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Children’s Services Assessment

EXECUTIVE SUMMARY

Executive Summary

The Children’s Services Fund of Jackson County (CSF) commissioned the 2024 Children’s Services Assessment to evaluate the current state of mental health and social-emotional well-being for children (ages 0-19) in Jackson County, Missouri. The assessment, conducted by The Liming Group, aimed to identify system facilitators and barriers, service gaps, and opportunities to enhance the children’s behavioral health service delivery system in Jackson County. Comprised of five main evaluation components (see Figure 1 below), the assessment intentionally solicited information from a variety of sources, individuals, professionals and community stakeholders. In total, the assessment included 310 community participants across all evaluation activities, spanning five months. We are grateful to all of the individuals who shared their experience and perspective to inform this project. Children’s Children’s Services Services Assessm Assess

Children's Services Assessment Evaluation Design Figure 1. Children’s Services Assessment Evaluation Components

Secondary Secondary DataData & & Literature Literature Review Review

Qualitative Qualitative Interviews Interviews

Goal: Goal: Goal: Goal: Goal: Goa Developed Developed a robust a robust (not (not Interviews Interviews focused focused on individual on individual Presented Presented overview overvie of C exhaustive), exhaustive), organized organized catalogue catalogue perspectives perspectives and experiences and experiences of of Services Services Assessment Assessme pr of publicly of publicly available available secondary secondary successes, successes, challenges, challenges, and and solicited solicited information inform data sources data sources and summarized and summarized futurefuture goals goals of agencies of agencies and and community community partners partn (in extantextant literature/data literature/data on on organizations organizations providing providing services services and via and survey). via survey). Inform well-being well-being indicators indicators of Jackson of Jackson to children to children and families and families of of gathered gathered directly directly informi County County children children and families. and families. Jackson Jackson County. County. groups, groups, quantitative quantita su and assessmen and asses Focus:Focus: Participants: Participants: Participants: Participa PublicPublic datasets, datasets, repositories, repositories, Children’s Children’s Services Services Fund Fund (CSF) (CSF) and dashboards and dashboards with child, with child, Leadership Leadership and admin and a leadership, leadership, staff, and staff,other and other student, student, and family-level and family-level at partner at partner organizat org identified identified community community well-being well-being indicators. indicators. professionals professionals (via snowball (via snowball sampling). sampling).

dren’s n’s ildren’s Services Services Services Assessment Assessment Assessment Evaluation Evaluation Evaluation Design Design Design

alitative Qualitative Qualitative erviews Interviews Interviews

Kickoff Kickoff Meeting Kickoff Meeting & Meeting Share & Share & Share Community Community Community & Young & Young & Young Organization/School Organization/School Organization/School YourYour Thoughts Your Thoughts Thoughts Survey Survey Survey AdultAdult Focus Adult Focus Groups Focus Groups Groups StaffStaff & Caregiver Staff & Caregiver & Caregiver Survey Survey Survey

Goal: Goal:Goal: Goal: Goal:Goal: Goal: Goal:Goal: Goal: Goal:Goal: ws erviews used focused onfocused individual on individual on individual Presented Presented overview Presented overview ofoverview Children’s of Children’s of Children’s Guided Guided by Guided statutory by statutory byservice statutory service areas, service areas,areas, Electronic Electronic surveys Electronic surveys were surveys were were and tives spectives experiences and experiences and experiences of of Services of Services Assessment Services Assessment Assessment project project andproject and structured and structured structured focusfocus group focus group questions group questions questions administered administered administered to: 1) organizational to: 1) organizational to: 1) organizational successes, challenges, sses, challenges, challenges, and and and solicited solicited information solicited information information from from from focused focused onfocused strengths, on strengths, on areas strengths, areas of areas of of staff; 2) staff; school 2) staff; school staff; 2) school and staff; and staff; and uture goals of agencies goals of agencies ofand agencies and andcommunity community community partners partners (in-person partners (in-person (in-person need,need, service need, service gaps, service gaps, and gaps, and and 3) caregivers 3) caregivers 3) caregivers (18+ years (18+ years old) (18+ years old) old) ganizations providing tions providing services providing services servicesand via and survey). via and survey). via Information survey). Information Information system-level system-level system-level barriers. barriers. A focus barriers. A focus A focus with lived with experience. lived with lived experience. experience. Surveys Surveys Surveys to ldren and children families and families and of families of ofgathered gathered directly gathered directly informed directly informed focus informed focusfocus groupgroup with group young with young with adults young adults withadults with with targeted targeted barriers targeted barriers and barriers facilitators and facilitators and facilitators Jackson on County. Jackson County. County. groups, groups, quantitative groups, quantitative quantitative surveys, surveys, surveys,lived experience lived lived experience experience were were held to were held to held to of service of service receipt of service receipt andreceipt and and and assessment. and assessment. and assessment. incorporate incorporate incorporate youthyouth voice. youth voice.voice. service/population service/population service/population gaps. gaps.gaps. icipants: Participants: Participants: Participants: Participants: Participants: Participants: Participants: Participants: Participants: Participants: Participants: hildren’s n’s rvices Services Fund Services Fund (CSF)Fund (CSF) (CSF) Organizational Organizational Organizational and School and School and staffSchool staff staff Jackson Jackson County Jackson County professionals County professionals professionals Leadership Leadership and administration and administration and administration leadership, rship, staff, and staff,other and staff,other and other Leadership in Jackson in Jackson in Co.; Jackson caregivers Co.; caregivers Co.; caregivers with with with from CSF-funded from CSF-funded and non-CSF and non-CSF and non-CSF at partner at partner organizations. at partner organizations. organizations. from CSF-funded dntified community identified community community lived experience lived lived experience experience navigating navigating navigating the the the funded funded agencies. funded agencies. Young agencies. Young adults Young adultsadults essionals professionals professionals services services system. services system. system. with lived with experience lived with lived experience experience as youth. as youth. as youth. ball snowball (viasampling). snowball sampling). sampling).

Kickoﬀ Kickoﬀ Meeting Meetin & YourYour Thoughts Though Su

EXECUTIVE SUMMARY

Findings

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Four overarching themes emerged from the assessment:

Children in Jackson County have Compromised Well-Being.

Workforce Capacity and Coordination is not meeting the need.

Children’s Services in Jackson County are operating in a Strained System of Care.

There are Community and Systemic Barriers to kids and families accessing children’s services.

EXECUTIVE SUMMARY

Findings Compromised Well-Being The assessment revealed critical concerns related to youth mental health in Jackson County, which closely aligned with state and national trends. Evidence suggests that anxiety, trauma exposure, depression and suicidality are increasing in severity, with children as young as five exhibiting significant mental health symptomatology. The COVID-19 pandemic has exacerbated these challenges, contributing to a rise in acute mental health conditions among youth and young adults. Additionally, social determinants of health—such as poverty, housing affordability and instability and exposure to neighborhood/community violence—play a substantial role in compromising overall well-being for children in Jackson County.

Strained System of Care The increasing demand for mental health services, coupled with systemic barriers, has placed significant strain on Jackson County’s system of care, making it difficult for vulnerable children and families to access timely and necessary support. A shortage of qualified staff perpetuate long waitlists and restrict access to care, particularly for early childhood and specialized mental health services, leaving children and families in need. While some agencies are being innovative to bolster their workforce pipeline and broaden their service array and modalities, this progress requires resources and is not uniform across agencies. Information was collected regarding both the need and the availability of services. Individual counseling, social-emotional learning and conflict resolution were identified as most urgently needed. Interestingly, those three areas were also noted as some of the most available, offered and utilized services. The lack of caregiver mental health services presents a critical gap, as addressing parental and family mental health is essential to supporting and sustaining children’s well-being. Service coordination remains fragmented, reactive and often reliant on informal referral networks rather than structured pathways, making it difficult for families to efficiently navigate the system of care.

