In 1979, McKinley called for “re-focusing upstream” to address social contexts responsible for manufacturing illness, rather than “downstream” approaches initiated after disease onset. Multiple social/contextual factors are linked to children's mental health problems, including socioeconomic status; neighborhood, school, and family factors; and victimization. Moreover, mental health problems are stratified by race, ethnicity, and gender. This dissertation examines the disjuncture between the need to “focus upstream” and the apparent lack of attention to contextual factors in the domain of children's mental health.
Examining how intervention research is funded could provide insight into this phenomenon. Intervention research is constrained and directed by funding, and by the content of funders' announcements, including federal Requests for Applications (RFAs). Using a sociology of science framework, this dissertation investigates three interrelated questions. First, what are the implicit or explicit explanatory foci and/or intervention strategies of child mental health-related RFAs? Second, to what extent do they recognize the importance of upstream factors? Third, what factors might account for their intellectual and analytical foci?
Content analysis of 39 RFAs released between 1992 and 2009 reveals that RFAs focused on individual explanations and solutions for children's mental health problems vastly outnumber those examining social factors; upstream social factors are virtually absent. Biological causes and solutions are particularly pervasive: Reductionist approaches dominate federal funding announcements relevant to children's mental health.
Interviews were conducted with five National Institutes of Health (NIH) program officers, who concurred that social interventions were few. Program officers embraced a biomedical model of mental health, providing one possible reason for the focus on individual explanations and solutions for children's mental health problems in RFAs. Program officers also identified the difficulty of implementing structural interventions, perceived functionality of the biomedical model, disciplinary divisions in responsibility for attention to environmental factors, and a dearth of sociological influence at NIH, as possible explanations.
Potential policy implications include systematic reflexivity on the framing of problems in NIH-funded research, improved engagement of social scientists in federal research policy formation, and re-calibration of child mental health policy to create balance between social and individual factors research, including targeting upstream causes.