For her part, Dr. Foy said she hopes the report sends a message to pediatricians that they are well positioned to provide a broad range of mental health care services to patients and their families.
As an example, she offered the case of an anxious child who resists going to school, with a family that is not willing to seek help from a mental health specialist. A technique to try in such a case is the common factors approach, which is described in the report. “It's a way to find out how the family perceives the problem; to express sympathy, support, and empathy for them; to address any barriers that they may experience in taking action-for example, conflict within the family or stigma about seeking mental health services-and then to agree on an incremental first step that they feel comfortable with and capable of taking.”
Dr. Foy noted that pediatricians and other primary care clinicians who care for children are “in a widely varied state of readiness to follow” the recommendations contained in the report. “Some are just beginning to think about expanding their mental health practice,” she said. “Others have very sophisticated multidisciplinary approaches to mental health practice, and the majority is in between. I do think that most primary care clinicians will be able to find some action steps in the wide variety of recommendations that we have made. That is our hope, that there will be something for everybody.”
The report's appendices even include appropriate billing codes.
The report was supported by the AAP, the AAP Friends of Children Fund, and the Substance Abuse and Mental Health Services Administration. ok Dr. Foy and Dr. Stein said they had no financial conflicts of interest.
“Addressing Mental Health Concerns in Primary Care: A Clinician's Toolkit” is intended to help clinicians implement action steps from the supplement and is expected to be available for purchase soon. For more information, visit http://tinyurl.aap.org/pub112382
Nurse practitoner Beth Spangle (left), teen patient Garrett Locklear, and Dr. Jane Meschan Foy, chair of the AAP Task Force on Mental Health, confer.
Source Courtesy Wake Forest University Baptist Medical Center Photography
My Take
'Brilliant and Timely'
I'm excited to see this. If it had come out in 2004 it would have been really brilliant, but before its time. In 2010 it's extremely brilliant and timely. It really points out the ongoing change in the nature of primary care of children and families. There are behavioral concerns and mental health concerns, and the state of Massachusetts has mandated that there be mental health screening at every well-child visit.
There's not a lot in the report that surprises me, but I think that when it goes to most physicians in practice, they're going to have some “Aha!” moments, and that's a good thing. This will need to be updated over time. As we learn more, we're going to learn to identify mental health problems better, we're going to learn how to treat patients better, and we're going to learn how to collaborate better with mental health professionals.
When I talk to colleagues about this issue, one of the things I always say is, 'If you have a mental health question, ask it.' For example, I always ask about divorce adjustment. Or if I think a child looks sad, I will screen him or her for depression.
The strength of this report is that it's going to encourage people to ask those kinds of questions and do that kind of screening, because now we've given them something to do with the findings. There are algorithms, and there are ways to talk about building collaborations with mental health practitioners. I think this is a real state-of-the-art good start.
JOSEPH F. HAGAN JR., M.D., is a pediatrician in private practice in Burlington, Vt. He was one of the coeditors of the AAP's “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,” 3rd ed. Dr. Hagan said that he had no conflicts of interest relevant to this topic.