Workforce Capacity and Coordination During the assessment, administrators and direct service professionals alike expressed concern over staff capacity and workforce recruitment and retention. This workforce strain is compounded by inadequate reimbursement rates from Medicaid, high provider turnover, and an alarming shortage of qualified mental health professionals. As a result, many providers carry unsustainable caseloads, leading to burnout and further exacerbating workforce shortages. Additionally, limited opportunities for specialized training and supervision, particularly in evidencebased interventions and trauma-informed care, hinder the capacity of the existing workforce to meet the growing complex needs of children and families. 4

These workforce limitations result in long wait times for services, inconsistent care, and a reliance on emergency or crisis-based interventions rather than preventive and ongoing treatment. While workforce capacity remains an issue, Jackson Schools have increasingly become County’s children’s behavioral a default provider health service delivery of mental health system has a dedicated and services. While they compassionate workforce deeply play a vital role, schools often lack committed to supporting the wellsufficient resources being of the county's youth. This and staff to meet the workforce is highly skilled, bringing growing demand. expertise in trauma-informed care, evidence-based interventions and culturally responsive practices that enhance service delivery but in numbers that are insufficient to meet the need. Their dedication is complemented by a widespread desire among agencies to strengthen formal collaboration, foster cross-sector partnerships, and create opportunities for greater systems-level cohesion and collective impact. Nevertheless, future growth will require additional financial resources and credentialing support to retain and expand this vital workforce.

Community and Systemic Barriers Families that reside in Jackson County face persistent challenges related to poverty, inadequate transportation and limited affordable housing—factors that significantly restrict access to mental and behavioral health care. Adding to the complexity of these strains, broader community and systemic barriers continue to impede mental health equity and access. Racial disparities are also evident, with Black youth disproportionately represented in both the child welfare and juvenile justice systems, highlighting the continued need for targeted interventions to address inequities. Despite challenges posed by funding constraints, agencies in the Jackson County community consistently demonstrate innovation and resourcefulness, finding creative ways to maximize their impact and better serve the community. The system also benefits from strong community engagement, a commitment to continuous improvement and a shared vision among stakeholders to enhance accessibility and quality of care for children and families.

EXECUTIVE SUMMARY

Moving Forward The catalyst for this project was to help inform CSF’s investments over the next several years. The findings validated much of what we suspected and point to some opportunities as we move forward. Overall, CSF will continue to invest in the 10 Missouri statute-defined service areas. It is clear that the need for all services exceeds capacity. Additionally, since we began this assessment, there have been immense changes for the nonprofit landscape. A flurry of actions at the federal level has led to both a reduction in funding for services provided by many partners and increased instability and uncertainty for many of the organizations focused on children’s behavioral health. Given this, we believe that to best support children in Jackson County, we need to offer consistent and stable funding over the next several years in each of the areas identified by statute. We have also identified key opportunities for CSF to maximize impact for children in Jackson County:

Compromised Well-Being + Expand investment in prevention and social-emotional well-being promotion and development activities, especially for younger children. + Invest in both child and family services to support mental health and well-being. As we continue our investment in services for children, we’ll also be looking at additional opportunities to support mental health and well-being services for families. One clear message from providers was that treating a child in isolation without including their family is less effective.

Strained System of Care + Promote coordination and collaboration among service organizations, using the CSF’s unique vantage point to improve service reach, accessibility and referral pathways, fostering a more integrated and comprehensive approach. 6

+ Invest in approaches that meet youth where they are. We will leverage current service access points to reduce or eliminate barriers to access. Many students accessed services in schools and caregivers noted that this location eliminated many barriers. Given The CSF’s investments into schools, we need to examine opportunities for deployment of resources that reduce duplication and maximize reach.

Workforce Capacity and Coordination Workforce challenges clearly rose to the top as a priority issue. CSF will invest in strengthening the workforce in ways that fit within its mission. These include: + Sponsor cross-agency training opportunities for continuing education, trauma-informed certifications, and professional development training opportunities. + Explore mechanisms to support supervision programs for clinicians seeking licensure.

Community and Systemic Barriers to Mental Health Equity While many of these barriers, such as transportation, fall outside the scope of CSF funding, there are still opportunities for CSF to play a role in addressing these challenges. + Create legislative policy agendas, initially at the state level, in collaboration with service organizations and engage more intentionally in advocacy efforts. + Engage those with lived experience, including youth and caregivers, to inform funding opportunities and practices. + Strategically leverage partnerships and facilitate cross-sector and interdepartmental collaboration to tackle broader systemic barriers.

Table of Contents Introduction

Assessment Process

Overarching Findings

Theme 1:

Compromised Well-Being

Theme 2:

Strained System of Care

Theme 3:

Workforce Capacity & Coordination

Theme 4:

Community & Systemic Barriers to Mental Health Equity

Moving Forward

References

Appendices

INTRODUCTION

Introduction The Children’s Services Fund of Jackson County (CSF) was established in March of 2017 to allocate resources generated by a ⅛ of a cent sales tax approved by voters. With a mission of “Investing in Children, Strengthening the Community”, the CSF provides financial support to organizations that focus on mental health, social-emotional well-being and prevention services for children and youth 19 years old and younger. In 2022, voters in Jackson County voted to increase the sales tax allocation to ¼ of a cent and extend the tax in perpetuity. Since its inception, the CSF has awarded more than $185 million to support services for children in Jackson County. Given the doubling of revenue and the time that had passed since the initial funding round, it is important to reassess the state of children in Jackson County and the systems that support or hinder their well-being. The goal of the 2024 Children’s Services Assessment, was to collect and reflect on recent data to inform future decisions at CSF. CSF partnered with Kiley Liming, Ph.D. and Whitney Grube, Ph.D. of the Liming Group to conduct this research, which was guided by the following objectives: + Evaluate and summarize the current state of mental health and social-emotional well-being for children aged 0-19 in Jackson County, Missouri. + Understand and document how the service delivery system functions within Jackson County, Missouri for this population, with specific emphasis on the system’s effectiveness at supporting children’s socialemotional development and mental health. + Identify existing assets that may be leveraged to strengthen the child and adolescent service system in Jackson County, Missouri, and identify critical gaps and opportunities for growth.

ASSESSMENT PROCESS

Assessment Process To achieve these objectives, a phased, mixed-methods (quantitative and qualitative) approach was implemented. The Assessment included five main evaluation components, with all activities occurring between August and December 2024. The evaluation design was informed by the Center for Disease Control (Kidder et al., 2024) and the Children’s Services Fund Impact Framework (CSF, n.d). The information to the right details each activity, the associated goals, and focus area or target population. In total, the assessment included 310 community participants across all evaluation activities, spanning five months.

Children’s Services

Secondary Data & Literature Review

Qualitative Interviews

Goal: Developed a robust (not exhaustive), organized catalogue of publicly available secondary data sources and summarized extant literature/data on well-being indicators of Jackson County children and families.

Goal: Interviews focused on individual perspectives and experiences of successes, challenges, and future goals of agencies and organizations providing services to children and families of Jackson County.

Focus: Public datasets, repositories, and dashboards with child, student, and family-level well-being indicators.

Participants: Children’s Services Fund (CSF) leadership, staﬀ, and other identiﬁed community professionals (via snowball sampling).

