A coalition of social and health service providers wants to remap the labyrinth of seven different agencies spread across state government that offer children’s behavioral health services.

The that make up the called for a new cabinet-level state department to oversee children’s behavioral health in a at an event in Providence.

“Kids’ behavioral health is not akin to adult behavioral health,” Benedict F. Lessing Jr., the CEO of Community Care Alliance, said of the findings in the coalition’s 22-page report titled “Children in Crisis Can’t Wait: The Case for System Transformation.”

“We know that kids suffer in terms of behavioral health concerns from infancy through adolescence.”

The proposed cabinet would be similar to the , said Tanja Kubas-Meyer, the coalition’s executive director. Technically a division within a department, the aging office reports directly to the governor like a cabinet position — a model preferable to what the new report calls “too-often disjointed access to care for children and their families.”

This hypothetical division would be charged with coordinating the services of existing state agencies who serve kids with behavioral health needs, which would mean being responsible for things like licensing and contracting providers.

One example: While the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH) handles both substance use and mental health treatments for adults, the agency is only responsible for youth who use substances. The Department of Children, Youth and Families (DCYF) is responsible for youth who experience what the state calls “serious emotional disturbance” — whether they are or aren’t in state custody or foster care, which DCYF also provides via contracted providers.

“This is not simply a matter the state will wrap up by itself, and it will be all unicorns and rainbows,” Kubas-Meyer said, adding the recommendations were made in the “spirit of collaboration, as opposed to a criticism.”

The report gives no estimate for what the creation of the new office would cost nor does it calculate the savings that could come from consolidating children’s services. Determining the cost would be difficult anyway.

“Another challenge is that there is not a state-wide unified Children’s Behavioral Health budget that clearly articulates how much money is being spent on these services, and which funding is available to children in general versus only for children with targeted needs,” the report states.

The executive-level has reported a “children’s budget” annually since 2018, which is included in the governor’s . For fiscal 2025, it rose 4.6% to over $2 billion.

But, “there is no clear breakdown of what this funding includes, without which the public is not able to understand what relevant investments were recommended or funded,” the coalition report states.

“The system is really fragmented,” said Sen. Bridget Valverde, a North Kingstown Democrat, one of two state legislators who attended the report release, in an interview after the event. “I think where there are a lot of duplicated efforts, that’s an opportunity where children fall through the cracks.”

Democratic Rep. Tina Spears of Charlestown, who is the executive director of the Community Provider Network of Rhode Island, a nonprofit that supports people with disabilities, also attended.

A new cabinet would have to be achieved through legislation, said Valverde, calling the recommendation “a good suggestion that should absolutely be explored.”

“Efficiency in government — I think that’s something that everybody wants, in all of our sectors, so let’s do it for our kids,” Valverde said.

Other recommendations from the report include establishing a working group of public and private stakeholders to shape the cabinet’s goals, as well as a shared state data hub with more reliable information for understanding children’s behavioral health.

“We worked with Brown University earlier this year, thinking that we were going to put together a data dashboard, and found that neither the coalition nor Brown could access the data that they needed within any kind of reasonable time,” Kubas-Meyer said.

An out-of-office reply for kids’ mental health

Rhode Island’s health system is “deeply frustrating” and it can be confusing for families to access the services they need for their children, the report states.

“You need to invest not just federal dollars, but also state dollars in children’s medical services,” Kubas-Meyer said. “Not every component of services for children are medically eligible, and we need alternate financing. The state must have financing mechanisms that make it possible for both large and small organizations to continue to provide services.”

Lessing pointed to an erosion of diverse outpatient services as one reason he sees behavioral health care having declined in the Ocean State the past two decades. An emphasis on residential treatments or hospitalization in the absence of alternative models has led to situations wherein kids may be staying in psychiatric hospitals — , who reported the agency was “warehousing” kids at Bradley Hospital for longer than needed.

“There has not been a concerted effort in terms of what are the outpatient needs for kids and families,” Lessing said. “These have been generally left to individual organizations to kind of figure out, and that has become more and more problematic over the years…I think what happened 20 years ago, when the state basically gave these programs to managed care, was that it got off track.”

The state lost control over programming, Lessing said, and assumed that managed care organizations would figure out the rest.

“We began to see kids being boarded in emergency departments. That never happened 20 years ago…There were just not enough services in the community.”

Margaret Holland McDuff leads the coalition’s public policy committee and is also CEO of Family Service Rhode Island, which hosted the event. She started her career as a home-based clinician — an example of the community-based care often referenced in calls to reform behavioral health care for children. It’s a holistic approach that means “having a clinician, a case manager, whatever support that you need, within the setting that you need,” McDuff said.

A community-based clinician can observe more deeply a child’s routine, life experiences and formative traumas, McDuff said. The community-based care model allows for collaborations with schools to intervene and offer support when needed.

“Whether it’s a coach or an art teacher or whatever, to say, ‘You know, we know that you’ve been having challenges. Let’s all work together as a team, wrap around this child to be able to get the supports that they need,’” McDuff said, “It’s about being out of the office and being in the community with family.”

McDuff arrived at that perspective after working in residential treatment, which she found lacked the perspective of family life.

“I really felt like I wanted to work with the whole family and not just the child while they were an inpatient, and then send them home, and then see them come back,” she said.

But McDuff noted that organizations like Family Service can’t compete with the wages offered by managed care organizations.

“People have to make a living,” McDuff acknowledged. “And so the two tracks that really became available were institutions or outpatient.”

Similar statewide or cabinet initiatives for kids’ behavioral health already exist in states like . McDuff said the state has seen a reduction in hospitalization rates.

“The biggest predictor of if a child is going to be in a psychiatric hospital is if they were in a psychiatric hospital before,” McDuff said.

