How Can We Improve Mental Health Care for Children and Families?

Combating stigma and fostering promotion and treatment for mental wellness
Dr. Aparna Kumar, Assistant Professor in Jefferson's College of Nursing.

Our mental health influences nearly all aspects of our lives, and mental illness can affect anyone, even children. Nearly 1 in 5 children have a mental, emotional or behavioral disorder, with anxiety, depression, attention-deficit/hyperactivity disorder (ADHD) being the most common. Early diagnosis and treatment is critical; unfortunately, only about 20% of children with these disorders receive care from a specialized mental health provider. Moreover, even if care is available, the cost, time and effort involved can all be prohibitive for parents and families. Aparna Kumar, PhD, assistant professor and program director of the Psychiatric Mental Health Nurse Practitioner Program in Jefferson’s College of Nursing, works to ensure that mental health care is accessible, evidence-based and integrated across healthcare settings like family medicine and primary care practices. Read more about her research goals and story.

Q: What is your research focus?

A: My research is driven by an over-arching question – how can my work contribute to people meeting their full potential, whatever that may mean to the individual? Within that bigger picture, I research how we can decrease stigma around mental health issues, how to foster positive mental wellness from an early age, and how public health campaigns can contribute to the promotion of mental wellness and treatment. I study all of this, particularly as it relates to children and families and the role that nurses play in improving mental health.

Q:  Can you talk a little more about the unique role that nurses play in improving mental health?

A: Nurses are trusted members of the healthcare team and are a part of patients’ lives throughout the full range of human experience — the best and worst parts. Nurses are also skilled communicators and can easily translate complex information to help patients and families. This combination of trust, experience and communication allows nurses to play a unique role and serve as a liaison between systems of care. In addition, nurses serve in many contexts, and understand that continuity of care is critical to improving mental health across the lifespan. Nurses advocate for patients in prison; they serve as school nurses who notice changes in children’s appetites or early symptoms of anxiety; they work in community settings where trauma may be endemic to the community; and they work in direct care, where they may be the member of the care team who spends the most time with a patient. This is why nurses are so important to the mental health care system.

I also have a special place in my heart for birthing individuals. Everyone wants to hold the baby, but who is there to support the parent?

Q: Within your research, what’s one question you’re investigating?

A: Can increased screening in pregnancy improve mental health outcomes for birthing individuals and developmental trajectories for children? At present, the recommendation is that women are screened three times in pregnancy for postpartum depression. However, this bare minimum is not a standard of care in most settings. Rather, women are screened when they give birth to a child (which is representative of the third trimester rather than the postpartum period) and at the six-week postpartum period. We think this is insufficient to pick up mental illness in pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool used to detect depression in during pregnancy and the postpartum period, but we believe it could also likely pick up symptoms of other mental health conditions. We are investigating whether improved screening can be implemented with greater frequency, and can improve outcomes for women and ultimately maternal-infant attachment and bonding if mental health issues are addressed promptly.

Q: What first sparked your interest in your area of research?

A: It started with personal and family experience with mental illness and the high stigmatization in my community. Then I began working with children and families and noticed that children with mental health issues very often had a parent with mental health issues. The care approach was always for the family as a unit – you cannot treat a child without looking at the family system. I began to wonder what might be modifiable in the family unit (genetic, environmental or other factors) that could possibly improve outcomes. I was particularly interested in individuals during pregnancy and started to inquire about the genetic influence and impact of the prenatal environment on the emergence of mental health symptoms in childhood. In other words – what effect does treatment of mental illness in pregnancy and the postpartum period have on the emergence of mental health symptoms in childhood? This question also integrates the influence of the fetal environment (for example: increased circulating stress hormones) on early childhood. I do believe that these are processes that we can support as mental health providers and influence in a positive way.  I also have a special place in my heart for birthing individuals as I feel that many people are lost in the period following childbirth, when the struggles are very difficult. Everyone wants to hold the baby but who is there to support the parent?

Q: What’s something about your study subject that people may not know?

A: Did you know that mental health sequelae are one of the leading causes of maternal morbidity and mortality in the postpartum period? The numbers are so clear and yet we overlook mental illness in pregnancy.

Q: Many researchers have superstitions. Things they’ve done to cosmically help their research work succeed. What are yours?

A: I wish I had some and I would take tips from others! I put my faith in the belief that good work will always outshine not so good work.

Q: What’s the best part of your job?

A: My colleagues, our team and our ability to directly help improve others’ lives through our work.

Q: What’s something people would be surprised to find out about you?

A: I lived in sub-Saharan Africa for two years. I also teach yoga! Finally, I am heavily involved with a social media campaign called Dear Pandemic and we have been working hard since March 2020 to get information out to combat misinformation. I consider this a side gig!


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