Kickoﬀ Meeting & Share Your Thoughts Survey

Community & Young Adult Focus Groups

Organization/School Staﬀ & Caregiver Survey

Goal: Presented overview of Children’s Services Assessment project and solicited information from community partners (in-person and via survey). Information gathered directly informed focus groups, quantitative surveys, and assessment.

Goal: Guided by statutory service areas, structured focus group questions focused on strengths, areas of need, service gaps, and system-level barriers. A focus group with young adults with lived experience were held to incorporate youth voice.

Goal: Electronic surveys were administered to: 1) organizational staﬀ; 2) school staﬀ; and 3) caregivers (18+ years old) with lived experience. Surveys targeted barriers and facilitators of service receipt and service/population gaps.

Participants: Leadership and administration at partner organizations.

Participants: Jackson County professionals from CSF-funded and non-CSF funded agencies. Young adults with lived experience as youth.

Participants: Organizational and School staﬀ in Jackson Co.; caregivers with lived experience navigating the services system.

Children's Services Assessment Evaluation Design

vices Assessment Evaluation Design

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)

Pr Se

ASSESSMENT PROCESS

Design & Approach An iterative methodology was designed and deployed with evaluation components informing proceeding phases. In addition to the primary data collection activities, the researchers conducted a robust secondary data review.

Primary Data Collection & Analytical Approach The Children’s Services Assessment included qualitative (e.g., interviews and focus groups) and quantitative (e.g., electronic surveys) data collection methods, detailed in Table 1. Please see Appendix A for additional information related to primary data collection, methodology, and analysis.

Secondary Data Collection A robust secondary data review of both literature and data repositories was simultaneously conducted alongside primary data collection activities. The researchers compiled and analyzed existing data (statistics and trend data, if available) and literature from publicly available and reputable sources, prioritizing databases, dashboards and repositories that focused—directly or indirectly—on child/youth behavioral health and well-being indicators. To complement this secondary data review, the researchers identified and systemically catalogued over 50 informative databases, data dashboards and repositories (available in the Data Catalogue, available upon request). Please see Appendix B for a summarized list of main data sources used to provide a county-level overview and key extracted indicators. Overall, data collection efforts were diverse and strategically designed to capture insights from multiple populations and data sources, ensuring a comprehensive examination of both the Jackson County youth population and the system of care.

Table 1. Summary of Children’s Services Assessment Methodology and Sample Size by Evaluation Activity Primary Data Collection Activity

Date/Date Range

Qualitative Interviews

Kick-off Meeting

Share Your Thoughts Survey

Community Provider Focus Groups

Young Adult Focus Group

Caregivers Survey

Agency Staff Survey

School Staff Survey

JULY-DEC 2024

AUG 7th, 2024

AUG 2024

SEPT – OCT 2024

DEC 2024

Purposive

Sampling Method

Purposive & Snowball

Purposive

Purposive & Snowball

Purposive, funded & non-funded agencies structured around the 10 statute areas

Administration Format

Virtual, 60– 90 minute interviews

In-person, Customized 60-minute Electronic collaborative Survey workspace

Virtual & In-Person

Virtual

Customized Electronic Survey

Total # of Participants

17*

Language

English

English & Spanish

English

Participant Incentive

N/A

$40.00 Electronic Gift Card

$20.00 Electronic Gift Card

N/A

Qualitative, Thematic Analysis

Qualitative, Thematic Analysis of Table Worksheets

Qualitative, Thematic Analysis

Qualitative, Thematic Analysis; Quantitative demographic descriptives

Quantitative Descriptives; Limited Bivariate

Analysis

Notes: * = two qualitative interviews were targeted, supplemental interviews; Community Provider Focus Group sample by administration format: virtual attendees = 21; in-person attendees = 30. Caregivers with lived experience were recruited via agency and represented 10 unique organizations; Agency staff survey had 73 participants, representing 62 unique organizations; School staff survey had 18 participants, representing 16 unique schools. All Evaluation Activities detailed in the above table were reviewed by WCG IRB and received an exempt status determination.

ASSESSMENT PROCESS

The "Who" & "What" of Behavioral Health in Jackson County A Profile of Jackson County Youth In 2023, 1 in 4 residents of Jackson County was 0-19 (U.S. Census Bureau).

24.3% 15 to 19 years old

184,53 (0-19)

26.0% 10 to 14 years old

25.5% 5 to 9 years old

24.2%

50.8% Male (0-19 yrs) | 2023

51.2% BIPOC* (0-17 yrs) | 2022

6.6% Uninsured (0-17 yrs) | 2022

Under 5 years old

Note: Data was compiled from a variety of data sources which had different age ranges as well as varying time periods. *Based on 2023 5 year American Community Survey estimates

Overall, the youth population of Jackson County is much more diverse than the state as a whole.

34 youth* 32.1% Single Parent Families (0-17 yrs) | 2021

19.4% Live in Poverty (0-17 yrs) | 2019-2023

26% Needed Mental Health Services (5-17 yrs) | 2021

14.7% Diagnosed Depression (5-17 yrs) | 2021

What is children’s behavioral health? Using a public health approach (Stiffman et al., 2010) the researchers operationalized children’s behavioral health as a youth’s social (relational), emotional (feeling), psychological (mental), and behavioral (action) development and well-being. Children’s behavioral health services encompass a variety of prevention, diagnostic and treatment services, such as: assessments and evaluations, therapy or counseling (individual, family, or group), substance use prevention and treatment, recovery support, medication management, emergency mental health/psychiatric services, in-home services or programs, outpatient treatment, residential and respite care, peer support groups and more.

Four overarching themes emerged from the assessment:

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Children in Jackson County have Compromised Well-Being.

Children’s Services in Jackson County are operating in a Strained System of Care.

Workforce Capacity and Coordination is not meeting the need.

There are Community and Systemic Barriers to kids and families accessing children’s services.

Overarching Findings The results presented in this report are not exhaustive; rather, the findings presented concentrate on the four main themes. Each of the main themes will be summarized highlighting pressing concerns, systemic gaps, and opportunities for growth within the children’s behavioral health service delivery system in Jackson County, providing a comprehensive understanding of the experiences of children, families, service providers and other stakeholders. Select quantitative results and qualitative quotes from the primary data collection activities will be presented. Each section includes secondary data to support and further validate key insights, providing a broader perspective and enhancing the overall credibility and depth of the analysis.

Compromised Well-Being

THEME 1

Compromised Well-Being A prominent and consistent theme was the ever-growing concern about the mental health and overall well-being of children and adolescents, which are affected by a range of evolving challenges. These challenges include the real and perceived threat of violence, social media’s pervasive influence and social isolation despite a broader societal shift toward increased community awareness and reduced stigma surrounding mental health issues. Participants expressed worry about the escalating acuity of mental health needs in youth, noting that cases are becoming more complex and severe. Such cases require specialized, intensive interventions that place additional strain on an already overburdened system of care workforce. Though this of organizational staff either "agreed" trend spans all youth age groups, concern over the prevalence or "strongly agreed" that the majority of severe symptoms among young children, such as suicidality, of children their agency serves were heightened. have multiple diagnoses. 58.9% of Of youth with mental or behavioral health concerns, caregivers reported on average 3.9 (SD = 2.6) mental or behavioral health conditions (either suspected, diagnosed, or treated).

61.7% organizational staff "agreed" or "strongly agreed" that most child-clients served remain in their care (i.e., open cases) for more than 12 months, with 42.1% of caregivers reporting their child received services for 12 months or more.

