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Integrated Mental Health in Primary Pediatric Care
Transcript of Integrated Mental Health in Primary Pediatric Care
in Pediatric Primary Care
Integrated Mental Health Care provides:
Improved outcomes in Mental Health
Improved outcomes in Primary Care
Improved outcomes in Parent skills
"More than 14 million children and adolescents in the United States, or 1 in 5, have a diagnosable mental health disorder that requires intervention or monitoring. The human and financial costs of emotional problems in children are both broad and deep; they affect the children and their families, schools, communities, employers, and the nation as a whole." --American Academy of Pediatrics
American Academy of Pediatrics Task Force on Mental Health: “Pediatricians have long been an important first resource for parents who are worried about their children’s behavioral problems, and today psychosocial problems are the
most common chronic condition for pediatric visits, eclipsing asthma and heart disease
Role play: each group will work together to write
every possible diagnosis
that you see as a possibility in the case presented.
What questions would you ask?
How would you narrow your diagnosis?
A broad mental health screen
Integrated Mental Health in Pediatric Primary Care
What does depression look like in children?
What are the most immediate issues?
Assessments (symptom questionaires) are tools to aid the clinician in making a diagnosis or tracking progress; they are NOT stand alone diagnostic tools.
+ clinical interview
+ assessment tool
+ clinical judgement = diagnosis
The disorders managed in primary care are
mild to moderate
mental health disorders; bipolar, psychosis, severely impairing disorders should be linked with an outside mental health provider and/or psychiatry.
Non-proprietary assessment tools found at http://www.cappcny.org/home/clinical_resources.php
Co-morbidities: depression, autism, eating disorders, sleep disturbances
"Family" of anxieties: OCD, trichotillomania, social phobia, separation anxiety, school phobia/avoidance
Psychopharm: determining when meds are indicated?
Anxiety Screens for children: SCARED, YBOCS
SCARED Anxiety Screen
YBOCS OCD screen
What other disorders present with inattention or hyperactivity?
What factors may contribute to inattentive or hyperactive behaviors?
What attempts at home and school have been tried so far?
Adult ADHD Assessment
Issues in assessing adult ADHD:
accurate history of long term symptoms
adjustment to college
Bipolar rule out
Ages & Stages Questionnaire
Causes of Aggression:
The Young mania scale
is used to rule-out, not confirm,
bipolar disorder in children. A score of 13 or higher indicates the potential for a bipolar diagnosis, and signals the need to refer for a psychiatric evaluation.
Is Is Not
Used across populations to identify issues in an individual that need further follow up
Best if brief, inexpensive, can lead to intervention if something is identified
Is Is Not
A questionaire that has been well-tested to measure symptoms & help predict a specific diagnostic entity
A diagnostic tool that will provide a diagnosis based on a score on a rating scale