Infants and Toddlers Left Behind

Abstract

Objective To determine (a) how child age relates to parent concerns about child behavior and (b) how child age and parent concerns correlate with provider referrals and family attendance at mental health consultant (MHC) appointments. Methods Data were obtained from Rhode Island’s Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) in which universal developmental and behavioral screening and MHCs were embedded within primary care sites serving low-income, diverse families. Children 9 months to 8 years were eligible for the study if they had a scheduled screening well child visit in 2010 (N = 1,451). Families completing screening and/or those referred for a MHC appointment were included in analyses (n = 700). Outcome measures included parent reported concerns about child behavior, referral status following screening, and family attendance at the MHC appointment. Results For every 1-month increase in child age, there was a 1.02 times increase in the likelihood of parent behavioral concern and a 1.04 times increase in the likelihood of mental health referral, even when controlling for child behavior. MHC-referred children over 5 years were 2.61 times more likely to attend than children less than 5. When examining parent behavioral concerns and child age jointly, only concerns remained significant. Conclusion Infants and toddlers, who have the highest rates of unmet mental health needs, may be least likely to benefit from universal screening and on-site MHC support. Efforts to incorporate behaviorally-based screening tools and increase parent concerns where appropriate appear warranted, particularly for families with very young children.

Rastreamento De Problemas De Saúde Mental Em Crianças Pré-Escolares No Contexto Da Atenção Básica À Saúde

“…This care environment provides the longitudinal follow-up of the children, promoting whole health care and contextualizing factors that determine the quality of life and health of the children, in relation to their community. 7 , 8 , 9 As a paradox, many professionals who work in BHC do not feel capable and comfortable to identify and handle possible infant MHPs. 10 The use of standardized screening instruments of MHPs in young children can be a strategy for these challenges.…”

Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH

“…Evaluations of models that promote universal behavioral health screening and embed mental health clinicians within primary care sites reveal mixed results (Godoy et al 2014; Spijkers et al 2013; Briggs et al 2012). For example, one model embedding an infant/toddler specialist in primary care settings reported improved ASQ-SE scores (Briggs et al 2012) whereas one offering brief counseling found no improvements over usual care (Spijkers et al 2013).…”

“…For example, one model embedding an infant/toddler specialist in primary care settings reported improved ASQ-SE scores (Briggs et al 2012) whereas one offering brief counseling found no improvements over usual care (Spijkers et al 2013). Results from Project LAUNCH in Rhode Island, an initiative without the family partner role, resulted in improved identification of young children at risk but found that subsequently younger children were less likely than older children to utilize subsequent mental health consultation (Godoy et al 2014). These results highlight needs for innovative family engagement approaches, particularly families with very young children in stressful circumstances.…”

“…Integration can take a variety of forms, including care coordination linked to mental health care, co-location of mental health and pediatric providers in same or nearby locations, or full integration of behavioral health specialists hired by primary care sites working iteratively with pediatric care providers about cases (Tyler et al 2017). Integration has been more thoroughly explored in adult mental health care but is gaining traction in pediatrics (Godoy et al 2014; Spijkers et al 2013; Briggs et al 2012). Early results are promising, suggesting improved identification of problems and improved screening results (Godoy et al 2014; Spijkers et al 2013; Briggs et al 2012).…”

“…Integration has been more thoroughly explored in adult mental health care but is gaining traction in pediatrics (Godoy et al 2014; Spijkers et al 2013; Briggs et al 2012). Early results are promising, suggesting improved identification of problems and improved screening results (Godoy et al 2014; Spijkers et al 2013; Briggs et al 2012). …”