"Unsiloing" Research and Practice for Children with Behavioral Health Multi-Morbidities

Children and youth with complex behavioral healthcare needs exhibit psychiatric multi-morbidities. Because of the multiple and diverse needs for services and supports, provided by professionals across multiple systems, families are forced to navigate complex and disconnected service systems financed through a variety of funding streams. The problematic disconnects between sectors serving this population has been highlighted in research and public advocacy for nearly forty years. However, despite federal, state, and local efforts at increasing cross-sector collaboration and coordination to enhance outcomes for these children and their families through the establishment and expansion of Systems of Care, children continue to face administrative and service gaps. Policies and organizational arrangements aimed at increasing coordination across child-serving systems and facilitating greater access to home and community-based care are under-funded and under-researched. Research in children's behavioral health continues to isolate populations served by single service sectors. Meanwhile, children with complex behavioral health needs face inadequate levels of care in highly restrictive settings.

This roundtable session will examine the political and financial forces perpetuating the "siloing" of these child-serving systems in social work practice and research and highlight how "siloing" exacerbates barriers to effective cross-sectoral research and practice. Presenters will examine similarities and differences in problems faced by these children and their families across key service systems and engage participants in exploring what is logistically and pragmatically needed for "unsiloing" children's behavioral health research: How do we formulate a multisystemic research question? What types of national, state, or local data collection is needed to answer these questions? What stakeholders are critical participants to this research? What policy and practice improvements should be sought through these efforts?

Presenters will share recent innovations in their research design, collaborative approaches, and analytic methods aimed at increasing cross-sector knowledge building and practice improvements. For example, one presenter will highlight strengths and limitations of the newly revised National Survey of Children's Health for understanding the experiences of children with behavioral health multi-morbidities across various service sectors. Another presenter will share findings from recent research on states' policy mechanisms to address coordination between child welfare and behavioral health systems for youth in foster care. A third presenter will discuss a systemic dynamics-based framework for the scale-up of evidence-supported interventions, highlighting the essential role that cross-system collaboration plays in the overall goal of increasing the reach and impact of child behavioral healthcare. This will be further explored by two additional presenters' illustrations of cross-system collaboration models that facilitate equity and culturally-infused engagement improvement efforts in work with diverse populations across all child-serving systems. The final presenter will draw on epidemiologic data and theories of disaster and trauma response, to outline the likely impacts on behavioral health needs across child-serving systems because of COVID, and challenge participants to identify research on the policy and workforce changes that could mitigate the pandemic's disparate racial-ethnic effects. This roundtable's goal is to generate conversation that will advance "unsiloed" research to improve outcomes for youth with complex behavioral health needs and their families.