Participants emphasized the critical need to distinguish between mental health diagnoses and developmental concerns, particularly in younger children, as overlapping symptoms can lead to misdiagnosis without accurate assessments. Such

Data from Children's Mercy Hospital Needs Assessments provide localized trend data on increased acuity. *Data was collected on children in Jackson, Clay, Platte, Wyandotte and Johnson Counties 2021

2024 2021 2018

10.70%

14.30%

11.80%

2024

11.00%

11.60%

2015 2012

2018

17.30%

9.40%

2012

6.90%

3.20%

% of children in Kansas City metro area experiencing "fair" or "poor" mental health*

2015

3.00%

% of children in Kansas City metro area who felt sad or hopeless for 2 or more weeks*

Jackson County children ages 5-17 with a mental health diagnosis (2024) 11.30%

23.40% Depression

21.80% Anxiety

ADD/ADHD

Source: PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. 2024 Note: The State of Children's Health: 2025 Community Health Needs Assessment for the Kansas City Region, Children's Mercy Kansas City, MO.

We can coach and work with the students all day on social skills, regulation, conflict resolution…and, if they go home to a house that does not have the same beliefs about how to handle conflict, it’s just starting from scratch every day. JACKSON COUNTY PROFESSIONAL

misdiagnoses can have significant, long-term consequences. In particular, participants noted the lasting effects of the COVID-19 pandemic on young children, highlighting how social isolation has contributed to speech delays that are sometimes mistakenly classified as mental health issues. Young adult participants expressed concerns about the overreliance on medication by providers, emphasizing the need for more holistic youth-centered treatment approaches. Additionally, trauma emerged as a pervasive factor impacting emotional, social, and academic functioning for both youth and their caregivers. External threats—including actual and perceived gun violence, domestic violence, and teen dating violence—were identified as key contributors to feelings of insecurity and instability within schools and communities.

The most common suspected, diagnosed, or treated mental and behavioral health conditions reported by caregivers were Anxiety (n = 12), ADHD/ADD (n = 10), and Trauma Disorders (e.g., PTSD, n = 9).

Social media and technology were frequently cited as both fostering connection and posing significant risks to youth mental health. Participants highlighted cyberbullying as a pervasive and inescapable threat, exacerbated by the constant presence of smartphones and social media platforms. However, young adults with lived experience noted that technology also served as a valuable tool for accessing virtual mental health services. Many preferred virtual therapy sessions after establishing rapport with their provider, citing the convenience and accessibility of remote care. Specifically, technology reduced their need for transportation and allowed them to access services from a more comfortable environment (i.e., their home).

Systemic challenges further complicate the well-being of children in Jackson County. One significant issue highlighted was the difficulty in sustaining the impact of school- and community-based mental health programs, as the skills learned are often not reinforced in the home environment. This systemic challenge is closely tied to the intergenerational transmission of mental health challenges and coping behaviors. Participants noted that these issues can be passed down through generations, often due to a lack of sufficient intervention or resources available to caregivers to disrupt the cycle. Without accessible and comprehensive services for entire families—not just children—caregivers may struggle to support their child's mental health while managing their own unmet needs. Relatedly, young adult participants emphasized the need for age-appropriate behavioral and mental health interventions rather than an overreliance on medication. These subthemes—increased acuity of mental health needs, the impact on younger children, diagnostic challenges, trauma, violence, social media risks, temporal conflict resolution and the intergenerational transmission of mental health issues—underscore the intersectional and complex factors that undermine the well-being of youth in the community. As a result, children and families experience a multifaceted and often fragmented system of care, where schools, families, healthcare providers and community organizations experience significant strain. 20

“There's lots and lots of problems with behavioral health... at a level we haven't seen before.” JACKSON COUNTY PROFESSIONAL

What’s the Data Show? Overall, youth mental health trends in Jackson County, Missouri, align with broader state and national patterns, with anxiety, depression and behavioral disorders among the most commonly reported concerns (Sappenfield et al., 2024). Nationally, nearly 80% of children in need of mental health care do not receive it (Agenda for Healthcare Research and Quality, 2022), and in Missouri, an estimated 41.4%–46.6% of children (0–17 years old) with a treatable mental health disorder go without treatment or counseling (Whitney & Peterson, 2019). The increasing mental health needs of Jackson County youth are reflected in the rising acuity and complexity of challenges they face, particularly within the juvenile justice system. Delinquency and juvenile justice concerns have escalated, particularly in relation to status offenses—offenses based solely on the youth’s age. Striking racial disparities persist, with Black youth accounting for 81% of delinquency and technical offense filings in 2023. In 2023, the number of status offenses more than doubled compared to 2022, continuing a steady upward trend over the past eight years. This concerning rise in status offenses is further compounded by a sharp increase in firearm-related incidents among youth, with 21 firearm offenses reported in 2023 compared to just two in 2022. These troubling trends underscore the urgent need for enhanced mental health services, early intervention and cross-system collaboration to address the growing acuity of behavioral health concerns among Jackson County’s youth. According to the Missouri Student Survey (2024: Missouri Department of Mental Health), approximately 1 in 10 (10.1%) Jackson County youth who voluntarily participated in the survey reported seriously considering suicide, with 19.2% of students reporting self-injury. Overall, as a state, suicide is the 2nd leading cause of death among 10- to 34-year-olds (Missouri Department of Health and Senior Services, n.d.).

I have a huge concern that we are misdiagnosing people with mental health issues when they are, developmentally, other things. JACKSON COUNTY PROFESSIONAL

I hate to say that it’s worse off, but it certainly feels heavier…a lot of anxiety and suicidal ideation. JACKSON COUNTY PROFESSIONAL

The Missouri Student Survey was identified as a common resource identified by and used among community partners (via interviews, focus groups, written qualitative data, and survey responses). 1

Strained System of Care

THEME 2

Strained System of Care

48.4% of responding organizations indicated they currently had a waitlist. Though variable by service provided, reported waitlists ranged from one week to one year, with most organizations reporting waitlists of 30-90 days. The greatest barrier to care identified by caregivers was “time to service receipt”.

17.7% of responding organizations and 22.2% of responding schools reported Medicaid as a payor source. Of the agencies that accepted Medicaid, the majority reported that it accounted for 20% or less of their collections.

The significant strain on the child and family service system in Jackson County has resulted in service delays, inefficiencies, and an inability to meet demand. Capacity constraints are among the most pressing concerns, with long waitlists for critical services, particularly for early childhood and Spanish-speaking populations. These delays can exacerbate crises, leaving families in distress without timely and appropriate support. Participants referenced recent statistics that over 2,500 individuals were turned away from a domestic violence shelter in one year, and only a fraction of 1,100 applications for transitional living beds were accepted. Additionally, a lack of caregiver services further impedes holistic treatment, as the absence of dual-generation support limits intervention effectiveness. Informal referral networks have become a common, yet inconsistent, means of service coordination. Many professionals rely on established professional connections and personal social media accounts, leading to inequities in access and inefficient service navigation. While this practice is inefficient it also speaks to the commitment of staff to continually push for solutions for their clients. Participants emphasized both their need and desire for structured app/web-based coordination tools, expanded telehealth Only options and in-person events focused on increasing awareness of Jackson County services for both professionals of organizational staff reported and community members.

Financial Barriers Medicaid reimbursement challenges and policy barriers create obstacles to effective service delivery. Professionals described difficulties agencies face, including long Medicaid approval processes, inadequate reimbursement rates, unpaid claims and long payment delays. These financial constraints contribute to workforce shortages, as low pay and impractical productivity standards make it difficult to attract and retain professionals. Young adults emphasized the challenges of accessing care, noting the limited availability of providers who accept Medicaid.

43.1%

that they agree their agency has the capacity to provide in-house language services for non-English speaking families.

53.4% of organizational staff reported that most children their agency serves need additional services outside of what their organization provides or offers. 80.8% of staff agreed that they refer to the same partners.