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“One of the things that happens in human development,” Davidson says, “is that the prefrontal cortex matures as we get older. It’s an important part of the brain that enables us to do what psychologists call mental time travel, where we can anticipate the future and reflect on the past. But in preschoolers, where the prefrontal cortex is not so developed, they’re not worrying about tomorrow. Their future is maybe three minutes from now.”

Teaching children mindfulness is easy, he says, but must be done in an age-appropriate way that looks very different from how meditation practices are typically taught to adults. One strategy he recommends for preschoolers is to practice belly breathing where the children lie on their backs and a little stone or stuffed animal is placed on their tummies. They’re asked to simply observe the stuffed animal or stone moving up and down as they breathe for a minute or two.

“They are really easily able to do that,” Davidson says, “and they get it immediately.”

Another technique is to have the children sit and listen keenly while the instructor rings a bell or chime, and to raise their hands when they can no longer hear the sound.

“You can be in a classroom with 20 kids, and the quietness and stillness are palpable during that time. As soon as they stop hearing the sound, they start jumping up and waving their hands. But for at least that 10 or 15 seconds, they can really taste what stillness is like, and they love it. They frequently will ask for it because at a non-conceptual, visceral level, they know that it’s beneficial.”

Once a child has “tasted the stillness,” Davidson says, they can return to it again and again and it becomes a useful strategy in learning their own self-regulation. Mindfulness isn’t just a way to get fidgety little ones to be quiet for a while; it serves as a means for them to be in charge of themselves — to learn to calm themselves and modulate their thoughts, behavior and emotional responses to their environment — skills that studies have shown to be robust predictors of success in multiple major life outcomes, from physical wellness and financial success to the likelihood of avoiding substance abuse or engaging in antisocial behavior.

“A large body of longitudinal data show that kids who have a better capacity for self-regulation at age 4 or 5 do better in life. If we can teach those skills early in life — and we can — they will have multiplicative effects as the children develop.”

Davidson, professor of psychology and psychiatry at the University of Wisconsin-Madison, is the founder and director of the . He came to the topic of mindfulness and the study of healthy minds by way of a question he couldn’t answer: Why are some people vulnerable and some resilient? He was already a neuroscientist in 1992 when he first met His Holiness the Dalai Lama, with whom he is now a close associate and friend, who issued a challenge that altered the direction of Davidson’s career and led to his groundbreaking investigation of emotion and the brain, for which he is now recognized as a global authority.

“You’ve been using the tools of modern neuroscience to investigate anxiety, fear and depression,” the Dalai Lama said. “Why can’t you use those tools to study kindness and compassion, to study the positive qualities of life?” Davidson says that simple challenge was a wakeup call that led him to focus on well-being and healthy qualities of mind and ultimately to the establishment of the Center for Healthy Minds. More recently, the Center has launched a “Kindness Curriculum” aimed at promoting social, emotional and academic skills among preschoolers.

It all starts with mindfulness, which is foundational in answering Davidson’s question about resilience. He defines resilience as the rapidity with which one recovers from adversity. To paraphrase the bumper sticker, he says, “stuff happens.” No one can lead a life completely buffered from adversity. Resilience is about how we bounce back from the stuff.

“And it turns out that the simple skills of mindful awareness can help us return back to that baseline more quickly. We can measure this objectively — it’s not based on self-reporting but actually measured in behavior and physiology, and in the brain. We have shown that through the increased practice of simple mindful awareness techniques you can actually learn to become more resilient and to recover more quickly from adversity.”

“This is not only at the core of our psychological well-being, but our physical health as well. Some of those systems that need to recover are the stress biology systems; for example, the stress hormone cortisol. Researchers have measured cortisol levels following an acute stressor and know that people differ dramatically in how quickly they come back to baseline. This has tremendous applications for physical health because when cortisol remains elevated beyond the point where it is serving a function, it can have really deleterious effects on the brain and the body.”

Developing an acquaintance with mindful awareness, Davidson says, is one of the “Four Pillars of Well-being” that the Center has identified. The next, which builds on mindfulness, is connection, the qualities that promote healthy social relationships such as kindness, compassion, appreciation and gratitude. The third and fourth pillar are insight and a sense of purpose, but Davidson says those really begin to take on significance in the early teen years. Kindness and connection start very early.

“We have done randomized, controlled trials on simple practices designed to cultivate kindness and compassion in both kids and adults and the practices translate into real behavior,” he says. “In one trial we did with preschool children with our Kindness Curriculum, we found that compared to a randomized control group, the kids who received our curriculum behaved more altruistically on a hard-nosed measure of altruistic sharing compared to their classmates who received a standard curriculum. These and other findings indicate that with practice kindness can be learned, which has led us to a simple but very radical conclusion, which is that characteristics like kindness — and well-being more generally — should be regarded as skills.”

The good news in this finding is that skills, unlike qualities which are innate, can be taught, practiced and learned.

“We all have various kinds of early predispositions, genetic and environmental, and have a starting place. But these characteristics can be further nurtured and developed. The way we now think about kindness and compassion is very much like the way scientists think about language. We all come into the world with a biological propensity for language, but we know that if we’re not raised in a normal, linguistic community, language won’t develop normally.

“Similarly, kindness and compassion are part of what it means to be human, and there are good data showing that the vast majority of young infants, when given a choice, behave in a prosocial, altruistic way.”

The default response for humans is to help others, not to be selfish, he says. But in order for those seeds to grow, they have to be intentionally cultivated. And they must be, he says. As the news of the day continues to underscore, humans have to learn to get along more cooperatively and compassionately: The flourishing of humanity and the planet are at stake.

It all begins with mindful awareness, and if you want to get started learning on your own, it’s easy. Just put a stuffed animal on your belly and breathe.