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Children's Voice Article, November/December 2003

Executive Directions

by Shay Bilchik

In a field boiling over with issues that are difficult to discuss-from neglect and abuse to drug and alcohol addiction and heart-wrenching stories of children separated from their parents--the subject of teen suicide stands out as one of the more troubling issues concerning the welfare of children.

We all have experienced the difficulties that come with teetering on the cusp of adulthood, but the fact that the adolescent suicide rate tripled between 1952 and 1995 reveals that much has changed since most of us traveled that terrain. Although the numbers have gone down slightly in recent years, they remain alarmingly high, making it difficult to imagine what has changed since the days I attended high school in Cleveland.

There's no question that increased drug use and the greater availability of guns have contributed to the problem, but as Tegan Culler points out in this issue of Children's Voice, teens at increased risk for suicidal thoughts and behavior have histories of abuse or neglect, chronic illness in their families, dating violence, or stressful life events, like the end of a romantic relationship, a family move or divorce, or troubles with school or the law.

But are these children pushed to the edge merely by the events they encounter, or are they somehow "wired" to respond to these events in less-adaptable ways? As with most questions of this kind, the causes probably involve a little nature and a little nurture, which is why programs that address the mental health of teens must approach the issue from both sides.

An innovative program in Florida, Harmony in the Streets, run by Florida Sheriff Youth Ranches (, is addressing some of the key environmental issues that put children at higher risk for potential suicide. The program targets violence among middle school students and is a spin-off of the larger Project Harmony, a weeklong leadership retreat aimed at reducing violence, racial tension, and negative behaviors.

Harmony in the Streets helps students develop and retain a high level of self-esteem, learn how to use their free time in a positive manner, teach and lead others by role-modeling positive leadership skills, and appreciate the cultural differences of others in the community. The program, which has won numerous awards, has yielded successful results in such areas as conflict resolution, leadership, cultural diversity, drug and tobacco use, and self-esteem.

While Harmony in the Streets attempts to change the environment in which these children find themselves, CWLA is working with the American Academy of Child and Adolescent Psychiatry (AACAP) to address the mental health needs of children themselves, specifically those who are part of the foster care system.

CWLA and ACAAP have formed a work group involving more than 60 local and national consumer and professional organizations. This dynamic collaborative has developed values and principles for addressing the mental health and substance abuse needs of children in the foster care system and their families. We have also developed a policy statement to guide screening and assessment services and supports for these children and their families, and another statement on the special needs of infants in foster care.

We are now working at the federal, state, and local levels to explore effective ways of disseminating the tools we've created to make sure they're put to use. We're also developing a toolkit for judges, child welfare workers, behavioral health staff, and parents and caregivers. This toolkit contains a pamphlet to help first responders identify potential mental health and substance abuse issues in children, lists steps to minimize further traumatizing these children when they are being removed, and includes practitioner guidelines that define the important parts of a comprehensive, in-depth mental health and substance use assessment. It even includes a workbook for children and foster parents.

CWLA and AACAP have developed recommendations for legislative and policy reform to help children and their families in the foster care system. And we've cosponsored a series of one-day conferences to improve mental health and substance abuse ser-vices and supports for children in foster care and their families.

The long list of school shootings over the last decade has left our nation frightened that our children are not safe, even in their own schools. The truth is the number of teens who fall prey to gunmen each year is far outstripped by the number who die at their own hands. It's clearly within our power to save those lives. As we move forward with our efforts, let's all do what we can to ensure that our children receive the services they need to cope with the difficulties life throws at them.

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