Evolution of Child Mental Health Services in Primary Care

Kelleher, Kelly J.; Stevens, Jack

doi:10.1016/j.acap.2008.11.008

Cited by 51 publications

(47 citation statements)

References 88 publications

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“…[61][62][63][64] Innovative means of consultation and collaboration will continue to evolve with emerging technology. 65 These relationships help build the capacity of pediatricians to manage various behavioral and emotional problems in the office. This is particularly true for the management of subthreshold problems not meeting the severity level warranted to refer for treatment.…”

Section: Guidance For Pediatriciansmentioning

confidence: 99%

“…66,67 Paper-and-pencil screening methods will need to be transformed into Web-based versions, smartphone apps, and waiting room tablets to successfully harness available technology. 65,68 These changes will be critical areas needing further evaluation to determine best practices. 69 Additional system challenges that will need to be addressed are included in Appendix 2.…”

Section: Future Directionsmentioning

confidence: 99%

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Promoting Optimal Development: Screening for Behavioral and Emotional Problems

Blum¹,

Bauer²,

Bridgemohan³

et al. 2015

Pediatrics

218

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By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems. SCOPE OF THE PROBLEM AND NEED FOR THIS REPORTBehavioral and emotional problems during childhood are common, often undetected, and frequently not treated despite being responsible for significant morbidity and mortality. By current estimates, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder at any given time. 1,2 Estimated prevalence rates are similar in young 2-to 5-year-old children. Developmental and behavioral health disorders are now the top 5 chronic pediatric conditions causing functional impairment. 3,4 Even greater numbers of children have This document is

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Section: Guidance For Pediatriciansmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

Blum¹,

Bauer²,

Bridgemohan³

et al. 2015

Pediatrics

218

View full text Add to dashboard Cite

show abstract

“…One approach is to focus on prescribing patterns among providers. There are now promising results from primary care interventions for pediatric ADHD targeted at improving adherence to clinical guidelines and coordinating care among PCPs, specialists, and educators (Kelleher and Stevens 2009).…”

Section: Clinical Significancementioning

confidence: 99%

The Impact of Long-Acting Medications on Attention-Deficit/Hyperactivity Disorder Treatment Disparities

Saloner

Fullerton

McGuire

2013

Journal of Child and Adolescent Psychopharmacology

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Objective: Long-acting stimulants have increased medication adherence for many children diagnosed with attention deficit/hyperactivity disorder (ADHD), but it is unknown whether the increase has been similar across racial/ethnic groups. Our objective was to determine whether differences in medication utilization and adherence among white, black, and Hispanic ADHD-diagnosed children and adolescents narrowed following the introduction of long-acting stimulants in the 1990s. Methods: We conducted a retrospective analysis of Florida Medicaid claims data from fiscal years 1996-2005. At each of three cross sections, we identified children and adolescents 3-17 years of age with at least two claims with an ADHD diagnosis. We used linear regression to model disparities over the study period in utilization of any ADHD medications (utilization of long-acting medication specifically) and medication adherence, and identified patient level, treatment setting, and geographic contributors to disparities. Results: Although ADHD medication utilization was lower for ADHD-diagnosed minorities than whites in all years, minorities were as likely as whites to switch to long-acting medications. The increase in prescribed days following longacting medication diffusion was comparable for white and black medication users (40 and 43 days, respectively), but lower for Hispanics (27 days). Geography and provider setting helped to explain disparities in medication utilization overall, but disparities in adherence were not explained by any of the covariates. Conclusions: Despite equivalent switching to long-acting medications in the study period, minorities continued to utilize all ADHD medications less than did whites, and for shorter periods. Provider setting helps explain the ADHD medication utilization gap. High-volume, minority-serving providers are potential targets for future interventions related to improved communication about medication and follow-up after medication initiation.

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“…28 Second, prevention and treatment of childhood and adolescent behavioral health problems demand highly engaged teamwork with the family or caregiver, as well as the education sector. 29,30 Last, the public administration and funding of pediatric behavioral health is highly complex and often fails to adequately serve certain populations, such as children in preschool. 31 Although gaps in knowledge remain, the current evidence base presents important opportunities to implement specific policy actions to advance behavioral health integration.…”

mentioning

confidence: 99%

The Medical Home and Integrated Behavioral Health: Advancing the Policy Agenda

et al. 2015

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There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patientcentered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration.

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Evolution of Child Mental Health Services in Primary Care

Cited by 51 publications

References 88 publications

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

The Impact of Long-Acting Medications on Attention-Deficit/Hyperactivity Disorder Treatment Disparities

The Medical Home and Integrated Behavioral Health: Advancing the Policy Agenda

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