key: cord-0950938-ry87uep1 authors: Youngstrom, Eric A. title: Editorial: Stepping Up Care to Reach More Families date: 2022-03-14 journal: J Am Acad Child Adolesc Psychiatry DOI: 10.1016/j.jaac.2022.03.006 sha: 3d3698eddf899bb499e6a6b7d76b53c6513227e5 doc_id: 950938 cord_uid: ry87uep1 There are not enough of us. That was true even before the COVID-19 pandemic, which has only made the need for mental health services more acute.(1,2) There are roughly 30,500 practicing psychiatrists in the United States, and 106,000 licensed psychologists, and perhaps a million mental health practitioners worldwide. That translates to roughly one psychologist per 3,000 persons in the United States, one psychiatrist per 11,000 persons in the United States, and one provider per 8000 persons globally.(3,4) That is obviously inadequate. Ramping up the training of professionals is not a sufficient solution. Even large percentage increases in the number of freshly minted providers still miss the mark by several orders of magnitude. biggest part of the cost savings comes from seeing whether the smaller dose of provider intervention was enough to achieve the desired outcome. But there is more good news to unpack. The psychoeducation materials also scale much more easily than anything requiring provider time. Websites are not consumable goods; there is no incremental cost for each additional family to access them, once the resources are created and deployed. The workbook could also be used electronically. All of these share the information at much lower marginal costs, and with a far wider reach than our geographic practice catchment area. 5, 8 These are not a replacement for our services, but they are apparently sufficient for some families to achieve satisfactory outcomes. In our own practices and networks, we could potentially not just screen a larger number of persons, but also provide similar materials to teach them about "mental health first aid," along with other strategies that are likely to be low risk and low cost while offering some potential benefit. Far from putting us out of work, it would keep us busy with those who need us most, while also educating and helping a larger swathe of the community. There are many ways that psychoeducation and selfadministered low-risk interventions could be expanded. The randomized controlled trial necessarily Q6 had constraints on enrollment that would not have to be maintained in a larger rollout. The initial parent training might be offered in a group format. The study was designed and conducted before the COVID pandemic. We have learned a lot since then about the promise and pitfalls of tele-health delivery of services we would not have considered before. There also is much good that could be accomplished with straight-toconsumer screening, information about treatment alternatives, mental health first aid, and coaching about when and how to access professional care. There is a lot to think through, as well, including how to strike a good balance between empowering patients and the public vs creating risks or unintentionally diverting people from services that they need. The program of work by Salloum et al. 7 lays a path toward improved access to care and resource allocation while preserving outcomes and satisfaction. Although it is not a complete solution, it is a major advance; and there are opportunities for us to apply some of these ideas in our own work, and not wait for other systems to implement stepped care. 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA The psychological impact of quarantine and how to reduce it: rapid review of the evidence The silent shortage: a white paper examining supply, demand, and recruitment trends in psychiatry APA Division 5 Presidential Address. Presented at: Annual meeting of the American Psychological Association The Future of the Professions: How Technology Will Transform the Work of Human Experts Rebooting psychotherapy research and practice to reduce the burden of mental illness Stepped care versus standard care for children after trauma: a randomized non-inferiority clinical trial. J Am Acad Child Adolesc Psychiatry Helping give away psychological science: putting information and resources where the public and professionals can find and use them All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry. See the Guide for Authors for information about the preparation and submission of Editorials