Additionally, policy and service gaps have left some families with no other option but to relinquish custody of their child to the state in order to access residential services. In this system, Juvenile Justice and Foster Care often serve as unintended pathways to mental and behavioral health support.

“Changing child welfare practices are placing a greater strain on agency resources…[we] need an advocate in the Medicaid system to hear the concerns.”

Current funding structures and data silos exacerbate systemic inefficiencies. Variations in data sharing forms and the lack of interoperability among agency data platforms lead to inefficient data ORGANIZATIONAL PROFESSIONAL, sharing processes, service duplication and increases in potential reJACKSON COUNTY traumatization for families who are required to repeatedly share their stories during each intake process. The absence of standardization prohibits service coordination and seamless access to necessary services. Even with the many system level challenges, organizations are consistently looking for innovative collaborations and solutions. A promising example of effective data use among community providers is the development of a real-time data dashboard by transitional living agencies. This tool enables providers to quickly see bed availability, improving coordination and access to services. A service-wide data dashboard, maintained and accessible to professionals, enhances timely service delivery, increases provider awareness of available resources, and reduces staff burden by streamlining the referral process.

The Role of Schools Schools are a cornerstone in the delivery of needed prevention and behavioral health services, and they recognize their potential in meeting the social and emotional needs of school-aged youth. The assessment revealed that while most schools offer a variety of school-based behavioral health and prevention services, the long-term sustainability of these efforts remains a significant challenge. Specifically, the majority of schools rely on their staff to provide both academic instruction and behavioral health support in some capacity. Schools who contracted services were also reliant upon their staff to provide the same or different school-based behavioral health services, revealing that many schools contract on a limited basis for limited services while relying on their staff to fill the void. This finding potentially exposes an inefficiency of school-based services that may result in unsustainable school-based behavioral health efforts and staff burnout and warrants further exploration. While schools are essential touchpoints for reaching families, participants emphasized the need for greater involvement from community agencies to support mental health interventions.

100%

of surveyed schools provided school-based social-emotional learning services to students. All schools reported that their staff provided some or all of these social-emotional learning services.

Overall, the identified structural challenges—including capacity limitations, service accessibility barriers, lack of caregiver support, inefficient service coordination, Medicaid reimbursement issues and funding/data silos—underscore opportunities for system-wide improvement. Strengthening capacity, enhancing coordination, optimizing Medicaid funding and streamlining data management and accessibility will help create a more responsive and effective support system for children and families in Jackson County.

Service Gaps: Does Availability Equate to Need? To identify potential service gaps, the organizational staff survey collected data on behavioral services provided and the ages of youth served. Given the purposive sample and the self-reported nature of the data, caution should be taken when interpreting the following. The chart below shows the percent of agencies providing different services.

Service Area Saturation Least Available Services (<10%) • Psychiatric Services • Early Childhood • Middle Childhood • Adol./Young Adult • Sub. Use Tx – Inpatient • 24/7 Crisis Response • Early Childhood • Middle Childhood • Respite Services • Emergency Shelters • Adol./Young Adult

Limited/Moderately Available Services (10% - 15%)

Readily Available Services (50%+)

• 24/7 Therapeutic Care • Day Treatment • Medication Tx./Manag. • Sub. Use Tx – Outpatient • Therapeutic Bx Aide Serv. • 24/7 Crisis Response • Adol./Young Adult • Permanent Housing Services • Visitation Services • Other Services, Speciﬁed

• Assessment and Evaluation • Case Management • Family Therapy – Outpatient • Individual Therapy – Outpatient • Behavior Management Skills Training • Conﬂict Resolution/Violence Prevention • Parenting Skills/Interventions • Social Emotional Learning

Examining the ages of youth served, scarcity was seen in the following areas: + Residential treatment options for young children (under 6 years old) and young adults. + Day treatment and medication management programs for older adolescents. + Psychiatric services for youth of all ages, especially for early and middle childhood. + Inpatient substance use treatment services, with no organizations providing inpatient substance use treatment services to 19-year-olds. + 24/7 crisis response services for youth of all ages, with the greatest restriction for middle childhood (6 12-year-olds). + Respite services, with only one organization serving children birth - 5 years, and only one organization serving 19-year-olds. + Transitional housing for youth 0 -15 years old. + Legal services for adolescents and young adults, with no organizations providing legal services for youth 12 years old and younger. Individual therapy (outpatient), social emotional learning, conflict resolution, violence prevention (interpersonal and community) and case management were identified as urgently needed services, despite being some of the most available, offered, and utilized services with the Jackson County system of care. Caregiver responses were in alignment with the provider findings, suggesting that provider perception converges with consumer need. Jackson County caregivers with lived experience identified counseling/ therapy and assessment and evaluation services for behavioral health as the most pressing needs, followed by school-based prevention services and social-emotional learning. These four services were also the most utilized, as reported by caregivers.

To effect meaningful and lasting change for children, we need supports within the school. There must be a comprehensive approach that includes interventions with the family, particularly the parents. If we do not get inclusion of the parents, the concern is that the supports to the children are only a band-aid approach to deeper issues that include mental health and substance abuse. JACKSON COUNTY ORGANIZATIONAL PROFESSIONAL

What’s the Data Show? To illustrate system strain, secondary data was examined to observe potential system capacity limitations and system demand, cross-sectionally and longitudinally, if available. Examination of mental health services revealed limited inpatient psychiatric facilities available for Jackson County youth, with no beds specifically designated for children experiencing both medical complexities and mental health concerns (Children’s Mercy Kansas City, 2022b). Of the available mental health services, 69% were rated as insufficient or poor by constituents (Children’s Mercy Kansas City, 2019).

“It's awful that you have to give up custody of your child to access services because they're not available or affordable to you otherwise. We only finally got help because the police contacted a community resource on our behalf. But even then, I could only get [child] services by giving up custody to the state.”

Capacity and availability limitations in the behavioral health system or care inadvertently deflect children and youth in need to other JACKSON COUNTY child-serving systems such as the child welfare and juvenile justice CAREGIVER systems. Despite a four-year downward trend in child abuse and neglect formal filings and removals, outcomes for Jackson County children already placed out-of-home are concerning. In 2022, 791 Jackson County youth exited foster care; however, less than half of these youth (49.9%) achieved reunification with their birth parents. Alarmingly, placement instability—which is associated with a variety of adverse outcomes—was high, with 431 youth in out-of-home care reporting five or more placements (Missouri Coalition for Children, n.d.). Children living in poverty and youth of color are disproportionately involved with the child welfare system. In Jackson County, just under 25% of the youth population identifies as Black; however, in 2022, Black children accounted for 40% of Jackson County children in foster care. .

“The only way you can ever get people in is through a side door connection." JACKSON COUNTY PROFESSIONAL

61.1% of surveyed school staff reported commonly referring students in need to child welfare services.

