Identification and Management of Behavioral/Mental Health Problems in Primary Care Pediatrics

Abstract

This study describes the experiences of and barriers for pediatricians in Kentucky in providing behavioral/mental health (B-MH) services in primary care settings. These data will serve as a foundation for improving service delivery. An online survey was completed by 70 pediatricians. Descriptive data are presented. More than 90% of the respondents said that they saw at least one patient a month with 1 of 10 specific B-MH diagnoses. Physicians' comfort with diagnosing and treating disorders varied widely by diagnosis, age-group, and drug classification. Major barriers to providing optimal care were inaccessibility of mental health professionals for consultation and referral, lack of communication, and lack of knowledge. Respondents were more likely to favor consultation and co-location models over an integration model of care delivery. Overall, the authors found that pediatricians are dealing with patients with B-MH problems for which they may not have been adequately trained. Communication and collaboration needs were identified.

Sleep in pediatric primary care: A review of the literature

“…(6, 9, 10) When providers were queried directly about the frequency of encounters with behavioral sleep problems (e.g., bedtime resistance, difficulty falling asleep), more than half reported either daily or weekly encounters (Davis et al 2012). (11) Across five studies, encounters with significant sleep problems were most common among the youngest patients (0-4 years old).…”

“…(6, 9, 10) When providers were queried directly about the frequency of encounters with behavioral sleep problems (e.g., bedtime resistance, difficulty falling asleep), more than half reported either daily or weekly encounters (Davis et al 2012). (11) Across five studies, encounters with significant sleep problems were most common among the youngest patients (0-4 years old). (6,9,10,12,13) Compared to other problems encountered in pediatric primary care, sleep always fell within the top half of concerns, following issues such as growth, and physical illness.…”

“…(14) However, when queried specifically about behavioral sleep problems, another study found much greater confidence in the diagnosis and treatment of behavioral sleep disturbance. (11) In another sample of US PCPs, fewer than half of respondents endorsed feeling confident or very confident in screening (46%), evaluating (34%) or treating (25%) sleep disorders. (6) In a sample of pediatric nurse practitioners, mean confidence ratings for evaluating and treating specific sleep disorders were highest for behavioral issues such as night wakings and lowest for sleep disorders including narcolepsy.…”

Cognitive Behavioral Therapy in Primary Care for Youth Declining Antidepressants: A Randomized Trial

“…This is especially concerning given difficulties referring to specialty mental health. 3,11,12 Consistent with youth and parent pre ferences for nonpharmacologic treatments such as psychotherapy, [13][14][15] we examined whether a viable alternative could be effectively delivered in primary care: brief cognitive behavioral therapy (CBT). Although primary care CBT has been tested with depressed adolescents in several previous trials, 13,16,17 none specifically examined the effects of CBT in patients unreceptive to pharmacotherapy.…”

A Practical and Effective Primary Care Intervention for Treating Adolescent Depression

“…Pediatric PCCs often cite concerns about inadequate training and time to comprehensively address adolescent mental health needs. [11][12][13] The use of co-located mental health expertise in a primary care practice is a useful strategy and one that can be structured "in person" (eg, mental health clinician physically located at the primary care practice) or "virtually" (eg, use of primary care telepsychiatry appointments in rural communities). The depression care manager can implement family engagement protocols, screening, and psychoeducation before the pediatric PCC sees the family so that the discussion about treatment options can be primed to be efficient and productive.…”