Current Problems in Pediatric and Adolescent Health Care最新文献

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.

The american: Academy of Pediatrics advocates for a preventive approach to children's mental health (MH) care and pediatric primary care providers (PCPs) are in a unique position to promote the emotional health of their patients, integrate systems for screening and assessment of MH conditions and provide MH intervention and ongoing clinical follow-up. Integration of a behavioral health service into pediatric primary care has the potential to increase the clinical confidence and MH competency of PCPs and improve patient health outcomes through increased access to and delivery of quality MH care in the primary care setting.

Method: This article describes the step-by-step process of developing and implementing a custom integrated behavioral health (IBH) program into two different academic pediatric primary care clinics located in New York, NY and Chicago, IL. The process of developing each clinic's: IBH needs assessment, setting of IBH priorities and defining and implementing initial and subsequent targeted educational and clinical interventions are described in detail. Specific consideration of each IBH program's issues related to physical space, staffing, funding, and billing is also addressed.

Results: Each clinic had different pre-existing strengths, challenges, resources, and priorities but both settings desired having an IBH program that would simultaneously improve patient access to clinic-based counseling and psychiatry services while building MH clinical capacity among pediatric residents and attending PCPs.

Discussion: Specific IBH educational and clinical interventions described in this article differed between the two settings, however, both IBH models were developed to provide pediatric residents and attendings with a combination of in-person and asynchronous clinical education and consultation and opportunities for mental health clinical skill modeling and guidance while also creating increased patient access to clinic-based MH services. This detailed review will be of benefit to pediatric clinics considering development of a customized IBH program.