Children's mental health

Over recent months, children’s mental health has become a topic of increased attention and scrutiny, both in the media and in local and federal legislatures. As pediatric providers, the importance of early attention to mental health concerns comes as no surprise to us and, in fact, is something most of us address on a regular basis.

In every practice setting I’ve worked in, I have had parents reach out to me – often confused and frustrated – wondering how to help their struggling child. Unfortunately, it is also an area where many feel ill equipped to do what is needed for children and families. Lack of resources, minimal training, inadequate time, and poor access to specialty care (just to name a few) place road blocks in front of our efforts to provide comprehensive care.

Discussing concerns about behavior, poor mental health, or parenting a difficult child can be awkward for both the family and the provider, and sometimes both are unsure where to begin. On the other hand, the strong relationships developed in a primary care medical home can provide the ideal support for addressing these concerns in an effective, thoughtful, and sensitive way.

Practices and providers vary widely in their resources and comfort in addressing mental health concerns. Given the magnitude of the problem, how does a provider or a practice begin to talk about mental health with families, or how can they improve on what they are already doing? How do you elicit concerns from families? How do you handle it when families come to you?

First, and most important, arm yourself with knowledge. It is not realistic to expect that you will become a psychiatrist, therapist, social worker, and pediatrician all rolled up into one, so learn about your community’s resources. You don’t have to do this yourself – a tech-savvy office staff member or industrious visiting medical student can do the research. Good places to start include your local health department or mental health department, local medical society, or even a general online search. As highlighted recently in Pediatric News, some states have regional child psychiatry access projects, which also can be a very valuable resource.

Second, if you aren’t already doing so, prepare your practice. Start talking with office staff and your clinical team about why it’s important to discuss mental health with families. Explain to them the role they can play in helping families to understand how and why we are asking these questions. Discussing these difficult issues is made easier when asking is the norm and not done only when things seem out of control.

A psychiatrist I work with recently made a terrific suggestion – put signs up in your office explaining that your practice is concerned with patients’ physical and mental health. Let families know how you hope to help, depending on your practice’s state of readiness to do so – by doing universal mental health screening, asking about behavioral concerns at all well visits (for example, "Does anything about your child’s behavior or mood concern you?"), or simply just making yourself available for questions.

Of course, these discussions can take time. Don’t hesitate to say to a parent, "I really want to make sure we have time to discuss this in depth, so I’m going to ask you to schedule a separate appointment." This also gives you the opportunity to ask the parent to gather additional information, such as letters from teachers, completed attention-deficit/hyperactivity disorder (ADHD) assessment tools, copies of report cards, or anything else that may give you a better picture of what is going on in order to allow for the most appropriate treatment and/or referral.

Not every child will need to see a psychiatrist or even a therapist, and with a careful history you can "triage" what can be addressed in primary care and what needs to be co-managed or referred elsewhere.

The best way to make sure that you are catching mental and behavioral health concerns early is to perform universal screening on all children in your practice – using a standardized screening tool – at regular intervals. Some pediatricians are doing this quite smoothly, others may have work to do before implementation is feasible in their own practice setting, but it is a good long term goal. The American Academy of Pediatrics offers some resources to make this easier.

Despite all the road blocks that currently exist, these are problems that aren’t going away on their own. By addressing them proactively, both families and providers will be happier and less frustrated, and ultimately children will get better care.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures. This column, "Practical Parenting," appears regularly in Pediatric News. E-mail Dr. Beers at [email protected].

Over recent months, children’s mental health has become a topic of increased attention and scrutiny, both in the media and in local and federal legislatures. As pediatric providers, the importance of early attention to mental health concerns comes as no surprise to us and, in fact, is something most of us address on a regular basis.

In every practice setting I’ve worked in, I have had parents reach out to me – often confused and frustrated – wondering how to help their struggling child. Unfortunately, it is also an area where many feel ill equipped to do what is needed for children and families. Lack of resources, minimal training, inadequate time, and poor access to specialty care (just to name a few) place road blocks in front of our efforts to provide comprehensive care.

Discussing concerns about behavior, poor mental health, or parenting a difficult child can be awkward for both the family and the provider, and sometimes both are unsure where to begin. On the other hand, the strong relationships developed in a primary care medical home can provide the ideal support for addressing these concerns in an effective, thoughtful, and sensitive way.

Practices and providers vary widely in their resources and comfort in addressing mental health concerns. Given the magnitude of the problem, how does a provider or a practice begin to talk about mental health with families, or how can they improve on what they are already doing? How do you elicit concerns from families? How do you handle it when families come to you?

First, and most important, arm yourself with knowledge. It is not realistic to expect that you will become a psychiatrist, therapist, social worker, and pediatrician all rolled up into one, so learn about your community’s resources. You don’t have to do this yourself – a tech-savvy office staff member or industrious visiting medical student can do the research. Good places to start include your local health department or mental health department, local medical society, or even a general online search. As highlighted recently in Pediatric News, some states have regional child psychiatry access projects, which also can be a very valuable resource.

