The second installment in our Best Practices for Children and Youth Behavioral Health series focuses on prevention – what it looks like, why it matters, and how evidence-based strategies can make a lasting impact. This article examines how recognizing and addressing early behavioral changes can help reduce the risk of children developing more serious behavioral health challenges later in life.
Three leading experts – ABHW board members Dr. Caroline Carney, President and CEO of Magellan Health; Dr. Deborah Fernandez-Turner, Deputy Chief Psychiatric Officer at Aetna, A CVS Health Company; and Dr. Doug Nemecek, Chief Medical Officer at Evernorth – share their views on the role of early childhood experiences, support structures, and social determinants in promoting lifelong behavioral health.
Many say prevention is the gold standard in children’s behavioral health. Do you agree? Why or why not?
- DEBORAH: Prevention is part of the gold standard, and so is early identification. By identifying concerns early—whether through school screenings or pediatric visits—we can reduce the severity of problems before they escalate. Teaching coping skills, supporting families, and building resilience not only improves individual outcomes, but also lessens the overall burden on the behavioral health system. Prevention means investing in children’s long-term wellbeing rather than waiting until crises emerge.
- CAROLINE: Prevention is critical, but I wouldn’t call it the only gold standard. Early identification and treatment are just as important. While prevention strategies, such as social-emotional learning in schools, lay the groundwork, we also need robust, accessible treatment for children already experiencing significant challenges. The real gold standard is a continuum of care where prevention, early intervention, and evidence-based treatment all work together.
How do early childhood experiences shape a child’s behavioral health trajectory?
- DOUG: Early childhood experiences lay the foundation for a child’s behavioral health trajectory. Positive, nurturing relationships and stable environments build resilience, while adverse experiences, such as abuse, neglect, or household instability, can increase the risk of mental health and substance use challenges across the lifespan. We know from decades of science on Adverse Childhood Experiences (ACEs) that early trauma is linked to higher rates of depression, anxiety, substance use, and even physical health conditions later in life. That’s why early intervention and prevention are so critical. By identifying risks early, supporting families, and creating safe, supportive environments, we can reduce the long-term impact of adversity and help children build healthier futures.
What does prevention look like in practice for children and youth behavioral health?
- CAROLINE: In practice, prevention means identifying concerns early and building protective factors before challenges become crises. Universal screenings in schools and pediatric settings are key tools because they help us catch emerging issues like anxiety, depression, or substance use risk that might otherwise go unnoticed. Coupled with education on coping skills and connecting kids and families to resources quickly, these screenings allow us to intervene early and change a child’s trajectory for the better. Finally, diagnostic accuraacy is critical given that all symptoms are not necessarily related to an underlying mental health condition, but might be due to lack of sleep, hunger, or even physical pain.
- DOUG: We know from research that more than half of all mental health conditions appear by age 14, and 75% by age 24. Prevention is a system of supports, not a single program. It includes universal screenings in pediatric offices and schools, teaching social-emotional skills, supporting parents, and ensuring families know where to turn for resources and help when concerns arise. These strategies work together to create an environment where children’s behavioral health needs are recognized early and addressed with the right supports, reducing the likelihood of more serious problems later.
What role do families and caregivers play in prevention, and how can they be supported?
- CAROLINE: Families and caregivers are at the center of prevention. They are often the first to notice changes in a child’s mood, behavior, or social interactions, and they shape the development of healthy routines, coping skills, and resilience. Supporting families means giving them education about behavioral health, access to parenting programs, guidance on positive communication and stress management, and connecting them to community resources. When caregivers are empowered and supported, they play an active role in prevention and help children thrive. There is not a parent among us, me included, who cannot continue to learn more about promoting wellbeing in our kids—parent training can be very beneficial.
How can schools and community organizations partner with clinicians to create preventive environments?
- DOUG: Schools and community organizations are critical partners in prevention. By collaborating with clinicians, they can implement universal screenings, social-emotional learning programs, and early intervention supports. These partnerships allow for timely identification of concerns, consistent reinforcement of coping skills, and coordinated care that extends beyond the clinic. Employers provide important resources for parents, too, including education and resources, time off to take a child to appointments, and Employee Assistance Programs to support the family’s needs. When educators, community leaders, employers, and clinicians work together, children benefit from a safe, supportive environment that promotes mental health, resilience, and long-term well-being.
How does addressing social determinants of health fit into preventing behavioral health issues in children and youth?
- DOUG: Addressing social determinants of health is essential for prevention. Factors like housing stability, food security, safe neighborhoods, and access to quality education all influence a child’s behavioral health. When these needs are met, children are better able to engage in school, foster healthy relationships, and develop coping skills. Prevention means creating conditions that support healthy development from the start.
- DEBORAH: Preventing behavioral health issues requires looking beyond the clinic. Social determinants, such as poverty, safety, housing and lack of access to community resources, can put children at risk of developing behavioral health conditions. Working with schools, community organizations, and public health programs helps address these underlying factors. By creating supportive systems, we give children and families the foundation they need to thrive and reduce the likelihood of mental health and substance use challenges later on.
What are some early warning signs clinicians and caregivers should look for to intervene before issues escalate?
- DEBORAH: Early warning signs can vary by age, but there are common indicators clinicians and caregivers should watch for. These include persistent changes in mood, withdrawal from friends or activities they once enjoyed, sudden decline in school performance, difficulty managing emotions, frequent irritability, or changes in sleep and appetite. In younger children, increased tantrums, aggression, or regression in skills can also signal concern. Recognizing these signs early allows families and clinicians to intervene with evidence-based supports before problems escalate. These are a few common early signs, but any change that is significant and persists for more than a few days is something to bring to your pediatrician for further assessment
You can read the first installment of this series, “How Experts Define Quality Care for Children and Youth Behavioral Health,” here.
