Abstract
Behavioral and mental health concerns are common, with depressive episodes reported by 1 in 5 adolescents and anxiety reported by 1 in 10 adolescents. In 2021, given the growing mental health crisis worsened by the COVID-19 pandemic, a state of emergency was declared in children's mental health and a national suicide prevention crisis hotline number, 988 was established. Despite the elevated rates of mental health concerns, the ability to access treatment is low and critical shortages in the U.S. Child and Adolescent Psychiatry workforce contribute to the lack of access to trained pediatric mental health professionals. Pediatric primary care is a natural setting for evidence-based and innovative primary, secondary, and tertiary prevention models due to universal access to patients. Pediatricians can integrate behavioral health care into their primary care practice though providing patients with care for common mental health issues either alone or collaborating with mental health specialists. However, the majority of pediatric trainees report that they do not feel competent to assess and treat pediatric patients with common B/MH concerns even though they feel that competency in these areas is important. Regulatory changes in pediatric training programs are necessary but change takes time. Integrated Behavioral Health (IBH) is a term used to describe a variety of models of care that can be implemented by teams of primary care and B/MH providers working together. These models use a systematic approach that emphasizes collaboration and communication to provide patient-centered care and improve patient health outcomes through increased access to and delivery of quality behavioral health care. The integration of behavioral health care into pediatric primary care has the potential to reduce disparities by increasing access to needed mental health care in a familiar and destigmatized environment, decrease wait time for services and improve the quality of B/MH care provided in the primary care setting.
Original language | English (US) |
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Article number | 101715 |
Journal | Current Problems in Pediatric and Adolescent Health Care |
Volume | 54 |
Issue number | 12 |
DOIs | |
State | Published - Dec 2024 |
Funding
Faculty are essential in providing and modeling curricular and clinical changes during pediatric residency training and enhancement and support for faculty engagement and development is vital. McMillan et al, outlined several key elements of successful faculty engagement and development. These elements included: identifying a faculty champion to promote B/MH care, developing a department set of goals (consider a scorecard for accountability), assigning a faculty member(s) who will have responsibility for integrating a B/MH curriculum, incorporating patient and family feedback, and developing mental health quality improvement projects and case conferences. 34 A needs assessment is often the first step in identifying current strengths and gaps in faculty knowledge and clinical skills. It is also important to take advantage of already established outside resources for community-based services, training, and consultation support. On a national level, the American Academy of Pediatrics has developed initiatives pertaining to mental health. The AAP Mental Health Initiative provides policy recommendations, resources for physician training, screening tools, and families, resident curricula, and local chapter action kits. Many local chapters and U.S. states have integrated mental health consultations for primary care pediatricians. 44 For example, providers in New York State have access to Project Teach 45 , which is funded by the state's Office of Mental Health and offers consultation, referral linkage, and mental health education to pediatric primary care clinicians. In addition, in order to support the \u201C2-generational care model\u201D, Project Teach has expanded targeted services to those clinicians who are providing care for patients during pregnancy and in the perinatal period. This program provides telephone consultation for mild-to-moderate mental health concerns from an on-call psychiatrist and program coordinators help with referrals to B/MH services in the patient/family's community. The program also provides CME to all New York State providers on how to assess, treat and manage common B/MH concerns. Similar programs exist across the country including robust programs in Texas (Child Psychiatry Access Network- CPAN 46 and North Carolina Psychiatry Access Line. 47
Keywords
- Integrated behavioral health
- Mental health
- Pediatric primary care
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health