201
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Affiliation(s)
- Julia Swartz
- Children's Emotional HealthLink (CEHL), New Directions in Behavioral Health, Compass Medical, Holbrook, MA, USA
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202
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Bauer NS, Sullivan PD, Hus AM, Downs SM. Promoting mental health competency in residency training. PATIENT EDUCATION AND COUNSELING 2011; 85:e260-e264. [PMID: 21570796 DOI: 10.1016/j.pec.2011.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/25/2011] [Accepted: 04/06/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the effect our developmental-behavioral pediatrics (DBP) curricular model had on residents' comfort with handling mental health issues. METHODS From August 2007 to January 2010, residents participating in the Indiana University DBP rotation completed a self-assessment questionnaire at baseline and at rotation end. Residents rated their comfort with the identification, treatment, and counseling of mental health problems using a 5-point scale. RESULTS Ninety-four residents completed both self-assessments. At baseline, categorical pediatric residents possessed higher comfort levels toward identification (mean 2.8 vs. 2.3 for non-categorical pediatrics residents, p<0.05), treatment (2.6 vs. 2.2, p<0.05) and counseling of mental health issues (2.7 vs. 2.1, p<0.005). Residents who were parents were also more comfortable. At rotation end, all residents showed significant improvements in self-rated comfort (4.0 vs. 2.6 for identification, p≤0.05; 4.0 vs. 2.4 for treatment, p≤0.05; and 4.0 vs. 2.4 for counseling, p≤0.05). This remained true regardless of being a categorical pediatric resident, a parent, or primary care-oriented. CONCLUSION Our curricular model promotes residents' comfort with handling common mental health issues in practice. PRACTICE IMPLICATIONS Increasing residents' comfort may influence the frequency of active discussion of mental health issues during well-child visits and lead to earlier diagnosis and needed treatment.
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Affiliation(s)
- Nerissa S Bauer
- Department of General and Community Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
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203
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Pattishall AE, Cruz M, Spector ND. Intimate partner violence, mental health disorders, and sexually transmitted infections: important screening opportunities for pediatric healthcare providers. Curr Opin Pediatr 2011; 23:674-83. [PMID: 22001767 DOI: 10.1097/mop.0b013e32834cd6ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article addresses three critical areas where pediatric healthcare providers must employ effective screening techniques to ensure the best care for patients: intimate partner violence (IPV), mental health issues, and sexually transmitted infections (STIs). RECENT FINDINGS IPV is now recognized as an important issue impacting the health of children. While long-term outcomes secondary to positive screening results are not known, routine, sensitive questioning can identify at-risk children and help connect families to resources in the community. Routine use of validated screening tools for mental health disorders (MHDs) in the office setting is now recommended. STIs disproportionately affect adolescents and young adults, yet timely diagnosis is often challenging because infections are frequently asymptomatic and adolescents may not be forthcoming about risk-taking behaviors. There is significant opportunity for pediatricians to improve screening rates of adolescents. SUMMARY Screening is an essential aspect of healthcare for pediatricians. An understanding of current screening recommendations for IPV, MHDs, and STIs will assist providers in earlier detection of medical problems in their patients and will likely improve patient outcomes.
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Affiliation(s)
- Amy E Pattishall
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, USA
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204
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Rosenberg AA, Kamin C, Glicken AD, Jones MD. Training gaps for pediatric residents planning a career in primary care: a qualitative and quantitative study. J Grad Med Educ 2011; 3:309-14. [PMID: 22942954 PMCID: PMC3179204 DOI: 10.4300/jgme-d-10-00151.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/14/2011] [Accepted: 04/06/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. OBJECTIVES To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. METHODS Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from "not at all well prepared" to "extremely well prepared" for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. RESULTS Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. CONCLUSIONS Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.
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Affiliation(s)
- Adam A Rosenberg
- Corresponding author: Adam A. Rosenberg, MD, The Children's Hospital, Box B158, 13123 East 16th Avenue, Aurora, CO 80045, 720.777.5332,
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205
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Trivedi HK, Pattison NA, Neto LB. Pediatric medical home: foundations, challenges, and future directions. Pediatr Clin North Am 2011; 58:787-801, ix. [PMID: 21855707 DOI: 10.1016/j.pcl.2011.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
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Affiliation(s)
- Harsh K Trivedi
- Vanderbilt Medical School, 21st Avenue South, Nashville, TN 37232, USA.
