The Ground Up Model: Why We Need Specialized Mental Health Support for Young Patients

In the evolving landscape of mental health care, there has been a critical gap in addressing the unique needs of young patients. Most current models designed for adults are simply adapted for children (primarily in effort to address access gaps) without considering the profound developmental and environmental conditions and differences in therapeutic requirements between the two groups. In order to ensure the unique mental health needs of our youth are met, we must customize mental health care specifically for children—from the ground up.

Why "Ground-Up" Models Matter

Children aren’t just mini adults. They see the world differently, process emotions uniquely, and express themselves in ways that often leave adults scratching their heads. Because of this, we need to employ a “ground-up” model. Addressing the needs of youth requires a clinical model designed specifically for developing minds and one that involves the people in their lives; families, caregivers, siblings, and community members including pediatricians and other supportive individuals — in other words, rather than late intervention, you’re starting from the ground up. To meet their needs, there are many key attributes of the ground-up model that we can explore:

• Developmental Stages: Kids don’t have the vocabulary—or patience—adults do. A 6-year-old in therapy isn’t going to "explore their triggers." They’re going to draw a cat with three heads to show they’re scared. Tailoring communication and techniques to these stages is essential.
• Trust as Currency: You need to get to their level, literally. From the ground up can actually start from the ground: if the child is sitting on the floor, so should you. If children think you’re not trustworthy, the conversation ends before it begins. Adults may reflect in silence during therapy, even feeling compelled to divulge because of the silence, but children do not share that drive. They’re perfectly content to sit in that silence. Trust-building activities like play and storytelling can pave the way for meaningful dialogue.
• It Takes a Village: Adult models are typically one-on-one, and usually at the want and discretion of the patient. When considering the mental health of children, we need to factor in their whole environment. These models require a family systems approach that involve siblings, caretakers, and pediatricians. 

This means adapting traditional methods, like Cognitive Behavioral Therapy (CBT), isn’t just challenging—it’s necessary. For example, at Bend Health, we’ve developed an anxiety program that required four distinct versions to meet different developmental needs of different age groups. Tailoring therapy takes time, but it pays off in outcomes that truly resonate with children.

The Challenges of the "One-Size-Fits-All" Approach

Historically, pediatric mental health hasn’t received the attention—or funding—it deserves. There are real changes that need to happen within the healthcare system to accommodate the ground-up model:

• Dedicate more time: Youth-specific models actually require more time and effort to deliver the right kind of care. Planning for this will require adjustments both in resources and expectations.
• Limited Incentives: Let’s face it—children’s health care isn’t where the money flows. Add to that outdated attitudes, like "kids are meant to be seen, not heard," and the focus shifts elsewhere. Yet the long-term benefits of early mental health interventions are undeniable. Investing in these tools takes a collaborative approach and can cost more upfront. The reimbursement models need to reflect that level of effort.
• Adult Models, Child Patients: Foundational mental health approaches weren’t designed for children. Adapting them means rethinking tools, language, and expectations. For example, role-playing exercises or visual aids can make abstract concepts more accessible to young minds.

Consider this: You wouldn’t hand a kindergartener a calculus textbook and say, "Figure it out." Why expect kids to navigate adult mental health frameworks that attempt to 'plug in' resources for kids and young adults? The gap leaves too many children struggling without appropriate support.

The Importance of Coaching

The "ground-up" model focuses on proactive mental health coaching rather than reactive care. Think of it as emotional fitness training:

• Not Diagnosis-Driven: Coaching equips kids and their families with tools to navigate challenges before they spiral. It’s less about "What’s wrong?" and more about "What can we work on?" Families learn practical strategies and are equipped with tools to handle stress, anxiety, and other challenges early on.
• Integrated Care: Pediatricians can lead the charge by embedding mental health coaching into routine checkups. Imagine if every wellness visit included a mental health check. Normalizing this could transform care and reduce stigma. Early discussions about emotional health can normalize mental well-being and encourage openness — and should begin before there is an urgent problem.
• Widely Available: The industry is broadly struggling with scarcity in regards to licensed MH clinicians, but not every child requires this level of care. Coaches are incredible resources and they’re available to help.

If children and their parents don’t engage in some form of mental health coaching, I want pediatricians asking themselves, why not? It’s about shifting the mindset from "wait and see" to "let’s start now." 

More Options, Less Stigma

Parents often hesitate to seek help for fear it reflects poorly on their parenting. Pediatricians and healthcare professionals can make a difference by reframing mental health. Present coaching as a tool, not a last resort. It’s like brushing teeth—something you do to stay healthy. This proactive framing can alleviate parental guilt or hesitation.

Plus, preventive mental health care isn’t just compassionate; it’s practical. Early intervention builds resilience, saving heartache (and resources) later. Providing families with stories of success and reassurance can help break through stigma.

The Business Case

Investing in early childhood mental health isn’t just good ethics—it’s good business. Emergency room visits for adolescent crises have surged 43% between 2015 and 2020. Addressing issues earlier could:

• Reduce Strain on Systems: Emergency rooms are not ideal settings for mental health crises. Kids facing mental health issues shouldn’t end up in chaotic and frightening ERs unless they’re truly at imminent risk. Early intervention lessens this burden.
• Lower Costs: Families and providers save money when issues are managed proactively instead of reactively. Addressing the unique needs of children has the promise of long term positive impact on future consumption of healthcare system resources. Healthy kids have a better chance at growing up to be healthy adults.
• Create Scalable Solutions: Programs that integrate mental health coaching into broader pediatric care can reach more families and foster systemic change.

The evidence is in: there are 9 peer reviewed studies out there on this model. It works — and the earlier you start, the better. Coaching a 5-year-old might mean that the same 15-year-old doesn’t end up in crisis. The return on investment is evident, both financially and in improved quality of life for families.

The "ground up" model isn’t just a shift in strategy—it’s a revolution in care. By tailoring approaches to the developmental realities of children, embedding mental health support into everyday practices, and tackling stigma head-on, we can rewrite the future of mental health care.

Because, honestly, children aren’t going to adapt to adult systems anytime soon. Why not meet them where they are—and where they can thrive? It's one thing for an individual business or practice to have a ground-up model, it's another to have a system that deals with scarcity, involves the broader family unit, and addresses the broader problems of healthcare today. 

This care model may be built from the ground up, but your understanding of it doesn’t have to be. Stay tuned for the next several pieces in this series on trauma-informed care in pediatric practices, why group therapy might be the next best investment, and how AI is being used to revolutionize the field of youth mental health.

‍