The Continuing Shortage of Child and Adolescent Psychiatrists

Thomas, Christopher R.; Hölzer, Charles E.

doi:10.1097/01.chi.0000225353.16831.5d

Cited by 323 publications

(180 citation statements)

References 15 publications

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“…This approach could be particularly important for low-income and minority children, who have limited access to mental health specialists and often receive their care in underresourced settings. 8,9 Although many reasons for symptom persistence exist, 3 reasons may be particularly salient for urban children. First, engagement with behavioral health care is often problematic.…”

Section: Departments Of a Pediatrics Andmentioning

confidence: 99%

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

et al. 2015

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OBJECTIVES: Although many attention-deficit/hyperactivity disorder (ADHD) care models have been studied, few have demonstrated individual-level symptom improvement. We sought to test whether complementing basic collaborative care with interventions that address common reasons for symptom persistence improves outcomes for children with inattention and hyperactivity/impulsivity. METHODS:We conducted a randomized comparative effectiveness trial of 2 care management systems for 6-to 12-year-old children being evaluated for ADHD (n = 156). All participants received care management with decision support. Care managers in the enhanced care arm also were trained in motivational and parent management techniques to help parents engage in their child's treatment, address their own mental health needs, and manage challenging child behaviors. We used multivariable models to assess inattention, hyperactivity/impulsivity, oppositionality, and social skills over 1 year.RESULTS: Both treatment arms generated guideline concordant diagnostic processes in 94% of cases; 40% of children had presentations consistent with ADHD. For the entire sample, there were no differences in symptom trajectories between study arms; mean differences in change scores at 12 months were -0.14 (95% confidence interval -0.34 to 0.07) for inattention; -0.13 (-0.31 to 0.05) for hyperactivity/impulsivity; -0.09 (-0.28 to 0.11) for oppositionality; and 3.30 (-1.23 to 7.82) for social skills. Among children with ADHD-consistent presentations, enhanced arm participants experienced superior change scores for hyperactivity/impulsivity of -0.36 (-0.69 to -0.03), oppositionality -0.40 (-0.75 to -0.05), and social skills 9.57 (1.85 to 17.28).CONCLUSIONS: Among children with ADHD-consistent presentations, addressing barriers to engagement with care and challenging child behaviors has potential to improve the effectiveness of collaborative care. WHAT'S KNOWN ON THIS SUBJECT:Collaborative care is known to be an effective system to manage child behavioral health conditions in the primary care setting. WHAT THIS STUDY ADDS:Among urban children with attention-deficit/hyperactivity disorder, using lay care managers to address barriers to engagement with care and challenging child behaviors has the potential to improve the effectiveness of conventional collaborative care. Dr Silverstein conceptualized and designed the study, oversaw its implementation, and drafted the initial manuscript; Drs Hironaka and Walter conceptualized and designed the study, oversaw its clinical implementation, reviewed and revised the entire manuscript, and assisted in the interpretation of analyses; Dr Feinberg assisted in conceptualizing and designing the study, oversaw its clinical implementation at one site, assisted in the interpretation of analyses, and reviewed and revised the manuscript; Ms Sandler managed the data for the project, assisted in preparing the analyses, and reviewed and revised the manuscript; Ms Pellicer supervised the care managers for the project, and reviewed and...

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Section: Departments Of a Pediatrics Andmentioning

confidence: 99%

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

et al. 2015

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“…The recommendations follow the promotion of psychosocial care and its inclusion in primary care over the past half-century and address the long-standing shortage of mental health professionals for children. 8,9 Recent research examined the response in primary care to these recommendations. Numerous studies have addressed PCPs' perspectives on treating mental health conditions, finding that PCPs are more comfortable managing ADHD than other mental health conditions.…”

Section: What This Study Addsmentioning

confidence: 99%

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

et al. 2015

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OBJECTIVE: To compare the mental health care US children receive from primary care providers (PCPs) and other mental health care providers.METHODS: Using nationally representative data from the Medical Expenditure Panel Survey (MEPS) from 2008 to 2011, we determined whether children and youth aged 2 to 21 years with outpatient visits for mental health problems in the past year saw PCPs, psychiatrists, and/or psychologists/social workers for these conditions. We compared the proportion of children prescribed psychotropic medications by provider type. Using logistic regression, we examined associations of provider type seen and medication prescribing with race/ethnicity, household income, insurance status, geographical area, and language at home. RESULTS:One-third (34.8%) of children receiving outpatient care for mental health conditions saw PCPs only, 26.2% saw psychiatrists only, and 15.2% saw psychologists/social workers only. Nearly a quarter (23.8%) of children saw multiple providers. A greater proportion of children with attention-deficit/hyperactivity disorder (ADHD) versus children with anxiety/mood disorders saw a PCP only (41.8% vs 17.2%). PCPs prescribed medications to a higher percentage of children than did psychiatrists. Children seeing a PCP for ADHD were more likely to receive stimulants or a-agonists than children with ADHD seeing psychiatrists (73.7% vs 61.4%). We found only limited associations of sociodemographic characteristics with provider type or medication use.

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“…• the shortage and inaccessibility of specialty mental health services, 33 especially for underserved children from low-income families who do not fall within the target population of public/community mental health services;…”

Section: Need For Statementmentioning

confidence: 99%

The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care

COLEMAN¹,

Dobbins²,

Garner³

et al. 2009

Pediatrics

302

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Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns.

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The Continuing Shortage of Child and Adolescent Psychiatrists

Cited by 323 publications

References 15 publications

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care

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