Advancing Equity in Youth Mental Health Services: Introduction to the Special Issue (Part I)

Abstract

Despite longstanding disparities in access to and quality of mental health services, efforts within the field of child and adolescent mental health have primarily focused on documenting these disparities. While identifying disparities is a critical first step, additional work is needed to develop an evidence base that can be leveraged to eliminate disparities. Fortunately, there has been a growing emphasis on diversity, equity, and inclusion in training, practice, research, and policy (e.g., Bernard et al., 2021; Clauss-Ehlers et al., 2019; Collins et al., 2021; U.S. Department of Health and Human Services, Office of Public Health and Science, Office of Minority Health (US DHHS), 2008). A racial reckoning in the United States and the ongoing impacts of the COVID-19 pandemic globally have also brought inequity to the forefront of society’s consciousness. Awareness of the need to dismantle institutional structures that maintain inequity and a motivation to achieve social justice provide a key opportunity to advance health equity. This special issue highlights work that advances our ability to achieve equity in youth mental health services. We rely on definitions of equity that emphasize the provision of resources based on need, fair access to those services, a goal of supporting optimal levels of health, and a focus on the social determinants of wellbeing (American Psychological Association (APA), 2021; Braverman et al., 2017). By centering equity and diversity at all levels, the articles in this special issue contribute to an evidence base that is equipped to support action. Part I of the special issue includes articles that synthesize and advance knowledge on the needs of diverse populations and examine key issues impacting equity in access to needed services. Part II of the special issue includes articles focused on engagement, service delivery and effectiveness, and the sustainability of services within systems. Articles in this first part of the special issue utilize systematic review, qualitative, quantitative, and community-engaged methods to address important questions related to health equity across unique populations, clinical needs, and service settings. DeLuca et al. (2022) use a minority stress and intersectional lens in their review of the literature on youth at clinical high risk for psychosis. The authors first describe the relevant social and policy contexts influencing inequities in identification and treatment of youth who could be served by specialty clinics targeting youth at clinical high risk for psychosis. They subsequently provide a narrative review of the literature across a comprehensive range of areas, making explicit connections to issues of equity. They end with a call-to-action and provide specific recommendations for advancing equity for this population. In a systematic narrative review of the literature, Xin et al. (2022) consider randomized controlled trials of cognitive behavior therapy (CBT) conducted with Asian American youth. Despite the general evidence base for CBT across a range of problems, only eight studies specific to Asian American youth were identified. Findings suggest that CBT (both culturally-adapted and non-adapted) was effective in reducing a range of emotional and behavioral problems for Asian American youth. The authors detail implications of these findings, including the need for enhancing the cultural responsiveness of clinical research and practice, and improving