Youth mental health

Building a Framework for a Newly Imagined and Inclusive System of Care for the Carolinas 


Ellen Carroll, Project Lead
Director of Program Design


Jai Kumar
Deputy Director


Miriam Tardif-Douglin
Senior Program Manager, Research & Policy



Youth Mental Health Opportunity Continuum Diagram

Youth Mental Health Framework

Youth Mental Health Framework Relationships Diagram

Youth Mental Health Patient Journey Map

The State of Youth Mental Health in the Carolinas - Executive Summary

The State of Youth Mental Health in the Carolinas

Crisis in the Carolinas: A Framework for Youth Mental Health

Project Overview

There is a youth mental health (YMH) crisis across the country. According to the U.S. Department of Health and Human Services, nearly half of adolescents have had a mental health disorder at some point in their lives. And often these young people have a difficult time getting timely and accessible treatment when they need it most, adding to their problem.

It’s troublesome at home, too. Nearly one in five North Carolinians ages three to 17 are unable to access needed MH care. In South Carolina, the figure is closer to one in three not obtaining care. This failure during the critical developmental phases of childhood, adolescence, and young adulthood can have lifelong adverse ramifications if problems are not properly addressed and resolved. MH issues such as anxiety disorders, depression, eating disorders, and attention-deficit/hyperactivity disorder, or ADHD, often have cascading effects, leading to behavioral issues, school attendance problems, and physical ailments. These, in turn, could further alienate and frustrate youth and keep them from the support they need.

We at CaroNova have been working to stem the tide of the devastating YMH crisis and help create healthier communities. We know it’s a tall order. But we are leveraging our ability to bring together critical stakeholders who can identify and create the necessary change to ease the problem in the Carolinas. We and our partners will identify and evaluate innovative, multi-sector solutions that meet youth where they are, whether in a community-based healthcare provider’s office or in school. We will use evidence-based interventions that can have life-altering impacts on youth and families who are the most vulnerable.

CaroNova Documents State of Youth Mental Health in the Carolinas and Maps Possible Ways to Improve It

Mental healthcare services in the Carolinas fall far short of serving the growing numbers of youth who need them, a longstanding challenge that was worsened by the coronavirus pandemic. As the demand for services outstrips available support, too many youths are suffering needlessly through untreated mental illness, putting them at risk as they grow and mature. When youth mental illness is not addressed in a timely and appropriate way, there can be tragic impacts on individuals, families, care providers, and communities. It doesn’t need to be this way.

The crisis is complex, exacerbated by fragmented efforts, inadequate funding, and concerned stakeholders’ differing opinions about how problems should be addressed. The growing tide of underserved youth will only increase without urgent action to align sectors across the full continuum of care. Both North and South Carolina need to improve efforts to address upstream needs before mental health issues become emergencies.

Recognizing the need for system improvements, in early 2022, CaroNova developed a report titled The State of Youth Mental Health in the Carolinas to reveal the consequences of disjointed, delayed youth mental health (YMH) care. In response, the CaroNova Advisory Board (CAB) recommended exploring consistent federal funding, disseminating the report to build stakeholder engagement, and identifying specific opportunities across sectors.

Later that year, the CaroNova report, A Framework for Youth Mental Health in North and South Carolina mapped federal block grant funding and enumerated specific roles for the school, community, and health sectors in an improved system of care. The CAB subsequently recommended focusing on cross-sector prevention of mental health crises in youth and on how to measure impact.

CaroNova has recently focused on speaking to leaders of local programs already integrating care across sectors. Ongoing discussions have yielded multiple outcomes. They have collaborated on the design of a recommended care model. They have also informed program- and population-level metrics being developed for the Topic Action Team.

The CaroNova Youth Integrated Care Model

Based on stakeholder discussions, CaroNova has started designing a care model as the basis for a system that better serves youth in the Carolinas. The CaroNova Integrated, Collaborative Youth Mental Health Care Model uses coordination and data sharing to maintain YMH as they move across school, community, and health care settings. This model, which adapts the standard, widely studied Collaborative Care Model by adding schools and youth-serving, community-based staff to the care team, serves youth where they already spend most of their time.

Next Steps: Continued Exploration of Upstream Determinants

CaroNova is continuing to explore upstream determinates that impact the mental well-being of all youth. Our long-term goal is to help design and implement scalable and sustainable prevention practices at the population level. This means we are looking at how social, economic, structural policies and practices affect risk factors that can impact one’s well-being.

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