“We have gone from serving approximately 125 people in 2021 to serving nearly 1,000 people in 2024.” LEADERSHIP/ADMINISTRATOR, JACKSON COUNTY ORGANIZATION

“I want to underscore the significant impact that a mental health first response unit would have for a families like mine…we adopted our [child] from foster care. [They] ha[ve] experienced trauma and were exposed to substances…when [they] experience mental health crises, many parents feel like their only option is to call the police for assistance.” JACKSON COUNTY CAREGIVER

“I was in a low point, like a not super busy time. So I got a therapist within a month, but they said that when I like, did all the paperwork, they told me that the average wait time was about 4 to 6 months.” JACKSON COUNTY YOUNG ADULT

“The waitlists are really long, because there are only like three places we can go and honestly, I'm not even sure it’s three [providers who accept Medicaid].” JACKSON COUNTY YOUNG ADULT

Workforce Capacity & Coordination

THEME 3

Workforce Capacity & Coordination Administrators and direct service professionals alike expressed an ever-growing concern over staff capacity and workforce recruitment, retention and qualifications. Significant saturation was observed among professionals around staff capacity, as there are simply not enough providers to meet the increasing demand for services. Long waitlists, provider burnout (due to complex cases and large caseloads to meet productivity thresholds and need) and an overburdened workforce limit access to timely and consistent care, particularly for children with complex mental health needs. Many agencies struggle to retain staff due to high turnover rates, salary constraints and vicarious trauma. Further compounding staff capacity concerns are the limited workforce development programs, insufficient opportunities for specialized training and supervisors, particularly in evidence based interventions and trauma care, and internship pipelines which hinder efforts to expand the number of qualified professionals entering the field. Cultural responsiveness is another area of concern, with providers noting the need for bilingual and multilingual staff to serve nonEnglish speaking families, though challenges remain in building diverse, demographically representative workforces. While initiatives like internships and fellowships have been implemented, recruiting and retaining qualified staff continues to be a struggle. Jackson County professionals and stakeholders are dedicated to enhancing the well-being of children and families by strengthening behavioral health services and improving the service delivery system. The current children’s behavioral health workforce consists of passionate and committed professionals. Providers in Jackson County emphasized the need and desire for better workforce coordination and collaboration to improve the effectiveness of service delivery systems. A key issue is the lack of formal coordination between agencies, which would promote awareness of each other’s services and target populations, breaking down existing silos. Providers also highlighted the importance of reducing duplication of efforts and clarifying each organization’s role in Jackson County’s system of care. Finally, there is also a call for greater coordination among community funders to foster a sense of unity, with suggestions for events like lunch-and-learns or formal networking to facilitate collaboration. This could lead to shared learning, better resource leveraging, and advocacy for increased state and federal investment in mental health.

19.1% of caregivers reported language being barrier to service receipt.

VOICES OF PROFESSIONALS

“Our greatest need is recruiting and retaining a high-quality team of direct service personnel.” “[We need] staff with the training and skills to provide traumainformed case management, and more staff to allow for more manageable caseloads.” “One of our most pressing needs is to expand our team of therapists to meet the growing demand for services…[and who] can do a deep dive into the complexities of family dynamics that include mental health and substance abuse issues, as well as clinicians who bring cultural sensitivity and competency to their practice.”

38.4% of organizational staff reported finding it difficult to locate the needed services in Jackson County for their child-client, with 39.7% of organizational staff indicating the referral process is not easy to navigate.

Estimating Workforce Shortages At any given time throughout the year, 25% of children are experiencing a mental health issue, and 10% of those children are experiencing a serious emotional disturbance, requiring higher levels of care (Williams et al., 2018).

In Jackson County

184,534

46,133

669*

Estimated Youth Population

Estimated children who experience a mental health issue each year

Estimated youth mental health service providers in Jackson County

*30% of all Jackson County registered service providers, representing a liberal estimate based on national data

69:1 Youth-to-Provider Ratio Using available secondary data and recent research, 69 youth per 1 Jackson County service provider represents a liberal estimate (meaning that in reality, the disproportion is even larger). This is nearly 4 times the best practice recommendation of 18 service recipients per provider, which is specifically intended for case management practices (Chen, 2019; Rapp & Goscha, 2012). (Note: it is important to exercise caution in interpreting this figure, as these are rough estimates and may not fully account for the variability in service delivery and provider caseloads across different contexts.

“I go through caseworkers every six months. So a lot of it [getting additional referrals] is just asking myself or bothering people.” JACKSON COUNTY YOUNG ADULT

“There's not enough of us…there's not. There's no coordination here.” JACKSON COUNTY PROFESSIONAL

It’s hilarious, for lack of a better word, because you're like, ‘Okay, does anybody have the latest? What's going on? Call the foster care liaison…No, no, you call the counselor's office’…that's chaos. It’s just chaos. JACKSON COUNTY PROFESSIONAL

What’s the Data Show? At the county, state, and national levels, there are significant concerns about the capacity and retention of the behavioral health workforce. According to the Missouri licensure registries by provider (Missouri Professional Registration, n.d.), there are 2,233 registered providers in Jackson County; however, this number should be interpreted with caution due to the county’s unique geographic location. Many providers are likely dually licensed in both Missouri and Kansas, which may inflate the count of available professionals. Additionally, the available data does not allow for an examination of practice status (e.g., active vs. inactive) or disaggregation by population served (e.g., child vs. adult). Jackson County's workforce trends highlight a significant shortage of child and adolescent psychiatrists, with only 20 registered professionals serving the youth population. Additionally, the average age of these providers is 50 years, suggesting potential future workforce challenges. Nationally, recent data indicates that the U.S. is projected to experience a shortage of nearly 31,100 psychiatrists (Association of American Medical Colleges, 2023). This scarcity of trained professionals exacerbates access limitations and contributes to prolonged waitlists, underscoring the urgent need for targeted workforce development.

Community & Systemic Barriers to Mental Health Equity

THEME 4

Community & Systemic Barriers to Mental Health Equity Emergent community and systemic barriers to mental health equity in Jackson County revealed several interconnected subthemes, including poverty, transportation challenges, violence, housing, the role of schools and the burden on dualrole administrators. These challenges are further compounded by geographic disparities and limited service availability. Young adult participants expressed frustration with community primary care physicians' lack of expertise in mental health concerns and reliance on medication.

“Low- and no-cost options don’t offer [the] greatest access/availability, can be overburdened and often don’t have staff knowledgeable about the specific needs or experiences of the [population].” ORGANIZATIONAL PROFESSIONAL, JACKSON COUNTY

Regarding housing, access to affordable options emerged as a significant barrier, with many families struggling to find stable housing that aligns with their financial means. Moreover, the definition of "affordable" remains highly subjective and often fails to account for the true cost of living in of organizational staff reported Jackson County, including expenses for transportation, childcare and affordable housing as a other essential needs. Relatedly, professionals identified poverty as significant or critical/severe a foundational issue affecting families – ultimately impacting access barrier to service receipt. to services. A key strength of the system, particularly for financially vulnerable families, is that many agencies and schools provide services at no cost. However, despite the absence or minimal cost of these services, it remains unclear whether most caregivers and community members are aware of this benefit, underscoring the need for improved community outreach and awareness efforts.

56.2%

38.4% of organizational staff identified transportation to services as a significant or critical/severe barrier to service receipt, and 38.8% of school staff reported referring students/families to transportation services somewhat or very commonly.

Transportation barriers, coupled with geographic constraints— particularly in Eastern Jackson County—further limit access to essential services, deepening disparities. Violence, particularly gun violence, both real and perceived, fosters an environment of fear and instability that negatively impacts children's social and emotional well-being. This climate of fear extends to service providers as well, with many agencies and schools struggling to balance client trust with individual and agency safety in their direct service delivery.

Finally, systemic capacity constraints lead to multirole administrators, where administrative professionals are required to juggle direct service provision alongside leadership duties. This workload contributes to burnout and turnover, further straining an already overburdened system. Addressing these systemic barriers is crucial to improving mental health equity and service accessibility for Jackson County children and families.

38.1% of caregivers reported awareness of community services—or lack thereof—was a barrier to service receipt.

37.9% of organizational administrators or leadership indicated they provided direct clinical services.

