Improving Pediatric Mental Health Screening Isn't a Solo Act

Despite the fact that mental health disorders are prevalent in 21% of children, just a small percentage of pediatric patients with behavioral health issues receive adequate care, said Thomas L. Young, MD, of the University of Kentucky College of Medicine, Lexington, KY, during a presentation Tuesday at the AACAP 57th Annual Meeting in New York, NY.

Most mental health disorders are present in children by age 14, he noted, with mood disorders, anxiety, behavior disorders, and substance abuse being the most prevalent. But although one in every five pediatric visits involves a behavioral health issue—whether a child is exhibiting symptoms of ADHD or has chronic abdominal pain—the problems aren’t being recognized by pediatricians.

So what’s the answer? “Mental health is interwoven with physical health,” said Young. “An integrated model is critical in addressing these needs.”

Twenty years ago, the University of Kentucky College of Medicine established an integrated care program to help solve the problem of under-recognition of mental health disorders. According to Young, pediatricians weren’t screening for behavioral health issues, there was a lack of resources, and the wait for an appointment with a psychiatrist was 3-6 months. What’s worse, the attitude many physicians had was “don’t ask, and you don’t have to deal with it,” he said.

The institute conducted a study which revealed that many physicians didn’t believe they were equipped to assess mental health problems, and few reported concerns they had about patients to their parents. To close some of the gaps in care, University of Kentucky set up an integrated model in which mental health screening was conducted at well visits, a team of mental health professionals was available for consultation and referrals, and physicians were provided screening tools, assessment information, and treatment protocols. It also included a therapist who performed triage assessments and provided assistance in identifying psychosocial problem cases, as well as social workers and pediatric psychiatrists who could be called upon for consultations.

According to Young, researchers found that incorporating behavioral health consultants led to increased satisfaction rates from physicians and helped improve their ability to refer patients.

The keys to success for University of Kentucky's care model, he said, were as follows:

• Raise awareness for need for mental health services
• Address the financial and time issues involved
• Make sure a behavioral consultant is available in the clinic for immediate contact with the patient or a quick call with the patient
• Feedback must be provided to referring clinicians
• Arrange resources for consultation and referral when needed

The organization plans to continue to develop the program by adding a second behavioral consultant and child psychiatrist to the team, improving resident teaching on child mental health screening, and implementing new tools for assessment and outcome screening, he said.