NAPNAP Statement on Pediatric Mental Health and Violence

Research indicates the incidence of pediatric depression and anxiety are increasing, and the effects of violence on youth are longstanding and may help contribute to this phenomenon. Violence, bullying and neglect directly and indirectly affect our children via social media, television, video games and they experience trauma in their homes, schools and communities. The dichotomy is that even as many of our communities are statistically safer, the stress on affected children is not decreasing and may in fact be increasing. These perceptions affect the mental health of children and may affect them into adulthood. For the U.S. to remain an economic and moral leader, we need adults who are mentally healthy. That starts with ensuring the mental health of our children. 

The National Association of Pediatric Nurse Practitioners (NAPNAP), a non-partisan professional society representing more than 9,000 pediatric nurse practitioners (PNPs) and fellow pediatric-focused advanced practice registered nurses (APRNs), calls on the federal, state and local governments to take immediate action to implement a multi-faceted public health approach to address the crisis of adverse childhood experiences (ACEs) related to violence, abuse, neglect and maltreatment and to ensure access to quality pediatric mental and behavioral healthcare for all children and youth. NAPNAP proposes an eight-point plan that includes improving coverage and payment for children’s mental health services, expanding the number and capacity of the highly competent primary care workforce to provide those services, fund community-based interventions to address social determinants of behavioral problems, and educate healthcare providers and the public about strategies to protect children and youth from violence, stress, and mental illness.

Specifically, NAPNAP calls on federal, state and local governments, on employer-sponsored health plans, and on issuers of private health insurance coverage to:

  1. Enact or support legislation, and implement and enforce regulations and policies at the federal, state and local level to provide incentives to encourage coverage that all public health care programs, employer-sponsored coverage, and private plans sold on health care marketplaces provide consistent, comprehensive coverage of mental and behavioral healthcare services for children and youth, and provide payment for those services sufficient to ensure access to a full array of qualified healthcare providers.
  2. Provide adequate federal, state and local funding to develop a primary care workforce sufficient to meet the needs of children and adolescents with behavioral and mental health issues, who are affected by ACEs, or who are at risk for violence, trauma, bullying, and maltreatment, including programs to improve healthcare providers’ competency in identifying at-risk children and managing their care.
  3. Establish and provide adequate funding for federal, state, and local programs to educate healthcare providers, parents, caregivers and the public educators about resiliency, coping, ACEs, and strategies known to protect against risk factors for mental illness and violence. Additional focus must include positive parenting skills including communication, developmentally appropriate expectations and discipline while stopping corporal punishment, including in the home, schools, and other settings.
  4. Provide funding to support research and the development and dissemination of evidence-based, brief interventions for pediatric healthcare providers across all settings to identify survivors of trauma and toxic stress; to provide timely, developmentally appropriate interventions for affected children; and to foster the development of healthy coping skills and resiliency.
  5. Provide funding to establish and support community-based interventions in schools, homes and non-healthcare environments to address social determinants of health, parental caregiver mental illness, and child/family isolation.
  6. Provide funding to support violence prevention programs administered by the CDC’s Injury Center and the Department of Justice, and to foster public private partnerships to determine best practices for minimizing violence risk factors of children and youth.
  7. Strengthen access to trauma-informed care for children and families to improve and to ameliorate the effects on those who experience violence. This should include promoting current SAHMSA programs on trauma-informed care and creating a grant program for hospitals and facilities to adopt evidence-based trauma-informed care models.
  8. Minimizing pediatric exposure to violence and bullying in homes, communities, schools, and media including movies, television, social media and computer games.


September 2018