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206
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Cole P, Lerner C, Mann TL. The Patient Protection and Affordable Care Act: an opportunity to address barriers that impact pediatric practice. Curr Probl Pediatr Adolesc Health Care 2011; 41:202-6. [PMID: 21757138 DOI: 10.1016/j.cppeds.2011.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pediatricians are uniquely positioned to partner with parents as they rear and nurture their young children. This article addresses the barriers that influence the pediatrician's ability to engage in developmental guidance during regular well-child visits. Challenges related to the current structure of pediatric training programs are discussed, as well as the economics of extending time with families, and the real limitations associated with insurance reimbursement policies that make it difficult for pediatricians to focus on developmental preventive care related to social and emotional development. Recent changes in the public policy arena provide an opportunity to overcome barriers. Specific provisions are described within the Patient Protection and Affordable Care Act that have the potential to enhance opportunities to address social and emotional development through the provision of developmental guidance to parents with very young children.
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Affiliation(s)
- Patricia Cole
- ZERO TO THREE: National Center for Infants, Toddlers, and Families, Washington, DC, USA
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207
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Whitaker TM, Bada HS, Bann CM, Shankaran S, LaGasse L, Lester BM, Bauer CR, Hammond J, Higgins R. Serial pediatric symptom checklist screening in children with prenatal drug exposure. J Dev Behav Pediatr 2011; 32:206-15. [PMID: 21200328 PMCID: PMC3069136 DOI: 10.1097/dbp.0b013e318208ee3c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. METHOD The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. RESULTS Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. CONCLUSION Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.
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Affiliation(s)
- Toni M Whitaker
- Department of Pediatrics, Boling Center for Developmental Disabilities, University of Tennessee College of Medicine, Memphis, TN 38105, USA.
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208
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Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 2011; 127:462-70. [PMID: 21300675 PMCID: PMC3065146 DOI: 10.1542/peds.2010-0165] [Citation(s) in RCA: 340] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine patterns of comorbidity, functioning, and service use for US children with attention-deficit/hyperactivity disorder (ADHD). METHODS Bivariate and multivariable cross-sectional analyses were conducted on data from the 2007 National Survey of Children's Health on 61 779 children ages 6 to 17 years, including 5028 with ADHD. RESULTS Parent-reported diagnosed prevalence of ADHD was 8.2%. Children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability versus 5% without ADHD, 27% vs 2% had a conduct disorder, 18% vs 2% anxiety, 14% vs 1% depression, and 12% vs 3% speech problems (all P < .05). Most children with ADHD had at least 1 comorbid disorder: 33% had 1, 16% had 2, and 18% had 3 or more. The risk for having 3 or more comorbidities was 3.8 times higher for poor versus affluent children (30% vs 8%). Children with ADHD had higher odds of activity restriction (odds ratio: 4.14 [95% confidence interval: 3.34-5.15]), school problems (odds ratio: 5.18 [95% confidence interval: 4.47-6.01]), grade repetition, and poor parent-child communication, whereas social competence scores were lower and parent aggravation higher. Functioning declined in a stepwise fashion with increasing numbers of comorbidities, and use of health and educational services and need for care coordination increased. CONCLUSIONS Clinical management of ADHD must address multiple comorbid conditions and manage a range of adverse functional outcomes. Therapeutic approaches should be responsive to each child's neurodevelopmental profile, tailored to their unique social and family circumstances, and integrated with educational, mental health and social support services.
