Children's Hospital Colorado
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Family-Based Mental Health

Introduction

Childhood and adolescence are critical developmental periods for mental health, with approximately 50% of all mental health disorders occurring before the age of 14. Prior to the COVID-19 pandemic, approximately 1 in 5 youth experienced a mental health disorder (CDC, 2021). The pandemic has significantly exacerbated youth mental health concerns (MHA, 2021). In Colorado youth, rates of anxiety and depression have doubled, and suicide has become the number one cause of death (CDPHE, 2021). In recognition of these concerns, the American Academy of Pediatrics (AAP), along with other national and state organizations, have declared a national pediatric mental health emergency (AAP, 2021).

How families impact youth mental health

Child and adolescent mental health are highly influenced by the family system, particularly the parent-child relationship. Family factors that can increase a youth’s risk of mental health concerns includes (CDC, 2021):

  • Parent mental health concerns
  • Adverse childhood events, such as poverty, family violence, abuse and neglect, and loss of a loved one
  • Isolation and limited social support
  • Parenting styles and practices, particularly those that are overly harsh, controlling, permissive, and/or inconsistent

Family-based screening tools

There are a number of helpful family-based screening tools available for use in a primary care setting. These tools assess for family functioning, family stress, parent mental health concerns, social support, and social determinants of health.

Download a summary of key screening tools

Family-based strategies

Fortunately, there are many ways families can increase their child’s resiliency and reduce their risk of mental health concerns. Consider providing families with the following recommendations:

  • Develop a strong, safe, and stable relationship with your child. Research has shown this is the #1 most important protective factor for youth.
    • Spend quality time together
    • Check in regularly with your child
  • Effectively communicate with your child.
    • Be willing to bring up and discuss difficult topics, including suicide. Having these discussions does NOT increase your child’s risk of suicide
    • Listen and be empathic
    • Collaboratively problem solve challenges
  • Be a good role model by taking care of your own mental and physical health.
    • Address your mental health concerns
    • Engage in healthy coping
  • Provide a supportive, stable, and predictable home environment
    • Maintain a daily schedule
    • Establish clear expectations and consequences
  • Watch for warning signs of mental health concerns and seek help when needed. Warning signs include:
    • Irritability or tearfulness
    • Acting out/tantrums
    • Isolating themselves
    • Changes to sleeping/eating habits
    • Feeling less motivated
    • Less interested in activities they used to enjoy

Effective family-based treatments

There has been increasing awareness of the importance of including parents and other critical family members in youth mental health treatment. Family-based treatments have several advantages including increased access and engagement in treatment, improved and sustained treatment outcomes for youth, and improved family functioning.

Components of family-based treatments can include supporting a healthy and secure parent-child relationship, empowering use of effective parenting styles and strategies, addressing parent mental health concerns, and improving family dynamics and communication. It is generally recommended that youth mental health treatment, including individual therapy, always have a family/parent-based component. Specific examples of family-based treatments include:

  • Parent management training (ADHD and disruptive behaviors)
  • Functional family therapy (high risk youth typically involved in juvenile justice)
  • Family-based treatment (eating disorders)
  • Dialectical behavior therapy for adolescents (depressive/mood disorders)
  • Family-based cognitive behavior therapy (anxiety disorders)

Resources for Parents and Families

References