I'd love to figure out a way for a lot of these interventions to happen outside of the school day or in collaboration with the school…putting some of the responsibility for these other interventions back on the community agencies where it's really their expertise. I mean, socialemotional learning is not an algebra teacher’s specialty. So, getting it back [to] the professionals [who] are actually equipped to deal with that. JACKSON COUNTY SCHOOL PROFESSIONAL

What’s the Data Show? The median Jackson County household income is $67,178, alongside an average of 2.3 persons per household (Greater Kansas City Regional Housing Partnership [RHP], n.d.). Over 43,600 households in Jackson County are cost burdened—which HUD defines as monthly housing costs exceeding 30% of monthly income—and an additional 36,800 households are severely cost burdened (monthly housing costs exceeding 50% of monthly income) (RHP, n.d.). Western and central Jackson County (from North Kansas City and Independence down to Grandview) have the greatest prevalence of housing units with cost burden greater than 30%. These geographic trends also correspond with the highest renter-occupied locations, greatest demographic diversity and the most households receiving emergency rental assistance (as reported by DataKC, 2023). Geographically corresponding with high poverty and cost-burden areas are the elevated rates of crime and violence reported throughout Jackson County. Kansas City’s violent crime rate is one of the highest in the United States, with 14.8 residents per 1,000 being a victim of violent crime annually. The highest criminal activity is observed among young adults, aged 18-24 years old (DataKC, n.d.). Looking at trend data, 0-17-yearolds had the greatest increase in homicide rates from 2020 to 2023 compared to other age categories, indicating that violent crimes among youth are increasing (Polic KC/MC, n.d.). These patterns may be permeating the milieu of schools, too, with school disciplinary events increasing over the last several years, particularly as it relates to discipline events involving a weapon (Missouri Behavioral Health Epidemiology Workgroup, n.d). This increase suggests growing challenges in maintaining a safe and supportive learning environment, potentially linked to post-pandemic behavioral and social-emotional difficulties among students.

If you're not housed and you don't know where you’re going to stay, you don't know where your food's going to come from. And you don't really know what school you’re going to go to. You’re going to have a lot of mental issues. And they just compile on each other. So, we have to get to the root of the problems. JACKSON COUNTY PROFESSIONAL

“It comes back to two big things: poverty and affordable housing. And honestly, I believe if we could solve some of that, the rest of it sort of falls behind.” JACKSON COUNTY PROFESSIONAL

“A lot of our kids are being witnesses to violence, gun violence, homicides, that type of thing.” JACKSON COUNTY PROFESSIONAL

“One of the biggest issues is transportation to and from….. And if you can't provide transportation, give them that option to do virtual, ….I don't like going down there. There's a lot of people, and it's not. It's not as comfortable.” JACKSON COUNTY YOUNG ADULT

MOVING FORWARD

Moving Forward The catalyst for this project was to help inform the CSF’s investments over the next several years. The findings validated much of what we suspected and point to opportunities as we moving forward. Overall, CSF will continue to invest in the 10 Missouri statute-defined service areas. It is clear that the need for all services exceeds capacity. Additionally, since we began this assessment, there have been immense changes for the nonprofit landscape. A flurry of actions at the federal level has led to both a reduction in funding for services provided by many partners and increased instability and uncertainty for many of the organizations focused on children’s behavioral health. Given this, we believe that to best support children in Jackson County, we need to offer consistent and stable funding over the next several years in each of the areas identified by statute. The Children’s Services Assessment found there to be compromised well-being for Jackson County kids, a strain on the service system, a lack of workforce capacity and coordination and community and systemic barriers to accessing services. Below, we note other opportunities for CSF to maximize impact for children in Jackson County in these identified areas.

Compromised Well-Being + Expand investment in prevention and social-emotional well-being promotion and development activities, especially for younger children. + Invest in both child and family services to support mental health and well-being. As we continue our investment in services for children, we'll also be looking at additional opportunities to support mental health and well-being services for families. One clear message from providers was that treating a child in isolation without including their family is less effective.

Strained System of Care + Promote coordination and collaboration among service organizations, using CSF’s unique vantage point to improve service reach, accessibility and referral pathways, fostering a more integrated and comprehensive approach. + Invest in approaches that meet youth where they are. We will leverage current service access points to reduce or eliminate barriers to access. Many students accessed services in schools and caregivers noted that this location eliminated many barriers. Given the CSF’s investments into schools, we need to examine opportunities for deployment of resources that reduce duplication and maximize reach.

Workforce Capacity and Coordination Workforce challenges clearly rose to the top as a priority issue. The CSF will invest in strengthening the workforce in ways that fit within its mission. These include: + Sponsor cross-agency training opportunities for continuing education, trauma-informed certifications, and professional development training opportunities. + Explore mechanisms to support supervision programs for clinicians seeking licensure.

References Association of American Medical Colleges. (2023). The growing psychiatrist shortage: Enormous demand for mental health services. https://www.aamc.org/news/growing-psychiatrist-shortage-enormous-demandmental-health-services Chen, J. (2019). Research summary: Caseload standards and weighted methodologies. Academy for Professional Excellence, San Diego State University School of Social Work. https://theacademy.sdsu.edu/wp-content/uploads/2021/10/CWDS-ResearchSummary_Caseload-Standards-and-Weighting.pdf Children’s Mercy Kansas (2019). Community health needs assessment. https://www.childrensmercy.org/siteassets/media-documents-for-depts-section/ documents-for-in-the-community/community-benefit/2019-community-healthneeds-assessment-kansas-city.pdf Children’s Mercy Kansas City (2022a). Community health needs assessment. https://flipbook.childrensmercy.org/2022-community-health-needs-assessment/fullview.html Children’s Mercy Kansas City (2022b) Behavioral health business plan: Final report [power point slides]. Children’s Services Fund [CSF]. (n.d.). Community impact framework. https://jacksoncountykids.org/about/#our-community-impact-framework Courtney, M., Terao, S., & Bost, N. (2004). Midwest Evaluation of Adult Functioning of Former Foster Youth: Conditions of Youth Preparing to Leave State Care. Chapin Hall Center for Children at The University of Chicago. DataKC. (2023). KCMO Emergency Rental Assistance Program. City of Kansas City, Mo. [data charts and map]. https://data.kcmo.org/stories/s/Emergency-RentalAssistance-Program/7h3g-6vjw/ DataKC. (n.d.). Data Catalog. City of Kansas City, Mo. [data set and data maps]. https://data.kcmo.org/ Greater Kansas City Regional Housing Partnership. (n.d.). Housing Data Hub. [interactive data set]. https://kcrhp.org/housing-data-hub/ Kidder, D. P., Fierro, L. A., Luna, E., Salvaggio, H., McWhorter, A., Bowen, S.-A., Murphy-Hoefer, R., Thigpen, S., Alexander, D., Armstead, T. L., August, E., Bruce, D., Clarke, S. N., Davis, C., Downes, A., Gill, S., House, L. D., Kerzner, M., Kun, K., … Young, K. (2024). CDC Program Evaluation Framework, 2024. MMWR. Recommendations and Reports, 73(6), 1–37. https://doi.org/10.15585/mmwr.rr7306a1 Lund, A. (2022). An historical narrative of the educational trajectory of the child raised in state care. Creative Education, 13(8), https://doi.org/10.4236/ce.2022.138152

References Mid-America Regional Council. (2022). Poverty rate by census tract (2022 ACS, 5-year estimate). https://data.marc.org/assets/data&maps/ACS_PovertyRate.jpg

