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Integrated Mental Health in Primary Pediatric Care

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by

Janine Artis

on 6 November 2013

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Transcript of Integrated Mental Health in Primary Pediatric Care

Integrated Mental Health
in Pediatric Primary Care
Integrated Mental Health Care provides:
Improved Access
Reduced Stigma
Early Identification
Collaborative care
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
.”
Differential Diagnosis
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?
The PSC-17:
A broad mental health screen
attention 5
externalization 7
internalization 7
attention 5
externalization 7
internalization 7
Total 15
Total 15
Integrated Mental Health in Pediatric Primary Care
Depression
What does depression look like in children?
What are the most immediate issues?
Differential diagnosis?
Common co-morbidities?
happy

depressed

angry

excited

relaxed

anxious
adolescent affect
Columbia
Depression
Scale
Depression screens
Columbia
CES-DC
PHQ 9
Edinburgh (post-partem)
CES-DC
Caution!!
Assessments (symptom questionaires) are tools to aid the clinician in making a diagnosis or tracking progress; they are NOT stand alone diagnostic tools.

thorough history
+ 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
Anxiety
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
Parent version
Child Version
SCARED Anxiety Screen
YBOCS OCD screen
Parent screen
Clinician's tool
ADHD
Consider:
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?
Vanderbilt Assessments
Parent report
Teacher report
Inattention
Hyperactivity
O.D.D.
Conduct
Internalization
Functional
Impairment
Adult ADHD Assessment
Issues in assessing adult ADHD:
accurate history of long term symptoms
stimulant diversion
adjustment to college
Scoring
Eating Disorders
Aggression
Bipolar rule out
Developmental Screens
Ages & Stages Questionnaire
M-CHAT
Causes of Aggression:
trauma
anxiety
modeling
exposure
impulsivity

Hot aggression
Cold aggression
Lethality risk
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.
Screening test
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
Diagnostic
Rating scale
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
Full transcript