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Affiliation(s)
- Kandyce Larson
- UCLA Center for Healthier Children, Families, and Communities, 10990 Wilshire Blvd, Suite 900, Los Angeles, CA 90024, USA.
| | - Shirley A. Russ
- UCLA Center for Healthier Children, Families, and Communities, Los Angeles, California; ,Department of Academic Primary Care Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert S. Kahn
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Neal Halfon
- UCLA Center for Healthier Children, Families, and Communities, Los Angeles, California; ,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles; ,Department of Health Services, School of Public Health, University of California, Los Angeles, California
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Taliaferro LA, Borowsky IW. Perspective: Physician education: a promising strategy to prevent adolescent suicide. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:342-347. [PMID: 21248597 DOI: 10.1097/acm.0b013e31820984ad] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many young people who present to primary care providers (PCPs) have high levels of emotional distress and/or suicidal ideation. Therefore, PCPs are in an ideal position to recognize and respond to early symptoms and distress signals that accompany suicide warning signs, yet they underrecognize mood disorders and suicidality among youth. Medical school and residency programs typically provide inadequate training on pediatric mental health and adolescent suicide prevention. Thus, PCPs lack complete knowledge of risk factors and feel unprepared to handle mental health problems among youth. In this article, the authors provide an overview of the epidemiology of adolescent suicide and describe risk factors, protective factors, and warning signs. They propose that physician education represents a promising strategy to prevent adolescent suicide, and they establish the need for improved educational opportunities that would provide PCPs with the necessary skills and supports to identify and respond to psychosocial concerns that may increase suicide risk among youth. They recommend strategies, methods, and content areas for addressing educational gaps, as well as organizational approaches to support enhanced physician education. They also suggest areas for future research.
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Affiliation(s)
- Lindsay A Taliaferro
- Healthy Youth Development Prevention Research Center, Division of Adolescent Health and Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota 55414, USA.
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211
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Pisani AR, leRoux P, Siegel DM. Educating residents in behavioral health care and collaboration: integrated clinical training of pediatric residents and psychology fellows. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:166-73. [PMID: 21169774 PMCID: PMC7931816 DOI: 10.1097/acm.0b013e318204fd94] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998-2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program's accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.
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Affiliation(s)
- Anthony R Pisani
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, and Rochester General Hospital, Rochester, New York 14642, USA.
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212
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Garfunkel LC, Pisani AR, leRoux P, Siegel DM. Educating residents in behavioral health care and collaboration: comparison of conventional and integrated training models. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:174-9. [PMID: 21169773 PMCID: PMC4176864 DOI: 10.1097/acm.0b013e318204ff1d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To determine whether former pediatric residents trained using a model of integrated behavioral health (BH) care in their primary care continuity clinics felt more comfortable managing BH care and better prepared to collaborate with BH professionals than did peers from the same residency who trained in clinics with a conventional model of BH care. METHOD University of Rochester School of Medicine and Dentistry pediatric residents were assigned to one of two continuity clinic sites. At one site, psychology fellows and faculty were integrated into the clinic teams in the mid-1990s. At the other, conventional patterns of consultation and referral continued. In 2004, the authors surveyed 245 alumni (graduated 1989-2003) about their experiences and their comfort with providing BH care and collaborating with BH providers in their current practice. RESULTS A total of 174 alumni (71%) responded. There were significant differences between graduates who trained in the two models. Those who trained in the integrated model were significantly more likely than others to report that they had consulted or planned treatment with a BH provider during residency and to report that their continuity clinic helped prepare them to collaborate with BH providers. They were somewhat more likely to believe that their overall residency training prepared them to manage BH issues in their current practice. CONCLUSIONS These findings suggest that an integrated training environment, described in detail in the companion article in this issue, can enhance pediatric resident education in the management of BH problems and collaboration with BH specialists.
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Affiliation(s)
- Lynn C. Garfunkel
- Department of Pediatrics University of Rochester/Rochester General Hospital
| | - Anthony R. Pisani
- Departments of Psychiatry and Pediatrics University of Rochester/Rochester General Hospital
| | - Pieter leRoux
- Departments of Psychiatry and Pediatrics University of Rochester/Rochester General Hospital
| | - David M. Siegel
- Departments of Pediatrics and Medicine University of Rochester/Rochester General Hospital
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Abstract
Although much debate continues about the prevalence of depressive disorders in prepubertal children, depression clearly is common in adolescents, increasing rapidly throughout the teen years. All physicians who work with young patients must to be able to recognize and treat these disorders. This article provides a brief overview of depressive disorders in children and adolescence, including their clinical presentation, prevalence, etiology, course, and prognosis. Psychopharmacological treatment options are reviewed in detail, including practical information for medication management including patient education, making the decision to treat with medication, selection of specific medications, strategies for nonresponsive patients, and decisions about stopping medication.