Second, if you aren’t already doing so, prepare your practice. Start talking with office staff and your clinical team about why it’s important to discuss mental health with families. Explain to them the role they can play in helping families to understand how and why we are asking these questions. Discussing these difficult issues is made easier when asking is the norm and not done only when things seem out of control.

A psychiatrist I work with recently made a terrific suggestion – put signs up in your office explaining that your practice is concerned with patients’ physical and mental health. Let families know how you hope to help, depending on your practice’s state of readiness to do so – by doing universal mental health screening, asking about behavioral concerns at all well visits (for example, "Does anything about your child’s behavior or mood concern you?"), or simply just making yourself available for questions.

Of course, these discussions can take time. Don’t hesitate to say to a parent, "I really want to make sure we have time to discuss this in depth, so I’m going to ask you to schedule a separate appointment." This also gives you the opportunity to ask the parent to gather additional information, such as letters from teachers, completed attention-deficit/hyperactivity disorder (ADHD) assessment tools, copies of report cards, or anything else that may give you a better picture of what is going on in order to allow for the most appropriate treatment and/or referral.

Not every child will need to see a psychiatrist or even a therapist, and with a careful history you can "triage" what can be addressed in primary care and what needs to be co-managed or referred elsewhere.

The best way to make sure that you are catching mental and behavioral health concerns early is to perform universal screening on all children in your practice – using a standardized screening tool – at regular intervals. Some pediatricians are doing this quite smoothly, others may have work to do before implementation is feasible in their own practice setting, but it is a good long term goal. The American Academy of Pediatrics offers some resources to make this easier.

Despite all the road blocks that currently exist, these are problems that aren’t going away on their own. By addressing them proactively, both families and providers will be happier and less frustrated, and ultimately children will get better care.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures. This column, "Practical Parenting," appears regularly in Pediatric News. E-mail Dr. Beers at [email protected].

Over recent months, children’s mental health has become a topic of increased attention and scrutiny, both in the media and in local and federal legislatures. As pediatric providers, the importance of early attention to mental health concerns comes as no surprise to us and, in fact, is something most of us address on a regular basis.

In every practice setting I’ve worked in, I have had parents reach out to me – often confused and frustrated – wondering how to help their struggling child. Unfortunately, it is also an area where many feel ill equipped to do what is needed for children and families. Lack of resources, minimal training, inadequate time, and poor access to specialty care (just to name a few) place road blocks in front of our efforts to provide comprehensive care.

Discussing concerns about behavior, poor mental health, or parenting a difficult child can be awkward for both the family and the provider, and sometimes both are unsure where to begin. On the other hand, the strong relationships developed in a primary care medical home can provide the ideal support for addressing these concerns in an effective, thoughtful, and sensitive way.

Practices and providers vary widely in their resources and comfort in addressing mental health concerns. Given the magnitude of the problem, how does a provider or a practice begin to talk about mental health with families, or how can they improve on what they are already doing? How do you elicit concerns from families? How do you handle it when families come to you?

First, and most important, arm yourself with knowledge. It is not realistic to expect that you will become a psychiatrist, therapist, social worker, and pediatrician all rolled up into one, so learn about your community’s resources. You don’t have to do this yourself – a tech-savvy office staff member or industrious visiting medical student can do the research. Good places to start include your local health department or mental health department, local medical society, or even a general online search. As highlighted recently in Pediatric News, some states have regional child psychiatry access projects, which also can be a very valuable resource.

Second, if you aren’t already doing so, prepare your practice. Start talking with office staff and your clinical team about why it’s important to discuss mental health with families. Explain to them the role they can play in helping families to understand how and why we are asking these questions. Discussing these difficult issues is made easier when asking is the norm and not done only when things seem out of control.

A psychiatrist I work with recently made a terrific suggestion – put signs up in your office explaining that your practice is concerned with patients’ physical and mental health. Let families know how you hope to help, depending on your practice’s state of readiness to do so – by doing universal mental health screening, asking about behavioral concerns at all well visits (for example, "Does anything about your child’s behavior or mood concern you?"), or simply just making yourself available for questions.

Of course, these discussions can take time. Don’t hesitate to say to a parent, "I really want to make sure we have time to discuss this in depth, so I’m going to ask you to schedule a separate appointment." This also gives you the opportunity to ask the parent to gather additional information, such as letters from teachers, completed attention-deficit/hyperactivity disorder (ADHD) assessment tools, copies of report cards, or anything else that may give you a better picture of what is going on in order to allow for the most appropriate treatment and/or referral.

Not every child will need to see a psychiatrist or even a therapist, and with a careful history you can "triage" what can be addressed in primary care and what needs to be co-managed or referred elsewhere.

The best way to make sure that you are catching mental and behavioral health concerns early is to perform universal screening on all children in your practice – using a standardized screening tool – at regular intervals. Some pediatricians are doing this quite smoothly, others may have work to do before implementation is feasible in their own practice setting, but it is a good long term goal. The American Academy of Pediatrics offers some resources to make this easier.

Despite all the road blocks that currently exist, these are problems that aren’t going away on their own. By addressing them proactively, both families and providers will be happier and less frustrated, and ultimately children will get better care.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures. This column, "Practical Parenting," appears regularly in Pediatric News. E-mail Dr. Beers at [email protected].