Children's mental health as a primary care and concern: a system for comprehensive support and service

The continuing shortage of child and adolescent psychiatrists

OBJECTIVE

The national shortage of child and adolescent psychiatrists has prompted efforts to improve recruitment. It is uncertain whether these efforts will be sufficient to address this shortage and its impact on youth mental health services.

METHOD

Data were compared from 1990 to 2001 by state, county characteristics, number of youths, and percentage of youths living in poverty to determine any changes in the number and distribution of child and adolescent psychiatrists. Trends in the number of residents and age distribution of child and adolescent psychiatrists were also analyzed.

RESULTS

The number of child and adolescent psychiatrists has increased, but it still falls below estimates projected to adequately serve youth mental health needs. Disparities in child and adolescent psychiatrist distribution persist, with significantly fewer in rural counties or counties with a high percentage of children living in poverty. The age of child and adolescent psychiatrists has shifted, with fewer below age 35. The number of residents in training has not changed significantly since 1995.

CONCLUSIONS

The shortage of child and adolescent psychiatrists remains and is still accentuated for those living in rural areas or in poverty. Despite the increased number of child and adolescent psychiatrists, the number of residents and changes in workforce age indicate that the shortage will continue.

Interventions for adolescent depression in primary care

BACKGROUND

Depression in adolescents is underrecognized and undertreated despite its poor long-term outcomes, including risk for suicide. Primary care settings may be critical venues for the identification of depression, but there is little information about the usefulness of primary care interventions.

OBJECTIVE

We sought to examine the evidence for the treatment of depression in primary care settings, focusing on evidence concerning psychosocial, educational, and/or supportive intervention strategies.

METHODS

Available data on brief psychosocial treatments for adolescent depression in primary settings were reviewed. Given the paucity of direct studies, we also drew on related literature to summarize available evidence whether brief, psychosocial support from a member of the primary care team, with or without medication, might improve depression outcomes.

RESULTS

We identified 37 studies relevant to treating adolescent depression in primary care settings. Only 4 studies directly examined the impact of primary care-delivered psychosocial interventions for adolescent depression, but they suggest that such interventions can be effective. Indirect evidence from other psychosocial/behavioral interventions, including anticipatory guidance and efforts to enhance treatment adherence, and adult depression studies also show benefits of primary care-delivered interventions as well as the impact of provider training to enhance psychosocial skills.

CONCLUSIONS

There is potential for successful treatment of adolescent depression in primary care, in view of evidence that brief, psychosocial support, with or without medication, has been shown to improve a range of outcomes, including adolescent depression itself. Given the great public health problem posed by adolescent depression, the likelihood that most depressed adolescents will not receive specialty services, and new guidelines for managing adolescent depression in primary care, clinicians may usefully consider initiation of supportive interventions in their primary care practices.

Training of evidence-based assessment and intervention approaches in cross-cultural contexts: challenges and solutions

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

Transforming mental health care for children and their families

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed.