Finding Allies to Address Children's Mental and Behavioral Needs
By Laurel Leslie, MD, MPH
Pediatricians are in a unique position to prevent, identify, and treat mental and behavioral problems in children and to work with families. But we face barriers, which include lack of training, lack of time, poor reimbursement, lack of available mental health specialists in many geographic areas, and outdated models for care delivery that do not focus on prevention, do not incorporate mental health professionals alongside pediatric doctors, and do not support effective collaboration.4,5
We’ve had thisdiscussion before. ABP President and CEO David G. Nichols, MD, MBA, has written about the mental health needs of children and adolescents previously in this blog. Our strategic planning committee (page 27) has evaluated the current situation, as we reported in our 2015 Annual Report, and in the most recent Stockman Lecture (page 23) at the 2015 American Academy of Pediatrics (AAP) annual meeting.
So how do we get better at helping children and adolescents with mental and behavioral needs?
Over two days last month in Chapel Hill, the ABP brought together 10 pediatric organizations to discuss ways to address the mental and behavioral health needs of children and the health care professionals who treat them. The meeting included representatives from the AAP, the Association of Pediatric Program Directors, the Academic Pediatric Association, the Association of Medical School Pediatric Department Chairs, the Society for Developmental and Behavioral Pediatrics, the Society for Adolescent Health and Medicine, the American Association of Child and Adolescent Psychiatry, the National Academy of Medicine, the Accreditation Council for Graduate Medical Education, and the ABP, as well as other pediatric leaders interested in enhancing residency training in behavioral and mental health.
The meeting was chaired by Julia A. McMillan, MD, Professor of Pediatrics at Johns Hopkins University School of Medicine and chair of the ABP’s strategic planning committee, which has been evaluating how the ABP can help improve care for pediatric mental and behavioral needs.
The group agreed that pediatricians have a unique role in preventing, recognizing, and managing behavioral and mental health problems, but they need the skills to do this important work. Therefore, these priorities have to be addressed:
Implementation of behavioral/mental health training for pediatric residents
Creation and dissemination of innovative models of care
Integration of care as an ultimate goal
There was also agreement that non-pediatrician partners (psychiatrists, psychologists, social workers) will be needed to accomplish the goal of improved training and that inter-professional models will be important.
Pediatricians already in practice need training and encouragement, too. Through maintenance of certification programs, the ABP can help providers learn about the latest medical findings and help them improve the quality of care in their own practices.
The problem is far-reaching. Early in April, I joined Dr. Marshall “Buzz” Land, a general pediatrician from Vermont and a consultant to the ABP, and a panel of five other professionals and two parents to address members of Congress about the role of primary care pediatricians in helping to prevent, identify, and treat the mental health needs of children, adolescents, and their families. The #PowerofParenting hashtag was used to capture input from parents and create a timeline of events that occured during the congressional briefing.
The situation is grim:
Approximately one in two Americans will experience a mental health concern at some point in their lives, and about three-fourths of those will originate in childhood 1
About one in six U.S. parents report their 2- to 3-year-old child has been diagnosed with mental, behavioral, or developmental disorders 2
More than four in 10 US youths have experienced a behavioral health problem by the time they reach seventh grade 3
One of every 13 US high school students attempts suicide 3
At the briefing, we joined with the AAP and many psychologists in recommending:
Co-located and co-integrated models of physical and mental health care
Congressional and agency support and funding for parenting skills intervention programs that can be taught in the pediatric medical home
Congressional funding for research that looks at implementing these types of models of care for all children and families, no matter where they live, the state of their health, or the culture they come from
I’d like to share part of a letter I received from Stacey Lihn, a mother and the president of Sisters By HeartTM, a group that provides peer support to others whose children are born with major heart defects:
“I'd love to see our healthcare system create national mental health standards, promoting and supporting processes enabling clinicians, teachers, therapists, and peer-to-peer leaders to work collaboratively, uplifting at-risk patients and families. The key to all of this is communication, and affording the professionals the time throughout busy days to focus on mental health care. We cannot afford to put the mental health of our children and families in the back seat anymore; we're in need of significant change. Not today, but yesterday. . . .”
We can make these changes. It won’t be easy and it will require that we all work together. But we are optimistic that things will improve.
About the Author
Laurel Leslie, MD, MPH, joined the American Board of Pediatrics (ABP) last year as Vice President of Research. Also a professor of medicine and pediatrics at Tufts University School of Medicine, she has extensive research experience identifying, treating, and delivering health services to children and adolescents with medical, developmental, and mental health needs.
1. Murphey D, Stratford B, Gooze R, et al; Robert Wood Johnson Foundation. Child Trends. Are the children well? a model and recommendations for promoting the mental wellness of the nation’s young people. http://www.childtrends.org/wp-content/uploads/2014/07/2014-33AreChildrenWellRWJF.pdf. Published July, 2014. Accessed May 6, 2016.
2. Bitsko RH, Holbrook JR, Robinson LR, et al. Health care, family, and community factors associated with mental, behavioral, and developmental disorders in early childhood — United States, 2011–2012. MMWR Morb Mortal Wkly Rep. 2016;65:221–6.
3. Kessler RC, Avenevoli S, McLaughlin KA, et al. Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med. 2012;42(09):1997-2010.
4. Horwitz SM, Storfer-Isser A, Kerker BD, et al. Barriers to the identification and management of psychosocial problems: changes from 2004 to 2013. Acad Pediatr. 2015;15:613–20.
5. Horwitz SM, Caspary G, Storfer-Isser A, et al. Is developmental and behavioral pediatrics training related to perceived responsibility for treating mental health problems? Acad Pediatr. 2010;10:252-9.