support children, adolescents and their families from the Office of Mental Health Services, Bureau of Children’s Behavioral Health Services. It is available online at and can be printed and distributed as desired.  

Gordon R. Hodas, M.D. is a child psychiatrist consultant for the Pennsylvania Office of Mental Health and Substance Abuse Services.