Missouri Behavioral Health Epidemiology Workgroup. (n.d.). School discipline events involving a weapon. https://seow.dmh.mo.gov Missouri Department of Elementary and Secondary Education. (n.d.) Missouri Comprehensive Data System. [interactive data set] https://apps.dese.mo.gov/MCDS/Visualizations.aspx?id=22 Missouri Department of Mental Health & Department of Elementary and Secondary Education [DESE]. (2024). Missouri student survey 2024: Summary of findings. Missouri Department of Mental Health. https://dmh.mo.gov/sites/dmh/files/media/pdf/2024/06/missouri-studentsurvey-2024-jackson-county.pdf Missouri Kids Count. (2024). Missouri Kids Count data book: Jackson County summary. https://missourikidscountdata.org/pages/2024/Jackson.pdf Missouri Professional Registration. (n.d.). License search. Missouri Division of Professional Registration. https://mopro.mo.gov/license/s/license-search Police KC/MO. (n.d.). Crime Mapping. Kansas City Missouri Police Department. [data set and data map]. https://www.kcpolice.org/crime/crime-mapping/ PRC Child & Adolescent Health Survey, Professional Research Consultants, Inc. 2024 Note: The State of Children's Health: 2025 Community Health Needs Assessment for the Kansas City Region, Children's Mercy Kansas City, Kansas City, MO, 2025 Rapp, C. A., & Goscha, R. J. (2012). The strengths model: A recovery-oriented approach to mental health services (3rd ed.). Oxford University Press. Ryan, J. P., & Testa, M. F. (2005). Child maltreatment and juvenile delinquency: Investigating the role of placement and placement instability. Children and Youth Services Review, 27(3), 227–249. https://doi.org/10.1016/j.childyouth.2004.05.007 Sappenfield, O., Alberto, C., Minnaert, J., et al. (2024, October). Adolescent mental and behavioral health, 2023. In National Survey of Children’s Health Data Briefs. Health Resources and Services Administration. https://www.ncbi.nlm.nih.gov/books/ NBK608531/ Stiffman, A. R., Stelk, W., Horwitz, S. M., Evans, M. E., Outlaw, F. H., & Atkins, M. (2010). A public health approach to children's mental health services: possible solutions to current service inadequacies. Administration and policy in mental health, 37(1-2), 120–124. https://doi.org/10.1007/s10488-009-0259-2

References The Annie E. Casey Foundation. (n.d.). Data center custom reports. https://datacenter.aecf.org/data/customreports/4196,67/1986,9546,9565 Tri-West. (2021). Behavioral health system asset mapping project: Brief document: Jackson County/Kansas City Region. U.S. Census Bureau. (2023). ACS 5-year estimates by racial categories. https://www.census.gov/data/developers/data-sets/acs-5year.html U.S. Centers for Disease Control and Prevention, Aug. 20, 2024 About Children’s Mental Health, https://www.cdc.gov/children-mental-health/about/index.html U.S. Department of Education, Office of Special Education and Rehabilitative Services, Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs, Washington, DC, 2021. This report is available on the Department’s website at https://www2.ed.gov/documents/students/supporting-child-student-socialemotional-behavioral-mental-health.pdf Whitney, D. G., & Peterson, M. D. (2019). US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children. JAMA Pediatrics, 173(4), 389–391. https://doi.org/10.1001/jamapediatrics.2018.5399 Williams, N. J., Scott, L., & Aarons, G. A. (2018). Prevalence of Serious Emotional Disturbance Among U.S. Children: A Meta-Analysis. Psychiatric Services (Washington, D.C.), 69(1), 32–40. https://doi.org/10.1176/appi.ps.201700145

APPENDICES

Appendix A Evaluation Phase

Activity

Target Population & Data Collection Methodology

Phase 1*

Qualitative Interviews

Qualitative interviews were conducted with the CSF personnel and key community stakeholders with current and historical knowledge of children’s behavioral health system in Jackson County, Missouri.

Kick-Off Meeting Table Worksheets

Written information was solicited from thirteen professional work groups via targeted worksheets with open-ended questions. Emergent themes from the Kick-off Meeting work groups were utilized to inform and develop Phase 3.

Share Your Thoughts Survey🖳

A brief, customized electronic survey was developed to solicit information from agency leadership and administrators related to barriers and challenges faced by Jackson County children and families, system of care facilitators, areas of growth, and service gaps.

Phase 2*

Phase 3*

Community Provider Focus groups

Informed by the emergent themes from Phases 1 and 2, five focus groups (2 virtual, 3 in-person) were conducted with community providers associated with CSF-funded and non-CSF funded agencies. Provider focus groups were organized around the ten statute service areas and lasted between 60-75 minutes. Customized, semi-structured interview guides were designed around the emergent themes and included targeted, service-area specific questions. Focus group participant demographics are available upon request.

Phase 4*

Young Adults with Lived Experience Focus Group

Utilizing the emergent themes from the qualitative interviews and community provider focus groups, a customized, semi-structured interview guide was developed that targeted barriers to service receipt and strengths and inefficiencies of the Jackson County children’s service system. The young adult focus group was facilitated via ZOOM (virtual) and was 75 minutes in length; all participants received $40.00 compensation. Young adult participant demographics are available upon request.

Phase 5*

Caregivers with Lived Experience, Organizational Staff & School Staff Surveys🖳

Three separate surveys for each of the respective target populations (e.g., caregivers with lived experience, organizational staff, and school staff) were developed. Surveys included curated open-ended (i.e., qualitative response fields) and close-ended (i.e., multiple choice fields) questions to thoroughly examine, from the perspective of the respondents, needs and availability of child behavioral health services in Jackson County, barriers to care receipt, overall well-being of children, and the overall functioning of the Jackson County children’s behavioral health service delivery system. Important notes specific to the Caregiver Survey: To adhere to and maintain confidentiality policies between clients and agencies, the CSF personnel provided the researchers with agency contacts that had volunteered to assist in the recruitment of caregiver clients with lived experience. An electronic survey link was provided to the agency representative and then shared to select caregivers who currently have – or recently had – a child (0-19) receive services from their agency. The survey was offered in English and Spanish. Caregivers who voluntarily chose to participate received a $20.00 gift card.

Notes: * = All qualitative data was cumulatively examined and analyzed using DeDoose 10.0. Qualitative, open-ended questions that were collected as a component of the electronic surveys were consolidated with the other qualitative components. 🖳 = All quantitative data was collected via Research to Electronic Data Capture (REDCap) and analyzed in IBM SPSS.

APPENDICES

Appendix B Secondary Data Sources Please note: A robust catalogue of available data sources and repositories is available via the Children’s Assessment Data Catalogue, available upon request.

Data Source

Description/ Example of Indicators Available: Community Health Needs Assessment data from 2022; inclusive of four domains:

Children’s Mercy Kansas City – mySidewalk Data Dashboard

1. 2. 3. 4.

Community, Social, Economic & Physical Context; Health & Health Conditions; Pediatric Health Care Utilization; and Children & Adolescents at Home, School & Community

Data is available for the following counties: Clay County, MO.; Jackson County, MO.; Johnson Co, KS; Platte County, MO; and Wyandotte County, KS.

Missouri Department of Elementary & Secondary Education

School-level, District-level, County-level data on academicrelated statistics, free and reduced lunch data, graduation and drop-out rates, and behavioral health information.

Missouri KIDS Count Data

County-level, state-level, and national statistics on a variety of child well-being indicators inclusive of mental health and socio-emotional factors

Missouri Student Survey

This survey provides insights into various educational, mental/behavioral health outcomes for Missouri students in select grades/counties. .

United States Census Bureau, American Community Survey (ACS)

Individual-level demographics; economic indicators; family composition variables

University of Missouri, All Things Missouri

This is a free, online platform/data dashboard-using data provided by the Missouri Department of Health and Senior services—designed to support decision-makers in accessing, analyzing, and visualizing data about their communities.

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