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Affiliation(s)
- Susan M Smiga
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA.
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214
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Steinberg-Epstein R, Book T, Wigal SB. Controversies surrounding pediatric psychopharmacology. Adv Pediatr 2011; 58:153-79. [PMID: 21736980 DOI: 10.1016/j.yapd.2011.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zuckerman B, Augustyn M. Books and reading: evidence-based standard of care whose time has come. Acad Pediatr 2011; 11:11-7. [PMID: 21272819 DOI: 10.1016/j.acap.2010.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 08/27/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
Reach Out and Read (ROR) is the only systematically evaluated clinical activity to promote child development in primary care used throughout the United States. The ROR intervention is straightforward: clinicians provide advice about the benefits of reading aloud, as well as directly giving books to high-risk children and parents to take home at each pediatric visit of children aged 6 months to 5 years. ROR builds upon a significant evidence base of the value of reading aloud to young children. The studies evaluating ROR from different sites from subjects from different racial backgrounds and numerous outcome measures are consistently positive. From its initial single site at Boston City Hospital in 1989, to over 4600 clinical sites in 2010, over 30 000 clinicians distributed over 6.2 million books a year to 3.9 million children across the United States. The future efforts for ROR include integrating mental health competencies found in American Academy of Pediatrics guidelines as part of residency and clinician training into the ROR paradigm, quality improvement to ensure fidelity to the intervention, and expanded pediatric clinician involvement in local early childhood/school readiness community efforts. Finally, the most important future goal is the adoption of giving advice about reading aloud and giving developmentally appropriate books to high-risk families as best practice by official bodies.
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Affiliation(s)
- Barry Zuckerman
- Department of Pediatrics (Dr Zuckerman), and Division of Developmental and Behavioral Pediatrics (Dr Augustyn), Boston University School of Medicine and Boston Medical Center, Boston, Mass
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216
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Delaney KR, Staten R“T. Prevention Approaches in Child Mental Health Disorders. Nurs Clin North Am 2010; 45:521-39, v. [DOI: 10.1016/j.cnur.2010.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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217
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Sarvet B, Gold J, Bostic JQ, Masek BJ, Prince JB, Jeffers-Terry M, Moore CF, Molbert B, Straus JH. Improving access to mental health care for children: the Massachusetts Child Psychiatry Access Project. Pediatrics 2010; 126:1191-200. [PMID: 21059722 DOI: 10.1542/peds.2009-1340] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inadequate access to care for mentally ill children and their families is a persistent problem in the United States. Although promotion of pediatric primary care clinicians (PCCs) in detection, management, and coordination of child mental health care is a strategy for improving access, limitations in training, time, and specialist availability represent substantial barriers. The Massachusetts Child Psychiatry Access Project (MCPAP), publicly funded with 6 regional consultation teams, provides Massachusetts PCCs with rapid access to child psychiatry expertise, education, and referral assistance. METHODS Data collected from MCPAP teams measured participation and utilization over 3.5 years from July 1, 2005, to December 31, 2008. Data were analyzed for 35,335 encounters. PCC surveys assessed satisfaction and impact on access to care. RESULTS The MCPAP enrolled 1341 PCCs in 353 practices covering 95% of the youth in Massachusetts. The MCPAP served 10,114 children. Practices varied in their utilization of the MCPAP, with a mean of 12 encounters per practice per quarter (range: 0-245). PCCs contacted the MCPAP for diagnostic questions (34%), identifying community resources (27%), and consultation regarding medication (27%). Provider surveys revealed improvement in ratings of access to child psychiatry. The rate of PCCs who reported that they are usually able to meet the needs of psychiatric patients increased from 8% to 63%. Consultations were reported to be helpful by 91% of PCCs. CONCLUSIONS PCCs have used and value a statewide system that provides access to teams of psychiatric consultants. Access to child mental health care may be substantially improved through public health interventions that promote collaboration between PCCs and child mental health specialists.
