ArticlePediatric Mental Health and the Power of Primary Care: Practical Approaches and Validating Challenges
Section snippets
BACKGROUND
The worldwide prevalence of pediatric mental and behavioral disorders is between 17% and 20% (Centers for Disease Control and Prevention, 2017). In the United States alone, it is estimated that as many as one in five children will have a debilitating mental disorder at some point in their life, with 50% of mentally ill adults showing symptoms before the age of 14 years (Centers for Disease Control and Prevention, 2017). Mental and substance use disorders are the leading cause of disability
DISCUSSION: WHY PRIMARY CARE?
Primary care is the initial setting where patients with mental health complaints present for evaluation and treatment (Olfson, Kroenke, Wang, & Blanco, 2014). The percentage of pediatric visits related to mental or behavioral disorders is increasing faster than any other type of primary care visit, with the top five “sick” visits related to behavioral concerns (Olfson et al., 2014; Yogman, Betjemann, Sagaser, & Brecher, 2018). Although children and families often seek care without framing it as
APPROACHES TO DATE
In 2007, to meet the growing need, the AAP released a “mental health toolkit” for providers to use as a blueprint for treating mental illness in primary care, offering techniques and competencies that address childhood mental health problems head on (AAP, 2009). Approaches to standardizing the integration of mental health into primary care were also made relevant in 2007 when the World Health Organization published the “Service Organization Pyramid for an Optimal Mix of Services for Mental
VALIDATING CHALLENGES
Although PCPs are optimally positioned to address the mental health needs of pediatric patients, several challenges have been identified in current literature, including cultural, structural, and financial barriers (Guerrero et al., 2017). The burden of additional training, finding time to provide routine mental health care in primary care settings, and issues with reimbursement are proven challenges to behavioral health integration (Kolko & Perrin, 2014).
PRACTICAL APPROACHES FOR INDIVIDUAL PROVIDERS
The most common models of care for children with behavioral health disorders highlight referrals and collaboration with behavioral health specialists (Yogman et al., 2018). However, in a large systematic review of reviews, the effectiveness of practice change in primary care using complex interventions was evaluated, with a common finding that of all the interventions applied, more improvements were seen when the strategies targeted individual providers (Lau et al., 2016). This is indicative of
Use Available Screening Tools
One of the key findings in an extensive research study by the U.S. Secret Service examining 37 incidents of target violence and mass shootings in schools found that the incidents were rarely impulsive acts, but rather the result of comprehensive planning and cumulative events, with the attackers exhibiting multiple signs of mental illness before the incident (Vossekuil, Fein, Reddy, Borum, & Modzeleski, 2004). The research suggested that there was no pattern or “profile” of students who engaged
CONCLUSION
On average, one in five children and adolescents experience mental health concerns, and mental illness will quickly become one of the leading causes of pediatric morbidity and mortality in this population if left unaddressed (Njoroge et al., 2016). Targeted school violence including mass shootings, high rates of suicide and self-harm, and decreased functioning in school and family life are all linked to untreated mental illness (Hjorth et al., 2016; Wissow et al., 2016). With barriers to care
Kassondra A.S. Brino, Pediatric Nurse Practitioner, University of North Carolina at Chapel Hill, Durham, NC.
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Kassondra A.S. Brino, Pediatric Nurse Practitioner, University of North Carolina at Chapel Hill, Durham, NC.
Conflicts of interest: None to report.