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Affiliation(s)
- Barry Sarvet
- Division of Child and Adolescent Psychiatry, Baystate Medical Center, 3300 Main St, 4th Floor, Springfield, MA 01199, USA.
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218
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Earls MF. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics 2010; 126:1032-9. [PMID: 20974776 DOI: 10.1542/peds.2010-2348] [Citation(s) in RCA: 329] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.
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219
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Gabel S. The integration of mental health into pediatric practice: pediatricians and child and adolescent psychiatrists working together in new models of care. J Pediatr 2010; 157:848-51. [PMID: 20633899 DOI: 10.1016/j.jpeds.2010.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 05/07/2010] [Accepted: 06/04/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Stewart Gabel
- Division of Children and Family Services, New York State Office of Mental Health, Albany, NY 12208, USA.
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220
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Borner I, Braunstein JW, St Victor R, Pollack J. Evaluation of a 2-question screening tool for detecting depression in adolescents in primary care. Clin Pediatr (Phila) 2010; 49:947-53. [PMID: 20724330 DOI: 10.1177/0009922810370203] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Eighty-five adolescents (ages 13 to 17), recruited from various metropolitan pediatric outpatient clinics, were administered the Patient Health Questionnaire (PHQ)-2, a two-item depression screener, along with two other well-established measures of depression, the Children's Depression Inventory (CDI) and the Beck Depression Inventory (BDI). Results indicated a significant relationship between the second question of the PHQ-2 and the two established measures of depression. Discriminant function analysis revealed that classification of adolescents as depressed or not depressed on the basis of their responses to this second question resulted in correct classification of 73% of adolescents with a sensitivity of 0.48 and specificity of 0.60. The use of both questions resulted in lower classification accuracy (67%) but a higher sensitivity of 0.85 and a slightly lower specificity of 0.51 than either question alone. These results support the use of this measure as a brief screener for adolescent depression in primary care.
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Abstract
OBJECTIVE Little has been published about the professional activities of developmental-behavioral (DB) pediatricians. To better understand the settings in which DB pediatricians work, allocation of their professional time, and how financial considerations impact their practice, the Society for Developmental and Behavioral Pediatrics surveyed its membership. METHOD An extensive on-line three-part survey was conducted in 2006-2007 assessing sociodemographic characteristics, practice descriptors, coding and billing practices, productivity goals and perceived pressures among Society for Developmental and Behavioral Pediatric's 438 physician members. RESULTS Of the pediatricians responding, representing all regions of the United States, 93% were DB pediatrics subspecialty board certified or eligible. The majority was practicing DB pediatrics full-time (73%); and 67% were exclusively in academic settings. All reported seeing patients, 84% reported teaching, 76% reported having administrative responsibilities, and 46% reported conducting research. Despite having non-clinical responsibilities, full-time equivalent positions included an average of 25 hours per week in direct patient care and 14.5 hours per week (37% of clinical time) in indirect patient care. Only 42% reported working with multidisciplinary teams. Salaries varied widely within and across regions. Deficits in billing/coding practices, awareness of personal clinical productivity, and familiarity with national productivity benchmarks were identified. CONCLUSIONS DB pediatricians work in diverse settings nationwide. They provide considerable time in indirect patient care, which is poorly reimbursed in general and relative to direct patient care. The results of this survey offer opportunities for provider, institutional and payer education.
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Affiliation(s)
- Jane Meschan Foy
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Foy JM. Enhancing pediatric mental health care: report from the American Academy of Pediatrics Task Force on Mental Health. Introduction. Pediatrics 2010; 125 Suppl 3:S69-74. [PMID: 20519564 DOI: 10.1542/peds.2010-0788c] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jane Meschan Foy
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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224
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Foy JM, Kelleher KJ, Laraque D. Enhancing pediatric mental health care: strategies for preparing a primary care practice. Pediatrics 2010; 125 Suppl 3:S87-108. [PMID: 20519566 DOI: 10.1542/peds.2010-0788e] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jane Meschan Foy
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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225
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Partnership in the Treatment of Childhood Mental Health Problems: A Pediatric Perspective. SCHOOL MENTAL HEALTH 2010; 2:93-101. [PMID: 20694177 DOI: 10.1007/s12310-010-9037-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatricians understand their role as promoting both the physical and mental health of children from birth until adulthood. Within the context of this long-term relationship, parents approach clinicians to address a full range of behavioral concerns ranging from variations of normal development to major mental illness. In this commentary that builds upon the earlier manuscripts in this collection, we explore the pediatrician's role in mental health care through the example of attention-deficit hyperactivity disorder (ADHD). ADHD is an ideal prototype for the exploration of partnership in mental health care because ADHD is the most common neurobehavioral disorder in childhood, it is commonly treated in primary care settings, multiple evidence-based treatments exist, personal values strongly influence the acceptability of treatment, treatment adherence is often poor, and effective treatment relies on the collaboration of pediatricians with families, schools, and the mental health system. Through the use of the Chronic Care Model for Child Health that emphasizes the importance of optimizing and coordinating systems of care for effective partnership, the following manuscript reviews the challenges and opportunities for pediatricians partnering with families and schools to address mental health problems. Strategies highlighted in the preceding papers are discussed within the context of this model.
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226
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Rockhill C, Kodish I, DiBattisto C, Macias M, Varley C, Ryan S. Anxiety disorders in children and adolescents. Curr Probl Pediatr Adolesc Health Care 2010; 40:66-99. [PMID: 20381781 DOI: 10.1016/j.cppeds.2010.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anxiety disorders are among the most common and functionally impairing mental health disorders to occur in childhood and adolescence. Primary care providers can expect to treat youth who have anxiety disorders frequently, and this article aims to provide the tools necessary to evaluate and manage patients who present with anxiety symptoms during childhood or adolescence. This article discusses the epidemiology of anxiety disorders, including the increased risk of future anxiety disorders and other mental health problems that are associated with having an anxiety disorder in childhood and adolescence. Next, the etiology of anxiety disorders is delineated, including discussion of genetic, cognitive-behavioral, physiological, and ecological explanatory models, and a summary of neurophysiological findings related to childhood and adolescent anxiety. Next, methods and tools are presented for assessment and treatment of anxiety disorders, with a focus on assessment and treatment that can be initiated in a primary care setting. Evidence-based therapy and medication interventions are reviewed. The article includes a focus on developmental differences in symptom presentation, assessment techniques, and treatment strategies, such that a primary care provider will have tools for working with the wide age range in their practices: preschool children through adolescents. We conclude that many effective intervention strategies exist, and their improving availability and ease of use makes it both critical and achievable for children and adolescents with anxiety disorders to be accurately diagnosed and treated with evidence-based medication and therapy.
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Affiliation(s)
- Carol Rockhill
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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227
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Trivedi HK, Pattison NA, Baptista Neto L. Pediatric medical home: foundations, challenges, and future directions. Child Adolesc Psychiatr Clin N Am 2010; 19:183-97, vii. [PMID: 20478495 DOI: 10.1016/j.chc.2010.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
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228
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Brito A, Khaw AJ, Campa G, Cuadra A, Joseph S, Rigual-Lynch L, Olteanu A, Shapiro A, Grant R. Bridging mental health and medical care in underserved pediatric populations: three integrative models. Adv Pediatr 2010; 57:295-313. [PMID: 21056744 DOI: 10.1016/j.yapd.2010.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Arturo Brito
- Children's Health Fund, 215 West 125th Street, New York, NY 10027, USA
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229
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Weiss SJ, Haber J, Horowitz JA, Stuart GW, Wolfe B. The inextricable nature of mental and physical health: implications for integrative care. J Am Psychiatr Nurses Assoc 2009; 15:371-82. [PMID: 21659251 DOI: 10.1177/1078390309352513] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.
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